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Your experiences: A Cognitive Behavioural Therapy (CBT) solution for depression

by Sarah Graham
Friday 28 November 2014
1576 7040

Depression is one of the most common mental health conditions, affecting one in ten people at some point in their lives, and is the most searched for issue on RSCPP. Symptoms include long-lasting feelings of unhappiness and despair, and loss of interest in normal activities. In especially severe cases, depression can also cause suicidal thoughts.


The client's situation 

Andrea*, now 37, has suffered from depression since her teenage years and attempted suicide in her late teens. Three years ago, after living and working in London for 15 years, her marriage broke down, her mother was diagnosed with breast cancer and her father had a heart attack. Coming all at the same time, it understandably all felt a bit too much. 

"I ended up separating from my husband and moved back up north to live with my parents, under the guise of taking care of mum and dad – but really, emotionally, I think they took care of me. I was feeling very badly depressed. I was bottling a lot up and was in a really, really bad place," she explains.

When Andrea's mum searched RSCPP for a counsellor in their area, she found Karole Thomas. In their initial session, Karole says Andrea "was experiencing moderately severe depression and moderate anxiety, with some functional impairment in her day-to-day life."

She adds: "Andrea presented as very distressed, overwhelmed and concerned about her ex-husband as she felt he was very unhappy because of her leaving. She felt anxious and guilty about the marriage split, and she was very tearful and fearful."

In their initial goal setting, Karole says Andrea "wanted to be able to see her current situation more rationally. Initially the goals were around helping her become less distressed by the break up in her marriage, and later about learning why she had struggled so much with severe loneliness and depression."


The therapist 

Accredited Counsellor Karole Thomas is accredited by the British Association for Counselling and Psychotherapy and has more than seven years experience providing therapy to individuals and couples. She offers Psychotherapy, Counselling, Cognitive Behavioural Therapy (CBT) and Client Centred Therapy from her practice in Stockport, Greater Manchester.

She says: "As an integrative therapist, I draw on a range of approaches that will fit best with what the client wants and how their issues present. CBT and mindfulness are often most helpful in working on symptoms of anxiety and depression."


The treatment

In their initial session, Andrea and Karole agreed to work on CBT, to help Andrea challenge how she was thinking about things. To begin with, Andrea says she found this extremely difficult: "It did take quite a while, and I actually stopped [going to see Karole] for a little while because I felt so bad and wasn't sure whether it would work."

When Andrea did go back to therapy, she says it was because, "I felt so hopeless and really didn't know what else to do." However, she adds, "I think initially I went because I wanted to make mum and dad happy, but when I went back the second time it was for me – it was something I thought I needed to do."

Eventually, she says, her relationship with Karole developed to a point where "I trusted her and we could actually start doing proper CBT. I was so broken at the time that it did take me a few months."


Overcoming challenges

During these early months, Karole says one of the biggest challenges was Andrea's tendency to minimise anything that had upset her, to 'gloss over' difficult issues, and to hide how she really felt. 

"I had to allow the time for Andrea to begin to acknowledge and process these feelings. Once she gained trust in the process, these tendencies reduced considerably, allowing her to look at [previously unmentioned] issues, like the way she had been treated at work by a senior manager," Karole explains.

As they worked through CBT techniques, Andrea says she found herself learning to be more mindful of the unhelpful thoughts going round in her mind. "Karole had given me some sheets and every time those thoughts came into my head, I had to look at the sheets and recognise what I was thinking."

She adds: "We talked about black and white thinking, and catastrophising, and once we'd actually spoken through it, it was so obvious that that's what I was doing, and it was really unhelpful. Unless you're mindful of it and you catch yourself and then stop that thinking, it's just like a vicious circle."


Breakthrough moments

For Karole, "the first obvious progress came when Andrea realised that, when she was feeling so upset and guilty about leaving her husband and thought of him having a difficult time, she had not actually checked it out with him and so did not know how he was feeling," she explains. "Andrea began to realise the awful picture she had of his suffering was starting in her head, not his."

As she became less distressed about the marriage break down, and felt more settled in the north west, Karole says Andrea was more able to understand the issues in her marriage that had led to the breakdown and where her feelings of loneliness had come from. 

"It made a massive difference," Andrea says. "Eventually my mood lifted, and I can see now that my mood lifted because I was looking at things and thinking about things differently." She also saw a shift in her relationship with her mum and dad, explaining: "our relationship changed to more of an adult relationship, as opposed to them being the parents and me being the child."

Six months into Andrea's therapy, Karole says her symptoms had reduced to "minimal depression, minimal anxiety and no functional impairment in the day-to-day."


A change of direction 

However, just as Karole and Andrea were about to bring their sessions to a close, Andrea's mother was diagnosed with a relapse of breast cancer, this time terminal. For Andrea, this was a real "game changer, and my mood dipped a lot," she says, "but I know for a fact that had I not been to see Karole in the year leading up to this, I wouldn't have been able to deal with it – I would have just fallen to pieces."

As Andrea and her father became her mother's carers, her therapy sessions with Karole continued, on a less regular basis, as an outlet for her feelings throughout this difficult time.

"Mum and dad said that, since I'd been going to see Karole, I'd really grown up and matured emotionally, and I was able to handle a lot more – which was great, because it meant that me being at home was obviously of some help," she says.

Sadly Andrea's mother passed away after several months, and she continued her therapy sessions with Karole during her bereavement. "My dad and I are still supporting each other emotionally, but going to see Karole is my one hour of being able to talk about exactly what I want and how I feel, and it's a real release," she says.

"Also, because Karole has been through all the CBT with me, sometimes our conversation will naturally go back to [issues we've discussed previously], and we revisit everything that we talked about in the first year, so I just keep remembering everything that I've learnt."


Outcomes and the future

Andrea is unwaveringly positive about her experience of therapy. "I know this sounds like an over-exaggeration," she says, "but I really feel like it saved my life. Before, when I got depressed, the only thing that I could think of was to commit suicide." 

Karole too feels positive about the outcomes Andrea has gained from therapy. "The severe depression and suicidal thinking she previously experienced is largely absent now. She can experience depression and difficult life events without feeling hopelessly lonely and destabilised, and she has become much more self-valuing and assertive," Karole says.

As Andrea's therapy sessions finish in the New Year, both women feel optimistic about what's in store for her. Karole explains: "The main strategy for Andrea is to know she has been through the most difficult of times and come out the other side, and to recognise her own amazing strengths as well as her weaknesses. All the work I do with clients is designed to offer them effective and easily memorable ways to deal with a range of situations – a 'toolkit', if you will."

With her emotional toolkit at the ready, Andrea says: "I actually feel really confident. I know that when my sessions with Karole come to an end it will be because I know it's the right time, and I'll take so much away from it."

If you're also struggling with depression, her advice is not to put off seeking help. "To anyone in a similar position to where I was, I'd say that therapy is an absolute life-changer and they have to do it," she says. "I've got so much more confidence now, just as a result of trusting myself to think through a situation."

*The client's name has been changed and her consent was provided prior to both interview and publication

Finding support

You can find out more about Bereavement and Depression, including how to find a therapist. If this route is not appropriate for you, your GP can assess you and direct you towards support.

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Updated 28 November 2014