Case Study Clinical Example CBT Transcript
Speaker 1: Hi Lucy, nice to meet you.
Speaker 1: I understand that you were referred here by your GP because you’ve been feeling quite down
Lucy: Yeah, I thought I should. I’ve been feeling quite bad for quite a while, so I thought maybe it’s time
to see someone about it because I don’t want to feel like this anymore.
Speaker 1: Okay. From your notes, I saw that you saw the GP about three months ago, so how long have
you been feeling down altogether?
Lucy: Quite a few months before that as well actually. But it has gotten pretty bad these past few
months, so that’s kind of why I came.
Speaker 1: Okay. Has it got worse since you saw your GP?
Speaker 1: Okay. Tell me how are things at the moment?
Lucy: Well, I kind of started just feeling a bit low and wound up about things. But I don’t know, just
recently I just can’t really be bothered to do anything. I kind of find it hard to get motivated for things
and I want to be, I really want to be better, but it’s just kind of reaching the end now where I just, I want
to do something about it.
Speaker 1: Okay. You said that you’re feeling really down, really sad and you feel like you haven’t got any
motivation. Are you okay?
Lucy: Yeah, I’m fine. Sorry.
Speaker 1: Okay. And you haven’t got any motivation, but it sounds like you’re putting quite a lot of
pressure on yourself to try and feel a bit better.
Lucy: Yeah, I just, it’s kind of hard as well because there’s not really anyone to talk about, so I just kind of
stay on my own trying to, I don’t like to think about it.
Speaker 1: You say you’ve been, you’re feeling quite isolated. There’s not many people around.
Lucy: Yeah. There’s no one I can talk to about it. No one would listen or understand anyway.
Speaker 1: Okay. I’m just going to try and find out a little bit more about you. I understand that you’re an
English student at Uni and you live away from home with some friends. Is that right?
Lucy: Yeah I live here.
Speaker 1: Okay. You don’t live far from the Uni. But you say you feel like you live with your friends, but
you don’t feel like you can talk to them?
Lucy: Yeah, they’re lovely. I get along really well with them, but I don’t know, I recently, whenever they
want to go out or stuff, I just, I don’t want to bring them down. I can’t, they don’t understand what I’m
going through, they kind of, I don’t know, they don’t make fun of how I feel, but they don’t really
understand what it’s like. I just I don’t want to go out with them, bring them down or stuff.
Speaker 1: Okay. It sounds, do you try and hide the way you’re feeling from them?
Lucy: I guess. It’s easier to hide it than to try to explain it all the time when no one really wants to know.
Speaker 1: Okay. It sounds like you’ve been feeling down, you’ve been feeling unmotivated, you feel like
you want to be better, but actually it sounds like you feel like you can’t reach out for help. You can’t
speak to anybody.
Lucy: No, I don’t really talk to my parents a lot either so that’s kind of hard.
Speaker 1: Okay. I’m just going to go back in time a little bit. 1 suppose I’m just wondering when did all of
this start? You said it’s been going on for quite a few months.
Lucy: Yeah, I guess it kind of started when I was actually when I was revising for my exams. I guess the
stress, I put a lot of stress on myself. I think I’ve always wanted to do well for me and I guess for my
parents so the stress of exams and it was kind of hard because my parents were going through bit of a
troubled time then.
Speaker 1: Okay. This would be last March? Last April?
Lucy: Yeah, I think so.
Speaker 1: Around that time. About six months-ish. And it sounds like a lot was happening. You had a lot
of Uni pressure on and you said that your parents were having marital problems.
Speaker 1: Okay. And it sounds like that was a real shock to you.
Lucy: Yeah, I guess it was hard as well because I wasn’t doing well at uni. I guess I just felt a bit guilty. I
know it sounds silly, but I felt like maybe if I could do better than they would get better, but it just
wasn’t really happening.
Speaker 1: Okay. It sounds like you were trying to work hard and be more successful because you
thought that that would make them happier and try and fix things.
