Presenting Client: "Jake is a 32-year-old African-American male, who is college educated and has a good job and a loving family. Lately he has noticed a change in his behavior; he has become withdrawn, anxious, and does not enjoy life events that he once found enjoyable."
A study conducted by Saluja, Iachan and Scheidt (2004) found that “major depressive disorder (MDD) accounts for greater mortality, morbidity, and financial costs than any other psychiatric disorder,” (p.760). Moran (2004) notes while that “depression is "an equal opportunity disorder" with similar prevalence rates among blacks and whites, African Americans are far less likely to receive a diagnosis,” (p.12) due to factors which include: the pre-existing stigmas associated with being a person of color, religious beliefs, distrust of the medical profession, lack of insurance, and language and literacy barriers to appropriate care (Moran, 2004). Based on these factors, it is important that improved, more aggressive screening methods are utilized when working with African American patients.
Therapists can use a variety of treatments methods when working with clients who are suffer from depression. Three such methods include: existential, person-centered, and Gestalt therapies. For the purpose of this paper, each of these theories will be described, as they would apply to a client with depression.
Those would subscribe to the existential theory tend to concentrate on those factors which are most related to one’s core existential concerns. Existential theory focuses on four “core principles: (1) suffering is a human achievement and accomplishment; (2) guilt provides an opportunity to change oneself for the better, (3) vulnerability motivates a person to become authentic; and (4) life’s unpredictability provides an individual incentive to take responsible action,” (Capuzzi & Gross, p.173). In embracing these opportunities, one is directed to embrace and accept their emotions, experience their life more deeply. This therapy has been utilized successfully with diverse populations (Cappuzzi & Gross, 2007), however Hoffman (2004) describes existential therapy as “difficult and, at times, terrifying process, but also very freeing,”(para. 16). Due to the approach and concentration of existential therapy, Hoffman (2004) suggestions that this method to psychotherapy may not be for everyone, therefore the therapist should carefully outline this method for the client prior to it’s initiation. When working with an individual suffering from depression it is important to note that their experience is most often the absence of feeling, rather than overall sadness, such as the case of the Jake. “Depression often results from the repression of experience and emotions. In a sense, all a person's energy is used in the service of repression leaving little energy left -- depression. So part of working through depression is learning to feel again,” (para. 9). Although the therapist must explore with the client the cause of these repressed feelings, the existentialist would also stress the importance of "living in the moment," "being in the here-&-now," and "being fully present" so as to not repress future emotions (Hoffman, 2004).
“The person-centered theory of Carl R. Rogers is one of the most popular in the fields of psychology, counseling, and education,” (Capuzzi & Gross, 189). Those who subscribe to this method maintain that “the forward moving tendency of the human organism and the conviction that when a therapist provides congruence, unconditional positive regard and empathetic responding – Roger’s necessary and sufficient conditions – the actualizing potential of the client will be released and the client will begin to change and grown,” (Knight, 112). Much like existential theory, the therapist believes that depression is a result of repressed or denied feelings. Therefore, they will assist the client in learning to trust themselves, their decisions, and aid them in finding direction in their lives, (Person-centered therapy, para. 8). They like the existential therapist will encourage the client to accept, embrace and experience their true emotions, believing that “good mental health is a balance between the ideal self and real self. This is where the problem lies, the result of difference between what we are and what we wish to be causes maladjusted behavior,” (para. 8).
Gestalt therapy, much like that of the existential theory focuses the client to the present or “being in the here and now.” Therapists who subscribe to this method present goals for their clients with include; being more self-aware by acknowledging and accepting the integration of their own thoughts, feelings, and actions. One could easily describe Gestalt therapy as an approach to “wholeness” or as being one with the environment in which the client lives. “The Gestalt Therapist views life (the way we play, work, live, make love, die, etc.) as a "creative process". Therapy becomes a modality to objectively examine the way individuals, couples, groups and systems creatively adapt to their environment. Change occurs by heightening awareness and modifying the behaviors that impede the process of effective adaptation,” (Gestalt Counseling & Training Institute, para.2). Unlike other approaches, the therapist/client relationship is the most important. The therapist assumes an active role by being warm, sympathetic, and accepting. Additionally, much like the other two approaches, the focus is on the direct experiencing of the here and now, even when events are recalled from the past. However, unlike the other two approaches, the therapist openly shares how the client is being perceived, mistakes that he or she views the client has made, and any lack of self-awareness or inaccurate interpretation is pointed out.
While one would be inclined to believe that most therapists would only utilize one particular therapeutic approach, “many mental health counselors continue to describe themselves as theoretically eclectic. Perhaps this resistance to identifying a single theory is a consequence of the widespread belief that one theory cannot possibly apply to,” (Bauman & Waldo, 13) all diverse populations. Additionally, many approaches have overlapping goals and principles, therefore this integration occurs in a natural process, rather than by abrupt changes. As described in the preceding paragraphs, all three approaches required the client to focus on the here and now of their experience, thereby accepting, embracing, and experiencing their true emotions, rather than continuing to repress those which they felt inappropriate or too painful at the time. When utilizing several therapeutic approaches, which maintain simple core principles, the therapist can strengthen their ability to successfully treat diverse populations with mood disorder such as depression.
Stephanie Henckel
References
Bauman, S. & Waldo, M. (1998). Existential theory and mental health counseling: If it were a snake, it would have bitten!. Journal of Mental Health Counseling, 20(1), 13.
Capuzzi, D. & Gross, D.R. (2007). Counseling and psychotherapy: Theories and interventions. Pearson Education: Upper Saddle River, New Jersey.
Gestalt Counseling & Training Institute. (2007). About gestalt therapy. Retrieved on July 21, 2008 from http://www.gestalt-annarbor.org/about_gestalt.htm
Hoffman, L. (2004). Existential therapy: Emotion and experience. Retrieved on July 21, 2008 from http://www.existential-therapy.com/Special_Topics/Emotion.htm
Knight, T.A. (2007). Showing clients the doors: Active problem-solving in person-centered psychotherapy. Journal of Psychotherapy Integration, 17(1), 111-124.
Moran, M. (2004). Culture, history can keep blacks from getting depression treatment. Psychiatric News, 39 (11), 11.
Person-centered therapy. (2005) Depression-guide.com. Retrieved on July 22, 2008 from http://www.depression-guide.com/person-centered-therapy.htm
Saluja, G., Iachan, R., & Scheidt, P.C. (2004). Prevalence of and risk factors for depressive symptoms among young adolescents. Pediatric & Adolescent Medicine, 16, 760-763.
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