I spoke with Adanna and her parents, both together and separately, over an extended 90-minute assessment session. Adanna had a history of low mood, but she had not received any treatment for this previously. She did well at school and enjoyed playing sport. Adanna’s parents wondered whether her current low mood had started following a broken leg she sustained the previous term, which prevented her from playing sports. Adanna agreed with this idea, but she added that he also felt very worried about the future. She was anxious about finishing school and she had no idea what she wanted to do in terms of a career. I learnt also that Adanna's solder sister, with whom she was very close, had died the previous Christmas. Adanna herself sometimes felt that life was not worth living any longer and she told me that she sometimes drank alcohol to forget about these thoughts.
At the end of the assessment I drew a diagram detailing the last year or so of Adanna's life. The death of her sister had come as a shock and she found herself trying to deal with a lot of difficult questions, such as what the purpose of one’s life should be. Not too long after the family suffered this loss, Adanna had broken her leg. She spent several months recovering, during which time she was not playing sport or seeing her friends. Adanna became increasingly withdrawn and isolated. The diagram showed how Adanna had now become stuck in a vicious circle of negative thoughts, which made her feel low, despondent and unmotivated, leading to a change in her typical behaviours: Adanna no longer went outside, she stopped focusing on school work, she distanced herself from her friends and she started drinking alcohol. These new way of acting did not help Adanna to think more positively about anything, and so the vicious circle continued.
Adanna said that she felt understood, and that the diagram helped her make sense of the ‘mess in her head’. Adanna’s parents found the assessment helpful because they had been able to have a frank discussion with their daughter, and learn about her perspective instead of feeling powerless to help her. We agreed to start a course of Cognitive Behaviour Therapy (CBT) for depression to reverse this vicious circle. I saw Adanna for a total of 12 sessions, initially on a weekly basis, but then fortnightly as she felt she was making such good progress.
Some of the elements of the therapy included:
- Helping Adanna learn to identify her thoughts and feelings, so she could gain control over them rather than feeling like her head was ‘a mess’
- Spending time discussing Adanna's sister's death to help her move forward (Adanna found it easier to talk about this to me because she was not worried about upsetting me, unlike other members of his family)
- Activity scheduling to encourage Adanna to change some of the new behaviours she had developed (i.e. going out more, getting back into sport, scheduling periods of time into her week for academic work so it felt manageable)
- Working with Adanna to develop strategies that worked for her to think in a more balanced way
- Teaching Adanna ways of tolerating distress and ‘getting through’ difficult days, without having to resort to doing something that made things worse (i.e. drinking alcohol)
- Talking with Adanna about her future and helping her putting less pressure on herself
All our appointments were conducted with just Adanna and myself. However, at the end of many of the sessions, Adanna and I would decide to invite her parents in for the last 10 minutes. Adanna’s parents were very pleased to be involved as it meant they could do something to help her. The whole family reported they felt closer to one another and were able, finally, to regain a shared sense of humour.
By the end of the therapy, Adanna had returned to playing sports. She found it much easier to strike a balance between study and other aspects of her social life, and less worried about her future. Adanna told me she felt ‘like myself’ again. She enjoyed life again and she did no longer drink to 'block out her thoughts'. Although Adanna admitted there were times (e.g. when something went wrong at school) when she noticed negative thoughts arising, she now felt able to stop any ensuing vicious circles in their tracks. She took away a summary of all the work we had covered together which she said she might refer to at these times.