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Depression: Major Depression & Unipolar Varieties
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Other Forms of Psychotherapy for Major Depression - Psychodynamic Therapy

Rashmi Nemade, Ph.D., Natalie Staats Reiss, Ph.D., and Mark Dombeck, Ph.D.

Psychodynamic psychotherapy is designed to help people explore the long-term sources of depression, including mental conflicts which may stem from attempts to reconcile, deny or repress painful emotions, and problematic connections with attachment figures such as parents and other caregivers. In addition to treating symptoms, psychodynamic therapists work to help patients understand the meanings inherent in their depressive symptoms. In other words, psychodynamic therapy helps patients to gain insight into the origin of and current function of their issues and problems, including their depression.

More specifically, psychodynamic therapy focuses on the impact of life events, desires, and past and current relationships on a person's functioning. In this type of therapy, the relationship between the depressed patient and the therapist is considered to be very important. Previous problematic relationship conflicts will tend to play themselves out within the current relationship between the therapist and patient through a process known as Transference. In the process of transference, patients may make erroneous assumptions about what the therapist is currently thinking that are based on what past relationship partners thought. The astute psychodynamic therapist watches carefully for this sort of error and relays the information back to patients so that they can gain insight into the way that past relationships may be influencing their perception of present relationships. In effect what is uncovered through the transference process are core beliefs, but this cognitive term is not used by psychodynamic therapists.

For example, a depressed patient may go overboard in avoiding discussing painful thoughts or emotions with his therapist (sometimes without even knowing it). A patient who has grown up with an overbearing parent may unconsciously find it difficult to risk developing a close relationship with the therapist out of fear that all close relationships will necessarily involve a domineering partner. The therapist can help the patient in this case by pointing out that avoidance is occurring, and by helping the patient to make connections between present day avoidance and past relationships that were characterized by avoidance. By becoming more aware of such patterns, the patient can make a decision to stop avoiding and to try out new ways of relating to others. The patient and psychodynamic therapist will typically discuss earlier life experiences (e.g., death of a parent, relationships with siblings) in order to determine their impact on current life experiences.

Traditional psychodynamic therapy was a long and involved process that required multiple weekly sessions over the course of many months or years. This long-term therapy has largely given way to shorter-term varieties in recent years. A recent time-limited form of psychodynamic therapy known as brief dynamic therapy, applies psychodynamic techniques to a specific emotional problem in a more limited time frame (generally between 12 and 20 weeks duration). Another form of brief therapy, psychodynamic-interpersonal psychotherapy, is similar to IPT (described above) but makes more use of the relationship between therapist and client in the course of therapeutic work.

Psychodynamic therapy tends to work best for people who are interested in developing insight into the unconscious factors and conflicts that contribute to their depressive symptoms. It must be kept in mind that understanding is not the same thing as symptom relief. It is quite possible to know why you are depressed without having gained any insight into how to stop being so depressed. As the saying goes, "The map is not the territory".