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S T E P O N E

Goals for Each Step

Step 1: Identify the extent of the counselee’s depression and its suspected causes.

Step 2: Offer practical, applicable scriptural truths for overcoming depression.

Step 3: Offer short-term help to those presently engulfed in depression.

Step 4: Minister biblical hope and a long-term perspective to those suffering from depression.

A Biblical Perspective on Caring for People

COUNSELING INSIGHTS

Emotional

DD EPRESSIONOffering Biblical Help and Hope to the Downcast

Observation and Identification of the ProblemIdentify the extent of the counselee’s depression and its suspected causes.

Meet the CounseleeMy wife left me a year ago,

and now I have nothing. I comehome every night to a cold,dark apartment—it’s more likea tomb, really. It’s awful. I madesome terrible mistakes, and Ilost my family. I lost everything.It’s all my fault. (weeping) Howcould I have been so stupid?

I pray, but it doesn’t help. Idon’t think I can take this painanymore. It’s like a huge,smothering weight, and it’scrushing the life out of me. Iwake up at night and can’t goback to sleep. I can’t thinkstraight. Nobody wants to bearound me anymore, and Ican’t blame them. All I want todo is curl up and disappear.

WHAT DO YOU KNOWABOUT YOUR COUNSELEE?

• What is the counselee’s spiritual situation? Saved?Involved in a local church?

• How are the counselee’s relationships with his spouse,parents, and friends?

• How is her depression affecting everyday life?

• Does the counselee have ideas about what is causingthe depression? What are they?

• Is this the first bout with depression? If not, hasdepression been a long-standing, continual problem?Or does it show up in episodes separated by periods ofnormalcy?

• Has the counselee sought help for depression before?With whom? How often?

• Has there been a medical exam to determine whether achemical imbalance or other physical problem is caus-ing the depression?

• Does he feel depressed to the point of being suicidal?Has the counselee made plans or thought about howhe might commit suicide?

38

Depression is more com-mon in the winter whenpeople do not see the sun

for months. It alsobecomes a problem to

many people during holi-days (Thanksgiving,

Christmas) and milestones(birthdays, anniversaries).

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Premise: Life is difficult. All ofus know that. . . . Periodicallydepression, of varying degrees,besets us all. Short-term depression isas common as the cold, and at least ten per-cent of adults will become seriouslydepressed at some time during their lives.The wise pastoral counselor will help believ-ers struggling with depression to determineits cause and encourage them to take healthysteps through this period of their lives.

Possible Causes of Depression1. SUFFERING

PHYSICAL: a handicap, a long-standing or debilitating illness (including ongoing severe pain), or a terminal illness

EMOTIONAL: a serious illness or death of a loved one, marital problems, work-related stress or losses, problems in the lives of one’s children

2. ANGER

MISHANDLED ANGER: repressed (“stuffed”) resentment or out-of-control anger

3. GUILT

TRUE GUILT: a refusal to make things right with God and/or others

FALSE GUILT: an unwillingness to trust God’s promise of forgiveness (1 John 1:9)or the result of false accusations by others or one’s own conscience

Important Signs of Depression

Emotional

t sadness, restlessness, hopelessness, impatience, irri-tability, anger, unnecessary self-criticism, feelings ofinferiority, feelings of guilt (true or false), or unex-plained mood swings

Physical

t lethargy (loss of energy), unexplained weight loss, orunexplained physical complaints (such as continuingheadaches)

t changes in eating patterns, including eating more andmore or loss of appetite

t changes in sleeping patterns, including excessivesleep or insomnia

Mental

t apathy (loss of motivation), difficulty making simpledecisions or fulfilling responsibilities

t changes in behavior, such as increased daydreamingor fantasizing

t thoughts, words, plans, or acts that are suicidal

de•pres•sion—A mental/emotional disorder marked especially by sadness, inactivity, difficulty in thinkingand concentration, a significant increase or decrease in appetite and time spent sleeping, feelings ofdejection and hopelessness, and sometimes suicidal tendencies. See chapter 33, “Suicide.”

“Depression is more than feeling low. It is a syndrome, a set of symptoms that indicates something moreserious than ordinary low mood states. Evaluation includes two key considerations—how severe is theproblem, and what is the cause?” 1 What does your counselee mean when he says that he is depressed?As a counselor, you should determine the severity and source of the depression and assess the risk ofsuicide. See chapter 33, “Suicide.”

DEPRESSION

1. Difficult situations can cause depression.• Is the counselee living with consistently

high levels of stress?• Has he recently experienced a significant loss:

of a loved one, a friendship, marriage, job,pet, opportunity, health, status, or freedom?

• Does she live with a great deal of criticismand demands, and with little support?

• Has he recently experienced a severetrauma?

2. Unhealthy thought patterns can causedepression.• Does the counselee dwell on self-talk such

as: “No one really loves me. I’m unlovable(ugly, stupid, weak)”?

