Counselling Strategies for Patients with Severe Depression Due to Obesity
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This article discusses the effective counselling strategies for patients with severe depression due to obesity. It covers the application of cognitive behavioral therapy, benefits of the therapy, and more.
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Running head: COUNSELLING STRATEGIES
COUNSELLING STRATEGIES
Name of the student:
Name of the university:
Author note:
COUNSELLING STRATEGIES
Name of the student:
Name of the university:
Author note:
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1
COUNSELLING STRATEGIES
Introduction:
A counseling session was arranged in four episodes during the time of my placement. I
got the scope of interacting with a patient with severe depression due to his obese body shape
and applied the cognitive behavioral therapy with him. I had conducted four counseling sessions
with him for four weeks and the outcomes of the counseling sessions were found to be
successful. This assignment would be mainly focusing on the different aspects of the counseling
sessions with the areas that went well and the areas that still require improvement.
Case study of the client:
The patient was 25 years old and having the BMI of 38.5. He had huge body weight that
impeded his daily activities and often interfered with his emotional and mental health condition.
He is bullied severely at his organization where he works and this adds to his further frustrations
in his life. Moreover, he is recently facing issues during sleep where he is having breathing
problems. He had visited the primary healthcare centre but the advices provided by the
healthcare professionals there had not helped him to tackle his issues sufficiently. He had started
to maintain diet but he is unable to manage the diet charts due to his heavy workload at office.
His partner had left him because of his lack of motivation to care for himself and lead a healthy
and safe life. All these had continued to affect him for long number of days that had affected his
happiness and satisfaction in life. He had isolated himself and he does not want to come out of
his home or attend social gatherings. His brother had requested him to attend a counseling
sessions in order to help him overcome his difficulties and lead a happy and healthy life.
COUNSELLING STRATEGIES
Introduction:
A counseling session was arranged in four episodes during the time of my placement. I
got the scope of interacting with a patient with severe depression due to his obese body shape
and applied the cognitive behavioral therapy with him. I had conducted four counseling sessions
with him for four weeks and the outcomes of the counseling sessions were found to be
successful. This assignment would be mainly focusing on the different aspects of the counseling
sessions with the areas that went well and the areas that still require improvement.
Case study of the client:
The patient was 25 years old and having the BMI of 38.5. He had huge body weight that
impeded his daily activities and often interfered with his emotional and mental health condition.
He is bullied severely at his organization where he works and this adds to his further frustrations
in his life. Moreover, he is recently facing issues during sleep where he is having breathing
problems. He had visited the primary healthcare centre but the advices provided by the
healthcare professionals there had not helped him to tackle his issues sufficiently. He had started
to maintain diet but he is unable to manage the diet charts due to his heavy workload at office.
His partner had left him because of his lack of motivation to care for himself and lead a healthy
and safe life. All these had continued to affect him for long number of days that had affected his
happiness and satisfaction in life. He had isolated himself and he does not want to come out of
his home or attend social gatherings. His brother had requested him to attend a counseling
sessions in order to help him overcome his difficulties and lead a happy and healthy life.
2
COUNSELLING STRATEGIES
Application of cognitive behavioral therapy:
The counseling session that was developed were mainly based on four important arenas.
These four arenas made the foundation basics of each of the four episodes of counseling sessions
designed by me. The first episode is planned in order to identify the troubling situations or the
conditions present in the lives of the patients. Cognitive behavioral therapy mainly focuses on
effective identification of the root causes of suffering of the patients and then helping the patients
to acknowledge the causes of suffering to make them motivated to work on them (Paul et al.
2015). Studies advise professionals to spend more time with the patient in this phase in order to
decide the problems and goals that the patient should focus on. I tried to develop good rapport
with the patient by communicating with him in an empathetic and compassionate manner. It is
important for the professionals to develop a therapeutic relationship with patient so that the
patient can rely in the professionals and reveal his concerns and grief (Ratcliffe and Ellison
2015). I tried my level best to make the patient comfortable and helped him to feel at ease and
trust me properly.
