and then decide how recovering from it might be measured. Then you have
to specify what you mean by treatment. Drug dosage is easy, but how would
you define psychotherapy? The treatments that fare best in research will obvi-
ously be those most clearly delineated by lesson plans, exercises, and the like.
This is why cognitive-behavioral and interpersonal therapies looks so good.
In the real world, there is no clear separation between techniques,
unless the therapist is particularly anal-retentive. Most of us have a whole
bag of tricks; if one doesn’t work, we reach in and try another. Every patient
and practitioner combination is different, but not so much so that we can’t
make a few generalizations. The inescapable conclusion from the research
is thatstructured approaches aimed at teaching people new skills and get-
ting them to do things differently are most effective with depression. Skilled
therapists, regardless of theoretical approach, try to accomplish similar goals
in treating depression. What they say about what they do varies consider-
ably more than what they actually do. It’s the sequence of goals that is
important, not the particular tricks we use to help people accomplish them.
Less skillful therapists are likely to focus more on the technique than
what the technique is supposed to accomplish. In the last chapter of this
book, I’ll share my ideas about how to find a capable therapist. For now,
remember that there’s more than one way to skin an elephant.
Step 5: Living at the Crossroads
According to the cognitive therapists, depressed people think in characteris-
tic, self-defeating ways. They expect the worst and usually get it, or at least
think they do because they pay more attention to negative aspects of situa-
tions than to the positive ones. At the heart of their distorted view of the world
is global thinking, the tendency to see life as a series of impossibly distant end
points rather than a process that must be taken a step at a time.
That first step is the hardest. Sometimes dying seems easier.
How to Handle Suicide Threats
There are approximately 30,000 successful suicidesper year in the United
States. More than half of these are done with firearms. Hanging is the
next most common method. There are about 300,000 suicide attempts
every year, so one in ten is successful. Most unsuccessful attempts are by
overdose. Men are about five times as likely to kill themselves as women,
192 ❧Explosions into Sadness