Feelings of excessive sadness, lifelessness, worthlessness and emptiness are often experienced by human beings at one time or another in life and are indicative of depression (National Institute of Mental Health, 2009). Psychological counseling proves important in overcoming depression. However, establishing a therapeutic relationship between the therapist and the client rather than just taking the client through a normal psychological counseling procedure proves more effective in dealing with depression.
This work establishes how therapeutic relationship helps in dealing with depression by discussing the skills required by a therapist. Such skills include eye contact, non-verbal prompts, body posture, verbal prompts, as well as feelings and empathy. The paper also establishes the Clarksons five different relationship modalities (i.e. the working alliance, the transferencecountertransference, the developmentally neededreparative relationship, the person-to-person relationship and the transpersonal relationship (Antoniou Blom, 2006). How each of these help in recovering from depression is central to this paper.
Depression
In the day-to-day life, it is normal to have feeling of sadness due to different encounters in life that leave someone disappointed or interfere with daily life. However, these should not be confused with depression which involves more than the normal sadness in life and feeling of lifelessness, emptiness and hopelessness are extreme and unrelenting and often the person never feels relieved (HELPGUIDE, 2009). There are several signs and symptoms that are indicative of depression and differ from person to person. Among the most common signs and symptoms include hopelessness and helplessness feelings withdrawal from daily activities noteworthy changes in weight appetite and sleep increased irritation and restlessness feelings of worthlessness poor concentration and unusual body aches (HELPGUIDE, 2009). The more the number of signs and symptoms in an individual in terms of severity and time span, the more likely it is that the condition is depression. Suicidal feelings, talks and thoughts are also common in depressed people (Shira Roth Counseling Psychotherapist, 2009b).
It is important to note that depression differs in terms of whether one is dealing with men or women as well as the age of the individual. Depression is twice common in women than in men (Stewart, Gucciardi Grace, 2004). Men present with signs such as fatigue, reduced interest in daily activities, irritability, drug and substance abuse as well as changes in sleep. The rate of depression is often lower than that of women in almost all cultures although suicide risk is higher in men as compared to women. Culture that almost universally associates depression with weakness influences the presentation of symptoms as men are less likely to acknowledge hopelessness or worthlessness (Pollack, 1998). Women, who have higher rates of depression than men show higher signs of guilt, hypersomnia, hyperphagia and weight gain with most of them getting seasonal affective disorder. Biological factors such as hormones associated with menstruation and menopause are usually cited as contributors of depression in women.
More often than not, teens express depression by being more irritable than even appearing sad. It is also almost obvious to have young people present with unexplainable aches as a sign of depression. Depression in young people mainly results into drug abuse and poor school performance among other adverse consequences. In older persons, physical signs are more common than emotional signs. Weight changes and pains are often encountered. Deteriorated health, high death rate more so from suicide are common consequences of depression in older persons (HELPGUIDE, 2009).
Other than environmental factors like bereavement and socioeconomic strains, medical factors are also known to cause stress. These include drugs like corticosteroids, withdrawal from cocaine, cancer drugs among others. Illnesses such as hypothyroidism, uraemia cancer and autoimmune disorders are also associated with depression. Depression is also thought to be familial (Tsuang Faraone, 1990).
There are several types of depression that are commonly diagnosed. Major depression has symptoms that present for not less than two weeks consecutively. Such symptoms include irritable mood, insomnia and fatigue among others. Dysthymia is a type of depression which has long-term symptoms that interfere with normal functioning although they are not disabling. Manic depressionbipolar disorder is mainly familial presenting with mood cycles with mania episodes or depression episodes (Dryden-Edwards Lee, 2009).
