Case Illustration

To illustrate further integrative case conceptualizations and family interventions that may be combined with CT, we describe the case of a person in individual CT that included a family meeting. Thomas, a 32-year-old man, lived with Mark, his partner of 5 years. Thomas had recently lost his job, and unable to find another job after looking for a few months, he became depressed and stopped looking. After a few more months of feeling down, he began individual cognitive-behavioral therapy for depression. As part of the initial assessment, he reported that his relationship with his partner Mark was "basically fine, although he's been sort of irritable lately." The therapist explained to Thomas that she liked to have a family meeting with her patients for the purpose of assessment and psychoeducation. Although Thomas was initially resistant to even asking Mark to attend a family meeting—"He's too busy. He'll never want to come"—the therapist helped Thomas to challenge some of the cognitions that prevented him from asking Mark to join them. Eventually, Thomas did ask Mark, and, to his surprise, Mark agreed to come in.

The family meeting began with an assessment. Talking with Mark and Thomas together, the therapist began to piece together the following conceptualization. When Thomas first lost his job, Mark was very accommodating; he did not expect a lot from Thomas, because he knew how terrible Thomas felt. Thomas, who was thinking "I am a failure at everything," relinquished more and more of his responsibilities (e.g., he did not look for a job or do chores at home) as Mark did more and more for him. Thomas's depression did not improve; he stayed home all day and watched TV. Through careful questioning, the therapist learned that Mark was feeling frustrated, but he was reluctant to say anything; he thought, "If I tell Thomas how frustrated I'm feeling, he won't be able to handle it, and he'll get much worse."

Although Thomas was upset to hear that Mark was frustrated, the therapist normalized both men's reactions. She explained to the couple that

Thomas's lack of energy and motivation were common symptoms of depression. She also validated Mark's feeling of frustration about the fact that Thomas had stopped looking for a job or helping around the house. Because depressed individuals often have trouble being activated, she suggested that it might be helpful if Mark asked Thomas to do more around the house, and if they went out together occasionally in the evenings. Because Thomas had begun to learn about the importance of planning both meaningful and pleasant activities in the context of his individual therapy, he agreed that this was important, and that he might be more likely to get things accomplished or to go out if Mark made a direct request of him. The couple left the meeting with a plan to make a list of tasks for which Thomas might take responsibility once again. They also planned to go out to dinner that weekend. In subsequent individual sessions, Thomas reported that he was feeling more active and less depressed, doing more around the house, and that Mark seemed less irritable. The therapist prompted Thomas to continue talking with Mark about what needed to be done around the house, and to make an effort to go out together in the evenings. With the support of both the therapist and Mark, Thomas started looking for a job again and eventually found a job that seemed promising.

Exploring EFT

Exploring EFT

EFT stands for Emotional Freedom Technique. It works to free the user of both physical and emotional pain and relieve chronic conditions by healing the physical responses our bodies make after we've been hurt or experienced pain. While some people do not carry the effects of these experiences, others have bodies that hold onto these memories, which affect the way the body works. Because it is a free and fast technique, even if you are not one hundred percent committed to whether it works or not, it is still worth giving it a shot and seeing if there is any improvement.

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