{"id":1523,"date":"2015-06-28T01:49:58","date_gmt":"2015-06-28T01:49:58","guid":{"rendered":"https:\/\/treatmentmaps.net\/?page_id=1523"},"modified":"2015-08-02T15:16:39","modified_gmt":"2015-08-02T15:16:39","slug":"depression-section-8","status":"publish","type":"page","link":"https:\/\/treatmentmaps.net\/?page_id=1523","title":{"rendered":"Depression Section 8"},"content":{"rendered":"<div style=\"overflow: auto; width: 482px; height: 720px; float: left;\">\n<div style=\"height: 720px;\"><a id=\"depressionmap1a\"><\/a><strong>DEPRESSION AND GRIEF MAPS:<\/strong> <a title=\"Depression Map 1A\" href=\"https:\/\/treatmentmaps.net\/?page_id=443\">1A<\/a> | <a title=\"Depression Map 1B\" href=\"https:\/\/treatmentmaps.net\/?page_id=445\">1B<\/a> | <a title=\"Depression Map 2\" href=\"https:\/\/treatmentmaps.net\/?page_id=447\">2<\/a> | <a title=\"Depression Map 3\" href=\"https:\/\/treatmentmaps.net\/?page_id=451\">3<\/a> | <a title=\"Depression Map 4\" href=\"https:\/\/treatmentmaps.net\/?page_id=453\">4<\/a> | <a title=\"Depression Map 5\" href=\"https:\/\/treatmentmaps.net\/?page_id=455\">5<\/a><br \/>\n<img loading=\"lazy\" decoding=\"async\" class=\"alignleft size-full wp-image-1812\" style=\"border: solid 1px black;\" src=\"https:\/\/treatmentmaps.net\/wp-content\/uploads\/2015\/01\/depr1Aa.jpg\" alt=\"depr1Aa\" width=\"448\" height=\"567\" srcset=\"https:\/\/treatmentmaps.net\/wp-content\/uploads\/2015\/01\/depr1Aa.jpg 448w, https:\/\/treatmentmaps.net\/wp-content\/uploads\/2015\/01\/depr1Aa-237x300.jpg 237w\" sizes=\"auto, (max-width: 448px) 100vw, 448px\" \/><br \/>\n<strong>SECTIONS:<\/strong> <a href=\"https:\/\/treatmentmaps.net\/?page_id=1507\/#depressionmap1a\">1<\/a> | <a href=\"https:\/\/treatmentmaps.net\/?page_id=1509\/#depressionmap1a\">2<\/a> | <a href=\"https:\/\/treatmentmaps.net\/?page_id=1523\/#depressionmap1a\">8<\/a> | <a href=\"https:\/\/treatmentmaps.net\/?page_id=1553\/#depressionmap1a\">23<\/a><\/div>\n<div style=\"height: 720px;\"><a id=\"depressionmap1b\"><\/a><strong>DEPRESSION AND GRIEF MAPS:<\/strong> <a title=\"Depression Map 1A\" href=\"https:\/\/treatmentmaps.net\/?page_id=443\">1A<\/a> | <a title=\"Depression Map 1B\" href=\"https:\/\/treatmentmaps.net\/?page_id=445\">1B<\/a> | <a title=\"Depression Map 2\" href=\"https:\/\/treatmentmaps.net\/?page_id=447\">2<\/a> | <a title=\"Depression Map 3\" href=\"https:\/\/treatmentmaps.net\/?page_id=451\">3<\/a> | <a title=\"Depression Map 4\" href=\"https:\/\/treatmentmaps.net\/?page_id=453\">4<\/a> | <a title=\"Depression Map 5\" href=\"https:\/\/treatmentmaps.net\/?page_id=455\">5<\/a><br \/>\n<img loading=\"lazy\" decoding=\"async\" class=\"alignleft size-full wp-image-1814\" src=\"https:\/\/treatmentmaps.net\/wp-content\/uploads\/2015\/01\/depr1B.jpg\" alt=\"depr1B\" width=\"448\" height=\"556\" srcset=\"https:\/\/treatmentmaps.net\/wp-content\/uploads\/2015\/01\/depr1B.jpg 448w, https:\/\/treatmentmaps.net\/wp-content\/uploads\/2015\/01\/depr1B-242x300.jpg 242w\" sizes=\"auto, (max-width: 448px) 100vw, 448px\" \/><br \/>\n<strong>SECTIONS:<\/strong> <a href=\"https:\/\/treatmentmaps.net\/?page_id=1511\/#depressionmap1b\">3<\/a> | <a