Conceptualization and Treatment Plan 1
Conceptualization and Treatment Plan:
Winston Schmidt
Victoria McCool
Counselor Education and Family Studies, Liberty University
Author Note
Victoria McCool
I have no known conflict of interest to disclose.
Correspondence concerning this article should be addressed to Victoria McCool.
Email: [email protected]
Conceptualization and Treatment Plan 2
Abstract
Cognitive Behavioral Therapy (CBT) is an evidence-based approach to counseling and
psychotherapy. This approach has been used by countless counselors and can also be used in the
case of Winston Schmidt. Schmidt is a classic case of faulty thinking and lack of cognitive
awareness causing him problems in life. By addressing his underlying concerns with CBT, I will
help him to recognize and rectify his thought processes. The treatment plan includes challenging
core thoughts and beliefs that cause Schmidt’s underlying problems.
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Conceptualization and Treatment Plan
Overview of Cognitive Behavioral Therapy
Cognitive Behavioral Therapy (CBT) is a relatively new approach to counseling and,
since its introduction, has found its way into counselors’ offices around the globe. This theory
has a basic premise that our psychological distress is more related to the way one thinks about
the situation rather than the situations themselves. With this foundation, CBT states that by
changing thinking, which also changes behavior, an individual can change their environments
and reduce psychological distress (Corey, 2021).
Origen of the Theory
CBT has its roots in both behavior and cognitive theories, which were previously viewed
as vastly different schools of thought. Alfred Adler was one of the first to study cognitive theory
and Adler’s work was an inspiration to Albert Ellis, founder of rational emotive behavioral
therapy. Cognitive theory believes that thoughts and feelings are at the root of psychological
pleasure or distress. Behavioral therapy saw its first wave of popularity in the 1940s and is based
in the idea that behaviors can be measured and changed. CBT in the form we know it today was
developed by psychiatrist Aaron Beck in the 1960s (Corey, 2021) It has evolved from that point
to the therapy that is used now.
Beliefs about Human Nature and the Counseling Process
CBT is generally neutral on humans nature but believes that the human experience is
largely governed by thoughts and behaviors, not events and situations (Tan, 2021). CBT also
believes that humans are born with the ability to think both rational and faulty thoughts. Rational
thoughts lead to mature, well rounded, and positive adults whereas faulty thinking can lend itself
to depression, anxiety, irrational anger, and other issues. This theory does not claim humanity is
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born to be good or born to be bad, but rather that humans are born with the capacity for both and
the option to choose their own path (Tan, 2021).
CBT views the counseling process as a collaborative approach where the client must take
an active role in order to receive positive results. The counselor’s role is to help the client
identify their thoughts and behaviors and allow the client to determine if the thinking is straight
or crooked. The goal is to allow the client to realize how thoughts and behaviors shape their
circumstances and to then work on changing and challenging faulty thinking.
Research
CBT has been heavily researched and is an evidence-based approach to counseling. It
has been proven to be effective in treating a variety off mental health disorders, especially
depression and anxiety. Many studies have been done to show the wide range of disorders that
CBT can help treat including anorexia, anger, and insomnia. It has also been proven to work in a
variety of settings including in-patient facilities and counseling offices (Henricksson, 2016).
Compatibility with Diverse Cultures
CBT has such a basic principle, that our thoughts determine our lives, that it is easily
applicable across cultures and communities, though it does not actively pursue diversity. Instead,
CBT ignores diversity concerns almost entirely. This can be a positive and negative. One issue
with CBT is that it focuses so much on the individual that it can sometimes ignore outside factors
completely. When factors such as race, gender, and culture play a part in situations, CBT is inept
at handling it on its own.
Appropriateness for Crisis Intervention
CBT is typically used for long-term results and can also be helpful in crisis situations. In
a situation such as a suicidal person, CBT can help identify the faulty thinking and change the
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subsequent behaviors. CBT is not as helpful on its own in times of natural disaster, war, or other
traumatic events. These traumas are not removed with a change of thinking and behavior.
However, CBT is still a resource as confronting thoughts and feelings about a disaster can help
an individual better understand a trauma.
