Depression and obsessive-compulsive disorder, which had not improved for several years, made the female patient feel desperate.
She claims that she will remain depressed and will never be able to stop thinking ruminant (an important mental feature of depression).
She is 38 years old, has never missed the opportunity to have a meaningful relationship with a man, and she feels particularly desperate for the future, feeling doomed to end up alone. In particular, she anticipates that her self-criticism, lack of attention, and regret will always and continue to accompany her, which will make her unbearable, and her work as a lawyer will be affected, and she may be poor in the future.
Because this patient has been suffering from depressive symptoms for many years and has recently begun to take medication, her complaints and strong sense of hopelessness can easily make family, friends, and doctors identify with her sense of hopelessness. However, the counselor knows that to avoid being led into this misconception by the client, and to use appropriate cognitive therapy, her desperate predictions can be treated as hypotheses to be tested.
For example, during counseling, when it is found that her mood has improved, when she has a smile on her face, and when she begins to challenge negative thoughts, the counselor can seize this evidence in time to test the perception that her emotions will always be negative and the distortion of judgment.
Counselor: Have you noticed that there are some changes in your mood during today's treatment?
● Visitor: Yes, I feel a little better, but only for a few minutes.
Consultant: What would you do if you could do it yourself as you would here— even a little bit every day, or a little bit every hour?
● Visitor: I guess it will be better than now.
Counselor: If you can feel better because you challenge your negative thinking during therapy, if you can notice that your mood changes when you do some activities. So, is it possible that you have found the key to a long-term change in your mood?
● Client: But I have also done treatment and medication before (I still haven't changed much).
Counselor: You have started a different treatment than before, and you have only just begun to do possible drug treatments, is it possible to make your treatment effective by changing your mind and changing biochemical transmitters?
● Visitor: Maybe it is possible, but I am not sure.
Consultant: You're right, either way, we really can't be sure until it's verified. So why don't we try these new treatments and see what happens?
Although the patient still maintains some sense of hopelessness, she has begun to question her depression. Her skepticism about treatment and medication was used as an reinforcement of the challenge to hopelessness.
The initial goal of treatment, which is to work with patients to create their doubts about hopelessness, is the most critical step in challenging hopeless negative thoughts.
Counselor: Just as you question the effectiveness of treatment, do you question your sense of hopelessness?
● Visitor: I never thought of it that way.
● Consultant: There are many different ways of thinking about anything. This time let's reach a common idea, and you'll maintain a healthy skeptical attitude of "waiting and watching."
Depressed people often self-criticize, and counselors will use her self-criticism (such as "I'm a loser", "everyone else can, I can't") and regret statements as a hypothesis to help clients identify and see other possible options.
Thinking rumination is another important feature of depression.
The presence of thinking rumination prolongs the duration of a depressive episode and makes it easy for depression to recur. Patients with thinking rumination often think that thinking rumination can make them think more clearly, be more sure of things, or find solutions to problems.
But in fact, thinking rumination alienates individuals from more rewarding, more positive behaviors and activities, leading to isolation and passivity. The counselor will help the client examine the nature of the regurgitation of the mind and find a more constructive alternative to this self-defeating approach.
Along with this woman's depression, she also has some degree of obsessive-compulsive disorder. Her obsessive personality traits make her accustomed to skepticism, perfectionism, demandingness, hindsight speculation and scrutiny.
So whenever a decision is made, she will inevitably be suspicious, because she can see two sides of a thing very easily. This trait has helped her as a lawyer and helped her become a good lawyer in the early days, but it has also made her daily life and emotional path difficult.
In psychological counseling, in addition to trying to help her change her thinking habits and learn new ways of thinking, the counselor should also point out to her that she may have to accept a certain degree of doubt and harshness as part of her own cognitive style.
Understand that these doubts are not evidence of her making bad decisions (which she almost always thought in the past), but merely the "noise" of her way of thinking. She can choose to listen to these "noises" or not to do anything.
After training, she began to accept that her compulsive skepticism was "innate", a quality as a good lawyer, and that this skepticism did not distort the real world in any way.
In addition, many clients of depression criticize themselves for being depressed. They'll say things like, "I shouldn't feel depressed," or "I should be able to work out my problems." They are locked in a self-cycle of cognitive circles, "I feel depressed because I criticize myself; I criticize myself because I'm feeling depressed; I feel depressed because I have depression."
In psychological counseling, it is necessary to help the depressed client realize that he or she has not chosen depression, depression is often a biological process, self-criticism will not help anyone to get rid of depression, and being responsible for depression means accepting the fact of depression and seeking help and treatment.
The feeling of hopelessness, avoidance, and procrastination that patients exhibit is largely a manifestation of depression.
After a few months, her sense of hopelessness was alleviated, her depression and regret eased a lot, her mental outlook improved, and she also started a new date by chance.