• Does she have unrealistic expectations of howthe world, other people, or she should be?

• Does he focus only on the negative in everysituation?

• Is she pessimistic, often creating a negativeself-fulfilling prophecy?

3. Long-term beliefs can cause depression.• Has the counselee’s family and background

modeled a depressive attitude?• Has he learned to use his helplessness as a

means of coping?

• Does she have unresolved anger at her fam-ily, herself, God, or life in general?

• Does he have unconfessed sin or an unwill-ingness to forgive or be forgiven?

• Does she have guilt (real or imagined)?

4. Physical factors can cause depression.• Does your counselee consistently cut short

his sleep?• Does she get insufficient exercise?• Is he taking a medication that might have

side effects?• Is there a possibility of alcohol or drug abuse?• Are any physical illnesses present?• Could poor nutrition be an issue?More complex physical illnesses can be diag-

nosed only by a medical doctor and may be relievedwith appropriate medication. These include:

• neuro-chemical imbalance • brain tumors • hormonal imbalances• thyroid and pituitary glandular disorders• cancer • Parkinson’s disease • anemia • various brain diseases.

Counseling ToolSince the depressed person often struggles to articulate his

problems, the counselor may approach the counselee with thistype of dialogue: “As I talk about some of these commoncauses of depression, I want you to think about which of thesemight be most typical of your situation. If you hear one ortwo which sound right, let’s start there.”

The guilt that thedepressed person is feelingcould be true guilt for hissins. Ask him to tell youabout his relationship withGod. He may not yet knowJesus as his Savior or under-stand true forgiveness.

WHY IS THIS PERSON DEPRESSED?

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See “Resources” at the end of this chapter for additional reading material on this subject.

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But I Need My Depression! Once depression gets a foothold, its victim maybegin to behave in a way that reinforces the depression. Depression “may not be pleasant,but it does help an individual avoid responsibilities, save face, attract attention, and have anexcuse for inactivity.”2 The self-pity that usually accompanies depression also serves as a wayto deal with loss. “Eventually however, emotionally hurting people realize that the benefitsof depression are not really satisfying. Such people begin to hate what they are doing and,in time, they may end up hating themselves,” 3 which in turn can create more depression.

An Important Antidepressant: Social Skills

Explore your counselee’s patterns of relating to others.Does she withdraw from social contact? Is she lacking in “peo-ple skills”? As a counselor, you can help by being a healthymodel of relational skills. You also need to promote opportu-nities for her to take safe risks in practicing these skills andthen offer positive feedback, sprinkled with suggestions forcontinued growth. Depression will be prolonged if she avoidsconfronting her weak areas. As a counselor, you can help hertake her first step in overcoming these barriers.

Ask your counselee to describedepression. It feels like:

• a small cloud that comes andgoes with the natural disappoint-ments in life.

• a dreary, pervasive fog thatclouds my perception of realityat times.

• a crashing thunderhead thatpounds me, leaving me fearfuland unable to function.4

Be on the alert forcounselees who make long-term decisions while they aredepressed. They may talkabout quitting their jobs, drop-ping out of school, or makingunwise relationship decisions.Urge them to wait till thedepression lifts before makinga life-changing choice, or inthe case of prolonged depres-sion, urge them to not makethe decision alone.

DEPRESSION AND MEDICATIONShould believers take antidepressant mediction? Does taking

medication mean they’re not relying on God? Does it signal alack of faith?

Medical studies have demonstrated the link between depressionand changes in brain chemistry. Experts disagree as to whetherthe changes are a cause or an effect of depression, but the factremains that the neurotransmitters in a depressed individual’sbrain are out of balance. Because of this, medicine for depressionthat changes brain chemistry is highly effective in alleviatingintense feelings of hopeless or sadness in most individuals.

Without medication, some believers feel unable to cope withlife. Antidepressants can enable them to feel strong enough tomake needed changes. Godliness is measured by whether we areliving daily for the Lord, regularly turning away from sin, andreaching out in love to those around us. If medication helps adepressed person to do this more effectively, then it is a blessingin their life.

Myths and Facts about Antidepressant MedicationMYTH FACT

Taking antidepressants means I’m not relying on God. A person can both rely on the Lord and takemedication to alleviate depression.

Antidepressants will make my problems better. Problems will remain, but a person will feel more ableto deal with them.

Medication alone can cure depression. Life patterns and habits should still be evaluated.

Biblical Instruction and EncouragementOffer practical, applicable scriptural truths for overcoming depression.

S T E P T W O

Scripture offers us many purposes behind our suffer-ing and pain. We suffer

4 so that God may teach us patience (James 1:3).

4 so that God may bring us to repentance (Heb. 12:5–11).

4 so that we might comfort and encourage others (2 Cor. 1:3–6).

