This post goes well with a previous post I wrote, Creating SMART Goals in psychotherapy: http://toddfinnerty.com/wp/2020/04/15/creating-smart-goals-in-psychotherapy/
When first starting out in cognitive behavioral therapy, your therapist doesn’t know your or what is going on very well. It can be difficult for you and your therapist to determine which symptoms to target first. For some guidance on this I’d like to bring up a classic book, Cognitive Therapy of Depression by Beck, Rush, Shaw and Emery. If you have the 1979 version you can check out page 96 and 97 for a more detailed discussion. Yes, this is a dated reference but I like to re-visit some of the classic work that our modern CBT-D is built upon.
When it comes to depression, the target symptoms “may be defined as any of the components of the depressive disorder that involves suffering or functional disability.” Two factors to consider are which symptoms are the most distressing to the patient and which are most amenable to therapeutic intervention. When the patient’s depression is less severe, Beck, et. al. note that the therapeutic focus is “often on external problems that are related to the precipitating or aggravation of the depression. These problems may include stresses or difficulties at home, school or work. The frequently have a component of loss, such as a disruption of a close personal relationship, failure to achieve a desired goal, or the deprivation of some pleasurable activity.”
Beck, et. al. note that target symptoms for depression can be broken down into categories:
- Affective Symptoms: sadness, loss of gratification, apathy, loss of feelings and affection toward others, loss of mirth response, anxiety
- Motivational: wish to escape from life (usually via suicide); wish to avoid problems or even usual everyday activities
- Cognitive: difficulty in concentrating, problems in attention span, difficulties in memory; cognitive distortions
- Behavioral: often a reflection of the other previously mentioned symptoms; includes passivity, withdrawal from other people, agitation
- Physiological or vegetative: includes sleep disturbance; appetite disturbance
Thanks,
