The essential features of treating clients with depression relate to physical treatment, psychotherapy, education and support for the individual and the family, reduce of residual problems – structured problem solving; improving sleep; increasing activity; encouraging “normal” eating behaviours; relaxation training; assertiveness and clear communication and prevention of relapse or recurrence of depression.

Treatment options are clearer after a thorough assessment has been completed. There are a variety of antidepressant medications, various psychotherapeutic and counselling approaches and usually a combination of treatments will bring the most benefits to the individual. It is outside of this course’s scope to discuss medical treatments such as use of medication or administration of the still controversial ECT.

Psychotherapy and counselling are useful treatment options for clients with depression, even if it is combined with use of medication. This kind of treatment may be useful if the client has had a prior positive response to counselling, a competent and trained counsellor is available and the client prefers psychological treatment. All counselling approaches with proven effectiveness tend to be time limited, focused on current problems and aimed at symptom reduction rather than personality change (WHO Collaborating Centre for Mental Health and Substance Abuse, 2000).

In 1991, Gorey and Cryns (as cited in Brown, & Lent, 2000) conducted a meta analysis of group therapy with clients who have depression and concluded that small groups with less than six members were more effective. They concluded also that brief group interventions are more effective than long-term group interventions with the population who have depression.

There are several different types of counselling modalities of choice such as cognitive therapy, peer support group therapy, family therapy and family support group therapy that are usually considered when working with clients who have depression (Dziegielewski, 2002).  

Thyer and Wodarski (1998) listed useful strategies for each therapy of choice:

Counselling Strategies for Cognitive Therapy

1. Look for cognitive distortions that influence the development and maintenance of mood disorders.
2. Discuss negative distortions related to expectations of the environment, self and future that contributes to depression.
3. Examine the client’s perceptions of environment and activities that are seen as unsatisfying or unrealistic.
4. Identify dysfunctional patterns of thoughts and behaviour and guide the client to evidence and logic that test the validity of the dysfunctional thinking.
5. Assist in understanding automatic thoughts that occur spontaneously and contribute to the distorted affect. If this technique work help the client to explore other possibilities.
6. Help the client use “I” statements in identifying feelings and reactions.

Counselling Strategies for Peer Support Group Therapy

1. Provide the client with a feeling of security when discussing troublesome or embarrassing issues. This group will also help the client in discussing medication-related issues and serve as a forum for promoting depression-related education.
2. Help the client gain a sense of perspective on his or her condition and encourage him or her to link up with others who have common or similar problem.
3. Convey a sense of hope when the client is able to see that he or she is not alone or unique in experiencing depression.

Counselling Strategies for Family Therapy for Depression

1. Work with families to formulate a therapeutic plan to resolve symptoms and restore or create adaptive family functions.
2. Build an alliance with the client and their family members.
3. Combine psychotherapeutic and medical treatment education.
4. Obtain each family member’s view of the situation and specify problems, clarify each individual’s needs and desires using each individual’s preferred vocabulary and accept his or her perceptions at this time.
5. Be non-blaming and accepting of the client and the family.
   Assure the family members that they did not cause the depression.
6. Allow the family members to ventilate about the chronic burden they have experienced.
7. Examine any objective and subjective burdens the family is experiencing due to observable aspects of depression and the need to provide care giving.
8. Look for criticism or emotional over involvement of family members in response to the client’s depression.
9. Help to redefine the nature of the family’s difficulties.
10. Encourage recognition of each family member’s contribution to the discord.
11. Recognise and modify communication patterns, rules and interaction patterns.
12. Increase reciprocity through mutual exchange of privileges.
13. Decrease the use of coercion and blaming.
14. Increase cooperative problem solving.
15. Increase each member’s ability to express feelings clearly and directly, and to hear others accurately.

Counselling Strategies for Family Support Group Therapy

1. Provide therapeutic benefits and support for the family.
2. Enhance knowledge in complying with the medication regimen.
3. Provide the family members with a feeling of security when discussing troublesome or embarrassing issues.
4. Help the family members in discussing medication-related issues and serve as an avenue for promoting education related to depression and its treatment.
5. Help the family members gain a sense of perspective on their condition and tangibly encourage the family members to link up with others who have common or similar problem.
6. Convey a sense of hope where the family members are able to see that they are not alone or unique in experiencing depression.

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