When we access depressed clients, two observations are common:
Given what’s happened to them, I’m not surprised they are depressed.
They have adopted a lifestyle that seems to be perpetuating the problem.
By the time they get referred for therapy, many depressed clients:
Eat little, or eat only junk food.
Get no exercise.
Have little to no social contact.
Have an irregular or reversed sleep-wake cycle.
Engage mostly in passive activities like watching TV, playing video games, or aimlessly surfing the Internet.
Even if we were able to resolve the original triggers for the depressive episode, it would continue due to the lifestyle the client has adopted. Yet clients see their behavior as the result of the depression, not as a perpetuating cause.
Once your assessment is complete, one option is to sit back and invite your client to consider a rather odd—but thereby memorable and potentially impactful—question.
“Imagine that we were to kidnap the next ten people that walk by this building, and give them your life—your diet, your activity level, your sleep schedule, your job, your boss, your family. Twenty-four hours a day, we’ll have them do exactly what you do. At the end of a month, we’ll come back and check in with them. How do you think they’d be doing?”
In virtually every case, clients say that the abductees would be depressed. Sometimes you may need to say, “And we’ll have them think the way you think as well.” With that little addition, I have never had a client say that the people would be fine.
This, of course, opens the door for you to say, “So, you think you’re responding normally. I think so, too.” We can depathologize the client, and increase receptivity for treatment at the same time.
“So, maybe we don’t need to work directly on these feelings because there’s nothing really very wrong with them—though they are painful. Instead, perhaps we should work on some of these aspects of your current life. If we could shift these, even a little, we might discover that the mood shifts too.”
Randy J. Paterson, PhD, is director of Changeways Clinic, a private psychology practice in Vancouver, BC, Canada. He is author of How to Be Miserable, The Assertiveness Workbook, and Your Depression Map, and conducts training programs for professionals on evidence-based treatment. Through Changeways Clinic, Paterson presents internationally on topics including mental health policy, cognitive behavioral therapy (CBT), the nature and treatment of depression and anxiety disorders, and strategies for private practice management. He is the 2008 recipient of the Canadian Psychological Association’s Distinguished Practitioner Award.