Depression, Counselling Theory
Depression and Counselling Theory
Counselling Theory Paper
George is an elderly man, aged 68 years, who showed serious signs of depression and addiction to alcohol and narcotics. He also exhibited signs of being a mentally ill man, who knows his past mistakes in life and sees no reason to even try changing his current situation. He is a divorced man who has little contact with the social world and the only relationship that he currently has is with his dog Spike. I decided on using the Cognitive Behavioral Therapy (CBT), as the most appropriate counselling theory to help him.
Rationale for Selection of CBT
The rationale behind choosing this specific theory is due to the capabilities of the theory and the nature of the case at hand. According to David, 2006 CBT, it is based on the premise that people should learn to let go of their past and focus on improving the future. Central to this therapy is that it focuses on talking. This allows people to express what they feel without fear of judgement (Williams, et al, 2013). According to Blehar, 1997, CBT works also when used with people who have an addiction to something.
George can very well express himself and his life with detail and precision; this is why this therapy best suits him. For a person of his age, he has good memory and is able to remember issues that had happened earlier in his life even under the influence of alcohol. George has serious cognitive impairments; he was able to score 15 in the MMSE test and a 45 out 60 in the CES-D score which is a clear indication of cognitive impairment. George is also an alcoholic, he uses drugs like marijuana and even hard core drugs to help him ease his thoughts and to feel better. George is also willing to corporate with the therapy; this is mainly because he recognizes the fact that his life is not exactly how he wanted it to be at his age. As much as the therapy is not meant to cure the physical ailments and addictions of George, it is meant to create an empowering foundation and a more optimistic way of dealing with his problems. His fear to face the future is hindering him from achieving the best he can in relationships.
Initial Problem Selection
George is a man troubled by many issues but I chose to deal with two of his problems, depression and addiction to alcohol and narcotics. From the interview, it was clear that George’s divorce had taken a toll on him. This was because it made him lose all personal contact that he had maintained earlier on. He has also lost touch with his religion. As a Muslim he was a dedicated follower but all that was lost ten years ago when he started eliminating himself from the society and all types of relationships.
According to Knight, 2006, depression is usually revealed when the individual pulls himself away from the society. This is because they feel that they are better off being alone as nobody wants to be with them. At this point George feels like there is no way his problems can be solved by anybody. This explains the reason as to why he is afraid to patch things up with his ex-wife. At this point he is afraid of starting any form of relationship with anybody and that is why he has had no intimate or friendly relationship with anybody in a long time.
Roth, Pilling and Hill, 2009, state that depression is associated with low self esteem and self criticism. Counselling for depression is a model that targets emotions that mostly are underlying and are the root cause of the depression. It is also meant to bring out the emotions that make sense to the person but must initially come from them for them to be willing to try them out in their lives. Roth, Piling and Hill devised a framework on how to help people with depression called the humanistic framework. It is based on allowing all the negative emotions and issues to come out and then the positive ones will slowly come out. The results of the experiment done at the Pearson Centre proved that people do indeed have the ability of coming up with the best solution for themselves but first they must be given that chance to do it themselves and must be dedicated to it as well.
The framework will work for George because from the interview it was clear he is suffering from clinical melancholy, which is depression couple up together with some cognitive problems.
Discussion of the Model
I will show how the qualifications that make George to fit into this framework.
The framework focuses on a step to step follow up of the individual who experiences different events in his life that ultimately lead to depression while others are as a result of the depression (Scherer, 2009).
First the individual makes a few wrong decisions in their lives. George had always wanted to have the life that everybody wants, a nice job and a lovely family. But somewhere down the line he made some few mistakes that caused him to lose some of these things and he now sees his mistakes.
