Read the following case example and answer the questions that follow.

HELGA: A depressed client with suicidal impulses

Helga has spent time in mental institutions because of deep depression, marked feelings of worthlessness, and several attempts to kill herself. She was born and reared in Germany and came to live in New Jersey in her late teens. She relates that she has never felt at home since she left Germany but that there is now nothing there for her to return to. She frequently mentions how lonely and isolated she feels. There are no friends in her life, no intimate relationships, and she feels a deep sense of rejection. Although she has been out of the last institution for over a year, she is an outpatient and has come to the day-treatment center on a regular basis. Assume that you are a new counselor and are seeing her for the first time. Think about how you might deal with her in the first five minutes of your initial session. At this first session Helga relates: "I just dread getting up every morning. Everything seems like such a chore. I'm afraid that anything I do will turn to failure. I see no real sense in going on. I have constant thoughts of ending my life. I'm surely no use to anyone around me. I couldn't hold a husband or any job, and then I lost my kids. I just feel so worthless and rotten and full of guilt and hate for myself. No matter what I do or try, I just can't see any light at the end of that long, dark, cold, scary tunnel. I look forward to death, because then I won't have to suffer anymore."

• In what ways might you use yourself as a person to create a relationship with Helga so that she might work through her depression? Do you think that your relationship with her by itself is sufficient, or would you see a need for interpretation, direction, and active techniques?

• Have you had enough life experiences similar to Helga's to enable you to empathize with her and enter her experiential world? How would you respond to her if she said: "You can't understand how uprooted I feel. I don't belong anywhere. But I just don't think you can know what this is like for me."