The second step is planned to make patients become aware of their thoughts, emotions
as well as the beliefs about their problems. The duty of the professionals is to identify the
different problems that the patient should work on and accordingly they would be encouraging
the patient to share their thoughts and opinions about the problems (Gade et al. 2015). The
client who was suffering from severe depression due to his obesity issues was continuously
encouraged to speak out about his different experiences, his interpretation of the meaning of the
situation and the beliefs about himself, other people and events. It was advised to him to
maintain a journal of thoughts so that he can identify his thinking procedures and engage in a
technique of “self-talk”. This is one of the most important aspect of CBT. Studies have shown
COUNSELLING STRATEGIES
Application of cognitive behavioral therapy:
The counseling session that was developed were mainly based on four important arenas.
These four arenas made the foundation basics of each of the four episodes of counseling sessions
designed by me. The first episode is planned in order to identify the troubling situations or the
conditions present in the lives of the patients. Cognitive behavioral therapy mainly focuses on
effective identification of the root causes of suffering of the patients and then helping the patients
to acknowledge the causes of suffering to make them motivated to work on them (Paul et al.
2015). Studies advise professionals to spend more time with the patient in this phase in order to
decide the problems and goals that the patient should focus on. I tried to develop good rapport
with the patient by communicating with him in an empathetic and compassionate manner. It is
important for the professionals to develop a therapeutic relationship with patient so that the
patient can rely in the professionals and reveal his concerns and grief (Ratcliffe and Ellison
2015). I tried my level best to make the patient comfortable and helped him to feel at ease and
trust me properly.
The second step is planned to make patients become aware of their thoughts, emotions
as well as the beliefs about their problems. The duty of the professionals is to identify the
different problems that the patient should work on and accordingly they would be encouraging
the patient to share their thoughts and opinions about the problems (Gade et al. 2015). The
client who was suffering from severe depression due to his obesity issues was continuously
encouraged to speak out about his different experiences, his interpretation of the meaning of the
situation and the beliefs about himself, other people and events. It was advised to him to
maintain a journal of thoughts so that he can identify his thinking procedures and engage in a
technique of “self-talk”. This is one of the most important aspect of CBT. Studies have shown
3
COUNSELLING STRATEGIES
that more the individuals are able to identify their own thinking procedures and the causes of
their sadness and grief; they would be able to modify such thinking procedures successfully.
Therefore, the patient was continuously encouraged to reveal all his deeper thoughts and
emotions. This helps the professionals in identifying the negative thinking patterns of the
patients and thereby helps in developing intervention and motivation techniques to help patients
overcome such negative thinking patterns (Palavras et al. 2015).
The third step is effective identification of the negative as well as inaccurate thinking
procedures of clients. In this step, the professionals mainly help the clients to recognize their
patterns of thinking and behaviors that are contributing to the problems. Accordingly,
professionals ask the patients to pay attention to their physical, emotional and the behavioral
responses in the different situations (Gu et al. 2015). In this step, the client was helped in a way
by which he himself successfully identified his behavioral, emotional and physical responses in
different critical situations. The client was motivated to be confident about his own will power
and accordingly bring changes to his life that would help him to overcome all bullying
behaviors of other people towards him. Moreover, he was also found to identify the unhealthy
habits that make him gain calories. He voluntarily declared to modify the poor health habits to
maintain a safe and healthy life. During the counseling sessions, active listening skills were
ensured. Researchers like Andersson et al. (2014) are of the opinion that active listening skills
help the patients to reveal their information completely allowing the professionals to understand
their feelings and grievances completely. Impatient listening skills makes the clients feel irritated
and upset making them feel that the professionals are not maintaining their dignity and
autonomy and that they are not concerned about the feelings of the patients. This creates barriers
in effective relationship development and hence affects trusts and reliance (Hallgren et al.
COUNSELLING STRATEGIES
that more the individuals are able to identify their own thinking procedures and the causes of
their sadness and grief; they would be able to modify such thinking procedures successfully.
Therefore, the patient was continuously encouraged to reveal all his deeper thoughts and
emotions. This helps the professionals in identifying the negative thinking patterns of the
patients and thereby helps in developing intervention and motivation techniques to help patients
overcome such negative thinking patterns (Palavras et al. 2015).
