Introduction

Therapist: Hi Lucy, nice to meet you. I understand that you were referred here by your GP (General practitioners’) because you’ve been feeling entirely down recently.

Patient: Yeah, I thought I should. I’ve been feeling quite bad for quite a while, so it may be time to see someone about it because I don’t want to feel like this anymore.

Background Information

Therapist: From your notes, you saw the GP about three months ago.

Patient: Yeah.

Therapist: So, how long have you been feeling down altogether?

Patient: Quite a few months before that, but it’s gotten bad these past few months, so that’s why I came.

Therapist: Okay, so has it gotten worse since you saw your GP?

Patient: Yeah.

Current Situation

Therapist: Okay, how are things at the moment?

Patient: Well, it started feeling a bit low and wound up about things, but I just recently can’t be bothered to do anything at all. I find it hard to get motivated, and I want to be. I want to be better, but it’s just reaching the end where I just want to do something about it.

Emotional State and Isolation

Therapist: Okay, you said that you’re feeling down and unfortunate and feel like you haven’t got any motivation. Are you okay?

Patient: Yeah, fine. Sorry.

Therapist: Okay, and you haven’t got any motivation, but you’re putting quite a lot of pressure on yourself to try and feel better.

Patient: Yeah, it’s also hard because there’s not anyone to talk about, so I stay on my own.

Therapist: I don’t like to think about it, but I know.

Therapist: Okay, so you say you’ve been feeling relatively isolated. There are few people around?

Patient: Yeah, there’s no one I can talk to about it. No one would listen or understand anyway.

Personal Life and Living Situation

Therapist: I’m going to try to find out more about you. So, I understand that you’re an English student at Uni.

Patient: Yeah.

Therapist: And you live away from home with some friends.

Patient: Yeah, I live here.

Therapist: Okay, so you don’t live far from the Uni, but you say you live with your friends but don’t feel like you can talk to them?

Patient: Yeah, I mean, they’re lovely. I get on well with them, but I don’t know. Recently, whenever they want to go out or do something, I want to keep them from being down. They don’t understand what I’m going through. They don’t make fun of how I feel, but they don’t know what it’s like. I don’t want to avoid going out with them and bringing them down.

Therapist: Okay, so you try hiding the way you feel from them?

Patient: I guess. It’s easier to hide it than to try and explain it all the time when no one wants to know.

Therapist: Okay, it sounds like you’ve been feeling down, unmotivated, and want to improve, but you can’t reach out for help or speak to anybody.

Patient: No, I don’t talk to my parents often either, so that’s hard.

Timeline and Triggers

Therapist: Okay, I will be back in time. When did all of this start? You said it’s been going on for quite a few months.

Patient: Yeah, it started when I was revising for my exams. The stress, I put a lot of stress on myself. I’ve always wanted to do well for myself and, I guess, for my parents, so the stress of exams and it was also hard because my parents were going through a bit of a troubled time then.

Therapist: Okay, so this is last March or last April?

Patient: Yeah, I think so, around that time.

Therapist: So, about six months, and it sounds like a lot was happening, so you had a lot of Uni pressure on, and you said that your parents were having marital problems.

Therapist: Okay, and it sounds like that was a real shock to you.

Patient: It was also hard because I wasn’t doing well at Uni. I felt a bit guilty. I know it sounds silly, but if I could do better, they would get better, but it wasn’t happening.

Therapist: Okay, so you were trying to work hard and be more successful because you thought that would make them happier and try fixing things?

Patient: I wanted to make them feel better, but it just backfired a little.

Therapist: How did it backfire?

Patient: It just ended up with them getting worse, and I’ve just been feeling worse since then.

Exam Period and Parental Influence

Therapist: Okay, so after the summer and exam period, how did that period go for you in the end?

Patient: Not very well.

Therapist: Okay, that’s an awful lot of pressure to put on yourself.

