Depression

A Cognitive Approach

Geoff Tomlinson, Dawn Slater

• Publisher: Routledge
• Year: 2017
• Print ISBN: 9781138046030
• eBook ISBN: 9781351695381
• Topic: Psychology
• Subtopic: Cognitive Psychology & Cognition
• Index: Psychology

Based on cognitive behavioural psychotherapy, this resource book describes how to treat mild to moderate depression. Aimed at the professional with little or no experience of treating depression, it provides detailed instructions on recognising a client's profile of depression, identifying dysfunctional thinking patterns and following through the ten steps for treatment. The methods described can be used with clients exhibiting mild to moderate depression in most therapeutic situations and also for people suffering from severe depression if they are in an in-patient setting. This book is divided into three parts. Part 1 contains basic information about depression, cognitive therapy and other approaches to treatment; Part 2 gives practical guidance in 10 steps to help clients overcome depression; and Part 3 provides additional information about sub-types of depression, drug treatment and the management of suicide and self-harm. Each step has handouts that can be photocopied and given to the client. It is suitable for use with groups as well as individuals.

Part 2
Therapeutic steps

Step 1 · Describing cognitive behaviour therapy to the client

Step 2 · Identifying the client's depression

Step 3 · Increasing the client's activity

Step 4 · Negative automatic thoughts

Step 5 · Quick control of negative automatic thoughts

Step 6 · Challenging negative automatic thoughts

Step 7 · Challenging negative automatic thoughts – behavioural experiments

Step 8 · Dysfunctional assumptions

Step 9 · Problem-solving

Step 10 · Preparing for the future

Step 1. Describing Cognitive Behaviour Therapy to the Client

Introduction

Set agenda – 5 minutes

This week's task: Describe the model of depression and therapy – 40 minutes

Review session – 5 to 10 minutes

Set homework – 5 to 10 minutes

Materials needed – Handouts 1 & 2 for Step 1 and also Handout 1 for Step 2

Introduction

In this first session, the main aim is to describe the cognitive behaviour therapy model of depression and the format of the therapy. All of the information that you need to do this is contained in Part 1. You will have seen that the sessions have a definite structure, which should be used in this first session. Therefore, you should start by setting the agenda. This will include the usual things, with the exception of reviewing homework as, this being the first session, none will have been set. Therefore, this week’s agenda will cover this week’s task (describing the cognitive behaviour therapy model and therapy structure); reviewing the session, and setting homework.

Set agenda

As this is the first time that you and the client will have attempted to set an agenda, you will need to explain the reasons for agenda-setting. Establishing the collaborative nature of the treatment is important, and agenda-setting is part of this. Also, at this point you cannot know what has happened since the client was last seen, so cannot judge what is most important to the client at this stage. Agenda-setting also enables the therapy to develop a focus, and be more targeted at the client’s symptoms and at the skills that they need to acquire to overcome their difficulties. As therapy progresses, the setting of the agenda becomes easier, but in the early sessions you will have to take an active role. This is because the client may not be aware of the style of therapy, and because, at the beginning, you will have lots of new information and skills to impart that you will wish to have on the agenda. Also, this will provide an opportunity for you to model some of the skills needed to work collaboratively, for the client. This is done by behaving in a way that promotes collaboration such as Socratic dialogue and asking for and giving feedback.

At this stage you will not usually have any difficulties in agreeing the agenda. However, this may not always be the case. If you and the client cannot agree, it is often best to go with the client’s agenda. If it turns out that it is not possible to achieve what was agreed then it is possible to renegotiate the agenda with the client. This allows the client to learn from their mistakes, which can be a very powerful experience.

The agenda in cognitive therapy tends to have a set format, within which the client decides what to include, in discussion with the therapist. The agenda will always include a review of homework; specific tasks for the day; reviewing the session, and setting homework for the next week. This format needs to be explained to the client, and then within this you need to negotiate the specific tasks for today’s session. It is suggested that these should focus on discussing the cognitive behaviour therapy model of depression and explaining the therapeutic style.

This week's task

Describing the cognitive behaviour therapy model and style of therapy forms the core of this week’s task. First, use the information in Part 1 to describe the cognitive model of depression. This will cover the interactive nature of negative automatic thoughts, mood and behaviour, and their mutual reinforcement. It is usually best to start the description of the cognitive behaviour therapy model at the negative automatic thoughts end, as this is the most accessible to the client. Then work backwards to dysfunctional assumptions, explaining the way these cause the negative automatic thoughts. Describe the nature of dysfunctional assumptions, and core beliefs – it is not necessary to go into detail at this stage. Describe the role of external events in activating dysfunctional assumptions, and of early life events in the establishment of dysfunctional assumptions and core beliefs. Again, detail is not required at this stage.

It is often helpful to draw out the model as in Handout 1 for Step 1 as you describe it to the client. If you have sufficient information about the client, you could personalise it for them by using some of the negative automatic thoughts and dysfunctional assumptions they have. It is unlikely that you will have this information unless you have seen the client on several previous occasions.

After you have covered the model, describe the nature of the therapy. Again use the information in Part 1 to help with this. You should also use Handout 2 for Step 1 to help with this.

Review the session

In reviewing the session you are doing several things. You are checking that the information you gave to the client was understood. You will also get an idea how the client interprets the information, which may tell you something about their thinking style, and how it affects their mood. It will also force the client to think through what has been said, which will help it to become more firmly embedded in their thinking. Finally, the review will allow you to correct anything that was misunderstood and make changes to the way you present information, if it becomes clear that the way you have been doing things is not easily accessible to the client.

How you review the session also helps to establish collaboration between you and the client, as you ask them to tell you what they think was covered in the session. If the client gets it basically right, then all is well. If they do not seem to have understood the information, then you have to be tactful in how you handle this, as the client will undoubtedly interpret any criticism negatively, which could further activate their negative automatic thoughts and dysfunctional assumptions. You should try to pick out the things they said that reflect what you think went on, and then also mention the other important things you covered. For example, if the client does not seem to have remembered anything about the role of dysfunctional assumptions and activating events, then you should say something like: ‘That’s right, we did talk about the role of negative automatic thoughts, but we also talked about the role of dysfunctional assumptions, do you remember?’

You should also remember to ask for feedback on ...

Table of contents

• Cover
• Half Title
• Title
• Copyright
• Contents
• List of Tables
• List of Figures
• List of Handouts
• Introduction
• PART1 BASIC INFORMATION
• PART 2 THERAPEUTIC STEPS
• PART 3 ADDITIONAL INFORMATION
• Additional reading and websites
• References