Health Counseling for a Client with Depression

Health Counseling for a Client with Depression

PART A

Introduction

A nurse counselor assists clients in identifying and clarifying health problems and in choosing appropriate courses of action to solve those problems. A counselor is responsible for providing information, listening objectively, and being supportive, caring, and trustworthy ( 2004). Counselors therefore do not make decisions; they help clients reach decisions that best suit them. Clients and families often require assistance in first identifying and clarifying a problem affecting health. To assist clients in need of counseling techniques, the nurse must be able to identify the need for counseling and possess communications skills to develop a therapeutic relationship. For this paper, a clinical scenario is given wherein health counseling skills are applied and discussed.

 

Clinical Scenario

Juliet is a 34-year old woman who works as a teller on a busy bank in the city. Juliet has been married to Kevin for 10 years and has two sons, aged 8 and 5 years. Juliet says that while they are seemingly happily married she has lately begun to fear that Kevin is having an affair and will leave her. Juliet came for counseling after her physician recommended that she seek counseling for her depression. Juliet went to the outpatient department initially for lack of energy and vague gastrointestinal symptoms. Her medical examination had found no physical cause and a discussion into her mood with the nurses on duty had uncovered feelings of depression for the past 4 months.

Juliet is the eldest of four children. When she was 8 years old her parents divorced and she and her sister and twin brothers moved to a different home with her mother. Her father moved back to Indonesia where he is originally from. Juliet describes how her mother became depressed after the divorce and seemed to withdraw emotionally from the children. Juliet recalls feeling great sadness over not seeing hr father and of feeling alone in their new home. Juliet describes how she took on the role of helping her mother to look after her younger siblings and begun to worry a lot about whether her mother would be okay. Her mother had remarried some years later.

 

Application of Health Counseling skills

Many counseling techniques are used to foster cognitive, behavioral, developmental, experiential, and emotional growth in clients. Depending on what kind of problem the client is experiencing, the nurse can select from different counseling strategies and identify a kind of therapy in general.

In the case of Juliet, her depression must first be identified before a counseling plan can be formulated. The type of depression that Juliet felt is that of exogenous depression. This kind of depression refers to factors outside of the individual which contribute to the individual’s negative feelings and stress, and which contribute to the depressive state (1997). An example of such factors and one which contributed to Juliet’s state is marital stress. Juliet’s depression is just a normal psychological response to her fear of her husband cheating. But it is not healthy to not do anything about this, that’s why there is a need for intervention in the form of a therapy. Juliet is thus undergoing a crisis in life, and based on nursing literature (2004), the counseling strategy to be used should be crisis intervention in the form of Family Systems Therapy.

The use of family therapy can repair family relationships and solve problems that have been eating away at families for years and family therapy can also become part of the solution if just one member of the family is having problems, just like the case of Juliet. Family therapy is often recommended in many situations including families with problems across generational boundaries.

As a general rule the therapist should invite all the family members living in the household (1988). However, in specific cases others significant to the problem should also be convened, for example, members of the extended family, office staff, neighbors, etc.

At the start, a genogram can be constructed by the nurse counselor. The genogram can provide an overall view of complex family constellations in an extremely concise and efficient form (1988). A genogram should include names and ages of family members in Juliet’s family; dates of birth, marriage, separation, divorce, death, and other significant life events; notations, with dates, about occupation, places of residence, illness, and other changes in life course; and information on three or more generations. From this basic format and the concepts about relationships plus some ingenuity, it is possible to map out a diagram of most families seen in counseling (1988).

The counseling will start with hearing about what each family member thinks about the presenting problem. The children can be asked about how they felt with their mother behaving that way. The husband could also be asked about his views. Juliet can be asked about why she felt that her husband is having an affair. But this kind of marital issues should be asked without the children present. As this proceeds, the problem tends to be enacted in the session. How the problem is connected to life as a family now and in the previous generation is then available for exploration. Initial meetings will focus on figuring out what is not working and why, and goals for the therapy will be agreed upon.  Often families need some help with conflict mediation, learning how to communicate more clearly, and developing more effective ways of coping with stress.

During the course of the counseling, the nurse should not in any way display any sign of condemnation or judgment about the client’s behavior. The nurse should be objective at all times as possible. The nurse should only think of what is the best course to help the client.

