does therapy work?
June 28, 2007 9:20 PM   Subscribe

I think I need to get back into therapy, but I also think that therapy doesn't work.

I have had major depressive disorder since I was a teenager (granted, not all that long ago). Although I've been able to lead a relatively happy and sane existence thanks to medication, I feel like I'm going through a particularly rough patch right now, and that it would probably be best for me to seek therapy.

I've had therapy before, of course - I wouldn't be medicated without it - but it's only the drugs that have ever helped me. I am a very rational person, so it is not too difficult for me to understand on my own what exactly is wrong with me (I know, self-diagnosis is a bad thing...), but just because I understand it doesn't mean I can do anything about it. It seems to me that this is all therapy is; that is, rationalizing depressive feelings and thoughts in order to realize the root of the problem, thus eradicating it. For me, it just seems like I'm rehashing things I already know about myself.

I've never had any kind of horrible traumas or anything like that. This is just chemical, genetic depression, as far as anybody has been able to tell. Should I forgo the head shrinking and try for a new medication instead? Is it worth trying therapy again, or is my mental block going to guarantee fruitlessness? Or is that in itself something that should be worked through... in therapy?
posted by timory to Health & Fitness (26 answers total) 24 users marked this as a favorite
Best answer: I would suggest some therapy..but perhaps different from what you've already experienced. This newer model (called "human givens") of depression may interest you... it really helped me. Many therapists using this model are available via phone (most are in the UK), and usually 1 or 2 sessions are all that's necessary. Worth a try... as it's not what you've tried so far and would take much less time and money to see if it is working for you (compared to other forms of therapy).
Contact me if you'd like for more info.
posted by swiffa at 9:45 PM on June 28, 2007

Response by poster: swiffa, this is dead on, at least for me:
Research shows that any therapy or counselling that encourages people to introspect about what they were unhappy about in their past will deepen depression. This type of therapy is based on a misunderstanding going right back to Freud. He had a model of the unconscious mind that saw it as being very like an underground cesspit – he believed that emotions that weren't fully expressed are held onto in this cesspit of repression, and the job of the therapist is to release the noxious emotions and thereby free the person. But this just does not work.

i'll definitely look into it.
posted by timory at 9:52 PM on June 28, 2007 [1 favorite]

This looks like a job for Cognitive Behavioral Therapy. Though I haven't read it myself, the book Feeling Good has been oft-recommended in AskMefi.
posted by Anonymous at 9:57 PM on June 28, 2007

Best answer: It seems to me that this is all therapy is; that is, rationalizing depressive feelings and thoughts in order to realize the root of the problem, thus eradicating it.

Um no. That is not all therapy is.

The kind that I'm into, ie CBT and its variants, is big on setting exercises and reconstructing your mental habits.

Furthermore, if you are going through a rough patch due to external factors, a good therapist is likely to provide advice on coping strategies. One of the features of depression is that either you can't conceive of how things could be better for you, or you can't believe that changes you make will work. Therapists can suggest changes and support you in making them.

As I understand it, dealing with depression is best with a three-pronged attack if you can - drugs to take the edge off, therapy to shake up your mental habits, and lifestyle changes (exercise, diet, ...).

I am a very rational person

Lots of people think they are very rational, but rationality is not not all it's cracked up to be. And rationality is no help if your premises suck. Therapy can help you re-evaluate those premises.
posted by i_am_joe's_spleen at 9:59 PM on June 28, 2007

If you do go back to therapy, here's some great advice (IMO) on getting the most out of it from a previous askme thread.
posted by treepour at 10:14 PM on June 28, 2007 [1 favorite]

I am a very rational person

Does anyone ever feel irrational? I don't think so. That's the subtle demon of mental illness- your brain is sick, and it's also telling you that you're not sick, and everything is the way it should be, and your life is what you deserve. Something that twisted is going to leave you with wounds and scars. And a lot of people in your life, even people who love you, are not going to understand that. Get a qualified professional in your corner who can provide you with some tools for healing.
posted by ThePinkSuperhero at 10:22 PM on June 28, 2007 [6 favorites]

