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1
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Positive
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F
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Career and work-related concerns
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https://www.youtube.com/watch?v=MyXdvt4_AZA
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17:34:00
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Behavioral Therapy Counseling Role-Play - Client
with Symptoms of Narcissistic Personality Disorder
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Counselor：Hello, Aspen. How you doing today?
Client：I'm doing well, thank you. How about yourself?
Counselor：I'm doing all right, thanks for asking. I had met you last time for our first session, and we talked a little bit about kind of your circumstances, what brought you here. And I was hoping today we could get into trying to really figure out how we can help you. Any thoughts on your current situation? Anything changed?
Client：Nothing's really changed. I mean, I'm amazing at my job. My boss just really is someone that I hold, you know, in higher regards than others I work with especially. We went to. We went to the same college. College, of course. And he suggested I come into counseling and he's way off. Way off. So I'm just gonna, you know, let him know.
Counselor：So, as I understand it, you came into counseling because he requested it.
Client：That was what initiated it. But now it's. I need to prove him wrong.
Counselor：Alright, so at first it was because he told you it would be a good idea, but now you kind of see it as an opportunity to prove your point.
Client：Yeah, have a little bit of fun with it. Prove my point.
Counselor：What would you. What would you like to prove through this?
Client：That I'm not the one in the wrong. You know, I. I'm extremely good at my job. I mean, I am the best employee that they have ever had. Not just currently, just. I mean, just ever. I make no errors. So how can I be wrong when it comes to these circumstances with my coworkers?
Counselor：Right. So your co workers have made some criticisms about you and that led to your boss suggesting this.
Client：I would call them criticisms because it's really hard to criticize me. So I would say they take it personally that I'm better than them, you know? So I feel that it's important for me to be able to work for this particular company. It needs to be the best company. And so I need the other employees to at least be at my level. Well, I mean, that's. That's really hard for them to come to my level, but at least be above average. At least.
Counselor：All right, so you have an expectation of them to become at least close to you in terms of your skill.
Client：I mean, it's pretty hard to not make any errors when it comes to accounting with the numbers, with the amount of numbers and the volume of accounts that we have, it's hard to be as good as I am with it, as far as no errors. But yes, I expect a higher standard from the coworkers.
Counselor：And you don't feel like they're performing at that level now?
Client：No, not at all.
Counselor：And evidently you made some different comments to them which maybe they took the wrong way.
Client：I just pointed out the facts of the situation.
Counselor：What type of facts did you, when.
Client：They make mistakes and, you know, how they should be better at certain tasks. I mean, they didn't attend the same, you know, type of college as far as, you know, Ivy League as myself. However, they do have a college education so, you know, that alone would, you know, just kind of go to speak to them having some sort of ability in that area.
Counselor：So you've kind of, in a way you've expressed your disappointment with them.
Client：Yes.
Counselor：To them?
Client：Yes.
Counselor：And what are some of the observations or comments they made regarding you?
Client：Oh, they told me my ego is too big, that I'm cocky. That's one. Yeah. I'm just overall, like, I don't know how you can be too confident when your ability is at that level. I mean, I am the best employee they've ever had overall. You know, I was the best student at my college. I received numerous awards from the president of the college alone. I received numerous calls from the college and other companies as well, trying to recruit me to work for them. You know, so I don't think there's, it's impossible to be overly confident, but they, you know, they consider it cocky and arrogant. Get arrogant a lot.
Counselor：The comment arrogant. So you feel they're just really, are they misunderstanding you?
Client：I think they take it as a personal attack.
Counselor：Okay.
Client：Like I'm can, like I'm that concerned with them personally. Like it affect, like I'm talking about them as a person instead of just their performance at work because I'm really not concerned with them as far as like existence outside the realm of performance at work.
Counselor：Alright. So your commentary to them has nothing to do with their value as a person, more with their performance as an employee. And you feel they're misconstruing your observations about their performance?
Client：Very much so.
Counselor：They're taking it personally.
Client：Taking it personally and trying as best they can to push it back on me as I'm the one who's wrong, but I'm obviously not.
Counselor：Alright, so you're not wrong in this and you're frustrated by their reactions.
Client：I mean, I'm okay with it, you know, I mean it's, I don't really take anything they say to heart because they're not at the level to really be able to criticize me. You know, I can take criticism, you know, from constructive criticism, from someone who would, you know, be at my level or above, however, they are not. So it's really nothing. It really doesn't affect me. It does interfere with my job as far as my employer is concerned.
Counselor：Right. That's what led to you. That's what led to him recommending you come here initially. So you don't feel that they're at a level where they can really criticize you. It doesn't really bother you if they have criticism in the first place, but you can appreciate how getting along with them would be better for you as an employee.
Client：I mean. I mean, overall, I like this company. You know, I like working for it. I've been friends with my boss. I mean, we went to the same college, you know, so we have that in common. You know, he is an extraordinary person as far as his abilities, you know, I would say as in the level realm as myself. So, you know, I hold his, you know, opinion, you know, in some sort of regards above the others, so.
Counselor：Okay, so to the extent that they communicate negative sentiment to him about you, that that affects you?
Client：Yes.
Counselor：Okay.
Client：Yes.
Counselor：And so what do you think, if anything, what do you think needs to be fixed here?
Client：Well, I think it's on their area and, you know, on their side. They didn't take what I said the wrong way.
Counselor：Okay. So if they had accurately interpreted your comments, that would fix the problem?
Client：Yes.
Counselor：Do you think that's realistic.
Client：If they worked at it, possibly.
Counselor：How long have you worked there?
Client：It's been about 15 years.
Counselor：15 years. And how long has this been something that you've been aware of them not feeling so great about your comments to them?
Client：Well, every now and then, this is. We've hit a peak here recently because a lot of the people that I work with feel here recently more. So they've been taken in the wrong way, more prevalent than in the past. In the past, they would, you know, I'd hear, you know, certain comments, but I understood, you know, comments just directed at me, and I just understood that, you know, it was just, you know, envious because I was able to give them. I was at a level where I was able to critique their work. So it never got to a point where I had someone like my boss say anything to me. So this is really the first time that has gotten to that point.
Counselor：So you've noticed things like this in the past, but now it's become more urgent to address it.
Client：It's become more urgent to prove that I'm not wrong in this fact that it is. You know, if this were the case, then, you know, it would have been, you know, it would have been continuous, not just, oh, don't come to a head. So, I mean, that just proves my point even more, that it is their issue and not mine.
Counselor：All right, so if you could somehow prove that they're in the wrong, would that help you?
Client：I mean, it's kind of. To me, it's obvious they are in the wrong because the numbers speak for themselves. It's the fact of the matter. So if. But I guess that if there was something that could change between the relationships that I have with them, then at least would be a little bit better of a flow. So maybe we could get up to the level, you know, that this company is deserving of.
Counselor：Okay, so there's like two. There's two things operating. There's your desire for them to improve and make the company better. And then they're discontent with withdeze your comments to them. So you'd like the company to improve. And you feel that means that you need to be able to voice your opinion to them in an honest way. But everybody needs to get along too. And that's at least to some extent, and that's not happening because they're upset. So do you think there's any steps you could take that could reduce the tension in those relationships?
Client：I need to figure out a way to present the information at a level that they would understand. So drop it down to their level, but also kind of sugarcoat it so they're not, you know, taking it the wrong way.
Counselor：All right, so you need to deliver the same message in a more polite, less threatening package.
Client：I mean, you could say that, yeah.
Counselor：Do you have any ideas how that might look?
Client：I mean, I could start with not comparing their work to mine because that's just unfair. I mean, at no point in time are they ever going to reach that. That level of quality with their work. So that could be a place to start.
Counselor：Okay, so just refraining from drawing that comparison. That could help.
Client：Yeah.
Counselor：Do you think there could be a benefit in just taking a break from offering any comments to them, any observations, just to let things cool down a bit?
Client：I mean, I could see where you would say, you know, refer that as cool down.
Counselor：Just in an effort to restore the peace. You could still, of course, be aware of different shortcomings in their performance. It might just be helpful to not share that for a while. Just as an idea. Does that seem like an idea that might work. Yeah.
Client：Just keep to myself a little bit more. I mean, that's not very hard around.
Counselor：Them keeping to yourself.
Client：Yeah.
Counselor：Do you think you would be okay with the. With doing that? Because you wouldn't really be able to offer those. Those helpful comments like, about performance.
Client：If. Well, really, it would, in fact, prove my point behind it all. It would prove that I was right, that it's not me, that it is them taking it the wrong way. You know, because, in fact, if it was, you know, if it wasn't them taking it the wrong way, then I would just say that that would, you know, it would continue. As far as trying to point out, I mean, really, I think it comes down to an issue of being jealous and seeing themselves as less than, so needing to bring. To try to bring me down to make themselves feel better. So if they don't have that to do that, it would prove my point behind this whole thing.
Counselor：Yes. You feel like they're just trying to. They're just trying to tear you down to make up for their own inadequacy.
Client：Oh, definitely. Yeah.
Counselor：And by you just not kind of offering those observations, you're taking the wind out of their sails.
Client：Right. And then it's not. It's only a matter of time before someone else notices that without me pointing that out to them.
Counselor：Right. So your kind of commitment to quality will still be honored because somebody else will see that.
Client：Oh, yeah. There's no way that that could go unnoticed.
Counselor：Yeah. So that'll. That'll take care of kind of both sides of this. Your concern concerns about quality would still be addressed, and you might be able to get more peace in that work environment.
Client：And I would prove that I was right all along.
Counselor：And proving your point, which you mentioned, was one of your reasons for being okay with coming into counseling. So when do you go back to work next?
Client：Tomorrow. Tomorrow morning.
Counselor：Do you think this is a strategy that we can try out right away?
Client：I can handle it for sure.
Counselor：So I will see you again in about a week, if that's okay, and maybe we can reevaluate and see how that worked.
Client：Yeah, I can tell you how I.
Counselor：Was proved to be right, but, yeah, that'd be fine. You could tell me what happened to, I certainly hope for a good outcome in that, and if we need to make any adjustments from that point, we can talk about it then. So give that a try.
Client：All right, sounds good.
Counselor：All right, well, thanks for coming in Aspen. I will see you in a week.
Client：Sounds good.
Counselor：Thank you.
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2
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Positive
|
F
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Self-esteem and confidence issues
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https://www.youtube.com/watch?v=7LD8iC4NqXM&t=81s
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13:54:00
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Case study clinical example CBT: First session with a client
with symptoms of depression (CBT model)
|
Counselor：Hi, Lucy. Nice to meet you.
Client：Hi.
Counselor：So I understand that you were referred here by your GP because you've been feeling quite down recently.
Client：Yeah, I thought I should. I've been feeling quite bad for quite a while, so I thought maybe it's time to see someone about it because I don't want to feel like this anymore.
Counselor：Okay. So from your notes, I saw that you saw the GP about three months ago?
Client：Yeah.
Counselor：So how long have you been feeling down altogether?
Client：Quite a few months before that as well, actually. But it's gotten pretty bad these past few months, so that's kind of why I came.
Counselor：Okay. So has it got worse since you saw your GP?
Client：Yeah.
Counselor：Okay, so tell me, how are things at the moment?
Client：Well, it kind of started just feeling a bit low and wound up about things, but, I don't know, just recently I just can't really be bothered to do anything at all. I kind of find it hard to get motivated for things and I want to be. I really want to be better, but it's just kind of reaching the end now where I just. I want to do something about it.
Counselor：Okay, so you said that you're feeling really down, really sad?
Client：Yeah.
Counselor：And you feel like you haven't got any motivation, but. Are you okay?
Client：Yeah, I'm fine.
Counselor：Sorry. Okay, and you haven't got any motivation, but it sounds like you've put quite a lot of pressure on yourself to try and feel a bit better.
Client：Yeah, I just. It's kind of hard as well because there's not really anyone to talk about. So I just kind of stay on my own trying to. I don't like to think about it, but I don't know.
Counselor：So you say you've been. You've been feeling quite isolated. There's not many people around.
Client：Yeah. There's no one I can talk to about it. No one would listen or understand anyway.
Counselor：Okay, so I'm just going to try and find out a little bit more about you. So I understand that you're an english student at uni.
Client：Yeah.
Counselor：And you live away from home with some friends. Is that right?
Client：Yeah, I live here.
Counselor：Oh, okay. So you don't live far from the uni, but you say you feel like you live with your friends, but you don't feel like you can talk to them.
Client：Yeah, I mean, they're lovely. I get on really well with them, but I don't know, recently, whenever they want to go out or stuff, I just. I don't want to bring them down. I can't. They don't understand what I'm going through. They kind of. I don't know, they don't make fun of how I feel, but they don't really understand what it's like. I just. I don't want to go out with them and bring them down or stuff.
Counselor：Okay, so it sounds. Do you try and hide the way you're feeling from them?
Client：I guess. I mean, it's easier to hide it than to try and explain it all the time when no one really wants to know.
Counselor：Okay, so it sounds like you've been feeling down, you've been feeling unmotivated, you feel like you want to be better. But actually it sounds like you feel like you can't reach out for help, you can't speak to anybody.
Client：No, I don't really talk to my parents a lot either, so that's kind of hard.
Counselor：Okay. I'm just gonna go back in time a little bit, I suppose. I'm just wondering, when did all of this start? You said it's been going on for quite a few months.
Client：Yeah, I guess it kind of started, actually, when I was revising for my exams. I guess the stress. I put a lot of stress on myself. I think I've always wanted to do well for me and I guess for my parents. So the stress of exams. And it was also kind of hard because my parents were going through a bit of a troubled time then.
Counselor：Okay, so this would be like last March, last April?
Client：Yeah, I think so.
Counselor：Around that time. So about six months ish. And it sounds like a lot was happening. So you had a lot of uni pressure on and you said that your parents were having marital problems. Okay. And it sounds like that was a real shock to you.
Client：Yeah, I guess it was hard as well because I wasn't doing well at uni. I guess I just felt a bit guilty. I know it sounds silly, but I felt like maybe if I could do better, then they would get better, but it just wasn't really happening.
Counselor：Okay, so it sounds like you were trying to work hard and be more successful because you thought that that would make them happier and try and fix things.
Client：Yeah, I wanted to make them feel better, but it just kind of backfired a little, I guess.
Counselor：How did it backfire?
Client：Well, it just ended up with them getting worse, and I've just been feeling worse since then.
Counselor：Okay, so after the summer, after the exam period. And how did that exam period go for you in the end?
Client：Not very well.
Counselor：Okay. That's an awful lot of pressure to put on yourself that you supposed to.
Client：Think it's just annoying because I know I should have done better and I just didn't. And I guess I beat myself up a lot about it.
Counselor：So you say. I know, I know I should have done better.
Client：Yeah.
Counselor：I mean, I suppose hearing it from my perspective, I'm thinking it sounds like you had an awful lot going on at the time. It would be understandable, absolutely. That you wouldn't do as well as normal. I suppose I'm just wondering if you have very high standards for yourself.
Client：Probably maybe more than other people. My parents have always kind of taught me. Not in a loving way, I guess, but that you should do your best, but also get the best. And I agree with that. I think that's the right thing to think. But when I don't do that, I don't know, it annoys me a lot and I worry that it annoys them.
Counselor：So it sounds like you feel you should always do your best. Is that the word you used? Yeah. And that there isn't any kind of exceptions for that, but no. Okay. So I can see then that was a really difficult time for you and that was when your mood started to get lower. And things are still quite bad now. I mean, what's the situation with your parents at the moment?
Client：I think it doesn't sound good. I don't really talk to them a lot, but I don't think they're going through very good. I don't like to talk to them about it because it just makes me feel worse. But I don't think it's getting any better.
Counselor：Were you home over the summer?
Client：For a little bit, yeah.
Counselor：And how was that?
Client：Not very fun? No, it was quite tense all the time. Stress me out more than relaxed me over the summer, I guess.
Counselor：Okay. Okay. So it sounds then like quite a lot has been happening. You've been feeling very low, you've had uni pressure on, and you've had problems with your parents marriage. And sounds like you feel like you can't really reach out to anyone. Like you can't understand, but you can't really reach out to your parents right now. You can't really confide in your friends. So I suppose I'm just wondering if you can tell me a bit more about how you've been feeling. I mean, say this past week.
Client：Really not good, to be honest. I actually. If I don't have to, then I don't really leave the house or get out of. But I just. I can't find the motivation for the things I used to join. I used to love doing sports or going out. And now I just prefer to lie in bed and not really do anything.
Counselor：Okay.
Client：I missed a few lectures this week that I should have gone to.
Counselor：Right. So I suppose I'm just wondering then let's see if we can think about one thing. Say a lecture. What kind of thoughts do you have about going to that lecture before it happens?
Client：I don't really see the point anymore. If I can't do as well as I should be doing, then what's the point in putting myself in those positions? I can't be bothered anymore to try. It just stresses me out more than I need to.
Counselor：Okay, so it sounds like the kind of thoughts you've got in your head are. It's pointless. It's not worth it.
Client：Yeah.
Counselor：Do you have any other thoughts in your head when you're just at that point before you go to the lecture?
Client：I feel like. I don't know. I don't really even deserve to be hear if I can't do well enough. I see all these other students who are doing well and doing better and want to be there. I don't know why I'm here, even at uni, to be honest.
Counselor：So it sounds like you feel like you're not as good as other people here.
Client：Yeah.
Counselor：Okay. I'm just. Sorry. Is it okay if I take notes as we go through? It's just I'm trying to, I guess, understand what you're telling me and it helps me just to write it down and I'll share this with you later. Okay. So it sounds like those are some quite negative thoughts to have. You're kind of saying, you know, it feels like it's pointless, it's more effort than it's worth, and I don't deserve to be here. I mean, when you have those thoughts, how do you feel?
