Jack:
Hi, this is Jack from ReachOut.com. This is part two in a two-part series on how a CBT therapy session is conducted. For support and advice in a personal crisis, call Lifeline on 13 11 14 or go to lifeline.org.au.

Speaker 2:
After their initial meeting, Zach returned to see Jenny, the therapist, the following Monday.

Jenny:
Hi Zach. It's great to see you again.

Zac:
Hi. Yeah. I found the place much easier this time.

Jenny:
So how have you been since we last spoke?

Zac:
Yeah, better. I'm still in my job. Haven't been fired yet.

Jenny:
That's good. And what's the last week been like for you? Did you have any more situations where you couldn't leave the house?

Zac:
No, I've been pretty good. Still been waking up a lot and finding it hard to get back to sleep, which stresses me out a bit.

Jenny:
I know. I find, often, it's hardest to relax when you need to the most.

Zac:
Yeah.

Jenny:
Well, we can talk a little bit later on about what you can do in those instances, just to calm your mind. But as I mentioned last time, what I'd like to talk to you about today are your thoughts and feelings and behaviors around those days when your depression really flares up.

Zac:
Yeah, okay.

Jenny:
So when we last spoke, you talked about the difficulty you had with your dad and that when you made the choice to come out to him, he didn't react well and he even went as far as to ask you to move out of the family home.

Zac:
Oh yeah, he pretty much threw me out and told me I had to be out by the weekend. So that's when I packed up my car and drove down here.

Jenny:
And you mentioned that was about a year ago?

Zac:
Yep. It was on my 18th birthday.

Jenny:
Oh, dear.

Zac:
So that was pretty much about 18 months ago.

Jenny:
Oh, wow. Zach, that must've been very, very hard.

Zac:
I mean, I had my friend, Tam, who made the move down here from the Central Coast, so I stayed with her for a bit. And then I got my job at the cafe through Tam and I moved into a share house.

Jenny:
Did you have any trouble with depression before moving to the city?

Zac:
I used to get really stressed when I would think about coming out to my family mainly.

Jenny:
Of course.

Zac:
But it only got really bad with the panic attacks since I moved to the city.

Jenny:
So take me through the steps of what may be going through your mind, just leading up to one of those days when you just can't go to work or can't get out of bed.

Zac:
Yeah. Okay. Well, if I know I have to go to work the next day, usually, I'll think about it all afternoon, the day before.

Jenny:
Mm-hmm (affirmative). Okay. And what are the ideas that you're having?

Zac:
I sought of imagine what it'll be like to be there, like getting things wrong, like the register or forgetting orders or like being yelled at by my boss.

Jenny:
Would he often do that? Your boss?

Zac:
Yeah. He's really always going on about what I'm doing wrong.

Jenny:
And what's going through your mind when he points out what you're doing wrong?

Zac:
That I suck. That I'm useless. That I'm dumb. That there's no point in me even trying because I'll never get good at it.

Jenny:
Get good at?

Zac:
The job, like using the register or clearing tables fast enough, all the things that usually slow me down.

Jenny:
Well, it sounds like these are all pretty negative thoughts to be having, that you don't deserve to be there, that you're not capable.

Zac:
Yeah, pretty much.

Jenny:
Okay. And do you think those ideas are real or true or accurate, that you wouldn't be able to get to learn what you needed to do for the job?

Zac:
Well, no. I mean... No, I think I could, just maybe not straight away, not as fast as I'm meant to.

Jenny:
And at the time you're having those doubts about yourself, what's going on for you emotionally?

Zac:
I guess I'm feeling sad, pretty angry as well, really hurt that he could make me feel that way. I just want him to back off and let me get it right in my own time.

Jenny:
Yeah. And do you notice any changes in yourself at that time? What's going on physically?

Zac:
Well, I'll either feel like sick in the stomach or short of breath. And if it goes on for a while, I'll get a headache and get pretty drained.

Jenny:
Well, they are pretty strong responses to be having in somewhere like a cafe when everyone around you is relaxing and there to have a nice time.

Zac:
Yeah, I guess.

Jenny:
So do you think your boss... What's his name?

Zac:
Rob.

Jenny:
Do you think it's Rob's intention to create that response in you?

Zac:
Yeah. I mean, maybe. Actually, no, probably not. No.

Jenny:
How do the other people that you work with find working with Rob?

Zac:
Oh, I don't reckon he has as much of a problem with anyone else as he does with me.

Jenny:
Well, it's hard when you feel like no one else at work can really empathize with what you're going through. What's the worst mistake you can imagine making at work.

Zac:
Well, I don't know, like spilling a coffee on someone.

Jenny:
Well, that would be unfortunate, especially if it was an extra hot coffee. I say that as someone who always orders their coffee extra hot.

Zac:
Oh, well, you're one of those people.

Jenny:
Yes. I'm ashamed to admit, I'm one of those people. But what's the worst thing that would happen if you made the biggest mistake possible?