href=\"https:\/\/treatmentmaps.net\/?page_id=1513\/#depressionmap1b\">4<\/a> | <a href=\"https:\/\/treatmentmaps.net\/?page_id=1523\/#depressionmap1b\">8<\/a> | <a href=\"https:\/\/treatmentmaps.net\/?page_id=1525\/#depressionmap1b\">9<\/a> | <a href=\"https:\/\/treatmentmaps.net\/?page_id=1527\/#depressionmap1b\">10<\/a> | <a href=\"https:\/\/treatmentmaps.net\/?page_id=1529\/#depressionmap1b\">11<\/a> | <a href=\"https:\/\/treatmentmaps.net\/?page_id=1531\/#depressionmap1b\">12<\/a> | <a href=\"https:\/\/treatmentmaps.net\/?page_id=1533\/#depressionmap1b\">13<\/a> | <a href=\"https:\/\/treatmentmaps.net\/?page_id=1535\/#depressionmap1b\">14<\/a><\/div>\n<div style=\"height: 720px;\"><a id=\"depressionmap2\"><\/a><strong>DEPRESSION AND GRIEF MAPS:<\/strong> <a title=\"Depression Map 1A\" href=\"https:\/\/treatmentmaps.net\/?page_id=443\">1A<\/a> | <a title=\"Depression Map 1B\" href=\"https:\/\/treatmentmaps.net\/?page_id=445\">1B<\/a> | <a title=\"Depression Map 2\" href=\"https:\/\/treatmentmaps.net\/?page_id=447\">2<\/a> | <a title=\"Depression Map 3\" href=\"https:\/\/treatmentmaps.net\/?page_id=451\">3<\/a> | <a title=\"Depression Map 4\" href=\"https:\/\/treatmentmaps.net\/?page_id=453\">4<\/a> | <a title=\"Depression Map 5\" href=\"https:\/\/treatmentmaps.net\/?page_id=455\">5<\/a><br \/>\n<img loading=\"lazy\" decoding=\"async\" class=\"alignleft size-full wp-image-1817\" style=\"border: solid 1px black;\" src=\"https:\/\/treatmentmaps.net\/wp-content\/uploads\/2015\/01\/depr2a.jpg\" alt=\"depr2a\" width=\"442\" height=\"642\" srcset=\"https:\/\/treatmentmaps.net\/wp-content\/uploads\/2015\/01\/depr2a.jpg 442w, https:\/\/treatmentmaps.net\/wp-content\/uploads\/2015\/01\/depr2a-207x300.jpg 207w\" sizes=\"auto, (max-width: 442px) 100vw, 442px\" \/><br \/>\n<strong>SECTIONS:<\/strong> <a href=\"https:\/\/treatmentmaps.net\/?page_id=1516\/#depressionmap2\">5<\/a> | <a href=\"https:\/\/treatmentmaps.net\/?page_id=1523\/#depressionmap2\">8<\/a> | <a href=\"https:\/\/treatmentmaps.net\/?page_id=1539\/#depressionmap2\">16<\/a> | <a href=\"https:\/\/treatmentmaps.net\/?page_id=1545\/#depressionmap2\">19<\/a> | <a href=\"https:\/\/treatmentmaps.net\/?page_id=1549\/#depressionmap2\">21<\/a> | <a href=\"https:\/\/treatmentmaps.net\/?page_id=1551\/#depressionmap2\">22<\/a> | <a href=\"https:\/\/treatmentmaps.net\/?page_id=1555\/#depressionmap2\">24<\/a> | <a href=\"https:\/\/treatmentmaps.net\/?page_id=1557\/#depressionmap2\">25<\/a> | <a href=\"https:\/\/treatmentmaps.net\/?page_id=1586\/#depressionmap2\">39<\/a> | <a href=\"https:\/\/treatmentmaps.net\/?page_id=1596\/#depressionmap2\">44<\/a> | <a href=\"https:\/\/treatmentmaps.net\/?page_id=1602\/#depressionmap2\">46<\/a> | <a href=\"https:\/\/treatmentmaps.net\/?page_id=1605\/#depressionmap2\">47<\/a> | <a href=\"https:\/\/treatmentmaps.net\/?page_id=1607\/#depressionmap2\">48<\/a><\/div>\n<div style=\"height: 720px;\"><a id=\"depressionmap3\"><\/a><strong>DEPRESSION AND GRIEF MAPS:<\/strong> <a title=\"Depression Map 1A\" href=\"https:\/\/treatmentmaps.net\/?page_id=443\">1A<\/a> | <a title=\"Depression