Client：Very unworthy, probably would be the best way to put it. Kind of, I don't know, lower than normal. Because then it makes me think about all the things that I should have been doing better.
Counselor：Okay, so what you described there, then you said, I'm unworthy. I should be doing lots of things better. Those are kind of what I would call thoughts, actually. I suppose I'm trying to understand what it feels like in your gut. What kind of emotions do you feel happier? Do you feel sad? What kind of emotions are you feeling when you have those thoughts?
Client：Sad. Not happiness? No, sad. A bit of. Kind of anger and frustration as well.
Counselor：Okay. I notice when you're kind of telling me this, and I know this is quite a heavy topic, but you're kind of laughing. And I suppose I wonder a little bit, are you a bit, you know, how do you feel about having these emotions, talking about these emotions, I guess embarrassed.
Client：I've never yet to talk about it. So it's quite uncomfortable to be in this situation.
Counselor：Well, you're doing a great job because I know. I know that this can be difficult. Okay. So it sounds like some of the thoughts you're describing are. It's pointless. It's more than it's worth. I don't deserve to be here. I'm unworthy. And those kind of thoughts, it sounds like they just flit through your mind. And then you kind of describing different emotions that those lead to. You're kind of describing sad, anger, frustration, embarrassed. What about in your body? What happens? How do you feel kind of physically?
Client：I used to be, I think from those emotions, very wound up, very kind of stressed all the time. But recently, it's just a lot more draining than anything. Just quite lethargic and just can't be bothered anymore. And my body reflects that. But then when I try and sleep, I just can't seem to have a satisfied night's sleep. It's really, really frustrating.
Counselor：So it sounds like this is affecting you. It's draining you of your energy. Like your body can't be bothered. I think that's a really good way of describing. And you're noticing sleep problems as well. And then what do you do? So this is back to the point before the lecture. So you start having these thoughts, these emotions, and, you know, your body, I guess it sounds like those thoughts are quite draining. So we're draining your energy. What then happens? What do you do next?
Client：I kind of focus on the negative thoughts when I probably should not think about them, but it, I focus on them and then I don't really want to do anything. Can I stay in bed or.
Counselor：So you think even more about those kind of worries that you have. So you do a bit of dwelling and you stay in bed. And it sounds like you don't, you haven't tried speaking to your friends about it.
Client：No.
Counselor：Or speaking to family. Okay. And then after you've done that, so after you've not gone to the lecture, you've stayed in bed. You kind of spent time, as you said, focusing on those thoughts, those negative thoughts. How do you feel after that? Do you feel better or do you feel worse?
Client：I guess I feel slightly worse, but then a bit numb in a way, kind of once you've felt that, because I do feel tired all the time. I just try and push it out, and then you don't really think about anything. And it's almost nicer that way than to keep focusing on how much you're getting wrong and how much you can't do stuff. Sometimes it's better just to not think about it at all.
Counselor：So it sounds like in some ways, it's a bit of a relief to do that.
Client：Yeah.
Counselor：But in other ways, maybe you think it might make things worse.
Client：Probably, in the long run, yeah.
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3
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Positive
|
F
|
Anxiety and fear
|
https://www.youtube.com/watch?v=XH2tF8oB3cw
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12:01:00
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Case study clinical example CBT: First session with a client
with symptoms of depression (CBT model)
|
Counselor：Hi, Hannah. Nice to meet you.
Client：Hi.
Counselor：So I understand that you were referred to me by your GP because you've been experiencing some anxiety difficulties.
Client：Yeah. Yeah, I guess it kind of started, like, five, six years ago.
Counselor：Okay.
Client：It kind of escalated a bit. I've just recently moved out from living with my parents, so it's made it a bit worse, I think.
Counselor：Is this the first time that you've left home?
Client：Yeah, it's the first time, actually. I was going to a few years ago, thought it would be easier to stay home.
Counselor：Okay. So it's been quite a big step and a big change. And it sounds like that that was what led you to go to your GP.
Client：Yeah.
Counselor：So how has that changed things for you?
Client：It's kind of. I haven't really told anyone, so, I mean, it's made it better in the sense I feel hopefully this is. This is it. Like, it'll help, but I don't know. I don't like thinking that I've had, like, how to do this. I never thought I'd be the kind of person who'd have to actually go and, like, get help, if that makes sense.
Counselor：Okay, so how do you feel about being here today?
Client：Bit like scared? I don't know. Hopefully it will help.
Counselor：Okay, so you've been feeling a little bit anxious about today?
Client：Yeah.
Counselor：Okay. So I guess just going back to why you went to the GP and how you've ended up kind of coming here today. So it sounds like you've been experiencing anxiety for quite a few years, but just recently you moved out of home for the first time, and that was what kind of led you to go to the GP. So how did that change things? How were things after you moved out?
Client：I thought that they'd be better because I thought I'd have to kind of be independent. And it's actually a lot worse. I'm just kind of staying in the house a lot. I don't really have any friends or anything. I mean, my family come and visit a bit, but it's nothing. I don't know. It's kind of scary because I've just been kind of literally just in the flat by myself, which I always thought I'd like, but I don't actually like it.
Counselor：Okay, so what are the kind of difficulties that you have been experiencing?
Client：I mean, I'm a photographer, so I kind of. It's been stopping me a bit, my anxiety from being able to get work, and because every time there's an opportunity that is kind of involving me having to interact with people, I just tend to just turn it down. So I was kind of making things hard in that respect and just kind of friends wise and everything, I feel like I'm just kind of increasingly more alone. So it's kind of stopping me from making friends and, you know, like, relationships and stuff.
Counselor：Okay, so you said that your difficulties are getting in the way of you doing certain things, so they're stopping you from taking up kind of certain types of work. And as a freelance photographer, I guess that can be kind of a problem. And they're also stopping you, or you feel like it's stunting you socially. You're not kind of able to make new friends and get to meet new people.
Client：Yeah. Yeah. It was kind of easier when I was at home because I was obviously. I mean, my parents and stuff, that's fine. But, you know, they would. I'd go to places with them or I'd kind of have people there. But more and more, I'm just finding myself just staying in a lot. I mean, I went, like, two weeks to get coffee with my friends, and the whole time I was just kind of wanting to go home again. So I just don't want to. I don't want that to happen. I don't want to lose everyone.
Counselor：So you're kind of worried about where this is going to lead to.
Client：Yeah.
Counselor：So you said that you first noticed the anxiety kicking in about five or six years ago, so you would have been about 19?
Client：Yeah.
Counselor：And what was happening around that time?
Client：I guess I'd finished school about a year before that. And, I mean, I've always been a bit shy at school, but it was never, ever like. It didn't really affect things as much as. Not at all, as much as it has been doing the last few years. I guess it just started when my friends went to university, and, I don't know, I felt like I was expected to kind of move out or just do something, and then it just kind of escalated from there. I'd just stop going to parties, or I'd just say no to invitations or. I thought my job would help because, I mean, I love it. I really like doing photography, but I'm just kind of getting less and less work as it goes on, which is my fault. I keep saying no, but what kind.
Counselor：Of work is the most difficult for.
Client：You in your job? I guess when I have to kind of be working with other people, I don't like that. It's like when I'm trying to kind of do an event or something where there's a lot of people there, not just photographers, but actual, you know, if I'm, like, taking photos of people that I don't know, I just kind of find myself saying no. I mean, I want to do them, but it's scary, so I just don't do it.
Counselor：So, I guess, tell me a bit more about what happens then. So let's focus on maybe an invitation to do a job with. You know, it's going to involve photography with a group of people, and you're going to have to have social interaction. What kind of thoughts go through your head?
Client：I mean, I get really hot and sweaty, and I feel like everyone's kind of looking at me and thinking that I'm just, like, really stupid. And I feel like they're all going to be staring and thinking, I just can't do my job and I'm just an idiot. And, I mean, they'll think that I just look like a weirdo. And I just try. And, I mean, I just kind of just try and get out of the situation or just focus on something else. So that's why I like doing shots where it's just me and the camera, because then I can just put all my attention on that instead of having to, you know, be with other people.
Counselor：Okay, so it sounds like you have quite a lot of thoughts rushing through your head. Then at the point where you get that invitation, you think people look, people will stare, people will think I'm a weirdo. There's quite a lot about what you think other people will think. Yeah. And how does that make you feel?
Client：It just makes me feel like an idiot. Makes me feel like I just shouldn't even bother trying to do it anymore. I should just go home. And I just. I think I just don't want to be in that situation. I just feel like everyone else is fine and they're normal, and I'm just the freak who can't, like, do normal things.
Counselor：Okay, can you give me an example of a recent situation? Maybe we can focus on that, like.
Client：A work situation or just. Yeah.
Counselor：A time when you were maybe doing a job with some people and you felt the social anxiety, you know, that you're describing. You felt that kick in.
Client：Yeah. I was doing a job where it was kind of like a nature shoot, and I was having to work with a lot of different people. And when they told me about the job, I thought it would be fine. I thought it was just going to be a few other photographers, but there were actually people in, you know, I was taking photos of people kind of ingest the trees and stuff like that. And I get. They asked me to.
Counselor：That sounds quite interesting. Was that a fashion shoot or something?
Client：Yeah, yeah, it was a fashion thing. I think it was for some kind of. I'm not sure if it was a campaign or something, but.
Counselor：Okay.
Client：Yeah, it was really cool. But I found it really hard to try and focus on that because I was so. I was kind of feeling really anxious. And.
Counselor：So it wasn't what you expected?
Client：No, it was. No.
Counselor：So how long ago was that?
Client：That was two weeks ago.
Counselor：Okay, so it's quite recent.
Client：Yeah.
Counselor：So on that particular day, what were the thoughts that you had in your head when you were in that situation?
Client：I just felt really. Just really kind of hot. I couldn't really breathe and just felt like I wanted to just get out. And I was kind of trying really, really hard to just focus and just, you know, like, kind of hold the camera and just not think about anything. But I just felt like everyone was looking at me and, like, when they'd say action, and they try and get me to start, and I was just felt like everyone was just thinking I was really stupid and I shouldn't have been there.
Counselor：And I can tell you're getting kind of anxious, even just thinking about that day.
Client：Yeah.
Counselor：Okay, so you're describing quite a lot there to me. So you're saying that you kind of got hot and sweaty. You said that you held the camera.
Client：Yeah.
Counselor：What was do you mean? You were kind of trying to hide behind it or.
Client：I was just trying to focus on it, just thinking if I could just hold it really tightly, it would just. I don't know, I'd kind of just be able to just get through it and just focus.
Counselor：So you're holding the camera very tightly?
Client：Yeah.
Counselor：And why was that helpful?
Client：Because I felt like I was getting really, like, hot and flushed. And I just thought, at least if I can just. I don't know, it sounds weird, but I was just trying to keep my hands still on it because my hands were kind of sweaty and, like, shaking, like, loads, like. And I could just tell everyone Washington looking and they could see, and I just thought if I just managed to hold onto it, it wouldn't be as noticeable, but.
Counselor：Okay, so, okay, so it sounds like you had a lot of thoughts going through your head. You said that you worried that everyone's looking at you. What other thoughts were there that were in your mind?
Client：Just. I was just stupid. And it just really just felt really like a. Kind of like everyone was just going to be staring and just thinking that I just felt like everyone was looking at me and just. They could tell and just thinking, what's she doing? And they could tell what? I was just really, like, sweaty and.
Counselor：Just that they could see that that was okay.
Client：Yeah. So I always try and wear black. So this kind of tries to cover it up and just, like, a lot of layers so they can't tell. But, I mean, my hands, like, they were so shaking. I was really red and just wishing that I just wasn't there.
Counselor：So, I mean, you've already described it to me a little bit, but if you think about how you looked that day, how do you say, how do you think you looked?
Client：I think just really stupid. And, like, I think my face was really red. I could feel it flushing, and I knew that I was probably sweating and shaking. Like, my hands were definitely, really, really shaking, and it was, like, definitely, really noticeable. Everyone could definitely see.
Counselor：Okay, and what did you do about how did you try and conceal that or hide that?
Client：Well, again, I was trying to grip the camera, just look down, just trying not to do anything weird or. Because, I mean, they could probably tell I was being weird anyway, but hopefully I just tried really hard to just focus and look down, not try, like, not look at anyone else, and just. Yeah, just kind of try and get on with it as best as I could.
Counselor：So you avoided looking at people. It sounds like you wore black as well in kind of preparation anyway.
Client：Yeah, no, I always do that, even if it's really hot or I wear just loads of layers and just because otherwise I'll just be really sweaty and, like, people would definitely be able to see, so.
Counselor：Okay, and how did it end?
Client：Well, it kind of went on for, like, an hour or so, and then people were going. After every shoot, people go out for drinks after just to kind of celebrate like that we've done it. But I just. I went home straight away. Just got in my car and went home. I just didn't want to be around them, especially after they would have seen me being weird. And I just wanted to get home straight away.
Counselor：Okay.
|
4
|
Negative
|
F
|
Self-esteem and confidence issues
|
https://www.youtube.com/watch?v=JKUFWK6iSsw
|
13:40:00
|
Case study clinical example: First session with a client
with symptoms of depression (CBT model)
|
Counselor：Hi, Gabriella. I understand that you're here today because you've been experiencing some low mood.
Client：Yeah, I just. Recently, I'm just feeling down a lot and I can't really, like, snap out of it. Like, sometimes if it's happened before, I can just, like, get myself back on track, but recently I just find it really difficult to do.
Counselor：Hey, so it sounds like you've been experiencing some low mood and you're kind of struggling to get going a bit.
Client：Yeah, yeah, definitely.
Counselor：You've had low mood in the past, but it's kind of. You've been able to pull yourself out of it before, but more recently you found that harder. Okay, so I understand that you first went to your GP. He referred you here about two months ago. Can I ask what led you to go to the GP in the first place?
Client：My long term boyfriend broke up with me and it was such a shock. Like, I really wasn't expecting it and it just got me really down and I just felt really lonely and I didn't really want to see people and just wanted to be in my own space. And my mum told me I should probably go to the doctors. Oh. And he's referred me to you.
Counselor：Okay. So it sounds then like you had that breakup and you weren't expecting it, so it kind of came out of the blue a bit and that you've been on your own quite a lot, so you've not been seeing people as much. And it sounds like your mum noticed that there's been a bit of a change in you. Okay. And how have things been then, since then, since that happened and since you went to the GP?
Client：I just. Nothing's really changed. Nothing's really improved. I just feel down, like everything's an effort and just feel distant from things. And like I said, I can't snap out of it.
Counselor：Okay. And how did you feel about coming here today?
Client：I was kind of disappointed in myself because I feel like nobody else my age is doing this. Like, I should have been able to snap out of it. Like, it's just another thing that I've not really. It's another thing that's making me stand out for the wrong reasons.
Counselor：Okay. So you feel like it's kind of odd or unusual to be coming to see a clinical psychologist? I suppose I just want to reassure you that it's absolutely normal to have feelings of depression and anxiety. It's really very common and it certainly isn't odd or strange at all. So it sounds like it was actually quite hard for you to come here today?
Client：Yeah.
Counselor：So what, I guess led you to do that? Because it sounds like maybe there was a lot pushing you against coming here today, but you've managed to come anyway.
Client：I'm just hoping that it's gonna help, I think. I didn't really want to admit it because it's just another failure, but my mum was talking to me and I know she's not really happy with the way I'm behaving. I didn't really want to disappoint her again and so I thought there's no harm in it, so she thought it'd come.
Counselor：So it sounds like partly you're doing it then, for your mum because you're a bit worried that she isn't pleased with you at the moment.
Client：Yeah.
Counselor：Okay. Well, I think it's great that you've come here and definitely there's a lot of evidence to suggest that psychological therapy can help depression and particularly the type of therapy that we're going to be doing, which is called cognitive behaviour therapy. And I'll tell you a bit more about that as we go on, but I'm just trying to find out a bit more about you today. So I saw from your notes that you're a medic student.
Client：Yeah, I'm not currently in uni at the moment, but, yeah, last year as a medic student.
Counselor：Okay. So I guess what's the reason that you're not in uni this year?
Client：It was pretty tough first year, so they then suggested that I took a year out. This is the break.
Counselor：Okay. So just thinking. So that would be about six months ago, was it that your year out started? Yeah. And it sounds then maybe like your first year was also quite tough.
Client：Yeah, it was. I thought it's tough for everyone, but obviously we all take it in different ways, don't we?
Counselor：And you're planning on. Are you planning on returning and.
Client：Yeah, I'm gonna have to. Really? So. Yeah.
Counselor：Don't sound too sure about that, though.
Client：I think returning is probably that's what's gonna make everyone happy. And I think, you know, at least I'll be able to finally achieve something and get something right, so. Yeah, like, next year I'm gonna. I'll get through it. Yeah.
Counselor：Okay. So it doesn't. It doesn't sound like you want to go back.
Client：I do. I do enjoy it. I just don't feel like me at the moment and I just. It's a lot of work and it's a lot of pressure, but that's what comes of it. And, you know, it'll work out for the best if I go.
Counselor：Okay. So I guess then there's quite a lot of thoughts and feelings about going back at the moment. I'm just wondering, in the meantime, what are you up to? What have you been doing?
Client：Well, I've not really had much on the horizon. My mum, her friend, owns a restaurant and she suggested that I did a bit of waitressing there just for a bit of money and stuff, because obviously I'm not in uni, so I've done that.
Counselor：Okay. How many shifts have you done there?
Client：I've only done one so far. Yeah. I don't know whether it's something that I'd probably go back to, but.
Counselor：Okay. When was that shift?
Client：It was last week, actually. Okay.
Counselor：And how was it? I suppose I'm intrigued. Can you tell me a bit more about that?
Client：It was different, you know, because it was like, I could. I did enjoy it because there was like. It's just different aspect and I had to, like, speak to people and, like, try to get their orders and try to remember it and stuff. Like, I wasn't very good, but I suppose, like, it was handy to have some money and, like, get out the house.
