Cognitive therapy an interview with a depressed and suicidal patientAaron T. Beck
Perhaps the most critical challenge to the adequacy of cognitive therapy is its efficacy in dealing with the acutely suicidal patient. In such cases the therapist often has to shift gears and assume a very active role in attempting to penetrate the barrier of hopeless-ness and resignation. Since intervention may be decisive in saving the patient’s life, the therapist has to attempt to accomplish a number of immediate goals either concurrently or in rapid sequence: es tab lish a working relationship with the patient, assess the sever-ity of the depression and suicidal wish, obtain an overview of the patient’s life situation, pinpoint the patient’s “reasons” for wanting to commit suicide, determine the patient’s capacity for self-objectivity, and ferret out some entry point for step ping into the pa-tient’s phenomenological world to introduce elements of reality.Such a venture, as illustrated in the following interview, is taxing and demands all the qualities of a “good therapist”—genuine warmth, acceptance, and empathetic understanding—as well as the application of the appropriate strategies drawn from the system of cognitive therapy.The patient was a 40-year-old clinical psychologist who had recently been left by her boyfriend. She had a history of intermittent depressions since the age of 12 years, and had received many courses of psychotherapy, antidepressant drugs, electroconvul-sive therapy, and hospitalizations. The patient had been seen by the author five times over a period of 7 or 8 months. At the time of this interview, it was obvious that she was depressed and, as indicated by her previous episodes, probably suicidal.In the first part of the interview, the main thrust was to ask appropriate questions in order to make a clinical assessment and also to try to elucidate the major psychological problems. The therapist, first of all, had to make an assessment as to how depressed and how suicidal the patient was. He also had to assess her expectations regarding be-ing helped by the interview (T-1; T-8) in order to determine how much leverage he had. During this period of time, in order to keep the dialogue going, he also had to repeat the patient’s statements.It was apparent from the emergence of suicidal wishes that this was the salient clini-cal problem and that her hopelessness (T-7) would be the most appropriate point for intervention.Several points could be made regarding the first part of the interview. The therapist accepted the seriousness of the patient’s desire to die but treated it as a topic for further examination, a problem to be discussed. “We can discuss the advantages and disadvan-tages” (T-11). She responded to this statement with some amusement (a favorable sign). The therapist also tried to test the patient’s ability to look at herself and her problems Cognitive therapy6 an interview with a depressed and suicidal patientAaron T. BeckExcerpt from Aaron T. Beck et al., Cognitive Therapy of Depression (pp. 225–243). Published in 1979 by Guilford Publications, Inc. Reprinted by permission of the publisher.
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An Interview with a Depressed and Suicidal Patient
After studying Module 4, review and discuss the Case Studies in Psychotherapy Workbook – An interview with a depressed and suicidal patient.
In your own words, summarize the case in your video:
What was the case about
Who did it involve
What happened in the case
What caused the distres
Create a work doucment that demonstrates you instructing the patient regarding the automatic thought recor Downloaded utomatic thought record/A Star is Born Download A Star is Borndurin
An Interview with a Depressed and Suicidal Patient
AUTOMATIC THOUGHT RECORD
When you notice your mood getting worse, ask yourself, “What’s going through my mind right now?” As soon as possible, fill in the table below.
Date,
Time Situation Automatic Thoughts (ATs) Emotion/s Adaptive Response Outcome
• What led to the unpleasant
emotion?
• What distressing physical
sensations did you have?
• What thought/s or image/s went
through your mind?
• How much did you believe the
thought at the time (0-100%)?
• What emotion/s did
you feel at the time?
• How intense was the
emotion (0-100%)?
• Which thinking styles did you
engage in?
• Use questions below to respond
to the automatic thoughts/s.
• How much do you believe each
response (0-100%)?
• How much do you
now believe your
ATs (0-100%)?
• What emotion/s do
you now feel? At
what intensity?
Questions to compose an Adaptive Response: (1) What is the evidence that the automatic thought is true? Not true? (2) Is there an alternative
explanation? (3) What’s the worst that could happen? What’s the best that could happen? What’s the most realistic outcome? (4) If a friend were in
this situation and had this thought, what would I tell him/her?
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The case is about a 40-year-old clinical psychologist who had recently been left by her boyfriend. She had a history of intermittent depressions since the age of 12 years, and had received many courses of psychotherapy, antidepressant drugs, electroconvulsive therapy, and hospitalizations. The patient had been seen by the therapist five times over a period of 7 or 8 months. At the time of this interview, it was obvious that she was depressed and, as indicated by her previous episodes, probably suicidal.
During the interview, the therapist’s main goal was to establish a working relationship with the patient, assess the severity of the depression and suicidal wish, obtain an overview of the patient’s life situation, pinpoint the patient’s “reasons” for wanting to commit suicide, determine the patient’s capacity for self-objectivity, and ferret out some entry point for stepping into the patient’s phenomenological world to introduce elements of reality. The therapist used cognitive therapy strategies and techniques to help the patient understand and manage her thoughts and feelings.
The main cause of the patient’s distress was her recent break-up with her boyfriend and the feelings of hopelessness and helplessness that it had triggered. The therapist instructed the patient to use an automatic thought record to identify and challenge negative thoughts, and provided guidance on how to use the record to monitor her mood and emotional state. The patient was also encouraged to practice adaptive responses and to focus on positive outcomes.