Map 1B\" href=\"https:\/\/treatmentmaps.net\/?page_id=445\">1B<\/a> | <a title=\"Depression Map 2\" href=\"https:\/\/treatmentmaps.net\/?page_id=447\">2<\/a> | <a title=\"Depression Map 3\" href=\"https:\/\/treatmentmaps.net\/?page_id=451\">3<\/a> | <a title=\"Depression Map 4\" href=\"https:\/\/treatmentmaps.net\/?page_id=453\">4<\/a> | <a title=\"Depression Map 5\" href=\"https:\/\/treatmentmaps.net\/?page_id=455\">5<\/a><br \/>\n<img loading=\"lazy\" decoding=\"async\" class=\"alignleft size-full wp-image-1820\" src=\"https:\/\/treatmentmaps.net\/wp-content\/uploads\/2015\/01\/depr3.jpg\" alt=\"depr3\" width=\"442\" height=\"636\" srcset=\"https:\/\/treatmentmaps.net\/wp-content\/uploads\/2015\/01\/depr3.jpg 442w, https:\/\/treatmentmaps.net\/wp-content\/uploads\/2015\/01\/depr3-208x300.jpg 208w\" sizes=\"auto, (max-width: 442px) 100vw, 442px\" \/><br \/>\n<strong>SECTIONS:<\/strong> <a href=\"https:\/\/treatmentmaps.net\/?page_id=1523\/#depressionmap3\">8<\/a> | <a href=\"https:\/\/treatmentmaps.net\/?page_id=1563\/#depressionmap3\">28<\/a> | <a href=\"https:\/\/treatmentmaps.net\/?page_id=1565\/#depressionmap3\">29<\/a> | <a href=\"https:\/\/treatmentmaps.net\/?page_id=1567\/#depressionmap3\">30<\/a> | <a href=\"https:\/\/treatmentmaps.net\/?page_id=1571\/#depressionmap3\">32<\/a> | <a href=\"https:\/\/treatmentmaps.net\/?page_id=1573\/#depressionmap3\">33<\/a> | <a href=\"https:\/\/treatmentmaps.net\/?page_id=1575\/#depressionmap3\">34<\/a> | <a href=\"https:\/\/treatmentmaps.net\/?page_id=1577\/#depressionmap3\">35<\/a> | <a href=\"https:\/\/treatmentmaps.net\/?page_id=1579\/#depressionmap3\">36<\/a> | <a href=\"https:\/\/treatmentmaps.net\/?page_id=1581\/#depressionmap3\">37<\/a> | <a href=\"https:\/\/treatmentmaps.net\/?page_id=1586\/#depressionmap3\">39<\/a><\/div>\n<div style=\"height: 720px;\"><a id=\"depressionmap4\"><\/a><strong>DEPRESSION AND GRIEF MAPS:<\/strong> <a title=\"Depression Map 1A\" href=\"https:\/\/treatmentmaps.net\/?page_id=443\">1A<\/a> | <a title=\"Depression Map 1B\" href=\"https:\/\/treatmentmaps.net\/?page_id=445\">1B<\/a> | <a title=\"Depression Map 2\" href=\"https:\/\/treatmentmaps.net\/?page_id=447\">2<\/a> | <a title=\"Depression Map 3\" href=\"https:\/\/treatmentmaps.net\/?page_id=451\">3<\/a> | <a title=\"Depression Map 4\" href=\"https:\/\/treatmentmaps.net\/?page_id=453\">4<\/a> | <a title=\"Depression Map 5\" href=\"https:\/\/treatmentmaps.net\/?page_id=455\">5<\/a><br \/>\n<img loading=\"lazy\" decoding=\"async\" class=\"alignleft size-full wp-image-1822\" style=\"border: solid 1px black;\" src=\"https:\/\/treatmentmaps.net\/wp-content\/uploads\/2015\/01\/depr4.jpg\" alt=\"depr4\" width=\"450\" height=\"453\" srcset=\"https:\/\/treatmentmaps.net\/wp-content\/uploads\/2015\/01\/depr4.jpg 450w, https:\/\/treatmentmaps.net\/wp-content\/uploads\/2015\/01\/depr4-150x150.jpg 150w, https:\/\/treatmentmaps.net\/wp-content\/uploads\/2015\/01\/depr4-298x300.jpg 298w\" sizes=\"auto, (max-width: 450px) 100vw, 450px\" \/><br \/>\n<strong>SECTIONS:<\/strong> <a href=\"https:\/\/treatmentmaps.net\/?page_id=1523\/#depressionmap4\">8<\/a> | <a