How Would I Handle Donald: Counseling on Wellness and Someone Who Might be Depressive by Tony Astro

As a career counselor for two decades now, I have encountered a client who may need a clinical counselor, but there should be a way to handle it as the need arises primarily in the military where a clinical counselor is not as accessible. The chaplain is usually the next step which some of my clients would instead not go. Instead of waiting for the next appointment to pass the buck for advice, I think we can handle this by just lending a listening ear.

Here is a scenario that I have encountered as a counselor who confided to me, although I am not a clinical counselor, I had a dilemma and so here is my observation on how to handle, it seems like a depressive male and determine if it needs a further referral.

·         Donald (not his real name): Well… I am here in needing advice because I have been feeling incredibly discouraged recently. I… um… can't discover inspiration for the things that I know I have to do. I am not working now, so fundamentally I rest. Furthermore, I do not escape the house much. I am engaged with karate… other than that, there isn't much.

·         Counselor:  Can you reveal to me more?

·         Donald: Well… I just feel so down, so discouraged… like nobody truly comprehends me. Also, I would prefer genuinely not to associate with individuals much since they make me apprehensive at any rate… I do not recognize what to state [Sigh]. In this way, I merely abstain from getting things done. It is miserable.

·         Counselor: So, you have been feeling so unmotivated and sad recently that you have been not able to work, leave the house, or associate with individuals. Is that right?

·         Donald: Yeah… I have not worked in about a year. My folks still live in Japan, yet they help me fiscally when I am not working. I have been willing work recovery for as long as a half year, yet they revealed to me I was excessively wiped out, making it impossible to work. I might want to work once more. However, I simply don't know how I could do it… .since… I feel so overpowered often. What's more, I do not recognize what to do. I simply feel so discouraged.

·         Counselor: You said that your folks still live in Japan. To what extent you have lived in the U.S., and how is your emotionally supportive network here?

·         Donald: I have lived here for around 15 years. I have a couple of companions here. However, they do not comprehend me. They endeavor to help me. However individuals merely exploit me, I figure since I am excessively decent… I do not have limitations.

·         Counselor: What might you want to see changed in your life at this moment?

·         Donald: Hmmm… I would get a kick out of the chance to not feel so continuously discouraged and have the inspiration to do the things that I need to do… like discover a vocation, be more engaged with karate, and possibly observe a pleasant lady to be involved. I just would prefer not to feel continuously confused… moreover, feel so discouraged and, stop most of the contemplations that continue surging around in my mind. Drug encourages a few, yet insufficient. I attempt to meditate and be more motivated. However, it is tough. I simply keep considering. I'd additionally get a kick out of the chance to have more inspiration to escape my home since it was tough for me to try and come here today.

Here is my observation whether it may need to be referred to next level of counseling or continue the effort to counsel the member.

Donald admits to the counselor of having some psychological concern and intends an answer. The counselor has already started the first step which is narrative and eventually expands it into a life review.

Davis and Degges-White use the term life reviews as a naturally occurring process in which individuals share their stories through written or oral means. Individuals depend on language to make sense of mental images and on constructed symbols to communicate ideas and intents to others (Davis and Degges-White, 2008).

Donald’s ability to proclaim his problem of depression: “I just feel so down, so depressed…like no one understands me” is a good prelude towards going further and trace the roots of his depression. A narrative or life review counseling would be a very appropriate technique to know and bring out questions and answers like:
1. Have you felt this way before?
2. Are there any activities you have done in the past five years that helped you not to feel depressed?
3. When and how did you think that no one understands you?

The 2nd Application to be proposed is to have Donald try to write down his daily events either through a journal for his private readings. Have Donald review anything he writes and observes his self and gets back to the counselor for a follow-up.

Davis and Degges-White continue their studies: Comparing participants' earlier writings with their later books and asking participants whether they thought the life review activities improved their ability to view themselves gave a more comprehensive perception. Overall, the participants saw the event as one that provided personal analysis rather than a pure description of past events or relationships. They believed, they did deepen their understanding of themselves, and they felt that looking back did provide an opportunity to find connections (i.e., self-actualization). Their comments revealed that the experience encouraged them to undertake a personal search for meaning (Davis and Degges-White, 2008).

