Francine Broder, PsyD, Beck Institute Faculty

Clients with long-standing depression and anxiety sometimes describe feeling “stuck”—unable to move forward with goals related to work, relationships, or independence. In Cognitive Behavior Therapy (CBT), clinicians help these clients identify unhelpful beliefs, reduce avoidance behaviors, and take small, achievable steps toward valued goals. This CBT case study describes a client who struggled with procrastination, low energy, and feelings of failure. Through collaborative goal setting, behavioral activation, and cognitive restructuring, CBT helped him challenge long-standing beliefs and begin making meaningful progress in his life.

Brian is a 42-year-old man, living at home with his mother. He has suffered from anxiety and depression since his 20s and has been in therapy for nearly 20 years. Brian came to treatment for help with significant depression, anxiety, and hopelessness. He also wanted to feel physically healthier, find meaningful work, and live independently. He stated that “nothing has worked.”  

Although Brian described his childhood as “okay overall,” he struggled socially in high school and recalled it as an exceedingly difficult time. Since graduating from high school, he has held a series of odd jobs, including working as a bartender, landscaper, and store clerk. Brian has two sisters, both of whom are married with children, have careers, and live out of state. He is close with his mother but feels that their relationship changed after his father passed away. Brian says that his mother prefers him to remain “stuck” so that he will continue to provide companionship to her at home. 

What Does It Mean When a Client Feels “Stuck”?

Brian reports that he physically feels poorly “all the time.” He has little energy, rarely exercises, and occasionally binges on junk food, one of his longstanding maladaptive coping strategies. He has never had a long-term romantic relationship, which he attributes to the fact that he still lives at home, struggles financially, is overweight, and doesn’t have meaningful work. When asked what brought him to therapy, he responds: “Everything.” Despite feeling overwhelmed by his myriad problems, he states that he does not think about suicide. 

In spite of his belief that nothing is going well in his life, Brian has many strengths and resources. He is intelligent and interesting. By and large, he feels loved and supported by his mother and sisters and a few close friends from school. In addition, I found Brian to be a kind, well-spoken, empathetic, and extremely likable person. 

How Can CBT Help Clients Who Feel Stuck in Life?

Early in treatment, Brian and I explored his values and aspirations, and discovered that he values loyalty, kindness, and helping others. As a result of his struggles as a teen, he aspires to work as a guidance counselor in a high school. He became emotional as he described how good it would feel to help high school students develop confidence.  

Brian’s goals for treatment included feeling better physically, finding meaningful work, and moving out of his mother’s house. I asked Brian if finding a partner was a goal, and he expressed anxiety about dating before solving his other problems. I identified his idea “I can’t date unless I fix all of my other problems first,” as a thought we might work on evaluating together. 

Because Brian had been in therapy for so long without success, I guessed that he likely didn’t feel very hopeful that he’d make progress with me. I recognized how important it would be to develop a strong collaborative alliance with him. One strategy I generally use is to suggest we work on smaller issues that are easier to resolve. Once clients have the experience of working together and successfully solving a problem, the therapeutic alliance is strengthened, and we are more equipped to tackle the larger issues. We agreed to work first on Brian’s physical health, specifically his eating habits. I asked Brian to complete a food log, including what he ate, and any thoughts he had before, during, and after eating. To make the process as easy as possible, I suggested he email me the food log prior to our next session. 

We also worked on evaluating his thought that he couldn’t date unless he solved his larger problems first. We discovered that underlying this thought was a fear that people (not just romantic partners) would judge him if they knew his situation. We roleplayed responding to the questions, “What do you do for a living?” and “Where do you live?” I offered to play Brian, and responded to the questions by highlighting his positive work history and the help he has provided for his aging mother following his father’s death. Brian noted that the responses made his situation seem more acceptable, and we switched roles so he could practice responding to these questions. 

We also explored Brian’s aspiration to work with teens. Brian has avoided making progress toward his aspiration because he “[is] not in a position to be a good role model.” We evaluated this thought and came up with the following response: “Being a good role model is about being respectful, kind, loyal, honest, and fair. It’s not about where I live or what I do for a living.” We discussed ways that he could take steps now toward achieving this aspiration. He agreed that he would contact a few local high schools to see if there were opportunities for him to be a tutor or mentor.  

man helping a teen boy

How CBT Addresses Procrastination and Avoidance

Next, we decided to tackle Brian’s tendency to procrastinate, which he identified as an obstacle to working toward his various goals. I asked Brian to give me several examples of times when he ended up procrastinating on an important task. Together, we identified and evaluated thoughts that served as a barrier in each situation. Brian and I conceptualized procrastination as a way to avoid doing something that seemed overwhelming or too difficult. I taught Brian how to respond to thoughts about difficult tasks to make them seem less overwhelming. For example, when Brian would approach a task and notice himself thinking, “I can’t do this,” he decided that an accurate and helpful response would be, “This is difficult; I’ll work on it for ten minutes and see how far I get.” He was largely successful in significantly reducing his procrastination and when he was, I asked him to draw conclusions about these positive experiences. In this way, Brian began to see himself as a person who can do hard things.  

Brian also had a great idea to download some simple project management software and stated that it was helpful for him to organize his tasks visually, and check them off when they were complete. And I taught Brian to give himself credit when he completed a task, however small. Like other clients I have treated with similar challenges to Brian, the idea of giving himself credit for doing a task that he should already be doing seemed undeserving to him. I helped Brian understand that depression can make even the smallest tasks seem difficult and that giving himself credit was an important part of healing and moving forward. 

After meeting for several weeks, Brian reported feeling comfortable with me and pleased with the progress we were making. He was feeling more energized, and regularly completing his Action Plans between sessions. Having worked together on—and solved—many of Brian’s smaller problems, Brian and I now enjoy a strong therapeutic relationship. We are ready to tackle some of his larger treatment goals. We continue to work on his physical health: making sure he gets enough sleep, limits his consumption of junk food, and takes a brief walk outside each day.  

Through a local high school, Brian had learned about an opportunity to get involved with an after-school program for teens who were having difficulties at home. He volunteered two days a week and found the experience extremely fulfilling. These experiences allowed Brian to take steps toward his aspiration, and act in line with his values of kindness and helping others. It also served as a behavioral experiment, where Brian could test his thought that he was not a good role model for the students. He discovered that the students did not care about his employment history or living situation—in fact, it barely came up. Mostly, they just appreciated having someone empathetic who would listen to them.  

How Examining Core Beliefs Supports Long-Term Progress

Alongside Brian’s goals and aspirations, I also worked on some of his core beliefs. Brian has been collecting decades of evidence for his core belief “I’m a failure,” while ignoring or minimizing his many strengths. Recognizing that he could do hard things made it easier for Brian to complete an application for his local community college, despite the fact that he needed to write an essay and compile all of the necessary materials prior to the deadline while working, volunteering, and helping his mother. Through our work together, he adopted a more adaptive and accurate core belief, that he had “strengths and weaknesses, just like everyone else.”   

I am enjoying being a part of Brian’s growth, helping him to become unstuck and to make progress toward his aspirations, living a meaningful life in line with his values. This CBT case study illustrates how helping clients identify unhelpful beliefs, take small behavioral steps, and align actions with their values can reduce depression and increase motivation. Even when clients feel stuck for many years, collaborative CBT strategies can help them build confidence and move toward meaningful life goals.

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