Academic journal article Perspectives in Psychiatric Care

Helping Depressed Clients Discover Personal Power

Academic journal article Perspectives in Psychiatric Care

Helping Depressed Clients Discover Personal Power

Article excerpt

TOPIC. Alleviating depression through cognitive therapy.

SOURCE. The authors' clinical work and review of the literature.

GOAL. To describe the empowerment of depressed clients.

CONCLUSION. Clients who are depressed can be helped by examining "who they are" as compared to "who they believe they are."

Key words: Cognitive therapy, depression, powerlessness

Depression is an alteration in mood probably treated by nurse psychotherapists more frequently than any other symptom in clinical practice, with the exception of anxiety. Powerlessness, a universal symptom experienced by the depressed client, is related to disruption of the self-system, self-worth, security, and control in the face of external or internal stressors. Indeed, depression can be described as a disorder of power. In previous work, the authors described depression as associated with "loss (real or imagined) of a particular person, function, capacity, object, dream, belief, or value to which one is 'normally' or 'inordinately' attached" (Drake & Price, 1975, p.163). Dwarfed in our loss model (Figure 1) is a description of the loss of personal power, ever the precursor to feelings of hopelessness, helplessness, and despair experienced by the depressed client.

[Figure 1 ILLUTRATION OMITTED]

The problem of powerlessness and how clients predisposed to an enduring depression by low self-esteem can be helped to recover, even discover, previously unrecognized personal power, is the focus of our effort here.

Cognitive Theory of Depression

The relationship between depressed mood, feelings of powerlessness, and cognitive appraisal is basic to cognitive theories of depression. The maxim of cognitive theory is that ideas, beliefs, and schema translate external events into meaningful internal representations (Beck, 1976; Kelly, 1955; Lazarus, 1966; Safran & Segal, 1990). "Internal representations," not the events themselves, are seen as the responsible agents. According to Gilbert (1992), "Lazarus . . . made the important distinction between primary appraisal (the evaluation of the meaning of an event); and secondary appraisal (the evaluation of coping abilities and options for dealing with it" (p. 381). Hammen (Gilbert, 1992) offers a clear statement of the current understanding of the role of cognition in depression:

. . . the cognitive constructs of meaning and

self-efficacy recur in the literature in many forms, and

the available data are consistent with their potential

mediating role in depressive responses to stress. The

mere occurrence of undesirable events, or the mere

presence or lack of coping resources predicts

depression far less adequately than does

consideration of the meaning of the event for the

person and the person's sense of personal efficacy . . . (p. 412).

Gilbert (1992) summarizes Beck's theory of predisposition to depression:

. . . Beck's model of depression suggests that the

depression-prone individual, early on in life, develops

particular negative cognitive schema relating to the

world, the self, and the future. Although these

negative schema may not be discernible at any given

time, they are easily invoked by life events which are

similar to those that were responsible for their

formation. Thus, for example, the individual who has

been labeled as inept or inadequate by others in

failing at a certain task will tend to respond to failure

with this concept (of being inadequate or inept) when

he confronts failure in the future. The result of this is

the activation of the negative view of the self . . . (p. 402).

Cognitive Therapy and Depression

Cognitive therapy recognizes the power of one's thoughts in creating personal reality and engaging one's internal construction and meaning-making processes. …

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