Another good indication that he is open to explore and cure his depression is admitting his weakness: “They try to help me, but people just take advantage of me, I guess because I am too nice…I do not have healthy boundaries.”

For some men, it is hard to admit any problems, even more, to acknowledge you have a depression which results to most men susceptible to other psychological illness (for not expressing weakness such as depression).

This widespread inability among men to identify emotions and put them into words has enormous consequences. It blocks men who have it from using the most effective means known for dealing with life's stresses and traumas— namely, identifying, thinking about, and discussing one's emotional responses to a stressor or trauma with a friend, family member, or therapist (Brooks and Good, 2001).
Moreover, so, coming from Donald’s narrative, setting boundaries is essential so that Donald will not be overwhelmed by the pressure of the people around him who do not understand his culture. Advise Donald some ideas on how to set boundaries like:
1. Don’t accommodate friends or acquaintance that he thinks takes advantage of him for being Japanese.
2. Encourage Donald to actually “find a nice woman to be in a relationship with” where he can talk about the pressures from around him.
3. Encourage Donald to keep busy or continue his hobby of Karate and find a job just keep his focus on something else -  may just be all he needs: a job.
The counselor should continue to see Donald for another six sessions while making a follow-up questions such as:
1. Find other sources of motivation: Have you find resources online as well as in his community that would develop his ways of keeping busy, be employed, and maybe have a relationship.

2. Life Review or Narrative in writing: Did his writing ever help? Can he continue to do his journaling, be consistent and patient for another five weeks?

3. Wellness Plan: How is Donald’s health and what are diets and physical activities does Donald have been doing for the rest of the weeks/months.

Donald’s willingness to get advice from the counselor is already a sign of health. Continuing to be proactive with all these suggestions and communicate consistently with the counselor should bring a positive light to Donald’s issues.

Davis, N. and Degges-White, S. (2008, Fall2008). Catalysts for Developing Productive Life Reviews: A Multiple Case Study. Adultspan: Theory Research & Practice, 7(2), 69-79. Retrieved November 24, 2008, from Academic Search Premier database.

Brooks, G. R. and Good, G. E. (2001). The New Handbook of Psychotherapy and Counseling with Men. Vols. 1 and 2 : A Comprehensive Guide to Settings, Problems, and Treatment Approaches. San Francisco, Calif. Jossey Bass, 2001


  1. Subject: Re:Week 8: Counseling John on Depression by Tony Astro Topic: u08d1 The Case of John
    Author: William Garris Date: November 25, 2008 8:15 AM

    I always am grateful when people get their posts in early. On my end, Wednesday starts the deluge, and it is hard to keep up.

    As for your posting, I find nothing inherently wrong in the questions you use to direct the conversation. However, I am curious about experience you may have had with solution-focused therapy and with the post-modern expression of narrative therapy, with a strong emphasis on "externalizing" as espoused by Michael White and David Epstein, among many others?

    ~ Bill

  2. Subject: Re:Week 8: Counseling John on Depression by Tony Astro Topic: u08d1 The Case of John
    Author: Tony Astro Date: November 28, 2008 12:23 AM

    Dr. Garris,

    Happy Thanksgiving! Thanks for your kind comment (I tried considering I'm still catching up from my 20 days transition).

    Externalizing or the mutual positioning of the counselor / patient and digging out unique outcomes, thickening the new plot, and linking the new plot to the past and the future simply put a narrative therapy should be the norm for many therapist. Based on my experience with the military, I find it effective but I am very limited into tackling issues that may involve medical and issues that maybe to personal and so there are limitations in my part.

    When I continue to ask more than 5 personal questions, a military personnel starts to shut down and prefer to either speak to a chaplain (who has a clause for more privacy) because I am limited to only tackle anything that would affect their careers and not as a whole person.