I'm in therapy (a combination of traditional talk and cognitive behavioral) right now for some pretty major anxiety issues. I was lucky enough to find a therapist who understand that I am essentially rational and practical. I pretty much know what my problems are, so it isn't so much a journey of self discovery as an examination of my behaviors, they way I get stuck in negative cycles, and how I can change those patterns. I'm really learning some great tools to make me feel better. I think it's a question of finding someone who can work with you in a way that will work for you.
posted by mostlymartha at 10:28 PM on June 28, 2007

When you state "Therapy is just...rationalizing depressive feelings and thoughts in order to realize the root of the problem, thus eradicating it."

I say it's not quite about rationalizing and second what schroedinger said. Cognitive Behavioral Therapy. Find a specialist in that department.

Check out this workbook, "Mind Over Mood"—Change How You Feel by Changing the Way You Think by Dennis Greenberger,PhD & Christine A. Padesky, PhD.

They also have a website.

You very well may have a chemical imbalance, but taking meds without therapy is only a stop gap. Finding the right meds or combination takes time also. Continue pursuing what works for you.
posted by alicesshoe at 10:44 PM on June 28, 2007

You could be experiencing anti depressant poop-out and need your meds tweaking. If that's the case, then therapy will probably not be sufficient by itself.
posted by happyturtle at 12:31 AM on June 29, 2007

I'm in therapy and my experience is basically what i_am_joe's_spleen describes. My psychologist told me straight out that she didn't want to dwell too much into "when i was a kid" territory; instead, she preferred to deal with things as they are now. She's actually rather scientific in her approach, sharing different psychological theories and models, and giving me exercises.

There are plenty of different kinds of therapy, not just "lie on a couch" ones. You may like art therapy or the ilk - not totally "rational" per se, but helps deal with things from a different perspective. I took singing classes for fun and they're actually really effective as therapy because I was concentrating more on how to get a good voice rather than my issues.
posted by divabat at 2:08 AM on June 29, 2007

I was also going to suggest CBT based on your description of your being a rational person. Forbes, of all places, did a pretty good article about it a few months ago.

Best of luck during this rough spot.
posted by stuboo at 3:24 AM on June 29, 2007

The answer to your overarching question is yes, therapy works. This is pretty conclusively proved, with effect sizes from meta-analyses of therapeutic effects ranging from ~.7-~.9. 0.8 is a reasonable effect size to ballpark, which means that ~79% of people treated by therapy see improvement over people wanting therapy but not receiving it.

The same research, much of which can be read in Bruce Wampold's book The Great Psychotherapy Debate, or in various papers and books by Michael Lambert, indicates that the type of therapy engaged in has very little impact on the outcome for the patient. It's simply not true that CBT is more useful for treating depression than insight oriented therapy, or that medications are more helpful than either of them. (The variations in the meta-analyses are less than 10%, and as low as 1%.) What is true, is that some therapy works better for some patients at some times. You should feel free to choose a form of therapy that accords with your ideas about your problem and your mind and feel confident that it will work.
posted by OmieWise at 4:30 AM on June 29, 2007

This is just chemical, genetic depression, as far as anybody has been able to tell.

In the interests of addressing your rationality and expanding the ways that you might feel comfortable thinking about your mood, I thought I'd address this.

This is a nonsense statement, it either means nothing or everything. The evidence that depression is "caused" by a chemical imbalance is tenuous, at best. Since we don't even have "normal" levels of neurotransmitters against which to discuss imbalance, it's hard to know how we might determine when someone is in imbalance. On the other hand, it's true that everything in the brain is chemical: speech and vision are chemical processes, as are mood and personality. The comment is either a reach or such a truism as to be irrelevant. What someone means when they say this to you is that they don't know why you're depressed and, since processes in the brain are all chemical, that seems plausible to them.