 

Discussion

Juliet attended counseling and described feeling down and depressed most of the time. She said she would burst into tears frequently, without knowing why. She said it was difficult to motivate herself to go to work and stopped going for most social activities. She said she felt on edge and agitated when she mixed with people because she felt she had to pretend to be happy all the time. She had also noticed she felt short-tempered with her sons and did not feel strong enough to spend much time with them.

Juliet has to undergo a Family Systems Therapy with the nurse counselor. The counseling and therapy should involve not only Juliet but the whole family since in reality each member of the family has played a part in the dysfunction or depression on the part of Juliet. Perhaps Juliet’s husband acted strangely which led her to believe he is having an affair. Juliet’s past also contributed to her state at present. Juliet, being the eldest, took on the role of helping her mother to look after her younger siblings and begun to worry a lot about whether her mother would be okay.

            Culturally competent family therapy with a particular case proceeds along the same steps as most other forms of counseling: Intake, diagnostic assessment, designing a therapeutic strategy, carrying out and monitoring the process and outcomes. What distinguishes this form of counseling, however, is that the family’s cultural programs are high priority for the counselor throughout the therapeutic process (1999).

            Behind the scenes, culture plays important roles in the creation of family -mediated distress in the individual (1999). The environment where Juliet grew up and lived perhaps scorn on the situation which she is in. This in return created her depression and evidently affected how she functions in the family. Culture also partly dictates the attempted solutions. Culturally acceptable and unacceptable ways of becoming “sick” and how to recover or be cured are present in Juliet’s society. And the way her society behaves and views things can contribute to Juliet’s cure. Culture must therefore be made a part and parcel of family counseling theory and methodology (1999).

            In addition to attending to cultural diversity and social justice issues, a fundamental part of the multicultural equation consists of the therapist attitudes that incorporate beliefs about individual and family resilience, and support clients’ personal agency and creativity. Counseling must not become a form of social and cultural reductionism, whereby a client’s gender, race, or social class automatically explains that person’s beliefs, attitudes and behavior. Although interlaced with historical moments, cultural discourses, and sociopolitical forces, the client’s biography is always unique ( 2003).

 

PART B

            To me, the experience with Juliet is quite an extraordinary one wherein I have helped a client and at the same time the client was able to help me learn and grow as a nurse counselor. I have encouraged a client to examine her life and chose between alternatives. To me it seems that I have helped her bring back her life. It is a wonderful opportunity to be able to help other people bring back their healthy lives. I am also thankful that I have been given the opportunity to counsel Juliet since I have learned many things from her and her family.

Juliet on her part is quite thankful for the help and support that I have given her. She has finally overcome her depression with the use of crisis intervention and family systems therapy. At the start, we both felt uneasy, especially on her part when I had to prod private information from her. But I assured her that everything she will say is confidential and will only be used in the context of the counseling sessions. Later on, Juliet became at ease with my presence and my questions.

In the end, Juliet felt happy that she has decided to undergo counseling. She said so herself and it is seen in the way she talks and moves. She now develops a sense of control and is able to better manage stress. She is able to find time to spend with her family in spite of the busy schedule that her work gives her. She is also able to manage the stress that she encounters at work. She and Kevin have also talked over about their problems and so Juliet does not feel any insecurities after the counseling. All in all, Juliet feels like she has been given a second chance in life and she wants to do it right this time. She feels happy and thankful of the counseling experience.

            Since the whole counseling sessions with Juliet has been a success, I thought that if I had to do it again, I would not change a thing. If I will have another client with much like Juliet’s problem, I might employ some of what I have learned in Juliet’s case. The relationship between me as the counselor and Juliet as the client is one of the factors that has contributed to the success of our counseling sessions and thus in my next counseling projects, I will start with the fostering of good relationships with clients.

            During the counseling sessions with Juliet, I have learned a lot of things. I have learned things regarding the process of counseling and chief among them is the importance of relationships in the counseling process. Aside from that, I have learned additional knowledge about counseling that is beyond the scope of books. This knowledge I have gained from practice alone. Experience itself is a very good contributor to ones learning. I have also gained an understanding on how big a role a nurse counselor plays in the life of a client. A nurse counselor has the power to help or to destroy a client, and thus a nurse counselor has to be careful at all times and think only of what is best for the client.

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