Therapeutic relationship
For something to be termed as therapeutic, it has to be good for an individual and mainly serves to bring healing or to possess or present curative powers (Answers.com, 2009). Relationship on the other hand is a situation whereby one is related to or a situation or a character based upon being related to (Clarkson, 1992). Relationships have been identified as part of human being and through a relationship, two or more persons are marked out and a bond between them is created that unifies them more than it divides them. In psychotherapy, relationship between the therapist and the client is found to be therapeutic just as it is in any other human relationship. It is for this reason that the relationship established between a therapist and a client is refereed to as a therapeutic relationship (Hartney, 2009). A therapeutic relationship is established to help a client to air painful thoughts and feelings in addition to assisting the client to solve problems in order to aid him in normal daily living. It also helps in bringing the client in a position where he can examine his selfdefeating behaviors as well as give alternative behaviors a chance. Through a therapeutic relationship, a client gets to enhance his self-care and self-rule (Slideshare, 2009). In the relationship, there is no manipulation or application of certain techniques. The relationship does not also involve giving advice to the client, or does the therapist force the client to modify his behaviour (Charnofsky, 2009).
Just like in any other kind of therapy, a therapeutic relationship entails the therapist having unfading interest on the patient regardless of how the issue at hand may be disturbing he must also show insight and empathy in addition to accepting the patient allow the patient to air out the pressing and unspeakable matters making the client feel most comfortable by providing convenient environments and tolerating as a transference object (Niolon, 1999). Being present for the client, acting responsibly (both the client and the therapist), offering a thought-provoking and safe environment and honoring what the client chooses are important attributes to be kept in order to maintain therapeutic relationship (Charnofsky, 2009).
A solid therapeutic relationship is built on trust, rapport, and collaboration with each party being equally committed to these principles. With time, client must trust the therapist whereas the therapist must also trust the client. Rapport is established between the client and the therapist by having client express himself freely and honestly with the therapist listening non-judgmentally, whereas collaboration is shown by having teamwork between the client and the therapist. Never should sexual contact, abuse of any nature or prejudice be brought in if a good therapeutic relationship is to abound (Hartney, 2009). It is therefore clear that an effective therapeutic relationship in psychotherapy calls for the total submission and commitment of the therapist and the client with the client having the largest responsibility in ensuring healing (Singer, 2009). Freedom of choice on the part of the client is also identified as central to therapeutic relationship.
Five types of therapeutic relationships have been identified. These include the I-You relationship the working alliance the transferential countertransferential relationship the developmentally needed relationship and the transpersonal relationship (Clarkson, 1992).
How therapeutic relationship helps
There is no doubt that human relationship, no matter how ordinary they may be, have therapeutic value (Clarkson Pokorny, 1994). The effectiveness of a good therapeutic relationship cannot be underestimated more so in psychotherapy. A therapeutic relationship is a transference relationship whereby the client unknowingly transfers onto the therapist his pattern of behaviors that have a basis from external and earlier influences. In the same relationship, it is the responsibility of the therapist to avoid counter transference whereby the therapist tends to transfer onto the patient feelings that he has acquired from people during past therapeutic experiences (Slideshare, 2009).
Since depression is mainly a mental problem, it is usually tackled through cognitive therapy, behavioural therapy, existential psychotherapy as well as experiential, schema therapy and psychodynamic therapy. In-spite of the treatment utilized, an established therapeutic relationship has always been found to be effective in reducing depressive symptoms (Krupnick et al, 1998). The better the relationship, the more likely the patient recovers from depression. While using any type of therapy in helping a patient recover from depression, the therapists application of the core principles of therapeutic relationship highly improves the condition. The therapeutic relationship principles maintained include creating an environment that enhances trust and honesty as well as encouraging the patient that he is capable of recovering. The therapist also has to show empathy to the client but at the same time ensures that calmness and objectivity are maintained even in situations where the client is upset. A client is likely to recover from stress when going through a therapeutic relationship since it involves collaboration with the therapist. Furthermore, the two parties are flexible and spontaneity is always possible in the therapy process. Helping the client to apply learnt lessons in day to day life is also effective in achieving therapeutic results in depression cases (Overholser Silverman, 1998).