4 so that we may glorify God (John 9:1–3; 1 Peter 4:16).

4 so that we may share in Christ’s suffering (Phil. 3:10).

4 so that we may be strengthened (1 Peter 5:10).

4 so that others will be saved (2 Tim. 2:8–10).

4 to conform us to Christ’s image (Rom. 8:28–29).

4 to move others to comfort and pray for us (2 Cor. 1:8–11).

4 to keep us from sin (2 Cor. 12:7).

4 to motivate us to learn to go to God for help (Ps. 30:6–8).

4 to allow us a special experience of God’s presence(James 4:6–8).

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DEPRESSION

Like the rest of us, principal Bible characterssuch as Moses, Elijah, David, and Jonah struggledwith the “dark night of the soul”—those desperatefeelings of hopelessness.

More than anything, the depressed personneeds hope. Webster defines hope as “desire accom-panied by expectation of or belief in fulfillment.”5 Ahopeful person longs for something and anticipatesit happening. Your counselees need hope that some-day the gray clouds that shroud their lives aregoing to lift and they will feel better.

Listen to David’s cry to God:Save me, O God,

for the waters have come up to my neck.I sink in the miry depths,

where there is no foothold.I have come into the deep waters;

the floods engulf me.I am worn out calling for help;

my throat is parched. My eyes fail,

looking for my God. (Ps. 69:1–3)

In our bodies, pain is a warning

signal of something that’s gone wrong.

Good doctors don’t just treat symptoms;

they get to the root cause. God has a pur-

pose for this emotional pain in your

counselee. Encourage her to examine the

possibility that He wants her to face some-

thing that has gone amiss in her life or

relationships and remind her to be willing

to submit to His direction. The exception

to this could be the natural pain of grief

associated with a significant loss---but

even then, she may find lessons to be

learned amidst the pain.

Chuck’s Counsel for the Depressed

“I have found that my first step towarda solution is turning ‘to the Lord’—going‘before Him’ as David did. To stay at thebottom, lick my wounds, and roll in mis-ery leads only to deeper despair. Callupon Him—shriek if you must—butdon’t sit for days in the silence of self-pity! God longs to hear your words.” 6

Depressed people often questionGod’s presence, character, or plan.Throughout the Bible, godly individualsexperienced these same emotions. Let thecounselee express his disappointment withGod, and then direct his thinking back toGod’s promises of love and faithfulness.Philip Yancey’s book Disappointment withGod explores this topic with great insightand encouragement.

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ELIJAH—GREAT SUCCESS, GREATLY DEPRESSED

Elijah, God’s great prophet, suffered from depression after his victory over wicked Queen Jezebel at Mount Carmel.How could Elijah be depressed after a victory like that? Let’s look at the contributing causes. (Read 1 Kings 19.)7

Self-pity often comes when you have

established an unrealisticstandard and then failed to match it. When we letGod set our standard, we can live within Hisexpectations, because He is always loving,always faithful, and

always accepting.

1. He wasn’t thinking clearly. As Elijah collapsedunder the juniper tree, he failed to consider thesource of his discouragement. It hadn’t comefrom God, but from wicked Jezebel. He waswallowing in the wash of his emotions ratherthan examining them for accuracy.

2. He separated himself from strengthening rela-tionships. Verse 3 concludes he “left his servant.”Lonely people are discouraged people. Junipertrees are skinny trees—shade for only one.

One of the best things Elijah could have donewas to get with someone who could bring himstrength and objectivity. But it’s interestinghow human nature works. When we get dis-couraged, the very first thing we tend to do is

to get alone. And that’s often the worst thingwe can do.

3. He was caught in the emotional slump fol-lowing a great victory. Often, our most vulner-able moments come after a tremendous effortor big success.

4. He was physically exhausted and emotionallyspent. Fatigue brings with it a great vulnerabil-ity to depression.

5. Elijah submitted to the beast: self-pity. Self-pity will lie to you. It will exaggerate. It willlead you to tears. And, seriously, it may bringyou to the very point of suicide, as it did Elijah:‘’I have had enough, Lord . . . take my life”(v. 4).

Elijah RefreshedThe great Elijah, follower of God, heroic servant . . . sniveling on

a hillside. How did God handle him? Clap him on the back—“Get a grip, buddy?” Chide him—“Where’s your faith?” No.

1. God gave him rest and refreshment (1 Kings 19:5–8).

2. God spoke with him gently (vv. 9–18).

3. God reassured him of his continued worth. Essentially, God said,“You’re still important! You’re not perfect, but you’re still Mychoice” (see vv. 15–18).

