Your Therapy

Talk Therapy for Depression

When discussing treatment options for clinical depression (also called major depressive disorder), I’m often asked just how effective talk therapy is for this common and serious mental health challenge. The answer is: very effective, but with a crucial qualifier.

Over decades of research, we’ve accumulated a lot of data about depression treatments and outcomes. The results show that the most effective treatment involves a combination of pharmacology and talk therapy, along with some lifestyle elements. We sometimes call this a “bio-psycho-social approach,” because part of the treatment process is finding out what combination of these therapies works for each person. For example, if depression has been persistent and serious, finding an effective medication can give you some energy and hope, which then allows you to start working on other aspects with a therapist.

Quick side note: When I worked at SickKids hospital, we always connected with teams from other disciplines when assessing a patient. So naturally, when I started my private practice, I’d often reach out to a client’s family doctor or psychiatrist to work on a treatment plan. I was surprised to discover this was considered unusual, but we’re doing our best to change that attitude.

One of the first steps in talk therapy is determining how long your depression has persisted, and how much it’s interfering with your day-to-day life. I often ask clients questions such as: When was the last time you remember being OK? What was happening in your life at that time? How have things changed? The answers can be surprising. In the year since the pandemic began, a lot of people have contacted me because their mental health got worse during this time of crisis. It turns out that many of them had been grappling with those feelings for a long time, and the pandemic was just the last straw.

How talk therapy works

Talk therapy allows you to connect with a mental health professional and discuss things that are difficult to talk about, in a supportive, non-judgmental manner. With major or persistent depression, there can be a wide range of issues to address, but a few common ones include figuring out factors that might be making the depression worse, and what’s getting in the way of feeling better.

In the past, I’ve written about some of the therapeutic techniques we use for depression, but a very effective one that’s not well known is externalization. This involves talking about what life is like when the depression is making decisions for you, versus when you’re making the decisions. Then we often “name” the depression by describing adjectives that belong to it, and perhaps even giving it an actual name. This may sound a bit silly, but it’s a powerful way to create some space between the person and depression. Major depression is so all-encompassing that it feels like it’s all of you. This technique lets us tame the depression, and give people space to be their non-depressed selves.

Another emerging technique is mindfulness. Studies show that engaging in an hour of mindfulness meditation a week, for as little as ten weeks, results in actual changes in your brain that are visible in MRI scans. We don’t yet understand the mechanism for this, but we know it helps you to build tolerance for uncomfortable thoughts or feelings, which leads to improvements in mood.

Talk therapy also moves at whatever pace you find comfortable. It takes time to address the issues involved—usually a minimum of six months, and more likely a year. But the bottom line is that most people who seek treatment for clinical depression are able to greatly improve their quality of life. Like other long-term challenges, it can be effectively managed, controlled and overcome, and talk therapy is a crucial part of that overall treatment plan.

Your Therapy is a safe, welcoming, counselling therapy practice in the Greater Toronto Area. Thanks for reading and, as always, please feel free to reach out with questions about talk therapy for depression or other mental health issues.

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