Patient: It isn’t enjoyable because I know I should have done better, and I just didn’t, and I guess I beat myself up a lot about it.

Therapist: So you say, “I know I should have done better.” Hearing it from my perspective, it sounds like you had an awful lot going on at the time. It’d be understandable that you wouldn’t do as well as usual. I’m just wondering if you have very high standards for yourself.

Patient: Probably more than other people. My parents have always taught me, not in a loving way, I guess, but that you should do your best and get the best. And I agree with it, that’s the right thing to think, but when I don’t do that, I don’t know, it annoys me a lot, and I worry that it annoys them.

Therapist: So you should always do your best. Is that the word you used?

Patient: Yeah.

Therapist: And are there no exceptions for that?

Patient: No.

Therapist: Okay, I can see that it was a tough time for you, and that was when your mood started to get lower. Things are still quite bad now. What’s the situation with your parents at the moment?

Patient: It doesn’t sound good. I talk to them infrequently, but they could be progressing better. I wouldn’t say I like talking to them about it because it makes me feel worse.

Therapist: Okay.

Patient: But it’s not getting any better.

Therapist: Were you home over the summer?

Patient: For a little bit.

Therapist: Yeah, and how was that?

Patient: Not very fun. It was always pretty tense; it stressed me more than relaxed me over the summer.

Current Emotional and Physical State

Therapist: Okay, quite a lot has been happening. You’ve been feeling very low, you’ve had Uni pressure on, you’ve had problems with your parents’ marriage, and it sounds like you can’t reach out to anyone. You can’t understand why you can’t reach out to your parents right now, so you can’t really confide in your friends. So, I’m wondering if you can tell me more about how you’ve felt this past week.

Patient: It’s not good. If I don’t have to, I don’t leave the house or get out of bed. I can’t find the motivation for the things that I used to enjoy. I used to love doing sports or going out, but now I prefer to lie in bed and not do anything. I missed a few lectures this week that I should have gone to.

Therapist: Right, so I’m just wondering then, let’s see if we can think about one thing, say a lecture. What kind of thoughts about attending that lecture before it happens?

Patient: I don’t see the point anymore. If I can’t do as well as I should be doing, then what’s the point in putting myself in those positions? I just can’t be bothered anymore to try. It just stresses me out more than it needs to.

Therapist: Okay, so it sounds like the thoughts you’ve got in your head are, “It’s pointless, it’s not worth it.” Do you have any other thoughts in your head just at that point before you go to the lecture?

Patient: I can’t do well enough. I see all these other students who are doing well and doing better and want to be there. I don’t know why I’m here, even at Uni, to be honest.

Therapist: So you feel like you’re not as good as other people here?

Patient: Yeah.

Therapist: Sorry, can I take notes as we go through? I’m trying to understand what you’re telling me, and it helps me write it down. I’ll share this with you later. Those are some quite negative thoughts to have. You’re saying it feels like it’s pointless, more effort than it’s worth, and I don’t deserve to be here; I’m unworthy. Those thoughts sound like they flip through your mind.

Therapist: Then, you describe different emotions that lead to sadness, anger, frustration, and embarrassment. What about in your body? How do you feel physically?

Patient: I used to be, from those emotions, very wound up and stressed all the time, but recently, it’s just been a lot more draining than anything. I’m pretty lazy and can’t be bothered anymore. My body reflects that, but when I try to sleep, I can’t seem to have a satisfied night’s sleep. It’s tiring.

Therapist: As you said, focusing on those thoughts, those negative thoughts, how do you feel after that? Do you feel better or worse?

Patient: I feel slightly worse but then a bit numb in a way. Once you think that, because I always feel tired, I try and push it out, and then you don’t think about anything.

Therapist: It’s nicer that way than to keep focused on how much you’re getting wrong and how much you can’t do stuff. Sometimes, it’s better not to think about it at all.

Patient: So it sounds like it’s a relief to do that in some ways, but you think it might make things worse in other ways.

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