Using case #2 in the "case examples" pdf, apply your knowledge of cognitive-behavioral theory through a case analysis/conceptualization and basic treatment plan. Critically analyze the benefits and challenges of this approach

Case #1: Yisel

Yisel is a 21-year-old Mexican American female. She is a college junior, Psychology major coming into the U of M counseling center seeking career counseling. She came in to get help with procrastination in applying for medical school. Yisel reports that she has no motivation because she doesn’t have the grades to get into medical school. She has a C average in her science classes but A’s and B’s in her Psychology courses. Yisel reports that whenever she sits down to work on applications, she finds herself wasting hours on the internet or hanging out with her friends. During her intake session, she reports that she has sleep difficulties, having nightmares several nights a week. In one nightmare, she described being unable to get her family out of a burning building. In another nightmare, she reported being kicked out of medical school because she failed all of her courses. She also reported that she has begun smoking marijuana daily because it helps her to relax and forget about her worries. Yisel reported that she is trying out counseling because she believes it will help her get her medical school applications done. Yisel’s married parents both live in Chicago with her four siblings. Her parents immigrated to Minnesota from Mexico in the early 1980s. Yisel and her two brothers were born in Chicago, and her older sister was born in Mexico. Her father works as a mechanic and her mother works as a secretary in Yisel’s former middle school. Both her parents were college educated in Mexico, but her parents had difficulty finding jobs in their fields because of language barriers and difficulty in having their credentials accepted in the US. Yisel talked about her parents’ hopes for her to become a doctor, which they once had for her older sister. Yisel reported that her old sister has “failed” her parents’ expectations; her older sister is currently unemployed, batting depression, and living at home. She says that although her parents have never explicitly pressured her to become a doctor, they have frequently expressed that “she is the smart one” in the family. Her parents also have indicated to Yisel that they will need her financial assistance to help pay for her younger brothers’ college tuition. Yisel says that her parents made many sacrifices to put her through school, which makes her feel guilty and selfish. She says that she feels like she will never be good enough, and that her parents will be disappointed in her if she does not follow through with her plans.

When asked about her current ways of coping with her stress, she says that she enjoys running, cooking, and spending time with her friends. Her favorite part of her week is tutoring struggling high school students. She says that she is happiest when she is helping others.

Case #2: Wesley Wesley is a 36-year-old White American male seeking counseling for his depression and

anxiety. For the last two years, he has been taking medication for his depression prescribed by a psychiatrist. He finally decided to seek counseling at the suggestion of his psychiatrist. He indicated that “it is unlikely” counseling will make him feel better. Wesley feels that he has been in a “constant state of blue” for the last five years, finding it difficult to get out of bed most days out of the week and lacking the energy and interest to do the many things he formerly enjoyed, such as hiking and spending time with his children, Luke and Andy (ages 10 and 8). When asked about possible triggers for his depressed mood, Wesley says that his marriage and work life have not turned out as he hoped. Wesley and his wife, Lindsey, have been married for ten years. He says that he thought, “Lindsey was initially perfect for me”, but now Wesley is unable to see past her flaws. He reported that Lindsey “is always working and won’t make time for him.” Wesley reports that in order to “teach her a lesson about what’s important,” that he has basically stopped communicating with Lindsay. Wesley cannot remember the last me that he and his wife were physically or emotionally intimate. Wesley reported that “there is nothing he can do to fix the marriage” -- that it is up to Lindsey to make it better. Another reported concern is Wesley’s vocational life. The neighborhood that Wesley grew up in was middle-class; his mother is a middle-school English teacher, and his father owns a business that does contracting for housing developments. Since Wesley is an only child, his father would tell him, “The baby [i.e., the business] is all yours when you become a man.” Currently, Wesley acts as a sales manager for the company. He says that he feels trapped in his job and comes home frustrated every day, sometimes taking it out on Lindsey and the kids with angry outbursts. He also reported that he drinks a six-pack of beer every night in order to “get away from it all.”

Growing up, Wesley always dreamed of being an actor. He staged plays for an audience that consisted of his parents (who divorced when he was 15 years old) and stuffed animals. He later starred in many high school productions but never further pursued this once he went to college to study business. He says that he felt like he had to “become an adult and let go of those silly fantasies.” Although Wesley has considered joining community theater productions, he says that he doesn’t have time and that he must be a “man” and provide for his children.

Case #3: Sarah

Sarah is a 31-year-old, biracial, Native American/White woman who presented at a community clinic with symptoms of anxiety. She grew up in a small town in rural Montana, and has been living in Minneapolis for much of the past 12 years. She has completed some college, during which time she switched majors numerous times. She reports that she currently works two part-time jobs in retail, and notes difficulty in making sure she gets enough shifts at work to cover her bills.

Sarah would like to return to school, but is anxious about going into more debt. She has

thoughts of going into nursing, or becoming a doctor, though she sometimes thinks she is too old to pursue those degrees, and wishes she had completed school earlier. When asked about her reasons for leaving college previously, Sarah states that she was experiencing anxiety at that time, and had a hard time focusing on completing coursework. Particularly, she reported that at the time, she was very concerned about her mother who had problems with alcoholism. Sarah reports that while growing up, she was closer to her mother, who is Native American, a police officer, and was involved in tribal politics, than to her father, who is White and a well- respected political figure in their town. Within the family, however, she reported, her father was often angry and verbally abusive, particularly toward Sarah. She also noted that she is close to her one sibling, an older brother who is happily married and working as an accountant in another state, but she sometimes feels like a failure when she compares her life to her brother’s. Sarah rarely returns to her hometown, and currently has little contact with her parents; the thought of visiting them produces high anxiety for her. When asked, Sarah denied having experienced racism or discrimination, but reflected that growing up, she was “the White kid” when spending time with other Native Americans, but was viewed as Native American by her predominantly White classmates. Currently, she does not feel very connected to her Native American heritage, and states that though she misses some parts of the culture, she also associates it with her conflicts her parents.

Sarah reports no major medical issues, and denies any chemical dependency concerns. However, upon questioning, she reports that when her anxiety is very high, sometimes (about once a week recently) she smokes cigarettes. Sarah reports that she is not currently in a romantic relationship. However, she describes a wide circle of friends whom she spends time with socially, but notes that she rarely confides in any of her concerns to these friends. Sarah would like to feel less anxious and more satisfied with her life.