Psychotherapy
Myrna Weissman, Ph.D.
Dr. Weissman is director of the Clinical and Genetic
Epidemiology at the NY State Psychiatric Institute, which conducts many studies
on depression in families, and co-author with late Gerald Klerman of the Comprehensive
Guide to Interpersonal Psychotherapy.
In the age of managed care, medications are the emphasis in the treatment
of depression. However, studies show that the combination of psychotherapy
and medication are more effective in the treatment of major depression than
either alone. Dr. Weissman discusses the various types of psychotherapy, what
you should ask your therapist, and how family members or caregivers can be
involved. She also discusses the results of her research into generational
depression and her current large-scale sibling study.
How would you define psychotherapy?
What is interpersonal psychotherapy?
How effective is psychotherapy in comparison
to medication?
What types of questions should one
ask about psychotherapy?
How should family members be involved
in psychotherapy?
What research are you conducting on
depression in families?
What results have you found about families
from your studies?
How would you define psychotherapy?
There are many kinds of psychotherapy. In general, it is a talk between the
patient and the therapist. But it is not just random talk. There is a theoretical
basis and a protocol that the therapist follows. During therapy, patients
should have a trusting relationship with their therapists so that they can
discuss anything that they want. Patients need to know that the talks are
confidential and they won't be chastised. That way, they can honestly evaluate
what is going on without blame.
What is interpersonal psychotherapy?
In the 1970s my late husband, Gerald Klerman, developed various studies to
test out the best maintenance treatment for major depression. He set out to
develop a psychotherapy that would be time limited, specified in a manual,
and could be tested the same way drugs are tested. The result is interpersonal
psychotherapy.
The idea behind interpersonal psychotherapy is not to cure major depression,
but to understand the relationship between the onset of depression and what
is going on in the patient's life at the time the symptoms emerged. This analysis
provides an understanding of the environmental triggers so that the patient
can better deal with those factors.
There are other structured psychotherapies that have been tested that are
good, especially cognitive behavioral therapy. Both interpersonal psychotherapy
and cognitive therapy have been tested in clinical trials and specified in
a manual.
How effective is psychotherapy in comparison to
medication?
There was a study published by Chuck Reynolds that showed that the combination
of medication and psychotherapy is better than either alone for major depression.
One of our studies showed that the combination is better than either treatment
alone. Psychotherapy and medication have different outcomes. Medications more
rapidly affect the symptoms. Patients sleep and eat better quickly on medication.
Psychotherapy usually takes longer.
What types of questions should one ask about psychotherapy?
You should ask your therapist what type of psychotherapy is being used, how
long will it last, and what you can expect (what will your therapist cover).
What will your therapist do if the psychotherapy doesn't work and how will
your therapist know it is not working? For example, if by the end of ten to
twelve weeks, you don't have some reduction in your symptoms (e.g., eating
or sleeping better), what will your therapist recommend?
How should family members be involved in psychotherapy?
We encourage family involvement and meeting with families, but only with patients'
approval. We have done studies involving martial partners. We found that often
the marital partner was also depressed. For adolescents, we always have the
parent involved in the initial phase and may bring in the parent later.
What research are you conducting on depression
in families?
We are studying three generations of depression in families. We have grandparents,
parents, and children that we have followed for over 15 years. We also have
studied depressed children, now grown up, that we followed into adulthood
to study the likelihood that childhood depression leads to adult depression.
We are currently looking for siblings for our Genetics
of Major Depression Study, the largest study involving at least two siblings
that have major depression. This is a study of depression that starts before
the age of 30, which is considered to be the most severe with the most familialty.
We compare the genetic material of siblings (blood samples) to help us discover
the gene location for major depression.
What results have you found about families from
your studies?
We have confirmed that depression runs in families. It is not inevitable and
you are not doomed if you have depression in your family, but your risk is
increased. If the general population risk for depression is 10%, your risk
may be 30%. Also, depression runs in generations, so grandchildren can develop
depression. Usually the first signs are not depression, but anxiety disorders,
which occur before puberty.
