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

Section 20
Track #20 - Helping Clients Fight Emptiness with the
CBT 'Framework of Concern'

CEU Question 20 | CEU Answer Booklet | Table of Contents | Depression
Social Worker CEUs, Psychologist CEs, Counselor CEUs, MFT CEUs

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Here is an example of a reversed advocate role-play with the same patient that focuses on the irrational attitude statement mentioned before, "I am entitled to a life without problems." This time, I attempt to impact upon a set of cognitive distortions more relevant to my client.

Share on Facebook Example: Reversed Advocate Role-Play

I began with, "Eric, let's try another role-play. Once again I'll take the role of another one of your
colleagues."

Eric asked, "And you want me to argue your points again?"

I said, "Good, you're really getting the idea. Just try to refute what I'm saying with an argument based on a more realistic and sensible set of beliefs. OK, let's begin."

I then began the reversed advocate role-play with, "My life is over. All I ever wanted was to be happy. I thought when I was an adult, I would be happy. I worked hard, tried to be a good husband and father, and a good son to my parents, but it's just not working out."

Eric replied, "I know exactly how you feel (Recognizing these complaints as similar to his own). He laughed a little and said, "I don't know if I can argue with this person. (OK, I'll cooperate.) How come you're not happy?"

I answered, "Oh, I know that sometimes I seem like I'm enjoying myself, but deep down there's this emptiness, wondering what life is about. How come I'm not really happy? My kids have an attitude, my wife and I argue, and teaching isn't the constant challenge I thought it would be. I feel like I deserve more than this. I should be happier. There's nothing I can do. I don't deserve this kind of life."

Eric asked, "What kind of life? You have a steady job; you have a family to go home to and lots of
friends."

I said, "Yeah, but so many problems too, and that seems so unfair. I expected so much more."

Eric asked, "What did you expect?"

I replied, "That if I was a good person and tried hard, I wouldn't have any problems, and I would be happy. I would feel good all the time."

Eric answered, "Nobody feels good all the time. At least you have a family! Even when you're basically happy, you still get sick, see people die, or have arguments. You're actually lucky to have someone to share your hassles with."

I replied, "I thought it would be different. That life would be like my daydreams when I was a kid -- Happy marriage, beautiful kids, good job and lots of appreciation for my hard work."

Eric then said, "You have some of those things, but life is not daydreams -- you can't be happy all the time!"

I said, "But I deserve to be happy all the time. I'm different than other people. I'd like to be like you --. single, footloose, and no worries!"

Eric then said, "Footloose! Are you crazy? Sometimes I get so lonely, I want to die!"

I asked, "You mean you get sad sometimes? I don't know. I feel like at this stage of my life I should be happy and content all the time."

Erin then asked, "Well, who do you think you are! What makes you think you deserve to be happy more than anyone else?"

I replied, "But I'm smart and nice, and I work hard."

Eric's response was, "So do a lot of people."

I said, "Then I guess those of us should be happy all the time; we're entitled to it!"

Eric said, "That's ridiculous! No one is entitled to perfect happiness all the time."

I asked, "Why not?"

Eric responded by saying, "Because that's not life. It's a stupid setup to expect it."

Then I asked, "What do you mean setup? I deserve it!"

He asked, "Where did you ever get that idea?"

I said, "From the movies."

Eric then laughed out loud and said, "Well, the movies are fake. Life is not Hollywood!"

In this example, I ended the role-play when the patient was advocating actively for a more rational approach to life's problems. In this particular sequence, I hypothesized that Eric's overt emotional expression (laughter) indicated heightened emotional sensitivity and awareness that the "happily ever after" theme of the dialogue was more closely striking upon the patient's own self-evaluations.

When using this strategy, it is important for you to couch the exercise within the framework of concern for the client. The patient should not perceive the therapist as attempting to sarcastically mimic his or her beliefs. Rather, the therapist explains that these beliefs at times may bring about feelings of depression or distress, which in turn may inhibit or interfere with later attempts to cope with a stressful problem. As such, the therapist indicates that the purpose of this procedure is to facilitate the client's adoption of a more positive orientation towards problems in living.

Online Continuing Education QUESTION 20
What is a perception problem that reversed role-playing may create? To select and enter your answer go to CEU Answer Booklet.


Thank you for the opportunity to provide you with continuing education credits to meet your state licensure renewal requirement. We hope this CD set has provided you with practical techniques and interventions that you can implement in your next session with this client population.

I wish you the best of luck in your practice. This is Brian Clark and thanks for listening.

 
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