4. God provided him with a friend who would minister to him(vv. 19, 21).

Ministry ofEncouragement

to Others“When we honestly ask our-

selves which persons in our livesmean the most to us, we often findthat it is those who, instead of giv-ing much advice, solutions, or cures,have chosen rather to share our painand touch our wounds with a gentleand tender hand.” 8

God used gentle questions to help Elijah seemore accurately the truth of his situation. Whenyou talk with those who are low or discouraged,

follow His example. Admonitions and advicewill only drive them further down.

Psychologists, whether they are aware of it ornot, have borrowed their questioning approach

from God’s counseling methodology.

KEEP IN MIND

Glimpses of God beyond the GrayKeep reminding the counselee

that God can and will usethis experience for good

in her life. She mayrationalize, argue,

ignore, or shoutagainst it, but encourage

her to believe that God is working. He isteaching prayer, patience, goodness, and ahope that can never be broken. He will notwaste even this—whether He engineered itor not, He will redeem this circumstance andturn it into a gift.

Moses—Overcome with the Pressures of Leadership (Exodus 18)PHYSICALLY: He didn’t know how to delegate. He took everything on himself, and this wore him out.EMOTIONALLY: He felt inferior to the task. The burden of leading the people appeared too big for him.SPIRITUALLY: Overcome by his burden for the people, he had shifted his focus away from God.

Elijah—Running from Jezebel after the Victory on Mount Carmel (1 Kings 19)PHYSICALLY: He was exhausted. His adrenaline had been pumping so hard and for so long that he was

depleted of all energy.EMOTIONALLY: He feared for his life.SPIRITUALLY: His fear of Jezebel overshadowed his faith in God.

Jonah—Wanting to Die after the Salvation of Nineveh (Jonah 4)PHYSICALLY: He was exhausted after his ride in the fish and the days of fervent teaching.EMOTIONALLY: He was torn between the expedient need to obey God and resentment of God’s concern

for such heathen people.SPIRITUALLY: He was angry toward God because of God’s mercy toward Nineveh.

David—Hiding in the Wilderness from Murderous Saul (Psalm 69)PHYSICALLY: He was worn out from running and scrounging for food and shelter.EMOTIONALLY: He described himself as “drowning.” He felt utter despair for his life.SPIRITUALLY: He waited on God for deliverance. He pleaded with God for answers and rescue.

Remember These Biblical Principles:• Depression is a symptom of a deeper prob-

lem that needs attention.• Rest and stress relief can help alleviate the

gloom.• Self-pity perpetuates the downward spiral

(1 Kings 19:1–10).

• Reassurance of God’s love for us is a criticalcounter to overwhelming circumstances (2 Cor. 4:8–11).

• The Enemy of our souls can be the author of depression (1 Peter 5:8). Fight him with allyou’ve got, no matter what the other causesmay be.9

DEPRESSION—A PROBLEM WITH MULTIFACETED CAUSES

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DEPRESSION

Be very careful about yourtiming when you share biblicalencouragement with depressedpeople. They may not be ready orable to accept those ideas right away.

When false guilt is present, guardagainst increasing it. When genuineguilt is present, help your counseleeto be released from it by leading himthrough 1 John 1:9.

Note how the following biblical characters were overcome by feelings of depression through the physical, emo-tional, and spiritual elements of their lives.

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Practical Helps for TodayOffer short-term help to those presently engulfed in depression.

ACTIONS THAT ATTACK DEPRESSION

1. Keep up your dailyroutine if it is at allpossible. . . . It ismore beneficial foryou to get up in themorning, get dressed,have breakfast, go toyour place of work[or do your house-hold tasks] and gothrough the motionsof working than toremain home in bedwith your discom-forting thoughts.

2. Try to get out, even for very short periods oftime.

3. Try to see family members and friends asmuch as possible, but for very short periods oftime.

4. Deliberate physical activity is a sine quo nonfor overcoming depression. We do not meancalisthenics or vigorous sports—unless youwant to try them—but involvement in anyphysical activity you ordinarily might like.

5. If you find it difficult during this period to talkto the people you live with, try writing a note,[explaining your feelings and struggles].

6. Let your partner know that it’s really not“business as usual” [in your relationship].

7. Try to remember that severe depressionsusually end. If you can believe that you willnot always be feeling this way, you might findeach day easier to get through.

8. Eat . . . small amounts of food [several timesthroughout the day].10

9. Deal with anger in a biblical manner(Eph. 4:26).

10. Find a trustworthy person, a family member,or friend to whom you can pour out your heart.

11. Change the way you talk to yourself. Instead of dwelling on your faults, look for positivethings in your life.

12. Understand your feelings, but focus on yourbehavior.

13. Utilize the Word ofGod as a resource ofencouragement andpower.14. Build relationshipswith others. Withdraw-ing only reinforcesdepression.15. Choose healthyways to cope withstress.16. Join a support groupwhere you can learn

from others seeking victory from depression.17. Learn to laugh at life.18. Play praise or worship music in the back-

ground as you go through your day.19. Realize there is hope. You will feel better

someday.Non-clinical depression usually “bottoms out”

within three weeks. After that, the person begins toimprove. However, a person with one untreated attackof depression runs a 50/50 risk of a second attackwithin three years.

