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

Hi Lucy, nice to meet you Hi, so I understand that your GP recommended you here because you've been feeling quite depressed lately. Yes, I thought I should. I've been feeling pretty bad for quite a while, so I thought maybe it was time. see someone about it because I don't want to feel that way anymore okay from your notes I saw you went to the GP about 3 months ago yeah so how long have you been feeling depressed a few months. before that too, actually, but it's gotten pretty bad in the last few months, so that's why I came good.

Has it gotten worse since you saw your GP? Yeah, okay, so tell me how things are right now. Well, it's something like that. I started to feel a little depressed and ended some things, but I don't know, recently. I just can't be bothered to do anything. I find it hard to get motivated for things and I really want to be. I want to be better, but now I'm reaching the end where I just want to do something about it. So you said that you feel very depressed, very sad, yes, and you feel like you have no motivation. but are you okay, yeah, okay, sorry, okay, and you don't have any motivation, but it seems like you're putting a lot of pressure on yourself to try to feel a little better, yeah, it's just a little bit hard too because there's really no There's no one to talk to, so I'm left alone trying to do it.

I don't like to think about it, but I know it. Okay, so you say you've been feeling quite isolated, there aren't many people. Yes, there is no one I can talk to about this, no one would listen to me or understand me anyway, okay, so I will try to find out a little more about you to understand that you are an English student at University. Yeah and um you live away from home with some friends that's right yeah I live here okay so no you don't live far from the university but you say you feel like you live with your friend but you don't feel like you can talk with them, yeah, I mean, they're lovely.

I get along very well with them, but I don't know. Recently, whenever they want to go out or things like that, I just don't want to tear them down. Can. They don't understand what I'm going through, I don't know, they don't make fun of how I feel, but they really don't understand what it's like, I just don't want to go. Go out with them and bring them or stuff, it's okay, that's what it sounds like, are you trying to hide what you feel from them? I guess it's easier to hide it than try to explain it all the time when no one really wants to.

I know it's okay, so it sounds like you've been feeling depressed, you've been feeling unmotivated, you feel like you want to be better, but really it sounds like you feel like you can't ask for help, you can't talk to anyone. No, I don't talk to my parents much either, so it's a little difficult. OK. I'm going to go back in time a little. I guess I'm wondering when all this started. You said it was. This went on for quite a few months, yeah I guess it started when I was actually revising for my exams, I guess the stress put a lot of stress on myself, I think I always wanted to do well.

I guess for my parents and I, the stress of the exams and it was also a little difficult because my parents were going through a bit of a troubled time, so okay, this would be like last March, last April, uh, yeah , I think so. At that time, about 6 months, and it seems like there was a lot going on, so you had a lot of college pressure and you said your parents were having marital problems, okay, and it sounds like that was a real shock to you. Yeah, I guess it was also difficult because I wasn't doing well in college.

I guess I felt a little guilty. I know it sounds silly, but I felt like maybe if I could do better, they would get better, but they did. It's not really happening right, so it sounds like you're trying to work hard and yeah, and be more successful because you thought that would make them happier and try to fix things. Yes, I wanted to make them feel better, but it was just like P shot. bit, I guess how it backfired, it ended up with them getting worse and I've been feeling worse ever since, okay, after the summer, um, after exam period, um, and how did that exam period go at the end, no very Well, okay, it's a lot of pressure on yourself and you're supposed to think it'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 for that, so you say I know.

I know I should have done better, yes. I guess, hearing it from my perspective, I think it sounds like you had a lot going on at the time. It would be totally understandable if you didn't do as well as usual. I guess I'm just wondering if you have very high standards for yourself, probably maybe more than other people, my parents have always taught me, not in a loving way I guess, but that you should do the best you can but also get the best and I. I agree, I think it's the right thing to do, but when I don't do it, I don't know, it bothers me a lot and I worry that it will bother them, so it seems like you feel like you should always do the best you can. the word that you used, yeah, um, and that there's no kind of exception for that, but no, okay, um, so I can see that it was a really difficult time for you and that's when your mood started to drop. and things got worse.

