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"Sad is How I Am!" Treating Dysthymia in Children and Adults
Dysthymia continuing education MFT CEUs

Section 8
Track #8 - CBT Tools for Building a Pyramid to See the 'Big Picture'

CEU Question 8 | CEU Answer Booklet | Table of Contents | Depression
Counselor CEUs, Psychologist CEs, Social Worker CEUs, MFT CEUs

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As you know behavior theorists place the emphasis on environmental stimuli. Maladjustment comes about, not from within the client, but as a result of the interaction between your client and their environment.

Share on Facebook Keep it Small and Simple - "KISS" CBT Technique
A colleague of mine, Colleen, spoke in Case Conference about her Dysthymic client, Andrea age 21. After a few sessions, Colleen found that Andrea needed to accomplish something. Colleen explained the KISS or "Keep it Small and Simple" principle to Andrea. With this in mind, Colleen suggested that Andrea tackle one of the problem areas she had mentioned that made her feel depressed.

Colleen mentioned Andrea's overstuffed, disorganized bedroom closet. According to Colleen, Andrea's response to this suggestion was, "What do you mean, clean my closet? That closet is the least of my problems! If I'm going to put my energy into anything, it should be getting my career back on track!"

Sound like a client of yours? As you can see, Andrea made the mistake that many depressed people make: She dismissed a task that was within her grasp; to save her limited physical and emotional resources for something that "really mattered." Getting her career back on track was the most global and ambitious goal that came to mind. This pattern of thinking affected all aspects of her life. When you ask your client to define a goal for themselves, do they say something very similar to what Andrea said.

Have you found, like I, that typically, depressed client's don't set their sights on anything as mundane as getting the unanswered mail off of their desk, learning a relaxation technique, reading a book on how to return to the job market, or organizing a closet. Instead, they "go for the gold" by setting goals like: to feel happy, have a good marriage, a fulfilling career, or an exciting social life. There is nothing actually wrong with those goals, as you know. They can still remain your client's ultimate destination. However, they are unlikely to reach that destination if they disregard the steps that take them there.

Colleen helped Andrea understand that feeling better is like building a pyramid. Andrea's pyramid needed to be built from the bottom up. Colleen felt it imperative for Andrea to start tackling the seemingly insignificant steps that are pieces of the "big picture." In other words, parts of the larger problem Andrea wanted to solve or the loftier goal she wanted to achieve. But before Andrea takes on huge projects or makes major life changes, she needs a track record of success. She had not accomplished much lately.

Andrea needed to prove she could succeed. Otherwise, her fear of failure or her sense of powerlessness and inadequacy kept her stuck in inactive, waiting for her circumstances to improve on their own, or for some miraculous change to come over her to make her capable of tackling something new. The KISS, keep it small and simple, technique helped to break down the steps for Andrea to accomplish her larger goals.

Steps 1 & 2 of the KISS Technique

Share on Facebook Step 1: Help your depressed client set a specific, attainable goal. By identifying a goal, you help them make a major leap toward restoring their sense of competency.

Consider the following when talking with them about their goal:
Make sure the task is not too big. If they feel overwhelmed by it, then it needs to be broken down into smaller pieces. For example, Andrea initially chose to fix up her whole apartment, but when she thought about its condition after five years of neglect, she became disheartened, exhausted, and more depressed. After sitting down with Colleen and listing everything that "fixing up" her apartment would entail, she finally agreed to choose one item on that list, cleaning out her closet, and made that her goal.
Colleen made sure Andrea fully understood what she wanted to accomplish, the criteria Andrea's goal had to meet.

a. First, Colleen made sure Andrea's goal was right for her today. Many depressed clients long for the good old days. They assume feeling better means returning to the way they were before they became depressed. Therefore, they tend to set goals that might have been attainable at one time but do not fit their present circumstances.

b. Second, make sure the goal is right for your client personally. Another trap many depressed clients fall into is letting other people set their agenda or goals for them.

Here are a few examples of this:
-- Losing ten pounds because their mother wants them to
-- Taking an aerobics class because their friend does
-- Returning to school because their brother thinks they should

If Andrea fell into this trap, she would probably find it more difficult to adhere to their plans. Do you agree with Colleen, Andrea's therapist, that it is best to let your client freely choose a course of action that they personally want to pursue.

Share on Facebook Step 2: The KISS method is, of course, keep it simple. When Andrea decided to clean her bedroom closet, she also wanted to repaint it, paper the overhead shelf, purchase and install colorful shoe and sweater racks, and perhaps carpet its floor. In aiming to make the end result "perfect," she managed to make the assignment more difficult, more costly, and more time-consuming. Andrea could have turned all of these complications into an excuse not to simply clean out her closet.

By adding unnecessary extras, have you found your client can turn a straightforward task into an overwhelming production and be tempted to abandon it? To help Andrea through this -- prevent this, as well as the paralysis that results from thinking, "If I can't do it perfectly, I won't do it at all," Colleen had her write down her objectives -- the reasons she wanted to accomplish this particular task. Colleen had Andrea keep the objectives simple and aim for what Andrea needed, rather than what was her "best possible" fantasy.

Andrea came up with three reasonable objectives:
1. To be able to easily find the clothes she wants to wear
2. To have enough room so that things can hang without getting wrinkled
3. To make extra storage space

By identifying the results your client wants, they can focus their efforts on achieving their goal, rather than perfection.

Online Continuing Education QUESTION 8
What are the first two steps of the KISS CBT technique? To select and enter your answer go to CEU Answer Booklet.

 
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