href=\"https:\/\/treatmentmaps.net\/?page_id=1569\/#depressionmap4\">31<\/a> | <a href=\"https:\/\/treatmentmaps.net\/?page_id=1584\/#depressionmap4\">38<\/a> | <a href=\"https:\/\/treatmentmaps.net\/?page_id=1586\/#depressionmap4\">39<\/a> | <a href=\"https:\/\/treatmentmaps.net\/?page_id=1588\/#depressionmap4\">40<\/a> | <a href=\"https:\/\/treatmentmaps.net\/?page_id=1590\/#depressionmap4\">41<\/a> | <a href=\"https:\/\/treatmentmaps.net\/?page_id=1592\/#depressionmap4\">42<\/a> | <a href=\"https:\/\/treatmentmaps.net\/?page_id=1594\/#depressionmap4\">43<\/a> | <a href=\"https:\/\/treatmentmaps.net\/?page_id=1598\/#depressionmap4\">45<\/a> | <a href=\"https:\/\/treatmentmaps.net\/?page_id=1602\/#depressionmap4\">46<\/a> | <a href=\"https:\/\/treatmentmaps.net\/?page_id=1605\/#depressionmap4\">47<\/a> | <a href=\"https:\/\/treatmentmaps.net\/?page_id=1609\/#depressionmap4\">49<\/a><\/div>\n<div style=\"height: 720px;\"><a id=\"depressionmap5\"><\/a><strong>DEPRESSION AND GRIEF MAPS:<\/strong> <a title=\"Depression Map 1A\" href=\"https:\/\/treatmentmaps.net\/?page_id=443\">1A<\/a> | <a title=\"Depression Map 1B\" href=\"https:\/\/treatmentmaps.net\/?page_id=445\">1B<\/a> | <a title=\"Depression Map 2\" href=\"https:\/\/treatmentmaps.net\/?page_id=447\">2<\/a> | <a title=\"Depression Map 3\" href=\"https:\/\/treatmentmaps.net\/?page_id=451\">3<\/a> | <a title=\"Depression Map 4\" href=\"https:\/\/treatmentmaps.net\/?page_id=453\">4<\/a> | <a title=\"Depression Map 5\" href=\"https:\/\/treatmentmaps.net\/?page_id=455\">5<\/a><br \/>\n<img loading=\"lazy\" decoding=\"async\" class=\"alignleft size-full wp-image-1825\" style=\"border: solid 1px black;\" src=\"https:\/\/treatmentmaps.net\/wp-content\/uploads\/2015\/01\/depr5.jpg\" alt=\"depr5\" width=\"448\" height=\"453\" srcset=\"https:\/\/treatmentmaps.net\/wp-content\/uploads\/2015\/01\/depr5.jpg 448w, https:\/\/treatmentmaps.net\/wp-content\/uploads\/2015\/01\/depr5-297x300.jpg 297w\" sizes=\"auto, (max-width: 448px) 100vw, 448px\" \/><br \/>\n<strong>SECTIONS:<\/strong> <a href=\"https:\/\/treatmentmaps.net\/?page_id=1518\/#depressionmap5\">6<\/a> | <a href=\"https:\/\/treatmentmaps.net\/?page_id=1521\/#depressionmap5\">7<\/a> | <a href=\"https:\/\/treatmentmaps.net\/?page_id=1523\">8<\/a> | <a href=\"https:\/\/treatmentmaps.net\/?page_id=1602\/#depressionmap5\">46<\/a> | <a href=\"https:\/\/treatmentmaps.net\/?page_id=1611\/#depressionmap5\">50<\/a><\/div>\n<\/div>\n<div style=\"overflow: auto; width: 458px; height: 720px; float: right;\"><a id=\"depressionsection8\"><\/a><strong>8. ALLIANCE BUILDING<\/strong><\/p>\n<ul>\n<em>Coordinates with <a title=\"Depression Map 1A\" href=\"https:\/\/treatmentmaps.net\/?page_id=1507\/#depressionmap1a\">Section 1<\/a> on Map 1A. Appears at the top of each of the other maps. These issues are also discussed more generally in <a title=\"New Patient Map 2\" href=\"https:\/\/treatmentmaps.net\/?page_id=1529\/#depressionmap1b\">New Patient Section 11<\/a>.