The Hypothetical Client


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I do not post information about my actual clients on this blog because therapy is a strictly confidential. This is as it should be.

And yet I also think it's helpful for people who are thinking about trying to therapy to get a feel for how therapy works and what we talk about.

Enter the HYPOTHETICAL client.

He could be young, old, male or female. He could be white, black, latino. He could be you, me, or your neighbor.

Our Hypothetical Client is depressed. Over the course of my practice, I've seen hundreds of depressed persons. Though I do not subscribe to the notion of putting people in categories (every client's depression is, in some ways, unique), depression tends to have universal symptoms. Our hypothetical client is struggling with depressed mood, low energy, loss of hope, and sleep problems. His concentration is not what it was and, perhaps more than anything, he just can't get going -- the depression is weighing him down. Maybe he spends too much time inert, sitting in a chair or on a couch, or maybe he forces himself to go work, but it's exhausting. Our hypothetical depressed person finds himself thinking that maybe he should just end it all...

If I were to work with our Hypothetical Client, here are three things I'd want to know:

1. What are the sources of his depression? Not the causes; causes are an entirely different matter, and they are complicated. But the sources. Most people who become depressed ruminate over certain aspects of their lives. Job, family, kids, failures, whatever. What I'd want to know is where does the rumination take him? First we follow the problems.

2. How can we make the problems solvable? Frequently when people become depressed, they become overwhelmed. Problems become mountains to climb and oceans to swim. In a depressed state, problems often seem impossible. As first step, however, we need to break the problems into solvable parts to make them more manageable. Therapy isn't just about talking out your feelings, it's about finding new actions to take.

3. Can we take a close look at his thinking patterns? Depression is a sad emotional state, true, but it is also a kind of thinking disorder. In the throes of depression, thinking gets muddled and distorted. Has our Hypothetical Client fallen into the trap of black or white thinking? (e.g., either I'm a success or a failure. Either I can do it right, or I can't do it at all. Hint: where is grey?) Or has he become a master of extracting negative information from all situations, while ignoring or dismissing the positive? We're not always aware of our own thinking patterns. We just think the way we think, and it feels natural to us. This is where I come in. I've spent countless hours helping people identify ways their own thinking is making problems worse.

This isn't the full story of what treatment for our Hypothetical Depressed Person would look like. Therapy is a complex business that is tailored to a specific individual (or couple). But maybe this gives you a taste of how a therapy for a depressed person might start.

For more information, check out these related posts: The Downward Spiral of Depression. And Tip for Coping with Depression.