Chronic Conditions and Depression/Finding Treatment that Works

Over a year ago, I wrote Is Counseling Necessary to Cope with a Crisis?.  I wrote this out of frustration as I was watching a “mental health” response in my state regarding Irene, which seems to be more about people making money versus anything that I’ve read in the literature as far as effectiveness. In addition,  I was friends with several people dealing with significant loss and couldn’t help but notice the number of people whose first reaction was to tell them to see a therapist. Not only didn’t that advice appear to be helpful, but it seemed to make them doubt their own ability to heal.

People with chronic conditions are more likely to suffer from depression. Whether they are depressed because of their health or they develop a chronic condition because of their depression is unknown. What is clear is that there are effective treatments for depression, but whether someone receives them is another matter.

According to an article in this week’s New York Times “Looking for Evidence that Therapy Works,” Over the last 30 years, treatments like cognitive-behavioral therapy, dialectical behavior therapy and family-based treatment have been shown effective for ailments ranging from anxiety and depression to post-traumatic stress disorder and eating disorders.

The trouble is, surprisingly few patients actually get these kinds of evidence-based treatments once they land on the couch — especially not cognitive behavioral therapy. In 2009, a meta-analysis conducted by leading mental-health researchers found that psychiatric patients in the United States and Britain rarely receive C.B.T., despite numerous trials demonstrating its effectiveness in treating common disorders. One survey of nearly 2,300 psychologists in the United States found that 69 percent used C.B.T. only part time or in combination with other therapies to treat depression and anxiety.

If depression or another mental health issue affects you or the person you are caring for, take a few minutes to read the New York Time's article and consider their recommendations for questions to ask a prospective therapist-or a current one for that matter. These are the same type of questions we’d be asking someone treating us for a medical issue. Keep in mind that you may have to shop around to find someone that is a good fit for you.

• What kind of trainings have you done, and with whom?

• What professional associations do you belong to? (If you’re looking for a Cognitive Behavioral Therapist (CBT), for instance, ask whether the therapist belongs to the Association for Behavioral and Cognitive Therapies, where most top C.B.T. researchers are members.)

• What do you do to keep up on the research for treating my condition?

• How do you know that what you do in treatment works?

• Do you consider yourself and your approach eclectic? (Therapists who subscribe to an eclectic approach are less likely to adhere to evidence-based treatments.)

• What manuals do you use?

• What data can you show me about your own outcomes?