Psychotherapy of depression: a self-confirmation model.

The concepts of self-confirmation, interpersonal diagnosis, and prototype construction are used to integrate research and clinical findings concerning depression. The person is conceptualized as sustaining his or her self-concept through a feedback loop that provides both interpersonal and intrapsychic confirmation. The personality styles specified in interpersonal diagnosis are viewed as prototypes that characterize the self-confirmation strategies used by different sorts of individuals. It is argued that various theories of depression reflect distinct segments of the depressive self-confirmation feedback cycle, and hence the stages of that cycle provide a systematic basis for deriving prototype features at both descriptive and causal levels. Various interventions are targeted toward different links in the self-confirmation cycle, and all effective interventions can lead, in different ways, to rechanneling the cycle as a whole. For this reason, combinations of interventions will often be particularly valuable. The therapeutic relationship also helps to redirect the depressive client's self-confirmation patterns and should be coordinated with target-specific interventions in order to attain maximum therapeutic impact.