Young Adults’ Experiences of Depression in the U.S.

Therapy and counseling

Psychotherapy, often referred to just as therapy, is a general term used to describe treatment that occurs through communicating (usually by talking) with a trained mental health professional. There are many different approaches to therapy, each with its own techniques and strategies. Generally, though, therapy tries to educate a person more about their condition, how to identify productive or negative thoughts or feelings, and how to cope with difficult circumstances. Many of the people we interviewed described experiences with receiving therapy. 

Getting access to therapy

Getting access to a therapy was a barrier for several of the people we talked with. Many who were students first sought free therapy appointments offered on campus or at their school, but these appointments were limited in number. Natasha had seven free sessions, but needed to continue therapy and that “was a bit of an issue because at the time I couldn’t really afford to get an off campus psychiatrist.” Others described issues with finding a therapist when they did not have insurance. In contrast, although Sam lost his student health insurance when he took a semester off, he was able to find a counseling center in the city where he lived who offered therapy at low rates for people without insurance. Julia found a similar service in her city.

Finding the right therapist

People we talked with who went to therapy talked about the importance of finding a therapist they felt was a good “fit” – that is, someone they could easily talk to. This fit greatly impacted how effective people felt therapy was for them. Jacob emphasized the importance of the first encounter with a therapist, saying it can, “make or break not just that therapist but therapy in general.”
Many people tried multiple therapists before finding one they could relate to. Sally found it difficult to find someone who “fits with what you need and your wants.” Mara needed to find someone she could “click” with. Colin and Sophie said it was important to have the feeling that they weren’t being “judged”. One therapist Leanna saw “didn’t mesh very well with her personality,” so she requested to be changed over to a different counselor. The new person she saw had a “softer approach” and she felt like, “I was hanging out with a friend instead of being drilled with questions which was nice and that really helped.” Julia described why the first therapist she saw was not a good fit, “And she was awful, we would end up talking about books and stuff. And I’m like, I’m not paying you to have a book club.”
Age and gender of the therapist also mattered to a few people we interviewed. Jacob wanted “somebody older” because he felt he has a hard time identifying with his peers and wanted someone “with way more experience who has seen way worse cases than me.” He also wanted to see someone who was female, because he feels he has an easier time communicating with women than men.
Types of therapy

People we talked with most commonly described their experience with behavioral therapies such as cognitive behavioral therapy (CBT) or dialectical behavioral therapy (DBT). They received this therapy from a variety of health professionals including psychologists, psychiatrists, and social workers. 

CBT works on identifying negative thoughts and behaviors and replacing these with more positive ones. Maya described “we dealt with these, very rationales, like how to deal with my negative thinking.” Whitney says CBT helped her understand the connection between her thoughts and substance use, “cause once you break down your thought process you really start to understand why you think the way you do…and ways to effectively cope and stay away from drugs and alcohol.” Julia said CBT has helped her learn to regulate her emotions as well as “just accepting something for what it is.” For Sophie, CBT helped her “try to find... alternative solutions or something to make it better, to make it less stressful or less scary for whatever it was that was bothering me.”
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DBT is a form of therapy that helps people identify and build upon their strengths, thoughts and assumptions that make life harder. Often it requires regular homework and practicing skills outside of the session. Sierra Rose described DBT as “rewiring the way you think.” Shayne says, “It’s for people who’ve experienced severe trauma in their lives and it’s research based, which means it’s been shown to work and help rehabilitate and cure these people who have experienced severe trauma and have problems emotionally regulating.”

A few of the people we talked with sought therapy with a psychiatrist, who also managed their medication. Sally went to a psychiatrist after seeing a therapist whom she felt was a little too “fluffy” and she preferred something more “concrete.” Although she found her psychiatrist helpful for managing her medication and providing therapy, she also found him biased and “old fashioned.” 

Social workers were also a source of therapy for some of the people we talked to. Shayne says he preferred this approach because “a social worker is trained to take your environment and the environmental factors into the way you act and react... as opposed to just putting you in a box based on this diagnosis and you acting in a certain way. It’s not about how you act, it’s about how you’re reacting to a certain environment that’s shaped how you function.”
Several people described how they used therapy on an “as needed” basis.
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A few people experienced therapy in group settings. Sierra Rose initially thought this was unhelpful, but after being forced to go by her grandmother, ended up staying in the program. 

A few people described group therapy as part of an intensive outpatient program. This is an important option. In the United States it is very expensive to be inpatient, and most insurers encourage or rapid discharge to outpatient treatment – so hospitalizations are short and often crisis management oriented rather than intensive treatment oriented. Out-patient programs include intensive therapy and intensive groups, usually for a number of hours per day a number of days per week often for a number of weeks.

Sam said his program was six to seven hours per day and included talking about “feelings” and “art therapy in which we would try to express them through drawing.” Sierra Rose agreed to continue with outpatient therapy after being hospitalized because of one special nurse, and described learning important skills once she attended.
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Pros and cons of therapy

Many people we talked with said therapy gave them useful suggestions or allowed them to see a situation from a different perspective than they might otherwise have had. Therapy also allowed them to better identify their thought processes and depression or anxiety triggers. Jason described the benefits of therapy as, “just being able to be completely honest with someone, talk about things. I think that helped me reflect back on what are the trigger points.”
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Many people also liked having someone they could “check in with,” especially about topics they might not be comfortable talking about with family or friends. Sometimes these visits were to deal with short term solutions. In therapy, Crystal works on short term solutions for “some of the daily struggles.” Sally discussed issues relating to transitional periods in her life, such as moving in with her boyfriend. For some, these “check in’s” evolved from talking about daily struggles to discussing issues like “self-perception”.
Some people we talked with had specific issues their therapists helped them address such as a death in a family of prior failed relationships. Teddy had issues at work, and his therapist told him, “the best way is to not give them a second chance, if they really hurt you badly”. He described that this advice “just stuck with me and it still is to this day.”
For some people we talked with, therapy was not effective. Some preferred medication, while others, like Sierra Rose described therapy as not helpful if they were not in the right mindset. Jackson “felt dead inside” and as a result, thought he wasn’t “receptive” to what a therapist had to say. Ben described therapy as “ok, but it wasn’t that beneficial but it, it was decent.” Frankie found the number and length of sessions to be unhelpful and felt like “it’s just not worth the time.” 

A few people described not liking how therapy approached dealing with their problems. Shayne didn’t realize the work she would have to put into therapy to feel better. At first, Shayne found therapy to be unhelpful because she thought “all I needed was a therapist once a week and [to] take all my medication.”
See also ‘Depression, medication, and treatment choices’, ‘Getting professional help for depression’, and ‘Holistic and integrative approaches to depression’.
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