John, "thinking over the past few weeks about trying to make a commitment to starting to exercise." Since the discussion was about cognitive distortions in depression ("When you're depressed, you will tend to feel more helpless, low self esteem, externalize control/responsibility, etc. - which makes the depression worse as long as you attend to such thoughts and feelings . . . ") I replied that she "'could continue to think about considering the possibility of beginning to form an idea for a commitment to one day exercise . . . Or, when her alarm went off tommorrow morning, she could get up, get dressed, walk around the block - whether she watned to or not. Because if you wait until you WANT to exercise, you never will." Which, perhaps fell on deaf ears. But at least the rest of the group understood, and it generated a lively and profuctive discussion. s it a coincidence that this patient was also obese? I am getting to the point where I think the best type of treatment for Drug Dependent Pain Patients and Obese/Dysthymic patients - both of which externalize control and have a sense of passivity which is extreme - is the development of a Day Treatment Program, highly stuctured, and run like a compassionate boot camp: Good regular meals, exercise, group therapy, etc. for at least 4 weeks, if not 6 or 8. So, if you want to get rich, let's start a Betty Ford Center for Drug Dependent Pain Patients and Depressed Obese Patients! But then, of course, we'd have to be the therapists and that might drive us to become patients. . .
Until today, I was convinced that Drug Dependent Pain Patients were the toughest patients to treat. Then today in my depression group a patient said that she was:
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