Essential Counseling Techniques for Supporting Clients Managing Chronic Depression and Anxiety - Sara W
Chronic Depression
Chronic depression hides in the background. It is part of the individual's daily routines, relationships, and self identity. Some counselors have reported a degree of frustration when attempting to meet the needs of individuals suffering from both anxiety and depression so the need for creativity and flexibility in the field of counseling is recognized. It is also evident that many clients come to counseling after years and years of trying to cope while others have only just begun to put a name to their feelings of anxiety and depression. Regardless of the starting point, the counselor plays a vital role in helping the client return to a place of control over their depression.
This article aims to give a practical description of counseling techniques that focus on anxiety and depression and on strengthening relationships. This article will also concentrate on couples counseling techniques. The article is aimed at licensed professionals, counselors in training, and family/friends that are seeking therapy for members of the family, but may be used by other individuals as well. The article aims to define the broad scope of what it means to compassionately care in this field.
Understanding Chronic Depression and Its Wide-Reaching Impacts
Chronic depression, or persistent depressive disorder, is the same as clinical depression, but the symptoms stay present for at least two years. Individuals with chronic depression feel a low-grade “heaviness” that permeates different aspects of life, such as how motivated they are at work and how patient they are with their family. One major difference between chronic depression and an acute depressive episode is that for individuals with chronic depression, the symptoms are not as dramatic and therefore chronic depression can be entirely unrecognizable as the main cause for an individual’s life choices and their social relationships.
Counselors must resist the temptation to look for large and dramatic changes with these clients. With chronic depression, progress is more incremental and more achievable with many small changes over time. This must be understood and explained to clients to keep their motivation to change throughout the process to manage chronic depression.
There are several behavioral techniques that chronic depression clients find helpful including:
Behavioral Activation.
Individuals with depression tend to withdraw which leads to even more withdrawal and low mood. Behavioral Activation is used to break this cycle by encouraging clients to do small, easily achievable things even if they do not want to. The idea is to do these things first and then the mood will follow.
Cognitive Restructuring.
Most chronically depressed clients have developed negative beliefs about themselves, their future, and people in their environment. Therapy can be useful to help clients recognize and analyze these automated negative thoughts. By stepping back from these thoughts, clients begin to see how negative the thoughts actually are. Clients are able to separate themselves from judgmental patterns and begin thinking in a less emotionally harmful way.
Values Clarification.
Clients can lose touch with their values due to several years of depression. Addressing these values, whether it be purposeful work, connection, or even creativity, can internally develop motivation. Clarifying values can also help develop motivation.
Psychoeducation.
Familiarizing clients with chronic depression can help a client begin to understand the neurochemical and psychological logic. Most suffer from wondering why they can't just "snap out of it." Understanding the disease as a proactive and constantly chronically depressed pattern, rather than a breakdown, can help relieve the inner shame.
Treating Anxiety and Depression
Treating depression usually involves addressing anxiety. Clients often show a combination of signs of high anxiety mixed with depression. This can lead to clients being exhausted combined with anxious energy. A lack of energy leads to an inability to carry out activities of daily living. This combination is confusing for clients since they can feel both exhausted and constantly hypervigilant.
Some techniques prove effective in the treatment of anxiety and chronic depression in combination with one other:
Grounding techniques – Certain grounding techniques work to interrupt an anxiety spiral, like focusing on physical feelings or naming objects in the room, and are particularly helpful for clients that respond to high levels of stress by either associating or dissociating.
Mindfulness-based therapy – As a component of mindfulness, having clients spiral through their thoughts and feelings subsequently diminishes how anxious and how depressive they feel. Clients practicing mindfulness learn to respond instead of react.
Exposure based techniques – Anxiety via avoidance is one of the primary reasons clients do not want to confront certain social fears or enter into certain social and/or decision making situations. Using exposure-based therapies within the context of this avoidance, clients start to confront their fears at a pace that is comfortable to them.
Sleep and routine – Both anxiety and chronic depression interfere with rest and poor sleep worsens both. Counselors help clients develop sleep and meal routines, and steady daily routines to boost overall stability.
