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New Hope
CE Notes, July 2002
William
Gaultiere, Ph.D.
WELCOME
I
hope you benefit from this class as much as I did. Thank you
for working to improve your skills as a New Hope Counselor!
We depend upon your help to care for the many hurting people
who contact us every day.
NOT ALL
DEPRESSIONS ARE THE SAME
Depression
can be endogenous (biological) or reactive (reaction to environmental
stressors).
Examples
of biological depression include Major Depression (acute, debilitating
depression), Bi-Polar disorder (Manic Depression), Dysthymia
(chronic depression). Biological depression is responsive to
medication (from a Dr. or Psychiatrist) along with supportive
therapy focused on improving daily functioning (from a Psychiatrist,
Psychologist, other therapist, or support group)
Reactive
depression is responsive to psychotherapy, support groups, and
self-help.
REACTIVE
DEPRESSION IS AN INDICATOR LIGHT ON THE DASHBOARD
"Warning.
Pay attention to this. You're hurting and struggling with something
personal and you need to address this."
Depressive
reactions are normal, appropriate, predictable responses to:
- Losses.
It is healthy and cleansing to g through the grieving process
when a loved one dies (including a pet) or when dealing with
divorce, health problems, loss of job or money, family problems.
- Injuries.
Battered women, child abuse survivors, marital unfaithfulness,
rejection from a friend are few examples of injuries that
normally evoke painful feelings and cry out for soothing.
- Trauma.
Abuse, rape, shootings, car accidents and other traumas that
you experience, whether as victim, observer, or concerned
loved one can evoke depressive reactions until they recover.
- Personal/spiritual
deficits. People who are isolated from other caring people,
neglecting hobbies and pleasures, failing to receive and appreciate
good things, over-working, or taking responsibility for others'
pain and problems will feel empty until they take inside what
they're missing.
- Failure.
Those who fail at an important project, have a moral failure,
or perform inadequately at an important responsibility will
feel appropriate guilt (to be distinguished from false guilt
when the person did nothing wrong but still feels bad) and
regret and need to receive forgiveness from God, others, or
self.
- Transitions.
Moving, changing jobs, child birth, child starting kindergarten
or going to college, empty nest, and aging are few examples
of sad transitions that need to be adjusted to.
CARE
vs. FIXING
Reactive
Depressions like these above are best responded to with caring
support that encourages participation in a healing/recovery
process rather than fixing/advice giving that tries to solve
the "problem." What's the difference?
- Care
is patient with the process, fixing seeks quick solutions.
- Care
understands feelings, fixing focuses only on problems.
- Care
is respectful, fixing is shaming.
- Care
is responsive to needs, fixing is rescuing (takes responsibility
for another's problem or gets someone to do that for you).
- Care
is compassionate, fixing is rejecting.
- Care
is helpful, fixing is hurtful.
DEPRESSIVE
REACTIONS CAN BE GOOD OR BAD
"Good" depression
is a normal and appropriate response to a loss; it's healthy
and helpful. "Bad" depression is harmful. Here are some key
differences summarized:
| |
Good
Depression |
Bad
Depression |
| Feelings: |
grief,
sadness, anger, remorse |
empty,
hopeless, isolated, shame, guilt, anxiety, blame |
| Actions: |
self-disclosure,
assertiveness, boundaries, intimacy |
over/under:
eat, sleep, sex -isolating, inactivity, lack of pleasure |
| Thoughts: |
focused,
positive |
distracted,
scattered, negative, distorted |
| Time: |
Present |
past
and/or future |
| Responsible
for: |
Self |
others
or nothing |
| Progress: |
Improving |
stuck
or worsening |
SILVER
LININGS, HELP FOR REACTIVE DEPRESSION
- Grieving:
Depression is often "ungrieved grief." The grief process
includes accepting reality, releasing painful feelings, receiving
comfort, meeting needs, adjusting, and finding new meaning.
This process is a model for healing/recovering from many different
types of pain in addition to grief.
