The word depression gets thrown around a lot. Socially, the word has become an overused synonym for sad, annoyed, frustrated, or simply disappointed. People often make offhanded comments like “I am so depressed that sweater hasn’t gone on sale,” which shows little thought or regard for those who bear the true weight of the word. The flippancy of its use can distract from the intensity of the lived reality of depression and can undermine those who have an intimate connection to it.
The reality of depression is that it is often all-consuming. It can steal the joy out of things once loved by the sufferer, alter perception of self and others, and at its worst, manipulate a person into planning for the relief anticipated from death. Depression is calculating, vindictive, and strategic. It thrives when left unattended and unmanaged.
From the clinician’s perspective, working with depression can be a working contradiction. It can be exhausting, overwhelming, while also incredibly rewarding. It is exhausting as clients struggle to make progress and suffer setbacks along the way. It can be overwhelming due to the initiative and impetus it takes to stay positive and motivated under the powerful energy influence that depression brings with it. It can be very rewarding when signs emerge to show that the cloud is potentially lifting and progress is looking more sustainable. Working with depression requires as much a commitment from the clinician as is needed from the client, and sometimes more.
From working with many people living with or struggling with either a formal diagnosis of depression or identified depression-related symptoms, I have been able to identify two key areas essential to successful interventions.
The strength of the relationship between counsellor and client, also known as the therapeutic alliance
The intentional application of 5 guiding principles.
The strength of the relationship between counsellor and client, also known as the therapeutic alliance refers to the counselor’s ability to stay connected, regulated, optimistic, and motivational. This is of utmost importance, particularly as it relates to creating an energy in opposition to the powerful and often paralyzing energy of depression. Being able to formulate a plan, collaboratively execute intervention efforts, modify and adapt strategies as needed, all while maintaining motivation throughout the process are necessities of any effective helper’s skillset and critical to the counsellor client connection. In many cases, the only one in the room who can see the color-filled pathway out of the black and white life of depression is the counselor. Tapping in and out of an intervention plan, either in energy or in effectiveness will undermine the therapeutic connection and simply is not an option for an effective counselling relationship.
The intentional application of 5 guiding principles refers to the counsellor’s ability to identify, explore and apply the following guiding principles, while also being able to articulate their relevance to the client. This not only reinforces the therapeutic alliance but also serves as a powerful springboard to purposeful interventions and identifiable outcomes.
1. Make the mind/body connection. Address persistent cognitive distortions and self-deprecating thinking patterns that aggravate and reinforce depression symptoms and behaviors. This also includes tending to and using the body through movement to work against depression.
2. Distinguish depression from the depressed. Recognize when depression is overruling an individual’s ability to intake, generate, process, and/or apply information and strategies. This may include having the “is it time to have a conversation with your doctor about medication” conversation.
3. Ignite hope in the face of hopelessness. Empathize, normalize, and capitalize on the counselor’s effect to generate the necessary engagement needed to implement thinking and behavior change strategies.
4. Motivate the unmotivated. Develop strategies for increasing behavioral change in the face of what can be chronic emotional and physical pain.
5. Build positive social connections by building connection capacity. Explore social isolation as both a cause and symptom of depression. Identify the influence of negative social experiences and the necessity of positive relationships for healing.
Connection in the therapeutic alliance, capacity in the application of the guiding principles, and a commitment to simultaneously building on both has become my tried and true foundational recipe for working with individuals living with depression.
This blog is a sample from our book, Counselling Insights.
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