For the Counselee

If morning is the worst time ofthe day for you, this may help.

Today’s goal—When you wake in themorning, do not lie in bed—get up right away,no matter how you feel. (This is your biggestchallenge!) Turn on some music or talk radio,and head into the bathroom. Step into a warmshower and soap down. Gradually turn thewater to cool, then jump out and towel offquickly. As you move into your bedroom todress, renew your list of things to do that day.Move into your schedule right away and keepup the momentum. Plan a good time for a walkor other exercise. Congratulate yourself! Theworst part of your day is under your control.11

Small goals are important for depressedpeople. As self-concept and confidence are

being restored by these small victories, your counselee will be able to take on new and biggergoals. In most cases, behavioral changes comebefore thinking patterns can begin to change.Choose one or two of the ideas on this page.Ask your counselee to practice them during

the next week and be prepared to talk about them in the next session.

S T E P T H R E E

Resurrection Evidences God’s Compassion

“God does not condemn our moments ofdespair and unbelief. He Himself set the tone bydiving into earth and enduring cruel, senselesssuffering. Before the final moment, His own Sonasked if the cup could pass from Him, and on thecross cried out, ‘God, why have You forsakenMe?’ The full range of anger, despair and black-ness . . . is present in the Christian message—complete identification with the suffering world.

“But Christianity takes a further step, whichhas been a stumbling block to many. It is calledthe Resurrection, the moment of victory whenthe last enemy, death itself, was smashed. [God]invites . . . you and me to step into joy andvictory. [God] does not ask us to accept a Polly-annaish world, He simply adds a further, mys-terious layer to human experience. He asks forhope in spite of hopeless surroundings. Whensuffering bleeds us, He asks us not to rejectHim, but to respond to Him as children, trust-ing His wisdom and affirming, as Corrie tenBoom said, ‘However deep the pit, God’s loveis deeper still.’”15

For the Counselee

Gotta Get Perspective . . . But How?Stop trying to discover why. Some answers arenot to be found this side of heaven.Look for good and expect to find it. Yourchoice of attitude will often determine what you find.As you can, concentrate on ways to help others.It will help to change the focus of your self-pity.Keep a journal. This record of God at work in your life can be a wonderful outlet for emo-tions and an avenue to gain perspective andexpress what’s on your mind.Cultivate intimacy with God. Spend timealone, thinking, praying, and seeking God. Read the Psalms and rejoice in His character.

“We are wholly in the hands of God.What we’re going through is redemptive.

It’s not lost time, wasted life, a parenthesis on realliving. No, a classic dark night of the soul is anexperience designed to transform, elevate, and

move us on and up the ladder of spiritual growthand commitment. It’s something God in His

wisdom and mercy uses for good, despite themaelstrom of evil that surrounds us.”14

4

4

4

4

4

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DEPRESSION

Women, Hormones, and Depressiono Contrary to once-common opinion, womenduring menopause are not predisposed to biologi-cally induced depression. Women may indeed feeldepressed during menopause, but this feeling is justas likely to be caused by other changes in their lives.

o Some women experience severe mood fluctua-tions with their monthly cycles. While biologicalchanges may be at the root of their depression, becareful not to conclude that the mood swing is onlyrelated to their menstrual cycle. Other factors maybe involved, and a doctor should be consulted.

o “The baby blues,” or postpartum depression, isone documented type of depression in women. Amild “maternity blues” occurring on the third orfourth day after birth is common among mothers andusually passes within a day or two. Those aroundher should be supportive and reassuring. Keep awatchful eye for later depression, as a small percent-age of mothers will become moderately to severelydepressed during the months after birth. This laterdepression should not be confused with the “babyblues” and should receive medical attention.12

The Four R’s of Counseling the DepressedRAPPORT—Establish a good rapport with your

counselee. Talk with him about his family,job, friends, and background. The mosteffective approach balances being warmand accepting with being firm and objective.

REASSURANCE—Depressed people need con-tinual support. The handout “Because GodLoves Me” found at the end of this chapteris an example of spiritual reassurance.

REVELATION—You will discover insights intothe negative thoughts and behaviors caus-ing your counselee’s depression. Help yourcounselee turn these discoveries into posi-tive growth.

REORGANIZATION—As the depression lifts,your counselee will need help understand-ing the causes of the depression and find-ing proactive ways of dealing with thosefeelings the next time they occur.13

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Because her perspective is clouded, the depressed person may be unaware of God’s minister-ing Spirit and her own growth, which may be obvious to others. But God does something marvelous inthe person who, despite her pain, remains consistent in her desire to trust God. She is learning patience ina world out of her control, discovering gentleness when she’d rather despair or lash out, and learning theintimate nuances of trusting God’s character when her vision is blocked. Depression often brings tremen-dous depth to the sufferer’s relationship with God, as she surrenders to His direction while travelingthrough the dark valley.

