Talking therapies for depression: experiences of talking therapy

Does therapy work?

That therapy can work (compared to having no treatment) is clear in the research. Certainly, 31 out of 38 people we talked to said that talking therapies had helped them. Despite the costs in money and time, people we saw considered talking therapies to be one of the most helpful approaches in depression. People were very positive about cognitive behaviour therapy (CBT) in particular, which many had had (see ‘Depression: Managing the mind‘). People were also positive about a range of other talking therapies, including person-centred counselling, psychosynthesis, systemic consultation, psychodynamic approaches, psychoanalysis, art therapy, group therapy and Gestalt therapy.

Argues that although talking therapies are costly if you go private, talking therapies are…

Age at interview 36

Gender Female

Age at diagnosis 34

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You could be paying ’30 to ’40 an hour if you do it privately. You probably talk at the moment probably an average of ’20 an hour, but I guess it’s about making. I mean the way you have to view it because I found I mean the girl that recommended it to me, she was paying ’20 odd an hour. She was on a very low income. And you have to make a sacrifice because the counselling is, it’s a really’ I can’t flag it up enough, say enough how valuable it is. How important’ and yes it might be expensive, especially for people who are on benefits, but it’s about making an investment for your lifetime.

And you think, without, you know, without some sort of. maybe you’re going to spend a few hundred pounds on it. But in the long term, you know, in a few years time, you may well be able to return to work or whatever or even if you don’t return to work, it’s just that whole sense of [sigh] just self the realisation, the acceptance of yourself, your ability to move on in life, to understand it, to have the knowledge base there to accept, yes I am a depressive or I do experience depression, but this is what I know. This is how I need to move on. So I mean for me it wasn’t that much’

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Cognitive behaviour therapy (CBT) helped him focus his thoughts on his successes, however small,…

Age at interview 69

Gender Male

Age at diagnosis 39

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And that [cognitive therapy] was by the chap he was the best’ he was supposed to be the best one of the cognitive therapists I was told. And I did find that, find that very useful.

How so?

Well that I could change my thinking and I could thereby change my feeling.

Can you give me an example?

A particular example was he said, when you go lie down to go to sleep, he said, “You tend to look back on your day and think of all the failures,” and he said, “why don’t you just think of everything that’s been successful?” He said, “With the proviso that for someone like you, who’s severely depressed they could just get out bed in the morning and that is a victory.” So’ and I started doing that, and every night I would just lie there I’d think well I shaved today, you know I was down in time for breakfast, and I did a crossword puzzle and so forth,” Well you know actually you’ve done quite a lot you know. And then I woke wake up in the morning with the memory of that. So just things like that, a few things like that with cognitive therapy. You know I think they helped quite a bit.

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The range of talking therapies available can be bewildering, but it was clear that a respectful and safe client-professional relationship, which helped people to sort out their problems, was more important than the kind of therapy they had.

The talking cure

Many people found that just being given the freedom to talk about their feelings and thoughts helped them to unburden themselves and work out what was at the root of their problems. Many were also surprised about the topics that arose through talking. One woman found herself talking about things she would not even tell a best friend. She discovered she had kept up a facade with other people all her life. Therapeutic discussions also worked by helping people to think about their problems in different ways. Practitioners commonly guided people to address their own issues, helping them to think of their problems in more helpful ways, rather than providing solutions. Through talking therapies, people became more insightful and could frequently make changes to improve their lives (see ‘Gaining insights about depression‘).

She saw a university-based counsellor and was relieved to be able to talk about anything she…

Age at interview 20

Gender Female

Age at diagnosis 19

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I got so worried during the last term, before the exams, that I started seeing a university counsellor, and that was very helpful, but I didn’t tell any of my friends about it.

Is it that you didn’t tell your friends about the counsellor, or about being depressed?

Both. I think I felt that I wanted to keep them both apart, and that I was going there to help myself understand what was going on, and you know, get help, but I wanted to keep it separate from my normal life. I was…. I think I was worried about how I might react to… I was worried about people seeing me differently’

You said the counselling was helpful – in what way was it helpful?

It was a big relief to have someone who I could tell anything I wanted, anything that was bothering me, and not worry about what they might think about it or how it might affect our relationship. And you know, it also helped to feel that I was doing something about my problems as well, so…

What did you like about the counselling?

Just the friendliness, and I always looked forward to the weekly session, and it, you know, helped me sort out my thoughts and feelings, describing them to someone else.

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In therapy she could talk to a stranger about issues she had never discussed, and work out what…

Age at interview 43

Gender Female

Age at diagnosis 40

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It’s not so much about, really… some times… in my case it was a relief being able to talk about things that I’d never, never been able to talk about to anybody else. And I think that the fact that I didn’t know this person and was never going to meet them again as long as I live, it didn’t matter that they knew the things that I was going to say. And it wouldn’t matter, it wouldn’t… make any difference to them because they don’t know me from Adam.

But I think in a sense it’s a relief that you can talk about something that is really… you don’t realise that that is what has caused everything. But you, when you talk about it and divulge things, it… you suddenly get this kind of relief and you don’t always know exactly what it is when you first start. And it’s only through regular therapy sessions that you suddenly find yourself talking about things that you never ever expected you were going to talk about.

