Friday, July 14, 2017

Check out this therapy plan for tackling stress and depression at work


Thanks to geralt from pixabay
When you go for therapy, a treatment plan is essential for tracking progress and reaching your goals.

Tony Soprano and Adrian Monk visit their therapists for years, talking about themselves and exploring their motivations in order to gain personal understanding. The positive is that it can be very revealing but the downside is that it can take a long time (read: expensive). Also, with a goal as vague as “self understanding”, it can be difficult to track and evaluate progress.

While I can provide that kind of service, I prefer to help my clients develop effective strategies for managing themselves. To do that, I use treatment plans that list goals, therapy strategies and timelines.

Check out how that works by looking at this hypothetical case.  

In our initial free session, Alex has decided to look for therapy because of stress, 
“I get this uptight feeling at work all the time. Every time the boss talks to me, I have this inner voice that says I suck. It’s getting to me so much that I’m having trouble sleeping. Help!”
In our first session, we find the following:
·        History reveals no family history of depression. Current physical health is excellent with medical exam for insurance showing no issues.
·        Alex scores 12 on the PHQ-9 depression inventory, indicating moderate depression. Items scored were low interest, low mood, sleep issues, little energy, feeling bad about yourself.
·        Alex scores 1 on the SBQ-R Suicide Behaviors Questionnaire-Revised, indicating almost zero risk of suicide.
·        The life stress evaluation form (Ellen’s design) highlights the following problem areas: a recent promotion, upgrading of home leading to renovations lasting 6 weeks, minor money budget issues, and upcoming large family gathering. Good solid marriage, nice kids, no issues with in-laws.

After a discussion, Alex decides on these therapy goals:
1.      Help me get over my depression
2.      Get me sleeping again
3.      Stop me thinking that I suck

I then go away, consider everything Alex has told me. I come to these conclusions:

First off, lack of sleep magnifies depression, fuelling the particular symptoms of low interest, low mood, and little energy. If we fix the sleeping problems, some of the depression will lift. It is my priority.

Second, I suspect the depression and “I suck” thoughts stem from pressure of promotion that are magnified by the stressful events at home - the renovations and the big family events. These mean extra money pressures and with the whole family focused on, “What’s new and exciting?” Alex is feeling the pressure to excel. This is a problem because of the recent promotion.

I think that when Alex understands why he’s thinking, “I suck” and learns to stop thinking it, his depressive symptom “feeling bad about yourself” will lessen.  Because of his new promotion, it would also help to give him an overall more secure sense of happiness at work.

So this is my plan:

The Big Picture
Alex is feeling less interest in daily life, is tired all the time and has unsettling “I suck” thoughts at work
Longterm Goal 1: Help Alex get back to an even keel, demonstrated by scoring 3 or lower on the PHQ-9
Longterm Goal 2: Help Alex to stop thinking, “I suck” and replace it with confidence, “I can do this” thinking.
Longterm Goal 3: Help Alex boost his overall happiness at work

#1 Problem Insomnia
Description: Alex can’t fall asleep, lying awake and worrying for hours
Goal: Help Alex go back to falling asleep within 15 minutes of going to bed.
Steps to Achieve Goal:
·        Sleep hygiene evaluation to pinpoint weaknesses and suggest improvements
·        Teach relaxation technique, choose Progressive Muscle Relaxation technique or Visualisation technique
Should take 3 sessions to reach goal

#2 Problem “I suck”
Description: when the boss talks to Alex, Alex’s first thought is, “I suck”.
Goal: Help Alex manage this by stopping the negative thought and replacing it with a positive thought of confidence
Steps to Achieve Goal:
·        We will tackle the “I suck” thoughts with Cognitive Behavioural (CBT) therapy
·        Should take 6 to 8 sessions to reach goal

#3 Problem depression at work
Description: Alex has been promoted and is feeling a little uncertain about his capabilities at work.
Goal: Help Alex boost his overall happiness at work
Steps to Achieve Goal:
·        Use Self Determination Theory to identify and boost areas that are weak: autonomy, competence and relatedness
·        We will identify Alex’s support structure in order to help provide long-term support.
·        Should take 5 to 8 sessions to reach goal

Plan and Schedule

Session
Process
Time and Cost
1
Discover background and broad goals
20 minutes, free
2
Set contract and evaluation
2 hours, RM100/ US$30

Ellen develops therapy plan
Free
3
Insomnia:
·        Sleep hygiene evaluation to pinpoint weaknesses and suggest improvements
·        Teach relaxation technique
Homework: practice relaxation technique
1 hour, RM100/ US$30
4
Insomnia:
·        Check on how relaxation technique is working
·        Practice if necessary
“I suck”:
·        Explain and practice Cognitive Behavioural therapy (CBT)
·        Anticipate and model real life opportunities to practice over the next week
Homework: practice CBT
1 hour, RM100/ US$30
5
Insomnia:
·        Check on how relaxation technique is working
“I suck”
·        Review and practice CBT
Happiness at Work
·        Use Self Determination Theory to examine and boost autonomy, competence and relatedness.
Homework: practice CBT
1 hour, RM100/ US$30
6
Insomnia
·        Should be good now! But check
“I suck”
·        We should be seeing some positive results now from CBT.
·        Review and practice CBT
Happiness at Work
·        Develop support network to underpin successful change
Homework: practice CBT, practice leaning on support network
1 hour, RM100/ US$30
7
“I suck”
·        Review and practice CBT.
Happiness at Work
·        Use Self Determination Theory to examine and boost autonomy, competence and relatedness.
Homework: practice CBT, pay attention to boosting self determination
1 hour, RM100/ US$30
8
“I suck”
·        Review and practice CBT.
Happiness at Work
·        Use Self Determination Theory to examine and boost autonomy, competence and relatedness.
Homework: practice CBT, pay attention to boosting self determination
1 hour, RM100/ US$30
9
“I suck”
·        Review and practice CBT.
Happiness at Work
·        Use Self Determination Theory to examine and boost autonomy, competence and relatedness.
Homework: practice CBT, pay attention to boosting self determination
1 hour, RM100/ US$30
At this point we have done the minimum sessions: 6 of CBT and 5 Happiness at Work
We may need to do 2 more sessions here. But supposing we’re doing great! Then we move on to the final stages.
10
Redo depression inventory
Redo stress inventory
Examine goals and progress
Decide if more sessions are needed
1 hour, RM100/ US$30
11
Follow up two months after
15 minutes, free


Note that this assumes that you are doing the homework and not blowing it off, and that you don’t turn up in session four saying, “Can we just have a chat about my dad who used to beat the hell out of me when I was six?” Of course you can, but then we need a new plan of action to tackle that issue.

If you’re still reading, thanks!  I hope this gives you an idea of how therapy works and how you might use a treatment plan to track progress and effectiveness. It’s also essential for budgeting.

If you want to ask something, or are looking for a counselling psychologist, contact me at happy@lepak.com.