- Assertiveness:
Depression may also be "anger turned inward against self"
or "immobilized anger" that's repressed. To be assertive
in this case includes owning up to and expressing angry feelings
(not raging, dumping, blaming, complaining), mobilizing aggressive
energy to meet needs or set boundaries, and forgiving (canceling
debts, letting go of anger, entrusting justice to God, praying
for enemies).
- Possibility
Thinking:
See "Shining Light on Depressive Cognitive Distortions" and
"Lamp Posts for the Depressed" below.
LIGHT
POSTS FOR THE DEPRESSED FROM www.ChristianSoulCare.com
The Bible offers tremendous comfort, encouragement,
and guidance for those who are discouraged or depressed. Here
are 18 examples of therapeutic, soul care principles (with corresponding
Bible verses) that can be applied as part of a program for overcoming
depression.
- Develop
Support Relationships: "Two are better than one..
If one falls down, his friend can help him up. But pity the
man who falls and has no one to help him up!" (Ecclesiastes
4:9-10)
- Ask
for what you Need: "Ask and you will receive, and
your joy will be complete." (John 16:24; see also Matthew
7:7-11, Luke 11:9-13)
- Rest:
"Come to me, all you who are weary and burdened and I
will give you rest. Take my yoke upon you and learn from me,
for I am gentle and humble in heart, and you will find rest
for your souls. For my yoke is easy and my burden is light."
(Matthew 11:28-30; see also Hebrews 4:1, 9-11)
- Enjoy
Your Life: "So I commend the enjoyment of life..
Then joy will accompany him in his work in all the days of
the life God has given him under the sun." (Ecclesiastes
8:15)
- Live
One Day at a Time: "Therefore, do not worry about
tomorrow, for tomorrow will worry about itself. Each day has
enough trouble of its own." (Matthew 6:34)
- Verbalize
your Feelings: "When I was silent. my anguish increased..
Then I spoke with my tongue.. Hear my prayer, O Lord, listen
to my cry for help." (Psalm 39:2,3,12)
- Present
Your Requests to God: "Do not be anxious about anything,
but in everything, by prayer and petition, with thanksgiving,
present your requests to God. And the peace of God, which
transcends all understanding, will guard your hearts and your
minds in Christ Jesus." (Philippians 4:6-7)
- Grieve
your Losses: "Blessed are those who mourn, for they
will be comforted." (Matthew 5:4; see also James 4:9)
- Be
Honest and Direct with your Anger: "Therefore each
of you must put off falsehood and speak truthfully to his
neighbor... `In your anger do not sin:' Do not let the sun
go down while you are still angry." (Ephesians 4:25-26)
- Set
Limits on Behavior that's Hurtful to You: "Do not
hate your brother in your heart. Rebuke your neighbor frankly
so you will not share in his guilt." (Leviticus 19:17)
- Confess
your Sins: "Therefore confess your sins to each other
and pray for each other so that you may be healed." (James
5:16)
- Forgive:
"Forgive whatever grievances you may have against one
another. Forgive as the Lord forgave you." (Colossians
3:13; see also Ephesians 4:32, Luke 17:4, Mark 11:25)
- Appreciate
and Think on the Good: "Rejoice in the Lord always.
I will say it again: Rejoice! .. Whatever is true, whatever
is noble, whatever is right, whatever is pure, whatever is
lovely, whatever is admirable - if anything is excellent or
praiseworthy - think about such things." (Philippians
4:4,8)
- Be
Content: "I have learned the secret of being content
in any and every situation, whether well fed or hungry, whether
living in plenty or in want. I can do everything through him
who gives me strength." (Philippians 4:12-13)
- Give
Thanks: "Give thanks in all circumstances, for this
is God's will for you in Christ Jesus." (1 Thessalonians
5:18)
- Do
Good: "The path of the righteous is like the first
gleam of dawn, shining ever brighter till the full light of
day." (Proverbs 4:18)
- Wait:
"I waited patiently for the Lord; he turned to me and
heard my cry. He lifted me out of the slimy pit, out of the
mud and mire; he set my feet on a rock." (Psalm 40:1-2;
see also Psalm 27:14)
- Don't
Give Up Hope: "`For I know the plans I have for you,'
declares the Lord, `plans to prosper you and not to harm you,
plans to give you hope and a future.'" (Jeremiah 29:11;
see also Hebrews 6:19)
SAMPLE NEW
HOPE REFERRALS
NEW
HOPE RESOURCES, www.NewHopeNow.org
LET'S PRACTICE!
