Counselling in Scotland

Therapy for depression has several major goals. One is to relieve the mental pain of depression, which distorts feeling and thinking so that sufferers cannot see beyond their current state of mind or envision feeling better. Another is to give people the mental tools to recognise and correct the kinds of distorted thinking that turn a problem into a catastrophe and lead to despair. Therapy also teaches people how to process negative emotions in constructive ways, so they have more control over their own emotional reactivity. And it helps people regain the ability to see themselves positively, the motivation to do things, and the capacity for pleasure.

Perhaps most important, no matter the type of therapy, patients form an alliance with the therapist; that connection is therapeutic in itself, plus it becomes an instrument of change. Patients learn to identify and to challenge their own erroneous beliefs and thoughts that amplify the effects of negative experiences. They learn to identify situations in which they are especially vulnerable. And they learn new patterns of thinking and behaving. They may be given “homework” assignments in which they practice their developing skills. In addition, good therapists regularly monitor patients to assess whether and how much the condition is improving.

Several types of short-term therapy have been found effective, each targeting one or more areas of dysfunction. Cognitive behavioural therapy (CBT) helps clients challenge their negative thoughts and beliefs, learn new behavioral strategies, and curb reactivity to distressing situations. Behavioural activation (BA) is a form of therapy often used in conjunction with CBT; it focuses on engagement in rewarding activity as a pathway to changing negative feelings and disturbed mood. Another widely used approach is interpersonal therapy (IPT), which targets the social difficulties that both give rise to and get exacerbated by depression. Therapists may combine approaches as needed.

Studies have found that online therapy can be highly effective for treating depression, although it may be more challenging to build a good therapist-patient alliance on screen than in person—at least at first. However, online therapy can offer considerable advantages. Accessibility and convenience are tops among them. Some people actually find it easier to talk about problems online than in person. While online therapy typically limits visibility of facial expression and body gestures that give important nonverbal cues to a patient’s state of mind, it can give therapists a glimpse into a patient’s world and life, providing information that can be highly useful in guiding therapy.

Many studies show that therapy is highly effective provided that patients complete the prescribed course of therapy, commonly 16 to 20 sessions. Over the long term, it is more effective than medication and the effects are more enduring. As a result, psychotherapy has the power not just to relieve current suffering but to prevent future episodes of the disorder. Therapy reverses the dysfunction in neural circuitry that disposes individuals to a negative view of themselves, the world, and their future and they acquire coping techniques, problem-solving skills, and understanding of their own vulnerabilities that are useful over the course of a lifetime.