The next step is that the person is caught up in looking at his mistakes instead of finding clear solutions to them. Instead of focusing more on what he still had even after making his small and major mistakes, he focused on the mistakes. This is evident from the fact that after he divorced his wife he completely cut all contact and relationship with everybody else. After his divorce, he saw no need of going to mosque and with that he lost a relationship with his God. He also let his relationship with his mother be reduced to an occasional phone call. His relationship with his brother is no longer the same and the one with his daughters is even worse. This cannot even describe the relationship with his friends because i is no longer in existence, he believes that they avoid him since he has his problems.
The third step is that the persons self esteem is seriously affected and they criticize themselves very harshly. George’s self esteem was seriously affected; this is the reason why on looking at him during the interview he looked unkempt. His uniform was dirty and he was not shaven. Hours after his shift ended he is still in his uniform while most people cannot wait to leave work and take off their uniform. This is because he sees no need to do that, to him it is not worth the trouble. He also believes that nobody wants to be associated with him, according to him he is not the one who pulled away from his friends, they are the ones who avoid him because they believe that he is mentally unstable. He is even not sure about reconciling with his ex-wife and it is not because he does not love her and does not long to have some company but it is because he feels he has failed her too much in the past and he doesn’t deserve her taking him back. He feels like he is failure and does not deserve to have someone with him.
The last step is when the person takes up a destructive addiction or activity that helps him escape from the world and feel better for just a while. The other step was George turning to alcohol and drugs and becoming addicted to them. He consumes alcohol because he believes it is the only way he can relieve himself of the stressful issues that he has. To him, there is realistically no way of solving as it is too late. Time has passed too much and there is not much that can be done. Once he uses these drugs and consumes alcohol he goes to another world where he gets the chance to get away from all the worries.
At the heart of the model is the interaction of emotions that lead to some cognitive and behavioural attributes;
Lacks of paying attention to the small things in life, for instance most people do not brush their teeth nor shave their beard. This is the behavioural character that is very visible on George. People also forget the day of the week, George can hardly remember the date and avoids doing any calculation on the test and does not write much on the questionnaire. This is because he probably finds it difficult to do simple addition and subtraction. This means that he is not interested in the events and occurrences of the country for instance politics, economics and even security matters. To him they are of less concern and there is no need to get to know them.
Poor communication skills are exhibited; this is because the people feel like others cannot understand them when they speak calmly. They may feel the need to act it out when trying to explain a specific point. This is reason as to why George feels the need to throw his arms out while speaking. This is because in his mind, he thinks that what he is saying will not be understood unless he actually demonstrates it using hands.
Denial is also a major emotional and cognitive defence mechanism. This is exhibited by tendency not to admit to some situations (Scherer, 2009). During the interview, George also skips over things that he does not feel like talking about. This means that his problem is actually bigger than he is willing to agree. The fact that he believes that he only drinks because he is lonely at times and not because he is an addict is also another point of denial.
Implications for Treatment
The treatment will be done in three phases the early, middle and final stage. This will be done in roughly 15- 20 sessions with George. At the end of the treatment there will be certain expected results and changes.
According to Williams, et al, 2013, the move to another stage will only be possible after the successful completion of the previous stage. The early stage is made up of discussion with George on the strategy to be used, to collect the necessary data required and all relevant information. It is in this stage that George gets to reveal his expectations at the end of the sessions and after several months after the sessions as well.
After that we shall move on to the second stage, at this point there will be several experiments performed to see if the strategy and the framework completely fits his situation, several adjustments can be made to ensure that the strategy is efficient (Blehar, 1997). It is also at this stage that we deal with George’s emotions, as stated earlier he will let all the negative emotions come out and with little assistance he will come up with a suitable and realistic solution that can solve his depression, fears and help mend his relationships. In the final stage, there will be the termination of the sessions and also the implementation of a strategy that will avoid relapse into depression and alcoholism.
During the first stage, all information and data pertaining George will be revealed. This is because the information in this stage will be used in the next stage. George is expected to grasp the seriousness and conceptualize the CBT and all the expectations from him. All the pre existing issues from his decision to leave the basketball sponsorship will be addressed and will act as a foundation in his case.
