Understanding Talk Therapy

Talk therapy (also known as psychotherapy) can be an important part of treatment for depression or bipolar disorder. A good therapist can help you cope with feelings, problem solve and change behavior patterns that may contribute to your symptoms. 

Talk therapy is not just “talking about your problems”; it is also working toward solutions. Some therapy may involve homework, such as tracking your moods, writing about your thoughts, or participating in social activities that have caused anxiety in the past. You might be encouraged to look at things in a different way or learn new ways to react to events or people. 

Most of today’s talk therapy is brief and focused on your current thoughts, feelings and life issues. Focusing on the past can help explain things in your life, but focusing on the present can help you cope with the present and prepare for the future. You might see your therapist or counselor more often when you first begin working with them, and later, as you progress towards your goals, you might have appointments less often. 

Talk therapy can help you:

  • Understand your mental health condition
  • Define and reach wellness goals
  • Overcome fears or insecurities
  • Cope with stress
  • Make sense of past traumatic experiences
  • Separate your true personality from the moods caused by your condition
  • Identify triggers that may worsen your symptoms
  • Improve relationships with family and friends
  • Establish a stable, dependable routine
  • Develop a plan for coping with crises
  • Understand why things bother you and what you can do about them
  • End destructive habits such as drinking, using drugs, overspending or unhealthy sex. 

Who provides talk therapy?

Many kinds of mental health specialists may provide talk therapy. Some common professionals include: psychiatrists (MD), psychologists (PhD, PsyD, EdD, MS), social workers (DSW, MSW, LCSW, LICSW, CCSW), counselors (MA, MS, LMFT, LCPC), or psychiatric nurses (APRN, PMHN). Your ability to talk honestly and openly with your therapist, set clear goals and make real progress are the most important things. Think of your relationship with your therapist as a partnership. The two of you will work together to help you feel better. You do not need to feel ashamed or embarrassed about talking openly and honestly about your feelings and concerns.

Getting the most out of talk therapy

When you first begin therapy, make a list of the things that are bothering you and the issues you would like help with. Bring it with you to your first appointment. You might include:

  • Issues in your family or other relationships
  • Symptoms like changes in eating or sleeping habits
  • Anger, anxiety, irritability or troubling feelings
  • Thoughts of hurting yourself

In your first few sessions, you will probably do most of the talking. You should tell the therapist why you are there and what you would like to get from therapy. This is also your time to make sure the therapist is a good fit for you. Ask questions about the types of therapy they offer and what they think might be a good fit for your specific needs. After a few sessions, your therapist may be able to give you an idea of how long therapy will take and when you can expect to see changes in your moods.

How will I know if I’m making progress?

Within the first few weeks, make a list of short- and long-term goals with your therapist. It may be helpful to track how you feel each day and how you cope with difficult situations. After some time has passed, check the list and see if you’re closer to reaching your goals. Review your progress with your therapist. Improvement won’t happen overnight, but you should see some change, even if it’s just a better understanding of your own thoughts and feelings. It is also helpful to learn everything you can about depression and bipolar disorder and their treatments.

If, after some time, you don’t begin to feel some relief, you should consider changing therapists. You have a right to have the best treatment possible, and you can feel better.

What kinds of talk therapy are there?

CBT or Cognitive Behavior Therapy is goal-oriented and works best when the patient takes an active role. One aspect of CBT helps a person recognize the automatic thoughts or core beliefs that contribute to negative emotions. The therapist helps the person see that some of these thoughts and beliefs are false or don’t make sense and helps the person change them. The behavioral aspect of CBT takes place after a person has a more calm state of mind. The person can then take actions that help him or her move closer to planned goals. For example, if depression has caused someone to withdraw from life, that person may be encouraged to participate in hobbies or spend time with friends. Or a person may be gently coached, under supervision, to confront situations, things or people that cause fear or panic. Through practice, a person learns new, healthier behaviors.

DBT or Dialectical Behavior Therapy is a form of Cognitive Behavior Therapy. The therapist assures the person that their behavior and feelings are valid and understandable. At the same time, the therapist coaches the person to understand that it is his or her personal responsibility to change unhealthy or disruptive behavior. The therapist consistently reminds the person when his or her behavior is unhealthy or disruptive—when boundaries are overstepped—and then teaches the skills needed to better deal with future similar situations. Often times DBT involves both individual and group therapy.

Interpersonal therapy (IPT) is time-limited and goal-oriented, and addresses a person’s symptoms, social relationships and roles. IPT focuses on what is happening “here and now” and attempts to help a person change, rather than just understand his or her actions and reactions. It looks at conscious, outward action and social adjustment. It does not try to change the personality, but rather to teach new skills that can lessen symptoms.

Family Focused Therapy (FFT) works to identify difficulties and conflicts among family members that may be worsening the person’s illness. Therapy is meant to help family members find more effective ways to resolve those difficulties. The therapist educates family members about their loved one's mental health condition and how to help their relative manage it more effectively. FFT also focuses on the stress family members feel when they care for a relative with a mental health condition. The therapy aims to prevent family members from "burning out" or disengaging from the effort. Often the person experiencing the mental health condition will attend sessions with family members.

Additional Types of Therapy

While talk therapy is the most common, there are many other forms of therapy that people find helpful.

Prolonged Exposure Therapy combines cognitive talk therapy with the mental re-living of a traumatic experience and/or exposure to things that are triggering but not dangerous. Often times the therapist may begin by encouraging the person re-visit the trauma in their mind and share what they experienced. This often helps the person better process the trauma that occurred. Additionally, the therapist may assign homework where they request the person confront a situation or thing that would cause them distress, beginning with something that likely will only cause minor distress and working up to things that will cause a lot of distress. This stepping process helps the person increase their tolerance and decreases the anxiety associated with each event or thing.

Eye movement desensitization and reprocessing (EMDR) therapy is a type of psychotherapy where the clinician asks the person to think about a traumatic event while watching an object or the clinician’s hand move from the left to the right. In addition to eye movement, clinicians also sometimes use tapping on the left side and then the right side of the body or headphones that produce sound in the left ear only, followed by the right ear.    

Light therapy is often used for the treatment of Seasonal Affective disorder where a person experiences depression in the months of the year when there is the littlest sunlight, but may also be used to treat other types of depression. During a light therapy session you would sit near a light box that gives off a bright light, similar to natural sunlight. The amount of time people spend near their light box each day varies but often falls in the 20-30 minute range. You can read or work while using your light box as you don’t look directly at the light.

Art therapy uses the creative process of art making to improve a person’s overall wellness—physical, mental and emotional. Participating in art activities has been shown to help people reduce their stress levels and better deal with problems in their life. For some the positive effects can come from self-directed participation in any form of art, but in true art therapy, a trained art therapist would select specific materials and assignments that are chosen to target the exact needs of the participant.

Animal assisted therapy is when animals are used as part of treatment to improve a person’s social, emotional or cognitive state. Animal assisted therapy occurs when the owner and the animal are trained in a specific way to help people. In contrast, animal assisted activity is often less structured and may focus more on the presence of the animal rather than a specific job they are performing. Both can be very helpful to individuals living with mood disorders.