Case study clinical example CBT: First session with a client with symptoms of depression (CBT model)

hi Lucy nice to meet you hey so I understand that you referred here by your GP because you've been feeling quite down recently yeah I thought I should I've been feeling quite bad for quite a while so I thought maybe it's time to see someone about it because I don't want to feel like this anymore okay so um from your notes I saw that you saw the GP about three months ago yeah and how long have you been feeling down altogether and quite a few months before that as well actually but it's gotten pretty bad these past few months so that's kind of why I came okay so as it got worse since you saw your gear yeah okay so tell me haven't health how are things at the moment and well it kind of started just feeling a bit low and wound up about things but I don't know just recently I I just can't really be bothered to do anything at all it kind of find it hard to get motivated for things and I want to be I really want to be better but it's just kind of reaching the hem now or I just I want to do something about it okay so you said that you're feeling really down really sad yeah and you feel like you haven't got any motivation um but are you okay yeah okay and you haven't got any motivation but it sounds like you've put quite a lot of pressure on yourself to try and feel a bit better yeah I just it's kind of hard as well because there's not really anyone to talk about some it just kind of stay on my own try to I don't like to think about it but actually so you say you've been feeling quite isolated there's not many people around yeah no one I can talk to about it don't listen I understand anyway okay so I'm just going to try and find out a little bit more about you so I understand that you're an English student at uni yeah and you live away from home with some friends is that right yeah yeah okay so you don't you don't it far from the Uni and but you say you feel like you live with your friends but you don't feel like you can talk to them yeah I mean they're lovely I get on really well with them but I don't know I just recently whenever they want to go out or stuff I just I don't want to bring them down I can't they don't understand what I'm going to they kind of I didn't they didn't make fun of how I feel but you don't really understand what it's like I don't want to go out with them and bring them down stuff okay so it sounds do you try and hide the way you're feeling from them I guess I mean it's easier to hide it then to try to explain it all the time when Lo and Brady wants to know okay so it sounds like you've been feeling down you've been feeling unmotivated and you feel like you want to be better but actually it sounds like you feel like you can't reach out for help you can't speak to anybody no I don't really talk to my parents about ether how's their hair kind of hard okay I'm just going to go back in time another suppose I'm just wondering when when did all of this start you said it's been going on for quite a few months yeah um I guess it kind of started when I was actually when I was revising for my exams um I guess the stress I put a lot of stress on myself I think I've always wanted to do well for me and I guess my parents so the stress of exams and it was also kind of hard because my parents were going through a little bit a troubled time limit so okay so this would be like last March last April yeah take so around that time so about six months ish and it sounds like a lot was happening so you had a lot of uni pressure on and he said that your parents were having marital problems okay and it sounds like that was a real shock to you yeah I guess it was hard as well because I wasn't doing well at uni any I guess I just felt a bit guilty I I know it sounds silly but I felt like maybe if I could do better than they would get better but I didn't it just wasn't really happening okay so it sounds like you were trying to work hard and be more successful because you thought that that would make them happier and try and fix things yeah I wanted to make them feel better but it just kind of kept fied a little I guess how did it backfire well it just ended up with them getting worse and I've just been feeling worse since then okay so after the summer after the exam period and how did that exam period go for you in the end not very well hey there's an awful lot of pressure to put on yourself you supposed to she's just annoying because I know I should have done better and I just didn't and I guess I beat myself up a lot of hmm so you say I know I know I should have done better I mean I suppose up hearing it from my perspective I'm thinking it sounds like you had an awful lot going on at the time it'd be understandable absolutely that you wouldn't do as well as normal I suppose I'm just wondering if you have very high standards for yourself properly it may be more than other people my parents have always kind of taught me not in a loving way I guess but that you should do your best but also get the best and I agree with that I think that's the right thing to think but when I don't do that I don't know it annoys me a lot and I worried that it annoys them so it sounds like you feel you should always do your best already is yeah and that there isn't any kind of exceptions for that but you know okay and so I can I can see then that was a really difficult time for you and that was when your moods started to get lower and things are still quite bad now I mean what's the situation with your parents at the moment um I think it doesn't sound good I don't really talk to them a lot but I don't think they're going through very good I don't like to talk to them about it because it just makes me feel worse but I don't think it's getting any better you home over the summer for a little bit yeah and how is that not very fun no hmm it was quite tense all the time stressed me out more than relaxed me over the