THERAPIST: It sounds like you used to be involved in a number of interesting activities. What about now?
DENISE: After my husband got sick and then my friends moved, I just stopped. I haven’t done any of those things in quite a while.
THERAPIST: What do you think about attending a lecture series now?
DENISE: I don’t know.
THERAPIST: Well, what do you think about that idea?
DENISE: It’s an OK idea, but it just seems like too much. I don’t think I’ll enjoy it . . . the way I feel . . . I don’t know.
THERAPIST: Would you be willing to test out that thought that you won’t be able to enjoy it now?
DENISE: I don’t know . . . I guess so.
THERAPIST: Is that a “yes”?
DENISE: Yes, but I don’t see how I’m going to get myself to do it.
THERAPIST: Well, how would you go about finding out about a lecture series?
DENISE: You look online at the museum’s website to see what’s available.
THERAPIST: OK. Do you have a computer?
THERAPIST: Is it working?
THERAPIST: How do you feel about doing that?
DENISE: I guess I could do that. . . . I’m so pa- thetic, I know what to do. I don’t need you to spell it out for me. Why didn’t I just do this before?
THERAPIST: Well, you probably had good rea- sons for not doing it before. Probably you were just so caught up in the hopelessness.
DENISE: I guess so.
THERAPIST: When you are hopeless you tend to deny, as it were, or cut off possible options or solutions.
THERAPIST: When you get caught up in hope- lessness then, there is nothing you can do. Is that what you think?
THERAPIST: So, then, rather than be down on yourself because you haven’t looked this up online before, why don’t we carry you right through?
This excerpt illustrates the process of graded tasks that is so important in the early stages of therapy with a depressed patient. The therapist asked the patient a series of questions to break down the process of attending a lecture series into smaller steps. Denise realized that she had known all along what to do, but, as the thera- pist pointed out, her hopelessness prevented her from seeing the options.
DENISE: Taking this step is going to be hard for me.
THERAPIST: First steps are harder for every- body, but that’s why there is an old expres- sion: “A journey of a thousand miles starts with the first step.”
DENISE: That’s very true.
THERAPIST: It’s the first step that is so very im- portant, and then you can ready yourself for the second step, and then the third step, and so on. Eventually, you build up some mo- mentum, and each step begins to follow more naturally. But first, all you have to do is take one small step. You don’t have to take giant steps.
DENISE: Well, yeah, I can see that. I guess I was thinking every step was just as hard as the first. Maybe it will get easier.
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