Ego Activation in the Treatment of Acutely Depressed Outpatients

This paper describes how our innovative psychotherapeutic method, called ego activation psychotherapy, can implement recovery from severe depression. Derived from an integration of Piagetian theory and psychoanalytic ego psychology, this approach has been, over the course of the past ten years, successfully used in the long-term, intensive treatment of obsessive-compulsive and hysterical neuroses (see Weiner, 1975, 1979, 1980, 1981a, 1981b, 1981c). We will now explore how we have adapted this approach for the short-term treatment of nonbipolar, nonpsychotic, acutely depressed outpatients.

We will first detail the therapeutic method. Second, we will present a case study of a suicidal patient treated with ego activation psychotherapy, including 6-month and 1-year followup evaluations. Third, we will identify and discuss the effective therapeutic ingredients and strategies which facilitated success.

Although conducted in accordance with accepted psychodynamic principles, the therapy sessions are restructured. They consist not simply of a series of “verbal exchanges,” but of “verbal exchanges plus actions.” These actions involve the patient's responses to specially devised tasks that are introduced and woven into the midst of the sessions. Over 200 tasks have been developed. These tasks are not just paper-and-pencil tests of the type encountered in diagnostic and projective assessment procedures.