Facilitating an individual counseling session with a depressed woman

Facilitating an Individual Session with a Woman with Depression and Anxiety

As a mental health professional, one of the most important things to keep in mind is that individual client characteristics are going to help determine and delineate the boundaries of sessions and shape client-therapist interactions. An approach that might be appropriate for one patient could be wholly inappropriate for another patient. The patient discussed in this paper has both depression and anxiety, two disorders that not only impact how the patient may interact with a mental health professional, but also require the mental health professional to engage in some behavior aimed at ensuring patient safety, but which might be damaging to the therapeutic process. It is important for a mental-health professional to understand this possible dichotomy and prioritize patient safety and health concerns, not only at the beginning of therapy, but throughout the therapeutic process.

It is important to understand if a patient has previously received an actual diagnosis of major depression and an anxiety disorder, or if the patient is simply presenting with symptoms of anxiety and depression. The reason that this is critical is that bipolar patients may present as depressed, but the treatments for the two disorders are different, especially if there will be a chemical intervention. Furthermore, it is critical to know whether or not the patient has been formally assessed. Depressed patients may have a risk of suicide, and a patient at a high risk of suicide may need hospitalization or other emergency interventions. In those scenarios, even beginning a therapeutic dialogue with the patient may increase patient risk because of failure to properly consider issues of patient safety. Therefore, when depression is an issue, it is important to conduct a safety assessment when beginning a therapeutic assessment. Furthermore, the patient should be reassessed at regular intervals.

It is important for the mental health professional not to dismiss a patient's needs because of that patient's underlying mental illness. Even a depressed patient should have considerable input in treatment, and a patient's wishes should only be disregarded if the mental health professional has a reason to believe that adhering to those wishes would lead to considerable harm. That does not mean that a therapist cannot or should not challenge a patient's assumptions, but challenges should be done respectfully. Therefore, the therapist needs to establish a therapeutic alliance with the patient. This involves collaborating "with the patient in decision making and attending to the patient's preferences and concerns about treatment" (National Guideline Clearinghouse, 2012).

One of the major issues to tackle when a patient has depression and anxiety, both of which respond positively to medication, is the issue of whether or not the patient should be medicated. Some patients are medication-seekers, happy to take medication if they believe it will offer them symptom relief, while other patients are very resistant to taking medication. It is important for the mental health professional to find out what type of treatment the patient wants, the goals for treatment, and expected treatment guidelines. 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 the idea that some anxiety can actually be helpful. 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.