To receive
CE credit and the satisfaction of accomplishment take the CE
Exam, which includes a role-play, and turn it into SheilaS@CrystalCathedral.org.
Complete all 11 classes for 2002 and you'll receive a special
award at the end of the year!
"EXTRA
CREDIT"
Here is
some material I developed on 15 cognitive distortions that are
present with depression. Of particular benefit to New Hope
Counselors are my sample reflecting feelings responses. The
"reframe" responses are the kind of interventions I would make
as a Psycholgosit, but in some cases are probably beyond the
scope of New Hope Counseling.
- Shoulding
on Self: Imposing rigid rules and unrealistic standards
on self. (Look for "should," "must," and "ought.")
Example: "I should study four hours every day and get A's
in all my classes."
Fallacy: There's nothing more important than getting A's.
Reflect:
"It sounds like you feel a lot of pressure."
Reframe:
"It's good to do your best in school, but it's not the only
things that's important. Other values include friends, family,
learning, working, spirituality, hobbies, fun."
- Self-Assassinations:
Reacting to a mistake or problem with harsh
self-criticism or negative labels of self.
Example:
"I forgot to pack my son's school lunch. I'm a bad mother."
Fallacy:
One mistake defines you as a bad person.
Reflect:
"I hear that you feel like a failure as a mother."
Reframe:
"Forgetting your son's lunch doesn't mean that you don't love
him or don't make other positive contributions to his life.
You can chose to base your self-esteem as a mother on the
good and helpful things that you do for your children."
- Personalization:
Seeing oneself as the cause of other's behavior, moods, or
words. (Symptoms: up and down moods, preoccupation with what
others think, anxiety, people-pleasing, egg shell walking.)
Example:
"If I'd been a better wife my husband wouldn't have lost his
temper at me."
Fallacy: You have to control others so that you can
be happy or successful.
Reflect: "It seems that you feel it's up to you to control
your husband's temper."
Reframe:
"You can't control your husband's anger. He's responsible
for that. You need to learn to set boundaries on his
destructive behavior and take care of yourself apart from
him."
- Mind
Reading: Making assumptions and conclusions based on your
perceptions of other people's thoughts or feelings about you.
Example:
"He's in a bad mood because he's angry that I didn't get his
clothes from the dry cleaners yet."
Fallacy:
The way he feels when he's around me is because of me.
Reflect:
"You're afraid that he's angry at you."
Reframe:
"If you want to know what he's feeling then ask him. Even
if he is angry about the dry cleaning that alone shouldn't
cause him to stay angry at you or to be in a bad mood. And
if it does that's his responsibility to deal with."
- All
or nothing thinking: Interpreting things in extremes of
all good or all bad, black or white, either-or, now or never.
Example:
"This is terrible! I missed the deadline for this project.
If I don't get it done now, I'll never get it done."
Fallacy:
If it's not perfect it's awful.
Reflect:
"It seems that you feel so bad about being late with this
project that you don't even want to try now."
Reframe:
"It's not all bad just because it's late. Ask for an extension
that gives you the time you need to complete it."
- Overgeneralizing:
A specific negative item is made into a global pattern
of defeat or attack. (Look for "never" and "always")
Example:
"She broke up with me. I'll never be loved."
Fallacy:
"This one rejection means you won't be loved by other people
in the future."
Reflect:
"It seems you're afraid you won't get another chance at love."
Reframe:
"Just because your girlfriend rejected you doesn't mean that
future dates or your friends and family will reject you.
There are other people who care about you will meet knew people
who do too."
- Filtering
out the good: Focusing on the negative in a situation
and overlooking the positive.
Example:
"Thanksgiving is going to be terrible. My mother always says
something hurtful."
