1. Treatment of Clients Experiencing Depression
A Collaborative Approach to Care
January 27, 2018 * Tex-CHIP Training Series

2. Using Treatment Manuals in Counseling Practice Breathing Life into Manual-Based Treatments

3. What is a treatment manual?
Standard presentation of a treatment protocol
Portrays content and processes of therapeutic activities for a specific presenting issue
Intended for a specific client population
3 components:
Client activities
Counselor activities
Materials

4. Why use treatment manuals?
provide an overall framework outlining treatment and session goals
especially helpful for counseling students learning a road map to promoting recovery from symptoms
helpful for seasoned counselors learning a new intervention
supply strategies that aid the counselor in achieving the goals
guide the counselor as they negotiate challenges that arises over the course of treatment.

5. Criticisms and Considerations
Too rigid and routine of an approach
Depict treatment client development as steadfast and linear
Generic treatment only permits use of certain knowledge and counseling skills
Standardized approaches promote standardized counselors
Considerations
When applied inflexibly, all of these things are likely true
There is a middle ground between rigidity and complete unstructured interventions
Result is the basis of evidence-supported treatments and evidence-based practice

6. Oh, queso, what now? The instrument of change will always be you-
the best manualized treatments are those uniquely yours, but integrate core package of skills
Relationship first- the creativity will source from the estuary of your identities
Understand the model that manual is based on
Know the skills and processes
Describing them
Providing rationale for them
Delivering them
Evidence for anything is sample-specific, so adaptations across the intersections of cultural identity is imperative
Collaborate with peers and supervisors
Practice in a way that supports your growth and client outcomes

7. Implementing Session Structure

8. Overall Session Structure
Greet client
Implement activity*
establish relational connection
Process activity
Helpfulness
Therapeutic alliance
Meaning of skill
Review previous session
Awareness
Content
Meaning of use
Process
Degree of motivation
Check on issue and action plan
Develop action plan
Summary, motivation, and closure
Conceptualize issue in context
Introduce goal for session and develop agenda

9. Structuring the Activity
Introduce skills and give examples
Provide rationale
Request acknowledgement (buy in)
Describe/demonstrate skill components (EDUCATE)
MODEL use of the skill
PRACTICE the skill
Evaluate performance (collaboratively)
Provide encouragement and praise as needed
Modify skill use or directions as needed

10. Treating Depression Using the STEADY Program

11. What we see in our office
Depressed mood most of day, most days
Decreased interests or pleasure in activities
Weight fluctuations
Changes in sleep
Psychomotor changes
Fatigue/loss or energy
Feelings of worthlessness or guilt
Difficulty concentrating or making decisions
Thoughts of death, dying, suicide
5 symptoms during 2 weeks period
Plus all other qualifying criteria

12. What is in your conceptualization toolkit
Ts + Bs + Fs = meaning
Cognitive Model
Core Beliefs
Rules and Assumptions
Situations
Thoughts
Response
(a) Feelings, (b) physiology, (c) action
Thoughts
Actions
Feelings
Meaning

13. We Need a Road Map STEADY Program

14. STEADY Program Overview
Screening
Intake and Evaluation
Medical
Behavioral Health
Case Management
Choice
Session
Phone Contact A1 C1 A2 C2 A3 C3 A4 C4

15. Our Treatment Plan Healthcare Domain: Behavioral Health
Provider: Mental Health Counselor
Objective:
Provide alleviation of depression symptoms as indicated by client report of decreased activity level, depressed mood, low engagement in pleasurable activities, fatigue, and difficulty making decisions
Goals:
a) Decreased symptom severity as indicated by a score less than 25 on depression symptom scale
b) Increased functioning as indicated by engaging in pleasurable activities 5 days per week
c) increased utilization of social supports and community resources as indicated by access/use of 3 supports/resources per month.
Interventions:
a) Educate, model, and practice cognitive copings skills using the STEADY curriculum (Sessions T1-T4)
b) Educate, model, and practice engagement in social and success-oriented activities using the STEADY curriculum (Sessions A1-A4).
 c) Provide linking to supports and resources as indicated.

16. Choice Session AGENDA Mood Questionnaire
(appendix)
Introductions and overview of counseling
Be personable, but appropriate
Confidentiality
Info about the STEADY manual content and process
Medication check in and review mood questionnaire
Inventory of personal beliefs
Review side effects
Make medication plan
Choosing how to change your life *
Mood questionnaire *

17. Choice Session YOUR PERSONALITY HAS 3 PARTS DOWNWARD SPIRAL
VERSUS UPWARD SPIRAL
FEELINGS
ACTIONS
THOUGHTS

18. Fun Activities: A-1 CHECK – IN REVIEW PREVIOUS SESSION
INTRODUCTION TO MODULE
IDENTIFYING AND PLANNING FUN ACTIVITIES
SOCIAL VERSUS SUCCESS ACTIVITIES
FUN ACTIVITIES MENU
KEEPING TRACK OF FUN ACTIVITIES
MOOD & ACTIVITY LOG
TAKE HOME TASK

19. Changing Your Thinking: T-2
CHECK IN AND MEDICATION REVIEW
REVIEW PREVIOUOS SESSION
THE A-B-C TECHNIQUE
BILL AND STEVE EXAMPLE
C-A-B REVIEW
ARGUING AGAINST NEGATIVE THOUGHTS
QUESTIONS TO CREATE POSITIVE COUNTER THOUGHTS
A-B-C FORM
TAKE HOME TASK

20. REMEMBER THE MANUALS REMEMBER OUR PROGRAM WELL
REMEMBER THE MANUALS REMEMBER OUR PROGRAM WELL! STAY MOTIVATED, STAY AMAZING!