The reason that this is not a helpful way to talk about depression is because even if it's true, it doesn't tell us anything about the treatment or the course of the disease. Just because something is chemical now does not mean it was caused, out of the blue, by chemical changes. In order to stop it from happening again, treating the chemical changes may not be enough. Similarly, just because we can offer chemical treatments that are effective for some people, like SSRIs, that does not mean that we've identified a cause or a cure: a tension headache is probably not caused by a lack of ibuprofen in your blood, even if it's temporarily treated by taking advil.

The fact is that just as everything in your brain is chemical, so to do all kind of activities change your brain chemistry. Have sex, dopamine increases; get a hug, oxytocin increases; have an ice cream, meditate, take a run, get therapy...all of these things and more change your brain chemistry in ways that have immediate effects on your mood.

While the mantra of "chemical imbalance" is reassuring in some ways because it seems to smooth out and demystify the vagaries of human mind, it's actually quite limiting because it ignores the myriad ways that brain chemistry changes as the result of human behavior. But, if your concern is that you have a chemical problem and therapy is not a chemical response to that problem, and therefore inadequate, that's simply incorrect. No one knows why people get depressed, and surely there are almost as many reasons as there are depressed people. (I'm sure you weren't given a chemically-based test to determine either if you were depressed or why.) But what we do know is that there are many, effective, ways to treat depression, and that different forms of therapy account for many, if not most, of those ways.
posted by OmieWise at 6:00 AM on June 29, 2007 [7 favorites]

IANAD: Therapy (the CBT-type) + meds (if necessary) works for many people. Finding the right med and dialing in the right dose can take some time.

I think i_am_joe's_spleen nails it: "rationality is no help if your premises suck." The basic premise of CBT is that people think themselves into corners mostly through over-generalization. Instead of thinking, "I'm an okay person, but I'm doing some counterproductive things right now that aren't helping me," we tend to think things like "I am a loser." Instead of focusing on behaviors that we can change, we focus on essences, which we can't. This is a big component of Albert Ellis' approach.

Besides therapy and meds, regular physical exercise helps.

Omniwise is right that the "just chemical depression" thing is a two-way street. You have a certain brain chemistry at any given moment, but behavior can modify brain chemistry, just as medications can modify it.
posted by wheat at 6:53 AM on June 29, 2007

I felt very similar to you for a long time, and one time I was going through a rough patch and blurted to some counselor: "I wish there was such a thing as Coping 101." Guess what? There was!

Dialectical Behavioral Therapy has a concept of "Wise Mind" -- uniting the rational and emotional sides of your brain. Since you said you can get to the rational end already, I suspect you're already halfway there.

This DBT website is not a website run by a facility or therapist, but I think that's why I like it best. It's approachable. Of course, it's no subsitute for actual therapy.

Whether or not this is something you choose, good luck!
posted by RobotHeart at 7:38 AM on June 29, 2007

Therapy seems to increase the rate of self-insight when helps a person understand what's at work in them. My personal experience was that, after the crisis which brought me there had ebbed, therapy made me focus on problems and sadness rather than happiness and the natural flow of things, good and bad.

I've kept a daily journal for most of my life and recommend this practice as a way to know yourself better, integrated with talks with friends and therapy if things get dicey.
posted by Riverine at 8:00 AM on June 29, 2007

You may need to interview several different therapists to find one that you’ll feel comfortable working with and whose overall goals of therapy match yours.

I have had several different therapists over the years, very few of whom were effective for me in the long run. The worst was one who would just sit there and periodically nod or smile. The best was one who challenged me, gave me homework and, while not dwelling on my childhood/past issues, helped me make the connections between what was going on *now* and what went on *then* and how to deal with those disordered thoughts. She practiced Dialectical Behavioral Therapy, which incorporates many of the same techniques as CBT.

It’s one thing to be a rational person and know what’s wrong with you, but that won’t help you unless you’re willing to do something about it. Don’t be the “My last boyfriend/girlfriend cheated on me so I’m completely unable and unwilling to trust you and that’s just the way it is” kind of person. Not that I’m saying that’s your problem, just an example that I think most of us are familiar with. I can do anything abou it.

Like RobotHeart mentioned, the concept of “Wise Mind” was what was most helpful to me. Most important was my willingness to do the work (“I’m baby stepping!”) and make the changes.