Lifetime Principles for GrowthMinister biblical hope and a long-term perspective

to those suffering from depression.

For the Counselee

For the Future: Detouring around DepressionChristian psychologist Gary Collins offers nine ways you can prevent or lessen the severity of depression.16

Trust in God. Faith does not preclude sadness ordistress. But a conviction that God is alive andin control will give hope and encouragementand will light the way out of the darkness.

Expect discouragement. Jesus warned that wewould have problems. The apostle James echoedhim, writing that trials and temptations wouldcome to test our faith and teach us patience.

Be alert to depression-producing situations.Anniversaries and birthdays that remind us of lost loved ones and holidays that can’t meetexpectations are just a few predictably depres-sive times. Realize they are coming andprepare for them.

Learn to handle anger and guilt. Some peopleslide into depression by dwelling on past injus-tices or failures. Ask God to help you forget thepast, forgive those who have sinned againstyou, and let go of your regrets.

Challenge your thinking. Pay attention to whatyou say to yourself and don’t assume it’s true.The Bible gives us guidelines for healthy think-ing (Phil. 4:8). Follow them!

Learn coping techniques. Learning how to copewith the stresses of life gives us some controlover our circumstances, preventing the feelingsof helplessness that so often lead to depression.(See “Actions That Attack Depression” in Step 3.)

Find support. The comfort and perspective of oth-ers can help you prevent depression’s worstdepths. Some valleys may still be dark, but youdo not have to walk through them alone.

Reach out. By considering how to ease someoneelse’s pain, your own depression is oftenreduced.

Practice physical fitness. Because poor diet andlack of exercise can make people susceptible todepression, you can combat depression’s influ-ence by taking care of your body.

“Brothers, as an example of patience in the face ofsuffering, take the prophets who spoke in the name ofthe Lord. As you know, we consider blessed those whohave persevered. You have heard of Job’s perseveranceand have seen what the Lord finally brought about. TheLord is full of compassion and mercy.” (James 5:10–11)

Depression dims our perspective of how God is working

in the overall plan of our lives.

S T E P F O U R

REPLACING NEGATIVE THOUGHT PATTERNS

“As we work with a [depressed] person, wemust follow several steps to correct his thinkingdisorders. First, we must help him become awareof what he is thinking. Then we must help himrecognize which of his thoughts are distorted.Third, we must help him substitute accuratethoughts and judgments for the inaccuratethoughts. Then he needs to have some kind offeedback to inform him whether his changes arecorrect or not.” 17

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DEPRESSION

If you are working with adepressed individual and observe

no signs of improvement after a monthor two, re-evaluate the possibility of anincorrect diagnosis and consider refer-ring or consulting for further evaluation.If the person you are counseling becomessuicidal or makes a dramatic withdrawalfrom your relationship, seek professionalhelp for them.

Resources

Biebel, David B., and Harold G. Koenig. New Lighton Depression: Help, Hope & Answers for theDepressed & Those Who Love Them. Grand Rapids,Mich.: Zondervan Publishing House, 2004.

Carter, Les, and Frank Minirth. The Freedom fromDepression Workbook. Nashville, Tenn.: ThomasNelson, 1995.

Hart, Archibald D. Unmasking Male Depression.Nashville, Tenn.: W Publishing Group, 2001.

Hart, Archibald D., and Catherine Hart Weber.Unveiling Depression in Women: A Practical Guideto Understanding and Overcoming Depression.Grand Rapids, Mich.: Fleming H. Revell Co.,2001.

LaHaye, Tim. How to Win Over Depression, updatedand expanded. Grand Rapids, Mich.: ZondervanPublishing House, 1996.

Lloyd-Jones, D. Martyn. Spiritual Depression: ItsCauses and Its Cures. Grand Rapids, Mich.:William B. Eerdmans Publishing Co., 1965.

Swindoll, Charles R. Elijah: A Man of Heroism andHumility. Nashville, Tenn.: Word Publishing, 2000.

———. “The Problem of Depression,” from the ser-mon series, Facing Life’s Problems with God’s Hope.Plano, Tex.: Insight for Living, FLP03A, 1972.

A Word from ChuckIf you are in the cave of depression, try

your best to look up. Call upon the Lord JesusChrist. Hold nothing back. You can trust Himto handle whatever you toss in His direction.Tell Him exactly how your situation is affect-ing you. If you are able, spell out preciselywhat you need at this time. Rely on Him.Do not doubt and do not waver. Stand firm.Remember, you are in His schoolroom. He isthe Teacher. He is giving you a lengthy exam-ination in the crucible of suffering . . . andno one can give you a more complete examthan our Lord! . . .

