Having treated many hundreds of depressed clients, my approach for effective depression treatment and counselling is quite clear and straightforward.
Are these two steps the definitive depression cure? Well you judge
- Firefighting to reduce arousal and rumination and to improve sleep and motivation.
- Doing whatever it takes to get essential needs better met. This in turn requires better problem solving – Setting the right goals, clearing emotional pattern matching that are not helping, and challenging rigid black and white thinking styles.
These two steps are obviously closely connected to a depression cure. The high arousal of a depressed person is a trance like self-obsessed focus, which destroys the capacity to problem solve and so correct the underlying problem that initiated the depression in the first place.
The mere fact of being able to problem solve and so take control gives a sense of hope and movement and is therefore a highly effective way to reduce arousal – the first step to a depression cure.
Depression Treatment: Firefighting To Reduce Arousal
We begin depression treatment right away in the first session. In the first instance this is not about obvious things like listening to relaxing music or enjoying the company of friends as arousal and hopelessness are too entrenched. Instead what helps the most is for you to really understand what is causing the depression – that it is not your fault and so to take pressure off.
I will normally suggest that you listen to my specially prepared Hope and Firefighting suite of MP3s – regularly and under my direction. This could be until you are sick of my voice, but by which time you will truly understand what is happening to you and why and what actually is good depression treatment and help.
I will also often remove pressure off you by taking the responsibility for the depression help you need and getting you feeling better – by allowing you to relax knowing that you can let me take the strain. Obviously this is not really the case as at the end of the day, it is your resources and capacities that will cure depression. But the extent that confidence and authority in me can be conveyed, then this will take away a lot of pressure – which in turn will remove a major source of worry.
Reducing arousal – one or more of the following:
- Explaining what depression is so that you do not feel that you are to blame
- Undertake a Needs Audit so that you can begin to perceive your situation differently and in a more detached way. This reduces arousal by engaging your problem solving capacity.
- Investigate whether there is trauma or threshold trauma and then clearing it
- Reframe at every opportunity – which may be directed at softening strong black and white thinking or suggesting more empowering explanations of the past.
- Explicit visualisation, rehearsal and guided imagery – designed to impart an experience of relaxation and to access your strengths and resources
- Teach relaxation techniques
- Master both practical firefighting and challenging black and white thinking
Depression Treatment: Practical Goal Setting
Being a fully signed up Human Givens practitioner, my thinking and instincts sooner or later turn to evaluating my client’s emotional needs – especially in relation to treating depression. How well is he/she getting them met, how balanced are they in relation to each of the essential needs and where and in what way are significant deficiencies impacting on the other needs?
Needs as formulated by Human Givens are summarized and explained here and feel free to download and complete your own Needs Audit. If you then send me your results I will happily evaluate them for you.
To get a clearer idea of how to use and understand needs analysis, do glance at the Depression Treatment and Cure case studies – of effective depression treatment and help.
And ponder this visual summary of how the Depression Virtuous Cycle takes hold.
Why Cognitive Behavioural therapy can help depressions
CBT is very fashionable today and is the therapy of choice in the NHS. There is in consequence a CBT industry supported by ”academic research of its effectiveness” and university departments and accreditation bodies who exist to keep public patronage going. And necessarily these now embrace a vested interest in maintaining the CBT brand as there is money to made and livelihoods to be had.
The reason why CBT has become so pervasive is because it’s easy to undertake research of its effectiveness and so much research has indeed been undertaken. CBT seems to me to be a quite manualised or rule bound counselling approach. When I am being unfair I say to myself that a monkey could do it.
However from the work of Duncan and Miller we know that CBT is no more effective than any other therapy model as a treatment and if you look at the research undertaken, it is the comparison of CBT’s effectiveness against the alternative of doing nothing that has become the clincher. But all therapy is better than doing nothing. And as I understand it, there are no pieces of research which show CBT going head-to-head with another therapy model and of course (following Duncan and Miller), CBT would then be seen to be not particularly special.
So, CBT is better than doing nothing. And the idea of challenging unhelpful thinking – which is the essence of CBT depression treatment – definitely does have its place. And when necessary, I will use CBT type methods. CBT’s future problem solving focus is also to its credit.
The weakness of CBT as a depression cure is also clear. There is no deep understanding of what a depression is and by focusing on thinking, rather than the emotion and feeling that comes before the thinking, CBT will always be hard work and plodding and for many it will just not be up to the task.
Why insight counselling can be the last thing needed
There are many types of insight counselling – by which I mean counselling which essentially explores the past in the belief that this will uncover certain patterns and connections and that this will be a helpful thing to do.
The problem with insight counselling for depression treatment (and there is evidence for this) is that by focusing on the past and the problems of the past, depression can quite easily be made worse. This will be because rumination and worrying can be intensified and so dreaming sleep and exhaustion become worse.
My view is that insight counselling can be immensely valuable for finding out about yourself but before you undertake it, be sure that you are in a healthy and resilient emotional state.
Why medication is rarely the answer for treating depression
Anti-depressants seem to have beneficial effects on some, due to the fact that they reduce REM sleep. Some people describe taking SSRI’s as allowing them to “take a holiday from the worry”. This may be enough to lift them from the cycle of depression. Others suffer from side effects or dislike the slightly “spaced” feelings they get whilst on these drugs. Some people feel that taking a pill will only mask the symptoms but will not address the underlying issues which may be due to unmet emotional needs.
There is now a growing literature and an evidence base which is exposing the scandal of the use of antidepressants (SSRIs) for the treatment of depression. The closer you look at the evidence of efficacy, the more it disappears. We know that pharmaceutical companies control, suppress and manipulate the evidence. We are also now aware that SSRIs create addictions and dependency. There will also often be side effects, some of which will be very serious.
Practically, the effects of anti-depressants can sometimes make the therapeutic process harder or longer, but some people clearly benefit from the help they can give. The conclusions of independent researchers (ie independent of the pharmaceutical companies) is that SSRIs are barely better than placebos.
But if you are using anti-depressants I can still help you.
Please be aware finally that it is often not safe to suddenly stop using SSRI’s. If you want to stop I recommend that you consult your doctor.
GPs View On Anti-Depressants
(Mental Health Foundation)
- GPs are lukewarm in their attitude to anti-depressants. 71% believe them to be ‘quite effective’ but 57% say they are over-prescribed.
55% of GPs prescribe anti-depressants as their first depression treatment response for mild or moderate depression, although only 35% believe anti-depressant medication is the most effective intervention for these conditions.
- 42% of GPs feel that most patients given anti-depressants would be as likely to get better if they were unknowingly prescribed a placebo.
- 78% of GPs have prescribed an anti-depressant in the last three years despite believing that an alternative treatment might have been more appropriate.