Depression has been described as the common cold of mental health problems (Hotopf, 1996) and 90 % of depression is managed in primary care (Mann, 1992). The National Service Framework (NSF, DoH, 1999) identifies cognitive behavioural therapy (CBT) as a major component of primary mental health care services, as it has a strong effectiveness research tradition (Salkovskis, 2002). CBT is a short term, structured form of therapy that provides clients with a rationale for understanding their problems (Blackburn & Davidson, 1990). CBT requires a sound therapeutic alliance; the therapist should demonstrate warmth, genuine regard and competence (Beck, 1995). It follows the premise that psychological problems arise as a direct consequence of faulty patterns of thinking and behaviour (Maphosa et al, 2000). In mild depression the person ruminates on negative themes and CBT examines the effects of people’s thoughts on how they feel and what they do (J. Williams, 1997). It is now common to draw out the central elements of CBT to offer a more condensed intervention (Teasdale, 1985). Self-help materials are usually given to clients as homework (Richards et al, 2003). Bower et al (2001) found that self-help techniques can have considerable impact on a broad range of mental health problems. Guided self-help should be considered for clients with mild depression. It is a collaborative form of psychotherapy; the client learns new skills of self-management that they can put into practice in their daily lives (DoH, 2003). The following analysis examines the role-play of a primary care graduate mental health worker (PCGMHW). These workers were part of a government plan to enhance mental health services in primary care (DoH, 2000). Throughout this analysis strengths and weaknesses of the therapist will be discussed and what improvements can be made to the demonstrated clinical skills.
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