Hang in there, my friend. He is preparingyou for a unique message and an enviableministry. Believe it or not, that dark cave ofdepression which seems endless is part of Hisdivine plan. Who knows? The light you havebeen longing to see could return today.19

Dismiss the MythsMyth: Depression always results from sin

or lack of faith in God.

Myth: Depression is caused by self-pity.

Myth: It is wrong for a Christian to everbe depressed.

Myth: A “depressed Christian is a contradiction of terms.”18

REIN IN THOUGHTS TOHARNESS FEELINGS

Sad things happen, but our thoughts caneither help or hamper our ability to cope. Theycan send us into a downward spiral or nudgeour noses above water. As a step along the roadout of depression, encourage your counselee toresist destructive thought patterns with theHoly Spirit’s help (see Prov. 23:7 NASB).

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Homework

Explore with your counselee her physical, emotional, and spiritual condition. Ask her to write howshe is doing in each area. The questions provided may help her get started. Reassure her that fallingshort of the ideal in any area(s) is okay and that she doesn’t need to worry about measuring up toanyone else’s expectations or demands. Encourage her to tell it like it really is. Conclude this time inprayer, asking God to direct your desire to help.

Physically• How do I refresh myself after an exhausting

accomplishment in order to avoid depression?• How do I rate my physical shape? What

would help me become more physicallyenergized?

Emotionally• When I experience a loss, where do I focus

my thoughts? Do I generally perceive the situation clearly?

• In what ways are my friendships a strengthto me when I’m discouraged?

• How have my thoughts about myself beenaffecting my attitude? In what ways can I bemore positive and confident?

Spiritually• In what ways am I disappointed with God?

How am I dealing with this?• How long has it been since I felt free to wor-

ship, grow through Bible study, or be ener-gized by prayer? 20

JournalA time of personal analysis can yield a great

deal of insight. In your journal, describe the“cave” you feel you are in today. Spend a fewminutes thinking through the reasons you findyourself submerged by such dark feelings anddismal outlook. Do they include:

• Something from your recent past?

• Something you feel angry about?

• Something between you and another person?

• Something you resent or thought had ended?

• Something you fear in the future? 21

Awareness of God’s love for you can bringreal comfort even in the middle of depressiveheartache. Memorize sections of Romans 8 andJohn 10 to remind yourself of His unchanging,unfathomable love for you.

Symptoms of Low-Grade Chronic Depression(All assume a persistent change from normal behavior,lasting two weeks or more.) • Are you tired even when you have had enough sleep?

Do you have difficulty getting yourself going in the morn-ing? Do you accomplish less than you like?

• Are you restless?• Have you lost interest in . . . your family? In your

work? In your friends? In your sex life?• Are you unable to make decisions?• Are you continually angry and resentful?• Do you often have feelings of dread as if something

terrible is going to happen?• Are you self-destructive; experiencing feelings of

helplessness, inertion, or addictive behavior?• Are you critical of yourself? Do you often feel

inferior or inadequate?

• Do you spend a great deal of time daydreaming?• Do you have “up” weeks and “down” weeks?• Has your appetite changed? Do you want to eat more or

less?Symptoms of Severe or Clinical Depression

• Do you cry often?• Have your sleeping habits changed? Does it take you

longer to fall asleep? Do you wake up several hoursearlier than you want to?

• Do you sleep more than you used to?• Does the thought of food almost make you sick?

Have you lost weight without dieting?• Do you feel full of guilt?• Do you think about ending your life?• Do you feel “unreal,” as if you’re “in a fog?”• Do you find you can’t concentrate and that you go

over and over certain thoughts? 22

DIAGNOSTIC QUESTIONS FOR DEPRESSIONThe following questions help diagnose not just the existence of depression, but also its severity and

duration. Depending on the results of your interview, refer to Steps 1 and 3 for suggestions on how torespond to your counselee’s depression.

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DEPRESSION

BBECAUSE GOD LOVES ME1 Corinthians 13:4 – 8

B ecause God loves me, He is slow to lose patience with me.

DeEB ecause God loves me,

He takes the circumstances of my life and uses them in a constructive way

for my growth.DeE

Because God loves me, He does not treat me as an object to

be possessed and manipulated.DeE

Because God loves me, He has no need to impress me with how great and powerful

He is because He is God, nor doesHe belittle me as His child in orderto show me how important He is.

DeEBecause God loves me,

He is for me. He wants to see me mature and develop in His love.

DeEBecause God loves me,

He does not send down His wrath for every little mistake I make, of

which there are many.DeE

Because God loves me,He does not keep score of all my sins and then beat me over the head with them whenever He gets the chance.

DeEBecause God loves me,

He is deeply grieved when I do not walk in the ways that please Him,

because He sees this as evidence that I don’t trust Him and love Him as I should.

