Running head: TREATMENT PLAN 1
Treatment Plan for Ms. Margaret Tate: Cognitive Therapy
Liberty University
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Abstract
Cognitive Therapy stands on the foundational belief that one’s maladaptive thoughts lead to
skewed perceptions of situations, and those situations will, in turn, produce negative feelings, as
well as, negative behaviors. Cognitive Therapy has been found to be one of the most researched
approaches to therapy and has been proven to be quite effective concerning a large range of
diagnoses, which include anxiety disorders. The client in this paper, Margaret, has skewed
thoughts, which include perfectionism. She has a hard time making proper social connections
and an even harder time regulating her emotions. She makes a catastrophe out of most of her
situations with no way to support what she perceives. However, she is highly intelligent and
rational, making her a perfect candidate for Cognitive Therapy. This form of therapy caters to
Margaret’s strengths, like rational thinking and planning, while simultaneously challenging her to
learn new practices towards attaining her goals. While this education approach may be a good fit
for Margaret’s desire for knowledge, it may not be a good fit for her religion.
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Case Conceptualization of Ms. Margaret Tate using Cognitive Therapy
Cognitive Therapy was founded by Aaron Beck. There are a good number of other
therapies that are categorized under the umbrella of Cognitive Therapy including Cognitive
Behavioral Therapy. The main identification for a good number of therapies that accentuates the
role of cognition in intervention and dysfunction is Cognitive Therapy (Hofmann, Asmundson, &
Beck, 2013). A good number of contemporary psychologists concur that Cognitive Behavioral
Therapy has allowed for the vast development of exclusive and efficient cognitive and behavioral
interventions that are capable of developing symptom belief (Hofmann et al., 2013).
According to Murdock (2017), how one perceives an event effects both feelings and
thoughts, and those particular feelings head directly towards behavioral consequences in
Cognitive therapy. The main purpose of Cognitive Therapy is to reconstruct maladaptive
thoughts, so that behavior leads to optimal consequence of survival, as well as, adaptation
(Hofmann et al., 2013). The main function of Cognitive Therapy is to identify maladaptive
thoughts that may contribute to emotional dysfunction (Hofmann et al., 2013). According to
Murdock (2017), the counselor walks alongside the client helping them to become aware of the
enlightened knowledge for which they seek, and the therapist has more of a guiding hand type of
role. In the beginning of the counseling relationship, the counselor may act more like a teacher,
educating the client on the specific process and laying out the goals that are to be met. Through
the walk of therapy, the counselor is to encourage the client to take charge of what his/her
treatment path will be, and this makes the counselor/client relationship strong.
According to Murdock (2017), Beck did create the blueprint for Cognitive therapy
making it very popular for research, but the findings have been found to be pretty weak. In fact,
depending on the client’s issues, the support could actually change. According to study
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conducted by Schroevers et al. (2017), there was a 61% increase in depressive symptoms over
time in clients who were treated at the Center for Cognitive Therapy (CCT). It has been learned
that several empirical studies which do, in fact, support Cognitive therapy for many different
anxiety issues, work along well with behavioral approaches too (Murdock, 2017). Cognitive
Behavioral Therapy, which is a branch of Cognitive Therapy, applies behavioral techniques that
have been found to be greatly effective in treating anxiety disorders (Grensman et al., 2018).
Adding emotional regulation and mindfulness approaches are believed to greatly help the client
(Grensman et al., 2018).
Cognitive Therapy, like stated before, is wonderfully effective when it comes to treating
various anxiety and depressive disorders. Also, Cognitive Behavioral Therapy has been found to
have positive effects. In relation to Margaret, short-term Cognitive Behavioral Therapy
interventions were shown to be positively associated with a decrease in clinical caviling
(Hofmann et al., 2013). For Margaret, the counselor/client relationship should begin in an
environment where the counselor is, as well as, viewed as the professional, or expert, and the
sessions should wrap up with her more confident to solve her own problems (Murdock, 2017).
Margaret is a very smart woman, so it is likely that she will prefer a counselor who is
educated and highly recommended. Her independent nature will allow her to figure out her own
issues, using the counselor as a guide (Murdock, 2017). Thankfully, there is cognitive research
related to perfectionism, which is one of Margaret’s main problems, which makes this approach
the most appropriate (Handley, Egan, Kane, & Rees, 2015). Lastly, according to Murdock
(2017), social skills training is found to be highly effective in Cognitive therapy practices.
Margaret has never had a support group, let alone knows how to establish one, making it difficult
for her to reach out to others. Social skills training will help her in this area.
