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Getting over your Thoughts
S/he is middle aged with children and live with spouse and extended family. S/he has through out life felt somewhat melancholic, and have been on medication for many years. Now s/he feels very sad because of life events and results on clinical scales indicate moderate to severe clinical depression.
First three sessions are spend exploring patients life and situation, to get a good understanding of background, present, daily habits, possible support and vulnerabilities, behavior and thoughts. Then, a behavioral analysis is conducted, in order to underline behavior that is done in excess, and behavior that is lacking. Patient has a lot of self critical thoughts and rumination. S/he blames self for things that has happened, and has intense feelings of worthlessness. S/he sleeps in access, has lost weight, stopped doing pleasurable activities and seeing friends, and is very irritable towards family. S/he procrastinates most of daily chores, and engage in destructive coping behavior.
A treatment plan is constructed, and therapist and patient agree on patient goals. Patient also gets information about depression and the positive results on therapy, to create understanding and hope. Already the second session, patient gets homework to start walking for at least 30 minutes per day. Patient is also informed that progress in therapy is dependent on exercises and homework to try out at home, to create change and to balance positive and negative behavior.
The following seven sessions involve creating a good sleeping pattern, continuing with exercise, mindfulness exercises to increase attention and awareness and to decrease stress and rumination, identifying negative thoughts and self criticism and challenging these with the attempt to exchange them for positive thoughts. We also work to improve problem solving skills and use these when discussing patient’s life issues. Patient learns about and gets to practice the art of forgiveness and compassion.
Patient is continuously measured with a clinical scale for depression along. At one point in therapy s/he comes in every day, in order to deal with crisis and to get up in the morning. Slowly, s/he is starting to feel better, have more energy, and am able to deal with life.
The final three sessions are scheduled every other week. Therapy focus on increasing general happiness, self-efficacy and self-esteem. We talk about the importance of having a reason to get up in the morning, to have close and loving relationships, to engage in healthy habits, the power of discipline, kind acts and several other key concepts for general happiness and contentment. We define life values and discuss how to live according to them. We also practice self-compassion, and thought care, in order to feel good and prevent mental ill-health. Patient gets and understanding of symptoms of depression so that s/he can seek help early if symptoms reappear.
Overall, patient has gone from moderate/severe clinical depression to mild depression on clinical scales, and agree s/he feels much better and is able to deal with life. We agree on a follow up dates in 3 months and 6 months, and patient promises to call clinic if symptoms get worse.