Assessment session: Anne

Therapist: As you know, this is an assessment for cognitive behaviour therapy or CBT for short …
[as before – see Andy’s assessment]. So, what would be helpful is if you could start by letting me
know what has been happening for you recently.
Anne: Oh, … [sighs], I just feel so tired and like I can’t be bothered with anything. I don’t want to be
bothered with seeing people or doing anything. All I feel like doing is crying … and that’s not me
[tear- fully], that’s just not me.
Therapist: How long have you been feeling like this?
Anne: You know, I’m really not that sure … it seems to have gradually got worse over time. Really,
the last couple of years, I’ve just not been myself but it’s hard to see what’s caused it. I’ve not got
many things to be depressed about really – I think about other people and how much they have to
deal with and then I look at me and think, what have I got to feel down about? I really should be
coping better than this.
Therapist: It sounds as though it’s difficult to identify why you’re feeling like this.
Anne: Mmm, … yeah.
Therapist: Sometimes, that can make people feel worse because it just feels as though the low mood
has come out of nowhere and they then feel they have no control over how they’re feeling. Have you
had any difficult or unusual events happen over the last year?
Anne: The menopause is pretty difficult … I just feel so hot and irritable a lot of the time … and it
reminds me I’m getting old … The children leaving home also makes me feel old and I miss them …
especially Jess, who’s moved to Australia, because she used to pop round quite a lot and although we
talk on the phone, it just doesn’t feel the same … there is something else but I feel really ashamed
about it … I may as well tell you. I had an affair with someone I work with … it’s not still going on
but it was for a year and I just feel really guilty.
Therapist: So, you’ve been feeling low about that … What prompted the affair do you think?
Anne: Me and Jack were going through a rough patch and he just wasn’t listening to me and the guy
at work did, but I know it wasn’t the right thing to do. Jack and I are getting on much better now but
I’ve just got this guilty feeling hanging on and I just don’t feel I can talk to anyone about it – you’re
the first person I’ve told …
Therapist: It sounds as though that has been quite an important event for you and left you with a lot of
guilty feelings. It must have been so difficult to cope with this on your own.
Anne: It has been … actually, it feels like a real relief to tell someone … I’ve been so ashamed of
myself.
Therapist: So, it may be something we come back to and spend some time talking about during
sessions … Do you think that would be helpful?
Anne: Yes, I think that would be really helpful, definitely.
Therapist: Okay, I’ll make a note of that. So, I just want to change tack a bit now and ask you a few
specifics regarding your sleep, appetite, mood and so on … How are you sleeping at the moment?
Anne: My sleep’s not good at all … It takes me ages to get off to sleep and then, when I do, I sleep
for a while but often wake up and toss and turn, thinking over things … I do get off to sleep again but
often wake up several times and I never sleep past 6 o’clock.
Therapist: So, what are you thinking about when you’re tossing and turning?
Anne: Oh, … all sorts of things. Often, I’m thinking about what a waste of time I am and that I’ve
never got anything to say when I see friends … and I feel like they’re all ignoring me, anyway. I just
don’t know why I’m feeling like this and that worries me so much … Things just go round and round
in my head.
Therapist: Makes it so much harder when it’s dark as well for most people …
Anne: Yes, it’s like that for me … I do feel better in the day and that’s when I can sleep, so my sleep
pattern is all messed up – I suppose you’re going to tell me off like my doctor.
Therapist: No, I don’t like to tell people off, but it does sound as though it would be good to work on
getting your sleep pattern sorted out a bit, as that will help.
Anne: Well, that would be really great.
Therapist: How about your appetite?
Anne: I just don’t feel hungry. I’ve lost loads of weight and that’s not like me …
Therapist: How much are you eating in a day?
Anne: Not breakfast but I try and have a bit of lunch and tea. It’s really hard to get the food in but I
am trying.
Therapist: Well, that’s good as it is important to get as much nourishment as possible. That’s one thing
that can really affect mood. Speaking of mood, how are you feeling in yourself? How would you
describe your mood?
Anne: Depressed … really low, nearly all the time.
Therapist: Is there anything that helps lift your mood?
Anne: Not a lot, talking to the children and … um, I don’t know. Sometimes, if I do get myself out of
the house … I just feel really low most of the time.
Therapist: How low do you get? Do you ever feel like harming yourself?
Anne: Yes, I’m ashamed to say I think about ending it all most days.
Therapist: And how far does that get? Do you ever have any plans about how you might end things?

Anne: Well, I’ve thought about taking a load of pills but I do know it’s not a very effective way of
doing it … and I just couldn’t do it to the children … It’s more the case that I’d like to die but I don’t
think I could ever do anything to actually finish it.
Therapist: Those are very difficult feelings to struggle with on a daily basis, though. How are you
managing to get through each day? What are you doing on a day-to-day basis?
Anne: Hardly anything … I’m so embarrassed but I just can’t get up the motivation to do anything …
I get up … watch a bit of TV, force myself to eat lunch, watch more TV … basically, I’m just a
useless lump … I’m so tired and I just can’t be bothered to bother about anything …
Therapist: What you’re describing is really common for people with depression … When people get
depressed, they just don’t feel like doing anything, so they tend not to do very much but then they tell
themselves off and feel guilty, which makes them feel even more depressed … It’s a vicious cycle,
really … We can talk more about how to break the cycle later.
Anne: Well, I’m glad it’s not just me and that there’s a way to sort it out …
Therapist: I just want to go back to some of the things you mentioned just now. You were saying you
feel useless … do you have many thoughts like that?
Anne: Oh, yes, … I’m thinking that all the time. I just feel like I’m a waste of space and useless.
Therapist: Do any particular situations set off those kinds of thoughts?
Anne: Hmm, … I think it every day … I think partly the fact that I’m not doing anything and feel so
tired and slow add to it. Also, when I see my friends, I feel like a waste of space … I haven’t got
anything to talk about … I just don’t know what to say to them any more so I’ve started avoiding
them because I can’t cope with seeing them.
Therapist: So, it sounds as though that’s another kind of cycle … Did you used to find it easy to talk
to your friends?
Anne: Oh, yes, … I mean it takes me a while to get to know someone new but with good friends I’ve
always been able to chat, so it feels like a shock to feel like this … I feel as though I’ve lost all my
confidence.
Therapist: So, in the past, you’ve had more confidence and been able to chat easily with people you
know … Actually, it would be really helpful just to get a bit of a view of how things have been for
you in the past and to hear a bit about your history so that I can put things in context … Perhaps we
could start right at the beginning … Were you born round here?

Anne: Yes, although I went to live in London for a while when I went to university, but I like it here
so I came back and then stayed.
Therapist: And what were things like while you were growing up … Did you live with a mum and
dad?
Anne: Yes, although Dad was away a lot with the Navy. I got on well with him, though, when he was
around … better than with Mum. She just wasn’t affectionate at all. I do wonder now whether she
was depressed. I never had any brothers or sisters and I can remember feeling lonely. Nan and Gramps
were great, though, they were my Dad’s parents, really warm and lovely. I can remember being
devastated when they died – I was about 14 at the time. They both died within a few weeks of each
other. It was really so sad …
Therapist: It sounds as though they were really important to you … It must have been tough when
they died, especially if they had such a special bond with you … How about school, what was that
like?
Anne: It was fine, I suppose … Actually, that’s not really true. I didn’t find the work that bad, but I
didn’t really make friends at school. I sort of managed to be in a group but I was always on the outside
a bit and Mum never allowed me to bring friends home … It was hard … things got better when I
got to university …