Counselor：Okay, so it sounds like you quite enjoyed that, then.
Client：Yeah.
Counselor：What makes you think you weren't very good?
Client：I just. I was just a bit slow and people sometimes didn't understand what I was saying, so I'd have to talk louder or quieter or slower. And I got a bit confused sometimes with the orders and I just don't really think that I'm not really, like, a friendly. Like, people don't really think that I'm a friendly person, so they didn't really want to talk to me and stuff. I felt like I was, like, inconveniencing them by, like, asking them things and getting things wrong. But, yeah, they said that apparently most people get, like, a few mistakes on their first shift. But then again, she's my mum's friend, so it's probably why she's saying it.
Counselor：So the person who owns a restaurant is your mum's friend?
Client：Yeah.
Counselor：Okay. So it says you're saying that you think you weren't very good and that's because you're a bit slow and you got confused with some orders.
Client：Yeah.
Counselor：Is it? But you said it's common for people to do that on their first shift.
Client：That's what she said to us. But it's probably just. She's just trying to make me feel better. She probably felt sorry for me because I'm obviously not very good at it. Like, I'm not very good at any things. Recently, I think she just felt sorry for me.
Counselor：Okay. So I've just been noting down some of those thoughts that you've been having. You kind of say that you feel like you're not very good. You're slow, you're confused with the orders, and you feel like you're inconveniencing her and she feels. So for you. I suppose I'm wondering, I mean, what makes you think that she feels sorry for you?
Client：Well, like, like I said, she's my mum's friend, and she's obviously feeling sorry for my mum as well because she's got a daughter that's not like anyone else of her age, and she's just, like, all alone and she's not getting involved. So I think she just feels sorry for me and she doesn't want to say anything to upset me.
Counselor：But, yeah, when you're having these kind of thoughts, because that's quite a lot of negative thoughts you're describing, how do you feel?
Client：Empty? I don't. I'm just calling as it is. I'm just calling it as reality. And I feel like I'm being honest with myself by just voicing it and not trying to get around hiding it, because I know, like, I can say in myself.
Counselor：So it sounds like you feel like those thoughts are very true, then. I mean, if you were going to rate them, say, I'm going to pick out some of those thoughts you described. So you said I'm not very good and I'm inconveniencing them. How much would you say you believe those on a scale out of a hundred, where a hundred is like, I absolutely believe it and zero is like, I don't believe it at all.
Client：I'm about 80. Yeah.
Counselor：So you feel quite sure that you definitely believe those? Okay. And you said that when you're thinking those thoughts, you start to feel quite empty.
Client：I just feel distant. And like I said, I'm not really myself. I just. It's like I'm not really there, but when I am, I can't even do a good job.
Counselor：Are there any other emotions that you experience?
Client：I feel drained. I don't feel like I'm in touch with anything. Just. It's like everything's going on around me, but I'm just not there. I'm just. It's like I'm just watching.
Counselor：Okay, so you feel empty, distant. You feel drained. And how when you're feeling these emotions, how do you feel in your body? Kind of what sensations do you notice?
Client：I don't know how to describe it. I get, like, I have a bit of, like, you know when you kind of get, like, butterflies when you're nervous and stuff? Kind of get a bit of that.
Counselor：Do you feel some butterflies?
Client：Yeah.
Counselor：Did you have butterflies that night when you were at the restaurant?
Client：Yeah, I was pretty nervous then, but when I got into it, they went away and, like, it distracted me for a bit until, obviously, I realized that I wasn't doing a very good job.
Counselor：Okay. And when you have those emotions, how does it affect your energy levels? Do you feel more energetic, less energetic or about the same?
Client：When I'm feeling down, yeah.
Counselor：When you're having those emotions that you were describing, I just feel drained.
Client：Like, I didn't even have, like, the energy to wake up in the morning sometimes. Like, oh, I just feel pointless and, like, my body's heavy and I don't want to. Yeah.
Counselor：So it sounds like you feel very tired, you're struggling to wake up. You said it's pointless. And what do you do then when you feel like that? So I guess you just talked about when you wake up in the morning and you feel heavy, and I suppose you've been maybe having some of these thoughts and those emotions potentially the night before. What do you then do? How do you respond to that?
Client：I just have to get up. I suppose I don't really have a choice because my mum. I live with my mum, and I know it's hard for her, so I don't want her to be too worried. So I just. I just try to carry on as normal. I get up. It takes longer and I don't want to, but I do, and I'll get on with my routine.
Counselor：So you're a bit slower in getting up.
Client：Yeah.
Counselor：But you are still getting up anyway. And what about your kind of. What do you think about when you're doing that?
Client：I'm just thinking that nobody else is like me, it's my age, like, nobody should be feeling like this, and I'm the only one that does.
Counselor：So it sounds like you think a bit more about the problem and you kind of spend time thinking about how.
Client：I hate having it. I don't want to feel like this, but I do, and nobody else I know does, so it makes me feel even more alone, and that gets me even more down, and I just don't want to disappoint anyone and I just don't really want it.
Counselor：Okay, so it sounds like you try and toughen up on yourself a little bit. Tell yourself to work harder, to be different.
Client：Yeah.
Counselor：Okay. And when you start telling yourself that kind of thing and how does that make you feel? Does that make you feel better afterwards or worse?
Client：It feels worse because I still can't snap out of it. Like, I'm aware it's happening and I just. And I'm trying, but I just can't. And then it's just another thing that I'm failing at. It's just another thing that I can't really get it.
|
5
|
Positive
|
F
|
Anxiety and fear
|
https://vimeo.com/147291070
|
15:15:00
|
CBT assignment
|
Counselor：Hi. Thank you for being here today. I just wanted to start off by asking how your homework was from last week and if it was helpful.
Client：Well, I think it was a little helpful. I did try the breathing exercises, but sometimes I don't think to do them right away. But I did try it a little bit and it did help. Good.
Counselor：So you said you wanted to work on the problem with your anxiety when you leave your son for therapy.
Client：Yes, that's what.
Counselor：Yeah. So we've been working on your breathing like you've been talking about, and if we work on this, then maybe we can move into other things, you know, like in addressing your anxiety elsewhere. But. So why don't you tell me about how you feel when he is in therapy or getting occupational therapy?
Client：Well, I just get very anxious. I don't want to leave him in the room without me. I want to be right there. I'm not used to leaving him alone with other people at all. And I know I get very anxious in the waiting area, and I pace and back and forth and wonder what's going on in the room and listening for anything that might be going on. So, yeah, I just have a lot of anxiety about being separated from him, even for that short time.
Counselor：So do you feel like there's anything that has caused this anxiety? Like, where is this coming from?
Client：Well, I did have a child of my own that passed away, and I think that it probably has affected me with my other children and especially now with, you know, me being older and adopting this little boy. And I'm just scared, always scared that something's going to happen to him.
Counselor：Yeah. Can you tell me more about the problem, like, what are your fears and what are your anxieties when he's in a therapy session?
Client：Well, I worry about, you know, if he's going to fall, if they're working with him on a table, if he'll fall off the table and get hurt. I don't know all the people that are in and out of the therapy bill or the building here. I have some anxiety about someone snatching him if nobody's watching him closely, which I'm sure they are, but I still have that fear that something's going to happen to him, and I'm not right there.
Counselor：So it sounds like you have a lot of anxiety just with your son in general. So does he been any time away from you?
Client：No, not really. Most of the time he's with me or I have a couple of people I trust to watch him. But other than that, he's usually with me, doctors appointments, anything like that? Of course I'm there.
Counselor：Do you trust the therapist that he sees for therapy?
Client：Well, it seems like an awfully nice guy, but I don't know him really well, and I'm hopeful that once I get to know him more, I'll be more trustful, but I still just have a lot of anxiety about him.
Counselor：So the anxiety that you feel about him being in therapy is what you want to focus on today, correct?
Client：Yes.
Counselor：Pick that and work for it. And once we've addressed that, then maybe we can address some of the anxiety you feel, like you said, and you can have some time to yourself, maybe, and be able to let him go to preschool. Cause it sounds like he really needs social interaction.
Client：Yes, I'm sure. Well, I know that would be good for him. At some point, he's. I know I'm gonna have to address these issues and work through these issues. It's just very difficult.
Counselor：Do you feel this way with your other children or just with the youngest?
Client：Just with the youngest. The other children are older and they're able to verbalize and tell me if anything's going on or. But this little boy, you know, like I said, I adopted him and he has some special needs and I just worry about him, I think, more, but it sounds like.
Counselor：So your anxiety goes beyond kind of normal parent like parental worry and sounds like it's pretty extreme.
Client：Yes, it is. And I don't think it's good for him. I know I need to work on this because I don't think it's good for Jack to be in this situation with all. With my anxiety. It's not good for him.
Counselor：So what do you say your biggest fears are when he's in the therapy session, when you can't see him?
Client：My biggest fear is that he's going to get hurt, that he's going to fall off the table or he's going to. They're going to have him doing activities that he could get hurt. That's probably my biggest fear. The second one would be that somebody would not be watching him for a moment and that someone would, you know, just take off with him.
Counselor：Well, why don't we kind of, with CBT, we think about different ways, like, kind of for and against those thoughts. So if you don't mind, you have a pen and a paper, so you would just write these down. You come up, we'll come up with some evidence for and against him getting hurt or someone taking him while he's in a therapy session and you're not there. So what is some evidence for him getting hurt or taken?
Client：Well, there's a lot of different people in the building to strangers or other families, and that could possibly lead to him.
Counselor：So you write that one down.
Client：Okay.
Counselor：What else?
Client：Well, you know, he's here for occupational therapy, and he's got some motor skill issues, and I'm afraid, depending on what they have him do, that he could be hurt, that he could hurt, get hurt or fall because he's not always real steady on his feet at times.
Counselor：Can you think of any other evidence that support these thoughts?
Client：Not really.
Counselor：So what is some evidence against these thoughts?
Client：Well, evidence against would be, obviously, the therapist, as a trained professional who knows, you know, what they're doing, and obviously, I'm sure safety is number one concern. So that would be something, you know, against. And I am pretty sure he would never be left alone at three years old, you know, where someone would be able to take him.
Counselor：Right.
Client：So in my mind, I know that, but I just can't get past that and feeling anxious about these things that might happen. Right.
Counselor：Well, it sounds to you, like, do you think any other children have ever been kidnapped or hurt at the center?
Client：I've never heard of anyone, but every day you see stuff on the news and about children in a lot of daycare centers and that kind of thing being hurt, abused, or, you know, abducted.
Counselor：Right. But with all the therapists and the adults in the building, it sounds like. And with the way things are set up, it sounds like him being kidnapped from the center is probably not very likely.
Client：No. Right. Like I say, in my mind, I understand that it's probably not very likely at all that that would happen.
Counselor：Right. So you can add that that's just not a very good, not a very high chance of anything happening. So let me ask you, why is he or why do you have to stay in the lobby? Kids don't. Typically, parents go back in the session with their kids.
Client：Well, I have been in, sat in with a few sessions with him, but he actually does much better if I'm not there, he participates more, and if I'm in there, he wants me to hold him, he wants to cling to me, and he doesn't seem to want to participate with the therapy, and I really want him to get the benefit out of the therapy. So, you know, that's why they suggested that I stay out in the lobby during the session. Right.
Counselor：So it sounds like you care about your son and you want him to do well in therapy. So that's why you're addressing this, but.
Client：Right.
Counselor：It's not good for either of you if you're having this kind of anxiety while he's in. While he's in therapy sessions, right.
Client：Yeah, because I think he picks up on it also.
Counselor：So what are some other kind of issues that you feel like you deal with? Like anxiety? Do you feel. Are you, do you feel the same kind of anxiety like when you go to the grocery store or when you're out or if you leave him with the sitter?
Client：I do have anxiety when I leave him with a sitter, even though they are, you know, like I said, a couple of different people that I do trust, but I still have anxiety that something could happen while I was gone away from him. As long as he's with me, I don't really have anxiety at the grocery store or anything like that. Mostly it's just if I have to leave him for any length of time in a situation where even though I trust people, I still have the anxiety that something's going to happen.
Counselor：So do you feel like your anxiety kind of gets in the way at therapy sessions? Like, do people notice?
Client：Well, I think people notice in the waiting area that I pace and just appear anxious. I'm sure I appear anxious, and I know it's best for him, you know, if I stay out there, because I want him to get the most benefit out of the therapy. Yeah.
Counselor：How do you cope? How have you been cope? I know we've been working on your breathing, but I'm sure that doesn't always happen. So how have you been coping with the anxiety? Because you're probably by yourself, right? When you're out of with him, you're probably by yourself, right? While you're out with him.
Client：Yes.
Counselor：So how do you feel like you've been coping? Do you have any support?
Client：Yeah, I do have family support, and I also, you know, have a strong faith, and I try to think through things that some of my anxiety, I feel like I just can't help but feel anxious. But at the same time, there's a lot of times I talk to myself about how really unrealistic some of my thoughts are, so I try to work on that part of it.
Counselor：Right. That's what we've been doing with this, with the kind of evidence for and against things in the therapy session. So, yes, it is. You know, there is a chance that he could get hurt and there is a chance that he kidnapped. It's very, very unlikely. And so your anxiety is projecting it to the extreme. Like you do that with everything.
Client：Yes. I do that a lot of times. Yes. Yes. If he has a little bit of a cough or fever and I get anxious that it's more than a cold or, you know, maybe a little infection and I'm just so afraid of losing him, I think.
Counselor：Yeah, that makes sense. Do you think that he picks up on your anxiety? Do you think he's had any issues with being anxious?
Client：I think he probably does. And I think he gets anxious. I think he senses when I'm anxious and he tends to get a little bit upset, clingy. And I think he's picking up on some of my anxiety.
Counselor：You discussed your anxiety with the therapist. Did they know?
Client：Yes, I did. I've talked to a couple of the people here at the rehab center and they've actually been very good and very supportive to try and, you know, reassure me. And so that has helped, too. And as I, as we come more each time, it seems to get a little bit easier to let him go back there on his own.
Counselor：That's good. So do you think that this will be helpful, like, since you've let him do. Have had some separation that. Do you think this will be helpful for other stuff, like letting him go out and do other things on his own? Like, would you be ready to send preschool?
Client：Not today, but yes, I think it will be. I think this is the start of trying to just maintain some, you know, letting him go a little bit. And even though he is only three, there are going to be things coming up and times for him to, you know, that he's going to need to do his own thing and. Yeah. So this has, this has been helpful. It's. I guess I've been putting it off for a long time and I've just not wanted to deal with separating from him just even for an hour. But I. This is a good start. Good.
Counselor：Well, what do you think for your homework for next week? Kind of coming up with some evidence for and against the same things that we've been talking about and letting him go to preschool. Does that sound good? Like coming up with.
Client：Oh, yeah.
Counselor：Like evidence. Right. Like we did today for him going to preschool.
Client：Yeah, I'd like to do that. Give me some time to think about it and make a list.
Counselor：Yeah, sounds good. Well, thanks for coming in today.
Client：Thank you.
|
6
|
Negative
|
F
|
Relationships (romantic, family, friendships)
|
https://www.youtube.com/watch?v=jQgkVKGqBCE
|
19:04:00
|
CBT Counseling Role-Play - Clients with Symptoms of Borderline Personality Disorder
|
Counselor：Hello, Marcy, how you doing?
Client：I've been better.
Counselor：Been better. Yeah, I saw that you called a few times between the last session and today. You left a few messages.
Client：Yeah, I was trying to get holding you. I had something I really needed to discuss with you, but nobody called me back. I emailed you a couple times, I never got a reply, so I was just wondering what's going on with that?
Counselor：We can talk about that. I want to talk about that after getting those messages. Remember we discussed the process for when your mood deteriorates and you had a few other resources you wanted to connect with before calling me.
Client：Yeah, I kind of remember it.
Counselor：Your brother was one of those resources.
Client：Oh, yeah, that's useless anyway. Go on.
Counselor：Did you attempt to.
Client：No, he's so busy with it, like he could never help me. I don't think he even cares what I'm going through. He's got his own stuff to deal with, he's got his own family and all this stuff and. Yeah, he doesn't care.
Counselor：So you didn't contact him first because he thought he doesn't care? Yeah, and we'd also talked about a few different friends that you had that you'd reached out to, you didn't contact them or did.
Client：Well, I did call my one friend, Beth, but I. She was like, oh, can I call you back? And of course she didn't because nobody ever calls me back. You know, I'm like, they all have their own lives. No one really cares what I'm doing. You know, it's always like that. So that's why I thought I could reach out to you since you're supposed to be helping me, but apparently you never call me back or answer any of my emails, so.
Counselor：Right. We talked about how there's limitations on time and how it would be better if we could keep the therapy in here in person. Right. And not get really too excessive with the telephone calls. I realize that when you're in distress, there's that kind of feeling that it would be a good idea to call. But remember, we discussed different levels of distress. And if it's something common that you've been through before and you kind of know the outcome, connecting with one of those resources might be more helpful.
Client：Yeah, I just feel like you're the only one that can help me, you know, I mean, my boyfriend, like, things aren't going well with him. I thought he could help me, but I guess he can't. And I think he's running around on me and all that. So I was just like, well, let me reach out to doctor Grande and see if it can help me, because it seems like my last resort.
Counselor：I remember you discussing, a few weeks ago, your boyfriend, and you had a fairly high opinion of him. Like, it was. It seemed like a positive.