Christian Worldview Compatibility
CBT is compatible with Christian beliefs. In the Proverbs it says that as a man thinks, so
is he (English Standard Version, 2001). This means that a person is made up of their thoughts
and feelings. These thoughts and feelings lead to behaviors and behaviors lead to identity. This
biblical concept is the premise of CBT.
In the Bible, Paul writes that we are to take every thought captive (English Standard
Version, 2001). This scripture means that we are in control of our thoughts and should think
intentionally and in the right way. The idea of intentional thinking is a core concept of CBT as
well.
The book of Romans speaks of renewing your mind on a daily basis (English Standard
Version, 2001). This renewal of the mind is both a biblical and a CBT principle. The concept of
renewing the mind means to have a new perspective and to have a fresh outlook on life. The idea
is that as time goes, thoughts and beliefs become rooted in us without us realizing. By renewing
our mind and addressing these beliefs, we can live more intentionally.
Case Conceptualization Using Cognitive Behavioral Therapy
Winston Schmidt has multiple presenting issues including moderate to severe anxiety,
boundary issues, and issues regarding his self-esteem. These issues are clearly linked to faulty
thinking patterns that I will help resolve with CBT. The following plan will use the Clinical
Targets Approach form the Inverted Pyramid Method.
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Cognitions
Schmidt has a variety of flawed thinking that relates to his presenting problems. One
thought is that his value comes from other people. He believes that without being a value to
others, he is not of value at all. Another faulty belief is that perfection is the expectation. He
expects perfection of himself and his environment. He thinks that he must be perfect to be
worthy of love.
Affect
The expectation of perfection leads to many negative feelings. When his environment
does not meet his high standards, he feels anxious. When others do not meet his high standards,
he feels frustrated. When he does not meet his high standards, he feels like a failure. He also
feels dejected when he is not of importance or a helping friend to others. Without the outside
benefit of the praise and gratitude of others, he feels incomplete and somewhat empty.
Behavior
These thoughts and feeling are the cause of many unhelpful behaviors for Schmidt. He is
often overzealous to help others, even when they do not want to be helped. He ignores instances
of boundary violations for fear that it will upset others, and his main goal is to be loved by
others. In addition, the feeling of dejection when he does not feel like an important part of others
lives gives way to somewhat manic attempts to change the situation.
Physiological Elements
Schmidt deals with a moderate amount of anxiety due to the thoughts and behaviors he
exhibits. He often feels restless and sometimes nauseous. Even when things go the way he wants
them to, Schmidt exhibits a lack of energy and digestive issues. He also has difficulty
concentrating and struggles with insomnia.
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Theoretical Inferences
Schmidt’s faulty thought pattern is the cause of many unhelpful behaviors and
uncomfortable feelings. Because he feels worthless when he is not being actively of use to
others, he often allows people to take advantage of him, especially his friends and employer. His
expectation of perfection in his environment causes him to spend hours cleaning and maintaining
a shared space. When the space is not clean and organized, Schmidt feels overwhelmed and
restless until it is perfect. His thought that love is something earned by being perfect gives way to
an unhealthy balance in friendships where he gives more than he receives. He also crosses the
boundaries of others when he feels the need to be needed and inserts himself into situations
where he is unwelcome. All of these things cause him physical and mental distress.
Narrowed Inferences
There are a few core beliefs that need to be addressed when it comes to Winston Schmidt.
The first core belief is that he must be perfect to be of value. He believes that if he does not
perform at a constant level of perfection that he is not worthy of love, friendships, and
opportunity. The next core belief is that his value comes only from what he can do for others. His
understanding is that without being of active contribution to others, he is not valuable to them.
Evidence Based Considerations
CBT is an appropriate therapy to use for Winston Schmidt. His concerns are based in
faulty thinking and automatic thoughts that can be shifted and changed. By changing these
negative thought patters, Schmidt’s behaviors will change as well. Once both thoughts and
behaviors are properly adjusted, Schmidt can replace the negative beliefs and behaviors with
positive ones and live a more fulfilling life.
