Even with aggressive awareness campaigns all over the world, clinical depression remains to be one of the least understood health conditions by many. This deficient knowledge causes strains on communication and consequently leads to faulty relationships and failed interventions. If you know someone diagnosed with depression; you find yourself taken aback and deeply upset to be in a place where you find yourself not knowing what to say and what to do.
Truly, one of the hardest things for the logic to process is the one that involves emotions, and at times, it feels like being too careful not to step on a fault line or they will withdraw themselves again. We know that one person who we do not expect to be diagnosed with depression. We have friends who lost their loved ones to social isolation. We may even have that private moment of shock when we realize we are the one fighting it. Simply put, we do not entertain the reality of it until it happens to us or to someone we know.
A constant feeling of sadness for at least two straight weeks and loss of interest in the things one finds satisfying is what depression is. Other manifestations include weight loss or change of appetite, fatigue, feelings of guilt or worthlessness, diminished ability to think and concentrate, and the presence of suicidal thoughts. It is not a ‘life phase’ that someone grows out, like a bad haircut or an old perm.
Unlike far-advanced stages of cancer and multi-drug resistant infections, nurses have powerful weapons accessible in their hands at any time of the day: self-awareness and communication techniques. So here are five therapeutic communication techniques nurses should utilize to deliver effective nursing care in working with individuals having depression:
1. Trash “I think…” and “You should…”
Giving opinions and advice on what should individuals with depression do to manage their condition is very easy. For some, it might sound good because this is an active way of helping them by providing concrete solutions and “straightening” out their perceptions. Statements like “You should just have chosen to stay positive” and “I think being happy is a decision” may mean well but roughly translates to having a choice on how one should feel and by free will, the person chose to feel depressed.
The goal is to help them find their feet again and maintain stability on the ground. The nurse should help the client explore his ideas regarding possible solutions to his problems. Giving advice may make the patient think that his problems can be easily solved, and this just makes the client feel inadequate. Add to this the possibility that the client may not agree with what the nurse offers and develops resentment towards the nurse which can sever the relationship.
Instead, the nurse can ask the client to describe his feelings about the problem and consequently may offer facts and services that can help depending on what client stressed that can make him feel better. Again, it is important the client’s decision-making skill should be given importance.
2. Acknowledge their pain.
The first thing that the nurse sets for to gain the client’s trust and cooperation is an environment of understanding and acceptance. When the client shares feelings of anger, worry, and anxiety, it is important for the nurse to acknowledge the feelings and encourage the client to express them more. Being able to recognize that it must be embarrassing or difficult for the client to feel as he does prevent passing of judgments to the feeling itself. Judgments shame and invalidate individuals with depression such as when the nurse asks them why they let their lives be complicated by the petty things they preoccupy themselves with.
3. Remain neutral.
It is a challenge for nurses not to agree nor disagree with clients. If the nurse approves and agrees with what the client just shared, the nurse sets standards of what is acceptable based on the nurse’s values. This might also force the client to attune his feelings to what the nurse’s approved of even when he does not feel the same because the accepted values will be used to judge his behaviors. The client may be prevented from saying what he believes in especially if it does not conform to the nurse’s standards. Agreeing with the client also makes the future modification of opinions stated by client difficult.
On the other hand, disagreeing on clients’ actions and feelings is imposing the nurse’s own beliefs on clients. This intimidates and angers clients and can lead to problems with the established relationship.
4. Silence is therapeutic.
Not all shared feelings need reply. Some circumstances render silence more appropriate than the most carefully crafted set of words for a response. This slows down the conversation and provides client some time for contemplation and reflection for what he just shared. This may provoke anxiety on the nurse’s part, but this proves to be beneficial as this allow clients to collect their thoughts. They can refocus clients by helping them to the part where they left off or to ask them what they are thinking. This is also the perfect time to assess non-verbal gestures.
5. Let client decide on the topic of conversation.
One thing that should be remembered in communication is to let the client decide on the direction of the conversation. Nurses should stay away from launching on the very first thing that caught their attention, such as when the client looks like he hasn’t slept or when he dresses up for the first time. Allowing the client some broad opening shows that the nurse wants to focus on the client and is interested in what he thinks is important as of now. When the client starts sharing, this is the time when the nurse can explore the client’s thoughts.
In a poetry entitled “Explaining My Depression to My Mother” by Sabrina Benaim, she struggled to let her mother understand her depression. It was even more difficult for her because she does not understand herself as well. The first few lines went “Mom, my depression is a shape shifter. One day it is as small as a firefly in the palm of a bear. The next, it’s the bear.” Depression may seem incomprehensible at first but with education, communication skills, and self-awareness, the relationship between nurses and clients will be successful and efficient.