In the second stage George will bring out all the negative emotions, what he actually and truly feels so that it can lead him to alcohol and to shut himself away from the rest of the world (Blehar, 1997). All the broken relationships will be discussed and the various ways in which they can be amended. It is obvious that George knows some of his mistakes but what he does not seem to know is how to solve them especially at this time when he has grown old. As a father, a son, a brother and a friend he has a role to play in these relationship. He has to come up with the solutions but a relationship at a time to avoid overwhelming him. Having closure is something important in any relationship, it may not mend it but it will help one not to carry emotional baggage.
In this stage George will explain how his life was like before all the changes and which aspects were there and he would like to have back. He will experiment by trying out some of the interests that he had prior to adopting the alcohol drinking habit. It is also at this point that all the negative side effects of his current life will be made to him; however he has to be the one to point out what exactly he feels he is ready to start changing. This will give him the chance to voluntarily give out information.
In the final stage, as the sessions are terminated there will be strategy that will be aimed at ensuring that George will have a social life that includes at least taking spike for a walk in the park full of people and trying out the outside world with his new friend and see if he can make new friends. George is expected to create a new habit that takes the place of drinking alcohol, for instance playing a sport or even reading a book. Then termination will occur with follow up to take place periodically.
Further Discussion
Although this paper is basically supposed to be dedicated to George and his psychological issue of depression, it is also going to dedicate on a few other issues that George is going through and how to best resolve them. These are issues that can be solved by CBT and others cannot be solved by it. It is limited to the psychological aspect of George.
At the age of 68 years George is still physically able to provide for himself but with time he will retire and will be dependent on other people. this is the high time that he solves the issues to do with his mother and daughters before it gets to the point that he completely has no other alternative.
George has cognitive impairment that requires to be treated. This is evident from his lack of coordination of the issues during the interview. This can be as a result of alcohol consumption over the years. This is because alcohol with time decreases proper mental and physical coordination. This may be the reason as to why his hygiene is questionable. Medical intervention is required as there be other physical negative effects that he has developed over the years and during the interview I was not able to detect. For a proper evaluation, a full body check up should be embarked on.
Due to years of withdrawing from the social world, he may be willing to go out there to make friends but may not know how to. He may require a few sessions to be conducted outside in the open where there is interaction with people. This being a person who is looking to stop alcohol intake and is looking for a new hobby, a visit to a golf court would be highly recommended. This however easily follows during the follow up sessions.
Conclusion
George has gone through many traumatic and tough times and he is only human to feel stressed. However he feels judged and this has made him to shrink further and further away from the society. At this point his ex wife is trying to reach out to him but he is way too deep and sees just a failure who will fail her again.
George dedication to the process and strategy will help him to be able to restore his life to the way it was if not better, but he still requires all the other to be willing to help in this process as well. This is because someone may dig themselves into a hole that gets too deep. But when at low place the only other place to go is up and this is his situation. He is willing to come up but he just needs the people around him to help dig his way out.
With a little help from his family and friends George will be able to solve all his psychological problems and become a well off productive citizen.
References
Cognitive-Behavioral Interventions With Older Adults: Integrating Clinical and Gerontological Research, Derek D. Satre, Bob G. Knight, and Steven David, 2006, Professional Psychology: Research and Practice, Vol. 37, No. 5, p 489-498
Psychotherapy for Depression in Older Adults, Edited by Sara H. Qualls and Bob G. Knight, 2006, Wiley Series in Clinical Geropsychology
Counselling for Depression; Critical look at Cognition, Roth, Pilling and Hill, (2009), Pearson Print Press
The Psychological Treatment of Depression, J. Mark, G. Williams, 2013, University of Oklahoma Print Press, p324-455
The cognitive Psychology of Depression at Old Age, Ian H. Gotlib, Howard S.Kurtzman, Mary C. Blehar, 1997, p 94- 150
Self stigma and Psychological Depression; Help Seeking for Depression, Joshua Scherer, 2009, p 7-56.