Brief Summary
This session focuses on building the patient's confidence and helping him take control of his life despite his depression. They discuss the importance of giving himself credit for small accomplishments, challenging negative thoughts, and engaging in activities that bring him joy and connection. The therapist and patient collaborate to create an action plan with specific, achievable goals for the week, targeting both daytime and evening activities to combat isolation and inactivity.
- Importance of giving self credit for small accomplishments.
- Challenging negative thoughts.
- Engaging in activities that bring joy and connection.
- Creating action plan with specific, achievable goals.
Review of Progress and Agenda Setting
The patient reports feeling "a little bit better" this week, noting improved sleep and concentration. He attributes this improvement to the therapeutic interventions. The goal for the session is to address the difficulties he faces in doing things that would help him get better, particularly in the evenings, and to start working on improving the state of his apartment. The therapist also wants to discuss the patient's depressing thoughts and the importance of giving himself credit.
Reviewing Therapy Notes and Action Plan
The therapist reviews notes from previous sessions, emphasizing the importance of working toward goals weekly and evaluating thoughts. The patient acknowledges that he may still be viewing the world negatively and agrees that small changes in thinking and behavior can lead to improvement. He admits to being better at giving himself credit this week due to pushing himself to do the things they discussed.
Identifying Positive Experiences and Cognitive Shifts
The patient identifies going out for ice cream with his grandson as the best part of the week, noting that it made him feel like a normal person and less depressed. He acknowledges that it was easier to go out this time because he was making a positive prediction and looking forward to it. The therapist reinforces the idea that his thinking influences his feelings and actions.
Addressing Negative Thinking and Self-Criticism
The patient reflects on therapy notes about self-criticism and acknowledges the presence of a real illness (depression). He recognizes that his negative thoughts are not always true and that engaging in activities can improve his mood. The therapist introduces the concept of automatic thoughts and encourages the patient to challenge them.
The Importance of a Credit List
The therapist observes that the patient has lost confidence in himself due to job loss, failed marriage, and the effects of depression. She introduces the idea of keeping a credit list to recognize steps taken to regain control of his life. She emphasizes that even small, difficult tasks deserve credit, using the analogy of someone with pneumonia managing to do basic activities. The therapist and patient begin creating a credit list together, including things like walking by the church, taking his grandson out for ice cream, straightening up the apartment, getting out of bed, and coming to therapy.
Building Confidence and Challenging Negative Thoughts
The therapist explains that giving himself credit can help build confidence by showing him that he is capable of doing difficult things. The patient acknowledges that he needs to remind himself that these actions contribute to building confidence. The therapist encourages the patient to use a rubber band as a reminder to identify both depressing thoughts and accomplishments.
Reviewing Goals and Planning for the Week
The therapist and patient review the patient's goals, including visiting family and finding a job. They discuss his accomplishments from the past week, such as walking by the church, visiting his grandchildren, and going to the supermarket. The patient commits to getting out of the house four to six times this week. The therapist emphasizes that these actions demonstrate his ability to do things he thought he couldn't and that they can help him take control of his mood.
Addressing Depressing Thoughts and Evening Challenges
The therapist and patient discuss the impact of depressing thoughts on his mood and explore ways to challenge them. The patient identifies two automatic thoughts: "I'll never get better" and "This isn't going to work." They develop responses to these thoughts, focusing on the evidence that he has started to feel better and that therapy is already showing some positive effects. They then shift the focus to addressing the challenges he faces in the evenings.
Strategies for Managing Evenings and Connecting with Family
The therapist explores ways for the patient to connect with his family in the evenings, such as calling his son and daughter. The patient expresses a fear of imposing on them, but the therapist challenges this thought by reminding him of past experiences when they were happy to hear from him. They discuss potential outcomes of calling and agree that the most realistic outcome is that they would be glad to hear from him and set a date to get together. The patient commits to calling his son, with calling his daughter as optional. They also discuss attending his grandchildren's activities and engaging in activities like reading the newspaper and cleaning the kitchen sink in the evenings.
Finalizing the Action Plan and Encouragement
The therapist and patient review and finalize the action plan, which includes giving himself credit, getting out of the house, reading therapy notes, talking to his son, attending a grandchild's event, reading the newspaper, and cleaning the kitchen sink. The therapist emphasizes the importance of giving himself credit for these actions and reminds him that they will help build his confidence and take control of his life. She encourages him, noting that even doing half of the plan would be a significant improvement.
Session Summary and Future Directions
The patient expresses optimism about the session and the potential for therapy to work. The therapist reinforces the importance of not doing what he feels like doing when he's depressed (sitting on the couch) but instead engaging in activities that will help him feel more in control. She asks for feedback on the session and schedules the next appointment.
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