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

Judith Johnson

23 Oct 201413:54

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

😔 The individual, Lucy, has been feeling down and unmotivated for several months, with her condition worsening recently.
🏥 Lucy was referred to the service by her GP three months ago, indicating her prolonged struggle with her emotional state.
📚 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.
🤔 Lucy's low mood seems to have started during exam preparation, compounded by her parents' marital issues and her own academic stress.
😔 She feels guilty and believes that if she performed better academically, it might have improved her parents' situation.
📉 Lucy's academic performance did not meet her own high standards, leading to self-criticism and a further decline in her mood.
🚫 She experiences difficulty in reaching out for help, feeling that no one would understand or listen to her struggles.
😞 Lucy's negative thoughts include feelings of worthlessness, believing she doesn't deserve to be at university, and that her efforts are pointless.
😡 Along with sadness, Lucy also experiences anger and frustration, likely directed at her situation and herself.
🛌 She has lost interest in activities she once enjoyed and has a lack of motivation to even attend lectures, which she finds stressful.
💤 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

00:00

😔 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.

05:01

🤯 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.

10:03

😖 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

💡Depression

Depression is a common mental health disorder characterized by persistent feelings of sadness, hopelessness, and a lack of interest or pleasure in activities. In the video, the individual expresses these feelings, indicating they have been feeling down for several months and have lost motivation, which are key symptoms of depression.

💡Motivation

Motivation refers to the psychological drive that influences a person to engage in activities to achieve a goal. The script reveals that the individual is struggling with a lack of motivation, as they express an inability to find the energy to do things they previously enjoyed.

💡Isolation

Isolation is the state of being alone or separated from others. The person in the video mentions feeling isolated and not having anyone to talk to about their feelings, which is a common experience for those dealing with depression and can exacerbate their condition.

💡Self-Pressure

Self-pressure is the internal stress one puts on themselves to meet certain standards or expectations. The individual discusses the pressure they feel to perform well, particularly in relation to their exams and parental expectations, which has contributed to their feelings of depression.

💡Parental Expectations

Parental expectations refer to the hopes and standards that parents have for their children. The script indicates that the individual feels a strong need to meet their parents' expectations, which has added to their stress and feelings of inadequacy.

💡Academic Stress

Academic stress is the tension and anxiety that students experience due to academic demands and performance concerns. The individual's struggle with exam preparation and the desire to do well academically are sources of stress that have contributed to their depressive state.

💡Marital Problems

Marital problems refer to conflicts or issues within a marriage that can cause distress to the individuals involved and their family. The script mentions that the individual's parents are having marital issues, which has had a negative impact on the individual's emotional state.

💡Self-Worth

Self-worth is the value and esteem a person holds for themselves. The individual expresses feelings of being unworthy and not deserving to be at university, indicating a low sense of self-worth, which is often associated with depression.

💡Emotional Drain

Emotional drain describes the depletion of emotional energy that results from stress or negative emotions. The individual describes feeling drained and lethargic, which is a manifestation of the emotional toll their situation is taking.

💡Sleep Disturbance

Sleep disturbance refers to disruptions in the quality or quantity of sleep. The script mentions that the individual is unable to have a satisfied night's sleep, which is a common symptom of depression and can further affect mental health.

💡Numbness

Numbness, in an emotional context, refers to a lack of feeling or emotional response. The individual describes feeling slightly worse but then numb, indicating a form of emotional shutdown that can be a coping mechanism in response to overwhelming negative emotions.

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.