Pastoral Care of Depression

Helping Clients Heal Their Relationship with God

Glendon Moriarty

• Publisher: Routledge
• Year: 2014
• ISBN:
  9781317787099
• Edition: 1
• Topic: Psicologia
• Subtopic: Salute mentale in psicologia

This book provides the essential tools needed to transform negative God images in depressed clients! Pastoral Care of Depression: Helping Clients Heal Their Relationship with God is designed to help clergy and mental health professionals understand how depression negatively affects the way people emotionally experience God and how, through therapy, this hurtful God image can be changed into a much more positive one focused on healing. In the past, the God image (as well as the essential differentiation between God image and God concept) has been explained in dull, analytic terms that are difficult to understand. This book's jargon-free language and engaging presentation make it an effective learning tool for students and professionals alike. Inside, you'll find numerous psychological tests, complete with sample test forms, that identify the God image. These are clearly explained and include all the information needed to take, administer, and interpret them. Pastoral Care of Depression teaches you to use psychodynamic and cognitive interventions to change a client's God image, including foundational knowledge and clearly presented techniques to implement in the therapeutic relationship. This comprehensive treatment manual arms you with the most comprehensive array of cognitive interventions published to date, with tens of easy-to-follow techniques designed to tap directly into an individual's subjective experience of God. Two appendixes give you a sample God Image Automatic Thought Record and Treatment Plan form. Part I: Depression and the God Image examines:

• the nature and development of depression
  
• symptoms of depression specific to religious people
  
• defining a client's image of God, how it developed, and what it reveals
  
• the relationship between self, depression, and God image, and how God images relate to Christian thought

Part II: Changing the God Image addresses:

• the importance of self-evaluation for therapists and counselors—and how to do it
  
• the nature of the therapeutic relationship
  
• counseling skills that strengthen the therapeutic relationship
  
• how to conduct an God Image Assessment Interview and how to work with what that interview reveals
  
• transference, countertransference, cyclical maladaptive patterns, and internalization in psychodynamic psychotherapy
  
• appropriate, effective psychodynamic interventions
  
• the essentials of cognitive therapy and how it can be utilized to positively affect the God image
  
• treatment planning and case conceptualization
  
• important ethical issues for consideration

With well-designed test and exercise forms and clear instructions on their use and interpretation, Pastoral Care of Depression provides the essential tools needed to work effectively with this important client group. Make it a part of your professional/teaching collection today!

Part I:

Depression and The God Image

Chapter 1

Depression and Religious Experience

What is Depression?

The diagnostic name for depression is major depressive disorder (American Psychiatric Association [APA], 2000). Technically, people either have depression or they do not. The determining factor is the number of symptoms they have. However, depression can also be viewed as existing on a continuum. People with some symptoms but not enough to meet the full diagnostic criteria still suffer from some level of subclinical depression. In fact, most people experience a degree of depression at one time or another in their life.

The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) (APA, 2000) is the reference in which all mental disorders are cataloged. In order for depression to be diagnosed, the person must exhibit five or more of the following nine symptoms during the same two-week period.

At least one of the symptoms must be either (1) depressed mood or (2) loss of interest or pleasure in once-enjoyable activities.

1. Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g., appears tearful). Note: In children and adolescents, can be irritable mood.

2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation made by others)

3. Significant weight loss when not dieting or weight gain (e.g., a change of more than 5 percent of body weight in a month), or decrease or increase in appetite nearly every day

4. Insomnia [too little sleep] or hypersomnia [too much sleep] nearly every day.

5. Psychomotor agitation [walking, talking, and/or moving in an aggravated, fidgety, manner] or retardation [walking, talking, and/or moving slower than normal] nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down)

6. Fatigue or loss of energy nearly every day

7. Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick)

8. Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others)

9. Recurrent thoughts of death (not just fear of dying), recurrent suicidal thoughts without a specific plan, or a suicide attempt or a specific plan for committing suicide (p. 356)*

Depression is a mood disorder, which means that the primary difficulty is with the mood or the way a person feels. People who struggle with depression often feel as if a black cloud follows them wherever they go. They are usually unhappy and have a hard time seeing any positive aspects of their life. Depression also causes people to feel burdened by an extreme sense of guilt. They often blame themselves for sins they have not committed. They frequently feel they have done something wrong, even though they have not, and therefore believe that they deserve to be rejected by others and God.

People who are depressed have a number of difficulties that accompany their ailment (Maxmen & Ward, 1995). One problem occurs with the breakdown of close relationships. Often their initial complaints are met with a listening ear, advice, and care. However, when these efforts fail, family and friends may become frustrated and irritated. This only makes matters worse because the depressed persons then feel doubly guilty for annoying those closest to them. In an attempt to please their family and friends they then keep their concerns to themselves, which unfortunately results in increased depression.

