Not all patient expectations will be realistic, but a mental health professional needs to be honest with a client about which expectations are reasonable and which ones are unreasonable.
Another issue to investigate in each meeting with a patient with depression and anxiety, particularly uncontrolled depression and anxiety, is whether the disorders are impairing function and otherwise negatively impacting quality of life. If so, then the facilitator needs to direct attention towards improvement of real-life skills during the counseling session. This may mean less client-directed interaction than a therapist would otherwise seek in a one-on-one counseling session, but maintaining a baseline level of functioning and quality of life is critical.
In addition, the therapist must be aware that anxiety, unlike depression, can actually be a productive and helpful emotion. Therefore, a patient manifesting some level of anxiety might not be seeking treatment for that anxiety; on the contrary, eradicating anxiety can sometimes lead to greater problems. This is difficult because many people are under the impression that all anxiety is maladaptive, so that they have learned to fear or avoid all situations that produce anxiety. Interestingly enough, this can actually lead to disproportionate anxiety in normal situations. Anxiety can also help increase performance, as long as that anxiety remains within normal limits. However, prolonged anxiety or anxiety that is disproportionate to the task at hand can be the most difficult. Therefore, it is important for the mental health professional to address...
Moreover, the mental health professional should address the fact that, at least initially, help-seeking is probably going to result in an increase in anxiety rather than a decrease in anxiety.
The important thing is to manage this anxiety during sessions so that the anxiety levels are not so debilitating that they the patient's ability to derive assistance from the therapy. Therefore, the therapist needs to investigate anxiety triggers for the patient and take steps to minimize those triggers. The patient's gender becomes critical at this point because gender can be related to anxiety disorders, as well as to the underlying causes of anxiety. For example, women are far more likely to be victimized than men, so understanding possible rational underlying causes for any anxiety is an important step.
Other than these precautions, working with a depressed and anxious client requires the same basic skill set as facilitating any one-on-one session. The therapist needs to be able to ask open-ended questions and engage in active listening. The therapist also needs to be able to direct the conversation and challenge avoidance. In other words, the most important thing for the mental health professional to keep in mind is that the patient is a person, not a diagnosis.
References
National Guideline Clearinghouse. (2012). Summary: Practice guideline for the treatment of patients with major depressive disorder, third edition. Retrieved May 8, 2012 from NGC website: http://guideline.gov/content.aspx?id=24158
