Recalling Recent Experiences in Session

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I do many things at the beginning of therapy sessions, one of which is to ask patients about their experiences since I last saw them. Depressed patients routinely report only negative incidents. I then ask them what positive things happened, or what was going on during the better parts of their week. One reason I do this is to collect data that may be contrary to their globally negative thinking. (“No one likes me.” “It isn’t worth doing anything.” “Everything is terrible.”)


Another reason I do this is to allow the session to be a little more conversational, a little lighter in tone. I also find that having patients recall positive experience lightens their mood and makes it easier for them to take a more realistic (less negative) view of their problems. A recent study confirms the importance of doing so. When people are depressed, their thinking is more rigid and ruminative when stimuli are negative, which translates into greater difficulty in solving problems.  

-Judith S. Beck, Ph.D.

6 replies
  1. Amanda Burlock
    Amanda Burlock says:

    Dear Judith,

    I too routinely use this strategy with patients (as recently as yesterday afternoon) and have found similar results. I also like to incorporate a strategy from the positive psychology literature that aims to retrain optimism (eg. Martin Seligman and colleagues).

    The strategy involves regularly pausing to reflect upon “three things that went well” and trying to trace the “causes” of those three things. There is no pressure or influence to identify either internal or external causes.

    Often patients will identify some personal action, personal contribution or personal “cause” for these positive events. This seems to increase sense of personal agency etc. Even when patients identify external “causes”, this seems to promote more optimistic and less negative thinking.

    I find this strategy complements behavioural activation nicely, particularly where people are being asked to increase pleasant events as part of a daily activity schedule.

    Hope you (and others) might find this useful too!

    Amanda

    Reply
  2. CT Today
    CT Today says:

    Judith S. Beck says: 

    Amanda,
    I’m going to try having my patients reflect on the causes of their positive experiences–I don’t routinely do this. Thanks for the suggestion.

    Reply
  3. susan
    susan says:

    i wholeheartedly agree. Asking a client to focus on a time when they did well this week reframes the experiences of the week and is empowering and motivating for the client as well . i adopted it from solution focussed therapy. its like a needle in a haystack sometimes but once the conversation starts, it can have a domino effect too for the client. sometimes they remember other positive activities they completed also.

    Reply
  4. Doanl
    Doanl says:

    Dear Judith
    Found that very useful for the purpose of lightening the session. As I see depressed clients as part of my work in the National Health Service, I try to personalise their contact a little by indicating, in a praising way, that I have remembered them since the last session, so might say something like ”when I was writing up your notes last week it just occured to me how brave you were to decide to walk into town on your own the other day” but of course trying to get the tone and moment correct as it could otherwise sound patronising.
    Donald

    Reply
  5. Deborah
    Deborah says:

    Hello. I’m new to CBT. I wanted to know if anyone would have any advice on how I can incorporate CBT for issues that I have pertaining to my adoption.. These are issues that may never have the opportunity to get resolved due to the nature of the discrection of adoption. I was adopted when I was about 4 or 5 years old. I’ve carried so much pain stemming from issues surrounding my identity (or lack thereof). I just want to be able to know who i’m supposed to be, accept it and figure out how to move on. I feel so lost and isolated.

    Thanks in advance
    Deborah

    Reply
  6. CT Today
    CT Today says:

    Hi Deborah,

    We’re very sorry to hear about the difficulties you’ve been having concerning your adoption. We DO think CBT can help. Cognitive Therapy certainly helps individuals to deal with things like emotional pain and isolation, and with ‘core beliefs’ that they have about themselves, others, and the world. CT also helps people to begin working on their problems in the present, for immediate change. 

    If you are interested in seeing a therapist, we would recommend looking for a Certified Cognitive Therapist in your area at http://www.academyofct.org. (Click on Find a Certified Cognitive Therapist in the left menu, then put in your zip code).

    And if you’d prefer to start with self-help resources, you may also want to look at these recommended books for consumers.

    Best of luck to you.

    Reply

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