After all these years, what have we learned about the most effective treatments for depression?

Michael Yapko: Just as there are many pathways into depression, there are many treatments that can provide pathways out of it. The most effective treatments have certain common denominators. We’ve learned that approaches that emphasize skill-building do better than those that don’t. Treatments that require the client to be active in the therapy process, as well as those that emphasize present and future orientation, rather than the past, also seem to get better outcomes. But the real skill in providing therapy is in knowing what approaches are going to be best for a given individual. In that respect, there’s no one-size-fits-all formula.

Overall, one of the most useful ways of understanding depression is the stress generation model. It’s based on the idea that depressed people need better skills and resources for managing life challenges so that they don’t wind up feeling trapped and victimized in their own lives. A major goal in therapy is helping depressed people learn to make better concrete choices, determining when to do this versus doing that in trying to manage their problems. The focus is on making more helpful distinctions or discriminations. Given the typical helplessness of depression, important discrimination questions to ask are “Is this hurtful situation in your control or isn’t it? How do you tell?”…