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Transference, in fitting responses, to the client’s reactions, and counselor fault are the
primary ethical responsibilities surrounding Cognitive Therapy, according to Murdock (2017).
Margaret has an impetuous personality, so it is possible that a counselor could misunderstand her
responses. However, selecting an effective and competent counselor should reduce the chances
of this happening. In crisis situations, Cognitive Therapy is preferred, and since it is short-term,
results can be seen fairly rapidly. In fact, according to Murdock (2017), a client’s emotional
discomfort can decline in the first session by employing rapid symptom relief approaches. In
relation, throughout these sessions, clients discover how to solve their own issues, as well as,
question where their thoughts may be coming from in Cognitive therapy approaches.
Interventions
Margaret has voiced several issues in her social, private, and working life. She is a self-
involved perfectionist who cannot meet her own unrealistic expectations. She greatly suffers
from depressive and anxiety-type symptoms when she finds herself falling short of reaching her
own highly-set standards. Due to the emotions that present a shadow over the relationships in
her life, she is having a very difficult time making any healthy connections with those in her
immediate social circle. She has trouble with emotional regulation when she does experience
strong emotions, making her react strongly and extreme at times. She is concerned with
presenting herself to others for fear of being perceived wrongly. She believes that this may
create adverse reactions towards her.
After going into detailed explanations with Margaret on the functioning of Cognitive
therapy, three goals were agreed upon to focus on extensively. The first goal focuses on her
perfectionist ways and how to better manage the anxiety she experiences from her negative self-
view. Secondly, it is suggested that Margaret takes the time to make the effort towards
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establishing healthy and genuine connections with those who she finds meaningful in her life.
Lastly, Margaret will focus on accepting and better regulating her emotions as the surface.
Questioning
The questioning technique suggests that the client ask him/herself what he/she is thinking
and why he/she is thinking it (Murdock, 2017). According to Socratic thinking, the client learns
that there might not be any proof leading to their wrong thinking. For instance, Margaret could
be asked what would happen if she were to submit a final report to her boss that full or errors.
She may respond that she will probably lose her position in the company, and that her boss
would probably give it to someone that she believes is better. Then, Margaret should be asked
what gives her this idea and what evidence does she have to support it. It is important that she
realizes that she is making assumptions concerning her boss without prior knowledge to support
her thoughts. Hopefully, in the future, Margaret will become more aware of these skewed
thoughts that are capable of surfacing, prompting her to question herself to a more sensible
conclusion.
It is possible that the perceived negative conclusion may come to pass, so how she would
handle it needs to be addressed. Confronting maladaptive thoughts so that the client becomes
more aware that he/she is assuming the worst possible conclusion without having all the facts, is
important to address with someone as strong-willed as Margaret. Considering that questioning is
organized, and forthright, very little apprehension is involved, making this the best approach to
take considering Margaret’s strong personality.
Emotional Regulation
Emotional regulation is crucial to Margaret reaching the goals that were set. According
to Goldin et al. (2014), emotional regulation starts off with very plain approaches that will allow
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her to become knowledgeable of what she is feeling, pinpoint it, and then decidedly react the
correct way. For Margaret, keeping a record of her positive emotions would be helpful, since she
prefers things to be orderly. Interventions that are designed to help those with emotional
regulation must include an increase in positive emotions and address any negative emotions
because positive emotions have the ability to affect the path and extent of experiencing negative
emotions (Goldin et al., 2014). Hopefully, Margaret will one day be capable of acknowledging
her emotion, pinpointing the source, and react accordingly in a proper manner.
Social Skills Training
Most of Margaret’s relationships were all within her company before she met Andrew.
These relationships at work involved her dominating all the conversations, making her co-
workers scared to even approach her. She never had a proper social life or support system. Now
she wants this relationship with Andrew to work, so she wants to learn how to interact with
others in an appropriate manner. According to Murdock (2017), social skills training is one of
the main components of Cognitive Therapy, and role playing and coaching, which are a part of
Cognitive Therapy education, will work will in this situation. Margaret will be encouraged, in
sessions, to discuss any future events that are on her calendar, like family get-togethers, and there
will be an acting out of all the possible interactions that she may have, so that she will be better
prepared to handle them. Modeling the appropriate behavior for her for each situation will help
ease her anxiety towards those situations. Hopefully, over time, Margaret will become more
comfortable with her social skills, building her confidence, which will be the foundation that
future sessions will build upon.
