Attending to Bills
In the second session, the therapist began by collaborating with Denise to set an agenda. Denise wanted to discuss the fact that she had not been attending to her bills or to her house- work and was still spending a good part of the day alone in front of the TV; the therapist uti- lized this as an opportunity to discuss the issue of activity versus inactivity on the agenda. They then reviewed the previous homework. Denise had carried out all the scheduled activi- ties and had also listed some of her negative thoughts in between sessions. Her BDI score had dropped somewhat. (Patients routinely fill out the BDI before each session, so that both the patient and the therapist can monitor the progress of treatment.)
Denise then shared her list of negative thoughts with the therapist. One concern was that she had expressed angry feelings about her husband during the first session.
DENISE: I don’t like revealing things about my- self, but you told me to write down my thoughts. So here it is. When I went to bed the night after of our first session, I thought about what I said to you, you know, about being angry at my husband. I was thinking that you probably think I am this really harsh and cold person. I mean, here my hus- band died this horrible death and I have this hard, insensitive reaction. I started thinking that now you probably feel really negatively toward me because of that statement and that you don’t want to work with me.
THERAPIST: I’m really glad you’re telling me these thoughts. Let me start by asking you who is having these negative thoughts?
DENISE: You? Well, no. Actually, it’s me.
THERAPIST: Right. Do you think that someone
like me might have another reaction to what you said?
DENISE: I don’t know. I mean it is pretty harsh being angry at someone who had no control over what was happening.
The therapist then offered Denise an alterna- tive perspective:
THERAPIST: Do you think that someone might react to your statements with empathy?
DENISE: How could they?
THERAPIST: I imagine it would be very upsetting and annoying to have lost both your hus- band and your friends—all around the same time. Even though you love and care about all of them, feeling angry is understandable. It sounds like a basic human reaction to some very difficult life events.
DENISE: Yeah, I guess that does make sense. Thanks.