Psychotherapy and Counselling for Depression (Counselling in Practice series)

425 Pages·2007·2.83 MB·English

by  Prof Paul Raymond Gilbert

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Psychotherapy and Counselling
for Depression
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Counselling in Practice
Series editor: Windy Dryden
Associate editor: E. Thomas Dowd
Counselling in Practiceis a series of books developed especially for counsellors and
students of counselling, which provides practical, accessible guidelines for dealing
with clients with specific, but very common, problems. Books in this series have
become recognised as classic texts in their field, and include:
Career Counselling, second edition
Robert Nathan and Linda Hill
Counselling Survivors of Childhood Sexual Abuse, third edition
Claire Burke Draucker and Donna Martsolf
Counselling for Post-Traumatic Stress Disorder, third edition
Michael J. Scott and Stephen G. Stradling
Counselling for Eating Disorders, second edition
Sara Gilbert
Counselling for Alcohol Problems, second edition
Richard Velleman
Counselling for Anxiety Problems, second edition
Diana Sanders and Frank Wills
Counselling for Family Problems
Eddy Street
Counselling for Stress Problems
Stephen Palmer and Windy Dryden
Counselling for Grief and Bereavement
Geraldine M. Humphrey and David G. Zimpfer
Counselling Couples
Donald L. Bubenzer and John D. West
Counselling for Psychosomatic Problems
Diana Sanders
Counselling People on Prescribed Drugs
Diane Hammersley
Counselling for Fertility Problems
Jane Read
Counselling People with Communication Problems
Peggy Dalton
Counselling with Dreams and Nightmares
Delia Cushway and Robyn Sewell
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Psychotherapy and Counselling
for Depression
Third Edition
Paul Gilbert
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© Paul Gilbert 1992, 2000, 2007
First published 1992
Reprint four times
Second edition published 2000
Reprinted four times
This third edition published 2007
Apart from any fair dealing for the purposes of research or
private study, or criticism or review, as permitted under the
Copyright, Designs and Patents Act 1988, this publicationmay
be reproduced, stored or transmitted in any form, or by any
means, only with the prior permission in writing of the
publishers, or in the case of reprographic reproduction, in
accordance with the terms of licences issued by the Copyright
Licensing Agency. Enquiries concerning reproduction
outside those terms should be sent to the publishers.
SAGE Publications Ltd
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London EC1Y1SP
SAGE Publications Inc.
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Thousand Oaks, California 91320
SAGE Publications India Pvt Ltd
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Mathura Road, New Delhi 110 044
India
SAGE Publications Asia-Pacific Pte Ltd
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British Library Cataloguing in Publication data
Acatalogue record for this book is available
from the British Library
ISBN 978-1-4129-0276-2
ISBN 978-1-4129-0277-9 (pbk)
Library of Congress Control Number 2006935792
Typeset by C&M Digitals (P) Ltd., Chennai, India
Printed in Great Britain by The Cromwell Press Ltd, Trowbridge, Wiltshire
Printed on paper from sustainable resources
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To my long enduring family for all your love and support, and my clients who
have tried to educate me
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Contents
Preface to the First Edition ix
Preface to the Second Edition x
Preface to the Third Edition xii
Acknowledgements xiv
Part I Understanding the Nature of Depression with a
Biopsychosocial Approach 1
1 Depression: The Basics 3
2 Multi-Level Systems in Depression 22
3 The Brain, Threats and Depression 47
4 Behavioural Approaches: Action Matters 63
5 Human Social Needs and Roles: Attachment,
Social Connectedness and Defeat 80
6 Thinking, Self-Awareness, Social Goals and
the Role of Shame in Depression 112
Part II Processes for the Therapeutic Journey 145
7 The Therapeutic Relationship and Working Alliance 147
8 Beginning the Therapeutic Journey with the Depressed Person 172
9 Thoughts, Beliefs and Safety Strategies: Constructing Formulations 192
10 Helping People Engage and Change: Some Basic Principles 223
11 Developing Self-Compassion 241
12 Focusing Interventions with a Special Reference to Self-Criticism 267
13 Working with Specific Difficulties I: Approval,
Achievement, Assertiveness and Rebellion 291
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viii Psychotherapy and Counselling for Depression
14 Working with Specific Difficulties II: Shame, Guilt, Ideal and Envy 306
15 Overview, Saying Goodbye and Personal Reflections 327
Appendix 1 Formulation and Case Conceptualisation 341
Appendix 2 Behavioural Scheduling 344
Appendix 3 Working with People’s Thinking 346
Appendix 4 Some Useful Things to Reflect on in Regard
to Working with Depressing Thoughts 348
Appendix 5 Compassion-Focused Therapy 354
Appendix 6 Building a Compassionate Image (Client Handout) 356
Appendix 7 Using Compassion to Change our Minds (for Therapists) 357
Appendix 8 Compassionate Letter Writing 362
Appendix 9 The Consequences of Becoming Compassionate
to Self and Others 366
Appendix 10 Self-Help Material and Useful Websites 367
Bibliography 370
Index 394
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Preface to the First Edition
Cognitive therapy began in America some thirty years ago. Since that time, it has
seen enormous developments in the client groups treated and in its therapeutic
approach. Two areas that have seen important changes to the early formulations
are a renewed focus on the therapeutic relationship (e.g. Beck et al., 1990; Safran
and Segal, 1990) and an increased focus on interpersonal cognitive processes (e.g.
Bowlby, 1980; Liotti, 1988; Safran and Segal, 1990). Both these concerns are a main
focus in this book. In 1988 Trower et al. published Cognitive-behavioural Counselling
in Action (London: Sage). They outlined the basic techniques and issues of the
cognitive approach. The present volume, for the ‘Counselling in Practice’ series, is
designed to build on their introduction. It explores interpersonal counselling with
a particular client group – depressed people.
The aims of this book are to focus on the interpersonal themes in counselling
depressed clients, including those of the therapeutic relationship. The book is
divided into two sections of four chapters each. Chapter 1 addresses issues of the
nature of depression and the therapeutic relationship. Here I try to capture some-
thing of the nature of the depressive experience and focus on important counsellor
skills. Chapter 2 explores the central issues of interpersonal approaches, the basic
domains of relationships and how these are affected in depression. Chapter 3 out-
lines the basic premises of the cognitive approach and why cognitive counsellors
are particularly concerned with the construction of internal meaning, ways of
attributing causes to things, and basic attitudes and beliefs. Chapter 4 explores
the many ways of conceptualising therapeutic interventions and challenging
dysfunctional thoughts and attitudes.
The second section aims to build on these concepts, and lead the reader
through a step-by-step approach to the process of counselling the depressed
person. Counselling scenarios are given to illuminate specific points and highlight
types of intervention. Most of these scenarios are not derived directly from taped
interviews (although some are) but from notes made at the end of sessions. They
are not meant to represent exact scenes but rather to indicate and highlight issues.
All client names have been changed, and minor alterations introduced in the his-
tory, to avoid identification. Chapter 5 outlines the issues that arise during the
early parts of the therapy, and how to engage and agree shared understandings
and goals of counselling. Chapter 6 explores the kinds of issues that arise in the
middle of counselling, as the counsellor and client engage in deeper explorations
and seek opportunities for change. Chapter 7 looks at some special problems that
arise in depressed clients. Special attention is given to shame, guilt, envy and ide-
alising which often figure prominently in depressive experience. Chapter 8
explores termination issues and offers some personal reflections.