Martinez M Case Conceptualization Using Cognitive Therapy.pdf

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Case Conceptualization Using Cognitive Therapy

Melissa S. Martinez

Liberty University Online

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Abstract

This paper will discuss Cognitive Therapy and how it would best benefit the client, Mr. Walt

Kowalski. Walt Kowalski is a mid-60 year old male who is a Korean War veteran, a recent

widow, and father to two. Walt Kowalski presented with problems regarding anxiety, depression,

guilt, post-traumatic stress, anger, relationship concerns, and spiritual health concerns

(Eastwood, 2008). Cognitive Therapy is based on the belief that each individual is in control of

their dysfunctional thoughts. The dysfunctional thoughts lead to distorted views of events which

affect the individual’s behaviors and feelings (Murdock, 2017). This therapy is found to be best

applicable to Mr. Kowalski’s case by incorporating the various techniques, to include

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Case Conceptualization Using Cognitive Therapy

Developer

The developer of Cognitive Therapy, also referred to as Cognitive Behavior Therapy, is

Aaron T. Beck. Cognitive Behavior Therapy is a generally used term to cover not only cognitive

functions but behavioral dysfunction as well. This includes coping skills, problem-solving skills,

dialectical behavior tactics, and acceptance therapy (Murdock, 2017, p. 307). Aaron T. Beck lost

two of his siblings when they were children and because of this, he felt as though his mother was

overprotective of him, especially due to him almost dying, as well. His influences for developing

Cognitive Therapy derive from Immanuel Kant, Magda Arnold, George Kelley, Albert Bandura,

also considered to be an adaptive theory. This means that human motivation derives from three

evolutionary goals. These goals include survival, resource conservation, and reproduction. “The

basic needs of humans include preservation, reproduction, dominance, and sociability”

(Murdock, 2017, p. 311).

Efficacy Research

While Murdock (2017) states that much of the support for Cognitive Therapy is mixed,

some studies state that the strongest rates of Cognitive Therapy effectiveness lies within treating

individuals with concerns regarding anxiety disorders, bulimia, anger control problems, general

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stress, and somatoform disorders. Out of eleven studies conducted to compare response rates

between Cognitive Behavior Therapy and other types of therapy, seven of these studies strongly

supported Cognitive Behavior Therapy. Overall, Cognitive Behavior Therapy has strong support

of effectiveness (Hofmann, Asnaani, Vonk, Sawyer, & Fang, 2012). In regards to individuals

with low-functioning schizophrenia, Cognitive Behavior Therapy has shown a clinically

significant improvement in functioning from the beginning of treatment, to up to 18 months.

Much greater than the standard therapy given to these individuals, which includes antipsychotic

medications and psychosocial interventions (Grant, Huh, Pericoliotis, Stolar, & Beck, 2012).

Diagnoses

traumatic stress disorder, and mild evidence for schizophrenia and depression (Murdock, 2017).

Appropriateness

In regards to the client, Walt Kowalski, Cognitive Therapy seems to be the most

appropriate theory therapy that could be applied. Mr. Kowalski had presented with problems that

included anxiety, depression, anger, guilt, relationship concerns, and spiritual health concerns. As

stated in Murdock (2017), Cognitive Therapy has been found to be most effective in disorders

and concerns such as the anxiety, depression, and anger that Mr. Kowalski presents. Cognitive

Therapy would also be most appropriate for Mr. Kowalski because it would best benefit the

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client to understand the entire process of therapy that Cognitive Therapy consists of, since Mr.

Kowalski also has concerns about being helped by someone who is younger than himself.

Ethical Issues

There are very few ethical concerns in Cognitive Therapy. In general, some ethical

concerns include inappropriate therapist reactions and other therapist errors (Murdock, 2017). In

regards to Christian therapists incorporating spiritual and Cognitive Therapy in their sessions,

there are some ethical concerns. For example, when providing psychotherapy and spiritual

direction, it can become an ethical concern when billing insurance because it is controversial on

how to bill psychotherapy when there was spiritual direction as part of the session (Jones &

Western clients are more likely to accept multiple explanations rather than one (Murdock, 2017).

