2. DSM Criteria for Major Depressive Episode Five or more of the
following symptoms have been present during the same 2-week period
and represent a change from previous functions; at least one of the
symptoms is either (1) depressed mood or (2) loss of interest or
pleasure. Depressed mood most of the day, nearly every day as
indicated by either self-report (feels sad or empty) or observation
made by others (appears tearful). In children or adolescents, can
be irritable mood. Markedly diminished interest or pleasure in all,
or almost all, activities most of the day, nearly every day.
Significant weight loss when not dieting or weight gain (5% body
weight in 1 month) or decrease or increase in appetite nearly every
day. In children, consider failure to make expected weight gains.
3. Insomnia or hypersomnia nearly every day. Psychomotor agitation
or retardation nearly every day (observable by others, not just
feeling restless or being slowed down). Fatigue or loss of energy
nearly every day. Feelings of worthlessness or excessive or
inappropriate guilt. Diminished ability to think or concentrate, or
indecisiveness, nearly every day. Recurrent thoughts of death,
recurrent suicidal ideation without a specific plan or suicide
attempt or specific plan for committing suicide. 4. Initial Intake
with Parents (Kids) Gather as much background information as
possible. Ask about school performance, friends, outside
activities, etc. Ask about sleep schedules, bed wetting,
medications, doctor visits. Ask about duration, family history, any
interventions tried and if they are/arent working. 5. Depressed
Kids Often say things like: I wish I was never born. I cant do
anything right. My mom loves my brother more. Im stupid. Have a
hard time seeing the good in a situation Blame themselves Lack
feelings of empowerment Think things will never get better 6.
Techniques for Kids 7. Good At Jar Have child make a pinch pot out
of clay. Choose one bead for one thing that he or she is good at.
Child places one bead in at a time sharing what he/she is good at.
Give child extra beads to take home to add to the jar. 8. Sick of
Eggs Give child several plastic eggs that open (like a plastic
Easter egg). Explain that some things in our life make us angry or
frustrated or feel bad. We often get sick of those things.
Demonstrate for child throwing the egg at the wall while saying, I
am sick of _____. Allow child to throw eggs against wall while
saying things theyre sick of (eggs should break open). 9. Bag of
Bad Feelings Have child choose things in the room that represent
things that make them feel bad. (Ex. figure of boy represents bully
at school.) Have child keep adding things to the bag until they
have chosen something to represent everything they feel bad about.
Have child carry the bag around the room and explain thatss what
they are carrying around with them on a day-to-day basis. Allow
them to take things they are willing to let go of one at a time to
lighten the load. 10. I Feel/I Need Draw a line down the middle of
the paper with the words I Feel on one side and I Need on another.
Ask child the write down current feelings on the I Feel Side. Have
them write down activities beside each feeling that expresses what
he/she needs on the I Need side. Allow child to take home paper and
refer back to it when they are experiencing a specific feeling. 11.
Initial Parent Intake (Adolescents) Ask about behavior changes,
overall mood at home, what seems to trigger moods. Suicidal
ideation? School performance, school activities, relationships with
teachers. Have teachers said anything? Changes in friends, groups
or activities Found anything suspicious? Notes? Texts? Facebook
posts? Drugs/Alcohol use. Weekend Activities. 12. Initial Things to
Consider Suicidal Ideation Medication or psychological evaluations
Support system Relationship with parents Level of success in any
one area Change in peer groups Academic decline 13. Depressed
Adolescents Irritability often comes out Resistance to change whats
not working Lack of communication Lack of motivation Often dont
know whats wrong Cry easily 14. What to Pay Attention to Music what
theyre listening to Friends what their friends are doing Movies
what theyre watching. Pay attention to movies theyre watching
obsessively. 15. Pumped up Kicks
http://www.youtube.com/watch?v=T3ldsF65cLM 16. We Need to Talk
about Kevin http://www.youtube.com/watch?v=0Z86CUVfFhE 17.
Basketball Diaries http://www.youtube.com/watch?v=1sfAZYmMig4 18.
Techniques for Adolescents 19. List of Bad Things Ask adolescent to
write down all of the bad things in his/her life. Rank them in
order from least to greatest Which ones are able to be changed?
What will help with the ones that arent able to be changed? 20.
What Triggers You? Write down all things that trigger negative
emotions. Rank reaction to triggers (1-10). How often do these
triggers occur? How long are the after effects? Is there a specific
theme to the triggers? 21. Automatic Negative Thoughts Talk about
CBT and how we have automatic negative thoughts about certain
events. Identify a difficult event and write the negative thought
about the situation. Choose a positive thought to replace the
negative thought. 22. Behavioral Activation Identify activities
that increase mood levels. Talk about how those activities are
helpful in increasing mood levels. Schedule those activities into
daily/weekly routine. Make up a schedule and implement before next
session. 23. Journaling Write down daily thoughts, ideas, feelings
in a journal. Encourage them to not filter what is written but to
be real. Bring in journal if comfortable with counselor reading it.
Either read it aloud or allow counselor to read it (aloud or
silently). 24. Coping Strategies How to breathe and/or meditate.
Help implement an exercise routine. Help them set boundaries with
phones, facebook and texting. Help them identify safe people they
can talk to. Make daily schedule that promotes a positive mood.
Sleep schedule, homework schedule, etc. 25. Case Study - 17 Year
Old Male Saw briefly when he was 13. Stopped coming to sessions.
Paranoid of me talking to mom. Worried she could hear him through
the air vents. Mom had affair. He overheard her on the phone. She
lied about it. Wasnt sure if parents were even married. Dad worked
out of town. Mom calls again when hes 17, found a suicide note. 26.
Initial Impressions Highly intelligent. Beyond his years in
thinking. Movie - Inception. Big picture thinker. Extremely rigid -
black/white, wrong/right thinking, mature for his age. No real
friends. Messing around with girl who has a boyfriend. Only
connection. No one knows him. No Connection to parents. *Highly
worried with this scenario. 27. Month 1 -3 Goes back and forth
between practical and emotional. Can t seem to integrate the two.
When hes emotional hes very emotional. Says he cant be who he
really is. Wont say who that is. Cant concentrate. Grades are
dropping. Mom on his case. Refer for medication. Gets on Zoloft,
things start improving. 28. Month 4 - 8 Wants to tell me something.
Cant. Takes three sessions for him to tell me. Wants to go to
cosmetology school. Almost hyperventilates after he tells me.
Explore opportunities for him to work at salon. Wont do it. Says he
cant. Also says he wants to dress differently. (hipster, skinny
jeans). Cant do that either. Feels trapped at his school, in his
part of town. 29. Month 9 - 12 Starts changing into skinny jeans in
the parking lot. Wears them in my office. How does he feel in the
waiting room? In my office? After 6 weeks, wears them to a hockey
game with friendsno one even notices. Begins wearing them at
school. Even mom doesnt notice. 30. Month 13 - 18 Starts coming
less frequently. Decides to go to college. Still no real
relationships. Still rigid at times. Goes completely off of
medication (tapers off slowly with MD help). Grades go back up.
Missed a session. Never rescheduled. 31. Final Thoughts Much
improvement was made. Was more into connection than strategies.
Still isolated from peers - a huge concern. Still very
uncomfortable with himself. Overall Goal hell end up going back
into counseling and continue to work on himself.