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Found herself talking to her counsellor about things she would not talk to friends about, and discovered that she had put on a façade to cope with the world.

Age at interview 24

Gender Female

Age at diagnosis 14

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I went in there, very defensive, very, I’m not going to talk about anything, I’m not going to explain anything, I’m not gonna, you know, give her the answers. If she wants to get this out of me shes going to have to try bloody hard. I’m very stubborn.

But the fact that she got beneath my surface in the space of an hour and got more out of me in an hour than a friend would get out of me in a year, shocked me. Because she hadn’t really done it, I had.

Yeah, I was learning, and as much as she [the counsellor] was learning from me, I was learning trying to understand myself a bit more. That I couldn’t always carry off a confident face, a fa’ade. I carried this face around for as far as I’m concerned, twenty four years, this false pretence of being somebody that I actually am not.

Because I believed it to be what other people expected. That’s what’ I was a character that everybody, that I thought everybody wanted me to be. I was a bubbly, lively person. I was probably one of the people you would never have thought suffered from depression. And, mainly because I hid it.

And I hid it so well that it came natural to me. That, I wouldn’t necessarily open up to anybody. So, although it was all bottling up inside me, I’d had this session and I found some things come out that I wouldn’t talk to my best friend about.

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Talking about difficult and intimate problems in her life to her counsellor helped her see her…

Age at interview 60

Gender Female

Age at diagnosis 27

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Then of course when you start to talk about the intimate details of your problems, you do sort of get upset and everything. And you know it’s horrific. I find myself telling her things I’ve never put into words before. And she was coming back, ‘Well, you’re saying such and such, you’re blaming yourself for this situation.

And the way she put it made me think, ‘Oh, perhaps I wasn’t as much at fault, perhaps only partly, perhaps somebody else was responsible for part, at least part of this situation. And that was tremendous, it really was. I mean, and this’ when did I last see her, possibly a year ago and I’ve not gone backwards. Yes, she really has resolved one or two issues with me.

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His counsellor supported him without setting the agenda, helping him to make his own decisions.

Age at interview 49

Gender Male

Age at diagnosis 37

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He was, I suppose, my age maybe, maybe a bit older. But he was balanced, objective and supportive in the ways that I felt I needed at the time.

And what did you get out of that counselling?

A return of self esteem, I think is the biggest thing. But that is one of the real big issues with depression anyway isn’t it? He helped me and supported and encouraged me without laying down an agenda which again I think is how it should be done. He helped me get my head around things and make my own decisions.

And it was largely with his support that I did go back into work again. I left the career in IT and some fifteen, fifteen months afterwards, I was out of work fifteen months. I returned to work as a college lecturer, teaching management. So although it was a black time in some ways, I think the blacker times were before the diagnosis.

After the diagnosis, [pause] I suppose I just had a break, a rest, I don’t know what the term nervous breakdown means, I don’t think it is clinically valid, but I do know what burn out is and I think it was burn out. And serious mental exhaustion that had been brought on by long term exposure to shitty workplaces. And you need time to recover from that kind of emotional damage.

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The past and present

Some people found it helpful to talk about their past, including childhood. They were very much helped by discovering through therapy that they had an ‘inner child’ who needed comforting. For instance, one man was surprised by his ‘reservoirs of pain’ and described how he found it therapeutic to reconnect with himself at age ten to listen to and ‘comfort’ that self. Others found going over their past unhelpful and even traumatic. Such people benefited more from talking therapies that focused on overcoming present-day difficulties e.g., work stresses, relationship problems.

Ending therapy

At some stage, people thought about ending therapy. With more open-ended therapy, people made their own decisions about when they felt they had finished therapy. Some felt they needed to finish because they were consuming resources that others in more distress could be using. But as one therapist explained to a client, it is part of depression itself that some people do not feel entitled to talking therapies. One man mistrusted a particular therapist, and suspected they were prolonging therapy for financial gain. Some women were clear that people should negotiate the ending of open-ended therapy, since like the end of any relationship, there is grieving work to be done. When one woman suffered a strong grief reaction when her long-term therapist was off sick for 6 months.

Says counselling involves a journey and relationship with your practitioner that will one day end…

Age at interview 36

Gender Female

Age at diagnosis 34

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Yeah they are on the journey and I think that’s its safe because they’re on a journey that you are on, and they are with you every step of the way sort of thing. And you don’t have to talk. Sometimes you can just, by not saying anything you are saying heaps, you know, so it’s yeah.

But then also they’re [laugh] the downside is that once you’ve been seeing your counsellor for so long and you’ve built this wonderful relationship you’re in.then you’ve got to have an ending and that’s quite scary’ is when you think, oh my gosh I’m not going to be seeing this counsellor anymore. “Who am I going to off-load it onto? Who am I? ”

And it’s the same with, within families that become dependent on, doctors, nurses, social workers. There can be a dependency culture where you think, well actually I don’t want to be going alone, because that’s what you’ve got to do at the end of the day. You have to take that step and you have to brave it on your own.

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With NHS or other therapy that is short-term, enduring relationships are not built, and so less grieving work must be done. The downside of short therapy courses is that the depth of the relationship is limited, and this may decrease the benefit of therapy. A few people were inspired by their own experiences of therapy to go on to learn how to become counsellors themselves. Their courses also helped them to further cope with their own issues.