Case study clinical example CBT: First session with a client with symptoms of depression (CBT model)

Example of case study for use in teaching, with the objective of demonstrating some of the triggers, thoughts, feelings and responses related to the low problematic mood. This section here represents the first 14 minutes of an initial therapy session, but to try to delineate the vicious circle, it moves faster than an average session would. The video presents an actor playing Lucy's character, but the dialogue is not written and, as such, represents a natural therapeutic exchange. I myself am a qualified clinical psychologist, but I definitely do not suggest that this is a perfect example of therapy!

This video was produced as a collaboration between the University of Leeds and Leeds Trinity University (Ricardo Barker).

Video credits to Judith Johnson YouTube channel

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    Case study clinical example CBT: First session with a client with symptoms of depression (CBT model)

    Comments 39

    1. i think the Dr more depressed than the patient. ( very low speech tone)
      anyhow well done , really gread

    2. Isnt this breaking confidentiality and anonymity of the client? Or is it actors to just show the the demonstration of a session

    3. i am in depression since 4 years .. but i dont trust any doctors here.. i always think if i will visit a doc. he/she will not understand me. and i am sure.. i will start crying..and oops they are acting.. i wish to see real

    4. Surely…….one of the questions, in fact maybe even the first one would have been :  " Have you had any suicidal thoughts and when was the last time you had suicidal thoughts. "  It's imperative to know that because, if that is the case, then the patient possibly needs help of a different type immediately  !!!

    5. I think I have depression and I wish I can go to therapy but I'm young and I have bipolar mom and shes really strict

    6. Excellent video! Very natural flow of conversation, solid trust being established. I could relate to the many symptons of depression when i was back in high school! There was a time where you asked "Are you OK?" Would you think of changing that? To me the visitor was held back from some raw emotional release. I feel it would be even better if she stopped the coping smiles and just let her true emotions be shown. what are your thoughts?

    7. Is this what CBT is? A therapist paraphrasing what your thoughts and fears are?
      Doesn't seem useful to me, in the slightest. I need tools to combat my depression… not have it explained to me.

    8. Is this what CBT is? A therapist paraphrasing you what your thoughts and fears are?
      Doesn't seem useful to me, in the slightest. I need tools to combat my depression… not have it explained to me.

    9. Thank you for this video. The symptoms of depression and the way "Lucy" displayed them, verbal and non-verbal, rang true. I really enjoyed the dialogue and the establishment of rapport/trust. Thank you so much, Judith! Look forward to seeing more from you.

    10. It is interesting to read the comments people, some of who sound like therapists, are crticising the process in which the therapist in the video is interacting with the client. If any therapaist is to publicly display a session they have with a client, they too would get such comments on the process. Unfortunately, a lot of therapists believe their delivery and approach is god-send.

      If you are therapist criticisn her skill and style, I would suggest make a consented recording and recieve critique, it helps so much. Also, put a video on youtube and you will also get inflammatory comments for how you practice.

    11. At what point does this dialogue become CBT? Or effective? As a therapist myself, this is exactly EXACTLY the reason why clients come to me from other counselors, or lose faith in the therapy process altogether. This is nothing more than Humanistic paraphrasing and swimming very inefficiently around the current symptoms instead of asking (and challenging) the root causes of so many things. "Where did this client learn that her performance was synonymous to marital discord or lack thereof?" "At what point did she feel that she had any control over her parents' issues?" The girl is feeling reactionary depression to her parents' break up, clear enough. But why? The answer lies wayyyyy back in her childhood, which is where the ABC of CBT becomes critical. Just sayin'

    12. I’m due for my first CBT session next week. This video was supper helpful before I experience my first session.
      Thankyou for sharing.

    13. This is a great example of a rapport-building first session. I’m an LMSW in my 19th year of practice. There are reasons for everything she is doing. Instead of criticizing, ask- If you truly want to understand why the approach is like this. There are reasons. It saddens me that there are so many critical comments of the therapist and ignorant comments about the client. It also saddens me that so many people don’t get to see a high quality therapist like this. Therapy can be so beneficial for so many.
      I specialize in treating self-injury. My website:

    14. My psychology class watched this video to show how NOT to conduct a therapeutic exchange, this psychologist is terrible. When lucy looks as if she is about to cry, the psychologist asks "are you ok?" which makes her stop the emotional relief she is experiencing which causes her to be unable to share her real emotions throughout the rest of the session. Horrible psychologist!

    15. Thanks for the video Judith…currently undertaking my level 4 counselling. This has been a great help to see what appears to be a mix of person centred and CBT?

    16. research also tells us that the dodo bird verdict holds true and that the main components of useful therapy are largely non specific factors. This means things like the alliance between therapist and client, belief the client has in the process and in you, and getting the person to do something for themselves between sessions – the research seems to tell us that the specific models like CBT accounts for around 15% of any change. It is also worth noting that CBT's basic philosophy is based on the idea that people are not bothered by things but rather how they think of them – this means the problems of the world are largely ignored or relegated to 'triggers' rather than causes of distress therefore making the person responsible for changing their own thoughts and behavior to get on with it. Super handy for the power structure to obfuscate the real world in a time of Neoliberalism mass austerity, huge inequality,rise of precariat, zero hours contracts, meaningless harmful jobs, debts, fear, lowering of empathy, looming wars and so on. It also relies on 'disorder specific models' for formulation and these so called disorders are in many ways a harmful nonsense because they again lend themselves to personal pathology. we all need to zoom out of our tiny lives, search for outsight not insight and place the world and ourselves in dynamic interaction perhaps then we might see more clearly the giant penis thrusting itself upon us rather than simply keep wiping its mess from our faces

    17. Seeing a therapist is a little expensive for me at the moment, is there an online course you would recommend?

    18. i've never related to anything as much as this video. i relate to everything that this girl is saying so much. this video really made me realize that i NEED to go get help.

    19. Ultimately CBT works better with full understanding of ambivalence that allows one to see what is on the table, as in S. Grau, MD "Ambivalence Based Psychotherapy".

    20. This actress is phenomenal. I wonder if depression is something she has real life experience with.

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