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Therapy Approaches for Depression: What to Expect

What to expect in therapy for depression

For many clients, depression is a sign that you are at the start of a transition phase in your life. It's often your body's way of telling you that something in your life is not working for you, and it needs to change.


In therapy for depression, I help clients (in and around Japan) learn skills to work with their feelings, making the shadow of depression less overwhelming. Together, we explore what gives your life meaning: your values, bringing you closer to what you would consider the best version of yourself, and ultimately helping you take actions towards your idea of a fulfilling life. 

Among expats, immigrants or internationals, depression may go together with the feeling of loneliness from being away from home or isolated in an unfamiliar city. If you feel this way, you may find iTherapy for Loneliness helpful.

Can depression be treated without medication?

This is a question I often get from my clients. When treating depression, it's important to know that there are effective options both with and without medication. Here’s a summary of what research tells us:

  1. Talk Therapy vs. Medications: Studies show that both antidepressants and talk therapy (like cognitive-behavioral therapy or CBT) can effectively reduce symptoms of depression. The choice between them often comes down to personal preference and specific symptoms. For many people, therapy alone can work just as well as medication​.

  2. Combining Treatments: In some cases, combining treatments (like medications with other therapies) can be especially helpful. For example, older adults with depression might benefit from a combination of antidepressants and other health interventions​. 

  3. Behavioral Activation: This is a type of intervention (often used within CBT or related therapies like ACT) that focuses on getting you involved in meaningful activities to reduce depressive symptoms. Research has found that clients are more invested in therapy (and drop out rates are reduced) when they are also encouraged to make these small changes in their life. These give you a sense of moving forward, even when do you do still have uncomfortable feelings. 

What are some therapy approaches for depression?

When it comes to treating depression, there are several effective therapy options to consider. Each approach offers unique benefits and can be tailored to meet individual needs. Here’s a brief overview of five popular methods:

  1. Cognitive Behavioral Therapy (CBT):

    • What it is: CBT is a type of talk therapy that helps you identify and change negative thought patterns and behaviors that contribute to your depression.

    • How it helps: Research shows that CBT is highly effective in reducing depressive symptoms. It helps you reframe negative thoughts and engage in positive activities, which can improve your mood and overall well-being​.

  2. Acceptance and Commitment Therapy (ACT):

    • What it is: ACT focuses on noticing, and allowing your thoughts and feelings rather than trying to change them. It emphasizes living in the present moment and committing to actions that align with your personal values.

    • How it helps: Studies have found that ACT can be very effective for depression, especially for those who struggle with emotional avoidance. It helps you develop psychological flexibility, making it easier to handle life’s challenges​.

  3. Schema Therapy:

    • What it is: Schema Therapy integrates aspects of CBT with techniques from other therapeutic models to address deeply ingrained patterns or schemas developed in childhood that influence current behavior and emotions.

    • How it helps: Schema Therapy has been shown to be effective for chronic depression, particularly in individuals with complex and severe cases. It focuses on changing these deep-rooted patterns and has been proven to be as effective as CBT in both outpatient and inpatient settings​​.

  4. Somatic Techniques:

    • What they are: These therapies involve using physical techniques like breathwork, movement, or acupressure to release emotional tension and reduce stress.

    • How they help: Somatic techniques can significantly reduce symptoms of depression and anxiety, particularly in individuals who experience physical symptoms alongside emotional distress​.

  5. Client-Centered Therapy:

    • What it is: Also known as Person-Centered Therapy, this approach is based on the belief that individuals have the capacity for self-directed growth and healing. It emphasizes a non-judgmental, empathetic therapist-client relationship.

    • How it helps: Research indicates that Client-Centered Therapy can be very effective for depression by providing a supportive environment that encourages self-exploration and personal growth​.

I use a combination of all these approaches customised to suit the individual client, when working with depression. Read more about my services here. 

How can you support someone who is depressed?

I get this question from my clients and people around me quite often too. 

