Case study clinical example CBT: First session with a client with symptoms of depression (CBT model)
Summary
TLDRIn this emotional dialogue, Lucy, a university English student, opens up about her struggle with persistent feelings of sadness and low motivation. She reveals her sense of isolation, difficulty in confiding in friends or family, and the pressure of high academic and parental expectations. Lucy's downward spiral began with exam stress and her parents' marital issues, leading to a cycle of negative thoughts and feelings of unworthiness. The conversation highlights her internal conflict and the challenge of coping with mental health struggles while navigating university life.
Takeaways
- đ The individual, Lucy, has been feeling down and unmotivated for several months, with her condition worsening recently.
- đ„ Lucy was referred to the service by her GP three months ago, indicating her prolonged struggle with her emotional state.
- đ She is an English student at university and lives away from home with friends, but feels isolated and unable to confide in them about her feelings.
- đ€ Lucy's low mood seems to have started during exam preparation, compounded by her parents' marital issues and her own academic stress.
- đ She feels guilty and believes that if she performed better academically, it might have improved her parents' situation.
- đ Lucy's academic performance did not meet her own high standards, leading to self-criticism and a further decline in her mood.
- đ« She experiences difficulty in reaching out for help, feeling that no one would understand or listen to her struggles.
- đ Lucy's negative thoughts include feelings of worthlessness, believing she doesn't deserve to be at university, and that her efforts are pointless.
- đĄ Along with sadness, Lucy also experiences anger and frustration, likely directed at her situation and herself.
- đ She has lost interest in activities she once enjoyed and has a lack of motivation to even attend lectures, which she finds stressful.
- đ€ Lucy's physical state reflects her emotional state, with feelings of being drained, lethargic, and struggling with sleep.
Q & A
Why was Lucy referred to the counselor?
-Lucy was referred to the counselor by her GP because she had been feeling quite down and hadn't been feeling well for a while, and she thought it was time to see someone about it.
How long has Lucy been feeling down?
-Lucy has been feeling down for quite a few months before seeing the GP, and it has gotten worse in the past few months.
What has been the impact of Lucy's low mood on her daily life?
-Lucy's low mood has led to a lack of motivation, making it hard for her to do things she used to enjoy and causing her to isolate herself from friends and family.
How does Lucy feel about her friends' understanding of her situation?
-Lucy feels that her friends are lovely and she gets along well with them, but she doesn't feel they understand what she's going through, so she hides her feelings from them.
What was the initial trigger for Lucy's low mood?
-The initial trigger for Lucy's low mood was the stress from revising for exams and her parents going through marital problems around the same time.
How did Lucy's parents' marital issues affect her?
-Lucy's parents' marital issues added to her stress and affected her emotionally, making her feel guilty and responsible for trying to fix things by doing well in her exams.
How did Lucy perform in her exams?
-Lucy did not perform well in her exams, which added to her feelings of guilt and failure, as she had put a lot of pressure on herself to succeed.
What are Lucy's thoughts about her self-worth and abilities?
-Lucy has high standards for herself and feels unworthy and inadequate when she doesn't meet those standards. She also feels she doesn't deserve to be at university if she can't perform well.
What emotions does Lucy experience when she has negative thoughts about herself?
-When Lucy has negative thoughts about herself, she experiences sadness, anger, frustration, and embarrassment.
How does Lucy's physical state reflect her emotional state?
-Lucy's physical state reflects her emotional state as she feels drained, lethargic, and struggles with sleep, which is indicative of her overall stress and depression.
What coping mechanism does Lucy use to deal with her negative thoughts?
-Lucy uses avoidance as a coping mechanism, trying to push out negative thoughts and not think about them, which she finds somewhat relieving but acknowledges might make things worse in the long run.
Outlines
đ Struggling with Depression and Isolation
The speaker, Lucy, discusses her feelings of sadness and lack of motivation with a healthcare professional. She mentions that her feelings of being down have been ongoing for several months and have worsened recently. Lucy feels isolated, unable to talk to her friends or family about her feelings, which adds to her distress. The conversation reveals that her depression may have been triggered by the stress of exams and her parents' marital issues, which she tried to alleviate by doing well in her studies. However, her efforts did not improve the situation and only added to her feelings of inadequacy and guilt.
đ€Ż High Expectations and Academic Pressure
Lucy shares her experience of the exam period, which was particularly stressful due to her high standards and the pressure to perform well, not just for herself but also to potentially improve her parents' situation. The outcome of the exams was not as expected, leading to self-criticism and a sense of failure. She acknowledges that her parents have instilled in her the belief that she should always strive for the best, which contributes to her feelings of inadequacy when she does not meet these expectations.
đ Negative Thoughts and Emotional Drain
In this paragraph, Lucy delves into the negative thought patterns that have taken hold of her mind, including feelings of worthlessness and the belief that her efforts are pointless. These thoughts are accompanied by emotions of sadness, anger, and frustration. She also discusses the physical toll these emotions have taken, describing a state of constant tension and stress that has recently transitioned into lethargy and a lack of motivation. Lucy's struggle with sleep and her tendency to avoid confronting her negative thoughts by choosing to numb herself to them is also highlighted.
Mindmap
Keywords
đĄDepression
đĄMotivation
đĄIsolation
đĄSelf-Pressure
đĄParental Expectations
đĄAcademic Stress
đĄMarital Problems
đĄSelf-Worth
đĄEmotional Drain
đĄSleep Disturbance
đĄNumbness
Highlights
Patient has been feeling down for several months and it has worsened recently.
Patient visited GP 3 months ago but depression has not improved since then.
Patient struggles with motivation and finds it hard to get things done.
Patient feels isolated with no one to talk to about their feelings.
Patient is an English student living away from home with friends but doesn't feel able to confide in them.
