Case Concepualization Treatment Plan docx.pdf

Running head: CASE CONCEPTUALIZATION USING COGNITIVE THERAPY 1

Case Conceptualization using Cognitive Therapy

Liberty University

Abstract

CASE CONCEPTUALIZATION USING COGNITIVE THERAPY 2

Kate presents to therapy seeking help with depression, secondary binge eating, and unresolved grief. She

would also like to work on her relationships with her mother and husband. The client is seeking

counseling because after just having her first child, she is realizing that she needs to address her issues of

depression, binge eating disorder and her strained relationship with her mother to prevent relapse or

negatively affect her parenting. Kate has a long history of ‘powering through’ her emotional distress,

being the ‘positive’ one in the room and seems to be more attentive to other’s needs than her own. Using

CASE CONCEPTUALIZATION USING COGNITIVE THERAPY 3

Aaron Beck is coined as the originator of cognitive therapy, beginning in the late 1960s

(Murdock, 2017). Beck is a classically trained psychoanalysis and spent the beginning years of his career

testing Freud’s hypothesis that depression is anger turned inward. Beck found that depressed individuals

were immersed in visions of loss and self-blame (Murdock, 2017). This launched his clinical investigation

into free association, analytic relationship, and automatic thoughts. Beck founded the Beck Institute for

Cognitive Behavior Therapy in 1994. Aaron Beck’s daughter, Judith Beck, became a psychologist and

constructivist theory because it stipulates that a critical aspect of human existence is the creation of

meaning from experiences (Murdock, 2017). Beck’s theory has roots in behavioral and psychoanalytic

approaches. Human motivation from a cognitive therapy stance state the basic needs of humans are

preservation, reproduction, dominance and sociability (Murdock, 2017). The central construct to

cognitive therapy is- “the way you think affects the way you feel” (Murdock, 2017, pg. 312). The

relationship between cognition and emotion is bidirectional, however, cognitive therapy focuses on the

causal relationship between thought and emotion. The counseling process in cognitive therapy is a

collaborative relationship between the client and the counselor. Beck called cognitive therapy a common-

sense therapy that simply helps the client correct faulty problem-solving techniques and thought processes

and is usually a short-term intervention. The process consists of formal and informal cognitive

CASE CONCEPTUALIZATION USING COGNITIVE THERAPY 4

the best-known trials of cognitive therapy is the National Institute of Mental Health (NIMH) Treatment of

Depression Collaborative Research Program (Murdock, 2017). A randomized controlled trial comparing

cognitive therapy to rational emotive behavior therapy and pharmacotherapy found that all three

treatments were equally effective for major depressive disorder (Murdock, 2017). Cognitive therapy has

shown to be effective mostly for depression, but also for anxiety disorders, bulimia, anger, somatoform

disorders, and general stress (Murdock, 2017). In summary, research generally supports the effectiveness

change faulty information processing and to modify beliefs that support psychological dysfunction to

ones that are more adaptive (Murdock, 2017). Through addressing Kate’s automatic thoughts, her basic

beliefs and schemas can be accessed, and the dysfunctional modes can be deactivated, and more adaptive

modes can be built. The goal of therapy will be to teach Kate problem-solving strategies that she can use

across situations and establish constructive processes to prevent relapse.

client’s culture. Kate is a middle aged, Caucasian female with a moderate socioeconomic status from the

Western culture, therefore there should not be other cultural implications that could interfere with

counseling. Highly religious clients may not respond well to the emphasis on individual choice and

control, but Kate is not religious or spiritual. It is noted that the collaborative nature of cognitive therapy

promotes egalitarianism is important when working with female clients (Murdock, 2017). Kate is a

CASE CONCEPTUALIZATION USING COGNITIVE THERAPY 5

discrimination, and oppression might have more difficulty locating the sources of their discomfort in their

cognitive processes (Murdock, 2017). This may affect Kate because she feels discriminated against for

her overweightness. Overall, I do not foresee many potential ethical issues that may arise using cognitive

therapy with Kate.

Cognitive therapy theory be used in crisis situations, including circumstances that threaten one’s

home, family, property, or sense of well-being or psychological crises involving a loss or threat of loss or

a radical change in one’s relationship with oneself or with some significant other (Dattilio & Freeman,

2010). The therapist uses behaviors and schemas to identify the individual’s coping style and strategies to

Intervention

being the ‘positive’ one in the room and seems to be more attentive to other’s needs than her own. Finally

becoming a mother, herself, she is recognizing the need to address the strained relationship she has with

her mother and the new role of parenting in her marriage.