Identifying the source of depression is very essential in the recovery path from depression. This is so because it becomes easy to choose the best method of treatment. If depression for instance results from bereavement, separation or traumatizing incidences, therapeutic relationship comes in handy as it promotes the expression of feelings. Therapeutic relationship requires the client to be vulnerable in order to effectively lay down the burden in the mind of a depressed patient and in so doing, it offers safety that the patient will be able to encounter uncertainties in life with tranquility and acceptance. In addition, the atmosphere provided in the relationship helps the patient to relieve distress and recollect into a stable person full of self awareness (Shira Roth Counseling Psychotherapist, 2009a).
When a therapist chooses to start a therapeutic relationship with a client, this is equivalent to accepting a kinship relationship with the patient making the patient feel adopted even in the sickening situation eventually causing healing. It is important to remember that a depressed person mainly has a lost attachment from the normal health relationships out of the view that may be nothing can come out of them. The initiation of a therapeutic relationship therefore comes timely to rescue the situation. A therapeutic relationship in this case becomes a helping relationship that brings back a depressed person to his conscious and state of self worth. (Clarkson, 1992). It is therefore no wonder that therapeutic relationship has been regarded as among the most essential factor necessary for successful psychotherapy.
In a nutshell, the therapeutic relationship works on the ground of genuineness, empathy, unconditional acceptance and mutual understanding between the client and the therapist. With these principles being core, it becomes possible to have the client speak out distressing feelings as may be associated with depression. The therapist in turn is able to help the patient solve the problem in addition to assisting him establish the causes of depression which is a step forward towards resolving depression (Slideshare, 2009). In essence, the therapeutic relationship is an important ingredient in any patient oriented psychotherapy that highly depends on the skillfulness of the therapist and his ability to apply those skills successfully in a psychotherapeutic procedure.
Skills required by the therapist
At the core of therapeutic relationship in depression just like in all other counseling sessions are special skills that the counselor or the therapist must have that ensure successful outcomes. Some of the therapeutic skills required include maintenance of eye contact between the client and the therapist, use of non-verbal prompts, appropriate body posture, verbal prompts as well as empathy. Since individuals suffering from depression have low sense of self worth and hopelessness, psychotherapy should aim at bringing the client back to himself by reassuring and showing concern for him. The above skills are therefore important during the therapeutic relationship otherwise the client is likely to withdraw from the relationship.
Maintenance of an eye to eye contact with the client reassures the client that the therapist is listening and has an understanding of the clients feelings. It is however important for the therapist to not overuse this skill as it makes the client feel uncomfortable thus halting the relationship. Also in the heart of encouraging the depressed person to continue elucidating their circumstances, it is important to look at the sitting position and posture maintained by both parties (Healthline, 2006). The therapist should sit facing the client face to face in order to grasp all the aspects of communication that the client may use. An open posture is particularly so as to help the therapist respond to the patient appropriately. The posture should be maintained in such a way that it shows that the therapist has interest in what the client is saying. Such can be expressed by slightly leaning towards the client. A similar sitting arrangement is encouraged as a way of maintaining the communication process. Noteworthy is that the therapist should avoid sitting in a manner likely to suggest authoritativeness or dependency. This happens for instance when the two parties sit with a desk directly across them. Interaction is enhanced by avoiding such barriers between the client and the therapist (Rand, 2009).
To encourage the depressed individual to continue pouring out their feelings, non verbal prompts are very important. Non-verbal prompts also assure the client that the therapist is following the client. Nodding the head appropriately can be an effective non-verbal prompt. Care should be taken not to overuse the prompts as this shows detachment from the conversation. Among the verbal prompts that can be effectively used to reach the same end include the use of sounds like mm or yes (Owen, 1994). Empathy is the ability to perceive accurately the feelings of another person and to communicate this understanding to him (Owen, 1994). A depressed person needs empathy at that point than ever. A therapeutic relationship allows the client to identify their problems and find ways of overcoming the same thus making empathy a very critical skill that the therapist must posses and should not be confused with sympathy which renders the therapeutic relationship weak. Empathy inspires the client to take action in dealing with the depressive state.
