Treatment history and its relationship to outcome in psychotherapy for depression

Patients with major depression can expect an average of four depressive episodes in their lifetime. Thus most clients presenting to therapy have had multiple prior episodes of treatment. These 'psychotherapy careers' have as yet received only minimal study and there is little data regarding the relationship of these prior treatments and responsiveness to psychotherapy. Aim: To explore prior treatment history and its relationship to psychotherapy outcome in people with major depression. Method: For 48 individuals with major depression presenting to an Australian community-based psychotherapy facility, structured diagnostic and treatment history interviews were taken and outcomes monitored. Results: In all, 90% had received some form of prior psychotherapy or counselling with on average 3.5 previous episodes of care (range 1-7). This Australian sample was less likely to have received group, family, or couples therapy than international samples. Those receiving psychotherapy at the time of intake showed higher levels of improvement over the following 12 months, although a more chronic subsample remained symptomatic and were seeking further therapy at follow-up. Discussion: Those actively engaged in some therapy experience at intake benefited more than those with an 'interrupted' psychotherapy career. Enhancing recent episodes of care may be helpful in achieving better long-term outcomes.