Spiritual Application
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It is very clear that Margaret loves being in control of her life, and that it drives her crazy
when she is not. What she needs is for the Lord to take the reins of control for her. Proverbs 3:5
commands all people, this includes Margaret, to trust Him with all of one’s heart and not lean on
one’s own understanding. Cognitive Therapy suggests a comprehension and understanding of
thoughts, actions, and feelings. In Margaret’s case, to surrender these would go directly against
everything she is comfortable with. According to Jones and Butman (2011), the job of the
counselor is to assist the client in constructing a story that brings about a certain degree of hope
and peace. Cognitive Therapy suggests that the counselors are the guide and the clients discover
their own path. The Holy Ghost guides the way, in the Christian faith, and the Lord gives His
followers the most supportive hope and peace there is. In this situation, both Margaret and the
counselor would have to acknowledge that neither of them is in control.
In Cognitive Behavioral Therapy, there have been no less than 10 studies conducted that
involve the use of God’s word and prayer (Knabb, 2012). It is the counselor’s goal to affirm
Margaret’s behavior and progress based on the God’s written word, which will produce change
that will improve her life, produce fruit, and encourage her to serve Him more. In her case,
though, an empirical study concerning this area would probably be most effective since she
prefers to utilize methods that have been proven to work.
In the instance that Margaret would require a referral, a Christian support group who
focuses a great deal on anxiety-type issues would be best, considering she struggles quite a bit in
this area. In a support group, she will be able to hear from fellow Christians who have turned to
God for help. She will also be able to practice on some of her social skills in this group setting.
This would be good for her. If she is not comfortable expressing her thoughts and feelings in this
manner, she can always begin in an online support group. A third option, for her, would be to
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join a meditation group, considering that she could probably use the quietness of a class like this
to unwind some of her many stresses. Meditation is used quite frequently in Cognitive Therapy,
according to Knabb (2014). This is a simple option for Margaret because she can join any
meditation group and fully focus her mind on God’s presence, where nobody else is involved.
She can become closer to God in this setting, as well as, relieve some physical tension that she
may be experiencing.
Considering that there are several different areas of Cognitive Therapy, it is not very hard
to find an area that works well with Christianity. According to Murdock (2017), Cognitive
therapy was born from a place of unsuitable morals where everyone is broken is some form or
fashion and needs to work towards becoming unbroken again. Christians are the same way,
broken and sinners who need redemption. According to Jones and Butman (2011), Cognitive
therapy supplies itself to Christianity through its ability to adapt.
According to Murdock (2017), in Cognitive therapy, clients are believed to be able to
control their reactions towards situations by also controlling how they perceive those situations.
As stated earlier, in Christianity, one must relinquish control of one’s life to God in order to
receive peace and maintain a spiritually healthy lifestyle. Cognitive therapy and Christianity
disagree when it comes to what each believe truth is. Cognitive therapists hold the belief that
truth is something that is entirely man-made (Jones & Butman, 2011). Christianity’s core belief
is that God’s word is absolute truth. What the client believes is a rational perception that the
therapist may or may not agree with, and this could go both ways. However, this could,
unfortunately, lead to the client disengaging and possibly questioning his/her own Christian
beliefs.
Conclusion
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Margaret will benefit quite a bit from Cognitive therapy, or any therapies that fall under
this category because it is rational. Margaret likes educating herself and working towards goals,
which allows her to use her molded intellect. Cognitive Therapy can best be described as
perceptions that affect thoughts and feelings, which in turn, affect behavior, according to
Murdock (2017). Margaret is highly intelligent and very driven. However, her outlook is
skewed by her weakness when it comes to socializing properly and her inability to get a nice
firm grip on her emotions. Socratic questioning, molding, and recording can teach her how to
change how she thinks, which can in turn, change how she acts (Braun, Strunk, Sasso, & Cooper,
2015). It is no secret that Margaret enjoys a good challenge. Focusing on facts that will support
her new thoughts and perceptions may very well interest her. The most challenging goal for her
will be recognizing and labeling her various emotions. Until she gets a handle on this, she will
continue to have problems at work and with Andrew. Cognitive Therapy approaches are
definitely a good fit for Margaret because of her belief that everything should be intellectual and
organized. However, for Margaret to effectively reach her goals, she needs to acknowledge that
intellectual and organized are, in fact, different.
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References
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Goldin, P., Ziv, M., Jazaieri, H., Weeks, J., Heimberg, R., & Gross, J. (2014). Impact of
cognitive-behavioral therapy for social anxiety disorder on the neural bases of emotional
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