Pairing therapy with medication requires the collaboration of both a psychiatric provider and a counselor. Contemporary therapies coordinate care, and integrate psychiatric care, to offer a range of care options for clients that significantly affect their functioning.
Couples Counseling Strategies for Clients with Relationships Affected by Depression and Anxiety
The depression and anxiety that individuals suffer from affects the couple as a whole. From the other perspective, chronic depression can erode communication and intimacy and cause partners to feel confused, helpless, or even resentful without their understanding of the situation. Chronic depression can entrench couples counseling techniques and possibly other techniques within the scope of treatment.
EFT (Emotionally Focused Therapy) helps couples identify the deeper emotions of an issue or conflict at the heart of the unconscious needs of both partners. In chronic depression, EFT helps couples understand that the partner's withdrawal may be perceived as rejection, when in fact it may be a symptom of chronic depression. Reestablishing a secure attachment of emotional ties to a partner may be therapeutic to the partner as well as relieve depression.
Fixing unhelpful communication patterns.
Certain communication patterns can be destructive and may cause the partner to either become defensive or totally shut down. Examples of destructive communication are: verbal attacks, denial, and silent treatment. Participating partners can learn how to communicate using structured techniques such as scheduled check-ins or reflective listening.
Educating Partners.
Just like depressed clients understand the implications of their illness on relationships, partners need to understand the implications of chronic depression and anxiety on the relationship. Once the partner understands that certain issues may be caused by depression, for example, being irritable and acting in a negligent or unhelpful manner, then the partner may understand the relationship has nothing to do with care.
Joint goal-setting.
Techniques in couples counseling that promote collaborative, realistic goal-setting can take many forms, from establishing scheduled connection time to more equitably distributing household tasks to creating a plan for how to handle difficult days. This ensures both partners' engagement and participation in the healing process.
Self and self care, boundary-setting conversations.
Counseling couples and partners with chronic depression will require some placement and guidance in how to handle boundary-setting self care conversations. Relationships in which one partner is completely depleted will usually not last.
Long term sustainability of treatment.
The treatment of chronic depression must reflect a marathon effort on the part of both client and counselor. The goal should be to shift the client’s focus from the pace of recovery relative to others, to expectations that are both realistic and positive.
Relapse prevention.
Clients should be provided the opportunity to identify the early signs of a depressive or anxiety episode so that they can formulate a plan of action for coping and for reaching out to supporters. This plan should deliver a clear indicator of when professional support should be accessed.
Balance.
The counseling relationship has the opportunity to facilitate a strategic balance for the client and help shift the self-narrative so that the client views personal strength and resilience.
Flexible technique integration.
Each method will not work with every client, and one that was useful in the past can become less useful over time. Counselors need to check in with clients and determine what is most useful, all the while being flexible enough to switch between cognitive, behavioral, mindfulness-based, and relational techniques, as needed.
Consistent collaborative check-ins.
Therapy should be as client-centered as possible. This means the counselor should work to ensure the client has ownership over what is happening in the therapy sessions including what the overall goals are. Having a collaborative check-in routine like this usually improves the overall outcome of the therapy sessions and the client's engagement.
Chronic depression and anxiety are challenging disorders because the process is rarely linear. Many of these clients face improvements and setbacks simultaneously. Counselors who are able to normalize the setbacks tend to be the ones who clients trust most.
Conclusion
Using a combination of relational and individual/self techniques in a slower, more supportive manner is the best way to work with clients who are suffering from chronic depression and anxiety. This may even mean drawing on unexpected techniques from couples counseling to strengthen the confines of the relationships of the clients. The overall goal is to help a client gain the stability and connection they have lost to depression and anxiety.
For deeper expertise, mental health counselors can take additional training to learn emotionally focused therapy and cognitive behavioral therapy for chronic conditions. Those with chronic depression and anxiety can reach out to licensed counselors or Mind Align Psychiatry providers for the first steps of support and healing toward recovery. Therapeutic recovery is progressive, and as long as the right tools and a therapeutic relationship are present, healing can be possible.