Client：Yeah, he was great. He was great. And then, you know, he was in the other room and he got a text message, and I was like, let me just look at that. Because I was just curious to see what's going on with him because he never talks to me about anything. And so I looked at it, and it was a girl's name and number that I don't know. And so he came back in. You know, they put it away quickly, and I didn't say anything, like, what's wrong with you? Because I was acting weird and I was like, nothing. So then he went out, so I followed him. And then he went to, like, some friend's house. And I don't know if there's girls there or not, but. So I kind of think he's running around, maybe. I don't know. And I can't trust him. I can't trust anybody, you know? So I don't know. I mean, he was so awesome before, but now I just don't know. But he was everything I ever wanted.
Counselor：Yeah, I remember. You seem very excited about where that relationship could go.
Client：Yeah.
Counselor：And you seem like you're much more negative about.
Client：Yeah. I mean, if he's not going to be faithful to me, what am I supposed to do? Yeah, I mean, it's just like every other guy that I've ever dated, like, either leave me or cheat on me or lie to me. So, I mean, I don't know why I thought this one was going to be different. Seriously, why would this one be different?
Counselor：So you have. You had this experience with the text message and you don't know? You don't know any more than that? But it sounds like you kind of jumped to, he's cheating. So, you know, he went to a text message and went to someone's house.
Client：Yeah. I don't know if they were related. The text message and him leaving, I mean, but I just assumed. So I'm just gonna assume because it seems to be a pattern in my life. You know, everybody lets me down.
Counselor：Could it be that you're jumping to that conclusion prematurely?
Client：Probably, but I guess it's all I know that's all. I've always been treated, so I kind of feel like, why would this be different? Even though I thought it was in the beginning, but I don't know.
Counselor：So you feel like you've seen this all before, this pattern?
Client：Yeah, I guess I just always pick the wrong people or it's probably just me. I think I'm the one that's just unlovable. I've been told that growing up a lot. So I think it's me because he's great. I mean, he's great and he's good looking, he has a good job. And I always thought I'm like, why is he with me? And then now I see, like, he doesn't really want to be with me. Whoever he was texting, that's probably the person wants to be with him. She's probably, like, pretty and has, she probably has a good job and she's got everything going for her and so.
Counselor：So you really, this week at least, you don't seem to think a lot of yourself.
Client：No. I mean, when things are going bad in my relationships, they really seem to get to me, you know?
Counselor：So in a way, you feel like your mood is subject to how your current romantic relationship is going?
Client：Yeah, I guess that's pretty right on. Yeah, I would say that.
Counselor：Is there anything that you can do from your side to improve what's going on?
Client：No, I don't think so. I think it's everybody else that is treating me wrong, you know? So unless I find the right person who's going to treat me right, then I don't know what I'm going to do. So.
Counselor：So the. So the key to feeling better is finding the right person.
Client：Yeah, I think so. And like I said, I thought he was the right one in the beginning, and now I don't know anymore. But, you know, I really don't want him to leave me because, like, then when I gotta do him, now I'm gonna be alone. I want to be alone because I love him, but, you know, so I think I probably will forgive him and just stay with them because I don't want to be alone. I'm too scared to do that. I mean, I don't want to be alone without somebody. You know, I really need somebody. Yes.
Counselor：So does some of this seem like what you're describing with your mood, does some of this seem like you're out of control?
Client：Yeah, because I feel like I can't control other people's actions, and that really makes me mad. That makes me really angry, you know? That what am I supposed to do? And so I think acting out and following them and checking their text messages, and it's the only thing that makes me feel in control, I guess. I don't know.
Counselor：I know in the past, when we've talked about this, you've mentioned that you thought that that behavior could be driving them away, too.
Client：Yeah, I mean, I can see that. I mean, people want, you know, some that they can trust, too. And I'm not sure I've always been honest with them, but I'm always looking for things that they're gonna do to manipulate me or try to, like, you know, screw me over or whatever. So here's my guard down. Yeah, I'm suspicious.
Counselor：I wonder if sometimes you acting on those suspicions, that's not making things a little worse in those relationships.
Client：Yeah, probably. But, I mean, like I said before, I don't want to be alone. I don't want to move out somebody. I need somebody. I need somebody. I need somebody to be with, you know, I need someone to help me with things. I don't want to be alone. You know, that's, you know, and he has said things to me like, you can't call me all the time at work because I'm at work, and you leave me, like, 40 voice messages because I just want to know if he's actually at work. You know? He's like, you can't do those things because I'm gonna get fired, and then where are we gonna be? He's like, you know, and you can't, like, call the numbers in my phone and find out who they are and, like, hang up because my friends know it's you, and you can't, you know, have your friends come to the bar and see who I'm with and, like, report back to you. Like, that's. He's like, I don't want to be in relationship with someone that doesn't trust me like that. So now, you know, I'm really scared of losing them. Yeah.
Counselor：So you have called other boyfriends and this boyfriend many times?
Client：Yeah.
Counselor：On the phone?
Client：Yeah. I just want to check up and see what they're doing. If they said they're at the place that they said they were going, you know, I just want to know that I'm not being lied to because I've always been lied to. All my life, I've been lied to.
Counselor：So is all that calling something you do to relieve anxiety?
Client：Well, when I find out they're at the place that they said they were, that I feel better for at least, you know, for a few minutes till the next time. Like, wait, maybe they left. Let me see where they are now, you know, and then it kind of builds upon itself till they just get so frustrated. And then usually it ends with, like, a screaming match when I do see them.
Counselor：Mm hmm. You know, there's a lot of screaming and yelling.
Client：A lot of screaming and yelling and accusations and finger pointing and just. Yeah, it's not good. It's not a good scene when those kinds of things go down. But like I said, I really love him. I don't want to be without him. I don't know how I live without him.
Counselor：All right, so there's the. There's screaming and there's yelling and some discontentment, but there's also this love you have for him and this fear that you'll be alone. So there's a lot of emotion here driving different behaviors.
Client：I said I would do whatever it took for him to stay with me. You know, he doesn't really talk about it. I think he gets really mad at me for being so needy. He's like, you're needy. Why don't you do your own stuff and leave me alone? And, you know, you need to have your own life. And, you know, I don't like to be ignored. You know, I was ignored all growing up, made a big family. I just got lost in the shuffle, and now here I am.
Counselor：So with all these things going on, all these kind of negative feelings, negative self image and trouble with the boyfriend, like this week, today, what's your goal? What do you want to change?
Client：Well, I guess I would like to be able to trust people more and not feel so desperate. I mean, and I don't know what to do. I don't know how to do that.
Counselor：To be able to trust people more. So maybe one place we could start is to ensure that you're accurately assessing what, for example, your boyfriend's doing. So in the past, when we've talked, you've been suspicious about different behaviors. And it turns out in many of those cases, nothing was happening. And the kind of chasing them around and making observations, that's what caused some of the problem. Does that make sense?
Client：Yeah. I mean, that's what they say the problem is. But I don't know. It could be something else. I mean, it could be somebody else. They could have been met somebody better. I don't know. That's what they tell me. Maybe they're trying to be nice, try to get out of the relationship. There's no way to know, that seems.
Counselor：To be where your mind goes first. It's kind of the worst case or one of the worst case scenarios. So sometimes with managing mood, one of the keys to success is encouraging, accurate thinking, logical thinking. Right. So there's a lot of emotion involved when you're following them around and when you're checking the cell phone, like, are you, you feeling.
Client：Yeah, I don't. I don't feel good. I mean, I feel completely anxious when I'm doing for a. I might get caught. You know, that's always a thing in my mind. And like, be like, why am I doing this? But beyond my control. Sometimes I just need to know.
Counselor：It would be possible to. When you have these thoughts like that, say, let's work on this idea that you're worried about him cheating. So you have this thought that something like, he's going to leave me. He doesn't really love me. He's cheating. Is that close to what you're thinking?
Client：Yeah, that's pretty close.
Counselor：And after you have a thought like that, are you. Is that when you're, like, checking up on him and checking on his phone and confirming?
Client：Yeah, it compounds itself, definitely.
Counselor：So something happens that leads to that thought. And I think that would be an area where maybe we could try to focus some energy. So maybe for this week. I know things are still tumultuous between you and your boyfriend. Maybe this week, before you follow him around, check his cell phone, confront him, anything like that. Instead of doing that, before you have that feeling or as you have that feeling that you want to do that, maybe document what is going through your mind at that moment, like what you're thinking. Ok, and I'll try that. It seems likely, based on our experience together, that this is something that will happen a few times between now and next week, there'll be a few times when you want to confront him or follow him around. You could write down what you're thinking at each point and not confront him or follow him around. So hold off on the behavior. Focus your energy on writing down those thoughts.
Client：That's gonna be hard.
Counselor：It's difficult.
Client：Yeah, I try.
Counselor：I know. Sometimes it feels like the emotion kind of takes charge.
Client：Yeah. Sometimes I don't even know what I'm doing. I just find myself in the car. I'm like, where am I going? I'm like, what am I doing?
Counselor：Yeah, the emotions are powerful. However, I'd like to be able to get these thoughts. I think that there might be a way to improve your mood if we can find out how these thoughts are working and maybe try to make some adjustments there. I know it's difficult, and I know the emotions are hard to control for you. Do you think it's a. A step you could try this week, though? And so whenever you find yourself about to do something that's maybe going to antagonize the situation, write down at that point what you're thinking. Maybe that way you can kind of channel some energy there and not act out on that. And it's also something we can take a look at in session next time and review those thoughts, see what we find, see if we find any patterns. Does that make sense? I know this is a struggle for you, and I realize that writing all these thoughts down and following this process is new and different. I want you to try to stick with it if you can. I think that you. You could be able to benefit from this if you could stick with it.
Client：Okay.
Counselor：All right. Okay. Give it a try. All right, Marcy, let's go with that plan and write down those thoughts. We'll go over the next week and between now and next week, the same thing, like, in terms of when you want to reach out to me, take a look at those guidelines we worked out with that process, and work through the process and see if you're actually supposed to contact me, if it's really something that requires that attention or if some of your supports can take care of that. I know it's tough when you call me and I can't get back to you.
Client：Yeah. I really feel rejected in my bathrooms.
Counselor：Yeah, I'm not rejecting. I know it feels that way. I'm trying to set a boundary that will help you and trying to focus our time in here instead of on the phone. All right. So if you could apply that same logic to when you want to call me, work through the process and write down the thought. Okay. We'll go from there, and I will see you next week.
Client：Okay. Thank you.
Counselor：Thanks, Marcy.
|
7
|
Positive
|
F
|
Self-esteem and confidence issues
|
https://www.youtube.com/watch?v=W3hMmZQAdhw
|
09:23:00
|
CBT for Social Anxiety Disorder: Using downward arrow and thought challenging techniques
|
Counselor：Okay, so you said that when you're at work, you really worry that you're gonna say something stupid?
Client：Yeah, that's something that's always on my mind.
Counselor：What would be so bad about that if you did say something stupid at work?
Client：Because people would think I was weird.
Counselor：Then what would be so bad if people. People at work thought you were weird?
Client：They wouldn't want to be friends with me.
Counselor：And what would be so bad about that if people at work didn't want to be friends with you?
Client：Well, I just have no one to talk to at work.
Counselor：Then what would be so bad about having no one to talk to at work?
Client：I mean, the shoots can go on the whole day, so I'd just be by myself the whole time.
Counselor：And what would be so bad about being by yourself, you know, for a whole day?
Client：I don't know. I guess I should be used to it now. I spend a lot of my time by myself.
Counselor：Oh, that must be tough. What does that mean to you? That you spend a lot of time on your own?
Client：Dunno. I guess it's just like I spend so much time by myself that it's kind of like I'm nothing even worth being friends with.
Counselor：So it sounds like deep down that you think that you're not worth being friends with. That's quite a negative belief. I mean, how much would you say that you believe that out of a hundred? If 100 is where you believe it totally. And zero is where you don't believe it at all?
Client：I guess like 9500.
Counselor：When did you start believing that?
Client：I think it was probably at school. Yeah, I think at school.
Counselor：And what was it about school that made you start to believe that you weren't worth being friends with?
Client：Just like quite a lot of things. Like I wouldn't have anyone sit at lunch or people's birthdays and stuff. I wasn't invited and you know, like I was the last one picked for teams and stuff like that.
Counselor：And what is it now that makes you think that that's still true?
Client：I mean, it's kind of similar at work, obviously. Difference is that it's work, not school. But you know, people go for drinks and stuff after work or after a shoot, and I just kind of excluded a lot of the time.
Counselor：That sounds tough. Is there anything that makes you think that it's not true that you are worth being friends with?
Client：I guess my friends and family would say that I am. Like, I try to make a lot of time for my friends and stuff.
Counselor：Okay, so it sounds like deep down you have this thought that you're not worth being friends with. And that started at school when you had trouble making friends at school and that you weren't always picked for teams and that now at work it feels like the same thing is happening, that you're not always invited out for drinks with people and that sometimes you feel that you're excluded from their social groups. But then that's not the whole story. That on the other hand, you are close to family and you do have friends who would say that it's not true that you are worth being friends with. In CBT, we do a thing called thought challenging where when we have these negative thoughts, sometimes we actually put them up to scrutiny. We weigh up the evidence for and against them. I like to think of it as putting the thought on trial. Could we do that now where we just actually try and weigh up the evidence for and against that thought a bit more?
Client：Okay.
Counselor：Okay. So if I just put two columns here, so for and against. And it sounds like the evidence for this thought that makes you think that it is true is difficulty at school, making friends, being picked for teams, and difficulty at work, feeling excluded sometimes from groups.
Client：Yeah.
Counselor：But actually in this other column we have that you are close with your family and that you have some close friends. Okay. Now moving back to this first column, is there anything else that makes you think it's true that you're not worth being friends with?
Client：Just like, I kind of don't go to a lot of stuff. People have, like gatherings and things and a lot of the time I just. I don't go and rather just stay at home.
Counselor：Don't go to parties. What kind of parties are we talking? Like big parties, small parties, mainly big ones.
Client：If there's a lot of people there, I just find it really. It kind of makes me really anxious. So a lot of the time I just prefer not even to be in that situation in the first place.
Counselor：Okay. So you don't go to larger parties and events. Okay. Is there anything else that maybe thinks that it's makes you think that it's not true that actually you are worth being friends with?
Client：I mean, I guess my friends would say that I was. I do have close friends and, you know, when it's like their stuff that's important to them, I always make sure that I think about that. And even if I find it stressful, I'll always make sure that I can kind of put them first.
Counselor：Okay. So your friends would say that you are worth being friends with and it sounds like you put your friends first.
Client：Yeah, I do. Make sure I try and do that.
Counselor：In what kind of ways do you put your friends first?
Client：I guess when it's birthdays or, you know, something important to them, I'll always make sure that I'm there and that I put a lot of thought into presence and stuff like that.
Counselor：Can you give me an example of a time that you've done that?
Client：It was my friend's birthday a few weeks ago and we did like a big surprise at hers and I made a cake and stuff like that.
Counselor：So you actually helped to organize events for your friends?
Client：Yeah.
Counselor：Is there anything that you do that you wouldn't do if you weren't a good friend?
Client：I guess I kind of always put myself in a situation, even if I find it kind of. It makes me anxious. If it's for my close friends and I know that it's something that's important to them, then I'll always put them first and make sure I'm there.
Counselor：So you'll tolerate your anxiety if it means something to a friend of yours?
Client：Yeah.
Counselor：Okay. So at the moment in the four category we've got that you had difficulty making friends at school, that you're having difficulty now at work making friends, and that you don't go to larger parties or events. But actually there's a lot of evidence in the against column, evidence that would suggest that actually you are worth being friends with and you're a good friend, that you're close with your family, you're close with your friends, your friends would say that you're a good friend of you put your friends first. Even when you're anxious, you tolerate that anxiety if you know it will mean something to them. That when things are important to your friends, like birthdays, you'll make a real effort. You'll even actually go to the effort of organising events and baking cakes and doing things like that for other people. Is there anything else that you do that makes you think that maybe you are a good friend, you are worth being friends with?
Client：I mean, I still have my friends, so I guess if I wasn't worth being friends with, I wouldn't have these friends I've had for quite, quite a long time.
Counselor：Okay, so it sounds like you've got long term friendships as well, so you might have trouble making friends, but when you make them, you stick with them.
Client：Yeah.
Counselor：Okay, I'm just going to give you this list now to have a look at.
Client：Okay.
Counselor：How do you feel now that you're looking at that list?
Client：It's weird. There's actually kind of more stuff in the against than there is in the for. I guess also a lot of the stuff that is in the fore column is kind of things that I make happen. Like I don't go to things. Yeah. It seems like some of it's kind of in my hands.
Counselor：So it's not that you're not worth being friends with but actually that you're choosing not to engage with people always?
Client：Yeah. Yeah, I think so. Yeah.
Counselor：Okay. And if I was to ask you now, you know, this idea that you're not worth being friends with, how much do you believe that now that we've done this exercise where 100 is where you really believe that you're not worth being friends with and zero is that you don't believe it?
Client：I guess I'd say maybe 40. I think I do still think that it might be true, but I think I believe it less than I did before.
|
8
|
Positive
|
F
|
Anxiety and fear
|
https://vimeo.com/770477688
|
17:26:00
|
CBT for Trauma - Scenario 1 Trauma Informed Care Intake Role Play with Dr. Laurie Markoff
|
Counselor：So one of the things that we know is that sometimes people who have difficulty with anxiety and things like that have also had some bad experiences in their lives. So I'm going to ask you some questions about some of your difficult experiences that you may have had. And I'm just going to ask sort of yes or no questions. I only need sort of headlines. I don't need a lot of detail about the things that happened right now, but I'm just going to ask you those questions. And if anything about this interview starts to make you uncomfortable, you can take a break. If I ask a question you don't want to answer, you can just say, pass, and I'll just move on. So it's really up to you what you share, but I do want to ask you these questions. Is that okay?
Client：Yeah.
Counselor：Okay. So have you ever been physically hurt by anyone, any. Either as a child or an adult? You know, hit.