Other than the above skills, the therapist must also posses other important skills such as accepting the client unconditionally, active listening and full attention to the client as well as asking open ended questions that helps the client to touch on important issues that he may not have thought of. The therapist should however refrain from overusing any of these skills in order to maintain genuineness in the relationship. The skills of reflection whereby the therapist uses words spoken by the client to encourage the client to continue telling their story can also be helpful in unearthing the matter. Keeping silent when necessary gives the client time to think and arrange their ideas ensuring that they are expressed in the clearest way possible (Healthline, 2006). It is pertinent that the therapist be not only understanding these skills but also apply them appropriately if he is to accomplish the goal of helping the client recover from depression.
Clarksons relationship modalities in depression
In every psychotherapeutic process, at least one of the five types of therapeutic relationships as described by Clarkson always comes into effect. In most cases, all the five types find use in achieving effectiveness. It is therefore expected that depression being a psychological problem, the application of the five relationships definitely becomes necessary. The feelings of lack of worthiness and tendency to withdraw from the normal activities and relationships in a depressed person can better be dealt with by establishing a working alliance with the client. In a working alliance relationship, the client has to be willing to continue with the psychotherapeutic relationship regardless of the pressures from within that may try to influence the client to abandon the relationship. The client is thus able to understand the therapists intention in helping him to come out of the depressive situation (Clarkson Pokony, 1994). To maintain a working alliance, the therapist has to be well skilled in understanding non-verbal signs portrayed by the client which may suggest that he is not interested with the discussion. In such a case, the therapist is able to take a leading role in influencing the patient to stick on in the relationship.
When handling depression, the reparativedevelopment tally needed relationship is very effective in helping the client come out of a depressive situation that might have been caused by for instance lack of good parenting or any other abuse during development. In so doing, the client is able to understand his future and differentiate it from the past and eventually recover from the depressive situation. The fact that the person may have missed a very vital relationship during development comes real to the client and he is able to transfer this to the therapist who in turn helps the patient to remember such a situation in a facilitative way rather than in a hurting way which worsens depression (Clarkson, 1992).
The I-You relationship or the person-to-person relationship is quite effective in depression cases. It is also known as the real relationship or the core relationship and it is very much like the ordinary relationships between humans that bring healing in life over time. With a depression patient, the need to have someone who recognizes his situation and shares some of the clients experiences becomes very vital. This is where the I-You relationship comes in as the therapist have a self-disclosure with the patient making the client be willing to walk together with the therapist through the healing process. This restores the lost sense of self-worth in a depressed patient. The therapist however is supposed to be very careful in this kind of relationship as client may interpret this as seduction or be suspicious of the therapist in any other way (Clarkson Pokony, 1994). The balance between taking care of the patient and maintaining professionalism should be struck by ensuring trust is core to the relationship.
The transpersonal relationship is spiritually oriented as well as timeless and the therapists unconscious and that of the client communicates without having consciousness coming between them. This unconscious relationship helps egotism to be expelled and instead a new transformative personality is established thus helping the depressed individual build new tension-free relationships (Clarkson Pokony, 1994).
Depression as a psychological problem often poses difficulties in terms of recovery due to complexities associated with it. The mainly intrapersonal mental illness requires great skills that are able to bring the individual to a point where his self-worth is restored. To reinstate hope and draw out the feeling of emptiness in such individuals, a psychotherapist must establish solid and sustainable relationship with the client aimed at bringing healing. This is the therapeutic relationship in which the therapist has to maintain interest in the client regardless of the prevailing circumstances. Without showing unconditional acceptance to the client, the relationship is doomed. Empathy and enhanced transference are also central to a successful relationship. Countertransference should however be avoided to ensure that the two parties do not compromise making the efforts futile. The Clarksons five relationship modalities have to be applied when helping a depressed patient otherwise depression persists to fatal levels.
