Cognitive Therapy for Depression

By inquiring about Denise’s automatic thoughts, the therapist began to understand her perspective—that she would go on forever, mostly alone. This illustrates the hopelessness about the future that is characteristic of most depressed patients. A second advantage to this line of inquiry is that the therapist introduced Denise to the idea of looking at her own thoughts, which is central to cognitive therapy.

As the session continued, the therapist probed Denise’s perspective regarding her daily life. The therapist chose to focus on her inactiv- ity and withdrawal. This is frequently the first therapeutic goal in working with a severely de- pressed patient.

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In the sequence that follows, the therapist guided Denise to examine the advantages and disadvantages of staying in her house all day.

DENISE: Usually I don’t want to leave my house. I want to stay there and just keep the shades closed; you know, I don’t want to do anything. I just want to keep everything out, keep everything away from me.

THERAPIST: Now do you feel better when you stay in the house all day trying to shut every- thing out?

DENISE: Sort of . . .

THERAPIST: What do you mean?

DENISE: Well, I can watch TV all day and just lose myself in these silly shows. I feel better when I see other people and their problems on these shows. It makes me feel less lonely and like my problems aren’t so bad.

THERAPIST: And so how much time do you spend doing that?

DENISE: Now, lately? . . . Most of the time. Staying inside and watching TV feels safe, sort of secure, everything . . . like my loneli- ness, feels more distant.

THERAPIST: Now after you have spent some time like this, how do you feel about your- self?

DENISE: Afterwards? I usually try not to pay much attention to how I’m feeling.

THERAPIST: But when you do, how do you feel?