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

On the previous track, I discussed having your dysthymic client create a list of possible solution alternatives, to help them evaluate these alternatives. For Wendy, if you recall, the solutions regarding her weight and appearance concerns that appeared to be the best for her were ones with more positive than negative expectations. For her, these became the ones to implement. This helped Wendy to make a decision as to how to solve the problem at hand. If you recall some possible solutions Wendy created were to:

-Join Weight Watchers
-Go on a total fast for 2 to 3 days
-Try the Atkins Diet

5 CBT Components of Problem Solving (Continued)

Component #5 - Solution Implementation and Verification

6 Criteria to Help Wendy to Evaluate her Alternatives
a. What is the likelihood that this alternative will achieve my goal by joining Weight Watchers?
b. What is the likelihood that I can implement the solution of going on a fast for 2 to 3 days
in its optimal form?
c. What personal consequences will this involve, such as time, effort, emotional cost or gain, consistency with my values and physical well-being, regarding the 2 to 3 day fast?
d. If I decide to join Weight Watchers, what are the social consequences such as effects on family, friends, community, or neighborhood?
e. What are the short-term consequences for example of the 2 to 3 day fast?
f . What are the long-term consequences of the 2 to 3 day fast versus joining Weight Watchers?

Wendy ended up deciding to join Weight Watchers rather than go on a fast.

Another dysthymic client I treated, Carol, age 30, gave the following brief description of her childhood:
"We kids never knew what to believe. Mother was completely different when she was well. But the big problem was her inconsistency. We kids would hear one thing at one time and something different thing the next time. This is what I am fretting over right now with my own children. How is a good mother to act?

...I really had no consistent model as a child. I don't know what the image of a good mother is supposed to be. Perhaps, that is why I am having problems with my own children." Carol's children were ages 6 and 10. Carol stated, "They never seem to mind me. My husband lays down the law in our house."

After sitting down and thinking about her childhood in detail, Carol realized that the things that her mother went through effected how she would be with her own family.

Carol also told me that she and her siblings had two sets of feelings growing up: happy and sad. But these feelings would not actually fit with what was going on at that time. This could be due to the fact that her mother often changed her moods at any point. According to the National Institute of Health Publication, depression not only causes suffering for those that are depressed, but also causes difficulty for the family and friends that may not know how to help.

Carol's mother may have been suffering from depression, and, as you are aware, only about two-third's of those that are depressed actually receive treatment. The low number receiving treatment may be caused by a number of different reasons. I feel the main reason a potential client may not receive treatment is because he or she simply does not recognize the signs or symptoms that something is wrong.

Carol's 6-Step CBT Decision Making Process:
--1. Goal Achievement: It will give me the opportunity to talk about my problems and get my feelings out in the open.
--2. Implementation: If I continue to attend the sessions with you, I will be able to understand myself and my thoughts better.
--3. Personal Consequences: However, attending the sessions will cost me money and time. I will have to attend the sessions at least once a week, and it will cost me at least $400 extra a month.
--4. Social Consequences: My family and friends will not be able to see me as often as they would like, or I would like.
--5. Short-Term Consequences: I will have to attend these sessions and take time away from my children at least once a week. It will take away from the quality time that we spend together and cause them to have to do without some things for a while.
--6. Long-Term Consequences: I will have to deal with my problems when I am faced with them instead of putting them off until ten or twenty years have passed by.

Looking into her answers that she gave to these alternatives, Carol realized that seeing a therapist was not a bad solution. Evaluating her alternatives helped Carol to push through or past her inaction. She felt evaluating alternatives helped her get to the best solution to her problem.

Peer-Reviewed Journal Article References:
Cummings, J. A., Ballantyne, E. C., & Scallion, L. M. (2015). Essential processes for cognitive behavioral clinical supervision: Agenda setting, problem-solving, and formative feedback. Psychotherapy, 52(2), 158–163.

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.

Klein, D. N., Leon, A. C., Li, C., D'Zurilla, T. J., Black, S. R., Vivian, D., Dowling, F., Arnow, B. A., Manber, R., Markowitz, J. C., & Kocsis, J. H. (2011). Social problem solving and depressive symptoms over time: A randomized clinical trial of cognitive-behavioral analysis system of psychotherapy, brief supportive psychotherapy, and pharmacotherapy. Journal of Consulting and Clinical Psychology, 79(3), 342–352.

Werner, K., & Raab, M. (2013). Moving to solution: Effects of movement priming on problem solving. Experimental Psychology, 60(6), 403–409.  

Online Continuing Education QUESTION 15
What are the six criteria to assist your dysthymic client to push through their inactivity and evaluate alternatives? To select and enter your answer go to CEU Test.