Ethical Considerations
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There are a few ethical considerations for CBT and its use in modern counseling. The
first is that the counselor has room for error and can understand different cognition than is
actually present. By being wrong about the thought patterns, they may unintentionally encourage
negative thoughts that did not previously exist. It is also often up to the counselor and not the
client to identify thoughts that may need to be changed. This can mean that a counselor is
forcefully changing beliefs that the client may not want to be changed.
Cultural Considerations
In this particular case, there are cultural considerations that must be examined. Schmidt
was raised in a Jewish household and still holds partially to his faith. In this instance I, as the
counselor, should be very aware of what beliefs I challenge. I should be careful to only challenge
thoughts and beliefs that the client wants to change and not impose my own core beliefs on the
client.
Theoretical Interventions
Recognizing and Challenging Thoughts
This intervention is the core of CBT and would be effective in the case of Winston
Schmidt. For this intervention counselor and client will work together to uncover core beliefs
and faulty thinking that is the root of the behaviors and feelings. Once these are uncovered, they
will work together to challenge these thoughts. The challenging process goal is to replace faulty
thoughts with positive beliefs.
Stimulus Control
This technique is specific to Schmidt’s presenting insomnia related to his anxiety. The
underlying thought is that if someone can help their brain associate the bed with rest and
relaxation, they will be able to have a better night’s sleep. Schmidt should avoid using the bed
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for activities other than sleep and sex. If he feels restless or unable to sleep, he should leave the
bed and do another activity until he feels ready to sleep. This removes the association of the bed
with other feelings such as restlessness and stress.
Relaxation Training
In order to address the anxiety and feelings of unease, stress, and restlessness related to
Schmidt’s faulty thinking, teaching him relaxation techniques would be very beneficial. These
are techniques to bring instant stress relief and are simple and easy to do. Exercises including
deep breathing, progressive muscle relaxation, and imagery.
Spiritual Application
Schmidt is a Jewish man by heritage but does not regularly practice the faith. Because he
has not expressed a desire to incorporate spirituality into the therapy, I will avoid doing so. If he
requests, I can focus on the common beliefs of Christianity and Judaism such as principles of
love and the effectiveness of prayer.
Prognosis/Outcome
The outcome of this therapy will be that Schmidt will have a changed thought process
and will have replaced negative and faulty thinking with positive thoughts and beliefs that more
align with his values. When this thinking is changed, Schmidt will be more empowered to set
healthy boundaries, establish positive self-esteem, and reduce symptoms of anxiety.
Theoretical Orientation
CBT is in alignment with my personal values and beliefs of human nature. I believe that a
person’s life is guided by their thoughts and beliefs, both conscious and unconscious. I agree that
by addressing core beliefs and challenging their accuracy a person can live a more intentional
life. By living a life guided by intentional thoughts, a person will be more likely to have rational
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and healthy behaviors.
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References
Corey, G. (2021). Theory and practice of counseling and psychotherapy. Cengage.
Crossway Bibles. (2001). Holy Bible: English standard version.
Free, M. L. (2015). Cbt and Christianity: Strategies and resources for Reconciling faith in
therapy. Wiley-Blackwell.
Henriksson, S., Anclair, M., & Hiltunen, A. J. (2016). Effectiveness of cognitive behavioral
therapy on health-related quality of life: An evaluation of therapies provided by trainee
therapists. Scandinavian Journal of Psychology, 57(3), 215–222.
https://doi.org/10.1111/sjop.12291
Ratnayake, S., & Poppe, C. (2020). Ethical issues in cognitive-behavioral therapy. Oxford
Handbook of Psychotherapy Ethics, 513–528.
https://doi.org/10.1093/oxfordhb/9780198817338.013.43
Schwitzer, A. M., & Rubin, L. C. (2015). Diagnosis & treatment planning skills: A popular
culture casebook approach. SAGE Publications, Inc.
Tan, S.-Y. (2022). Counseling and psychotherapy: A Christian perspective. Baker Academic, a
division of Baker Publishing Group.
Waller, R., Trepka, C., Collerton, D., & Hawkins, J. (2010). Addressing spirituality in cbt. The
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