Early interventions in cognitive behavioral therapy for depression: A study contrasting a low-adherent and a highly adherent case

In cognitive behavioral therapy for depression, the first sessions play a crucial role in determining treatment outcome. In the first sessions, the therapist needs to form an alliance to facilitate application of the techniques; agree with the patient on problem definition, problem solution, and goals; explain the rationale; and create confidence in therapy by producing early symptom relief. This article illustrates the cognitive behavioral therapy treatment process of two depressed clients: One for whom the treatment manual was followed neatly and one for whom the therapist chose not to adhere to the manual strictly. Both had a comparable end result in terms of symptom change and alliance scores. The existing literature shows evidence for starting off with behavioral techniques, supported by assigning and reviewing homework, structuring sessions, and negotiating goals. The cases also illustrate that there are circumstances, such as urgent financial problems, in which the therapists may need to leave the treatment manual early in the therapy process, albeit temporarily.