Troy was a 16-year-old Caucasian male presenting with depressive symptoms
that had worsened in recent months.Following a thorough assessment that included a structured interview, Troy
was diagnosed with major depressive disorder.For
example, he established a "cool-off zone" in his room that allowed him space and
time to get control of his feelings. As his confidence grew, he assumed more inde-
pendence in the problem-solving process. He seemed to enjoy reciting the steps
for the therapist at the beginning of each session and even attached a copy of the
brainstorming rules to the refrigerator at home. Troy's father helped by prompting
him to use the skills at home and being more mindful of ways that he might unwit-
tingly support Troy's avoidance. Over time, Troy's family began using the skills to
address common problems at home. Over the course of the 12 sessions, Troy made demonstrable progress. His
mood improved, and he reported feeling more confident in his ability to manage his
anger and irritability. His father noted that Troy seemed less stressed in general,
was talking more at home, and had begun playing in pick-up soccer games with his
friends. The two were getting along better but "still had their moments."Instead,
she emphasized how stepping up to take some action could make things better
and that the "practice" would make him get better at solving future problems. After
some discussion, Troy agreed to give it a try, and the therapist noted that learn-
ing any new skill requires effort and persistence, much like what he had shown in
refining his soccer skills. To end the initial session, the therapist overviewed the
major problem-solving steps and "talked through" each step in solving a hypotheti-
cal problem.His father described Troy as "going through a major shift in the wrong direction"
over the past several months. Troy had become irritable and sometimes lashed out
verbally at his siblings with no obvious provocation. Though they used to get along
well, Troy rarely engaged in conversation with his father, resorting instead to nods
and simple "yes and no's."He
also withdrew from extracurricular activities, deciding not to rejoin the soccer team
despite the fact that he had lettered as a freshman.Tak-
ing time to think it over and gather some information, he observed that he usually
thought of calling his mother right after school when he still had energy and "things
to talk about." The problem was that his mother was at work during that time and
would often return his messages later in the evening when he was too tired to talk. During the brainstorming step, Troy quickly discounted each alternative he came
up with. The therapist reminded him that evaluation was not allowed at this point
and encouraged him to "just let ideas flow."To address
this, the therapist added two joint sessions in which Troy and his father learned
some communication and negotiation skills and practiced collaborative problem
solving, targeting relationship issues.The goal was to help Troy learn how
to better cope with his negative emotions and motivate him to begin engaging in
activities that he used to find enjoyable.Contacted by phone, Troy's mother described him as
"just going through the motions" and agreed that he had become very irritable in
recent months.Troy was clearly able to engage in PST, but
he did not appear to be very motivated to participate in the program.His father was
very receptive to the proposed treatment plan and demonstrated concern about
Troy's recent decline and struggles with anger.Though he was generally open to
allowing Troy a role in family decision making, he tended to get more dictatorial at
times of stress.After Troy noted that he now really enjoyed talking with his mother on the
phone, the therapist encouraged him to use the skills to plan more pleasant activi-
ties.In discussing the rationale for PST with the therapist, Troy acknowledged that
it could be helpful "for someone else." He said he "just had too many problems" and
that every time he tried to "fix them they just get worse."The therapist contrasted
Troy's avoidant style with a more adaptive approach to problems.After reviewing the list, the therapist
suggested that they start with a problem that was fairly straightforward and not tooemotionally charged.Troy also devised plans for better coping with his anger and irritability.After the divorce of his parents about a year
earlier, Troy's grades began to decline to the point that he failed two courses.His therapist suggested PST in
combination with pleasant events scheduling.Over the next few sessions, Troy was able to identify a few problems to work
on and developed an implementation plan to try to solve one of them.Experiencing some success motivated Troy to apply his new skills to other
problems.His mother lived out of state, but the two remained close by
talking on the phone and sharing a 1-month visit at her home during the summer.She told him that
it sounded like his problems just seemed so overwhelming that he stopped trying
to solve them and that when we stop trying it often causes more problems.The therapist
taught Troy to interpret his negative feelings as a cue that a problem existed and
some action was needed.Troy selected a problem that involved calling his mother.Eventually, Troy chose to talk with his
mother about scheduling their phone calls for early in the evening.Troy lived with his father and
two younger brothers.As a homework assignment, Troy was asked to make a
list of 10 problems he faced during the week.As part of his
plan, he would record things he wanted to tell her in the notes section of his cell
phone.After a couple of practice runs using role play, Troy called his mother, and
the two agreed to the plan.