Patient has high standards for themselves and feels unworthy when not meeting them.
Patient's depression began around exam time 6 months ago when also dealing with parents' marital issues.
Patient felt guilty, thinking they could improve parents' situation by doing well in exams.
Patient's exam performance was not good, adding to feelings of failure and self-blame.
Patient avoids social activities with friends to not bring them down.
Patient has difficulty sleeping and feels physically drained and lethargic.
Patient finds it pointless to attend lectures when feeling unworthy and unable to perform well.
Patient feels embarrassed discussing their emotions and finds it uncomfortable.
Patient's negative thoughts lead to feelings of sadness, anger, frustration, and embarrassment.
Patient copes by trying to avoid thinking about their problems, which provides temporary relief but may worsen things long-term.
Patient's depression has significant impact on daily life, motivation, and emotional well-being.
Transcripts
hi Lucy nice to meet you hi um so I
understand that you were 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 3 months ago yeah
um so how long have you been feeling
down all together um 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 has
it got worse since you saw your GP yeah
okay so tell me him how how are things
at the moment um 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 I 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 end now where I just I want to do
something about it okay so 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 fine
sorry okay um and you haven't got any
motivation but it sounds like you're
putting 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 so I just kind of stay on my
own trying
to I don't like to think about it but I
just know okay so you've you say you've
been um you feeling quite isolated
there's not many people around yeah
there's no one I can talk to about it no
one would listen or understand anyway
okay so um 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 um you live away
from home with some friends is that
right yeah I live here okay so you don't
you don't live far from the uni um but
you say you feel like you live with your
friend but you don't feel like you can
talk to them yeah I mean they're lovely
I I 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 through they kind of I don't know
they don't make fun of how I feel but
they don't really understand what it's
like I just I don't want to go out with
them and bring them down or 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 than to try
and explain it all the time when no one
really wants to
know okay so it sounds like you've been
feeling down you've been feeling
unmotivated um 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 a lot
either so that's kind of hard okay I'm
just going to go back in time a little
bit I 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 kind of
started uh 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 for my parents so the
stress of exams and it was also kind of
hard cuz my parents were going through a
bit of a
a troubled time then so okay so this
would be like last March last April uh
yeah I think I think so around that time
so about 6 months is and it sounds like
a lot was happening so you had a lot of
uni pressure on and um and you you 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 I I guess I just felt a bit
guilty I know it sounds silly but I felt
like maybe if I could do better then
they would get better but I it just
wasn't really happening okay so sounds
like you were trying to work hard and
yeah 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 P fired a little I guess
how did it
backfire it just ended up with them
getting worse and I've just been feeling
worse since
then okay so after the summer um after
the exam period um and how did that exam
period go for you in the end not very
well okay that's an awful lot of
pressure to put on yourself that you
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 about
so you say I know I know I should have
done better yeah I mean I suppose
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 probably maybe more than other
people my parents have always kind of
taught me not in in a loving way I guess
but
that you should do your best but also
get the best and I agree with it 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 worry that it annoys them
so it sounds like you feel you should
always do your best is that the word you
used yeah um and that there isn't any
kind of exceptions for that but no okay
um so I can I can see then that was a
really difficult time for you and that
was when your mood 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 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
okay but I don't think it's getting any
better were you home over the summer uh
for little bit Yeah MH and how is that
uh not very
fun no um it was quite tense all the
time stress me out more than relax me
over the summer I guess MH
okay okay so it sounds like quite a lot
has been happening you've been feeling
very low you've had uh uni pressure on
um you've had uh problems with your
parents' marriage and sounds like you
feel like you can't really reach out to
to any one like you can't understand
where you can't really reach out to your
parents right now you can't really
confide in your friends um so I suppose
I'm just wonder if you can tell me a bit
more about how you've been feeling I
mean say this past week
um really not good to be honest um I
actually if I don't have to then I don't
really leave the house or get out of bed
I just I can't find the motivation for
the things that I used to join 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 let's see if we can think about one
thing say a lecture what kind of
thoughts do you have about going to that
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 to try it just stresses me
out more than I needs to okay so it
sounds like the kind of thoughts you've
got on your head are it's pointless um
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
lecture feel
like I don't know I I I don't really
even deserve to be here if I can't do
well enough I see all these other
students are are doing well and doing
better and want to be
there I don't know why I'm here even at
youi to be honest so it sounds like you
feel like you're not as good as other
people here yeah okay um I'm just sorry
is it okay if I take notes as we go
through it's just I'm trying to um 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 um
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 um and I 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
just lower than normal because then it
makes me think about all the things that
I should have been doing better okay so
what you described there then you said
I'm unworthy I should be doing lots of
things better um those are kind of what
I would 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 are you
feeling when you have those
thoughts
sad not
happiness no sad I I
bit of kind of anger and frustration as
well
okay I know just when you're kind of
telling me this and I know this is quite
heavy topic um but you're kind of
laughing and I suppose I wonder a little
bit of you a bit you know how do you
feel about having these
emotions talking about these emotions I
guess embarrassed I'm MH but is I I've
never yet to talk about it so it's quite
uncomfortable to be this situation okay
well you're doing a great job because I
know I know that this can be difficult
um okay so it sounds like some of the
thoughts you're describing are 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 um
and then you kind of describing
different emotions that those lead to
you're kind of describing 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 been a lot more draining than
anything just quite lethargic
and just can't be bothered anymore and
it my body reflects that but then when I
try and sleep I just can't seem to have
a satisfied night sleep it's really
really
time as you said focusing on those those
thoughts those negative thoughts how do
you feel after that do you feel better
or do you feel
worse I guess I feel a slightly worse
but
then a bit numb in a way kind
of once you felt that cuz 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 focused 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 you think it might make things
worse probably in the long run
yeah
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