Client：Yeah, my. I had a boyfriend a couple years ago, and he. He would hit me sometimes, but we're not together anymore, so.
Counselor：Mm hmm. Was there other kinds of physical abuse? You know, did he do more than hit you? Was there anything.
Client：No, he would just slap me sometimes. Usually when he was like, if he'd had a really hard day at work and maybe he would be drinking or something. He wouldn't slap me when he got home, but I got out of that, so that's good.
Counselor：Well, it's good that you recognize that that was really not acceptable behavior and that you didn't want that in your relationship. And it's great that you were able to get away from that. That's really good self care, that you were able to make that decision and, you know, and make a different choice and create more safety for your. Yourself. That's really good.
Client：Thanks.
Counselor：What about sexually? Has anybody ever, you know, when you were a child or as an adult, touched you against your will, anything like that?
Client：Yeah. I don't really want to talk about it, though, but, yeah, when I was. When I was little.
Counselor：How little? Just vaguely ten. Okay. Okay. And was it a family member or a stranger or.
Client：It was. It was a family member, but I don't really like talking about it.
Counselor：Okay. You don't have to. Okay, great. Thank you for telling me that much. That's really all I need for right now. Although it may be important for you to talk about that later, at some point you can wait until you're ready.
Client：Okay.
Counselor：Okay. As a child, you know, sometimes parents aren't very available, don't provide basic food, clothing, shelter, that kind of thing. Did you ever have that experience of being neglected? Hmm? What's going on, Tricia?
Client：I don't like all these questions.
Counselor：Yeah? Starting to get uncomfortable, huh? You feel that somewhere in your body, you're feeling that in your. Your body? Yeah. Sometimes these questions can bring up very difficult things. I know. Sorry. When you're feeling like this, what helps you?
Client：My cat.
Counselor：Hmm. Tell me about your cat.
Client：She's a jerk. She's a jerk? Yeah. She's not very friendly. Um, she's friendly to me, though, when I'm really upset. She, uh, she'll, like, cuddle with me on the bed and stuff, so she knows when I'm really upset. But it's great that she knows. Yeah.
Counselor：That's pretty amazing.
Client：She's just kind of a jerk. She'll bite and scratch it, whoever she wants to. She wants to be snuggled until she doesn't want to be snuggled.
Counselor：What's her name?
Client：Persephone.
Counselor：Persephone. That's a great name for a cat.
Client：She came with it, and I decided to just leave it.
Counselor：Wow. I like it a lot.
Client：Great.
Counselor：It's wonderful to have a cat named Persephone who's good at helping you when your feelings are difficult. That's really good. That's, you know, that's a blessing there. Can we go on with the interview now?
Client：Yeah, I guess.
Counselor：Okay. About continuing. Okay. I'm going to ask you some different questions. I want to ask you a little bit about your living situation. So what kind of housing do you live in?
Client：I have an apartment.
Counselor：Mm hmm. And how long have you lived there?
Client：Almost a year.
Counselor：So not that long. And who do you live with?
Client：Just the cat.
Counselor：Just per second. Okay. Do you feel safe where you live?
Client：Safer than when I was homeless.
Counselor：Mm hmm. Safer, but maybe not entirely safe.
Client：Yeah.
Counselor：Yeah. What makes you not feel that safe where you live?
Client：I've kind of a. Have a landlord situation. Mm.
Counselor：Difficult relationship with your landlord?
Client：You could say that.
Counselor：Can you tell me about it?
Client：I don't. I don't make a lot of money, and my hours got cut at work recently, and he said he was going to evict me, and I really didn't want to be homeless again, so he said if I had sex with him that I wouldn't have to pay my rent.
Counselor：Wow. That's really hard. It makes sense. So you agreed to that I didn't.
Client：Want to be homeless again.
Counselor：That's right. And in order to survive, anyone is going to do what they have to do. Right.
Client：But it sounds like that's what I keep telling myself.
Counselor：Mm hmm. But it's also upsetting you a lot.
Client：I just keep thinking, like, what if somebody finds out? And now I told you so, obviously people are gonna find out.
Counselor：Well, what do you mean people?
Client：Well, I mean, don't you have to tell people when stuff like that happens?
Counselor：No, actually, what you and I discuss is between us, and you'll get to decide what you want to do about that situation so we can talk about it. But you get to decide. I only have to disclose if you're going to kill yourself or someone else to somebody else. Those are, you know, or if you're abusing an elder. Those are the circumstances under which I have to let other people know. So this is something that's just for you and I to talk about. And as part of, you know, our work together, we can decide what's the best way to take care of yourself going forward. So it's entirely up to you what we do from here. And I totally appreciate the courage it took to let me know that that was happening. And I'm happy to be with you as you sort out what's really the best path for you going forward for your own well being. We'll work on that together. Does that make sense to you?
Client：Kind of. No one's ever said it to me like that before, so I thought you had to tell people. But no. If not, but no.
Counselor：And I should tell you that. Remember how I said earlier in the interview that people who've had adverse experiences like sexual abuse in their past or physical abuse in their past, that sometimes that's connected to what happens going forward?
Client：Yeah.
Counselor：Well, it's not. It's really common for girls who've experienced sexual abuse later in life to end up using or being in a position where they end up using that for survival purposes. So what you're experiencing is actually probably a lot more common than you think. But just like you didn't want to talk about it, you know, the reason you don't know that other people are doing that is because they don't have often talk about it. So that way you think you're the only one in the world who ever ended up in this position. But in reality, lots of girls who've experienced sexual abuse grow up and it changes something that then they end up putting themselves, they end up in situations. Now, obviously you didn't create this situation. Your landlord is the one who is proposing to use his position of power to get you to do something that isn't what you want to do. And you're not responsible for his doing that. You're not. You're just doing what you've learned to do to help you survive. And we can work together for you to figure out what other options you have and what else you can do. Do.
Client：Okay.
Counselor：Does that make sense?
Client：Yeah.
Counselor：Good. Thanks. Thanks for being so open. So are you ready to continue with the rest of the interview?
Client：Yeah.
Counselor：Yeah. You're doing a really good job. A really good job, a lot of hard stuff. And you're letting me in and that'll help us to be able to, you know, figure out together what you need to do to, you know, help with your anxiety and to make your life work better for you.
Client：Okay?
Counselor：Okay. So now I'm going to ask you some questions about your. So we've come to the end of all the questions and thanks for hanging in with me. I know it was a lot of questions, but I feel like, you know, I've gotten to know you a lot by asking these questions. So actually you've done a really good job of helping me to sort of begin to piece together the puzzle of what we're going to work on together. So that's really good. So now that the interview is over, the next step will be we'll make an appointment before you go, you know, for you to come back. But I just want to ask you now, how are you doing? How are you feeling?
Client：Well, I'm not shaking anymore, so that's good. I think I'll be okay.
Counselor：All right. So if after this interview you go about your life and you start to have difficult feelings, what are some things that you already know that you can do to help yourself with those feelings?
Client：Well, I. I play the guitar, so I think sometimes that helps a little bit. And, you know, and then there's Persephone, the mean cat. Yeah.
Counselor：Yes. Uh huh.
Client：Yeah.
Counselor：And is there anyone in your life that you could call if you were having a hard time?
Client：Yeah, actually my best friend, she knows about all my anxiety and everything, so. So sometimes I'll call her and just say, hey, I really need to not, you know, be here or whatever. And she lets me come over.
Counselor：So that's great. So you have some ways to take care of yourself. I just want to make sure that the stuff we opened up in this interview doesn't end up interfering too much in your regular life. So thanks very much, Tricia, and I'll see you next week.
Client：Thank you.
Counselor：Take care of.
SPK_3：This scenario illustrates an example of a trauma informed intake or initial assessment. It's really important before beginning to ask questions about trauma to explain to the client exactly why you're doing that. And that also begins the psychoeducation about the connection between trauma and the kinds of problems that people have. You also want to give the client real control over what she shares. And there are a lot of things that I do to help that to happen. I tell her that she can refuse to answer or she can take a break. And when I do that, some clinicians will say, oh no, if I do that, then I'll never get through the intake in time. The thing is, if you're doing a trauma informed assessment, it's really more important to create a safe relationship than it is to meet your deadlines. And also, even though I offer people.
Counselor：The opportunity to take a break, they.
SPK_3：Almost never do because they want to get through the session as much as you do. Notice that we ask short answer questions, looking for headlines and not pressing for details. Again, we don't need that information, and that information might be dysregulating to the client. In this interview, when Tricia begins to share her experience with domestic violence, I maintain the nonjudgmental kind of approach and point out her strength in leaving that relationship rather than focusing her on the difficulty of being in that relationship in the first place. That also helps with re regulation. Eventually, the interview does create some dysregulation for Tricia, and it is important that I notice that and acknowledge it and then that I help her to re regulate. And the way that I do that is by focusing her on what she can do about it, what she normally does to self soothe when things are difficult. And of course, that's good information for me to help to have. And also it gives her some idea of what we can do together that will help her moving forward. In a real trauma informed agency, we would have gone over the rules of confidentiality before I ever asked Tricia a single question. In this role play, I wasn't expecting that issue to come up. And therefore, when I gave her the information about confidentiality, I left out some of the exceptions to confidentiality. In a real situation, it is important, even if the client has already heard them, to mention all of the exceptions so that there's never a sense of distrust because something has to be shared that she wasn't aware of. At the conclusion of an interview like this, it's really important to take the client back and check in and make sure how she's feeling at the end of the interview. And even if the client says that she's feeling okay. It's a good idea to create a safety plan for going forward about what she's going to do should feelings develop that are difficult afterwards.
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9
|
Positive
|
M
|
Anxiety and fear
|
https://vimeo.com/773310338
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07:00:00
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CBT for Truma - Imaginal Exposure Role Play
|
Counselor：Alex, we're going to continue today with the trauma memory task like last time. So this is, of course, you talking about your memory of the attack from beginning to end in as much detail as you can. Just to remind you, we've said that we are doing this to help put this memory sort of back into the past, I guess, where it belongs. We hope that by doing this, it's going to help lessen those nightmares and flashbacks and other upsetting memories of the attack that are bothering you quite a bit at the moment. So how do you feel about that? About going through the memory again together today?
Client：Can't say I'm excited about it, but I'll give it another shot.
Counselor：Yeah. Look, I think we do know that this is difficult right now. But what I also expect is that it's going to get easier and easier for you to talk about this memory the more often you do. And I'll be right here with you to support you with that. So, same as last time, I'm going to ask you to talk about the memory as if it were happening now. So in the present tense. And I'm going to ask you to start at the bit where you are waiting for the tramdhead and end it at the part where your mum is there or your mum arrives. And I'll be checking in with you about where you are on the thermometer again. So before you begin, where are you in terms of your distress on that zero to ten thermometer?
Client：I'm about a five.
Counselor：About a five?
Client：Yeah.
Counselor：Okay, well, let's go through that memory again, starting whenever you're ready.
Client：So I'm sitting playing with my phone at the tram stop. I see them out of the corner of my eye. Two guys wearing jeans, hoodies and sneakers. I don't think much of it. Then they come up behind me, grab my arms and put them behind my back. My phone smashes to the ground. I can feel my heart pounding. I'm thinking, oh, God, what are they gonna do to me?
Counselor：Okay, you're doing well. Where are you on that thermometer?
Client：About a seven.
Counselor：Okay, stick with it.
Client：Then. I feel something cold metal on my neck. I realize it's a knife. I think, oh, shit. Then one of them whispers into my ear, give us your watch or I'll stab you. I can smell booze on his breath.
Counselor：You're doing well. Where are you now?
Client：Eight.
Counselor：Okay.
Client：I'm too paralyzed to speak. I just try and nod. They let go of my arms, but the knife is still there. One of them takes the watch off my arm. Then they start going through my pockets. I guess they're looking for cards or money. He finally puts the knife away. Then they pull me onto my feet and one of them knees me so hard in the stomach that I fall back down. Then they start kicking me in the stomach and just run off.
Counselor：Ok, you're doing well. Where are you on that thermometer now?
Client：About a seven.
Counselor：Keep going if you can.
Client：I'm lying on the ground in pretty bad shape. I can't breathe properly. I'm thinking, I don't have my phone. How is anyone gonna find me? Are they gonna come back for me?
Counselor：Okay, doing well. Where are you on that thermometer?
Client：I'm about an eight.
Counselor：Okay, keep going.
Client：I feel like I'm there forever, but finally I hear a guy calling out. He's asking him if I'm okay. I couldn't get any words out, so I just make a weird sound. He comes over. He's an older guy, about 50. He says everything's gonna be okay. And I'm so relieved I start crying.
Counselor：Where are you on that scale now?
Client：About six?
Counselor：Yeah, yeah, keep going.
Client：I don't remember telling him my mum's number, but I must have. Cause the next thing I know, she's there next to me. She looks like she's been crying. She holds me in her arms and says, I'm safe now.
Counselor：Okay, and where are you on the thermometer now?
Client：Back down to a five.
Counselor：Back down to a five. Okay. Great job. Alex, how was that for you today?
Client：It was hard, but easier than last time. Some bits were easier.
Counselor：Yeah, yeah, I noticed that too. It was still hard. And we'd expect that you're still getting used to talking about this memory that you've been trying to push out of your mind for a very long time. So I would expect that it would still be hard right now. But I noticed too, that there were parts where you seem to be a little bit lower on that thermometer than last time. And you came down to a five at the end. And I also noticed today that you seem to tap into a little bit more detail about some of the things that were happening than last time we went through the memory. So that's going to be really helpful for us as we continue to process this memory as well. So great job.
Client：Thanks.
Counselor：We're going to go through the memory again probably another couple of times in this session, but let's just take a moment to sit quietly and you can let me know when you're ready to start again.
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10
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Neutral
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F
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Self-esteem and confidence issues
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https://www.youtube.com/watch?v=KqbXZJ80yFU
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08:13:00
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CBT formulation in anorexia: Case study clinical example
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Counselor：Hi, Jodie. Nice to see you again. How have you been since I saw you last?
Client：Yeah, I've been fine. Been sticking to the plan. So it's been going well?
Counselor：Oh, the plan that the hospital set you?
Client：Yeah.
Counselor：Okay, fantastic. And how have you been finding that?
Client：Yeah, it's been, it's been good. I've been trying to follow it, but last week wasn't very good. I had a bit of a bad day, but since then I've been fine, so it's okay.
Counselor：Okay, so tell me a bit more about that bad day. I mean, what did you eat on that day?
Client：I don't think I had anything.
Counselor：Okay, so you just ate nothing at all?
Client：Yeah.
Counselor：Okay. I mean, tell me a bit more about why was that day difficult? Was there anything that had been happening around that time?
Client：It's been quite busy at school because we've got our exams and we had, like, a test the next day, so I think I was just a bit, like, worried about that, so I was trying to focus on that instead.
Counselor：So you were feeling a bit anxious about the exam that was coming up. Was there anything else that was worrying you?
Client：No, I think we had, well, we had 6th form applications due in and that was coming up in the next couple of days and I didn't really want to fill in my application.
Counselor：So it sounds like there was a couple of things that were worrying you that were on your mind.
Client：Yeah.
Counselor：Which thing was worrying you more, do you think?
Client：Probably the 6th form. Yeah, the 6th form one.
Counselor：Okay. What kind of. How did you feel about that? When, when we talk about that now and when that's brought up, what kind of emotions do you experience?
Client：I don't really want to start 6th form yet. It's quite soon. But I don't really want to. I mean, I've got exams first, so I've got to think about those. But I don't really want to go to 6th form at the minute.
Counselor：Okay. So what is it about sick form that makes you not want to go?
Client：I have to start over again and make new friends and like, a new routine and stuff, and I don't have, I don't really feel ready for that yet.
Counselor：What do you think might happen when you have to make new friends and start a new routine?
Client：I don't. I don't know if anyone's gonna like me, like, if they might not want to talk to me and then I won't be able to, like, focus on my work and get through it.
Counselor：So you're worried that you might not be able to make friends.
Client：Yeah.
Counselor：And you might not be able to focus on the work.
Client：Yeah.
Counselor：And how do you feel when you have those thoughts?
Client：A bit worried. I don't know what people are going to think, so I don't want to upset them and say anything wrong or do anything wrong.
Counselor：And I suppose I'm just trying to understand kind of because what you were just describing, that's more what I would kind of think of as being a thought, you know, worrying about what people might think and that people might think the wrong thing. And I suppose I'm wondering how you're feeling. You said you feel worried. Are there any other motions that you feel about it?
Client：I feel it makes me feel a bit sick inside having to talk to new people.
Counselor：So you feel a bit worried and a bit sick. How easy is it for you to think? Think about those kind of emotions and those feelings that you're describing.
Client：I don't really think about them. I just try and ignore them and get on with what I need to do.
Counselor：Were you aware that you were feeling worried on the day that you stopped eating? Were you conscious that you were feeling anxious and worried?
Client：No, I didn't feel worried that day. I was just trying to get on with my work and I actually felt bit better that day.
Counselor：Okay. So why do you think that you turned to stopping eating? Because, I mean, now, I suppose, now that you're aware that you are feeling worried about sick form and about the exam, why do you think that you opted to stop eating on that day? What was it about that you think that you thought might be helpful?
Client：I didn't feel like I needed to because I didn't feel hungry, so I just wanted to do my work. And then it made me feel better and I felt more focused on my work, so I thought I should carry on with that because I needed to revise.
Counselor：So you thought it helped you to focus and you felt like it helped you. Do you feel like it did help you with the revision?
Client：Yeah, I was more focused on the work I needed to do.
Counselor：Okay, so you felt like it improved your focus as well?
Client：Yeah.
Counselor：Okay. Is there any other reasons why you think you might have turned to constricting your diet at that time?
