Application of Narrative Therapy in Major Depression - Essay Example

Application of Narrative Therapy in Major Depression xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx Name xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx Course xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx Lecturer xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx Date Application of Narrative Therapy in Major Depression Hasler et al, (2004) state that, depression is a mental illness which they defined as feeling of sadness, misery and unhappiness. Clinically, these feelings lead to an interference of everyday life due to alteration of emotional and physical aspects of a patient. According to Katon (2003), symptoms of depression include; low or irritable mood most of the time, loss of pleasure in usual activities, faulty sleeping patterns, tiredness, feelings of self worthlessness, difficulty in concentrating as well as repeated thoughts of death or suicide. Low self esteem is a common characteristic among depressed individuals. Major depression is diagnosed when an individual exhibits more than five symptoms among the ones listed above. This is especially so when the symptoms persist for at least two weeks. According to a research by Mykletun et al (2007) depression is caused by complex interactions between chemicals and hormones that influence a person’s feelings, sleeping and eating habits as well as energy levels. In addition, this illness is brought about by a person’s family history of illness, traumatic life experiences like death of a loved one as well as prolonged stressful conditions within the life of an individual. Research indicates that depressed persons experience changes in vital brain chemicals such as norepinephrine and serotonin. There are several risk factors for development of major depression (Bruce et al 2004). One of them is gender. According to research, more than twice as many women than men suffer from this kind of depression whereas 25% of women and 10% of men suffer from at least one episode of major depression within their course of life (Evans et al 2005). Age is another predisposing factor for development of this illness. Normally, it strikes individuals who are within the age of 22-44 years. At this age, the disease is not recognizable since its symptoms resemble normal adolescent problems like irritability, risk taking behavior and troubles with school work. If untreated, the victims become suicidal. The elderly also suffer from this disease where their sad moods and feelings of fatigue are mistaken for normal aging process. According to Lyketsos et al (2003) major depression is treated through a combination of medicines, talk therapies and self help. In evidence based practice, talk therapy is a recommended intervention for treating individuals suffering from this kind of depression. An evidence-based practice is an instructional strategy whose results indicate consistency following experimental tests. Over the past decade, evidence- based practice has had an upper hand in the behavioral health education fields. There is as a result of the increased demand for treatments that produce better outcomes as observed by Evans (2005). Narrative therapy also known as talk therapy was pioneered in Australia in the 1980’s. It bore the emphasis on the importance of using story and language to develop and express intrapersonal and interpersonal problems. It involves counseling where sick persons are encouraged to talk about their feelings and thoughts with the aim of learning how to deal with them. There are several types of talk therapy. Cognitive behavioral therapy teaches the sick person on how to fight off negative thoughts. Here, the victim is assisted to become aware of symptoms as well as spotting depressing issues. This kind of therapy does not emphasize on the impact created by the events in a person’s past life. Instead, it concentrates on how one can change the way they think, feel and behave presently. Narrative therapy is based upon social constructivism (Katon 2003). It indicates that culture determines how people build social interactions and as such their way of expressing themselves is different. Stories and language make it possible for different cultures to pass powerful messages to their members concerning meanings of vital concepts that exist including gender, health, class among others. Questioning is the basic tool of narrative therapy used by clinical social workers in treating depressed patients. They ask questions that help to identify the main complaint as well as capture the history of the illness which helps in formulating a differential diagnosis. These questions are structured in a way that they the social worker has an advantage of knowledge over the patient. During this process, the patient comes to terms with their own problem. This is because the questions expose patients to their own interpretation of events as well as formulation of insights. The result is a self discovery process that makes understanding the pivotal element, while the clinical worker becomes just a facilitator and ally. As stated by Shapiro and Ross (2002), narrative therapy involves helping people who have been stuck in stories that have been imparted to them by the society and which have acted the role of defining their identity. For example; a person who is told by his friend that he should obtain a well paying job few months after completing college just like him. Such a story has a disabling effect to the recipient simply because he is not that kind of person. This kind of belief prevails in both the culture of larger society as well as education about hardworking and lazy fresh graduates. In order to solve such a problem, it is important for the clinical worker to help the patient externalize the problem by locating it outside them and within the culture. As a result, the patient experiences freedom from guilt and self blame. This acts as a trigger towards taking up responsibility for the effects of their problems. Moreover, the patient develops resistance to a problem that they view as distinct from themselves. In addition to questioning and listening, narrative therapy also involves family setting techniques that are relevant to the patient. Note taking helps in sharing the observations with the patient as a way of incorporating them into the healing process (Shapiro & Ross 2002). There is need to come up with a receptive audience that will offer relevant support to the patient through optimism of the existing condition. As the patient works towards developing a new phase of life, there is need to pay careful attention to the details of change as well as the effects of small advancements in change. These factors lead to development of hopeful moments (Larner 2004). One of the limitations that face narrative therapy is under conceptualization of patients’ value (Gilgun 2004). There has been little or no effort toward outlining the implications of incorporating the values of patient. Clinical professionals should make use of qualitative research which sheds light on the feelings of the patient, notions as well as wider understanding rather than measuring objective results. Under conceptualization of personal bias in clinical decision making is another limitation. Clinical professionals should make use of critical reflection which is useful and assists in