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Sad is how I am! Treating Dysthymia in Children and Adults

Section 19
CBT Technique for Suicidal Thoughts in Depressed Clients

Question 19 | Test | Table of Contents

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The previous section discussed Uninvited Thoughts.

This section will provide you with a Cognitive Behavior Therapy technique regarding your client's uninvited thoughts.

♦ Role-Playing CBT Technique
I used the role-playing strategy with a patient of mine, a 38-year-old high school teacher named Eric. Eric had entered treatment following several months of depression that included loss of energy, significant weight gain, strong feelings of loneliness, and suicidal thoughts. He had recently separated from his girlfriend and was expressing feelings of hopelessness and worthlessness about both his overall life and himself. This exercise uses a role-play situation.

I began with, "Eric, it seems as if, at times, the way you think tends to affect your feelings. I would like to try a role-play exercise where I'll take the part of a friend of yours at the school where you work. Try your best to make a valid, realistic case against any irrational, illogical, or incorrect statements that you hear, OK?"

Eric replied, "OK, I'll give it a try."

Then, I began the role-play exercise by saying, "I know I seem really down lately. I wouldn't blame you for not wanting to see me anymore. Who wants a real jerk for a friend?"

Eric replied, "I don't think you're a jerk, but it does sound like something is bugging you. What's wrong?"

I replied, "Something bugging me! That's an understatement. Nothing in my life goes right! Just when I thought things were getting a little better in my life, I get a call from the principal saying two kids in my class are complaining that they can't understand my teaching. I'm unfair and unreasonable. He wants to come in and observe my class! Boy, when I can't even teach after 10 years, I might as well pack it in. I feel like going to bed and giving up."

Eric countered, "Why give up? You're a good teacher. It must be a pain in the neck to have to go through an evaluation, though."

I replied, "Pain in the neck? My teaching career is over! To have this problem after 10 years in the classroom, I must be a bad teacher."

He replied, "That's not true! A lot of teachers have problems with kids from time to time. I know I have."

Then I said, "But not like this. Don't you realize that if he's coming to evaluate me, he probably believes those two? That means I've failed and lost my professional respect."

Eric replied, "No, it doesn't! It's just that you have a pain-in-the-neck problem with a few kids."

In response to his comment, I said, "But if I was any good, I wouldn't!"

Eric then said, "Then you're saying that we're all no good, because all of us have problems from time to time."

I responded with, "But it's different with me; I never thought this would happen."

Eric replied, "That doesn't mean you can't get through the evaluation, and go on teaching, and do a good job just because this happened. We all have problems sometimes. You're no worse or different than any of us."

I said, "I don't know. When I have a problem with a kid accusing me of bad teaching, I take it personally. That's just the way I am. I can't change that."

Eric then said, "Yes, you can. You better change or you're going to be miserable. That's part of teaching. You can't be perfect."

I replied, "I feel like I should be perfect. You know how I am. I want to be really good."

Eric replied, "It's impossible to be perfect and never have any problems with the kids."

I asked, "Are you sure about that?

Eric answered, "Of course I'm sure. Be realistic for heaven's sake!"

In the above sequence, I presented a situation relevant to Eric's own life experience, but focused on a situation which he could objectively appraise. My aim was to strengthen the rational attitude that he already held concerning work-related difficulties.

"Displacement" CBT Technique
I like to use a displacement CBT technique. Here's how it works. Rather than suggesting that he argue with the "professional clinician," I assumed the role of a hypothetical friend or colleague. This strategy minimizes the likelihood that the patient may feel inhibited toward disagreeing with the therapist.

This section discussed the role-playing technique. In the next section, when I use a reversed advocate role-play situation concerning interpersonal relationships, which was an emotionally charged topic for him, Eric's ability to develop a counter-attitude to my distorted thinking had already been practiced, and thus became more easily facilitated regarding the significant problem of loneliness.

Peer-Reviewed Journal Article References:
Chesin, M. S., Brodsky, B. S., Beeler, B., Benjamin-Phillips, C. A., Taghavi, I., & Stanley, B. (2018). Perceptions of adjunctive mindfulness-based cognitive therapy to prevent suicidal behavior among high suicide-risk outpatient participants. Crisis: The Journal of Crisis Intervention and Suicide Prevention, 39(6), 451–460.

Labelle, R., Pouliot, L., & Janelle, A. (2015). A systematic review and meta-analysis of cognitive behavioural treatments for suicidal and self-harm behaviours in adolescents. Canadian Psychology/Psychologie canadienne, 56(4), 368–378.

Ramos, K., Erkanli, A., & Koenig, H. G. (2018). Effects of religious versus conventional cognitive–behavioral therapy (CBT) on suicidal thoughts in major depression and chronic medical illness. Psychology of Religion and Spirituality, 10(1), 79–87. 

Rather than suggesting that your client argue with you, as in your role of clinician, what role might you assume? To select and enter your answer go to

Section 20
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