This work establishes how therapeutic relationship helps in dealing with depression by discussing the skills required by a therapist. Such skills include eye contact, non-verbal prompts, body posture, verbal prompts, as well as feelings and empathy. The paper also establishes the Clarksons five different relationship modalities (i.e. the working alliance, the transferencecountertransference, the developmentally neededreparative relationship, the person-to-person relationship and the transpersonal relationship (Antoniou Blom, 2006). How each of these help in recovering from depression is central to this paper.
Depression
In the day-to-day life, it is normal to have feeling of sadness due to different encounters in life that leave someone disappointed or interfere with daily life. However, these should not be confused with depression which involves more than the normal sadness in life and feeling of lifelessness, emptiness and hopelessness are extreme and unrelenting and often the person never feels relieved (HELPGUIDE, 2009). There are several signs and symptoms that are indicative of depression and differ from person to person. Among the most common signs and symptoms include hopelessness and helplessness feelings withdrawal from daily activities noteworthy changes in weight appetite and sleep increased irritation and restlessness feelings of worthlessness poor concentration and unusual body aches (HELPGUIDE, 2009). The more the number of signs and symptoms in an individual in terms of severity and time span, the more likely it is that the condition is depression. Suicidal feelings, talks and thoughts are also common in depressed people (Shira Roth Counseling Psychotherapist, 2009b).
It is important to note that depression differs in terms of whether one is dealing with men or women as well as the age of the individual. Depression is twice common in women than in men (Stewart, Gucciardi Grace, 2004). Men present with signs such as fatigue, reduced interest in daily activities, irritability, drug and substance abuse as well as changes in sleep. The rate of depression is often lower than that of women in almost all cultures although suicide risk is higher in men as compared to women. Culture that almost universally associates depression with weakness influences the presentation of symptoms as men are less likely to acknowledge hopelessness or worthlessness (Pollack, 1998). Women, who have higher rates of depression than men show higher signs of guilt, hypersomnia, hyperphagia and weight gain with most of them getting seasonal affective disorder. Biological factors such as hormones associated with menstruation and menopause are usually cited as contributors of depression in women.
More often than not, teens express depression by being more irritable than even appearing sad. It is also almost obvious to have young people present with unexplainable aches as a sign of depression. Depression in young people mainly results into drug abuse and poor school performance among other adverse consequences. In older persons, physical signs are more common than emotional signs. Weight changes and pains are often encountered. Deteriorated health, high death rate more so from suicide are common consequences of depression in older persons (HELPGUIDE, 2009).
Other than environmental factors like bereavement and socioeconomic strains, medical factors are also known to cause stress. These include drugs like corticosteroids, withdrawal from cocaine, cancer drugs among others. Illnesses such as hypothyroidism, uraemia cancer and autoimmune disorders are also associated with depression. Depression is also thought to be familial (Tsuang Faraone, 1990).
There are several types of depression that are commonly diagnosed. Major depression has symptoms that present for not less than two weeks consecutively. Such symptoms include irritable mood, insomnia and fatigue among others. Dysthymia is a type of depression which has long-term symptoms that interfere with normal functioning although they are not disabling. Manic depressionbipolar disorder is mainly familial presenting with mood cycles with mania episodes or depression episodes (Dryden-Edwards Lee, 2009).