<br \/>\n<\/em>\n<\/ul>\n<p>An alliance is a sense that you are both working for a common purpose, and can help each other do your respective jobs. An alliance not only helps by facilitating the diagnostic and treatment work; it is also part of the treatment, by giving the patient a sense of not being alone, of being able to talk openly and to express his\/her thoughts and feelings safely.<\/p>\n<p><u>FIRST SESSION<\/u><\/p>\n<p>You can help the patient feel comfortable, secure, and able to talk with you in a variety of ways:<\/p>\n<p>1. Ask questions that lead the patient to say what he\/she wants to say. Usually, this could include the experience of depression, other people&#8217;s reactions, his\/her theories about the reasons for being depressed.<br \/>\n2. Ask questions that the patient hasn&#8217;t thought of but that seem important and related to the problem once he\/she <u>does<\/u> think about them. This could include<\/p>\n<ul>\n<li>specific symptoms, such as mood cycles, changes in sleeping or eating patterns, etc.<\/li>\n<li>physical symptoms. Depressed people are often preoccupied with their health and more sensitive than others to real illnesses. Some symptoms may be imagined, many may be real and important.<\/li>\n<li>when the depression started, and what else was happening in the patient&#8217;s life around that time.<\/li>\n<li>why the patient is here right now: what changed recently that led to this appointment.<\/li>\n<li>what the patient has done to treat the problem<\/li>\n<li>any feelings of anger that the patient may have.<\/li>\n<\/ul>\n<p>This is not only information-gathering; it is also one of the early phases of treatment. By asking questions, you help the patient re-frame the experience of depression, and re-evaluate the causes of his\/her mood. [ cf. <a title=\"Depression Map 1A\" href=\"https:\/\/treatmentmaps.net\/?page_id=1507\/#depressionmap1a\">Section 1<\/a> ]\n<p>Your main job at this point is to understand the patient and what is leading to the patient&#8217;s symptoms, depressive and otherwise.<\/p>\n<p>3. Ask about prior depressive episodes and their treatment.<\/p>\n<ul>\n<li>When.<\/li>\n<li>reasons for it\/them.<\/li>\n<li>outcome[s].<\/li>\n<\/ul>\n<p>4. Ask why the patient came to you. This has several aspects:<\/p>\n<ul>\n<li>What about the patient&#8217;s symptoms led to treatment? [gives information on severity of distress or patient&#8217;s symptom tolerance]<\/li>\n<li>Why now, not a month ago? What changed? [can lead to discussion of severity of symptoms, changes in symptoms, change in life, or change in his\/her impact on others]<\/li>\n<li>Was the patient pressured or coerced to come? [may give information on conscious resistance or interpersonal relationships]<\/li>\n<li>Why you and not another therapist? this especially if the patient was in prior treatment [may reflect rejection, disappointments, prior success or failure of treatment]<\/li>\n<li>Who recommended you and what did he\/she say about you [gives information on expectations] Why ask that person?<\/li>\n<\/ul>\n<p>5. Give the patient information about your plan or way of working and what to expect. How much you say will depend on your approach and your sense of the patient&#8217;s need to know.