On the last track we discussed five steps a caregiver can take in order to be supportive. The five steps include communicating effectively, offering support for spiritual concerns, working with health care professionals, working with others who also care about the client, and taking care of personal needs.
On the next two tracks... we will discuss coping with depression.
Doug, age 33, was in a caregiver role to his homosexual partner, Pete, age 31, who was HIV positive. When I met with Doug, I explained to him the differences between natural depression and clinical depression. I also stressed to Doug that he cannot expect to get rid of all the feelings of depression. Instead, I asked Doug to focus on helping Pete limit the duration and severity of depression.
Doug attempted to limit Pete’s depression with three steps. The three steps for coping with depression that Doug used were taking care of personal emotional needs, talking about depression, and decreasing depression. As you listen to how Doug implemented the three steps for coping with depression, consider how these steps can benefit the caregiver of your HIV positive client. You might also consider playing this track for that caregiver.
3 Steps for Coping with Depression
#1 Taking Care of Personal Emotional Needs
First, let’s discuss taking care of personal emotional needs. Clearly, care-giving was stressful for Doug. He stated, "It’s hard to spend so much time taking care of someone else. And when Pete starts getting depressed and acting hopeless, it really drags me down, too." I stated to Doug, "To do your best in this difficult role, you need to find ways to stay emotionally well yourself. Let me give you some suggestions.
1. First, understand that it is not your fault that Pete is depressed. Changes in Pete’s life are what is making him depressed. Some caregivers may feel guilty if the person they are caring for becomes or stays depressed.
2. Second, schedule some positive experiences for yourself. Do some things you enjoy, and try to stay as active as possible. Remember that if you become depressed yourself, you won’t be able to take care of Pete.
3. Third, get the companionship you need. Being with others is as important for you as it is for Pete. You might find it helpful to talk to others about your problems. Or you might find it helpful to talk about things that have absolutely nothing to do with your problems!"
#2 Talking About Depression
Second, Doug and I discussed objectives regarding talking about depression. Doug stated. "Sometimes I just want to act like everything’s fine when Pete gets upset." I responded, "It may be uncomfortable to acknowledge that Pete is upset, but ignoring his feelings probably makes it worse. Pete may feel that you do not care." Doug agreed. He stated, "I don’t want Pete to think I don’t care. What can I do?"
How would you have responded to Pete? I stated, "You can be of the most help early on; before the feelings of discouragement or depression become severe. And agree with correct thinking. For example, if Pete says something like. ‘I’m a complete failure;" you know that it’s not true. Respond by saying something like, ‘Maybe you have failed at some things, but just think of all the things that you’ve accomplished.’ Then, go ahead and talk about some of Pete’s accomplishments."
On the next track, we’ll discuss some additional ways clients like Pete and his caregiver Doug can control negative thoughts. Think of your Pete. Could your HIV positive client benefit from talking about depression with their caregiver? Would it be helpful for your client to also talk with other HIV positive clients who have experienced similar feelings of depression?
#3 Decreasing Depression with 4 Strategies
In addition to taking care of personal emotional needs and talking about depression, the third step in coping with depression is decreasing depression. Before I discussed these techniques with Doug, I stated, "These techniques work for most people, but they won’t work for you and Pete if he doesn’t have an interest. Much of the work will have to come from Pete." Doug realized that his role was basically to help Pete learn to use the strategies for coping with depression. We reviewed four basic strategies.
Strategy #1 - Encourage Participation
The first strategy for decreasing depression was for Doug to encourage participation in pleasant experiences. As you know, enjoyable activities can go a long way in decreasing depression. Therefore, I discussed Pete’s participation in such activities with Doug. I stated, "There are three basic categories for enjoyable activities. They are activities with other people, activities that give a sense of accomplishment, and activities that make the person feel good. You know what Pete likes."
Doug stated, "I’ve got some fun activities in mind. But what about people? How do I know who to include?" How would you have responded? I replied, "Pick people who are sympathetic, understanding, give good advice, and can solve problems. What you really want are just people who are able to help Pete turn his attention away from his problems."
Think of your Doug. Could the caregiver of your HIV positive client benefit from objectively choosing companions for their relative or friend? Would you also want to consider fostering an acceptance of companions that the HIV positive client enjoys that, perhaps, the caregiver dislikes?
Strategy #2 - Setting Reasonable Goals
The second strategy for decreasing depression that Doug and I discussed was setting reasonable goals. As I explained to Doug, setting reasonable goals not only gives the HIV positive client something to look forward to, but also gives the client a sense of accomplishment when he or she reaches his or her goals. Doug helped Pete set his goals by helping him recognize that his goals should match his energy level, degree of wellness, and capabilities.
Doug stated, "Pete isn’t that healthy anymore, and that’s why he needs me to help him so much, but we set a few goals. Pete talked to his doctor about what would be a reasonable increase in T-cells to expect, so there’s that goal." What kind of goals might your client set? Do you think it was productive for Pete to set goals regarding his health? Why or why not?
Strategy #3 & 4 - Point Out Negative Thinking & Support Efforts
The next two strategies for decreasing depression are to point out negative thinking and to support efforts to control negative thoughts. These two strategies will be described in more detail on the next track, as we discuss obstacles to care-giving and techniques for controlling negative thoughts.
On this track... we have discussed coping with depression. The three steps for coping with depression that Doug used were taking care of personal emotional needs, talking about depression, and decreasing depression.
On the next track we will continue to discuss coping with depression. Our focus will be on obstacles to care-giving and techniques for controlling negative thoughts.
What are four basic strategies for decreasing depression regarding an HIV positive client?
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