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  #1  
Unread June 16th, 2005, 05:54 AM
Julia Warren Julia Warren is offline
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Default "Even my thoughts are wrong..."

I have been seeing a client for 8 sessions now and I thought we were working quite successfully on her depression and thoughts of being a failure. I believe I presented the cognitive model in a sensitive and non-blaming way, talking about how depression causes people to have unhelpful thoughts that are then taken to be true. However, in our last session my client spoke about how friends of hers had been making comments such as:

"It's a question of mind over matter"
"You can pull yourself out of the depression if you really want to"

This has further fed into her ideas around being a failure - "why can't I pull myself out of it? If it's mind over matter then it's my fault for not having a strong enough mind" etc.

I responded to these concerns as if they were another thought we could challenge and we discussed depression as an illness rather than some sort of personal failure. But she's been thinking this way for a while and I am concerned that I fed into this belief by continuing with CBT and not picking up on these underlying concerns.

How would other people respond to the idea that "even my thoughts are wrong"? (I have observed CBT being badly explained in ways that would fit with the idea that it's all down to the client's choice about the way they think and therefore possibly leaving clients with further guilt and a sense of failure...)

Any advice or thoughts would be appreciated!

Julia
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  #2  
Unread June 16th, 2005, 09:47 PM
James Pretzer James Pretzer is offline
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Default Handling "Even my thoughts are wrong..."

Julia,

The way you're handling it sounds good. Here are a few other thoughts that come to mind:
  1. When I'm helping the client deal with others' opinions, I usually start with something like "So, your friend thinks that someone who really wants to can pull themselves out of depression. What do you think of that idea?" in order to get them to start looking critically at the opinions.
    .
  2. "Examining the evidence" is often a good initial intervention. I might ask what evidence they know of that would support the idea that someone who really wants to can pull themselves out of depression. Then I would ask about evidence they see that doesn't fit with that idea.
    .
  3. I also like to think of good examples. For example, my understanding is that Abraham Lincoln struggled with depression for years. Does that mean that Lincoln was weak? Does it mean that he was a failure? Does it mean that he wanted to be depressed?
    .
  4. A different way to approach the issue would be to help the client summarize the progress you and he or she have made in eight weeks. Then you can ask them who's been doing the work (they have, you're the coach and they're the player, you can be helpful in many ways but they're the one who's carrying the ball, you can't carry it for them). If they've improved over the course of eight weeks and they've been doing the work, it sounds as though they're in the process of pulling themselves out of depression and it sounds as though they're turning out to be strong enough to do so successfully. Why didn't they pull themselves out of depression before this? Because they didn't know how to do it.

What other ideas do people have?
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  #3  
Unread June 17th, 2005, 10:34 AM
Joop Meijers Joop Meijers is offline
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Location: Jerusalem Israel
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Default Re: "Even my thoughts are wrong..."

Dear Julia
I think there are several possible avenues you could try. Depending on your familiarity with the case, you are in the best position to know which one has more potential.
First I would like to know what your client means by ' not having a strong enough mind' . If she means to say that it is possible that she has ' cognitive errors ' (Beck's term), then I would ask her what errors she thinks she is making. Now assuming that she concedes making erronuous assumptions, I would explore with her if she can accept herself as a fallible person= that it is human to make mistakes. If she cannot accept herself as a fallible person, then this is something to work on first. (Ellis REBT would be helpful in this case). Only after this, I would explore with her the errors she thinks she makes and ask her which ones she wants to focus on and hopefully change.
A second , related, possibility: according to new research by CBT therapists in Oxford, ( Teasdale, Williams, Segal) for people who relaps in depression is, a mindfulness based cognitive therapy might be more indicated then classical CBT. I do not know if this is the first time your client is depressed. If not, then maybe consider a mindfulness based approach. The book by Teasdale et al offers an excellent format for working with depressed clients ( Guilford Press 2002).
I
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  #4  
Unread July 4th, 2005, 11:00 PM
Micah Perkins Micah Perkins is offline
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Location: Oklahoma City, Ok, USA
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Default Re: "Even my thoughts are wrong..."

Julia,
It REBT this would be called a "secondary disturbance". Your client is not only feeling depressed, but also angry at herself (or depressed) for feeling depressed- she is engaging in what REBT calls 'people rating' or 'conditional self acceptance'. The REBT therapist would help her identify, evaluate, and dispute her (possible) beliefs of "I MUST not be depressed" and "being depressed makes me a weak rotten person".
A possible response would be the therapist asking her "why must you not be depressed? Although it is preferable to not be depressed there is no reason why you MUST not. There is no law in the universe which states that people MUST not ever get depressed. People do get depressed." Next "how does you being depressed make you a rotten person? It is preferable to not be depressed, but just because you frequently become depressed does not mean that you are a no good rotten person- it just means that you are a erson who frequently struggles with depression."
She may be able to 'agree' with these statements, but still have difficulty replacing her self defeating beliefs with more self helping beliefs and behaviors. Therefore, you will want her to identify self statments that she can tell herself WHEN she begins to damn herself again- and encourage her to practice these self statments over and over again.
Also, in subsequent sessions you may ask her to play the part of a "friend" (maybe one who is more encouraging than the other ones ? as you play the part of her. She will then debate with you about why you are not a no good rotten person. With A LOT of work she can come to the point where she damns herself less (and this may actually be a core issue surrounding her overall depression)
For more on people rating go to

http://rebt-cbt.net/rebt/page3.html

Good luck with your client. I hope this helps

Micah
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