THE CHRONICALLY DEPRESSED CLIENT

A particularly difficult situation which the counsellor may face is dealing with a chronically depressed client. In cases where depression is clearly linked to life events, traumas, and so forth then the skills previously discussed in this book may be directly applied. However, the counselling process and use of techniques we discussed in Chapter 1 i.e. beginning with attending and listening skills and working up to influencing skills may not be appropriate when dealing with a chronically depressed client.
This is particularly so for such skills as reflection of feeling. If you were to persistently reflect back feelings to a depressed client then this may only serve to encourage them to wallow in their negative emotions.  Some strategies for dealing with chronic depression are outlined below

Refer the Client On  

It’s you duty as a counsellor to know when to refer a client on to another professional. Factors to look out for which may help you to reach this decision are:

• The client cannot function adequately in day to day life.
• The client is a threat to themselves or someone else.
• The client has been depressed for a very long time.
• There appears to be no cause for the client’s depression.

You may, however, be in a situation where you need to counsel a chronically depressed client, perhaps as part of an agreement with a multidisciplinary team.

Anger and Depression

One possible cause for depression is blocked anger i.e. depression is a manifestation of anger which cannot be expressed for whatever reason. Sometimes we may consider that being angry is inappropriate or that we might upset someone and so we hide our anger. This can lead to feelings of frustration at being unable to express ourselves - and this in turn may lead to hopelessness and depression.

The counsellor can explore whether there is any blocked anger by encouraging the client to discuss who they might be angry with and perhaps normalising being angry in the client’s circumstances.

The counsellor may encourage the client to express their anger in an appropriate way e.g. by imagining the person they are angry with is sitting in an empty chair in the room and telling them how they feel. Obviously, this should only be done with clients that the counsellor has assessed to not be at risk of uncontrollable anger outbursts.

Counselling Skills 

Although it is important to de-emphasise reflection of feeling, other micro-skills are still very important for dealing with depression. Really, the counselling process just needs to be readjusted. The idea is to hopefully move the client into finding ways of re-storying their issues and putting new narratives into action sooner in the counselling process. This way, there is a shift from the affective component of depression towards thoughts and actions.

The counsellor may also need to be more direct and to make greater use of influencing skills such as confrontation and use of directives.

When goal setting with the client it may be necessary to adjust one’s expectations – not all clients will make a marked improvement. Help the client to set small, achievable goals.