Chronic depression hides in the background. It is part of the individual's daily routines, relationships, and self identity. Some counselors have reported a degree of frustration when attempting to meet the needs of individuals suffering from both anxiety and depression so the need for creativity and flexibility in the field of counseling is recognized. It is also evident that many clients come to counseling after years and years of trying to cope while others have only just begun to put a name to their feelings of anxiety and depression. Regardless of the starting point, the counselor plays a vital role in helping the client return to a place of control over their depression.
This article aims to give a practical description of counseling techniques that focus on anxiety and depression and on strengthening relationships. This article will also concentrate on couples counseling techniques. The article is aimed at licensed professionals, counselors in training, and family/friends that are seeking therapy for members of the family, but may be used by other individuals as well. The article aims to define the broad scope of what it means to compassionately care in this field.
Understanding Chronic Depression and Its Wide-Reaching Impacts
Chronic depression, or persistent depressive disorder, is the same as clinical depression, but the symptoms stay present for at least two years. Individuals with chronic depression feel a low-grade “heaviness” that permeates different aspects of life, such as how motivated they are at work and how patient they are with their family. One major difference between chronic depression and an acute depressive episode is that for individuals with chronic depression, the symptoms are not as dramatic and therefore chronic depression can be entirely unrecognizable as the main cause for an individual’s life choices and their social relationships.
Counselors must resist the temptation to look for large and dramatic changes with these clients. With chronic depression, progress is more incremental and more achievable with many small changes over time. This must be understood and explained to clients to keep their motivation to change throughout the process to manage chronic depression.
There are several behavioral techniques that chronic depression clients find helpful including:
Behavioral Activation.
Individuals with depression tend to withdraw which leads to even more withdrawal and low mood. Behavioral Activation is used to break this cycle by encouraging clients to do small, easily achievable things even if they do not want to. The idea is to do these things first and then the mood will follow.
Cognitive Restructuring.
Most chronically depressed clients have developed negative beliefs about themselves, their future, and people in their environment. Therapy can be useful to help clients recognize and analyze these automated negative thoughts. By stepping back from these thoughts, clients begin to see how negative the thoughts actually are. Clients are able to separate themselves from judgmental patterns and begin thinking in a less emotionally harmful way.
Values Clarification.
Clients can lose touch with their values due to several years of depression. Addressing these values, whether it be purposeful work, connection, or even creativity, can internally develop motivation. Clarifying values can also help develop motivation.
Psychoeducation.
Familiarizing clients with chronic depression can help a client begin to understand the neurochemical and psychological logic. Most suffer from wondering why they can't just "snap out of it." Understanding the disease as a proactive and constantly chronically depressed pattern, rather than a breakdown, can help relieve the inner shame.
Treating Anxiety and Depression
Treating depression usually involves addressing anxiety. Clients often show a combination of signs of high anxiety mixed with depression. This can lead to clients being exhausted combined with anxious energy. A lack of energy leads to an inability to carry out activities of daily living. This combination is confusing for clients since they can feel both exhausted and constantly hypervigilant.
Some techniques prove effective in the treatment of anxiety and chronic depression in combination with one other:
Grounding techniques – Certain grounding techniques work to interrupt an anxiety spiral, like focusing on physical feelings or naming objects in the room, and are particularly helpful for clients that respond to high levels of stress by either associating or dissociating.
Mindfulness-based therapy – As a component of mindfulness, having clients spiral through their thoughts and feelings subsequently diminishes how anxious and how depressive they feel. Clients practicing mindfulness learn to respond instead of react.
Exposure based techniques – Anxiety via avoidance is one of the primary reasons clients do not want to confront certain social fears or enter into certain social and/or decision making situations. Using exposure-based therapies within the context of this avoidance, clients start to confront their fears at a pace that is comfortable to them.
Sleep and routine – Both anxiety and chronic depression interfere with rest and poor sleep worsens both. Counselors help clients develop sleep and meal routines, and steady daily routines to boost overall stability.