The third step is effective identification of the negative as well as inaccurate thinking
procedures of clients. In this step, the professionals mainly help the clients to recognize their
patterns of thinking and behaviors that are contributing to the problems. Accordingly,
professionals ask the patients to pay attention to their physical, emotional and the behavioral
responses in the different situations (Gu et al. 2015). In this step, the client was helped in a way
by which he himself successfully identified his behavioral, emotional and physical responses in
different critical situations. The client was motivated to be confident about his own will power
and accordingly bring changes to his life that would help him to overcome all bullying
behaviors of other people towards him. Moreover, he was also found to identify the unhealthy
habits that make him gain calories. He voluntarily declared to modify the poor health habits to
maintain a safe and healthy life. During the counseling sessions, active listening skills were
ensured. Researchers like Andersson et al. (2014) are of the opinion that active listening skills
help the patients to reveal their information completely allowing the professionals to understand
their feelings and grievances completely. Impatient listening skills makes the clients feel irritated
and upset making them feel that the professionals are not maintaining their dignity and
autonomy and that they are not concerned about the feelings of the patients. This creates barriers
in effective relationship development and hence affects trusts and reliance (Hallgren et al.
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COUNSELLING STRATEGIES
2016). Moreover, interrupted conversations can also prevent revealing of minute information by
patient that could be useful to the professionals in intervention development.
The fourth steps involve proper reshaping of the negative or inaccurate thinking and
thereby helping clients to develop a positive thinking frame. This frame would be based on
motivation, strengths and will power of successful change towards leading better quality lives.
In this step, the therapist are seen to communicate with the clients asking them whether they
view their situations based on fact or on inaccurate perception about the aspects of their lives.
Studies have suggested that this is the most difficult part of the counseling sessions as clients
might have long-standing ways of thinking about themselves and their lives. However, they have
also accepted that with practice, helpful thinking and behavior patterns would become a habit
of the clients and would not take much effort (Jellalian et al. 2016). By the fourth week, mutual
respect and trust had been inculcated in the relationship between the patient and me. Therefore,
the patient successfully participated in the planning of the interventions and hence he was found
to be motivated to modify his lifestyle and thinking procedures and start his life afresh. Proper
diet management, physical activity sessions every day, avoiding fast foods, participating in social
gathering, being motivated and many others were included in the discussion sessions.
Benefits identified from the application of the therapy:
The application of the cognitive behavioral therapy helped me to identify a number of
aspects of the therapy that are helpful for the patient to overcome mental and emotional
problems. Firstly, this therapy helps in identification of the problems of the patients more clearly
and developing of the awareness of the automatic thoughts (Forman et al. 2016). As in the case
study, the patient was seen to be highly affected by his thoughts of the body image that made
COUNSELLING STRATEGIES
2016). Moreover, interrupted conversations can also prevent revealing of minute information by
patient that could be useful to the professionals in intervention development.
The fourth steps involve proper reshaping of the negative or inaccurate thinking and
thereby helping clients to develop a positive thinking frame. This frame would be based on
motivation, strengths and will power of successful change towards leading better quality lives.
In this step, the therapist are seen to communicate with the clients asking them whether they
view their situations based on fact or on inaccurate perception about the aspects of their lives.
Studies have suggested that this is the most difficult part of the counseling sessions as clients
might have long-standing ways of thinking about themselves and their lives. However, they have
also accepted that with practice, helpful thinking and behavior patterns would become a habit
of the clients and would not take much effort (Jellalian et al. 2016). By the fourth week, mutual
respect and trust had been inculcated in the relationship between the patient and me. Therefore,
the patient successfully participated in the planning of the interventions and hence he was found
to be motivated to modify his lifestyle and thinking procedures and start his life afresh. Proper
diet management, physical activity sessions every day, avoiding fast foods, participating in social
gathering, being motivated and many others were included in the discussion sessions.
