Adult Treatment Planner

Objectives and Interventions

• Describe current and past experiences with depression complete with its impact on function and attempts to resolve it.
  • Assess current and past mood episodes including their features, frequency, intensity, and duration (e.g., Clinical Interview supplemented by the Inventory to Diagnose Depression by Zimmerman, Coryell, Corenthal, and Wilson).
• Verbally identify, if possible, the source of depressed mood.
  • Ask the client to make a list of what he/she is depressed about; process the list content.
  • Encourage the client to share his/her feelings of depression in order to clarify them and gain insight as to causes.
• Complete psychological testing to assess the depth of depression, the need for antidepressant medication, and suicide prevention measures.
  • Arrange for the administration of an objective assessment instrument for evaluating the client's depression and suicide risk (e.g., Beck Depression Inventory-II and/or Beck Hopelessness Scale); evaluate results and give feedback to the client.
• Verbalize any history of suicide attempts and any current suicidal urges.
  • Explore the client's history and current state of suicidal urges and behavior (see Suicidal Ideation chapter in this Planner if suicide risk is present).
• State no longer having thoughts of self-harm.
  • Assess and monitor the client's suicide potential.
  • Arrange for hospitalization, as necessary, when the client is judged to be harmful to self.
• Take prescribed psychotropic medications responsibly at times ordered by physician.
  • Evaluate the client's possible need for psychotropic medication and arrange for a physician to give him/her a physical examination to rule out organic causes for depression, assess need for antidepressant medication, and order a prescription, if appropriate.
  • Monitor and evaluate the client's psychotropic medication compliance, effectiveness, and side effects; communicate with prescribing physician.
• Identify and replace cognitive self-talk that is engaged in to support depression.
  • Assist the client in developing an awareness of his/her automatic thoughts that reflect a depressogenic schemata.
  • Assign the client to keep a daily journal of automatic thoughts associated with depressive feelings (e.g., "Negative Thoughts Trigger Negative Feelings" in Adult Psychotherapy Homework Planner, 2nd ed. by Jongsma, "Daily Record of Dysfunctional Thoughts" in Cognitive Therapy of Depression by Beck, Rush, Shaw, and Emery); process the journal material to challenge depressive thinking patterns and replace them with reality-based thoughts.
  • Do "behavioral experiments" in which depressive automatic thoughts are treated as hypotheses/predictions, reality-based alternative hypotheses/predictions are generated, and both are tested against the client's past, present, and/or future experiences.
  • Reinforce the client's positive, reality-based cognitive messages that enhance self-confidence and increase adaptive action (see "Positive Self-Talk" in Adult Psychotherapy Homework Planner, 2nd ed. by Jongsma).
• Utilize behavioral strategies to overcome depression.
  • Assist the client in developing coping strategies (e.g., more physical exercise, less internal focus, increased social involvement, more assertiveness, greater need sharing, more anger expression) for feelings of depression; reinforce success.
  • Engage the client in "behavioral activation" by scheduling activities that have a high likelihood for pleasure and mastery (see "Identify and Schedule Pleasant Activities" in Adult Psychotherapy Homework Planner, 2nd ed. by Jongsma); use rehearsal, role-playing, role reversal, as needed, to assist adoption in the client's daily life; reinforce success.
  • Employ self-reliance training in which the client assumes increased responsibility for routine activities (e.g., cleaning, cooking, shopping); reinforce success.
• Identify important people in your life, past and present, and describe the quality, good and bad, of those relationships.
  • Assess the client's "interpersonal inventory" of important past and present relationships and evidence of potentially depressive themes (e.g., grief, interpersonal disputes, role transitions, interpersonal deficits).
• Verbalize any unresolved grief issues that may be contributing to depression.
  • Explore the role of unresolved grief issues as they contribute to the client's current depression (see Grief/Loss Unresolved chapter in this Planner).
• Learn and implement problem-solving and/or conflict resolution skills to resolve interpersonal problems.
  • Teach the client conflict resolution skills (e.g., empathy, active listening, "I messages," respectful communication, assertiveness without aggression, compromise) to help alleviate depression; use modeling, role-playing, and behavior rehearsal to work through several current conflicts.
  • Help the client resolve depression related to interpersonal problems through the use of reassurance and support, clarification of cognitive and affective triggers that ignite conflicts, and active problem-solving (or assign "Applying Problem-Solving to Interpersonal Conflict" in Adult Psychotherapy Homework Planner, 2nd ed. by Jongsma).
  • In conjoint sessions, help the client resolve interpersonal conflicts.
• Implement a regular exercise regimen as a depression reduction technique.
  • Develop and reinforce a routine of physical exercise for the client.
  • Recommend that the client read and implement programs from Exercising Your Way to Better Mental Health (Leith).
• Learn and implement relapse prevention skills.
  • Build the client's relapse prevention skills by helping him/her identify early warning signs of relapse, reviewing skills learned during therapy, and developing a plan for managing challenges.
• Increase assertive communication.
  • Use modeling and/or role-playing to train the client in assertiveness; if indicated, refer him/her to an assertiveness training class/group for further instruction
• Read books on overcoming depression.
  • Recommend that the client read self-help books on coping with depression (e.g., Feeling Good by Burns); process material read.
• Show evidence of daily care for personal grooming and hygiene with minimal reminders from others.
  • Monitor and redirect the client on daily grooming and hygiene.
• Increasingly verbalize hopeful and positive statements regarding self, others, and the future
  • Assign the client to write at least one positive affirmation statement daily regarding himself/herself and the future.
  • Teach the client more about depression and to accept some sadness as a normal variation in feeling.
• Express feelings of hurt, disappointment, shame, and anger that are associated with early life experiences.
  • Explore experiences from the client's childhood that contribute to current depressed state.
  • Encourage the client to share feelings of anger regarding pain inflicted on him/her in childhood that contributed to current depressed state.
• Verbalize an understanding of the relationship between depressed mood and repression of feelings - that is, anger, hurt, sadness, and so on.
  • Explain a connection between previously unexpressed (repressed) feelings of anger (and helplessness) and current state of depression.