What Psychologists Wish You Knew About Talk Therapy for Depression

Talk therapy is a powerful treatment option. Here’s what psychologists want people to know to get the most out of depression therapy.

Psychotherapy, or talk therapy, is one of the best treatments for major depression. After all, it’s about regaining control and building confidence. “You have the power to take charge and manage your feelings,” says Clifton Saper, PhD, a clinical psychologist and executive director of the outpatient programs at AMITA Health Alexian Brothers Behavioral Health Hospital in Hoffman Estates, Illinois.

Whether in the form of cognitive behavioral therapy, behavioral activation therapy, acceptance and commitment therapy, or interpersonal therapy, talk therapy helps to change your behavior, thinking, and emotions — and, ultimately, your brain, explains Stephen Scott Ilardi, PhD, a clinical psychologist and an associate professor of psychology at the University of Kansas in Lawrence.

Yet this won’t happen unless you become an active player in the process. Your first step: Find out what to expect — and what’s expected of you — to get the best results from your talk therapy sessions.

Talk Therapy for Depression: What Your Therapist Wants You to Know

What’s talk therapy really like? We’ve asked several psychologists to offer some insider insight.

It’s not magic. If you’re going to be successful, it means putting in the work, Dr. Saper says. Therapists typically ask you to examine what triggered your feelings of depression, how your body feels when you’re depressed, and how long the feelings last.

You’ll have homework. Your therapist may ask you to think about the positives in your life and to do something different to see a change. For example, rather than getting pulled in by negative thoughts, take a walk, finish a project you’ve been putting off, volunteer, or do another activity that will help stop negative behavior and thinking patterns.

Commit to therapy even if you think it won’t work. “Come to therapy determined to do whatever it takes to get to a better place,” says Scott Bea, PsyD, a clinical psychologist and an assistant professor of medicine at the Cleveland Clinic. Ideally, you and your therapist will agree on the strategies, but sometimes people need to trust their therapists and try new things.

Set specific goals. Saper suggests talking with your therapist every time about what’s working and what’s not working from your talk therapy.

Keep up on your meds. Sometimes the best approach to treating depression is both medication and talk therapy. If you’ve been prescribed an antidepressant, keep taking it while you see a therapist.

What you say is confidential. By law, what you share won’t be discussed with anyone else. The only time psychologists can share your personal information without your permission is if you’re at risk of harming yourself or someone else, your therapist has received a court order, or in cases of abuse or neglect, according to the American Psychological Association.

Let honesty rule. If you’re not honest with your therapist, you won’t get propertreatment and your depression symptoms won’t improve.

You probably can’t shock your therapist. Therapists who are early in their careers may be surprised by what comes out during sessions, but a seasoned therapist will never show surprise, Dr. Bea says. If you’re seeing an experienced psychotherapist, it will be very difficult to shock him or her at all.

Wanting to get better isn’t always enough. Dr.Ilardi says people with depression typically want to get better. The problem is that depressive neurological changes affect the area of the brain that controls goal-directed behavior, which means it’s often hard for people who are depressed to do things that help them feel better.

Ilardi’s clinical research team uses so-called therapeutic lifestyle change to address this problem. Rather than simply telling people to exercise (because physical exercise has profound antidepressant effects), the team sets them up with a personal trainer. Instead of telling people to set a social calendar, the team follows up to make sure they’re scheduling activities. You may need extra pushes like these from a therapist or loved ones.

You may have to make your own conclusions. Ideas seem more valid when we come up with them ourselves. Good therapists will help people gain new insights on their own, Bea says.

Watching the clock may mean you need a change. If you’re not focused during therapy, there may be a reason. You might not have a solid connection with your therapist, and that could mean your therapy won’t be as helpful, Ilardi says. You might also be getting therapy that isn’t right for you. Non-directive therapy involves the person sharing thoughts while the therapist holds back on giving advice. Ilardi says depressed people usually do better when they’re directed. “In my experience, if they have an expertly guided session, they can keep their focus,” he says.

Ask questions. You should understand what you’re doing in therapy and have a sense of how it’s supposed to be helpful and lead to change, not just during your therapy session but outside of therapy, too, Ilardi says. If your therapist isn’t sharing that information or if you don’t understand something, be sure to ask questions.

You shouldn’t see a therapist forever. When therapy is done right, a therapist is a short-term coach who helps you gain the skills you need. When you keep this in mind and follow these other key pieces of advice, you’ll be more likely to get the most out of talk therapy for depression.

Last Updated: 2/22/2016

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