Benefits identified from the application of the therapy:
The application of the cognitive behavioral therapy helped me to identify a number of
aspects of the therapy that are helpful for the patient to overcome mental and emotional
problems. Firstly, this therapy helps in identification of the problems of the patients more clearly
and developing of the awareness of the automatic thoughts (Forman et al. 2016). As in the case
study, the patient was seen to be highly affected by his thoughts of the body image that made
5
COUNSELLING STRATEGIES
him suffer from depression and social exclusion. The application of this therapy helped in
developing positive thought patterns and motivation in the obese patient. Secondly, the therapy
helps in challenging the underlying assumptions that are wrong and helps in distinguishing
between real facts and irrational thoughts (Manzoni et al. 2016). Third, it helps in understanding
how experiences can affect the present feelings and beliefs and help individuals to stop fearing
about the worst. Fourth, it helps clients to see a different situation from a different perspective
and better understand the actions and motivations of the other people. Fifth, the therapy helps
patients in developing a more positive ways of thinking and seeing different situations and
thereby become aware of their own moods. Sixth, the therapy helps in establishing goals and
avoids any form of generalizations and all-or-nothing thinking (Karyotaki et al. 2017). Seventh,
it helps to modify the thinking procedures of clients in ways by which they stop taking the
blaming for everything and focus on the ways the things are rather than focusing how the things
should be (Gade et al. 2014). Eighth, it gives the clients the scope to face their fears rather than
avoiding them. It also enables the clients in describing, accepting as well as understanding rather
than judging themselves or the others.
Conclusion:
From the above discussion, it becomes clear that the people may face from severe mental
and emotional disorders. Cognitive behavioral therapy can help in managing such disorders
successfully. It can be explained as the short-term therapy technique that can help people in
finding various new ways to behave by modifying the thought patterns of the individuals
successfully. Huge number of positive outcomes is associated with this therapy and this helps to
ensure that the affected clients can overcome their symptoms and leaf quality lives. However,
effective communication skills are extremely important as this can from the main foundation
COUNSELLING STRATEGIES
him suffer from depression and social exclusion. The application of this therapy helped in
developing positive thought patterns and motivation in the obese patient. Secondly, the therapy
helps in challenging the underlying assumptions that are wrong and helps in distinguishing
between real facts and irrational thoughts (Manzoni et al. 2016). Third, it helps in understanding
how experiences can affect the present feelings and beliefs and help individuals to stop fearing
about the worst. Fourth, it helps clients to see a different situation from a different perspective
and better understand the actions and motivations of the other people. Fifth, the therapy helps
patients in developing a more positive ways of thinking and seeing different situations and
thereby become aware of their own moods. Sixth, the therapy helps in establishing goals and
avoids any form of generalizations and all-or-nothing thinking (Karyotaki et al. 2017). Seventh,
it helps to modify the thinking procedures of clients in ways by which they stop taking the
blaming for everything and focus on the ways the things are rather than focusing how the things
should be (Gade et al. 2014). Eighth, it gives the clients the scope to face their fears rather than
avoiding them. It also enables the clients in describing, accepting as well as understanding rather
than judging themselves or the others.
Conclusion:
From the above discussion, it becomes clear that the people may face from severe mental
and emotional disorders. Cognitive behavioral therapy can help in managing such disorders
successfully. It can be explained as the short-term therapy technique that can help people in
finding various new ways to behave by modifying the thought patterns of the individuals
successfully. Huge number of positive outcomes is associated with this therapy and this helps to
ensure that the affected clients can overcome their symptoms and leaf quality lives. However,
effective communication skills are extremely important as this can from the main foundation
6
COUNSELLING STRATEGIES
basis on which rapport development and relationship making might be based. This would help
the client to align and communicate with professionals successfully multiplying the chances of
success by many folds.
COUNSELLING STRATEGIES
basis on which rapport development and relationship making might be based. This would help
the client to align and communicate with professionals successfully multiplying the chances of
success by many folds.
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7
COUNSELLING STRATEGIES
References:
Andersson, G., Cuijpers, P., Carlbring, P., Riper, H. and Hedman, E., 2014. Guided Internet‐
based vs. face‐to‐face cognitive behavior therapy for psychiatric and somatic disorders: a
systematic review and meta‐analysis. World Psychiatry, 13(3), pp.288-295.
