What You Can Change _. And What You Can't - Martin E. Seligman [56]
These kinds of premises set you up for depression. If you choose to live by them—as so many of us do—your life will be filled with blue days and weeks. You can, however, choose a new set of more forgiving premises to live by:
“Love is precious but rare.”
“Success is doing my best.”
“For every person who likes you, one person doesn’t like you.”
“Life consists of putting my fingers in the biggest leaks in the dam.”
CT works quite well, bringing considerable relief to about 70 percent of depressed people. It is roughly as effective as the typically prescribed drugs, but somewhat less effective than ECS. It takes about a month to start working, and therapy is brief—usually a total of a few months, once or twice a week. In one way, CT is clearly superior to a single course of drugs or ECS: It lowers your future risk of depression by teaching you new skills of thinking that you can use the next time really bad things happen to you. While CT lowers future risk more than drugs, it does not lower your risk of recurrence even close to zero.15
My main reservations about CT are, first, that it may work better on moderate depression than on severe depression—for which drugs should probably be tried first; second, cognitive therapy has mostly been used with educated people who are “psychologically minded”—aware of their thoughts and how thinking affects their emotions. Little is known about how well it works for less educated and less sophisticated people; third, there is so much recurrence of severe depression, even with CT, that there is a long way to go before anything more than “moderate relief” can be claimed.
Interpersonal therapy (IPT). Interpersonal therapy focuses on social relations. It has become important because in the major NIMH-sponsored outcome study of depression, it was intended to be a placebo treatment but proved just as effective as tricyclics and at least as effective as CT in relieving depression.16
This therapy has its origins in the long-term psychoanalytic treatments devised by Harry Stack Sullivan and Frieda Fromm-Reichmann. But IPT is decidedly not psychoanalytic. In contrast, it does not deal with the childhood underpinnings, the decades-old defenses. IPT is also not long-term; rather, it consists of twelve to sixteen sessions, usually once a week.17
IPT sees depression in a medical model, asserting that depression has many causes, biological as well as environmental. Salient among the causes are interpersonal problems. IPT hones in on the here-and-now problems of getting along with other people. Current disputes, frustrations, anxieties, and disappointments are the main material of this therapy. IPT looks at four problem areas in the current life of the patient: grief, fights, role transitions, and social deficits.
When dealing with grief, IPT looks for abnormal grief reactions. It brings out the delayed mourning process and helps the patient find new social relationships that can substitute for the loss. When dealing with fights, the IPT practitioner helps determine where the disrupted relationship is going: Does it need renegotiation? Is it at an impasse? Is it irretrievably lost? Communication, negotiation, and assertive skills are taught. Role transitions include retirement, divorce, and leaving home. When dealing with these, the IPT practitioner gets the patient to reevaluate the lost role, to express emotions about the loss, to develop social skills suitable for the new role, and to establish new social supports. When dealing with social deficits, the IPT practitioner looks for recurrent patterns in past relationships. Emotional expression is encouraged. Both abiding social strengths and weaknesses are uncovered. When weaknesses are found, role playing and enhanced communication skills are encouraged.
The main virtues of IPT are that it is brief (a few months) and inexpensive, it has no known adverse side effects, and it has been shown to be quite effective against depression, bringing relief in approximately 70 percent of cases. Its main drawback is that it is not very