A right match between you and your mental health provider is key to your wellness and recovery from depression. If you are looking for a therapist, the most important thing to enquire is if they use evidence-based psychotherapy to treat depression. Cognitive-behavioural therapy (CBT) and interpersonal psychotherapy (IPT) are two modalities of psychotherapy that have the most evidence to support their first-line use for treating acute depression. There is some evidence to suggest that CBT may be more effective than IPT in individuals with severe depression, but the two are comparable for treating mild and moderate depression. In addition, ask the prospective therapist the following questions:
- How did you get your training in CBT or IPT? (You are not looking for a therapist whose only training was a weekend workshop.)
- How much experience do you have with these approaches?
- What are your professional credentials?
- What kind of methods would be used during the therapy?
- How often would I have to come in for therapy?
- How long would the treatment last?
- How would you assess that I am getting better?
- Are you a provider for my insurance plan?”
- If I were to pay out-of-pocket, could a reduced fee be worked out?
It not necessary to seek a therapist who is only trained in CBT or IPT. Other modalities of psychotherapy that are shown to be effective in depression include behavioral activation, mindfulness-based cognitive therapy (MBCT), cognitive-behavioural analysis system of psychotherapy (CBASP), problem-solving therapy (PST), and psychodynamic psychotherapy (the latter has less evidence compared to other therapies).
If you are going to see a psychiatrist, some of the questions as mentioned before would also be applicable here. In addition, you may want to ask them the following questions:
- What is your philosophy behind prescribing medications for depression?
- How do you objectively assess if the medication is working?
- How do you monitor for side effects?
- What do you do in case of side effects?
- How long would I have to take the medication?
- Would I be able to come off the medication if I wanted? How?
- Would you check if the prescribed medication interacts with my other medications?
- How would you be communicating with my primary care physician or therapist?
- Will I have access to more urgent services if I am not doing well?
Some of the above questions may be more appropriate for the first session with the psychiatrist, especially if you are unsure about taking medications.
Questions to ask yourself after your first visit with the mental health provider
Following your first session with a mental health provider, you will have a good feel if you and your mental health provider are a good fit. Ask yourself these questions suggested by Mary Ellen Copeland and Ronald Pies to ascertain if the provider meets your expectations or values:
- Was the provider courteous?
- Did the provider interact with you in a manner that conveys warmth?
- Did the provider create an atmosphere of empathy, concern, and acceptance?
- Did the provider take a reasonably complete psychiatric and medical history (the latter more relevant for a psychiatrist) or suggested and/or made a referral to a physician, if indicated?
- Did the provider make it easy to communicate?
- Did the provider make a good eye contact with you?
- Did the provider allow you to finish your statements?
- Did the provider use a vocabulary suited to your education and style?
- Did the provider listen to and explore your feelings before offering interpretations?
- Did the provider show interest in you and in what you say?
- Did the provider appear knowledgeable about depression?
- Did the provider appear knowledgeable about the treatment you are seeking (medication or psychotherapy)?
- Did the provider give you tools and resources to get better, but also encouraged personal responsibility for getting better? A good therapist guides you in the right direction, but doesn’t do the homework for you to reach your goals.
- Did the provider explain your diagnosis and prognosis?
- Did the provider discuss available treatment options (including types of medications for psychiatrists)?
- Did the provider give a rationale for the chosen treatment?
- Did the provider mention the duration of treatment and frequency of appointments?
- Did the provider explain how they would assess improvement?
- Did the provider involve you in arriving at a shared decision regarding your treatment?
- Did the provider give you their contact information or other resources in case of any emergencies?
- Did the provider ask you at the end if there was anything else that needed to be discussed?
- Did you feel a sense of hope and optimism following your interaction with the provider?
One of the best predictors of how well you will do in therapy is the strength and quality of the relationship between you and the therapist. This relationship entails you trusting your therapist, seeing them as empathic, and also believing that you and the therapist are working on the same goals. Another factor that predicts success of treatment is the competence of the therapist. Research shows that efficacy of cognitive therapy appears to depend to a considerable extent upon the competence of the therapist and you are more likely to acquire cognitive therapy skills if your therapist adheres to concrete cognitive therapy techniques. You are not obliged to continue seeing a provider who is not a good match for you. Sometimes this is evident in the first session, but should become clear in three to four sessions. Waiting longer than that to switch therapists can be taxing and time consuming.
Five essential requirements for a successful treatment by a provider
There are five general principles that underlie any successful treatment, particularly for psychotherapy:
- The satisfaction of being understood – All human beings have a strong desire to be understood at an emotional and intellectual level and without this need being met, it is unlikely that any treatment is going to succeed.
- The release of emotional tension – This is also called catharsis and may bring about a relief, though sometimes temporary, by ‘getting things off your chest’.
- The pleasure of self-expression – Putting a name to your feelings gives you a sense of satisfaction about your ability to organise sometimes vague and chaotic inner experiences.
- Acceptance by the provider – It doesn’t mean that your provider will or should accept everything you say or do. What it means is that despite your shortcomings, your provider treats you with respect and as a worthwhile person.
- Increase in self-esteem – Your self-esteem and self-confidence will grow during treatment as you master more and more problems.
In choosing a mental health provider for your depression, you should be the leader. This could be achieved by arming yourself with a lot of questions about how your provider can help you, what the treatment process is going to be like, and what are your alternatives. Having this information is a crucial step toward being proactive in your own treatment, which is an essential aspect of successful treatment outcomes for mental health issues.
Harpreet Duggal, MD, FAPA, is a board-certified psychiatrist in private practice in the San Francisco Bay Area. He received his training in psychiatry at the University of Pittsburgh Medical Center (UPMC). He is trained in psychopharmacology and psychotherapy and has authored more than one hundred peer-reviewed articles. He is an advocate for client-centred care based on the principles of wellness and recovery. Visit his blog on self-management of depression.