Pairing therapy with medication requires the collaboration of both a psychiatric provider and a counselor. Contemporary therapies coordinate care, and integrate psychiatric care, to offer a range of care options for clients that significantly affect their functioning.
Couples Counseling Strategies for Clients with Relationships Affected by Depression and Anxiety
The depression and anxiety that individuals suffer from affects the couple as a whole. From the other perspective, chronic depression can erode communication and intimacy and cause partners to feel confused, helpless, or even resentful without their understanding of the situation. Chronic depression can entrench couples counseling techniques and possibly other techniques within the scope of treatment.
EFT (Emotionally Focused Therapy) helps couples identify the deeper emotions of an issue or conflict at the heart of the unconscious needs of both partners. In chronic depression, EFT helps couples understand that the partner's withdrawal may be perceived as rejection, when in fact it may be a symptom of chronic depression. Reestablishing a secure attachment of emotional ties to a partner may be therapeutic to the partner as well as relieve depression.
Fixing unhelpful communication patterns.
Certain communication patterns can be destructive and may cause the partner to either become defensive or totally shut down. Examples of destructive communication are: verbal attacks, denial, and silent treatment. Participating partners can learn how to communicate using structured techniques such as scheduled check-ins or reflective listening.
Educating Partners.
Just like depressed clients understand the implications of their illness on relationships, partners need to understand the implications of chronic depression and anxiety on the relationship. Once the partner understands that certain issues may be caused by depression, for example, being irritable and acting in a negligent or unhelpful manner, then the partner may understand the relationship has nothing to do with care.
Joint goal-setting.
Techniques in couples counseling that promote collaborative, realistic goal-setting can take many forms, from establishing scheduled connection time to more equitably distributing household tasks to creating a plan for how to handle difficult days. This ensures both partners' engagement and participation in the healing process.
Self and self care, boundary-setting conversations.
Counseling couples and partners with chronic depression will require some placement and guidance in how to handle boundary-setting self care conversations. Relationships in which one partner is completely depleted will usually not last.
Long term sustainability of treatment.
The treatment of chronic depression must reflect a marathon effort on the part of both client and counselor. The goal should be to shift the client’s focus from the pace of recovery relative to others, to expectations that are both realistic and positive.
Relapse prevention.
Clients should be provided the opportunity to identify the early signs of a depressive or anxiety episode so that they can formulate a plan of action for coping and for reaching out to supporters. This plan should deliver a clear indicator of when professional support should be accessed.
Balance.
The counseling relationship has the opportunity to facilitate a strategic balance for the client and help shift the self-narrative so that the client views personal strength and resilience.
Flexible technique integration.
Each method will not work with every client, and one that was useful in the past can become less useful over time. Counselors need to check in with clients and determine what is most useful, all the while being flexible enough to switch between cognitive, behavioral, mindfulness-based, and relational techniques, as needed.
Consistent collaborative check-ins.
Therapy should be as client-centered as possible. This means the counselor should work to ensure the client has ownership over what is happening in the therapy sessions including what the overall goals are. Having a collaborative check-in routine like this usually improves the overall outcome of the therapy sessions and the client's engagement.
Chronic depression and anxiety are challenging disorders because the process is rarely linear. Many of these clients face improvements and setbacks simultaneously. Counselors who are able to normalize the setbacks tend to be the ones who clients trust most.
Conclusion
Using a combination of relational and individual/self techniques in a slower, more supportive manner is the best way to work with clients who are suffering from chronic depression and anxiety. This may even mean drawing on unexpected techniques from couples counseling to strengthen the confines of the relationships of the clients. The overall goal is to help a client gain the stability and connection they have lost to depression and anxiety.
For deeper expertise, mental health counselors can take additional training to learn emotionally focused therapy and cognitive behavioral therapy for chronic conditions. Those with chronic depression and anxiety can reach out to licensed counselors or Mind Align Psychiatry providers for the first steps of support and healing toward recovery. Therapeutic recovery is progressive, and as long as the right tools and a therapeutic relationship are present, healing can be possible.