Forman, E.M., Butryn, M.L., Manasse, S.M., Crosby, R.D., Goldstein, S.P., Wyckoff, E.P. and
Thomas, J.G., 2016. Acceptance‐based versus standard behavioral treatment for obesity: Results
from the mind your health randomized controlled trial. Obesity, 24(10), pp.2050-2056.
Gade, H., Friborg, O., Rosenvinge, J.H., Småstuen, M.C. and Hjelmesæth, J., 2015. The impact
of a preoperative cognitive behavioural therapy (CBT) on dysfunctional eating behaviours,
affective symptoms and body weight 1 year after bariatric surgery: a randomised controlled
trial. Obesity surgery, 25(11), pp.2112-2119.
Gade, H., Hjelmesæth, J., Rosenvinge, J.H. and Friborg, O., 2014. Effectiveness of a cognitive
behavioral therapy for dysfunctional eating among patients admitted for bariatric surgery: a
randomized controlled trial. Journal of obesity, 2014.
Gu, J., Strauss, C., Bond, R. and Cavanagh, K., 2015. How do mindfulness-based cognitive
therapy and mindfulness-based stress reduction improve mental health and wellbeing? A
systematic review and meta-analysis of mediation studies. Clinical psychology review, 37, pp.1-
12.
Hallgren, M., Herring, M.P., Owen, N., Dunstan, D., Ekblom, Ö., Helgadottir, B., Nakitanda,
O.A. and Forsell, Y., 2016. Exercise, physical activity, and sedentary behavior in the treatment
COUNSELLING STRATEGIES
References:
Andersson, G., Cuijpers, P., Carlbring, P., Riper, H. and Hedman, E., 2014. Guided Internet‐
based vs. face‐to‐face cognitive behavior therapy for psychiatric and somatic disorders: a
systematic review and meta‐analysis. World Psychiatry, 13(3), pp.288-295.
Forman, E.M., Butryn, M.L., Manasse, S.M., Crosby, R.D., Goldstein, S.P., Wyckoff, E.P. and
Thomas, J.G., 2016. Acceptance‐based versus standard behavioral treatment for obesity: Results
from the mind your health randomized controlled trial. Obesity, 24(10), pp.2050-2056.
Gade, H., Friborg, O., Rosenvinge, J.H., Småstuen, M.C. and Hjelmesæth, J., 2015. The impact
of a preoperative cognitive behavioural therapy (CBT) on dysfunctional eating behaviours,
affective symptoms and body weight 1 year after bariatric surgery: a randomised controlled
trial. Obesity surgery, 25(11), pp.2112-2119.
Gade, H., Hjelmesæth, J., Rosenvinge, J.H. and Friborg, O., 2014. Effectiveness of a cognitive
behavioral therapy for dysfunctional eating among patients admitted for bariatric surgery: a
randomized controlled trial. Journal of obesity, 2014.
Gu, J., Strauss, C., Bond, R. and Cavanagh, K., 2015. How do mindfulness-based cognitive
therapy and mindfulness-based stress reduction improve mental health and wellbeing? A
systematic review and meta-analysis of mediation studies. Clinical psychology review, 37, pp.1-
12.
Hallgren, M., Herring, M.P., Owen, N., Dunstan, D., Ekblom, Ö., Helgadottir, B., Nakitanda,
O.A. and Forsell, Y., 2016. Exercise, physical activity, and sedentary behavior in the treatment
8
COUNSELLING STRATEGIES
of depression: broadening the scientific perspectives and clinical opportunities. Frontiers in
Psychiatry, 7, p.36.
Jelalian, E., Jandasek, B., Wolff, J.C., Seaboyer, L.M., Jones, R.N. and Spirito, A., 2016.
Cognitive-behavioral therapy plus healthy lifestyle enhancement for depressed,
overweight/obese adolescents: results of a pilot trial. Journal of Clinical Child & Adolescent
Psychology, pp.1-10.
Karyotaki, E., Riper, H., Twisk, J., Hoogendoorn, A., Kleiboer, A., Mira, A., Mackinnon, A.,
Meyer, B., Botella, C., Littlewood, E. and Andersson, G., 2017. Efficacy of self-guided internet-
based cognitive behavioral therapy in the treatment of depressive symptoms: a meta-analysis of
individual participant data. JAMA psychiatry, 74(4), pp.351-359.
