Online therapy for depression by Canadian psychotherapist

Ontario forest, soothing and therapeutic

Cognitive-behavioral therapy (CBT) and other approaches

By Toronto, Ontario registered psychotherapist Beth Mares

Much of my work has been with depression and depressive traits, and my own experience confirms the research findings that on the whole therapy works as well online by video, chat or phone as in the office. Clients who live nearby also benefit from being able to do some sessions in person and others online.

I have found that integrative psychotherapy combining CBT with some other useful modalities is the most effective and reliable.

Family systems theory, which grew out of the study of how alcoholism is passed from one generation to the next, helps people to identify depression-related patterns of family interaction in their families of origin so that they can avoid repeating them in their present relationships. Cognitive therapy helps them to become aware of and get control over dysfunctional thinking patterns which damage their self-esteem, generate anxiety, or otherwise reinforce depressive traits. Behavioral therapy (counselling) is useful for those who need help with assertiveness or with developing a more rewarding and less stressful lifestyle.

For some people these methods are insufficient because of emotional blocks. In this event it is necessary to work with the unconscious, using a method suited to the individual. This can range from short term dynamic psychotherapy to some form of inner child work or analytically-oriented (insight-oriented) psychotherapy. It can include interpersonal therapy, dream work, body work, working with parts of the self, and NLP (Neuro-linguistic programming, the best-known forms of which are hypnosis, hypnotherapy and guided imagery).

The format varies. Some people do this work in individual sessions, usually weekly or alternate weeks; some attend a weekly group; others combine individual and group work, or combine psychotherapy with a self-help group; etc.

When a mood disordered person is married or in a close relationship, couple therapy is sometimes the main intervention needed. When one member of a couple is depressed, there is a problem in the relationship; if this is not addressed because the couple sees the depression as an "illness" of one partner, the problem will continue and probably get worse. This is true even when the depressed state was precipitated by events unrelated to the relationship.

Besides offering psychotherapy to people who are depressed or have depressive traits, I provide assessments to those who have been in psychotherapy without achieving their objectives. I also offer consultations and supervision to counsellors and psychotherapists working with these issues.

Distance counselling for depression--research findings

For some people the telephone or instant messaging (chat) works best for a mild or moderate depression. It is easier to deal with for someone whose energy is low and/or who is having difficulty coping with everything. Recent studies have shown that the attrition rate is much lower when therapy for depression is done remotely at home via phone or internet. For information about online therapy with Beth, see therapy for depression at home. (Beth also sees people in her office near the Beaches, near the border of Toronto and Scarborough.)

Exercise, anxiety and mood disorders

It is important to deal with the physiological aspects of mood disorders, stress and anxiety. Their prevalence in our society is probably due in part to our sedentary lifestyle. Studies have shown that for many people exercise combats low mood as well as or better than antidepressants, and that the effects last longer. Exercise regularly--if possible, find something you enjoy, and make a priority of it. Don't exercise within a couple of hours of bedtime, though, as it may disturb your sleep, and avoid sports that are so competitive that you get in a bad mood when you lose or get obsessed with them to the point that your life becomes unbalanced. Tai chi, qigong, yoga and hanna somatics are particularly useful, as they include stretches, and their slow, rhythmic movements tend to calm the mind.

For depressive symptoms in old age, see Depression treatment for the elderly, including sleep hygiene and CBTi. For identifying depressive traits that do not present as depression, see Depression and the Family. About how to help a depressed family member, see depressed brother and depressed sister.