This could be a possible experience when handling a counseling session with Mr. Kowalski.

Crises

Cognitive Therapy is an ideal therapy in crisis situations. Cognitive Therapy is a

psychoeducational model of therapy which is extremely important in crisis situations. Instead of

trying to cure the patient, Cognitive Therapy focuses on helping the client gain necessary skills

to cope with their own thoughts. In a crisis situation this psychoeducational framework can

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promote better coping strategies and skills to handle the trauma that has affected the client (Beck,

Interventions

Walt Kowalski is the main character from Gran Torino (Eastwood, 2008). He presents

concerns regarding his Korean War past, the recent passing of his wife, anxiety, guilt, depression,

relationship issues with his children, and spiritual health concerns. Mr. Kowalski has new Korean

neighbors who constantly remind him of his traumatic experiences in war. With the recent

passing of his wife, his children have not been emotionally available for him which leaves him

with much anxiety and depression. His late wife had always wanted him to be more involved

client questions that help the client further examine their thoughts and beliefs around a topic or

event (Murdock, 2017). This could be extremely useful in helping Mr. Kowalski understand the

differences between his past and his present as well as handling his anxiety, depression, and guilt

about his past.

Social Skills Training

Another therapeutic technique that would benefit Mr. Kowalski is social skills training.

Social skills training is when the counselor teaches the client how to productively interact with

other people. Typically, this involves role-play scenarios, coaching, and modeling (Murdock,

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2017). This technique would be extremely beneficial for Mr. Kowalski and his relationship

concerns. A way to implement this therapeutic technique with Mr. Kowalski would be to

incorporate role-play scenarios to help him interact with his next door neighbors as well as his

children.

Thought Recording

The third therapeutic technique that would benefit Mr. Kowalski is thought recording.

Thought recording is a technique that is almost always utilized by cognitive therapists. This is

when the counselor give the client an assignment to record the occurrences and instances of

automatic thoughts between scheduled sessions (Murdock, 2017). This could help Mr. Kowalski

Kowalski has never been much of a religious individual and only attended church services to

make his late wife feel better about spirituality and their relationship. Another challenge is that

the priest at his wife’s church is constantly trying to get Mr. Kowalski to come to services alone

and to confess his sins but Mr. Kowalski is getting more aggravated each time the priest is

approaching him. Therefore, religion and spirituality are not something Mr. Kowalski wants to

be bothered with (Eastwood, 2008). A way to handle this case if Mr. Kowalski were to be

interested in having Christian Counseling be a part of the treatment plan would be to always ask

before including anything about spirituality and religion. Just because one counseling session,

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Mr. Kowalski would like to end with a prayer, does not mean that he would want to end with a

prayer at the next counseling session.

There are many compatibilities between Cognitive Therapy and Christianity. To begin,

Cognitive Therapy holds a high standard on human rationality which is compatible with the

words of Paul (Philippians 4:8-9) which state “Whatever is true, whatever is noble, whatever is

right, whatever is pure, whatever is lonely,… think about such things… And the God of peace

will be with you” (Jones & Butman, 2011). The second compatibility with Christianity is that in

Cognitive Therapy, the thoughts an individual has, is under control of the individual and these

thoughts have an effect on the life of the individual. Much like suffering in the bible, if we do not

Conclusion

In conclusion, Cognitive Therapy, which focuses on helping individuals understand their

thoughts and behaviors and how they can have control over them, would be the most beneficial

therapy to implement with Walt Kowalski (Murdock, 2017). The outcomes of this theory would

result in Mr. Kowalski having a better understanding of how to productively interact with his

neighbors and children, understand and interpret the guilt and depression he feels from his war

past, as well as becoming more consciously aware of his automatic thoughts. The most

challenging aspects of this treatment would be getting Mr. Kowalski to feel comfortable with

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having a younger counselor than himself helping him understand a life the counselor has never

lived, as well as letting Mr. Kowalski feel as though the counselor can be trusted completely.

Building the therapeutic alliance that is so important in Cognitive Therapy, may a challenging

and timely process (Murdock, 2017).