When it comes to treating your major depressive disorder (MDD), you probably already have a lot of questions. But for every question you ask, there’s likely another question or two you may not have considered.

It’s important to remember that the client and therapist construct and direct the psychotherapy process together. Indeed, therapists prefer to use the word “client” rather than “patient” to emphasize the active role of treatment seekers throughout the course of care.

Here’s what a therapist wishes clients who have MDD asked during their sessions.

1. Why do I feel depressed?

The initial step in getting treatment for your depression should be a comprehensive assessment. However, this doesn’t always happen.

If you’re taking medication for depression, your provider has already determined that you meet the diagnostic criteria for depression (that is, how you’re feeling). That being said, primary care providers often don’t have the time to do a comprehensive assessment on why you’re feeling the way you do.

Depression involves a disruption in neurotransmitter systems in your brain, particularly the serotonin system (hence the common use of selective serotonin reuptake inhibitors, or SSRIs, for medication). In addition, a number of other factors need to be discussed and should become part of treatment. These include:

  • thinking patterns
  • values and beliefs
  • interpersonal relationships
  • behaviors
  • other stressors that may be associated with your depression (for example, substance use or medical problems) 

2. What do I do in case of emergency?

From the outset, it’s important to have an understanding of what the therapy process is going to look like. For many, this’ll mean one-on-one sessions with a therapist once a week, lasting from 45 minutes to an hour. The number of sessions may be fixed or open-ended.

Depending on your needs, other treatment settings include:

  • group therapy
  • intensive outpatient therapy, for which you visit a therapeutic setting multiple times each week
  • residential therapy, during which you live at a facility for a period of time

Whatever the case, it’s important to know what to do in an emergency — specifically, who you should contact if you have thoughts of self-harm or suicide outside of the therapy setting. For safety reasons, you should work with your practitioner to put in place a contingency plan from the outset of therapy.

3. What is therapy exactly?

If you’re considering psychotherapy, often simply referred to as therapy, it’s likely you’ll be working with a licensed psychologist (PhD, PsyD), social worker (MSW), or marriage and family therapist (MFT).

Some medical doctors perform psychotherapy, usually psychiatrists (MD).

The American Psychological Association defines psychotherapy as a collaborative treatment that centers on the relationship between the client and care provider. Psychotherapy is an evidence-based approach that is “grounded in dialogue” and “provides a supportive environment that allows you to talk openly with someone who is objective, neutral, and nonjudgmental.” It isn’t the same as advice or life coaching. That is, psychotherapy has received a great deal of scientific support.

4. Should I be in psychotherapy or counseling?

Today, the terms “counseling” and “psychotherapy” are often used interchangeably. You’ll hear some people say that counseling is a briefer and solution-focused process, while psychotherapy is long-term and more intensive. Differences come from the origins of counseling in vocational settings and psychotherapy in healthcare settings.

At any rate, as a client, you should always ask your care provider about their training and background, theoretical approach, and licensure. It’s critical that the therapist you’re seeing is a licensed health professional. This means that they’re regulated by the government and legally accountable, as any doctor would be.

5. What type of therapy do you do?

Therapists love this question. There is scientific evidence for a number of different approaches to therapy. Most therapists have one or two approaches they draw heavily upon and are experienced in several models.

Common approaches include:

  • cognitive behavioral therapy, which focuses on unhelpful thought patterns and beliefs
  • interpersonal therapy, which focuses on unhelpful relationship patterns
  • psychodynamic psychotherapy, which focuses on unconscious processes and unresolved internal conflicts

Some people may jibe more with a particular approach, and it’s helpful to discuss what you’re looking for in treatment at the start with your therapist. Whatever the approach, it’s critical for clients to feel a strong bond or alliance with their therapist in order to get the most out of therapy.

6. Can you contact my physician?

Your therapist should contact your prescribing physician if you have taken or are taking medication for depression. Medication and psychotherapeutic approaches aren’t mutually exclusive. In fact, there’s evidence to suggest that the combination of medication and psychotherapy corresponds to greater improvement in mood than medication alone.

Whether you choose medication, psychotherapy, or both, it’s important for your treatment providers, past and current, to be in communication so that all the services you receive work in conjunction with one another. Physicians should also be included in treatment if there are other medical services you’re seeking (for example, you’re pregnant or you plan on getting pregnant, or you have another medical condition).

7. Is depression hereditary?

There is strong evidence that depression has a genetic component. This genetic component is stronger in women than in men. A number of specific genes may carry an increased risk for depression, as well. That being said, no gene or set of genes “makes you depressed.”

Doctors and therapists will often ask for family history to get a sense of this genetic risk, but that’s only part of the picture. Not surprisingly, stressful life events and negative experiences also play an important role in MDD.

8. What should I say to my family and employer?

Depression can affect those around us in a number of ways. If there has been a significant change in your mood, you may feel irritable with others. You may also change the way you conduct your day-to-day life. Perhaps you find it difficult to enjoy time with your family and have had disruptions at work. If this is the case, it’s important to let your family know how you’re feeling and that you’re seeking help.

Our loved ones can be tremendous sources of support. If things have deteriorated at home or in your romantic relationship, family or couples therapy may be beneficial.

If you’ve been missing work or your performance has slipped, it may be a good idea to let your employer know what’s been going on and if you need to take some sick leave.

9. What else can I do to support my treatment?

Psychotherapy is the foundation upon which change takes place. However, the return to a state of happiness, health, and wellness takes place outside the therapy room.

In fact, research suggests that what happens in the “real world” is critical to treatment success. Managing healthy eating habits, sleep patterns, and other behaviors (for example, getting exercise or avoiding alcohol) should be central to your treatment plan.

Similarly, discussions of traumatic experiences, stressful or unexpected life events, and social support should emerge in therapy.

10. Why don’t I feel better?

If psychotherapy doesn’t seem to be working, it’s essential to share this information with your therapist. Early discontinuation of psychotherapy is linked to poorer treatment outcome. According to one group of studies, approximately 1 in 5 people leave therapy before completion.

It’s important to define what the course of your therapy will be from the outset of treatment. During any point in treatment, a good psychotherapist would want to know if things don’t seem to be working. In fact, regular tracking of progress should be a central component of therapy.

The takeaway

Asking these questions at the outset of therapy will likely be helpful in getting treatment moving in the right direction. But remember, more important than any specific question you ask your therapist is establishing an open, comfortable, and collaborative relationship with your therapist.