The Rest of the Story: Digging Beneath the Diagnosis By Dan Bates, LMHC on 6/23/22 - 3:02 PM

I remember sitting across from my client, wondering why we couldn’t make any progress with his depression. We had covered the terrain of cognitive distortions, the necessity of making behavioral changes, and even stepped outside the CBT stream in order to address insights he had experienced into the relationship between his childhood and current state of unmotivated listlessness. Nothing seemed to work.

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He didn’t have the kind of sad, angry, irritable depression that practitioners commonly see in clients. His was the kind of depression that stripped him entirely of his energy. For him, it was a daily struggle to get out of bed in the morning, to make his own meals, to take out the garbage, or even to take on the seemingly insurmountable task of doing the laundry. But, I thought, or hoped, that with enough time, support, and psychoeducation, he might begin to budge in the right direction—in any direction. So I put my nose to the grindstone and retreaded familiar ground, covering cognitive distortions once again, revisiting the treatment plan, formulating habit-building strategies, and enlisting social support.

Our clinical stagnation seemed to give way during one session when we began discussing the clients’ interests. He shared that he was a huge sports fan. He religiously checked game stats, participated in online discussion forums, watched basketball, football, and soccer games. He devoutly followed his favorite teams and knew everything about his favorite players and coaches. It was really fascinating to observe the life flood back into my client when talking about this. Following my curiosity, I asked him to estimate how many hours of sports media he was consuming on a daily basis. He guessed that he was consuming upwards of 14 to 15 hours of sports media a day, every day. My jaw hit the floor.

It became apparent to me that my client was not suffering from depression, although his presentation was consistent with MDD, but was in fact addicted to media. So addicted that he had no time, attention, or energy for anything else. And since sports media is so pervasive and readily available in every platform and media outlet imaginable, my client’s addiction was readily fed, monetized, and maximized to the fullest extent. The problem was only worsened by a very forgiving, if not too forgiving, roommate. My client wasn’t working, nor pulling his weight regarding household responsibilities around his apartment. He couldn’t even recall the last time he took out the garbage. I asked if his roommate ever got upset; he said sometimes, but mostly he just ignored it or covered for him (like doing his chores for him and not pressing him on missing rent). That is one forgiving roommate, right?! Sadly, it was also a very enabling roommate. The roommate’s lax standards and minimum expectations were like gasoline to my client’s media addiction fire.

After exploring and reflecting on this new data set, we had a candid conversation—my client was coming to counseling because he wanted something in his life to change. He knew he needed to change. He wasn’t satisfied with the way things were going. Yes, he loved sports and couldn’t get enough of the latest sports news, but at the end of the day, he wasn’t satisfied. He had bigger goals for his life and felt like he was letting himself down by not getting a job, not pursuing his ambitions, and not contributing to the apartment. I put it to him rather bluntly that there wasn’t space in his life for his goals and that his sports media was a form of addiction; one or the other would have to go. He acknowledged that I was right but expressed fear of going “cold turkey” on sports media. So we devised an experiment: if he titrated his consumption of sports-related media down to something more manageable, he would feel more energy and motivation throughout his day? The thought of having more energy to accomplish his goals without the total loss of sports seemed to intrigue him. He committed to running the experiment and would report back his findings next session.

In my career, I haven’t had many spontaneous recoveries, but this, I am pleased and proud to say, was one of them. Something about the experiment clicked for him, and he realized that there was more to life than his media consumption addiction. His dissatisfaction with not making progress on life goals paired with lessened consumption of sport media carved out enough energy and motivation for him to make progress on smaller, more manageable alternate goals, leading to increased self-efficacy. He ran with the motivation boost and parlayed his newfound enthusiasm to accomplish bigger and bigger goals. Even getting outside to retrieve the mail felt good to him. Within a matter of weeks, he was doing household chores, grocery shopping and preparing his own meals, submitting job applications, and reconnecting with friends. I knew our therapeutic relationship was near its end when he got a job and joined a gym. He was feeling good and didn’t see the need for him any longer, for which I was grateful.


This clinical experience was an eye-opener for me. It was helpful to step outside the confines of my favored, tried-and-true therapeutic modality and the client’s presumptive diagnosis in order to consider contextual factors that often get ignored. This was the “rest of the story,” as broadcaster and commentator Paul Harvey so famously said, when digging just a bit deeper into the context beneath the headline, or in my case, the context beneath my client’s ostensible depression.

I now make it a regular practice to broach the topics of diet and nutrition, media consumption, social connectedness, feelings about current events, and finances, to name a few. In my better moments, I take time to consider what isn’t manifestly evident in my client’s clinical presentation that may be critical to address in counseling. What have I not thought of or asked about may make the difference for my client. What is going on in their life that they haven’t thought to mention, but may hold the key to their motivation, growth and healing?

File under: The Art of Psychotherapy, Musings and Reflections