Therapeutic relationship
For something to be termed as therapeutic, it has to be good for an individual and mainly serves to bring healing or to possess or present curative powers (Answers.com, 2009). Relationship on the other hand is a situation whereby one is related to or a situation or a character based upon being related to (Clarkson, 1992). Relationships have been identified as part of human being and through a relationship, two or more persons are marked out and a bond between them is created that unifies them more than it divides them. In psychotherapy, relationship between the therapist and the client is found to be therapeutic just as it is in any other human relationship. It is for this reason that the relationship established between a therapist and a client is refereed to as a therapeutic relationship (Hartney, 2009). A therapeutic relationship is established to help a client to air painful thoughts and feelings in addition to assisting the client to solve problems in order to aid him in normal daily living. It also helps in bringing the client in a position where he can examine his selfdefeating behaviors as well as give alternative behaviors a chance. Through a therapeutic relationship, a client gets to enhance his self-care and self-rule (Slideshare, 2009). In the relationship, there is no manipulation or application of certain techniques. The relationship does not also involve giving advice to the client, or does the therapist force the client to modify his behaviour (Charnofsky, 2009).
Just like in any other kind of therapy, a therapeutic relationship entails the therapist having unfading interest on the patient regardless of how the issue at hand may be disturbing he must also show insight and empathy in addition to accepting the patient allow the patient to air out the pressing and unspeakable matters making the client feel most comfortable by providing convenient environments and tolerating as a transference object (Niolon, 1999). Being present for the client, acting responsibly (both the client and the therapist), offering a thought-provoking and safe environment and honoring what the client chooses are important attributes to be kept in order to maintain therapeutic relationship (Charnofsky, 2009).
A solid therapeutic relationship is built on trust, rapport, and collaboration with each party being equally committed to these principles. With time, client must trust the therapist whereas the therapist must also trust the client. Rapport is established between the client and the therapist by having client express himself freely and honestly with the therapist listening non-judgmentally, whereas collaboration is shown by having teamwork between the client and the therapist. Never should sexual contact, abuse of any nature or prejudice be brought in if a good therapeutic relationship is to abound (Hartney, 2009). It is therefore clear that an effective therapeutic relationship in psychotherapy calls for the total submission and commitment of the therapist and the client with the client having the largest responsibility in ensuring healing (Singer, 2009). Freedom of choice on the part of the client is also identified as central to therapeutic relationship.
Five types of therapeutic relationships have been identified. These include the I-You relationship the working alliance the transferential countertransferential relationship the developmentally needed relationship and the transpersonal relationship (Clarkson, 1992).
How therapeutic relationship helps
There is no doubt that human relationship, no matter how ordinary they may be, have therapeutic value (Clarkson Pokorny, 1994). The effectiveness of a good therapeutic relationship cannot be underestimated more so in psychotherapy. A therapeutic relationship is a transference relationship whereby the client unknowingly transfers onto the therapist his pattern of behaviors that have a basis from external and earlier influences. In the same relationship, it is the responsibility of the therapist to avoid counter transference whereby the therapist tends to transfer onto the patient feelings that he has acquired from people during past therapeutic experiences (Slideshare, 2009).
Since depression is mainly a mental problem, it is usually tackled through cognitive therapy, behavioural therapy, existential psychotherapy as well as experiential, schema therapy and psychodynamic therapy. In-spite of the treatment utilized, an established therapeutic relationship has always been found to be effective in reducing depressive symptoms (Krupnick et al, 1998). The better the relationship, the more likely the patient recovers from depression. While using any type of therapy in helping a patient recover from depression, the therapists application of the core principles of therapeutic relationship highly improves the condition. The therapeutic relationship principles maintained include creating an environment that enhances trust and honesty as well as encouraging the patient that he is capable of recovering. The therapist also has to show empathy to the client but at the same time ensures that calmness and objectivity are maintained even in situations where the client is upset. A client is likely to recover from stress when going through a therapeutic relationship since it involves collaboration with the therapist. Furthermore, the two parties are flexible and spontaneity is always possible in the therapy process. Helping the client to apply learnt lessons in day to day life is also effective in achieving therapeutic results in depression cases (Overholser Silverman, 1998).
