Thursday, September 8, 2011

Is Your Therapist Really Helping You Treat Your Mood Disorder?

My sister and I have been having an on-going conversation about therapy.  We've both have mood disorders (her's is depression with severe anxiety disorder) and we've both done tons of therapy.  She also works as an administrator of a chemical dependency program, which has given her a lot of insight into the therapeutic process.

Basically, my sister has noticed that there are huge differences between therapy for chemical dependency and traditional therapy..  The crux of the matter is that therapy for chemical dependency is goal-oriented.  The goal is to get you clean and help you stay clean.  Very specific steps are followed in order to help the client meet this goal.

What is the "goal" of therapy for a mood disorder?  How do you know you've met your goal?  What exactly are you doing to achieve this goal?  As a client, it's pretty hard to figure this out.

Addiction is a tough problem to beat, and getting clean takes some serious work.  Treatment requires clients to attend individual and group sessions.  But it also requires -- get this -- homework.  Clients are given assignments to keep careful track of when they felt like using and what event, emotions, and thoughts triggered this desire.  By doing this, clients learn valuable things.  I felt like getting plastered last night ... it was after a fight with my boss ... he really treats me disrespectfully ... I felt so stressed out ... and angry! ... I just wanted to drink until I couldn't feel anything.

Already, the client is learning some very important things about her drinking problem.  She knows that her supervisor's disrespect makes her stressed and angry.  When she's stressed and angry, she wants to purge these feelings with alcohol.  Since that's out of the question, she knows she needs to find a more constructive way to deal with her feelings.  Eventually, she may come to the conclusion that her current work situation isn't healthy for her, and she needs to change it.

To make all of these changes may take three to six months, but it's effective.  It helps clients get clean and stay clean.  The goal -- sobriety -- has been achieved.

Can the same be said of therapy for mood disorders?

Well, maybe not really.  Many of us see our therapists for years, spending hundreds of hours and thousands of dollars in order to feel better.  We may learn valuable things about ourselves, but we are not taught how to cope with our illness.  Our symptoms improve slightly, if at all.

What if therapy could be more like chemical dependency treatment?

Maybe it can.  Cognitive behavioral techniques, the ones I described earlier that are used in drug treatment programs, can be applied to mood disorders.  For anxiety disorders, CBT has been shown to be more effective than medications at preventing symptoms from returning.  A study of people with Bipolar I has shown that CBT results in fewer mood episodes, shortened mood episodes, and fewer hospitalizations.  For chronic depression, a sister technique to CBT (Cognitive Behavioral Analysis System of Psychotherapy, or CBASP), is one of rigorous and effective therapies out there -- even for chronic depression that has become treatment resistant.

CBASP resembles the chemical dependency treatment I described above in that it involves not just work, but a lot of homework.  Clients keep track if incidents that have triggered them during the week.  They keep track of their moods, feelings, and automatic thoughts that arise.  Specific triggering events are examined -- what was the client's desired outcome, and what was the actual outcome?  Then, the client and the therapist examine the client's emotional, cognitive, and behavioral response to this.  Was their response helpful?  Harmful?  If their response was harmful, the client and therapist work on healthier alternative responses.

For a more detailed explanation of CBASP, read this article by Michael D. Anestis, PhD.

Like most forms of CBT, CBASP is short-term, usually lasting about 12 weeks.  When combined with medication, it can achieve success rates for 85% of participants.   What I appreciate about this technique is that it seems to treat depression like the chronic illness that it is.  Just like with asthma or a suspected food allergy, the client keeps track of events that trigger the illness, and learn what they need to do to avoid or minimize those triggers in the future.

I also appreciate CBASP for its cost-effectiveness.  It's a short-term therapy, usually taking about 12-16 weeks.  The client may chose a monthly maintenance schedule after that.  Compared to talk therapy that may last indefinitely, where the goal of therapy may not be clear and symptoms may not be reduced, it seems like a pretty good deal.

I don't mean to bash traditional talk therapy here.  As I've mentioned elsewhere, I got a lot out of my long-term Jungian work.  And to be fair, a lot of therapists take an eclectic approach, and many of them include elements of CBT.  Even my Jungians did that.  For some people, it may be valuable to see a therapist once a week, knowing that they have that one hour to vent about their life to someone who knows them well, will listen non-judgmentally, and may help them see patterns that they aren't able to.

I think the important thing, if you're seeking therapy to treat a mood disorder, is that you know what you're getting into.  Remember, your therapist will be working for you.  You should feel you're getting your money's worth.  Interview prospective therapists.  Ask them about their approach, and ask them to explain any terms you don't know.  Ask them if they're willing to set goals with you, and to check in periodically to make sure those goals are being met. If you do these things, you're likely to get the most out of your relationship with your therapist.


  1. Thanks for posting this information about CBASP and the link. I found it quite interesting. It reminds me of a book that I read called "The Feeling Good Handbook" If I remember correctly, this book takes a similar approach and has homework in it that is similar to what's described by Dr. Anestis.

  2. I remember my mother recommending "The Feeling Good Handbook" to me when I was first diagnosed. I think I wasn't in a place where I was stable enough to take advantage of it. I was also put off my the huge picture of the author on the cover. And his shining white teeth. It creeped me out.

    But I should really give it another chance. I might now have the maturity to appreciate it :)

  3. Maybe other people agreed with you, because it looks like they reduced the size of his picture on later editions :)


What are your thoughts? Talk amongst yourselves!