<br \/>\nIt could include<\/p>\n<ul>\n<li>the idea that talking can help a person feel better;<\/li>\n<li>that you won&#8217;t be able to tell the patient a lot the first session because you need to learn about him\/her first.<\/li>\n<li>the idea that he\/she needs to decide in a first session only whether he\/she feels comfortable with you and is able to talk reasonably easily, that you seem to listen and understand.<\/li>\n<\/ul>\n<p><u>ONGOING<\/u><\/p>\n<p>6. Give the patient some information about depression in his or her context [disease, medications, history]. This can normalize the patient&#8217;s situation, offer hope, and be reassuring. It can also show the patient that you have knowledge and sympathy.<\/p>\n<p>7. Consider giving the patient a homework assignment, possibly to explore and keep track of<\/p>\n<ul>\n<li>mood as a function of time of day.<\/li>\n<li>antecedents of depressive feelings.<\/li>\n<li>Dreams.<\/li>\n<li>other feelings, especially anger.<\/li>\n<\/ul>\n<p>8. One dimension of process is the extent to which you should make various treatment decisions alone or in consultation with your patient. Issues could include<\/p>\n<ul>\n<li>the patient&#8217;s need to be taken care of and reassured.<\/li>\n<li>the patient&#8217;s need for self-expression.<\/li>\n<li>the patient&#8217;s need for control over his\/her own life.<\/li>\n<\/ul>\n<\/div>\n<div style=\"overflow: auto; width: 458px; float: right;\"><div class=\"divider\" style=\"margin-bottom:10px;border-bottom-width:1px\"><\/div>\n<a href=\"http:\/\/www.treatmentmaps.com\/topics\/depression\/\" target=\"_blank\"><strong>CLICK HERE TO MAKE COMMENTS OR SUGGESTIONS<\/strong><\/a><\/div>\n","protected":false},"excerpt":{"rendered":"<p>DEPRESSION AND GRIEF MAPS: 1A | 1B | 2 | 3 | 4 | 5 SECTIONS: 1 | 2 | 8 | 23 DEPRESSION AND GRIEF MAPS: 1A | 1B | 2 | 3 | 4 | 5 SECTIONS: 3 | 4 | 8 | 9 | 10 | 11 | 12 | 13 | &#8230;<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":631,"menu_order":8,"comment_status":"open","ping_status":"open","template":"","meta":{"footnotes":""},"class_list":["post-1523","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/treatmentmaps.net\/index.php?rest_route=\/wp\/v2\/pages\/1523","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/treatmentmaps.net\/index.php?rest_route=\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/treatmentmaps.net\/index.php?rest_route=\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/treatmentmaps.net\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/treatmentmaps.net\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=1523"}],"version-history":[{"count":6,"href":"https:\/\/treatmentmaps.net\/index.php?rest_route=\/wp\/v2\/pages\/1523\/revisions"}],"predecessor-version":[{"id":2214,"href":"https:\/\/treatmentmaps.net\/index.php?rest_route=\/wp\/v2\/pages\/1523\/revisions\/2214"}],"up":[{"embeddable":true,"href":"https:\/\/treatmentmaps.net\/index.php?rest_route=\/wp\/v2\/pages\/631"}],"wp:attachment":[{"href":"https:\/\/treatmentmaps.net\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=1523"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}