Client：I think my father wanted me to. My dad, he wanted me to focus on my work because of my exams, so I didn't want to upset him, and I thought I needed to do well in the test, so I was trying to do that.
Counselor：So you thought that by not eating, you would help yourself to do better in the exam and kind of please your dad?
Client：Yeah.
Counselor：And do you think that it was helpful constricting your diet?
Client：It seemed to be. I got more work done during the day because I didn't get distracted by anything, so I was revising all day, and then the test went really well, so it should be good. Should get a good mark for it.
Counselor：You seem like you may be getting a little bit anxious right now. I notice that you're shaking your leg. Is there anything that you're worried about right now?
Client：I just don't want to upset my parents and make them feel like I'm a disappointment to them if I don't do well.
Counselor：Okay. Is that something that you're often worried about?
Client：Usually. Because I don't want them to think like, they shouldn't have had me because I'm so worthless to them.
Counselor：Okay. That's quite a heavy worry to be carrying. Really? Have you talked to them about this worry? No. You haven't said it to them before? How do you think they might react if they did know that you felt this way?
Client：They'd probably say, like, as long as I do well, I'll be fine. Like, and they'll love me if I do well in my exams and go to good 6th form and get good grades.
Counselor：So you think that maybe they wouldn't love you if you didn't do well? Go to a good sick form?
Client：I don't see how they would want to if I was so worthless and useless at whatever I do.
Counselor：Okay, so it sounds like you're really worried about losing your parents love and approval, and you think that by passing these exams you will kind of secure that love and approval from them.
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11
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Neutral
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F
|
Health-related worries
|
https://www.youtube.com/watch?v=9P2CTtrnmaU
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12:58:00
|
CBT Initial Interview
|
Counselor：Hello, misses James. How are you doing today?
Client：I'm okay.
Counselor：That's good. I just want to start out really quickly by getting a couple of the formalities out of the way. I know it's a little bit awkward coming in, you know, always the first time, but I'll just introduce myself and then you can introduce yourself and we'll just talk a little bit about you and your family and all that. So again, my name is Marisa and I just want you to know in the beginning that what I do as a counselor is more important to me than just a paycheck. I'm not in this job because it's just a source of income from. I really enjoy getting to know the clients that come through those doors and I like to help them in whatever ways I can. If it's just listening for that day and there's a burden that you have or if it's. If it's some kind of resource that you need from me and that I'm able to reach out there and get for you so that you can. You can be more successful and more fulfilled and happier than. That's what I want for you. Definitely. But why don't you tell me a little bit about yourself?
Client：Well, I don't know what to tell. I mean, they. The Medicaid office told me I had to come down and to be counseled so I can continue getting my benefits, which I need because I cancer. So that's why I'm here.
Counselor：What about your family? Tell me a little bit about them.
Client：Well, I'm married, I have three children. They're all grown. And I'm taking care of my grandson, Jason. He's seven.
Counselor：Seven, okay. And you said that you were referred here because you needed to continue benefits now that you found out you have cancer.
Client：Mm hmm.
Counselor：Okay. Do you want to tell me a little bit about that?
Client：Well, the doctors have said that I have cancer again. Had it a couple of years ago, and I beat it. And now they're saying that it's come back. It's not something I really want to talk about, but I'm still working and just trying to get through the day.
Counselor：Definitely. You are working. What is that? You know, what is it that you do?
Client：I'm a housekeeper for a hotel here.
Counselor：Okay, that's wonderful. That's good. How have you been balancing that with. With getting sick? Are you feeling the effects of being sick yet? Or is it just recent that it's just.
Client：Oh, yeah, I'm tired. I'm tired all the time. You know, it's just a real struggle to get out of bed all the time, and then when you go to bed at night, you can't sleep. So I'm just tired all the time, and then I'm taking care of Jason, my grandson, and I'm just tired all the time. But you gotta do what you gotta do. You gotta get up and go every day. There's nothing. You just have to keep on going.
Counselor：Definitely. Well, that's really good, though, because if you heard a little bit of surprise in my voice, I mean, it was. I'm very impressed that you have cancer. You're taking care of your grandson, and you're still out there working, and you keep saying, you know, gotta do what you gotta do. Gotta get up every day, gotta keep going. You seem to have a lot of perseverance, and I really think that's gonna be a strength and asset for you during this whole process. And just coming here, being willing to cooperate, that's very good. So I want you to know that that is a positive characteristic. A lot of people wouldn't necessarily respond in that same manner. That's really good.
Client：Well, there's nothing else to do. You just gotta keep on going. Keep on. You know, nobody else would take care of Jason if it weren't for me, so. And you got to pay the bills. So you really. I mean, you might not understand that since you have a high paying job, but, you know, it's paycheck to paycheck. You got to keep. It's not like I can't go to work if I don't. I don't have the money, and I don't care. Pay the bills.
Counselor：Yeah, I can understand that. I haven't always had this job, and getting here has been an extremely long process, so I can empathize a little bit with the beginning parts of my life and being in school. Students don't have any money at all. I was working two jobs in order to go to school with loans. So, you know, I feel you a little bit on. On that feeling like you. You have to. You just have to.
Client：You can't, you know, I'm a choice.
Counselor：Yeah. So many people have been there. That's a normal thing to feel, to feel that way. But why don't you tell me a little bit about your children? You said. Did you say you had how many?
Client：Three. I have two sons and a daughter. My daughter's not around that much, and my sons are busy. They're busy working, and they've got their families and their own lives and stuff. So they don't have a lot of time. They just, you know, doing the best they can, too. They have to work.
Counselor：Do they live near, in the area, or do you see them very often?
Client：They live around here, but I don't see them too often. We get together for birthdays and stuff for Christmas.
Counselor：How would you rate, like, on a scale of one to ten, how would you rate your relationship with your, with your three children at this point? You can do them individually or collectively whenever.
Client：I don't know. Um, I guess my sons are all right, but I don't talk with my daughter that much. My sons are okay. They're just busy. They're trying to take care of their families. But my daughter, she's, she drinks and she uses drugs, and she don't hang out with the right crowd, and so she can't take care of Jason right now.
Counselor：Okay, so she's Jason's then biological mother. Okay.
Client：Yeah, that makes sense.
Counselor：Okay. And what about your husband? What role does he play in all of this? At this?
Client：None. None. No, he doesn't. He's mad because he doesn't think Jason should be with us. He thinks that his mom should be raising him. But Jason doesn't need to be with his mom right now. He needs to be with us. He needs to be in a good home. And even as tired as I am, she can't take care of him.
Counselor：So that situation has affected them, your husband and youre relationship? Mm hmm. Okay.
Client：Yeah, he's just mad. He just works, goes home and watches tv and goes to bed, works, goes home, watches tv, goes to bed. That's all he's good for right now.
Counselor：Well, there's a lot of things that you've just expressed to me in the past few minutes that are definitely areas that we can work on, that we can try to find some solutions. And that's going to be one of our main goals throughout our sessions, is to look for solutions. It is healthy and wonderful, actually, in a way, even if it's painful and difficult to talk about some of these things. But what makes our time so effective is that we actually identify little things here and there that we can definitely utilize to bring about positive change. So we can definitely look at just, you know, your relationship with your husband, your relationship with your children. I'm not doing counseling with your daughter, but definitely at least providing you with some resources that you could equip her with to get her on the right track. And you seem to mention your grandson a lot, so that can even be a strength, even though it's an extra thing to put on the table that you care for him and you really want him to be successful. So what is your relationship with him like? Tell me a little bit about him and what kind of young man he is.
Client：He's good. Good little guy. He likes to play ball and he's good in school, but he's seven, so he likes to be playing. And, you know, I get tired with the chemo and I can't do that all the time. You know, part of me feels like he should be with, you know, someone that can take good care of him and I'll worry about him a lot.
Counselor：Does he go well? If he's seven, he's in school. Then. Does he have any programs at school? Like best friends or anything that he's involved in sports?
Client：Yeah, he does. All right. Yeah, he does. Okay.
Counselor：Okay, well, that's good, too, that he's. He's healthy. He's healthy and he's involved. That's good. That's gonna be a strength for him throughout this process. One question that I like to ask towards the beginning of my sessions with my clients is. It's called the miracle question. And if you could experience a miracle, maybe aside from, like, the cancer just being totally gone and life being perfect. Well, if life was perfect. Actually, if life was perfect for you, and you woke up tomorrow and everything was the way that you would hope that it would be, and everything was turned out awesome, what would that look like for? If you just woke up in the morning and everything was perfect, how would you describe that perfect state or that perfect day?
Client：I guess that things would just be normal. That I could pay the bills and I wasn't tired and Jason had his mom, that everybody was just normal. Just everything was okay. Not worrying about the bills.
Counselor：Can you tell me a little more? Is there any little details that would be different for you?
Client：No, I just want things normal.
Counselor：What would that. What is normal? What is your ideal for normal meaning?
Client：Well, not being sick and Jason having his mom and the family being together and being happy again, and, you know, being able to work and pay the bills.
Counselor：Yeah. Okay. Okay. Well, I just want to thank you for coming in today. Blah, blah, blah. We're done. Oh, I think let's see if this worked. We have a twelve.
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12
|
Positive
|
M
|
Anxiety and fear
|
https://www.youtube.com/watch?v=-Wc7MUNBSRo
|
08:41:00
|
CBT Psychosis Techniques
|
Counselor：Tony, you've been given this diagnosis of schizophrenia by one of your doctors. I just wondered what it's like for you and what the main problems are.
Client：The main problem is these. Well, they tell me that it's a problem to do with musketsophrenia. These voices, they come and they. I heard these people talking about me and talking about how rubbish I am and what a failure I am, and I really just wish they'd leave me alone.
Counselor：Yes, that's extremely negative content to what's being said. So it's a clear voice outside of your head, is it?
Client：Yeah, yeah, it's two voices. And, you know, sometimes they're talking to me and sometimes they're talking about me, but it's always really negative. There's no helpful things there at all.
Counselor：It sounds like these voices are associated with a feeling of sadness. Am I getting that right or is that another feeling?
Client：Oh, well, when I let them, they get me really down. They get me really, really down. But, you know, I'm fighting these. Fighting them still, you know.
Counselor：What are you doing to fight?
Client：Well, there's where I get into a real problem, because I shout back at them. And, you know, my neighbors, they. Well, you know, they don't understand and they say they don't hear these voices. Sometimes I wonder if my neighbors are in on it as well, but, you know, they say that they can't hear them, but I don't understand how they can't hear them because they're so loud.
Counselor：So loud.
Client：Yeah.
Counselor：What do you make of these voices, then? Do you think it's part of an illness, or do you think the neighbors are doing it? Or what do you think?
Client：Well, you know, I think there was somebody once that I really didn't get on with at school, and I think it's him. And I think he's kind of got these people to be kind of harassing me. I think they're trying to drive me mad, I think, is what they're trying to do.
Counselor：That's a very distressing experience. I can understand that. So do you think other people can hear them if they're very loud?
Client：Well, you know what? They say they can't, but that makes me wonder if they know what they're. If maybe they're on it. But everybody says that they can't. And, you know, I don't know. I've tried my CPN said, you know, why don't I put a recorder on, you know, when the voices are there and, you know, it didn't pick them up, but I don't know. Maybe it was faulty or something. It just nobody else can hear them, I guess, is the answer to your question. Or everybody says they can't.
Counselor：Even with the tape recorder, you still don't think. Well, you think other people maybe can see them, hear them?
Client：Well, sometimes I think people can hear them, and sometimes I think, you know, well, maybe my CPN's right. Maybe it's my imagination.
Counselor：So is it just you that hears voices, or do other people in society hear voices, Tony?
Client：Well, there's somebody else at the day center, and he hears voices that other people can't hear. And we've talked together, and I can't hear the voices that he's hearing.
Counselor：That's interesting, isn't it?
Client：Yeah.
Counselor：And I wonder if there's certain types of stress which can make anybody hear a voice. Have you ever heard of that kind of a thing? No, because quite often, soldiers coming back from the war will be hearing the sounds of battle, gunfire and helicopters, etcetera. So they're not actually there, but they hear them as if they're real, and it's linked to the stress of being in a war. Do you ever find that your own voices are worse if you're not getting asleep, if you're sleeping really badly?
Client：Definitely, definitely. What I find is that sometimes when I get really worried about what they're doing to me, and I think, well, maybe I'll stay up just in case they're going to pull some tricks or something in the night. And times when I do that, actually, I do hear them more the next day.
Counselor：So maybe lack of sleep has something to do with voice hearing. And this is very commonly seen in society that the longer that people stay awake, the more liable they are to hallucinate. What about drugs? Are the certain drugs that cause voices? What do you think?
Client：I don't know. I guess I've heard people talking about being a bit paranoid when they take cannabis, but I don't know whether that would be.
Counselor：I mean, there's other types of drugs that make you see things like taking LSD or anything really nasty like that.
Client：Yeah, I've heard of that.
Counselor：Can really make you hallucinate things that aren't actually there. So there's lots of possible causes. It seems like the human brain can very easily hallucinate under certain conditions, and there are certain things that can keep that hallucination going. So it seems like about 8% of society will have a period in their life of hearing the kind of voices that you're hearing, Tony. But the vast majority of them will get better again. 8%. 8%. So it's a very common human experience. But at the far end of that 8%, there's a group of people with a diagnosis of schizophrenia because their voices are so distressing. They're hearing them day in, day out, and they're really affecting their life. So that is where that kind of label comes from. Basically, everybody at some point has had some kind of hallucination, whether it be hearing things, seeing things, feeling a touch.
Client：How do you know that?
Counselor：Well, it is said, tony, that following grief, you know, when someone close to you dies, as you grieve over the loss, there's always a phase of hallucination. And during that phase, you will either see that person or you'll hear them speaking to you, or you'll smell a perfume or an aftershave or feel their touch. And after you've finished grieving, it doesn't happen anymore.
Client：Right.
Counselor：One of my friends is an artist, and after his mother died, he heard her speaking to her for three months. He eventually got over her death and she stopped speaking to him. So it's something that we all do and how we react to it seems to be crucial.
Client：That's interesting, because I know that I've been fighting this experience for a long time now. What effect does that have?
Counselor：Well, it seems to be the case that there are some things we can do that will worsen and perpetuate voice hearing.
Client：Right.
Counselor：There are some things we can do which will take the edge off it and bring it under a bit of control. Now, to have it under a bit of control would be very different to the way you've dealt with your voices to date.
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13
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Positive
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F
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Health-related Worries
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https://vimeo.com/828662674
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11:27:00
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CBT Role Play
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Counselor：Hi, Jean. How are you?
Client：I'm good.
Counselor：So this is the second time that we've seen each other. Right. You came in for the initial assessment about a week ago now, I think, and I got to know you and your history and kind of the symptoms that you've been dealing with, and it seems like you've been struggling with depression. Is that. Does that sound right?
Client：Yes.
Counselor：Yeah. So between, you know, last time you were here and now, did anything come up, anything positive, anything challenging?
Client：Yes. When I try to pull weeds, it just takes me forever in my garden, and then I have to come in and sit down, and then I just don't understand why I can't do it like I used to, and it's frustrating.
Counselor：Okay. So is that. That's related to the medical issues that.
Client：Yes. I have arthritis in my knees and my back.
Counselor：How long has that been going on for?
Client：Oh, really bad for the last, like three years. So.
Counselor：And that's been kind of a difficult adjustment. You were really active before, right?
Client：Yes. I could do all my gardening one day and not have to stop. And now I have to stop. And it's.
Counselor：So what do you think about all that?
Client：I hate it. It's like, why? Why can't I do it? You know?
Counselor：Yeah. Yeah. Well, it is. It's a big difference when you are, you know, not experiencing physical pain and you can do all these things that you enjoy and then something happens, you know, as we're getting older, it always does. So, yeah, it can definitely present a lot of challenges. Anything else happened in the last week?
Client：Well, I've been wanting. I need to go walking more often, and I just can't. It just bothers me, my knees and. And I get frustrated because I can't do that and.
Counselor：Okay. And then, you know, when you get frustrated and you can't do something, what do you do after that?
Client：I, um, just sit there and usually get up and eat something, and that's not good for me when I'm trying to lose weight. So then.
Counselor：Oh, I see. So it's kind of like a cycle. You want to do good things for your health and exercise, but it's been challenging because of your medical issues. And then it kind of leads you to overeating, which is kind of counterintuitive to your goals.
Client：Right. It's like, why. Why am I eating this?
Counselor：Well, you may have noticed that I ask a lot of questions about what you think about things and how you feel about things. You know, in the first session you came in, and then today I just kind of wanted to point out how cognitive behavioral therapy works. That's the kind of therapy that I actually do and will be using together to kind of hopefully help you get through this time to where you feel like there's some improvement in your mood and how you're feeling. So let me just start by drawing a little diagram using an example that we just talked about together. So say a situation comes up like, you go to pull the weeds in the garden. I'm going to write pull the weeds in the garden. And then you said you were able to do it, but for a short period of time before pain kind of got in the way. Right. And then when that pain got in the way, what was the thought that you had?
Client：It's like, why do I have this pain? Why? Before, I never did. I should be able to do this, but I can't.
Counselor：Okay. So I got, you know, why do I have this pain? And I should be able to do this. So then after you had that thought, what did you feel? What emotions came up for you?
Client：Frustrated, sad, and I get anxious.
Counselor：Okay. And then after you felt those things, the frustrated, sad, and anxious, that's when.
Client：I would eat the ice cream.
Counselor：Okay.
Client：Our sweets, candy, whatever.