Identifying the source of depression is very essential in the recovery path from depression. This is so because it becomes easy to choose the best method of treatment. If depression for instance results from bereavement, separation or traumatizing incidences, therapeutic relationship comes in handy as it promotes the expression of feelings. Therapeutic relationship requires the client to be vulnerable in order to effectively lay down the burden in the mind of a depressed patient and in so doing, it offers safety that the patient will be able to encounter uncertainties in life with tranquility and acceptance. In addition, the atmosphere provided in the relationship helps the patient to relieve distress and recollect into a stable person full of self awareness (Shira Roth Counseling Psychotherapist, 2009a).
When a therapist chooses to start a therapeutic relationship with a client, this is equivalent to accepting a kinship relationship with the patient making the patient feel adopted even in the sickening situation eventually causing healing. It is important to remember that a depressed person mainly has a lost attachment from the normal health relationships out of the view that may be nothing can come out of them. The initiation of a therapeutic relationship therefore comes timely to rescue the situation. A therapeutic relationship in this case becomes a helping relationship that brings back a depressed person to his conscious and state of self worth. (Clarkson, 1992). It is therefore no wonder that therapeutic relationship has been regarded as among the most essential factor necessary for successful psychotherapy.
In a nutshell, the therapeutic relationship works on the ground of genuineness, empathy, unconditional acceptance and mutual understanding between the client and the therapist. With these principles being core, it becomes possible to have the client speak out distressing feelings as may be associated with depression. The therapist in turn is able to help the patient solve the problem in addition to assisting him establish the causes of depression which is a step forward towards resolving depression (Slideshare, 2009). In essence, the therapeutic relationship is an important ingredient in any patient oriented psychotherapy that highly depends on the skillfulness of the therapist and his ability to apply those skills successfully in a psychotherapeutic procedure.
Skills required by the therapist
At the core of therapeutic relationship in depression just like in all other counseling sessions are special skills that the counselor or the therapist must have that ensure successful outcomes. Some of the therapeutic skills required include maintenance of eye contact between the client and the therapist, use of non-verbal prompts, appropriate body posture, verbal prompts as well as empathy. Since individuals suffering from depression have low sense of self worth and hopelessness, psychotherapy should aim at bringing the client back to himself by reassuring and showing concern for him. The above skills are therefore important during the therapeutic relationship otherwise the client is likely to withdraw from the relationship.
Maintenance of an eye to eye contact with the client reassures the client that the therapist is listening and has an understanding of the clients feelings. It is however important for the therapist to not overuse this skill as it makes the client feel uncomfortable thus halting the relationship. Also in the heart of encouraging the depressed person to continue elucidating their circumstances, it is important to look at the sitting position and posture maintained by both parties (Healthline, 2006). The therapist should sit facing the client face to face in order to grasp all the aspects of communication that the client may use. An open posture is particularly so as to help the therapist respond to the patient appropriately. The posture should be maintained in such a way that it shows that the therapist has interest in what the client is saying. Such can be expressed by slightly leaning towards the client. A similar sitting arrangement is encouraged as a way of maintaining the communication process. Noteworthy is that the therapist should avoid sitting in a manner likely to suggest authoritativeness or dependency. This happens for instance when the two parties sit with a desk directly across them. Interaction is enhanced by avoiding such barriers between the client and the therapist (Rand, 2009).
To encourage the depressed individual to continue pouring out their feelings, non verbal prompts are very important. Non-verbal prompts also assure the client that the therapist is following the client. Nodding the head appropriately can be an effective non-verbal prompt. Care should be taken not to overuse the prompts as this shows detachment from the conversation. Among the verbal prompts that can be effectively used to reach the same end include the use of sounds like mm or yes (Owen, 1994). Empathy is the ability to perceive accurately the feelings of another person and to communicate this understanding to him (Owen, 1994). A depressed person needs empathy at that point than ever. A therapeutic relationship allows the client to identify their problems and find ways of overcoming the same thus making empathy a very critical skill that the therapist must posses and should not be confused with sympathy which renders the therapeutic relationship weak. Empathy inspires the client to take action in dealing with the depressive state.
