Healthy Activity Program Manual PDF

CONTENT All the skills we learnt on general counselling skills in the CR manual (Chapter 2) are applicable when counselling patients with Depression using the Healthy Activity Program. You are strongly recommended to read the CR manual before proceeding as many of the terms used here are explained i...

CONTENT All the skills we learnt on general counselling skills in the CR manual (Chapter 2) are applicable when counselling patients with Depression using the Healthy Activity Program. You are strongly recommended to read the CR manual before proceeding as many of the terms used here are explained in that manual. There are some key aspects of the counselling style that are particularly important in Healthy Activity Program and these are highlighted below: Maintain session structure Keep the focus on action Learn together collaboratively Be non-judgmental Acknowledge the patient’s experience Be encouraging Express warmth and be genuine 1. Maintain session structure As we have discussed, a counselling session is characteristically different to a friendly chat. One of the most distinguishing features is to set and maintain a structure throughout the session. Thisis extremely important while working with patients with Depression, who can feel easily overwhelmed and discouraged. The components that make up the session are described in Chapter 4. At the start of each session, it is recommended that you and the patient set an agenda, or a plan for the session, together. A clear agenda for each session will help you and the patient focus on what is most important for the patient to make progress. This plan or agenda includes a list of topics to discuss or tasks to complete in the session and provides a guide for you to follow for the remainder of the session. In general, it is important to remember that setting and following the agenda for the session is: Collaborative, such that the session focuses on what matters most to the patient Useful, such that patients and counsellors have a guide for conducting the session and ensuring that they stay on track with the goals for the session Flexible, such that new topics or tasks can be added, but are best if done so in a clear and collaborative manner by directly discussing and deciding whether to modify the original agenda. 2. Keep the focus on action Healthy Activity Program emphasizes action and doing things differently in order to help the patient feel better. This is described in Chapter 4. This is another way that a counselling session differs from a friendly chat. In a HAP session, we keep our focus on action and limit the time 18 spent on topics that are not central to the patient taking action in order to solve problems and feel better. Of course, there are times that it may be necessary to talk about topics that are less central (e.g., when greeting the patient); however, we emphasize discussions that help the patient take action and solve problems. 3. Learn together collaboratively Healthy Activity Program emphasizes the importance of counsellors and patients working together as a team. We can do this by introducing the patient to each step and ensuring that the patient understands the reasons for the steps that we are recommending. We also encourage the patient to take an active role during the session and share responsibility for setting and following the session agenda. We also emphasize working collaboratively when identifying activities that will be targets for change as well as in planning the best way to accomplish these activities. Often at the start of treatment (or with patients experiencing severe Depression symptoms at any point), it is important for us to take a very active role in the sessions. This may mean that we are more directive in setting the agenda and suggesting actions to take (or even requiring them if the patient is at risk of self-harm or suicide), but even at such times, we maintain collaboration by explaining to patients the reasons for what we are recommending. In addition to collaborating with the patient, it also may be helpful to collaborate with a family member who is close to the patient and may be available to support and help the patient through the treatment. 4. Being non-judgmental Since depression affects one’s motivation and interest in doing activities, patients may often fail in completing activitiesor regularly attending sessions.. Becoming critical or judgmental of patients at such times can make counselling even harder. Being judgmental often gets in the way of active problem solving because it makes it harder to learn collaboratively with the patient. For example, when patients report spending all afternoon lying in bed instead of doing a homework plan we developed with them, we may think, “This is terrible!” or “she is making a mess of things!” Practicing a non-judgmental style, instead, helps us to focus specifically on what happened, rather than on our opinions or reactions. In this example, we might ask in a direct and matter of fact way, “what was happening when you got into bed? What were you feeling or thinking then? What happened as you were lying in bed?” Being non-judgmental helps us to shift to learning collaboratively together. Also, often patients have been subjected to judgmental comments from others like ‘get yourself together’ or 'you need to be strong.’ They also may have many judgmental thoughts about themselves, such as “I’m a bad person.” If we are judgmental, it can make it harder for patients to connect or work with us in sessions. Our non-judgmental attitudes can help us build trusting relationships with patients and support the patient in opening up and sharing more with us. 5. Acknowledging the patient’s experience In addition to being non-judgmental, it is also important that we acknowledge the patients’ experience and communicate that their experience makes sense to us. For example, we may need to acknowledge that it makes sense that when the patient feels depressed, she/he withdraws from friends and family, doesn’t complete homework, or fails to attend counselling sessions. Also, many patients with Depression attribute their problems to physical illness and focus a lot of attention on their physical health. It is important to accept and acknowledge the patient’s experience of such physical health concerns. You can build on such acknowledgment by explaining the link between physical health and stress and explaining how the Healthy Activity Program will help them feel better. 19 6. Encouraging progress A counsellor’s role is to encourage the patient every step of the way, looking out for even the smallest signs of progress and improvement. The nature of Depression is such that it tends to take away the patient’s confidence and motivation. It is our job to help patients set small manageable tasks and encourage even the smallest signs of action and improvement in mood. 7. Express warmth and be genuine Being warm and genuine with clients also can help to establish a positive working relationship. We can communicate warmth verbally and non-verbally in ways that are genuine and natural for each of us. Verbal expressions of care (e.g., “I’m happy to see you today” or “I’m sorry that was so hard”) or non-verbal expressions of warmth (e.g., a smile, body language, eye contact, tone of voice) are simple ways in which this can be done. SUMMARY The Healthy Activity Program counsellor maintains a specific style throughout the counselling treatment. Key aspects of this style include setting and following an agenda, keeping the focus of counselling on action, and learning together with the patient. It also is important for the counsellor to be non-judgmental, acknowledge the patient’s experience, be encouraging, and express warmth and genuineness.