summer idea mm-hmm okay okay so it sounds like quite a lot has been happening you've been feeling very low you've had a uni pressure on and we've had problems with your parents marriage and sounds like you feel that you can't really reach out to anyone that you can't understand but you can't really reach out to your parents right now you can't really confide in your friends and so I suppose I'm just wondering if you can tell me a bit more about how you've been feeling I mean say this past week and really not good to be honest I actually if I don't have to though I don't really leave the house or get out of but I just I can't find the motivation for the things I used to join them I used to love doing sports or going out and now I just prefer to lie in bed and not really do anything okay I missed a few lectures this week that I should have gone to but right so I suppose I'm just wondering then it's as if we can think about one thing say a lecture what kind of thoughts do you have about going to our lecture before it happens I don't really see the point anymore if if I can't do as well as I should be doing then what's the point in putting myself in those positions I just I can't be bothered anymore to try it just stresses me out more than I need to do okay so it sounds like the kind of thoughts you've got in your head are it's pointless and it's not worth it yeah do you have any other thoughts in your head when you're just at that point before you go to the lek so like I dunno I I don't really even deserve to be here if I can't do well enough I see all these other students so doing well and doing better and want to be there I don't know why I'm here even that you need to be so it sounds like you feel like you're not as good as other people here yeah okay um I'm just as sorry okay if I take this as we go through it's just I'm trying to em I guess understand what you're telling me and it helps me just to write it down and I'll share this with you later okay so it sounds like those are those are some quite negative thoughts to have you're kind of saying you know it feels like it's pointless it's more effort than it's worth and I don't deserve to be here I mean when you have those thoughts how do you feel very unworthy probably would be the best way to put it kind of I don't know lower than normal because then it makes me think about all the things I should have been doing better okay so what you described there then he said I'm unworthy I should be doing lots of things better and those are kind of what I would call thoughts actually I suppose I'm trying to understand what it feels like in your gut what kind of emotions do you feel happier do you feel sad do you what kind of emotions you feeling when you have those thoughts sad you don't happiness very sad a bit of kind of anger and frustration as well I noticed when you're kind of telling me this and I know this is quite a heavy topic but you're kind of laughing and I suppose I wonder a little bit you a bit you know how do you feel about having these emotions talking about these emotions yes embarrassed mm-hmm but is it I've never yet to talk about it's it's quite uncomfortable to be in this situation okay were you doing a great job I know I know that this can be difficult okay so it sounds like some of the thoughts you're describing our it's pointless it's more than it's worth I don't deserve to be here I'm unworthy and those kind of thoughts it sounds like they just flip through your mind and and then he's kind of describing different emotions that those lead to kind of scramming sad anger frustration embarrassed what about in your body what happens how do you feel kind of physically I used to be I think from those emotions very wound up very kind of stressed all the time but recently it's just a lot more draining than anything just quite lethargic and I can't be bothered anymore in it my body reflects that but then when I try and sleep I just can't seem to have a satisfied night's sleep it's really really frustrating so it sounds like this is affecting as it's draining you if your energy like like your body can't be bothered I think that's a really good way of describing it and you're noticing sleep problems as well and then what do you do so this is so we're back to the point before the lecture so you start having these thoughts these emotions and you know your body I guess it sounds like those thoughts quite draining so we draining your energy what then happens what you do next and I kind of focus on the negative thoughts when I probably should not think about them but it I focus on them and then I don't really want to do anything can I stay in bed or so you think even more about this kind of warring so you have to do a bit of dwelling and you stay in bed and it sounds like you don't you know you haven't tried speaking to your friends about it no family okay and then after you've done that so after you've not gone to the lecture you've stayed in bed you kind of spent time as you said focusing on those those thoughts those negative thoughts how do you feel after that to feel better or do you feel worse I guess I fill up slightly worse but then a bit numb in a way kind of once you've felt that because I do feel tired all the time I just try and push it out and then you don't really think about anything and it's almost nicer that way than to keep focusing on how much you're getting wrong and how much you can't do stuff sometimes it's better just to not think about it at all so it sounds like in some ways it's a bit of a relief to do that yeah but in other ways maybe think it might make things worse probably in the long run yeah you

Channel: Judith Johnson

Views: 1,526,734

Keywords: Depression (Symptom), Cognitive Behavioral Therapy (Medical Treatment), Mood, Therapy (Literature Subject), Clinical Psychology (Field Of Study), Judith Johnson, Stress, Health

Id: 7LD8iC4NqXM

Length: 13min 54sec (834 seconds)

Published: Thu Oct 23 2014