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on January 27, 2014 with no comments
- Get depressed clients thinking and behaving is such a way that they are better able to thrive.
Encourage them to stop talking “overwhelm,” “the world’s out to get them” or “it’s somebody else’s fault.” That’s all negative nonsense which serves as a vehicle for self-sabotage, keeping them in the “doom loop.” Get them in the “success loop” by encouraging them to socially isolate less, improve their attitude and better understand the unrealistic aspects of their fears. All of these demons fuel helplessness, hopelessness and worthlessness.
- The bulk of your work should focus on helping the client “strengthen their strengths” not shore up their weaknesses.
Most clients will light up when I ask about their strengths and how these have helped them get as far as they have in life. On the other hand, inquiring about their weaknesses and suggesting a plan for improving them invites a sense of dread. It’s much more effective and efficient to have the client identify and utilize tools for beating their depression that are already in their skill set than to have them start from scratch to improve in areas in which they are unaccomplished and disinterested. Don’t introduce resistance into treatment; invite cooperation.
- Get depressed clients moving and doing things.
Depression attracts rumination and inertia like a magnet. Getting them moving and doing something – anything productive, interesting or fun – serves a viable distraction. Inactivity feeds malaise which in turn feeds dysphoria; activity keeps it at bay and out of mind.
- If the depression is severe, treat with medication.
Once a depressed individual begins exhibiting physiological symptom changes such as a change in appetite or sleep, energy loss, cognitive fog or demonstrable melancholia, medication intervention becomes a mainstay. Debilitation invites resistance to behavioral interventions and cognitive-based psychotherapy, so medication is warranted to get the client into a better position physically.
- Assuming some measure of improvement via medication, get the client moving and doing things.
Discourage an attitude of using medication as an end-all. It’s not and you need to be assertive about this. Medication does not change behavior; it can however, light the path to improvement.
- Reevaluate the need for medication going forward.
It’s common for a depressed client to not respond to the first regimen tried because there is no one drug, combination, algorithm or augmentation strategy that applies to all. Trial and error, mixing and matching rule.
Joseph Wegmann, R.Ph., LCSW is a licensed clinical pharmacist and a clinical social worker with more than thirty years of experience in the field of psychopharmacology. His diverse professional background in psychopharmacology and counseling affords him a unique perspective on medication management issues. In addition to consulting with numerous psychiatric facilities, he has presented psychopharmacology seminars to thousands of clinicians in 46 states.