Counseling and Depression

By far, the most well-researched form of treatment for depression is counseling, and no form of treatment has been shown to be more effective for depression.

Choosing a therapist or counselor

Over the past 50 years, researchers have learned a great deal about what makes someone a good therapist. They have found that what matters most are qualities such as whether he or she is a good listener, easy to connect with, does not try to pressure you, and says what he or she means. One of the most important characteristics in a therapist is being unconditionally accepting.

In order to choose a therapist, it can be helpful to meet with several. Talk with them about your depression and notice whether you feel better after the conversation. Trust your first impressions. You will usually be able to get a good enough sense of a therapist in one meeting. If someone tries to pressure you to commit to more sessions before you are ready, that is not the person you want.

Surprisingly, research has consistently shown that level of training has little effect on a therapist's skill. This means that whether your therapist is a PhD psychologist or an unlicensed life-coach does not predict whether he or she will be effective at helping you feel better. Similarly, theoretical orientation (cognitive-behavioral, psychodynamic, eclectic, etc.) does little to predict whether a therapist will be very good. While more than one thousand forms of psychotherapy exist, very few have been adequately studied and there is not good evidence that any are more or less effective than any others.

Therefore, when interviewing therapists pay particular attention to their personal qualities and how you feel talking with them.

Therapy vs. Medications

It has been well-established that medications do not out-perform psychotherapy as a treatment of depression. There is some debate as to whether combined treatment with drugs and therapy is superior to therapy alone. However, there have been no studies comparing therapy and drugs to therapy and placebo-drugs. Looking at the rest of the evidence on antidepressants, one can reasonably assume that drugs would not add any addtional effect beyond placebo when combined with therapy. Some studies have found that therapy out-performs therapy and drugs over the long-term.

Research on Counseling and Therapy

Leslie A. Robinson, Jeffrey S. Berman, and Robert A. Neimeyer. Psychotherapy for the Treatment of Depression: A Comprehensive Review of Controlled Outcome Research. Psychological Bulletin. 1990, Vol. 108, No. I, 30--49.

A huge metanalysis of all available controlled studies on treatments of depression. It found psychotherapy to be superior to medication, and therapy with medication to be equal to therapy alone.

Antonuccio, David O.; Danton, William G.; DeNelsky, Garland Y. Psychotherapy versus medication for depression: Challenging the conventional wisdom with data. Professional Psychology: Research and Practice. 1995 Dec Vol 26(6) 574-585.

Found that therapy is more effective than medications when patient-rated measures are used and long-term follow-up is considered.

Wampold, B. (2001). The Great Psychotherapy Debate: Models, Methods and Findings. Laurence Erlbaum: New York.

Reviews the evidence on what makes psychotherapy effective. Supports a common factors model over treatment modalities.

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copyright © 2007 Tim Desmond, MA. Last updated 31Jul2008.
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