Depression: Not Just a Bad Term Paper

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[. . .] Finally, I would validate Taylor's challenge in coping with depressive symptoms while being expected to function normally in her parents' house and in this unsupportive environment. I would explain that therapy is a safe place for us to explore her interpersonal challenges and all related feelings, and that I will do my best to be a positive support figure for her. It would be critical to empathize with the client's perception of her experience and synthesize strengths and supports in order to boost her emotional functioning. The core of empathic attunement, that is, seeing the world from the client's perspective, can have a powerful effect on the therapeutic process and outcomes (Mahrer.)

The treatment planning phase must include the beginning, middle and end stage goals for treatment. One way to frame these goals can be as follows: In phase one, the goal would be to build therapeutic alliance, and explore a detailed history of Taylor's symptoms as well as relationship with her boyfriend. We would also have to formulate how we are going to work on her goals of symptom reduction and increased functioning. In the middle phase of therapy, the details will unfold and we will work more directly on cognitive restructuring, as well as behavioral modification. At the same time, as a therapist I would depict a compassionate and empathic stance, in order to facilitate positive transference which can then be utilized in-vivo interpersonal work (Lichtmacher, 2008.) Role playing and assertiveness training may be beneficial at this stage, both in order to heal from her breakup, and empower Taylor to interact more effectively with her family members. Exploration of any of Taylor's negative thoughts and self-doubts would be encouraged, including how the issue of her religion may have been a factor in her breakup and her beliefs about that now.

In the final phase of treatment, we will discuss relapse prevention and synthesize her support system, including her internal resources for coping with setbacks. The termination phase will also have to include specific feelings that come up for Taylor regarding terminating therapy, which may or may not relate to similar feelings of grieving her loss of her boyfriend. Often termination can be of the more challenging aspects of treatment, especially for those clients with prior relationship issues and interpersonal loss. However, if handled appropriately and sensitively by the therapist, it can be a healing process in and of itself. Part of termination would be to explore what feelings arise in Taylor at saying goodbye, and exploring any lingering concerns, so as not to recreate another loss for her. Finally, we would review the progress she has made and schedule a follow up session in the future if she would like.

First Therapy Session:

T (Therapist): So, what brings you here today?

C (Client): Well, I have been having a really hard time getting over a difficult breakup. I mean, it did happen six months ago, and everyone keeps telling me it's about time I move on but I can't seem to.

T: It sounds like there is outside pressure on you to suppress your feelings, is that right?

C: Yes, and on top of that, my mom just doesn't understand what the big deal was in the first place. It's like she doesn't even care that I was dumped like a ton of bricks by my boyfriend of five years! It's really hard to talk to her…and I hate feeling this way!

T: There may be several issues that you will want to address in treatment, and hopefully you will find that this will be a safe place to explore your feelings- but firstly, let's talk about your symptoms and what concerns you the most right now.

C: I guess the biggest problem is that I don't feel like doing anything and it takes enormous amounts of energy to get out of bed in the morning and attend my classes. I really want to do well in school but it's so hard to concentrate when all I can think about is how it ended. I just keep replaying the scene in my head and feel like crying all the time. I don't feel like eating, and I'm just exhausted! What's the point?

T: I sense your despair. It seems that the breakup has really affected your functioning.

C: Yeah! And I'm just so mad at Ted for wrecking my life like this! How can I ever move on when it haunts me like this?

T: The breakup has really been difficult for you! I can sense the pain you are suffering on a daily basis. And it doesn't help that you can't stop thinking about the painful past while trying to live your life and move on.

C: Yeah, that's right.

T: Well, the good news is that you came here today. That must have taken a lot of courage to come to a total stranger and be willing to open up about your struggles. I'd like to tell you a bit about what to expect from the process of therapy and explore your goals a bit further.

C: Okay.

T: In my experience, I have seen that techniques from Cognitive Behavioral Therapy have proven helpful for others who come in with symptoms like those you describe. Depression comes in many forms, especially in ways that affect our thinking. Do you find that you have a lot of negative thoughts during the day?

C: Totally. I feel rotten when all I can think about is how much I hate the world and myself for getting into this in the first place.

T: I'm hearing you blame yourself. What do you think that is about?

C: Maybe I should've listened to my parents when they told me to date a "nice Jewish boy!" Why can't I just forget about him already?

T: Well, that's tough to say…people take time to grieve. You suffered the loss of a lengthy relationship. I mean, you knew him for five years! That is a long time to just be expected to "get over."

C: I guess you are right. Thanks for understanding!

T: This is actually a perfect example of how CBT can help. You see, the thoughts we have and the actions we do are all connected to the feelings we have also. Does that make sense?

C: I guess so.

T: So by learning how to control our thinking and alter our negative thoughts, we can also improve our mood. We can do this by exploring the thoughts that interfere more specifically throughout our time together, and work on changing them to more neutral thoughts. How does that sound?

C: I guess it sounds good if it works! But it's not just my thoughts that are the problem. It's other things

T: Could you give me an example of what else bothers you?

C: Um, well, I don't know if changing my thoughts will help how depressed I feel. I mean, I guess I can understand how it's connected, but I'm just so edgy and sad all the time. And I have trouble sleeping.

T: How is your appetite?

C: Terrible. I can't eat even if I try. I just have no desire for anything anymore.

T: I hear. The symptoms you are describing all interfere with the quality of your life. Have you ever considered taking anti-depressant medication to help take the edge off?

C: I have considered it. Actually, I frequently think of how awesome it would be if I could just take a pill and make this all go away.

T: Well, it's not magic, but many people experience positive reactions to medication. I would suggest you get evaluated by a psychiatrist and explore this option. Also, taking medication together with therapy will probably have even better results than either one alone. It's good that you are open to all the options.

C: Thanks. I'm just sick of the way I've been feeling and I'm willing to try anything!

T: That attitude will come in handy in our work together! Well, we are almost out of time, and though we will spend more time next time on the details of your experience and how you are coping, I'd like to wrap up today by contracting for the time we will meet and how often. I generally find it is useful to meet once a week for forty five minutes, does that sound good to you?

C: I guess, but maybe it would help if we started out with twice a week, just until I get to feel more under control. Is that possible?

T: Sure. So we will meet twice a week for forty five minutes each. And by next session, maybe you can try to schedule an appointment with a psychiatrist for an evaluation.

C: Ok, I think I can do that. Thank you very much- I feel somewhat better already!

T: that's probably because you took… [END OF PREVIEW]

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