How to Work With Depressed Clients

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There are several accepted therapeutic paradigms with depression, but the existential therapist, the person-centered therapist and the gestalt therapist all share some similarities when it comes to working with depressed clients.

Trusted Relationship

Establishing trust comes by way of professionalism, expertise and empathy. At the initial appointment, practitioners should already know the patient’s name, major complaint and any relevant medical history. Underlying physiological causes for an episode of depression should already have been noted. Any medications the client is on should also be reviewed for specific side effects, dosing schedule and indication.

A professional demeanor is critical and establishing a good client—therapist relationship from the start is necessary. Listening in a non-judgmental, fact finding manner will help demonstrate your role without validating your clients misperceptions. You should also evince a positive belief in growth and change – a guarded optimism.

Other Items of Note

Although the client—therapist relationship is the grounding for all that follows, some specific guidelines that improve outcomes and efficiency are:

• For clients with both depression and anxiety, depression should be seen as the main problem and focus.
• Assessment of safety and risk of self harm should be an early effort.
• Sleep hygiene, diet, exercise and other self help strategies should be discussed with mild depression and considered as a primary treatment.
• Assessment of substance abuse that may be related to depression.
• Collaboration with client’s other medical professionals should be sought where medications have been prescribed or when the client is seeing multiple caregivers.
• Compare and assess written survey results with cues and responses given orally.
• Discuss antidepressant medications, side effects and expectations as well as results.

Remember, as the professional, you will be looked upon as the expert. Part of initial consultations (and subsequent sessions) will be devoted to teaching. Clients need to understand that much is known about depression – the causes and cures—and much can be done to remedy the symptoms. A positive outlook is important, but honesty should rule over false hope.

Remember that clients may be experiencing excessive fatigue and cognitive difficulties. This can make communication difficult. Using techniques like repetition, rephrasing and getting responses that indicate understanding will all help. Remember the objective is to reach the logical mind behind the emotional wall.

This should highlight the importance of a professional, trusted relationship—one that inspires believability and can be leveraged into progress. With this in mind, focus on small goals that can be praised. Even breakthroughs in understanding are cause for hope. Reframing is part of the process.

 
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