Lucy: Yeah, I wanted to make them feel better, but it just kind of backfired a little, I guess.
Speaker 1: How did it backfire?
Lucy: It just ended up with them getting worse and I’ve just been feeling worse since then.
Speaker 1: Okay. After the summer, after the exam period, and how did the exam period go for you in
Lucy: Not very well.
Speaker 1: Okay. That’s an awful lot of pressure to put on yourself.
Lucy: It’s just annoying because I know I should have done better and I just didn’t and I guess I beat
myself up a lot about it.
Speaker 1: You say, I know, I know I should have done better. I suppose hearing it from my perspective,
I’m thinking it sounds like you had an awful lot going on at the time. It’d be understandable, absolutely
that you wouldn’t do as well as normal. I suppose I’m just wondering if you have very high standards for
Lucy: Probably. Maybe more than other people. My parents have always kind of taught me, in a loving
way I guess, but that you should do your best but also get the best. And I agree with that. I think 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
Speaker 1: It sounds like you feel you should always do your best. Those were the words you used, yeah.
And that there isn’t any kind of exceptions for that.
Speaker 1: Okay. I can see then that that was a really difficult time for you and that was when your
mood started to get lower and things are still quite bad now. What’s the situation with your parents at
Lucy: I think it doesn’t sound good. I don’t really talk to them a lot, but I don’t think they’re going
through a very good thing. I don’t like to talk to them about it because it just makes me feel worse, but I
don’t think it’s getting any better.
Speaker 1: Were you home over the summer?
Lucy: For a little bit, yeah.
Speaker 1: How was that?
Lucy: Not very fun. No, it was quite tense all the time. Stressed me out more than relaxed me over the
summer, I guess.
Speaker 1: Okay. Okay. It sounds then like 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 sounds like you feel
like you can’t really reach out to anyone. That you can’t understand that you can’t really reach out to
your parents right now. You can’t really confide in your friends. I suppose I’m just wondering if you can
tell me a bit more about how you’ve been feeling, say this past week.
Lucy: Really not good to be honest. I actually, if I don’t have to, then I don’t really leave the house or get
out of bed. I just, I can’t find the motivation for the things I used to join in. I used to love doing sports or
going out and now I just prefer to lie in bed and not really do anything. I missed a few lectures this week
I should have gone to.
Speaker 1: Right. I suppose I’m just wondering then it’s, see if we can think about one thing, say a
lecture. What kind of thoughts do you have about going to a lecture before it happens?
Lucy: I don’t really 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, I can’t be bothered anymore to try. It just stresses me out
more than it needs too.
Speaker 1: Okay. It sounds like the kind of thoughts you’ve got on your heads are, it’s pointless, it’s not
worth it. Do you have any other thoughts in your head when you’re just at that point before you go to
Lucy: I don’t know, I don’t really even deserve to be here if I can’t do well enough. I see all these other
students, they’re doing well and doing better and wanting to be there. I don’t know why I’m here even
at Uni to be honest.
Speaker 1: It sounds like you feel like you’re not as good as other people here.
Speaker 1: Okay. I’m just, sorry, is it okay if I take notes as we go through? It’s just, I’m trying to, I guess
understand what you’re telling me and it helps me just to write it down and I’ll share this with you later.
It sounds like those are some quite negative thoughts to have. You’re kind of saying, it feels like it’s
pointless, it’s more effort than it’s worth and I don’t deserve to be here. When you have those thoughts,
how do you feel?
Lucy: Very unworthy probably would be the best way to put it. kind of, I don’t know, just lower than
normal because then it makes me think about all the things I should have been doing better.
Speaker 1: Okay. What you described there that you said, I’m unworthy, I should be doing lots of things
better. Those are kind of what I would call thoughts actually I suppose I’m trying to understand what it
feels like in your gut. What kind of emotions. Do you feel happier? Do you feel sad? Do you, what kind of
emotions are you feeling when you have those thoughts?