  3. Subject: Re:Week 8: Counseling John on Depression by Tony Astro Topic: u08d1 The Case of John
    Author: Michelle Cox Date: November 25, 2008 5:54 PM

    Tony, I agree that life narratives would be an excellent technique to implement with John. Apparently, he is focused on all that is negative in his life and completing a life review would allow him to perceive the positive aspects of his life. He is first generation Japanese and seems to have acculturated to western society. Although he has been unemployed, he has the financial support of his family. These are issues which can positively influence his mental health through life review.

  4. Subject: Re:Week 8: Counseling John on Depression by Tony Astro Topic: u08d1 The Case of John
    Author: Barbara Lingg Date: November 27, 2008 8:13 PM

    Tony, Nice post. I was curious why you chose these two therapies instead of F2F therapy? I guess I am concerned about your recomendation for John to "find a nice woman" at this point in his life. Sure we all would like to not be alone, but choosing someone when he is feeling depressed does not sound like a very good idea to me. When someone feels good enough about themsleves it is hard to find a "nice" person. How does he go about findng this person when he does not want to venture out and he does not appear to even like himself? Wouldn't that add more stress to his life?
    Thanks Barb

  5. Subject: Re:Week 8: Counseling John on Depression by Tony Astro Topic: u08d1 The Case of John
    Author: Tony Astro Date: November 28, 2008 12:04 AM

    Hi Barb thanks for your observation.
    When people are depressed, they usually isolate including myself and avoid company. Integration with people is not always what you feel like doing, but solitude is one of the major causes of depression. Knowing that relationship is not the cause of his depression and if I may quote John again in verbatim: “I’d like to not feel so depressed all the time and have the motivation to do the things that I want to do…like find a nice woman to be in a relationship with” I will answer to him, go ahead, get out there and do what other else are doing who are enjoying life, especially those in relationship: from non-committal friendship to committed companionship. That was John’s request, if I said NO and don’t look for a relationship, would you think it would help his self-esteem? I would definitely agree with you if he just got out of a recent relationship.

    Social activity is what John needs, he may hate it at first due to lack of motivation but, he said it himself, he needs a relationship. It will ultimately help John uplift his self-esteem, giving him challenges and not to feel so alone. At the same time, I will encourage him to have a social circle, join a volunteer organizations, Japanese-American groups, churches, sports clubs, hobbies (for his Karate).

    As a counselor, it is a default that my job would always be to do face-face counseling and will continue to do so for at least 6 sessions. The journal or writing his issue is just an additional to my narrative counseling and also a way to listen and find out about himself.

    If I may quote Viktor Frankl, M.D., psychiatrist and survivor of Auschwitz concentration camp: A man's concern, even his despair over the worthwhileness of life is an existential distress, but by no means a mental disease. It may well be interpreting the first in terms of the latter motivates a doctor to bury his patient's existential despair under a heap of tranquilizing drugs. It is his task, rather, to pilot the patient through his existential crisis of growth and development (Frankl, 1963).

    Happy thanksgiving!

    Frankl, Viktor Emil; Man’s Search for Meaning: An Introduction to Logotherapy (New York: Simon & Schuster, 1963, 1984)

  6. Subject: Re:Week 8: Counseling John on Depression by Tony Astro Topic: u08d1 The Case of John
    Author: Barbara Lingg Date: November 28, 2008 11:40 PM

    Thank you Tony, GReat post. I appreciate you taking the time to answer. I agree it would not help his self-esteem if you limited his activities and the positive thoughts in his life. He does need to be out there with others but you know as well as I do that some days you do not want to get out of bed. Of course he may have to force himself out sometimes, but if he can make 1 good connection, whether it be romantic or friendship it could be the catalyst he needs to climb out of his current situation. I love the quote. It is so true. Oh, I am not one who journals but I have seen the faces of my patients when they reread what they wrote several months ago when they began treatment and it sure does help them see how far they have some. Some counselors return these papers to them immediately, but since I facilitate Phase I and Phase III groups I like to hold on to them to show them later. It does work. Thanks and I hope you had a Happy. Barb


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