Initial Formulation

On the basis of information gleaned at assessment, the treating therapist hypothesized the following mechanisms as being central to the maintenance of Alan's depression:

• A perceived loss of control over events at work and a perception he had made mistakes in how he conducted himself. This had compromised Alan's self-esteem, which was based entirely on work and the sense of role, purpose, and status that this inferred. Prior to the onset of his illness, Alan perceived himself as capable, competent, and master of his own domain.

• His view that becoming depressed was a sign of weakness. Alan viewed the persistence of his illness as further evidence of his weakness. This further undermined his self-esteem.

• His sense of shame at becoming depressed. Although Alan admitted feeling ashamed regarding his depression, he did not readily articulate the concomitant sense of himself as weak that was hypothesized by the therapist but rather, he expressed a strong view that his depression was biological in origin.

Alan expressed reservations regarding the utility of CT as a treatment. This, in conjunction with his sense of shame, led the therapist to exercise caution in terms of sharing the formulation with Alan. The therapist was concerned that being too explicit with Alan regarding his sense of himself as weak might lead him to disengage. Therefore, the initial formulation was presented tentatively, with ample opportunity for Alan to contribute and to disagree. The initial formulation drew on the Beck et al.'s (1979). model by considering the practical (actual) losses that Alan was confronting. The therapist then developed this further by looking at the personal (perceived) losses that arose from them. This was presented in written form as follows:

Practical losses I have suffered as a result of becoming depressed:

• Loss of ability to be as active as I used to be

• Loss of financial security

• Loss of retirement plan

Personal losses I have suffered since becoming depressed and losing my job:

• Loss of a sense of security

• Loss of purpose and meaning in life

• Loss of respect for self and in the eyes of others

Alan responded favorably to the formulation and was able to make a connection with the idea that certain practical external losses had also triggered internal change and losses.

A number of important conditional beliefs were hypothesized and subsequently endorsed by Alan: If you are not in control, it is a sign of weakness. The theme of control was central to the onset and maintenance of his illness. Alan perceived that he had not taken control of events in a climate of change at work. He also invested a great deal of mental and emotional effort into trying to control his depression. If you show your emotions, you will be ridiculed and humiliated. This belief to a large extent reflected a cultural norm. The environment in which Alan was raised and currently lived endorsed men who were strong and did not show their feelings. If you work hard, you will be rewarded. Alan saw working hard as a virtue in itself that also conferred a sense of self-worth. Hence, his self-esteem was predicated on work. This belief was a contributory factor in the onset of Alan's depression, because he always believed that if he worked hard (which he did), he would gain not only material reward (which he would deserve for working hard) but also self-respect and respect in the eyes of others.

Formulating Alan's unconditional beliefs presented more of a dilemma. Since becoming depressed, he interpreted much of what went on in his life in terms of his own weakness. In contrast, prior to becoming depressed Alan had viewed himself, and had perceived that others viewed him, as strong, capable, and in control of his life. On this basis within the formulation, Alan and the therapist made sense of his problems in terms of his positive view of himself as strong, capable, and in control as having been shattered by an inability to control events at work and by his resultant depressive illness. Alan's view of himself as weak related only to having become depressed, not as a pre morbid, global negative view of self. In terms of his view of the world, Alan believed it should be a fair place was closely linked to his belief that if he worked hard, he would be rewarded. Prior to the changes at work, Alan believed life had treated him fairly, and it had done so because he had worked hard.

The extremity (all or nothing nature) and rigidity with which Alan held his beliefs was formulated as being an important contributor to his distress and fundamental to his vulnerability.

Letting Go, Moving On

Letting Go, Moving On

Learning About Letting Go, Moving On Can Have Amazing Benefits For Your Life And Success! Don't be held back by the past - face your guilt and fears and move on! Letting go is merely arriving at a decision, no more allowing something from the past tense to influence your life today or to cut down your inner sense of peace and welfare.

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