discovering as well as managing personal bias. Such attitudes includes increasing capacities for presumptions that are challenging as well as ideal ways of examining self, others and the world in general. There are different types of bias such as optimistic bias which is a belief that the interventions are more efficient than reality. As Clegg (2005) asserts, advocacy bias is the aspiration of the researchers to have positive outcomes. It states that following the steps systematically can protect against bias. This seems to overlook the likelihood that personal perception shape interpretations of even the most meticulous research as well as the most scrupulously followed process. A limitation of research evidence in narrative therapy is another challenge. Academic communities as well as the broad practice distinguish the limitations of this research. In addition, they press the obvious value of using it when it is obtainable. Research evidence used in narrative therapy can be uncertain, contentious, ambiguous, nonexistence as well as hard to apply to personal cases. Argument on the effectiveness of treatment is regular. Clinical professionals should use clinical knowledge and reasoning which are founded on principles derived from basic scientific research when research evidence is not available or inconclusive (Gilgun 2004). According to Rooney et al (2011), choices on how evidence based practice is viewed are made not only by the trainers, professionals and agency administrators, but also by staffs in a broad variety of organizations planned to encourage the incorporation of research and evidence. This is because, evidence based practice as stated above is an instructional approach whose the outcomes shows the steadiness through an experimental assessments. Narrative therapy which is known as talk therapy and pioneered in Australia expresses on use of story as well as language in developing as well as expressing intrapersonal and interpersonal problems (Meier 2002). This is a way of giving patients a chance to talk about their feelings as well as thoughts, this assist the clinical professional to understand on how to treat them. As stated above, there are different types of talk therapy such as cognitive behavioural therapy which trains the patients on how to avoid negative thoughts. The patient gets help and becomes aware of symptoms as well as issues that are depressing. This therapy concentrates on assisting the patient to change the way of thinking, feel as well as behave constantly (Beck 2011). Affiliation has been hailed as the cornerstone of transformation in clinical social work. In regards to this, therapeutic affiliation entails a patient or structure and the worker’s self. Narrative therapy seeks to be a respectful as well as non blaming approach to counselling and social work, which centres individuals as the experts in their own life. It separate and views problems different from individuals and presumes that persons have a lot of knowledge, beliefs, commitments, values as well as capabilities that assists them to minimize the influence of problems in their lives. Of late, evidence based practice has been a major impact in health profession (Brown & Augusta-Scott 2006). As a clinical officer, it is necessary to practice understanding of what one and other professionals know or what is learned from the patients which comprise of professional values. It is the duty of a clinical professional to apply the research evidence to the patient, and this needs the clinical worker to have full knowledge of patients’ values which includes concerns, preferences and prospects that patients come along with. In addition, clinical worker’s assumptions, values, biases as well as world views are vital when attending to the patient. The experience in which the patient brings into the practice situations is necessary, this can be termed as provisional which means that the understanding is open to adjustment as new evidence continues to disclose(Gilgun 2004). Narrative therapy is suitable to culturally diverse populations. This therapy, as (Payne 2006) explains, enlightens and empowers individuals from different cultures on how to deal with problems from their cultural perspective. It empowers people by instilling them with skills, strengthening of their values, importance of commitment, beliefs, competency development and abilities. These aspects assist people from different cultural background to change their relation with problems that influence their lives. Some cultures have beliefs that some problems are part of their lives and that they have to live with them. Narrative therapy seeks to discern these beliefs in people and thereby separate the problems and people’s lives, (Riessman & Quinney 2005). It is suitable as it make people to be experts of their own lives. This therapy is applied to different races, communities, gender and abilities thereby asserting its appropriateness to culturally diverse populations. Furukawa et al, (2007) assert that it investigates the roles beliefs, ideals and behaviors play and then work to rewrite the negative areas that are depicted by the people. This helps individuals and people to the problematic circumstances in a different new perspective. It shifts character dynamism. From different cultures it alters and manipulates their beliefs to fashion new endings that separate the situations from their lives. It is very reliable as it places new perspective in the people’s landscape. Narrative therapy brings in to light themes, plots or characters to people until they are fully aware. 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Furukawa, A, Cipriani, A, Barbui, C & Geddes, R 2007, Long-term treatment of depression with antidepressants: a systematic narrative review, Canadian journal of psychiatry, Revue canadienne de psychiatrie, 52(9), 545-552. Gilgun, J, F 2004, Research on Social Work Practice, Research on Social Work Practice, 15(52), pp 53-55. Hasler, G, Drevets, C, Manji, K, Charney, S 2004, Discovering endophenotypes for major depression, Neuropsychopharmacology, p 765-1781. Katon, J 2003, Clinical and health services relationships between major depression, depressive symptoms, and general medical illness, Biological psychiatry, Vol 54, Iss3, p 216-226. Larner, G 2004, Family therapy and the politics of evidence, Journal of Family Therapy, p17-39. Lyketsos, G, DelCampo, L, Steinberg, M, Miles, Q, Steele, D, Munro, C & Rabins, V 2003, Treating depression in Alzheimer disease: efficacy and safety of sertraline therapy, and the benefits of depression reduction, Archives of General Psychiatry, Vol.60 Iss, 7 p737. Meier, A 2002, Narrative in psychotherapy theory, practice, and research: A critical review, Counselling and Psychotheraphy Research, 2(4), 239-251. Mykletun, A, Bjerkeset, O, Dewey, M, Prince, M, Overland, S & Stewart, R 2007, Anxiety, depression, and cause-specific mortality, Psychosomatic medicine, Vol 69, Iss 4, p.323-331. Payne, M 2006, Narrative therapy, Sage. Riessman, C, K & Quinney, L 2005, Narrative in Social Work, A Critical Review, Qualitative Social Work, 4(4), 391-412. Rooney, H, Rooney, D & Strom-Gottfried, K 2011, Direct social work practice: Theory and skills, Cengage Learning. Shapiro, J & Ross, V 2002, Applications of narrative theory and therapy to the practice of family medicine, family medicine-kansas city- p96-100. Read More