"Sad is How I Am!" Treating Dysthymia in Children and Adults

In the previous track, we discussed steps one and two of the Cognitive Behavior Therapy KISS, Keep It Small and Simple, technique with a depressed client; set an attainable goal and keep it simple. In this track, we will discuss steps three through five of the KISS technique.

Steps 3, 4, & 5 of the KISS CBT Technique

Step 3: Andrea needed to make an approach plan. Developing an approach plan enabled Andrea to map out the best possible route to her goal and allowed her to clarify how she was going to get the job done. This increased her efficiency and decreased the potential for obstacles to hamper her progress. To make an approach plan with Andrea, Colleen did the following four steps:

a. First, Establish checkpoints: Colleen helped Andrea break the task at hand into small pieces. Colleen guided Andrea not to worry about the sequence of events, but rather try to envision an overview of checkpoints.

b. Second, Predict problems and obstacles: Colleen had Andrea identify any potential obstacles or problems she might encounter. Next, how she can prevent these problems or overcome these obstacles. Solutions may include the time-management techniques discussed in the next track.

c. Third, Prepare for the task: Colleen helped Andrea make a list of what she needed to have on hand in order to accomplish her goal. This list needed to be as specific as possible, and include how or where they will obtain these prerequisites. With Andrea, this was as simple as obtaining boxes and labels for storage and marking the contents of each box. Then, have your client add these preparation steps to their list.

d. Fourth, Plan some rewards: Colleen helped Andrea identify rewards she could build into her plan as added incentives to keep working towards their goal. Although accomplishing the goal will be a reward in itself, it is beneficial to include a few positive reinforcements along the way. Colleen suggested to Andrea, she might buy herself a small present, read a magazine, take a bubble bath, get a massage, or go out to a nice restaurant for dinner after accomplishing steps toward the closet cleaning project. Colleen also emphasized that Andrea should verbally praise and reward herself every step of the way and when the goal is accomplished.

Step 4: Have your client schedule their steps. Colleen had Andrea look over her approach plan and helped her select what she would do first; determine how much time it would take; decide exactly when she would begin; if it would take a number of days or weeks to complete, how long she intended to spend on it each day. On their personal calendar, have them pencil the task into their schedule, and have them repeat this process for the second, third, fourth, and fifth tasks. To avoid overwhelming and overburdening them, and also to be able to see progress, have them avoid scheduling more than five tasks.

Step 5: It is important that they do what they have planned. One at a time, Andrea should perform each task and adhere to their schedule. Colleen told Andrea if she found she could not spend as much time as she had scheduled, make the most of the time you can devote to the task. As you know, procrastination, leaving things half-finished, or giving up before even beginning are not easy habits to break. Your client may be tempted to talk themselves out of doing what they had planned. Other times, they will find themselves moping and brooding, as they did in the past.

Colleen warned Andrea about procrastination, and suggested that she try the "five minute plan." Colleen told her to make a pact with herself to devote just five minutes to the task she had scheduled. After five minutes, she has the option of going back to doing nothing. Usually after five minutes are up, have you found, like I have found about myself, you are willing and able to continue?

Would this process, that allows your depressed client to keep tabs on where they are at in accomplishing their goals, be of assistance to you in your next session? I have found the KISS technique reminds client that they are making progress, moving forward, and accomplishing things. Each accomplishment then, of course, adds to their sense of competence and self-worth. In short the more they do, the better they will feel.

Peer-Reviewed Journal Article References:
Delgadillo, J., & Gonzalez Salas Duhne, P. (2020). Targeted prescription of cognitive–behavioral therapy versus person-centered counseling for depression using a machine learning approach. Journal of Consulting and Clinical Psychology, 88(1), 14–24.

Dickson, J. M., Moberly, N. J., & Kinderman, P. (2011). Depressed people are not less motivated by personal goals but are more pessimistic about attaining them. Journal of Abnormal Psychology, 120(4), 975–980.

Geschwind, N., Bosgraaf, E., Bannink, F., & Peeters, F. (2020). Positivity pays off: Clients’ perspectives on positive compared with traditional cognitive behavioral therapy for depression. Psychotherapy, 57(3), 366–378.

Online Continuing Education QUESTION 9
What should you do to avoid clients feeling overwhelmed and overburdened, and also to be able to see progress? To select and enter your answer go to CEU Test.