Manzoni, G.M., Cesa, G.L., Bacchetta, M., Castelnuovo, G., Conti, S., Gaggioli, A., Mantovani,
F., Molinari, E., Cárdenas-López, G. and Riva, G., 2016. Virtual reality–enhanced cognitive–
behavioral therapy for morbid obesity: a randomized controlled study with 1 year follow-
up. Cyberpsychology, Behavior, and Social Networking, 19(2), pp.134-140.
Palavras, M.A., Hay, P., Touyz, S., Sainsbury, A., da Luz, F., Swinbourne, J., Estella, N.M. and
Claudino, A., 2015. Comparing cognitive behavioural therapy for eating disorders integrated
with behavioural weight loss therapy to cognitive behavioural therapy-enhanced alone in
overweight or obese people with bulimia nervosa or binge eating disorder: study protocol for a
randomised controlled trial. Trials, 16(1), p.578.
Paul, L., van Rongen, S., van Hoeken, D., Deen, M., Klaassen, R., Biter, L.U., Hoek, H.W. and
van der Heiden, C., 2015. Does cognitive behavioral therapy strengthen the effect of bariatric
COUNSELLING STRATEGIES
of depression: broadening the scientific perspectives and clinical opportunities. Frontiers in
Psychiatry, 7, p.36.
Jelalian, E., Jandasek, B., Wolff, J.C., Seaboyer, L.M., Jones, R.N. and Spirito, A., 2016.
Cognitive-behavioral therapy plus healthy lifestyle enhancement for depressed,
overweight/obese adolescents: results of a pilot trial. Journal of Clinical Child & Adolescent
Psychology, pp.1-10.
Karyotaki, E., Riper, H., Twisk, J., Hoogendoorn, A., Kleiboer, A., Mira, A., Mackinnon, A.,
Meyer, B., Botella, C., Littlewood, E. and Andersson, G., 2017. Efficacy of self-guided internet-
based cognitive behavioral therapy in the treatment of depressive symptoms: a meta-analysis of
individual participant data. JAMA psychiatry, 74(4), pp.351-359.
Manzoni, G.M., Cesa, G.L., Bacchetta, M., Castelnuovo, G., Conti, S., Gaggioli, A., Mantovani,
F., Molinari, E., Cárdenas-López, G. and Riva, G., 2016. Virtual reality–enhanced cognitive–
behavioral therapy for morbid obesity: a randomized controlled study with 1 year follow-
up. Cyberpsychology, Behavior, and Social Networking, 19(2), pp.134-140.
Palavras, M.A., Hay, P., Touyz, S., Sainsbury, A., da Luz, F., Swinbourne, J., Estella, N.M. and
Claudino, A., 2015. Comparing cognitive behavioural therapy for eating disorders integrated
with behavioural weight loss therapy to cognitive behavioural therapy-enhanced alone in
overweight or obese people with bulimia nervosa or binge eating disorder: study protocol for a
randomised controlled trial. Trials, 16(1), p.578.
Paul, L., van Rongen, S., van Hoeken, D., Deen, M., Klaassen, R., Biter, L.U., Hoek, H.W. and
van der Heiden, C., 2015. Does cognitive behavioral therapy strengthen the effect of bariatric
9
COUNSELLING STRATEGIES
surgery for obesity? Design and methods of a randomized and controlled study. Contemporary
clinical trials, 42, pp.252-256.
Ratcliffe, D. and Ellison, N., 2015. Obesity and internalized weight stigma: A formulation model
for an emerging psychological problem. Behavioural and cognitive psychotherapy, 43(2),
pp.239-252.
COUNSELLING STRATEGIES
surgery for obesity? Design and methods of a randomized and controlled study. Contemporary
clinical trials, 42, pp.252-256.
Ratcliffe, D. and Ellison, N., 2015. Obesity and internalized weight stigma: A formulation model
for an emerging psychological problem. Behavioural and cognitive psychotherapy, 43(2),
pp.239-252.
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