Counselor：Okay. So I kind of put this in a model to show you how cognitive behavioral therapy works. So all these different situations happen, and different people see them in different ways. So when you had, you know, this situation come up where you went to go pull the weeds in the garden and you couldn't do it as long as you wanted to, you had this kind of, like, more negative, self critical thought going on. I mean, you were able to go pull some of the weeds even if you weren't able to do as much as you wanted to. But because, you know, you kind of had these negative thoughts, it led you, it affected your emotions, and then in turn, it affected the behaviors that you did afterwards. And what we find in cognitive behavioral therapy is that we have the most control over our thoughts. You know, what we think of an event. Like I mentioned, we could think like, oh, well, you know, at least I was able to do this much. You know, I can give myself a rest. My body's telling me to take a rest, and then I can go back to it again. So that's kind of what our target is going to be. And it all starts with identifying these automatic thoughts that you're having, these quick reactions that are happening in your brain. And it seems very simple, but it is, you know, challenging to do. So that's what we're going to start off working on. Did that all make sense?
Client：Yes.
Counselor：Okay, good. So I have this worksheet here that you can take with you and we'll get going on our first step in working together. So right here there's a lot of columns, but I really only want you to worry about the first three columns. And this is going to get you tracking what automatic thoughts are coming up for you. So we've got date and time, the situation or event that happened, and then automatic thoughts. So maybe we can go through one more because you did mention walking as well, right. That was also a challenge for you. So when was that you were going to go for a walk?
Client：Well, I was going to go yesterday and then I just. I just couldn't because my knees started. I just get out the door and can't even get down the steps sometimes.
Counselor：Oh, that must be difficult.
Client：Yes.
Counselor：Right. And then I'm gonna put for the situation. Couldn't go for a walk. Alright. And then do you remember what thoughts you had?
Client：Looks like? Here's another thing I can't do.
Counselor：Okay. Any other thoughts that came into your head?
Client：Just frustrated because I should be able to do this. I always do it. I just used to walk a lot last year, not this year.
Counselor：So I'm gonna write I should be able to do this. And actually when you said, you know, I was frustrated, that's more of what we call an emotion, which is the fourth box. We're not going to worry about that yet. We're just going to focus on identifying those thoughts. Now just keep this somewhere handy and then you can come check in a couple times a day and write down what you can remember. You don't have to be perfect with this. This is just to like, get us started. So does that seem like something that you could do over the next week?
Client：Yes.
Counselor：Okay. And where's a good place that you think you could keep this so that you'll remember to do it?
Client：Well, I don't know. I guess I could hang it by the calendar.
Counselor：Okay. Yeah, that's a good place for it. All right. Do you have any questions for me?
Client：No, not really. Just thank you.
Counselor：You're welcome. Yeah. Well, I'm glad that you came in today and that we get to work together as a team towards, you know, improving your health.
Client：Thank you.
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14
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Positive
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M
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Health-related worries
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https://vimeo.com/693820701
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50:09
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CBT Role Play
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Counselor：Okay. All right. I think it's recording. All right, so let me get started here already.
Client：I'm ready to go.
Counselor：Okay. Hi, Paul. It's good to see you again. Hey, how's the past week been for you since we last saw each other?
Client：Yeah, no, it's been good, you know, just trying to keep busy, I guess, you know, trying to stay away from using. I mean, it's not easy at times because, you know, just the pain I'm in and I just think about things, but, yeah, no, I mean, I'm doing okay. Hanging in there, I guess you could say.
Counselor：So, where would you say your pain is at right now? And it's one to ten, maybe, like, changes every day, but, you know, on average, what would you say?
Client：Like, maybe five? I guess you could say, okay, so, like, not bad, but, you know, it's annoying, but, I mean, could be worse. I guess so. Yeah.
Counselor：Could also be better, though. You know, it's about middle. Middle of the pack.
Client：Yeah, true.
Counselor：Okay. And you said you've been keeping busy. What, uh, what have you been doing?
Client：Um, just, um, like, um, you know, like, watching. Getting myself, like, involved in, like, watching, like, tv shows and playing some games. Also just been doing just, like, since it's been getting nicer up and, like, going up outside with friends for, like, walks, which kind of helps keep me distracted, so. Yeah, so it's. It's. It's been a. That's been helping to a degree.
Counselor：How have the walks been? Even though you're in that level of pain, what is it like?
Client：I mean, it helps, I would say, because, you know, I feel like probably the more if I sit around, I think about it, so, I mean, I guess if I usually get myself up and moving, it helps to distract me from it, so. Yeah.
Counselor：All right. Before your injury, would you kind of. Are those things that you would do, like, going outside, taking walks, watching. Watching things, playing games, are those kind of activities that you would occupy your time with before you got injured?
Client：Yeah, I mean, I also used to go to the gym a lot, so that was, like, a big thing for me. That's kind of like, why to the injury? Because I guess, you know, unfortunately, I don't know, I was overdoing it, maybe, or whatever, but, you know, I used to do that a lot. I just was more. I was definitely more involved, like, physically, with physical activity at that time.
Counselor：Mm hmm.
Client：But, you know, I guess, you know, I don't mind going on walks and stuff like that. It's nice. It's just. It's like, not as satisfying. It's like what I used to do. You know, I look back at what I was able to do, like, where it was at. It's kind of like, you know, it's kind of can be frustrating at times.
Counselor：Yeah, sure. Absolutely.
Client：You know, like, yeah, I do. It does help a little bit, the distract for the distractions, you know, like, doing those types of, you know, those types of activities. So, yeah.
Counselor：Yeah. It sounds like you're dealing with a sense of loss, even though, you know, we kind of tend to assume or associate loss with more grief, you know, losing someone to death or something. Or something like that. But what you're describing is a sense of loss. You know, losing abilities that used to have, that made you feel happier and that that's its own sense of loss.
Client：So, yeah, so it's just like, you know, it could be aggravating and, like, upsetting, like, just, you know, with that, you know, then I just kind of like to deal with the pain. I think that's what kind of leads me. That's what leads me to use because just, you know, makes me feel better. So.
Counselor：And have you. Have you used it all in the past week?
Client：I did. I did once, yeah. I didn't do as much as I usually do, so I guess that's better. But I still did, so.
Counselor：Yeah. Okay. And right now, where would you say, like, your cravings are your urges?
Client：My cravings? I would say, I don't know. It's not, like, terrible right now. It's on the lower end. It's with my sending with my urges, I guess just because I've been doing what I can to kind of, like, occupy myself, which helps a bit, but they're never gone. Yeah, it's always. And obviously, like, they're there because that's why I used this this week. And, yeah, you know, so, I mean, it's. I think it's just trying to, like, work on it to get better at, like, trying to figure out how to, like, keep away is, you know, would be beneficial.
Counselor：Yeah.
Client：Yeah.
Counselor：It's going to take time and hard work, so that. But, you know, that's what we're here to do, so. And last week we talked about increasing kind of awareness of your use, what goes into it, what comes out of it. How did you feel about how last session went?
Client：No, I think it was good because it made me aware of, more aware of are accountable if I do use, I guess, and kind of helped me see my cycle of use or reasons for it, I guess. It's kind of, like, put me on. Like, I don't like a watch or notice. So, in a way, I guess it may be, like I said, a bit more conscious of, like, when I. Like, when I was thinking about it. So it was helpful, I would say.
Counselor：Yeah, yeah, that's great, because that's. That's kind of what the. The main goal of that. That session was. So I'm glad to hear that it helped a little bit. And were you able to. To fill out that record that I gave you a list of, you know, triggers, some thoughts, intensity of cravings, those kinds of things. Were you able to work?
Client：Yeah, I did it. I did it.
Counselor：And how was that experience?
Client：Yeah, it was helpful. Helped me, like, kind of recognize myself a little bit more. Like, for triggers, you know, I put down things that trigger me are, like, boredom, isolation. I would say just, oh, overthinking is a big one, and, like, you know, like, I guess also, like, thinking about, like, the past is a big trigger for me. So there was that, and then what was the. I'm trying to. What the next. What about the other parts again, can.
Counselor：I just ask first? What. What about the past? Do you tend to think of the most that. That really affects you?
Client：Just, like, you know, where it was, like, for my health wise and, like, my physical condition and just, like. No, like, I guess I would even say mentally where I was at. At that time, I was much better. And, you know, like, I. I want to get it be. I want to get back to that point, but, you know, at the same time, like, this. This injury I have, God, is, you know, like, not helping the situation, so I could. It's kind of like. It causes me to, like, think about that. Like, I lose motivation to, like, do anything because, you know, I don't see myself getting back to where it was. So it's kind of like, you know, I sometimes, like, think to myself, like, what's the point, you know? So.
Counselor：Yeah, like, a sense of hopelessness, it sounds like.
Client：Yeah, I guess you could say that. A little bit of that. It's. I think it's just more like denial, like, about accepting the reality of it, maybe, or whatever. I guess. I guess it. Yeah, I don't know. You know, it's a little bit. It's a little. It's a little bit of everything, I guess.
Counselor：Yeah. Okay, so you have it listed, triggers. Um, the next one was some thoughts, feelings, and beliefs that go into. Into use. Like, one of them when you're about to use what. What am I thinking? What am I feeling. What do I tell myself? What kind of. Were you able to think about that kind of thing?
Client：Yeah, I mean, I guess I kind of mentioned it before, right? About, like, you know, the, like, thinking about, like, the past or just, like, getting consumed in my thoughts about, like, you know, like, thinking about different things. Such as, you know, like, I think it is the past mostly, I guess. And then I get, like, upset with myself. And then I guess the more I think about it, the more I focus on the pain, usually, which then leads to me wanting to use because it's just, you know, makes me feel better.
Counselor：Yeah.
Client：So there was that. What else was there? I'm sorry.
Counselor：No problem. So it sounds like when you. When you're about to use, you're telling yourself where the common thoughts that you tell yourself are. I'm not going to get back to. Back to what I used to be, how I was. You know, it's. It's just not really realistic for me. I used to be so much better than I was. Now I'm less of who I want to be. Does that sound accurate?
Client：Yeah. Yeah, I would say it's pretty accurate, yeah.
Counselor：Okay. And then we kind of talked about this a little bit, but the intensity of the cravings. So over the past week, you said it was on average, like a five. And then right before you. You did use, you said you used once. What was the. How high were the cravings on a scale of one to ten, would you say?
Client：Um, uh, I don't know, maybe like six. I would say at that. In that moment. So it was enough for a course I used. Yeah.
Counselor：So, yeah, but overall, on average, it was like a five out of ten.
Client：Yeah.
Counselor：Okay. And then we talked about behaviors like, what do you do when you use? Were able to kind of talk about that and list that out.
Client：Yeah, so. Sorry. So, like, behavior. You mean like, when. I'm sorry. When I do use, like, what I am doing in that moment, you mean or like.
Counselor：Yeah, yeah.
Client：I don't know. I guess, you know, I guess more or less. I just. When I use it, it's just that kind of relieve the pain. So, I mean, it's just kind of like, not really doing anything, like, different, you know? I guess, like, for example, the more of the reason why I use what I don't, like, get myself involved. Right. I. I isolate. I just have myself. I don't, like, that's. You know, I don't go out or I get my. I get myself doing things. Like, I can mention, I think boredom is the biggest trigger and then when I get bored and I'm not, I don't distract myself with something. That's when I start to overthink, and that's what leads to it. So.
Counselor：Yeah, that's interesting because you. You identified isolation and boredom as some of your triggers. And then after you use you, you also tend to isolate and stay put and don't do much either. So it's kind of like a self feeding cycle.
Client：Yeah, yeah, yeah. Now they say like that. Yeah, it's true.
Counselor：And we talked about analyzing the positive results and the negative results of your use. So what would you say are the positive results of using for you? Maybe not just this past week, but in the past, what are the good things that come out of it?
Client：Well, I mean, it gives me. It helps me to. Definitely helps me to feel better. It helps relate, obviously, it's like an instant release of the pain and what else? Yeah, it helps me, I guess, you know, it's good with distracting me and feeling okay, but otherwise, I mean, yeah, I mean, that's really. I guess that's really it, you know, just helps me feel. Feel better in the moment. But then for the negativity, obviously, it's like, I know it's technically just temporary, and it's not like it's not a healthy way to go about things. And I feel like I could get. Try to get myself. I know. I think I have to try to try to be more realistic and know I can get myself back into a better place again. It's just having to get over those temptations or that feeling of quick, you know, release, I guess you could say, or feelings that would really, you know, would help, I guess, would help me more in the long run. So.
Counselor：Yeah. Okay. And have you ever heard the phrase or the term playing the tape?
Client：Sounds familiar, but can you kind of tell me a little more about that?
Counselor：I guess I. Yeah, sure. So it's kind of a common term in addiction between recovering. Recovering addicts. Those. Those in recovery, they kind of refer to playing a tape as basically consequential thinking, like taking an action that they're thinking about doing. Like, say, I'm thinking about picking up and using in this moment and then playing the tape would be okay if I did this, what would happen? And just kind of playing, like, the scenario out in your mind and think and visualizing what happens. And then it's supposed to help think of the consequences and be more mindful of the outcomes of what you're about to do. So that's kind of what goes along with this last piece of what we were talking about, the results, the positive and the negative. So, yeah, that's if you. Yeah, so that's just something to keep thinking about as well.
Client：Yeah, that's helpful. So maybe that's something I can, like you said, think about and try to focus a bit more on as when I get to those points. So, yeah, that's interesting. I guess you gotta piece probably good. I would piece things together.
Counselor：Yeah, it's definitely a skill, you know, like all things. So it's gonna take practice and time, so it's not gonna come 100% right away, but so we talked about all these things, like triggers, becoming more aware of the situations, the thoughts and the feelings, the cravings, all that kind of thing that go into substance use. And now today, the focus is mainly going to be on styles of communication. So in the future, it's going to be important to avoid situations that involve alcohol and drug use. It's important for anyone in recovery to do that. But it's not always going to be realistic. You're going to be, no matter what, you're going to be in a situation that has some kind of relationship to alcohol or drug use. You might be at a pharmacy, you might be at the grocery store. You might just find yourself against your best actions. You might just find yourself around people who are engaged in that kind of use. So it's important to be able to also have strategies and be able to practice those strategies that can make you better at being able to stay away from using. So can you just think of what would be a situation where you would be, where you would feel most pressured to use? Like, you'd feel that, that pressure to engage in that kind of activity.
Client：I mean, realistically, I think it's actually more like when I'm not with friends or like, you know, not out socially, because, like, when I'm, like I mentioned, when I'm out, I'm with people or doing something, that's when I have, like, I'm more distracted. So it's really more like when I'm on my own, you know, think. Because then I have just myself there to, you know, like, think about things. That's probably, like my scenario, the worst case scenario, where that's when, you know, the use kind of comes into play because, you know, just kind of, like, there and, like, and annoyed or upset with things. And I just, like, you know, I don't. I'm thinking I focus on the pain and then, so then I use, okay, okay.
Counselor：So it's less so the more it's less. So the social interaction, more the opposite. The social, the lack of social interaction.
Client：Yeah, exactly.
Counselor：Affects.
Client：Exactly. Yeah.
Counselor：Okay. And today I wanted to go over the different types of communication styles. There are about four, four primary types. I don't want to go over that with you. But first I thought we could just do a basic role play, not related to any kind of substance use, but just try to see what youre, your instinctual, most common type of communication style is. So would you be open to that?
Client：Yeah, sure.
Counselor：Okay. So we can think of a situation where maybe someone, maybe I'm asking you for, to borrow some money for you and just kind of react how you would, you think you would normally react. And I'm going to try to really get you to give me the money, but just react in the way that you think you would normally react. Okay.
Client：Okay. That's fine.
Counselor：Okay. Hey, Paul, I'm really in a, kind of a jam right now. Do you have, like, $20 that I could borrow? I promise I'll pay you back, but it would really help me out right now.
Client：Yeah, I mean, that's, that's fine. Twenty's, twenty's not a big deal. I can do that for you. What do you need it for exactly?
Counselor：I kind of owe some, oh, so guy some money. So this really helps me out, just being able to pay that guy back, that really, I really need it right now. So, um.
Client：Yeah, all right. I mean, yeah, it's $20. I mean, are you sure you're, as long as you're good for giving it, you know, getting. Pay me back at some point. That's, that's cool. I don't mind.
Counselor：Yeah, totally. I'm. You got my word. I'm, you know, I'll totally, totally pay you back, you know.
Client：All right. That's cool, man. Oh, I'll let you, you know, I'll give you a freebie this time, and we'll just try to, like, you know, get, get it back from you when you can. No rush. But I, you know, when you have the time.
Counselor：Okay. So how did, how did that kind of feel?
Client：I felt like, kind of, well, for me, that wasn't too big of a deal because, you know, my opinion, like, $20 is not a lot. So I wasn't too, like, annoyed by that. I mean, if it was, like, maybe a lot more money, it'd be a different story.
Counselor：You know what?
Client：The whole reason is so, like, but for me, like, $20, it's fine. It's not a big deal. And honestly, even if I didn't get that kind of money back, it wouldn't really irritate me too much. It's not like another day. It's not a lot. But, you know, I mean, uh, I mean, clearly, if. I guess if you were to come back, this guy would come back. My friend would come back to me for more money. I wouldn't give it to him because, you know, like, he already owed me. He would already owe me. So. So, you know, I wouldn't do that, essentially. Okay.
Counselor：All right. So that was an example of what we'd call passive communication. And you're always going to run to a different situation that has its own nuance and complexity. No situation is going to be identical. So it's always a complicated process to communicate with someone else and weigh what you want versus what they want, what you're thinking, what you think they might be thinking. It's a very difficult balancing act to strike. But that was an example of what we call passive communication, which is.
Client：A.