Fallacy:
My enjoyment of the holiday depends exclusively on my
mother's behavior.
Reflect:
"It sounds like you're afraid to be with your mother."
Reframe:
"You don't have to let your mother ruin your time. Your sister
and her kids will also be there and you really enjoy them."
- Spoiling:
Negating good, helpful, or hopeful events and the actions
of others.
Example:
"My therapist just sits there and listens. He hardly says
anything to me."
Fallacy:
The success of therapy is entirely up to the therapist.
Reflect:
"You sound angry at him."
Reframe:
"If your therapy is going to work for you it'll take you and
your therapist working together. Why don't you tell him when
you want to hear his feedback?"
- Catastrophizing:
Overeacting to a situation in such an exaggerated manner that
you interpret in the worst-case scenario.
Example:
"My son has a cold. I'm sure he'll get pneumonia - he could
die."
Fallacy:
Colds inevitably lead to pneumonia and then death.
Reflect:
"It sounds like you're afraid to lose your son."
Reframe:
"He's strong enough to fight off this cold. If not he'll
see the doctor and get antibiotics if he needs them.
It's very unlikely that he'd catch pneumonia and even if he
does he'll get treated and he won't die."
- Emotional
Reasoning: If you feel it then it must be true.
Example:
"I feel like such a failure. I know I am."
Fallacy:
Subjective feelings in themselves accurately reflect objective
reality.
Reflect:
"I hear that you're feeling badly about yourself."
Reframe:
"Your feelings and opinions about yourself change all the
time. Just because you make mistakes or aren't good at some
things doesn't mean you're a failure. Tell me about some
things that you are good at."
- Helplessness:
Events in your life are totally controlled by forces outside
of yourself.
Example:
"What's the use in looking for a job in my field. I don't
have any good contacts. I'm sure they're all filled already."
Fallacy:
Competent workers don't have to look for jobs they just magically
appear.
Reflect:
"It feels discouraging to you."
Reframe:
"Just because you're feeling hopeless doesn't mean that it
is. If you keep working at it you'll get a job."
- Superman
Complex: Believing that you are responsible for everything.
Example:
"I can't take a vacation now. The place will fall apart."
Fallacy:
Nobody in the office can get work done without you.
Reflect:
"You feel responsible for the functioning of the whole office."
Reframe:
"You need a vacation. Your role in the office is important,
but others have important jobs too and they need to be able
to do them even when you're away."
- Expectations
of Fairness: You expect things to be fair and others to
do as much for you as you do for them.
Example:
"If my husband cared about me he'd help more with the house
and the kids."
Fallacy:
His caring is defined by the amount of housework he does and
child care he offers.
Reflect:
"It sounds like you're frustrated with him."
Reframe:
"You can't keep waiting for him to do his share and lighten
your load. You need to talk to him about how overburdened
you feel and take care of yourself better by putting limits
on your workload."
- Fixing
Others: Others will change if you say or do the right
thing or pressure them enough. (You get depressed when they
don't)
Example:
"If my father would listen to me and go to that A.A. meeting
at church then he'd get on track."
Fallacy:
If you nag him you can get him to go to A.A.
Reflect:
"You sound discouraged that you can't get your father to get
the help he needs."
Reframe:
"You can't get your dad to go to A.A. and get in recovery.
That's up to him. You've made your recommendation, now it's
up to him to change. If he continues to spiral down you can
consider doing an intervention."
- Martyrdom:
If I make others more important than me then I will be
rewarded in the end.
Example:
"I want to raise healthy, happy kids so I can't take time
for me now. Their needs and their activities are more important
than taking care of myself."
Fallacy:
Your kids' needs are more important than yours and sacrificing
for them will result in them being well-adjusted.
Reflect:
"It seems that you don't feel that your needs are very
important."
Reframe:
"Your needs are just as important as your kids' needs. In
fact, by making time for yourself you'll be a better mother
because you'll have more energy, model self-care, teach
them to respect others, and be less likely to over-indulge
them."
Dark
Clouds, Silver Linings: Moving From Bad Depression to Good Depression
CE Exam
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