Other complicating factors include suicidal ideation, substance abuse, and impaired judgment (Maxmen & Ward, 1995). Males complete suicide twice as often as females, but females attempt more often. Males usually use active, direct methods (e.g., firearms, hanging), whereas females use more passive, indirect methods (e.g., overdose, cutting). To escape their pain, some depressed individuals learn to cope through using substances. It is not long before they learn that they can control the feeling of despair through the amount of substances they take. Eventually, many become addicted to drugs or alcohol. Because individuals with depression feel so poorly, they often misjudge and misinterpret situations. If they are not aware of their distortions, they will make decisions that have detrimental effects on their future.

Universally, women have twice as high a rate of major depressive disorder as do men (Kaplan & Sadock, 1998). The prevalence rates for women are between 10 to 25 percent, and between 5 to 12 percent for men. This is thought to be the result of “hormonal differences, the effects of childbirth, differing psychosocial stressors for women and for men, and behavioral models of learned helplessness” (Kaplan & Sadock, 1998, p. 539). The average age of onset for men and women is age forty, and 50 percent of individuals diagnosed are between ages twenty to fifty. Individuals who are single, separated, or divorced have a higher rate of depression than do those who are married. The prevalence of depression has not been found to be related to ethnicity, education, or income (APA, 2000).

Major depressive disorder is usually precipitated by a psychosocial stressor (e.g., divorce, job loss), and can occur over days or weeks or develop over months or years (Maxmen & Ward, 1995). The span of time between early depressive episodes is usually longer than the span of time between later episodes (APA, 2000). As the episodes accrue, the chances of having another increases. People who move into partial remission of symptoms have a greater chance of having another episode than do those who move into full remission of symptoms. Studies suggest that after one year, 40 percent of those diagnosed will again warrant diagnosis of a full episode, 20 percent will no longer meet full criteria, and 40 percent will no longer have a mood disorder.

How Does Depression Develop?

In my opinion, there are two main schools of thought in clinical psychology. The first is the psychodynamic school, and the second is the cognitive school. Psychodynamic and cognitive theorists view the same person in different ways, but both are important and give valuable insights into his or her makeup. This section reviews these theories one at a time. The psychodynamic school predates the cognitive school, so it will be reviewed first.

Psychodynamic Theory

Psyche means “soul” and dynamic means “with movement.” Psychodynamic theory looks at the movements of the soul. This theory has a long history that started in the late 1800s and continues to evolve and change even to this day. The breadth and depth of this field is overwhelming, so the focus of this section will be limited to the foundational points for discussion. These points are taken from four different subschools of psychodynamic theory: psychoanalysis, ego psychology, object relations, and relational psychoanalysis.

Psychoanalysis

Psychoanalysis began with Sigmund Freud, an extremely controversial figure, who has had and will continue to have a tremendous impact on human thought. His ideas have been absorbed into our culture and have had a profound influence on the way we think of ourselves and others (Gay, 1989). This chapter will focus on two of his main contributions: the different levels of consciousness and the structural theory of personality.

One of Freud’s (1915) greatest discoveries was that people have three different levels of consciousness: the unconscious, the preconscious, and the conscious. The iceberg is a metaphor often used to illustrate the different levels of awareness. The unconscious corresponds to the bulk of the iceberg that falls far below the surface of the water. The preconscious parallels the part of the iceberg that lies underwater but is still visible from the surface of the water. Finally, the conscious is represented by the tip of the iceberg—it is visible, but is overall a very small and unsubstantial part of the entire substance.

The unconscious, similar to the bottom layer of the iceberg, is the most powerful part of the personality. According to Freud (1915), the unconscious contains the instinctual urges that guide and direct most of conscious life. In addition, it contains thoughts and feelings that are too threatening to consciously evaluate. These thoughts and feelings are often tied to early memories that are too devastating to directly think about. When these painful incidents occur, they are not processed or worked through but are instead quickly banished from the conscious mind and relegated to the unconscious. These contents desire to be processed and understood, so they often surface in dreams and slips of the tongue. Bradshaw (1988) likens repressing issues to trying to keep beach balls underwater. You can do it with one or two, but if you add more it gets difficult and they start to pop up.

The preconscious is not nearly as powerful as the unconscious and gains information from both the unconscious mind and the conscious mind (Brenner, 1973). Sometimes the unconscious will allow information to surface to the preconscious mind that is not too threatening or anxiety provoking. The conscious mind frequently deposits information in the preconscious mind by simply removing focused attention but maintaining awareness of the information. For example, you are currently reading this book and focusing on these words, but if you think about it, you can switch your attention to the pres...