Depression (depending on how mild or severe) can be a very distressing experience not just for the person experiencing it, but also for people who care about them. As a carer, you may feel helpless, hopeless or stuck. 

I just want you to know that the fact that you feel this way shows that you care, and just by being there with the depressed person, you are acting as a valuable supportive resource for them. 

Here are some first steps you can take to provide support: 

  • Listen Without Judgment:

    • Encourage them to talk about their feelings and listen without interrupting or judging.

    • Show empathy and understanding; let them know their feelings are valid.

  • Be Available:

    • Regularly check in with them through calls, texts, or visits.

    • Let them know you're there for them whenever they need to talk.

  • Encourage Professional Help:

    • Suggest they seek help from a mental health professional if they haven't already.

    • Offer to help them find a therapist or accompany them to appointments if they are comfortable with it.

  • Assist with Daily Tasks:

    • Offer practical help, like running errands, cooking meals, or helping with household chores.

    • This can reduce their stress and help them focus on recovery.

  • Promote Healthy Habits:

    • Encourage them to engage in regular physical activity, which can improve mood.

    • Suggest maintaining a healthy diet and ensuring they get adequate sleep.

  • Involve Them in Activities:

    • Invite them to join in social activities they used to enjoy, but respect their need for space if they decline.

    • Gentle invitations can help them feel less isolated.

  • Positive Reinforcement:

    • Remind them of their positive qualities and the good things they have accomplished.

    • This can help counteract their negative self-perception.

  • Be Patient and Persistent (This is a tough one, I know!)

    • Understand that recovery from depression takes time and there may be ups and downs.

    • Continue to offer support even if it’s initially rejected.

  • Learn About Depression:

    • Educate yourself about depression to better understand what they are going through.

    • This knowledge can help you provide more empathetic and effective support.

  • Avoid Giving Unsolicited Advice:

    • Refrain from telling them to "snap out of it" or "just think positively."

    • Instead, offer support and encouragement without trying to solve their problems.

  • Encourage Routine and Structure:

    • Help them establish a daily routine to provide a sense of normalcy and control.

    • This can include scheduled times for meals, exercise, and relaxation.

  • Take Care of Yourself (The most important one!)

    • Supporting someone with depression can be emotionally draining, so ensure you have your own support system.

    • Take time for self-care to maintain your own well-being.

Is depression a lifelong condition?

The question of whether depression is a lifelong condition is complex and depends on various factors. Research shows that while some individuals experience only one episode of depression in their lifetime, many others face recurrent episodes.

For instance, a study from the Mayo Clinic indicates that many people with depression will have multiple episodes throughout their lives, with symptoms recurring frequently and causing significant impact on daily activities​. This recurrence is influenced by factors such as residual symptoms after treatment and the number of previous episodes, which are strong predictors of future depressive episodes​.

A long-term study conducted over 15 years found that individuals who recover from a major depressive disorder still have a significant risk of recurrence. The frequency and severity of these recurrences can vary, with some experiencing persistent depressive disorder (PDD), where symptoms linger for at least two years​.

However, it's important to note that with effective treatment, which may include therapy, medication, lifestyle changes, and support, many people can manage their symptoms and lead fulfilling lives. Continuous monitoring and adaptive treatment strategies are key to reducing the impact and frequency of depressive episodes over a lifetime.

In summary, while depression can be a recurrent and chronic condition for many, it is not necessarily a lifelong sentence. Effective management and treatment can significantly improve quality of life and reduce the likelihood of frequent recurrences.

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I hope this article has been helpful to you, and do note that these are only a few first steps based on research. For more details and customised support, I would recommend talking to a therapist. 


If you're new here, I'm Diya John, a counselor and psychotherapist with a Masters in Psychology and a Diploma in Counselling from Australia. I founded Therapy Garden to make evidence-based counseling more accessible to expatriates, immigrants and the international community. I am based in Tokyo, Japan but I work with clients in different parts of the world via online therapy. You can book a free consultation or read more about my areas of specialisation and services.

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