The purpose of this post is to discuss cognitive behavioral techniques that would be appropriate in the treatment of this case client. Alana, the client, has been diagnosed with depression and is motivated to work with the therapist. She has a childhood history that includes trauma. She was often berated by her elder, male, siblings and despite her efforts, was told she was not a successful student and was physically punished for her writing. She also has a history of sexual abuse in childhood and in college. She is now married and expecting her first child. She feels that if she had had more support from her family, she would not have so many problems.The goal of cognitive behavioral therapy is to discard self-defeating perspectives on life and help clients acquire more accepting and rational views (Corey, 2017). This is accomplished by teaching the client how they incorporated self-defeating beliefs, how these beliefs continue to persist, and how they can teach themselves new ways of thinking that will affect their behavior and feelings (Corey, 2017). Initially the therapist will build alliance with the client by listening to and understanding the client’s story, validating the client’s experiences, and respecting her goals for therapy (Faber & Lee, 2020). Educating the client about CBT as the best fit treatment also gives her the opportunity to ask questions and share concerns about the CBT approach (Faber & Lee, 2020). Approaching Alana’s treatment plan based on cognitive theory requires digging deeply into her underlying core beliefs. Cognitive theory states that it is the client’s perception of their situation that elicits an emotional or behavioral response, rather than the situation itself (Faber & Lee, 2020). Though she may be unaware of her core beliefs, the therapist can identify any cognitive errors by exploring Alana’s cognitive information processing at the automatic thought level (Faber & Lee, 2020). The therapist can further assess the accuracy and rationale of these cognitive errors by using techniques such as thought monitoring and change by cognitive restructuring to reduce the intensity of emotions that have resulted from negative thoughts and errors in cognition (Faber & Lee, 2020).Teaching the client about cognitive errors, while conveying understanding and empathy for the client’s situation, will help her understand how repetitive negative experiences in her life created negative thoughts that formed into rigid cognitive errors (Faber & Lee, 2020). By teaching the client how to assess the validity of negative thoughts and how to resist and rescript them, the process of cognitive restructuring takes place (Faber & Lee, 2020). Having the client keep a thought record can help her recognize when a thought is not true and can help her to establish alternative thoughts which can lead to reducing the intensity of negative self-appraisal and emotions (Faber & Lee, 2020). Training the client in the stress inoculation model: conceptual-educational phase, skills acquisition and consolidation phase, and application and follow-through phase can help her learn how to respond to stressful situations, develop new coping skills, practice relaxation methods, practice new self-statements, and apply new skills (Corey, 2017). Because CBT uses the client’s belief system as part of the method of self-exploration, it is inherently culturally sensitive (Corey, 2017). Teaching Alana how to communicate her wants and needs in her workplace may require that she become more assertive. Communicating these needs and learning how to set boundaries can be practiced during therapy by role playing (Faber & Lee, 2020). Using CBT as a problem-solving approach can help the client understand her options so she can take the best course of action (Everitt-Penhale, 2019).

 

References

Corey, G. (2017). Theory and practice of counseling and psychotherapy (10th ed.). Boston, MA: Cengage.Everitt-Penhale, B., Kagee, A., Magidson, J. F., Joska, J., Safren, S. A., O’Cleirigh, C., Witten, J., Lee, J. S., & Andersen, L. S. (2019). “I went back to being myself”: acceptability of a culturally adapted task-shifted cognitive-behavioural therapy (CBT) treatment for depression (Ziphamandla) for South African HIV care settings. Psychology, Health & Medicine, 24(6), 680–690. 

https://doi.org/10.1080/13548506.2019.1566624

Faber, J., & Lee, E. (2020). Cognitive-behavioral therapy for a refugee mother with depression and anxiety. Clinical Case Studies, 19(4), 239–257. 

https://doi.org/10.1177/1534650120924128

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