![[Depression#^ccd424]] Valuable questions to consider for [[Case Management]] [[C20200327 Why do we formulate cases]] Psychological 1. 1  What does the client think and feel about him/herself? Especially important are attributional style (a tendency to self-blame), shame, and social comparison (feeling less able, less competent than others or different in some way). 2. 2  What does the client think and feel about the future? 3. 3  In what ways are certain styles of behaviour, such as avoidance and ruminations, contributing to depression? 4. 4  What are the client’s current life circumstances? Do they feel defeated in their life goals? 5. 5  How long has the client felt depressed? 6. 6  Is the depression changing from his/her normal mood state or accentuating more chronic low mood? 7. 7  Is there loss of enjoyment of previously enjoyed activities (e.g. sex, meeting friends, going out)? 8. 8. Does the client see their depression in psychological and/or relationship terms, or is there a belief that they are physically ill? Strong beliefs in physical illness can make some counselling difficult. 9. 9  How trapped does the client feel and what thoughts do they have in that regard (e.g. assess risk of self-harm)? 10. 10  How does the client view their resources to cope? What outside sources of help are there, and how might these be utilised in the counselling? Social 1. 1  Are there any major life events or upsets that might have triggered the depression, accentuating or maintaining it? 2. 2  What are the client’s perceptions of social relationships? Have there been major losses? Is the home environment aggressive or neglectful? Are there conflicts with family members – parents, in-laws, spouses/partners or children? Does the client have feelings of hostility to others (that maybe they feel unable to express or work through), entrapment, and/or feelings of being let down? 3. 3  What are the sources of social support, friends and family relationships? Can the client use these if available or have they gradually withdrawn from social contact? 4. 4  Does an unstimulating or socially isolating social environment play a role (e.g. young mothers struggling to cope with young children and lacking adult company and sharing interests)? 5. 5  Are there major practical problems that may need other sources of help (e.g. social work for accommodation problems or advice for financial problems or job seeking)? Practical problems can sometimes be overlooked. 6. 6  Are their problems in the work domain (e.g. being out of work or bullying at work)? Biological 1. 1  Is there sleep disturbance (early morning waking, waking after being asleep for a short period and/or difficulties getting to sleep)? 2. 2  Are there major changes in appetite and weight? 3. 3  How serious is fatigue and loss of energy? 4. 4  Psychomotor changes, especially agitation and retardation, should be noted. If a client is very slowed up and finds it difficult to concentrate, this can hamper coun- selling. Severe retardation and lowered concentration may be a poor prognostic indicator for some counselling. 5. 5  Would a trial of anti-depressant drugs help to break up a depressive pattern? Most studies suggest that anti-depressants do not interfere with counselling and are indicated if the depression is severe. The National Institute for Clinical Excellence (NICE, 2004) does not recommend anti-depressants for mild depression. 6. (Also ask about whether they have been taking any new medications, possible side effects might be depression. Any physical illness?) - Source [[Book - Psychotherapy and Counselling for Depression 3rd Ed]] ----