Zac:
I'll get fired.

Jenny:
And then what?

Zac:
I'd have to find another job, I guess.

Jenny:
And could you do that?

Zac:
Well, not straight away, but yeah.

Jenny:
So when you're getting ready for work and you feel that sense of dread for the day ahead, what goes through your mind?

Zac:
Mm-hmm (affirmative). Panicking about making a mistake, getting yelled at in front of everyone, getting the sack.

Jenny:
Has Rob ever actually said that he might fire you?

Zac:
No, not really. But I just reckon it could happen. You never know what he's going to do.

Jenny:
And while you're having a shower and putting on your work clothes... Do you have a uniform?

Zac:
Yeah, just black T-shirt and jeans.

Jenny:
Okay. So while you're getting ready for work, putting on your black T-shirt and jeans, thinking of scenarios in which things might go wrong, what's happening to you emotionally?

Zac:
I guess I'm feeling scared and panicked.

Jenny:
And what about physically?

Zac:
Yeah, my heart speeds up and I feel sick in the stomach and then I feel really drained.

Jenny:
And that's what makes you want to go back to bed?

Zac:
Yeah.

Jenny:
Well, when you're in these situations, when you feel yourself having a strong, emotional, or physical response, just try to check in with yourself and fact check to see if your concerns are warranted. Like questioning your fear of your boss telling you you're fired, is it based on a fact or is it a fear that could be linked to another story? I'd love to share with you a little exercise that I think can be really helpful. Zach, if I gave you a simple homework task, do you think you could find the time for it?

Zac:
Yeah. Yeah. No, probably I can.

Jenny:
Great. Okay. It's called keeping a thought diary. And I used to recommend carrying an actual notebook, but now, just like everything else, there's an app.

Zac:
Yeah. Right.

Jenny:
The main purpose is to make a note, basically, whenever you notice yourself having a strong response to something.

Zac:
Well, like if I make a mistake at work and I get really pissed off when my boss says something?

Jenny:
That's a great example. Awesome. Okay. So there are a few thought diary apps, but they all allow you to do, basically, the same thing, which is to record the date, situation, what your automatic thoughts were, the emotion it created. And you can also rate it out of a 100% intensity. In this case, the situation would be, "My boss tells me to be more careful putting an order through." The automatic thought might be, "I'm incompetent. He thinks I'm an idiot. I'm hopeless. He might fire me, yadda yadda."

Zac:
Cool. Yeah, I've thought all those things.

Jenny:
Yeah. Okay. So as you continue to list the automatic thoughts that come up for you, you might end up on, basically, something awful like, "I'm not good enough," which is a powerful realization to have that your boss's fleeting comment could leave you feeling something so awful and so strongly.

Zac:
Yeah. Wow.

Jenny:
So in the emotion section, what comes up for you might be frustration or anger or sadness as you move through them. And if you were to give the severity of your action in this moment and rating out of 100, well, this one might be 70%.

Zac:
Yeah. Right. It's funny, even while you're explaining this, it kind of made me think how Rob made me feel like my dad did sometimes.

Jenny:
That might be the case for you, yeah.

Zac:
Yeah. Okay, cool. So what? I just download the app and use it this week and then I'll bring it back with me again when I see you next?

Jenny:
That would be great. Fantastic, Zach. Yeah.

Zac:
Cool.

Jenny:
Well sometimes just by naming what's going on for us, it's less scary. And that's a good thing to remember if you have trouble sleeping. You just call it exactly what's going on for you in that moment in your mind. "Oh, I'm playing out a scenario from work. I'm worrying about sleeping in and running late." Or, "I'm worried about not having enough money to pay my rent." Just try to name it, what's going on for you, and let it go.

Zac:
Yeah. Yeah. I mean, I suppose I can't actually do anything about it when I'm lying in my bed.

Jenny:
Absolutely, yeah. And you can trust that the next morning you'll be much more available to whatever the task is.

Zac:
Yeah. Cool. Thanks.

Jenny:
Okay. Awesome. So how do you think things went today for our second session?

Zac:
Yeah. I was pretty nervous coming here. I don't know, maybe because I didn't know what to expect.

Jenny:
And how do you feel now?

Zac:
Way better actually. I know I'm not totally over it, but I don't know, I feel like I know what to do next time.

Jenny:
Okay. Like you've got some tools you can call upon when you need them?

Zac:
Yeah. Yeah. I mean, I don't feel as afraid of what might happen.

Jenny:
Oh, that's great. We did some great work today, Zach.

Zac:
Yeah. So I'll see you again in a couple of weeks?

Jenny:
Yeah. I'll see you in a couple of weeks.

Jack:
This was part two in a two-part series on how a CBT therapy session is conducted. To begin your journey towards CBT, ReachOut recommends the following apps, LifeCharge and Behavioral Experiments-CBT, both available in the App Store. And for support and advice in a personal crisis, call Lifeline on 13 11 14 or go to lifeline.org.au.