Depression-Focused Psychotherapies: Shared Features of Depression-Focused Psychotherapies
The depression-focused psychotherapies are nontraditional in that they do not posit that depression is the result of core unconscious or neurotic conflicts; nor do they consider the therapeutic relationship to be the central vehicle for clarification and resolution of such conflicts. Nevertheless, it would be incorrect to surmise that these therapies discount the importance of the working alliance between patient and therapist. Rather, a therapeutic alliance based on mutual respect, genuineness, and empathy is understood as the foundation on which the specific tasks and methods of the therapy are based.

The depression-focused psychotherapies share a number of other features (

Table 40-1). First, each model of treatment was initially developed as a short-term therapy, generally delivered over 2-4 months. The time-limited nature of therapy has been emphasized explicitly in terms of the goal to achieve relief of depressive symptoms as rapidly as possible—that is, in order to be cost-effective in comparison with pharmacotherapy. Furthermore, by emphasizing short-term goals, these therapies capitalize on the acute nature of many episodes of depression.

Some patients with more chronic and/or recurrent depression may not be well served by time-limited treatments and are prone to relapse or recurrence after termination of treatment. By necessity, longer-term models of treatment have been developed for behavior therapy, CT, and IPT. Although they have been criticized as “reinventing the wheel,” these longer-term adaptations of time-limited psychotherapy are generally less intense (e.g., monthly sessions) and more focused on maintenance of gains and prevention of relapse than is traditional long-term psychotherapy. As will be discussed subsequently, evidence in support of the efficacy of these psychotherapies as continuation- or maintenance-phase treatments for high-risk patients is beginning to emerge.

As summarized in

Table 40-1, other shared features of the depression-focused psychotherapies include their specific linkage of a theoretical model of phenomenology with strategies for symptom reduction, with specification of methods to facilitate training and enhance fidelity, and with acceptance of the need to identify observable and measurable goals and outcomes. The latter two qualities are crucial advantages for empirical studies in that both independent (i.e., type of therapy) and dependent (i.e., symptom change) variables can be readily defined to ensure internal validity. The particular theoretical orientation of each model of treatment also yields predictions about specific outcomes, such as the effects of behavioral treatment on measures of social skill, CT on measures of dysfunctional attitudes, or IPT on measures of social adjustment. Finally, these therapies have several pragmatic features in common, including their compatibility for use in combination with pharmacotherapy and their suitability for use by selected nondoctoral therapists after appropriate training.