The two steps of effective depression treatment

Having treated scores 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.

1. Fire fighting to reduce arousal and rumination and so improve sleep and motivation
2. Doing whatever it takes to get essential needs better met.
   This in turn requires effective 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.

And 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.

First, fire fighting 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 burn my Lifting depression mp3 onto a disc and ask that my client listens to it at least once daily for at least a week - until they are sick of my voice, but by which time they will truly understand what is happening to them and why and what actually is good depression treatment and help

I will also often remove pressure off my clients by taking the responsibility for the depression help and them getting better – by allowing them to relax knowing that they can let me take the strain. Obviously that is not really the case as at the end of the day, it is their 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 for my depressed clients - one or more of the following:

1. Explaining what depression is so that the person does not feel that they are to blame.
2. Undertake a Needs audit so the client can begin to perceive their situation differently and in a more detached way.. This reduces arousal by engaging the client’s problem-solving capacity.
3. Investigate whether there is trauma or threshold trauma and then clear it.
4. Reframe at every opportunity - which may be directed at softening strong black-and-white thinking or suggesting more empowering explanations of the past.
5. Explicit Visualisation, Rehearsal and Guided Imagery - designed to impart an experience of relaxation and to access the client’s strengths and resources.
6. Teach relaxation techniques.

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 summarised 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.

Or download my goal setting MP3

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.

Despite its pervasiveness in the NHS, CBT is not completely without merit.

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.

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.

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.

1. 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.
2. 42% of GPs feel that most patients given anti-depressants would be as likely to get better if they were unknowingly prescribed a placebo.
3. 78% of GPs have prescribed an anti-depressant in the last three years despite believing that an alternative treatment might have been more appropriate.

Call or email me if you know that you need to borrow some outside intelligence and wisdom to get you started.

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