Other than the above skills, the therapist must also posses other important skills such as accepting the client unconditionally, active listening and full attention to the client as well as asking open ended questions that helps the client to touch on important issues that he may not have thought of. The therapist should however refrain from overusing any of these skills in order to maintain genuineness in the relationship. The skills of reflection whereby the therapist uses words spoken by the client to encourage the client to continue telling their story can also be helpful in unearthing the matter. Keeping silent when necessary gives the client time to think and arrange their ideas ensuring that they are expressed in the clearest way possible (Healthline, 2006). It is pertinent that the therapist be not only understanding these skills but also apply them appropriately if he is to accomplish the goal of helping the client recover from depression.
Clarksons relationship modalities in depression
In every psychotherapeutic process, at least one of the five types of therapeutic relationships as described by Clarkson always comes into effect. In most cases, all the five types find use in achieving effectiveness. It is therefore expected that depression being a psychological problem, the application of the five relationships definitely becomes necessary. The feelings of lack of worthiness and tendency to withdraw from the normal activities and relationships in a depressed person can better be dealt with by establishing a working alliance with the client. In a working alliance relationship, the client has to be willing to continue with the psychotherapeutic relationship regardless of the pressures from within that may try to influence the client to abandon the relationship. The client is thus able to understand the therapists intention in helping him to come out of the depressive situation (Clarkson Pokony, 1994). To maintain a working alliance, the therapist has to be well skilled in understanding non-verbal signs portrayed by the client which may suggest that he is not interested with the discussion. In such a case, the therapist is able to take a leading role in influencing the patient to stick on in the relationship.
When handling depression, the reparativedevelopment tally needed relationship is very effective in helping the client come out of a depressive situation that might have been caused by for instance lack of good parenting or any other abuse during development. In so doing, the client is able to understand his future and differentiate it from the past and eventually recover from the depressive situation. The fact that the person may have missed a very vital relationship during development comes real to the client and he is able to transfer this to the therapist who in turn helps the patient to remember such a situation in a facilitative way rather than in a hurting way which worsens depression (Clarkson, 1992).
The I-You relationship or the person-to-person relationship is quite effective in depression cases. It is also known as the real relationship or the core relationship and it is very much like the ordinary relationships between humans that bring healing in life over time. With a depression patient, the need to have someone who recognizes his situation and shares some of the clients experiences becomes very vital. This is where the I-You relationship comes in as the therapist have a self-disclosure with the patient making the client be willing to walk together with the therapist through the healing process. This restores the lost sense of self-worth in a depressed patient. The therapist however is supposed to be very careful in this kind of relationship as client may interpret this as seduction or be suspicious of the therapist in any other way (Clarkson Pokony, 1994). The balance between taking care of the patient and maintaining professionalism should be struck by ensuring trust is core to the relationship.
The transpersonal relationship is spiritually oriented as well as timeless and the therapists unconscious and that of the client communicates without having consciousness coming between them. This unconscious relationship helps egotism to be expelled and instead a new transformative personality is established thus helping the depressed individual build new tension-free relationships (Clarkson Pokony, 1994).
Depression as a psychological problem often poses difficulties in terms of recovery due to complexities associated with it. The mainly intrapersonal mental illness requires great skills that are able to bring the individual to a point where his self-worth is restored. To reinstate hope and draw out the feeling of emptiness in such individuals, a psychotherapist must establish solid and sustainable relationship with the client aimed at bringing healing. This is the therapeutic relationship in which the therapist has to maintain interest in the client regardless of the prevailing circumstances. Without showing unconditional acceptance to the client, the relationship is doomed. Empathy and enhanced transference are also central to a successful relationship. Countertransference should however be avoided to ensure that the two parties do not compromise making the efforts futile. The Clarksons five relationship modalities have to be applied when helping a depressed patient otherwise depression persists to fatal levels.
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