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Cognitive Behavioral Therapy: Case Analysis Paper

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Cognitive Behavioral Therapy

Susan Lagesse

PCN 500

30 Sept 2015

Mrs. Linn, Melissa


Cognitive Behavioral Therapy

Introduction

As a counselor it is my responsibility to help any client who comes to me for counseling services, if I am unable to meet the client’s needs then I need to refer them to someone who can. The following is a brief summary given from my new client, Ana, seeking advice and counseling services. After the summary I have included my observations and information relevant and important to her future care and my treatment recommendations.

My new client, Ana, states that she is currently 24 years old, and a first generation immigrant of Guatemala, in addition, she is married to a U.S. military soldier who is currently serving overseas in a dangerous combat zone. As a result of his deployed, she is currently alone in the US with the added responsibility of raising their one year old son. My client states that despite the distance - she is very close to her family however, she has not been able to see them for over a year. Ana feels extremely anxious because she has been laid off from her banking job leaving her to worry over finances and the chance she and their son could end up having no place to live. Although Ana says she is very close with her family and they have financial stability, she does not want to ask them for help.

My observations of Ana’s immediate behaviors include: Anxiety, Depression, High stress levels – especially over worries for her husband overseas and their young son. She also has financial concerns due to having been laid off three months ago, estranged - yet close family relationships and extreme weight loss in the past two months.

Cultural / Social Needs of Client (Ana)

Understanding Ana’s culture will help to create a treatment plan that is tailored to her. Understanding the ways she was raised and how family members are perceived within that culture are important. Social needs are also important. It is necessary to understand how she interacts socially and to help her, through encouragement, to seek additional support through social and familial channels of communication. Also, with her husband currently serving over -seas in a dangerous combat zone, it is also important to find a connection outlet for Ana with the family support group (through her husband’s unit or post duty station prior to his deployment), these groups are meant to be supportive to spouses especially during these types of deployments. Support, understanding and caring are number one to spouses whose soldiers are deployed.

CBT Counseling Goals, Strategies and Length

The goals for counseling should always be first and foremost for the well-being of the client. Ensuring the client is safe and is receiving the best possible care, help, and treatment possible to them at all times, including ethically and lawfully. “CBT helps a person focus on his or her current problems and how to solve them (NIMH, n.d.).”  In Ana’s case her treatment goals are to receive treatment and assistance for her anxiety and depression, with the use of medication only if necessary. As the counselor it is my role to assist Ana in addressing her desire and need for a familial relationship, and to help her discover why she feels ashamed and unworthy of receiving support and assistance from her family. Together we, Ana and I, will explore her current situation and reflect on her self – confidence, and her core beliefs about herself and her life. Ana will need to learn to make sense of her emotional state and to get a better sense of self and stability.

Additionally, her goals will include creating a social network support while her husband is away and for when he returns. Ana also needs to be informed of resources available to her and her son for her current situation.

There are many different areas for application of CBT which focuses on “…cognitive restructuring, modifying behavior and/or developing alternative coping skills (integration.samhsa.gov, n.d.).”

The Counselor’s Role

As the counselor we teach people that they upset themselves. We cannot change the past, so we help them to change how they think, feel and behave today. The CBT counselor teaches the client how to identify irrational and non-helpful thinking patterns, to recognize and change irrational or illogical beliefs, to relate with others in a positive manner and to change their own behaviors accordingly (NIMH, n.d.).

“Cognitive behavioral therapy also differs from other therapies in the nature of the relationship that the therapist will try to establish (Martin, B., 2013).” Also that “CBT favors a more equal relationship that is, perhaps, more business-like, being problem-focused and practical. The therapist will frequently ask the client for feedback and for their views about what is going on in therapy (et al, 2013).” Which “Beck Coined as ‘collaborative empiricism’ (et al, 2015).” CBT differs significantly from other forms of therapy in that the counselor begins by immediately addressing the problem or problems that brought the client in for therapy. It is most likely that the counselor will not spend any significant amount of time taking the client’s history, talking about childhood memories, their dreams, or even allow free association.

CBT also uses the ‘ABC’ model. Activator – the trigger or cause of the thought or behavior; Belief - that A has caused the bad or negative thing to happen which then leads to Consequences the result of A+B. With the understanding of the belief the therapist and the counselor can explore deeper and find the core belief – where the belief actually came from or how it was formed, and then change it. If the belief is changed then the consequences will also be changed. After the client is able to use the ABC model they can then add the ‘TIDE’ Type of feelings Intensity of the emotions Duration of the event Effect on the consequences. The ability to use both parts of the model helps the client to better understand themselves, their feelings, emotion, thoughts and behaviors which then leads to a more positive life.

Another aspect in CBT is the ‘cognitive distortions’. Cognitive distortions are the negative thoughts and how they are categorized. So in CBT we have:

All or nothing (black and white) thinking; catastrophizing ( like a fortune teller – predicts only bad for the future); downplaying the positive – nothing good ever happens unless something really bad will follow; emotional reasoning – believing that whatever is said is true even if it is irrational or illogical; labeling; magnification or minimization – the negative is noticed and disciplined whereas the positive is ignored or not acknowledged; mental filter (selective choice); mind reading; overgeneralization – I never have so I never will; personalization – taking responsibility for other peoples’ actions even when it has nothing to do with you; should and must statements – simple as it should be… or I must do…;tunnel visions – focus on only one thing – the negative (Murdock, 2013, p.327).

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