Because God loves me, He rejoices when I experience His

power and strength and stand up under the pressures of life for His Name’s sake.

DeEBecause God loves me,

He keeps on working patiently with me even when I feel like giving up and can’t see why

He doesn’t give up with me, too.DeE

Because God loves me, He keeps on trusting me when

at times I don’t even trust myself.DeE

Because God loves me, He never says there is no hope

for me; rather, He patiently works with me, loves me and disciplines me in such a way that it is hard for

me to understand the depth of His concern for me.

DeEBecause God loves me,

He never forsakes me even though many of my friends might.

DeEBecause God loves me,

He stands with me when I have reached the rock bottom of despair,

when I see the real me, and compare that with His righteousness, holiness,

beauty, and love. It is at a moment like this that I can really believe

that God loves me.DeE

Yes, the greatest of all gifts is God’s perfect love! 23

Permission granted to duplicate this page.

436

1. William A. Miller and Kathleen A. Jackson, PracticalPsychology for Pastors, 2nd ed. (Englewood Cliffs, N.J.: Prentice-Hall, 1995), p. 229. Reprinted by permission of PearsonEducation, Inc., Upper Saddle River, NJ.

2. Gary R. Collins, Christian Counseling: A Comprehensive Guide,rev. ed. (Dallas, Tex.: Word Publishing, 1988), p. 110.

3. Collins, Christian Counseling, p. 110.

4. Adapted from the study guide Great Stories from OldTestament Lives, written by Bryce Klabunde, from the Bible-teaching ministry of Charles R. Swindoll (Anaheim, Calif.:Insight for Living, 1992), p. 44.

5. Webster’s Ninth New Collegiate Dictionary (Springfield, Mass.:Merriam-Webster Inc., Publishers, 1984), see “hope.”

6. Charles R. Swindoll, Living Beyond the Daily Grind:Reflections on the Songs and Sayings of Scripture (Book II)(Dallas, Tex.: Word Publishing, 1988), pp. 382–383.

7. The sections “Elijah—Great Success, Greatly Depressed”and “Elijah Refreshed” are adapted from Charles R. Swindoll,“Sure Cure for the Blues” message in The Life and Times ofElijah audiocassette series (Anaheim, Calif.: Insight for Living,1975), ELJ04A.

8. Henri Nouwen in Out of Solitude, as quoted by MarkLittleton in The Storm Within (Wheaton, Ill.: Tyndale HousePublishers, 1994), p. 117.

9. For further information, see “The Problem of Depression”message by Charles R. Swindoll in Facing Life’s Problems withGod’s Hope audio series (Plano, Tex.: Insight for Living, 2003),FLP03A.

10. Numbers 1–8, Helen A. DeRosis and Victoria Y. Pelegrino,The Book of Hope: How Women Can Overcome Depression (NewYork, N.Y.: Macmillan Co., 1976), pp. 17–18.

11. Adapted from John Shelton and J. Mark Ackerman,Homework in Counseling and Psychotherapy (Springfield, Ill.:Charles C. Thomas, 1974), p. 96, as quoted by H. NormanWright in Crisis Counseling: What to Do and Say During the FirstSeventy-Two Hours, updated and expanded edition (Ventura,

Calif.: Gospel Light Publications, Regal Books, 1993), p. 118.

12. For more information, see Miller and Jackson, PracticalPsychology for Pastors, 2nd ed., pp. 223–224.

13. Based on Louis Jolyon West, “Integrative Psychotherapy ofDepressive Illness,” from The Nature and Treatment of Depression,Frederic F. Flach and Suzanne C. Draghi, eds. (New York, N.Y.:John Wiley & Sons, 1975), pp. 170–173.

14. Mark Littleton, The Storm Within, p. xiv.

15. Phillip Yancey, Where Is God When It Hurts? (Grand Rapids,Mich.: Zondervan Publishing House; Wheaton, Ill.: CampusLife Books, 1977), pp. 93–94.

16. Based on Collins, Christian Counseling, pp. 115–118.

17. H. Norman Wright, Training Christians to Counsel (Eugene,Ore.: Harvest House Publishers, 1977), p. 79.

18. Collins, Christian Counseling, p. 106.

19. Swindoll, Living Beyond the Daily Grind, pp. 385–386.

20. Based on Great Stories from Old Testament Lives, BryceKlabunde, pp. 44–45.

21. Based on Swindoll, Living Beyond the Daily Grind, p. 387.

22. Adapted from DeRosis and Pelegrino, The Book of Hope,pp. 4–16.

23. Dick Dickinson, (Los Alamitos, Calif: Interface PsychologicalServices, n.d.) as quoted by Wright in Training Christians toCounsel, p. 83. Used by permission of Dr. H. Norman Wright.

NOTES

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