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

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