Best of luck to you
posted by zach braff's mixtape at 8:37 AM on June 29, 2007

dang. this was my very first post and i goofed it up! please ignore the "I can do anything abou it" nonsense.
posted by zach braff's mixtape at 8:40 AM on June 29, 2007

Short answer is that, no, therapy doesn't work (despite the hundreds of posts on Ask Metafilter telling everyone it does). Statistically, you have the same chance of feeling better if you have no therapy as if you do.

Especially pointless is psychoanalysis and modern therapies derived from it. Read this book.

Should I forgo the head shrinking and try for a new medication instead?

posted by dydecker at 11:33 AM on June 29, 2007

dydecker is incorrect. The research on the effectiveness of therapy is quite settled. dydecker's link is to a book that examines the research into whether or not the Freudian model of the mind is correct or not. That is, obviously, not the same thing as whether or not therapy is effective.

Psychotherapy has an effect size of .80, which is a greater effect size than for most medications that are designed to treat depression.
posted by OmieWise at 12:32 PM on June 29, 2007

OmieWise, is incorrect. Crews' book goes into the implications that the fraudulent Freudian model of the mind has on modern therapy, and most especially psychotherapy.

If you're interested, you can hear an outline of the Crews' arguments here. He goes into stats of the effectiveness of therapy models, too.
posted by dydecker at 1:02 PM on June 29, 2007

sorry, replace psychotherapy with psychoanalysis in the above.
posted by dydecker at 1:06 PM on June 29, 2007

dydecker, read Bruce Wampold, read Michael Lambert. There really is no debate here about the effectiveness of therapy. If you want to argue the statistics, then do that, but your blanket dismissal is ill-informed and incorrect. Even the British Medical Journal not so long ago recommended that psychotherapy, not medications, be used as the first line treatment for depression and anxiety of all but the most severe sort.

I like Crews, even when I disagree with him, but his focus is different from what we're talking about here, even if he is dipping into it a bit. However, whichever side he writes on, and Crews used to be very Freudian indeed, he writes with the fervor of a convert, not of someone coolly examining the evidence and reaching a balanced conclusion.
posted by OmieWise at 1:17 PM on June 29, 2007

I will read that book. I hope it goes into the root causes of the the therapy movement in the United States, which to my understanding is more to do with the atomization of your society and the subsequent neccessary moneterization of interpersonal relationships than anything based on hard science. There are many countries around the world where therapy does not exist, and many people even in the US who talk through their problems with close friends and family, which has much more of a benefit than communicating with a paid stranger schooled in faulty psychological models.

But you would disagree :) You're probably a therapist?
posted by dydecker at 2:23 PM on June 29, 2007

Sure, I'm a therapist. I'm also a social worker, so issues of social justice and healthy people and communities are my stock in trade.

It doesn't go into "the root causes of the therapy movement in the US," because it sets itself a different question, which is precisely why it's helpful. Mental health is a political topic all around, with people holding dear opinions on every side about what can and should be done for people with mental health issues. It's very easy to get caught up in those questions and elide both the real suffering of people who are in distress and the answerable question of whether or not the techniques we have available to alleviate that suffering are effective. The question of whether or not someone should get therapy is a different one from whether or not it works, and one which is much more political.
posted by OmieWise at 2:42 PM on June 29, 2007

timory, this is something that absolutely can be helped through therapy, of various sorts. I think recognizing that your "understanding" of your problems as an impediment to further exploration is a good starting point. With the right person you may be able to find your way through that.

dydecker, you're going to have to try harder than that. Besides the great number of people who have benefited from various types of therapy, here are two quotes from Crews himself:

From "The Consolation of Theosophy II" [pdf]: All such pronouncements on the basis of origins alone must be resisted as illogical and antihistorical.

From Time magazine: "Those of us who are concerned about pointing out Freud's intellectual failings are not, by and large, experts in the entire range of psychotherapy. I take no position on whether psychotherapy is a good thing or not."
posted by wemayfreeze at 2:56 PM on June 29, 2007

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