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
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
ended up deciding to join Weight Watchers rather than go on a fast.
dysthymic client I treated, Carol, age 30, gave the following brief description
of her childhood:
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."
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.
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.
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:
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.
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
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