Counselor：Person is primarily characterized by a lot of fear of expressing themselves directly. Maybe they feel unable to. They tend to kind of go along with what the other person wants. They might feel like the other person won't listen to them or they won't care if they actually express what they really want. Not that that's necessarily what you were thinking in that moment, but in a situation similar to that, it's the difficulty with expressing one's own opinion and advocating for what you want in that moment. So another example would be if you were asked to go to maybe an event for work or something like that, that is kind of out of your way and it's kind of inconvenient. And instead of, you know, making it known that, oh, this is kind of tough for me, like, I can't. I have other stuff going on. You kind of. You just. Okay, yeah, sure. I'll be able to go that, you know, no problem. Not, you know, not expressing what they need and what they want in a clear way. How do you. Do you have any association with that? Does that ring a bell for you at all?
Client：I feel. Ben. Just give me one sec. Sorry. Cat's being kind of annoying anyways. Um, yeah. Uh, I mean, maybe. Maybe the times I could be, uh, passive, I guess, about certain things. Um, like, I guess probably in the sense of like, passive of like, for example, if, like, I guess I can think of like, if for me, the using temptations are high. Where it's like. And if I. In that moment, like, if it's high. Let's say someone does get in touch with me at that point. Like, you know how I think I miss since I was mentioning before, you know, usually, like, if I do something with friends or something, or, like, even if, like, I play games online with them or something, that's a good distraction, but, like, you know, they might ask me, like, if I want to play. And I kind of just was like, I'm like, I'm like, you know, like, I'm passive about the idea of, like, saying no because of my, like, my feelings of, like, wanting to, uh, you know, use instead, where I probably could be more aware of, like, that I know I'm gonna use or that I could, like, kind of just say, like, be, like, take nothing the easy way out or just, like, kind of do, you know, actually do also, you know, what I enjoy. So, like, play games or something. So I'm actually kind of tough to tell myself, like, oh, this is better. Or I can, you know, actually, you know, have a good reason to want to, you know, do something, not just because of, like, for the. To get away from the drug use, but just because I want to, like, actually, you know, do something with my friends. So, yeah, okay.
Counselor：So it, you feel some connection to it sometimes that kind of, that kind of style of behavior or communication, rather.
Client：Yeah.
Counselor：Okay. And then from passive, we also have passive aggressive communication, which is someone may appear to go along with, with what another person wants, but then their, their actual behavior stands in contrast to that. They, they may, their behavior may indicate their true feelings about what's going on, even though what they're saying might, might be the opposite. So there's kind of that contradiction between expression and behavior. So an example would be maybe you're invited to another work thing or maybe a family gathering, and you don't really want to go, but you don't want to outright say they don't want to go. So you say, yeah, I just, I got some other things to do first, but then I'll stop by later. That would be an example of passive aggressive, which it can be difficult to kind of identify sometimes because maybe you might not be fully aware of what, what that kind of behavior is. But does that sound familiar at all or.
Client：Yeah, I mean, I can probably, like, use, think of that example. Like, even, like, actually, I feel like, actually, the example I was giving you before was when you're doing the role play was actually probably more past progressive because, like, overall, like, I was like, yeah, I'm fine with the. Given the $20, but technically speaking, probably still in the back of my mind. Like, I'm like, do I really want to do it per se? But I don't, like, speak up. I think. I don't think it's that big a video enough where I need to say something, so I still give it. But, like, even if, like, I guess the example, like, or just in general, if I wanted, like, you know, if people do invite me to do, go somewhere, do something, like, especially if, like, I'm, you know, mentally not. Or physically also, like, you know, mentally not feeling right or physically? Physically. Like, thinking about the pain. Like, I kind of think at that moment more about the. The drugs. And so because of that, I kind of, like, delay it, what I have to do, because I'd rather get my fix first, essentially. You know, obviously, if I get my fix and then I do things with my friends, I'll feel better by doing it then. So, you know, and, of course, sometimes I feel like what happens to that is that I don't even follow through with doing those things anyway because then I'm just kind of, like, content with how I feel. So, like, what's the point of, you know, going out or doing that if I'm already feeling in that moment? Fine, you know, so, yeah, that, that.
Counselor：Specific example, it's a very common aspect of those who experience addiction, those who are in recovery. You're definitely not alone in that wanting to kind of prioritize your own use, but also wanting to satisfy the wants and the needs of others. So that's always definitely a difficult balance to strike as well. And then from passive aggressive, we have aggressive communication, which it's characterized by you primarily ignoring the rights or the feelings of others and ignoring what they might need and putting more focus on what you think, what you need, what you want. And it can be often be very. It can come out in example of, like, yelling, shouting, threatening, someone using intimidation, that kind of insensitivity to the delivery of the message. You may not even want to hear how someone else feels. You just totally disregarded. You know, an example might be giving. Giving people advice that's not needed or they didn't ask for and kind of cutting them down based on how you feel they should be acting. Does this kind of style of communication relate to you at all?
Client：I don't know if I usually, like, per se, give people advice. The only thing I can say sometimes is that I guess if, like, maybe more if, like, I can say in the back. And if, like, my friends tell me what to do per se, I could see it, like, because, you know, they. I think some of them are aware of, like, my drug use, and they, you know, tell me, like, I gotta, you know, they tell me, you know, they try. They try to, like, they kind of tell me I need to stop or, I mean, they don't. The thing is, what I don't like is that it's like they don't. I feel like they don't fully understand what's going on with me, so, like, you kind of. And it's like, I feel like they're telling me what to do, and it so frustrates me at times. And so because of that, I can. You know, I just don't, you know, I don't want to listen to what they have to say because, you know, it's like, they don't. I feel like, you know, like I said, they don't get it entirely. I mean, I know they're trying to help, but, like, it's not like I asked for it at times. So in that sense, I guess I could say, like, it's more. I guess I can see how when someone can get aggressive with you. And I guess in a sense, I'm also aggressive back where I'm, like, being, you know, like, closed off about, you know, like, listening to what they have to say, so.
Counselor：Yeah. Yeah. Aggressive communication is definitely a very. It's a very cyclical kind of process where as soon as someone starts communicating aggressively, it very likely will prompt the other person to escalate their communication, and things just kind of rise and rise and rise, and the outcomes are usually not what either person wants, so. Yeah, that sounds like what you're describing as well.
Client：Yeah.
Counselor：But it sounds like overall, you don't. You mostly don't kind of associate yourself with this kind of communication.
Client：No, not really. Yeah, I don't like to do that because. I don't know, I just. Because I wouldn't like everybody, especially more lately since I feel like my people doing it to me, like, it kind of. It irritates me, so I wouldn't want to do it like other people. It's not showing because I don't. I just kind of messed up, in my opinion. I don't know, I just. I wouldn't like, you know, I already don't like being told things. I feel like somebody would feel the same way.
Counselor：Yeah. Yeah. And that's a sense of empathy, understanding why someone might not want to be. To be communicated with in that way.
Client：Yeah. Yeah.
Counselor：And then the last. Last style of communication we're going to talk about is assertive communication, which is someone expressing their thoughts, their feelings, what they want directly to the other person, and doing it in very clear terms, but also being respectful and acknowledging what the other person's rights and what their feelings might be. So, you know, communicating in a. In a calm, calm manner, not using threats, are raising their voice, but also not diluting their own. Their own message, what they want to get across. So it's a very. It's a. It's a big compromise between what you want, what the other person wants, and then meeting in the middle to try to find the best solution. So.
Client：Yeah.
Counselor：Would you say that you, you associate with that kind of communication?
Client：Yeah, I mean, I. I think myself. I try that. I think it's just, like, hard, though, at times. Cause, like I said, it's like, I feel like, you know, and, you know, you have people see you in a certain way. Like, my friends, like, they know I use. So it's like, I think they're, like, aggressive about it towards me, and so it's like, I don't. I don't want to kind of get. I try not to, like, I don't want to, like, even get myself trying to even talk to them about things because I feel like they're not going to, like, listen to me anyway. So it's like, what's the point of having conversations with them? Um, but, yeah, I mean, I guess I could try, you know, like, a little bit more to, like, kind of tell them how I feel about things and see if they can get me a bit more. Because, you know, otherwise, I don't think it goes anywhere. It's just kind of like, I don't, like. Like I said, it's like I don't want to list. Hear their advice because I feel like it's kind of just coming straight at me. Like, I mean, I know they're my friends and, you know, I do. I, you know, I do like them, but at the same time, it's like, you know, they're not my parents, so my own person, I mean, I. Look, I know, I know I got an issue. I mean, hey, that's why I'm, like, here. But, yeah, no, I think it's just. I think it's just kind of getting past that, maybe getting past that whole, like, idea that there, I can't talk with them or it's not worth it. I'm just trying to, like, just trying to. Trying to make an effort, you know, to, like, compromise about things or whatnot. So. Yeah.
Counselor：Yeah, that makes sense. So you feel like they're not always very sensitive to what. What you may be feeling at that moment?
Client：Yeah, I mean, because, you know, like, they're all, like, from what I know is, I don't think any of them might really have an issue. Like, I do, I guess you could say, like, they don't use. So, I mean, you know, so I guess they. I don't know if they just look at me and, like, why? Like, I. I guess in a sense of, like, why I'm doing this and, uh, you know, like that, I, you know, like, I'm better than this and, you know, like, I guess, you know, I know I am, technically, but it's just, I don't. That's the way they kind of. I don't like to bring that stuff up with them because personally, just, you know, like, they're my friends, so I just. I don't want to, like, I don't want things to become, like, heated between us and, you know, like, I don't want to, like, ruin our friendships or anything like that, you know? Like, so I just. That's why I just try to, like, not really get myself involved and talking them about those things.
Counselor：Yeah.
Client：You know, it's not worth it. It's, like, it's not gonna go, and it's not gonna make me feel any better anyway, so.
Counselor：Yeah. Okay, so you feel like they can be more aggressive more often than you. Than you are?
Client：Yeah, I would say so.
Counselor：Okay, so basically, the four. There are some primary purposes of an aspect of assertive communication, which is informing others of what you think and what you feel. Informing them in a way that is not hurtful to them and asking others to change their behavior that affects you, and then accepting what others say or request from you and also rejecting, if as necessary. So those are the kind of main principles of assertive communication. So how do you feel now that we've gone over those various types of communication?
Client：Yeah, I mean, I guess it kind of, like, gives me a better idea about, like, how, like, in different situations, I can be. I think, like, the assertiveness, I have to kind of, like, try to work on, like, especially around my friends because, you know, like I said, I don't, like, I kind of just try to, like, turn up, you know, just kind of close off with them about, like, different things because I just don't want to hear what they have to say. And so I don't. I don't want to deal with it. So I kind of just. I don't, like, tackle it. I guess you could say maybe with them about, like, different things. So, you know, maybe that's, you know, something, I guess hope maybe if I gave it a shot and sat down with them and talked, they could understand it a bit more. Maybe they would be, wouldn't be as, like, on me about it. So, yeah, I feel like that could be helpful. It's just, you know, just, it's, it's hard because I don't want to. I don't want to, like, you know, make things. Like, I don't want to make a mess out of things, you know, because, you know, they're good friends of mine, so it's. I don't want to create tension, essentially, I guess you could say, but it's. I'm saying that, yeah. Like, they annoy me, but. Yeah, I know it sounds stupid, but.
Counselor：No, it doesn't sound stupid at all. You care about your relationships with them.
Client：Yeah.
Counselor：So would you. How would you feel about doing a quick, another quick role play, wherever I might be playing the part of one of your friends who is communicating with you in a way that you might feel in that, that sense of disrespect and insensitivity, and then you can try to practice some, some assertive communication. Would you be okay with that?
Client：Yeah, that's, that's fine. Sure.
Counselor：Okay. Okay. So based on what you've talked about with your, your relationship with their friends, I'm going to try to try to channel that and, you know, replicate that for you.
Client：All right.
Counselor：Hey, Paul, have you used this week? I'm. I get the feeling that you have, and I just, I can't. I need to talk to you about it.
Client：I mean, I don't. Listen, I mean, listen, I don't want to, I just don't want to, like, I don't want to talk about that right now. It's kind of, uh, you know, like you'd rather just kind of just chill, if that's okay.
Counselor：Well, I can't. I can't really chill, because it's, it's, it's just on my mind a lot, and, like, you understand, like, what. What you're doing, right? Like, you can't keep going like this. It's just, it's, it's, it's not you.
Client：Yeah. I mean, listen, um. Listen, man, I mean, I. Look, I appreciate you, like, kind of telling me this. I get it. I just, I just want you to kind of, like, understand that, you know? Look, I'm working on, I'm working on myself right now. I'm actually you know, I am, I am seeing somebody right now to kind of, like, work on myself with this, and I just, you know, I understand, like, your concern. I get it. I just want you to, like, I want you to just, you know, be aware that, you know, I'm doing. I'm. I need to, you know, I do need to work on myself, and, you know, I just, I just want to, you know, you're. Listen, man, I appreciate you're a good friend of mine, but I just feel like, you know, like you're just coming on a little too strong at times. I'm like, you know, it doesn't help. I'm ready. Feeling kind of low about, like, what I'm doing, and I just, you know, I'm aware of what I need to fix. I just, you know, I just need some space on that. This. All I ask is, you know, can you, like, just kind of try to support me? You know, it's not like I'm not trying. Like, I'm trying, like, you know, it's. I've been through a lot through the past couple of years, so I, you know, I just, I don't, I don't want you to think that, like, I'm not, like, you know, that this is, that's all I do. I mean, you know, I just, you know, I want to be able to talk to you as, like, a friend where he understands more than just, like, kind of, like, coming at me like my parent, you know? So I. Sorry. I'm not trying to be harsh or anything. I just, you know, I just, I need. I need you to kind of, like, come down a level for me and, like, kind of, you know, see where I'm at.
Counselor：You. You don't think I've really been supporting you?
Client：I mean, no, not saying you haven't. It's just sometimes I feel like it's like you're you, you know, it's like you're in my face, you know, like, I feel like you just kind of, like you've seen, like, on the outside what's going on, and. But, I mean, you know, I feel like, and I get it. It's like, that's partially my fault, too. I feel like we haven't talked about, like, what's really bothering me and, like, why. Why I'm this way, you know? So maybe, I guess, you know, like, we should. It would help if we talked about that, so, like, you know, you can understand where I'm coming from a bit more, you know? So. Because, you know, like, I don't think I. We probably, you know, I don't think we've really talked about that because, you know, I don't like to really say much because I'd rather not, like, get in. I don't like to kind of open up about these things because, you know, I. It's embarrassing, but, you know, if. If you're willing to listen, you know, I'd be, you know, I would be, you know, would want to share with you because, you know, you're a good friend of mine. Just. I want you just kind of, like, understand a bit more.
Counselor：Yeah. I wanted to have you to talk to you about it, and I wanted you to talk to me about it, but it just seems like you're always kind of unwilling to. But I guess. I guess maybe I tend to come on a bit stronger than I maybe should, and maybe I haven't been totally, totally receptive to what. To what you're going to, so. Yeah. Yeah, I think that, yeah, I'd really like to sit down sometime and really kind of talk about what you're. What you might be going through, so.
Client：All right, cool. Thanks, man. Yeah. It's just been hard because, you know, I just been dealing with issue myself, and I don't know what to say. And, you know, like I said, I don't want to, like, kind of ruin what we have and everything like that, but, you know, I just. I just want you to kind of, like, try to, you know, understand what's going on with me a bit more, so that's all.
Counselor：Okay. How did that feel? Better.
Client：I mean, obviously good. It's just, you know, like, the only thing of course I think about is, like, I'm hoping, like, if I kind of, like, talk about that, like, that my friends or whoever I'm talking to is going to be receptive to what I'm saying, you know, I mean, sometimes I feel like, you know, I don't know because I could say that, and then they may not really want to deal with it, so, like, because everybody's different, but I I guess I have to try or. And kind of do that because then, otherwise, I'm not gonna know, so.
Counselor：Yeah. And I can tell from. From that, I I saw that. I noticed that you. You kind of started more of a passive kind of style where you just kind of didn't want to talk about it. You were resistant to talking about it, but then as it kind of went along, you got more. More assertive and more. More clear about what you were thinking, what you were feeling, and how the other person was affecting you. So I thought that was a really good starting point.
Client：So cool. Thanks.
Counselor：All right, so we're coming to the end of this session. So we've talked about first we went over last week, becoming more aware of your triggers, what you're thinking, the thoughts that come to mind, how the cravings, behaviors, how you act, and then the positive and negative results of those behaviors. And then today we went over these different styles of communication. We role played a little bit and kind of analyzed maybe how you tend to associate with communication the ways that you tend to communicate most often. So, yeah, I want to just. How did you feel today's session went?
Client：Yeah, no, I think it went pretty good. Honestly, got some good information from it today. So, yeah, it just makes me maybe try to start working on that with, like, talking, communicating my friends that are just kind of letting them know how I feel. And it's going to be hard, I feel like. But, I mean, I got to try, I guess. So, you know, I'll do, you know, see what. I'll see how it goes.
Counselor：Yeah. Yeah. And again, this is going to take practice. It's. It's. It's difficult work, but, you know, I'm never going to ask you. I'm not always going to ask you to do something that's easy, but I'm always going to ask you something to do something that you are able to do. So. Yeah, so I guess next week we're going to. We're going to talk more about social aspect, building social supports. And this can kind of go along a long way with that, with enhancing the level of support you feel from your friends by also communicating with them in a more assertive way. And they kind of, you know, the different sessions kind of build off each other, you know?
Client：Right.
Counselor：And each one improves on the other one. So. Okay, so I guess for the next week, if you could maybe make a list of different interactions you have with other people and kind of play out or write out what. Reflect on. Sorry, reflect on what. How you felt you communicated based on what we talked about today, and then maybe think about, okay, how could I have done something differently? What do I think? What went well in this interaction? What went not so well? And then next week we can come back and talk about it a little bit. Does that sound. Oh, how does that sound?
Client：Yeah, I could do that. It's fine.
Counselor：Okay. So thank you for coming again to this week. It's good to talk to you again, and I'll see you again next week.
Client：All right, cool. Sounds good. Thanks. Bye.
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