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Case study clinical example CBT: First session with a client with symptoms of depression (CBT model)

Judith Johnson

2,310,858 views

Case study example for use in teaching, aiming to demonstrate some of the triggers, thoughts, feelings and responses linked with problematic low mood. This section here represents the first 14 minutes of an initial therapy session, but in order to try and outline the vicious cycle, it moves faster than an average session might. The video features an actor playing the character of Lucy, but the dialogue is not scripted, and as such represents a natural therapeutic exchange. I myself am a qualified Clinical Psychologist, but would definitely not suggest that this is a perfect example of therapy!

This video was produced as a collaboration between the University of Leeds and Leeds Trinity University (Ricardo Barker).

Chapters:
0:00 Introduction
0:19 Meeting Lucy and the GP referral
1:00 How things are at the moment
2:10 Onset: exam stress and family difficulties
3:40 High standards and self-criticism
5:40 Withdrawal: staying in bed and missing lectures
7:40 Eliciting the thoughts behind the avoidance
9:20 Separating thoughts from feelings
11:30 Physical symptoms and sleep
12:30 Completing the vicious cycle

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These videos are educational resources and are not a substitute for professional training, supervision or individual psychological advice.

Next watch: See how a first CBT session and formulation can be applied when the presenting problem is social anxiety: Case study clinical example: First session...

20 Comments

@JudithJohnsonphd Creator 2 months ago Pinned

I'm the therapist in this video. Ten years on, I'm filming new CBT demonstration sessions and I want to cover what people actually want to see.

What would help you most? Some options: OCD, panic attacks, PTSD, social anxiety, low self-esteem, worry and overthinking. Or tell me a technique you've heard about and want to see done properly.

Reply below. I read all of these and they will shape what gets made.

If you're struggling right now, please do speak to your GP or a local mental health service. I can't offer personal advice here, but I do read everything.

@mineeenexttt4618 6 years ago

She's asking every question I don't want to answer

@bperry573 10 years ago

People need to realize that therapy isn't going in and your therapist telling you that "everything will be alright", then you're gonna be cured after 12 sessions of hearing that. You have to put in work. Heavy emotional work, that is. If you think you are going into a therapist office expecting for THEM to make you all better, you will never get better. A therapist is more like a tour guide of your experiences and they help you to see things in a different way so that YOU can change your way of thinking about whatever you are being impacted by.

@nicholelejeune3503 1 year ago

I love that client is being portrayed as someone suffering with depression who is good at masking with a smile. So many people mask and deny their depressive symptoms and it can be really hard for them to seek help as they can function fairly well up until a point.

@prarthanadutta6934 8 years ago

I was feeling like I'm hearing myself. Left me crying.

@alexaambrose5170 3 years ago (edited)

Just had my first therapy session and I might say... this girl is an ACTUAL REPRESENTATION of me when I just had my session a few hours ago.

@SlightlyBliss 8 years ago

wow didn't even know she was an actress till i read the description, great acting!

@yayothejowen2541 4 years ago

For those people who are commenting how she's a terrible actor that portays depression wrong doesn't know the fact that most patients are usually nervous in their first session and so they used smiling and laughter as a defense mechanism and to look less vulnerable to someone they are completely meeting for the first time. There are lots of depressed people out there who end up trying to hide their true emotions due to various reasons. The mindset that a person can only be truly depressed if they can't smile anymore is the problem. Not everyone is what they seem, take a look at Robin Williams for example. He looked like such a wonderful and charming man only for us to find out he was struggling with depression for a long time...

@FlyKidzy786 9 years ago

The actor is incredible. Body language and vocal tonality were on point.

@explainous 3 years ago

I had my first therapy session today,; this is exactly how I behaved in front of the therapist.

@hughjass311 7 years ago

poor girl. she smiles while talking about all these things that trouble her. that just shows how accustomed she is to masking her pain.

@binuamy6543 5 years ago

I kept my mouth shut in my very first CBT session 😂. As a stubborn teenager I didn't want to express my feelings in front of a stranger even she's my psychologist. My psychologist became friendly, loving, kind and understandable, So as I was comfortable, I started revealing everything to her in my 3rd session. I just want to say my psychologist thank you for being patient with me and having my back each and every time. She's such a good & truthful friend of mine today.

@ashleymdesouza14 5 years ago

I think this is great representation of a first session. Building rapport, providing validation and actively listening. I know people are so quick to want a solution.. but recovery takes time. Recovery and change happens in the process of therapy, regardless of what modality the therapist is utilizing!

@colindonald3161 2 years ago

This brought me back more strongly than I expected to my 20s when I was in this position. I think she’s acting this very well

@DaShadowKnows22 3 years ago

People are people. Some people smile when they are nervous, look around a lot…people with depression don’t always show it physically.

@JennaRose957 3 years ago

As someone going to school to be a therapist, this video was a great representation! It reminds me of all the years I’ve spent in therapy

@thewisdomtherapist 5 years ago

CBT saved my life. After that I became a CBT therapist and CBT wisdom promotor to help as many people as possible.

@uyenbui4810 5 years ago

I could feel the sadness in her eyes.

@anfiscka 7 years ago (edited)

The therapist didn’t let her cry, but still she’s way better than all the therapists that I’ve visited and I lost all the faith in therapy.. all they do is made things much worse and I’m trying to help myself now.. that’s hard

@dorimaknae 6 years ago (edited)

I had a session with a psychologist last year which was pretty much the same as this one, with me telling her my thoughts and her rephrasing them and asking questions that I myself have pondered hundreds of times. found it very unhelpful, guess cbt isn’t for me. it feels like I just get my own thoughts thrown back at me without any constructive dialogue.

edit: just remembered that her summing my thoughts up felt somehow detached, like she could be talking about anyone. you’re sitting there, baring your soul, and she’s throwing names of emotions you’re experiencing without attaching them to you and your personal circumstances.