Lucy: Sad . Not happiness. No, sad. A bit of kind of anger and frustration as well.
Speaker 1: Okay. I think when you’re kind of telling me this, and I know this is quite a heavy topic, but
you’re kind of laughing and I suppose I wonder a little bit, are you a little bit, how do you feel about
having these emotions? Talking about these emotions?
Lucy: I guess embarrassed. I’ve never had to talk about it so it’s quite uncomfortable to be in this
Speaker 1: Okay. Well you’re doing a great job because I know that this can be difficult. Okay. It sounds
like some of the thoughts you’re describing are, it’s pointless, it’s more than it’s worth. I don’t deserve to
be here, I’m unworthy. And those kind of thoughts, it sounds like they just flip through your mind and
then you’re kind of describing different emotions that those lead to. You’re kind of describing sad,
anger, frustration, embarrassed. What about in your body? What happens? How do you feel kind of
Lucy: I used to be, I think from those emotions very wound up, very kind of stressed all the time. But
recently it’s just been a lot more draining than anything. Just quite lethargic and just can’t be bothered
anymore and it’s my body reflects that. But then when I try and sleep I just can’t seem to have a satisfied
night’s sleep. It’s really, really frustrating.
Speaker 1: It sounds like this is affecting you, it’s draining you of your energy, like your body can’t be
bothered. I think that a really good way of describing it. And you’re noticing sleep problems as well. And
then what do you do? This is say we’re back to the point before the lecture, so you start having these
thoughts, these emotions, and your body I guess it sounds like those thoughts are quite draining. They’ll
be draining your energy. What then happens? What do you do next?
Lucy: I kind of focus on the negative thoughts when I probably should not think about them, but I focus
on them and then I don’t really want to do anything. Kind of stay in bed.
Speaker 1: You think even more about those kind of worries that you have.
Lucy: Yeah, dwell on them.
Speaker 1: You do a bit of dwelling and you stay in bed. And it sounds like you don’t, you haven’t tried
speaking to your friends about it.
Speaker 1: Or speaking to family. Okay. And then after you’ve done that, so after you’ve not gone to the
lecture, you’ve stayed in bed, you kind of spent time, as you said, focusing on those thoughts, those
negative thoughts. How do you feel after that? Do you feel better or do you feel worse?
Lucy: I guess I feel slightly worse, but then a bit numb in a way. Kind of once you felt that, because I do
feel tired all the time. I just try and push it out and then you don’t really think about anything, and it’s
almost nicer that way than to keep focusing on how much you’re getting wrong and how much you can’t
do stuff. Sometimes it’s better just to not think about it at all.
Speaker 1: It sounds like in some ways it’s a bit of a relief to do that, but in other ways maybe you think
it might make things worse.
Lucy: Probably in the long run, yeah.
In your initial post, choose two of your evaluation notes from Part B of the Critique Form to share.
Part B: Evaluation
- Session Notes (Any behavioral observations?)
- Communication skills (What skills were predominantly used in this session? Were these appropriate
to the timing and issues being discussed?)
- Reaction to session (Your thoughts and feelings about what happened in the session, what was
helpful [or not helpful] in the session, and why.)
- What the therapist could have done differently and why (What are some different counseling skills,
responses, and interventions that you might have used instead and why?)
- Progression (Did the session progress as you anticipated it would, if not why not?)
- Application (Did the video utilize any principles applicable to a specific type psychotherapy, if so what
principles where applied and how were these principles applied within the session?)
- Applicability (How might this psychotherapy approach relate to your future work as a PMHNP? In
other words, how [cite examples] will you might able to use and apply the knowledge, skills, and
dispositions of this psychotherapy session to your own practice?)
- Evaluation (Summarize your experience of the therapy session observed. What was your greatest
learning from this video?)
Type Of Service: Academi paper writing
Type Of assignment: Case study
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Number of sources: 2
Academic Level: Master’s
Paper Format: APA
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Language style: US English