Becoming an Active Partner in Depression Treatment

Most stories about getting life back from depression describe how each person had to become an active partner in treatment in order to recover. I know it’s not easy to think about being active when you’re deeply depressed, but there’s a lot of support for the idea. Dozens of research studies indicate that if you can take a leading role, your chances of improving are better.

There are at least three ways an active role can help you.

1. Finding the types of treatment that are most effective for you.
2. Forming a trusting relationship with a therapist.
3. Making it easier to draw on your own inner ability to heal.

Although there are many who choose to work toward recovery without the aid of medical help, the best approach for most people is to partner closely with psychiatrists, psychotherapists or primary care doctors – if they can find ones they trust.

Searching

On this blog, Donna-1 and Tony Giordano both emphasize what they had to do to turn the corner in recovering. I learned the same lesson in my own search.

Donna relates that she used medication, had a therapist, tried electroconvulsive therapy, kept a journal and did other things as well. Those were all positive steps in her own search, but none of them got her beyond the ups and downs of immediate moods. To get beyond that, as she says, “I had to do difficult things.”

She pushed herself to engage with other people through volunteer work, and that step helped move her to a richer level of experience in healing. There were many other dimensions to the work she did to get better, but the point is she worked hard on her own to make progress. The standard treatments simply didn’t do enough.

Initially, Tony Giordano had no idea that depression could be the problem that was undermining his life. He found temporary remission of his symptoms from early treatment, but serious relapse forced him to take a different approach. Learning as much as he could about depression and its treatment was extremely important.

Armed with that knowledge, he worked with several forms of therapy and a number of therapists. After many disappointments, he found the key to his recovery through connecting emotionally with his own childhood and the abuse he had suffered at the hands of an alcoholic father.

If they had not become activists in their own treatments, neither Donna nor Tony would likely have made as much progress as they have. I’ve had a similar experience, and, like them, have to keep active and alert every day to ensure that I keep moving in a positive direction.

Therapeutic Alliance

Ever since the 1950s when studies on the effectiveness of psychotherapy began, research has found that the relationship between client and therapist is the most important factor in success. It was even more important than the type of therapy. This is not a passive relationship but one in which both trust and respect each other. Clients are active in setting goals for treatment and applying what they learn.

Recent studies of specific aspects of treatment have found similar results. If clients made their own choice of treatment for depression, the outcomes tended to be more positive. The most important study to date of antidepressant effectiveness, known as STAR*D, used this principle in a limited way by giving patients a choice of treatment if an initial medication failed to remit their symptoms.

Mary Ellen Copeland’s research and long experience in working with depressed clients has shown the importance of their active involvement. This is the basis for the success of her approach in having each client write their own treatment plans. The plans summarize the techniques each person has found most effective and serves as a reminder and reference on what to do if depression diverts them away from their healing routines.

Healing and the Mind

There’s another dimension of research and practice that emphasizes the need for medical patients and therapeutic clients to draw on their inner strengths and resilience.

Norman Cousins publicized the idea of an active patient role in the late 70s in his classic, Anatomy of an Illness as Perceived by the Patient. He described the close partnership with his physician that enabled him to draw on the internal powers of his mind and emotions to assist his healing from a serious illness. The idea was referred to as patient responsibility at the time.

Cousins became an advocate for this view and received support from the medical research community to set up a university-based institute. The research its staff carried out demonstrated the impact of human emotions on specific aspects of the body’s biochemistry and immune system.

This was a revolutionary idea in medicine at the time. In Mindsight, Daniel Siegel vividly describes his own run-in with the prevalent mindset when he was a medical student. A doctor evaluating his work with patients criticized him for talking to them about how they felt. She told him that if he wanted to do that he should become a social worker. If he wanted to do medicine, he had to stick to the physical realm exclusively.

That attitude has changed a lot. A great many physicians have come to recognize the importance of the patient’s self-healing powers in the succeeding years. Bill Moyers interviewed 15 of the most prominent practitioners for his PBS series and subsequent book, Healing and the Mind. Their stories drew on experience ranging from inner-city community health centers to the prosperous world of Marin County, California.

Their experience reaffirmed the importance of considering all the conditions of a person’s life in the healing process. The narrow focus on eliminating symptoms was broadening to include the inner changes of the human beings who needed to heal. Even beyond the individual, the roles of social bonds, personal relationships and support of the larger community were also being recognized as additional dimensions of recovery from serious illness.

Recent Guidance on Recovery

These days a new emphasis on recovery has emerged, one that places regaining a full life at the center of the treatment process. The American Psychiatric Association has formally supported this goal.

Its recent revision of guidelines for the treatment of major depressive disorder describes the importance of creating a therapeutic alliance between psychiatrist, the patient, the patient’s family and other health providers.

Though unfortunately not always followed in practice, the guideline is an acknowledgement of the central importance of the patient’s active role in treatment. The therapeutic process is more effective when the person who’s trying to get well works on the treatment plan and carries it out in collaboration with mental health providers.

There are also new general recovery guidelines adopted by the federal government and recommended by the Surgeon General. They give the highest priority to each person’s role in defining goals and taking responsibility for their own treatment. They also define the process of recovery as a personal journey toward well-being, not only as the elimination of symptoms.

A Long and Winding Road

It’s easy to list the barriers that depression puts in your path. They’re all too familiar and discouraging. That’s why I’m only briefly mentioning them last in this post. If that discussion came first, listing them out could confirm the skepticism you may well have.

If you’re having trouble getting out of bed, what’s the point of talking about grand ideas of springing into action?

You’re right. You can’t go from being flat on your back to the active role I’m talking about. The point is that none of us who have managed to do this could start out at that level.

As Donna, Tony and I describe in our stories – as do the others you’ll find on the Recovery Stories page – you may only get there through a painful process of trial and error, failed treatments and relapse after relapse.

And the “there” you’re aiming for depends entirely on what you want and what is feasible for you. If ending symptoms is what you need, that’s recovery. If you’re searching for a way to resign yourself to living with the illness, that’s recovery.

Setting your own goals is the best way I know to put all the therapies and skills together as a means to good living, not as ends in themselves.

Where are you in the process of trying to live well despite the illness? Does the idea of assuming a lead role in treatment seem feasible?

Image by kevindooley at Flickr