Still pretty bad now, I mean, what's the situation with your parents right now? I don't think it sounds good. I don't really talk to them much, but I don't think they're having a very good time. I don't like talking to them about it because it just makes me feel worse, okay, but I don't think it's getting better if you were home over the summer, uh for a while. Yes, MH, and how is that? It's not very fun, no, um. I was pretty tense the whole time, stressing out more than relaxing over the summer. I guess MH is okay, okay, so it seems like a lot has been going on, you've been feeling very depressed, you've had uni pressure on You had problems with your parents' marriage and it seems like you feel like you can't really communicate with anyone, that you can't understand where, you can't really communicate with your parents right now, you can't really trust. on your friends um, so I guess I'm wondering if you can tell me a little bit more about how you've been feeling, I mean, last week, um, it's really not good, to be honest, really, if it's not necessary. so I don't really leave the house or get out of bed.

I just don't find the motivation for the things I used to join. I used to love playing sports or going out and now I prefer to stay in bed and I didn't really do anything, okay I missed some lectures this week that I should have attended but well I guess I'm just wondering so let's see if we can think of something, I gave a lecture, what kind of thoughts do you have about going? to that conference before it happens I really don't see the point anymore if I can't do it as well as I should so what's the point of putting myself in those positions?

It just doesn't bother me anymore to try it just stresses me out more than it needs to ok so it seems like the kind of thoughts you have in your head are pointless it's not worth it yeah do you have any other thoughts in your head when you're ? At that moment, before going to the conference, I feel like I don't know. I really don't even deserve to be here if I can't do it well enough. I see all these other students doing better and better and they want to do it. Being there I don't know why I'm here, even with you.

To be honest, it seems like you feel like you're not as good as other people here, yeah, okay, um, sorry, is it okay if I take notes? As we go along, I'm just trying to understand what you're telling me and it helps me write it down and share it with you later. Okay, so it looks like those are some. Pretty negative thoughts, you're like saying you know it feels like it's pointless, it's more effort than it's worth um and I don't deserve to be here, I mean, when you have those thoughts, how do you feel? It would probably be very undignified.

The best way to say it is I don't know, just 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 and then you said I'm not worthy, I should be. do a lot of things better, um, that's what I would call thoughts, actually I guess I'm trying to understand how it feels in your gut, what kind of emotions do you feel happier, do you feel sad, what kind of emotions do you feel? when you have those thoughts Sad, not happy, not sad.

I also feel a little anger and frustration. Okay, I know when you're telling me this and I know this is a pretty heavy topic, um, but you're. I laugh a little and I guess I wonder a little about you, do you know how it feels to have these emotions? Talking about these emotions. I guess I'm ashamed. I'm MH, but I haven't talked about it yet, so there it is. It's pretty uncomfortable to be in this situation, okay, you're doing a great job because I know this can be difficult, um, okay, so it seems like some of the thoughts you're describing are useless, it's more than it's worth.

I don't deserve to be here I'm not worthy and those kinds of thoughts sound like they just go through your mind um and then you described different emotions that they lead you to are you describing sadness anger frustration ashamed what's going on in your body what's going on? how do you feel physically? I used to be, I think those emotions made me feel very stressed all the time, but recently it's been much more exhausting than anything else, I'm just quite lethargic and can't be bothered. ya and my body reflects that, but then when I try to sleep I can't seem to get a satisfactory night's sleep.

It's really time, like you said, to focus on those those thoughts, those negative thoughts, how do you feel after that? better or do you feel worse I guess I feel a little worse but then a little numb in a way once you felt that because I feel tired all the time I just try to get it out and then you don't really think about anything and it's almost better so keep it up focused on how much you are making mistakes and how much you can't do things. Sometimes it's better to just not think about it at all, so it sounds like in some ways it's a bit of a relief to do that, yes, but in other ways you might think it could make things worse probably in the long run, yes.