Questioning

Questioning is one of the most prominent techniques in cognitive therapy. One of the most basic

interventions in cognitive therapy involve asking the client, “What was going through your mind just

CASE CONCEPTUALIZATION USING COGNITIVE THERAPY 6

now?” when the counselor notices a change in the client’s affective state (Murdock, 2017). This

questioning allows for exploration of the presented emotions and indicates the presence of automatic

thoughts. Socratic questioning, termed after Greek philosopher Socrates, is a technique where the

therapist uses a line of questioning in order to identify and challenge the validity of thoughts, beliefs and

assumptions (Murdock, 2017). An example of such is simply, “Where is the evidence for this thought/

belief?” (Murdock, 2017). It is the counselor’s responsibilities to structure questions that help clients alter

CL: “Well it isn’t helpful, but it is the truth. I try to do things that make me happy but then I

always wind up unhappy again.”

CO: “What could be the effect of changing this thinking?”

CL: “If I went into it with a positive regard and believed it would make me happy, maybe I would

actually be happy.”

(Murdock, 2017). The Thought Record is given to the client to take home and use to record occurrences

of automatic thoughts between counseling sessions and then together at the next session, the client and

therapist will review the responses to the automatic thoughts and work on alternatives if necessary. The

thought record has a place for the situation, automatic thoughts, emotions, adaptive response and the

outcome for each occurrence. This technique will be helpful with Kate to implement what is learned in

therapy into her everyday life and heighten her awareness of dysfunctional thought processes and replace

them with appropriate alternatives. I will assign this task to Kate after our first session and when she

CASE CONCEPTUALIZATION USING COGNITIVE THERAPY 7

shows progress of understanding the technique in session. An example of how this could be used with

Kate is:

feels tight and I want to cry.

Automatic Thoughts: I am not good enough to be a parent.

Emotions: Sad, useless, hopeless

Adaptive Response: Labeling, magnification, overgeneralization. I understand that my mother is

Outcome: I know believe my automatic thought 30%. I still feel sad, but not as much. I reframed

my thoughts and hugged my mother. She made me feel safe and understood.

client’s confidence while teaching a new skill and helps to desensitize the client. The role-playing

technique will be helpful for Kate because there are many areas of her life that she is not ready to

confront outside of therapy yet. Kate struggles with low-self esteem and the confidence received from

practicing role playing will assist her in everyday situations. An example of role-playing with Kate, could

be:

CASE CONCEPTUALIZATION USING COGNITIVE THERAPY 8

CO: Let’s role play a conversation you could have with yourself when you are feeling sad and

have the urge to binge eat. We have learned from our work on automatic thoughts that you

typically have the urge to eat when you are afraid to address the situation that is making you feel

inferior. I am going to exhibit the thought process and an alternate response, then you will try. “I

am so tired, the baby just will not sleep, Toby is dealing with his own stuff, so I do not want to

bother him. I feel so defeated and alone. I cannot do this. Eating will make me feel better. Then I

Spiritual Application

did not believe that she was in control of her own fate, individual choices and control. If Kate wanted to

implement Christian Counseling into her treatment plan, I would structure it with her collaboration and

insecurity. I would reminder her that God has given her a great purpose for her life, and we must rid of all

the doubt we have in His plan for us. I would use the wise words from the Apostle Paul, “Do not be

anxious about anything, but in every situation, by prayer and petition, with thanksgiving, present your

requests to God” (Philippians 4:6 ESV) to comfort and guide Kate. In dealing with her unresolved grief, I

will Scripture to remind her that, “the Lord is close to the brokenhearted and saves those who are crushed

CASE CONCEPTUALIZATION USING COGNITIVE THERAPY 9

Conclusions

I expect that Kate will thrive greatly from cognitive therapy treating her depression, secondary

will be able to identify automatic thoughts and her basic beliefs and schemas and alter them to a more

productive system. Kate will learn and implement problem-solving strategies that she can use across

situations and establish constructive processes to prevent relapse. Using cognitive therapy techniques

such as questioning, thought recording and role playing, Kate will be able to implement new thought

her new role of being a mother will fuel her passion to adhering to therapy.

References