Case Study Paper - COUN 835

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CASE STUDY: COGNITIVE THERAPY FOR MR. C Case Study: Cognitive Therapy for Mr. C Jennifer Marisol Tayler Fort Hayes State University, Masters in School Counseling Program COUN 835 Theories of Counseling Brian Weber, PhD, NCC 5 November 2023

CASE STUDY: COGNITIVE THERAPY FOR MR. C Case Study: Cognitive Therapy for Mr. C Abstract This paper considers the application of cognitive behavioral therapy to the case of Mr. C. Cognitive behavioral therapy was developed in the 1960s by Aaron Beck (1921-2021); this therapy is a good match for Mr. C because it teaches clients how to adjust or correct the counterproductive or faulty ways of thinking in order to improve their behavior or actions with the goal of enhancing their overall quality of life. According to the theory behind cognitive behavioral therapy, psychological problems are based on learned patterns of maladaptive beliefs, and by learning alternative and more productive thought patterns, one can cope with or correct psychological symptoms to improve how they function in life. This paper explores the rational for using a cognitive behavioral approach in treatment by identifying Mr C’s presenting problems, presenting a potential treatment plan, explanation of how cognitive behavioral therapy to address Mr. C’s most immediate concerns (such as depression and chest pains). This paper will also suggest some of the useful cognitive behavioral strategies that may be effective for Mr. C.

CASE STUDY: COGNITIVE THERAPY FOR MR. C Presenting Problems Mr. C reports experiencing depression, relationship problems, low self-esteem, a lack of confidence, social avoidance, career stagnation, and chest pain. After receiving an ultimatum from Mr. C’s girlfriend that they either marry or terminate the relationship, he is feeling more pressure to advance his career. He is also struggling with societal and personal norms around gender roles (e.g., the male as financial provider) associated with discrepancy between his salary and his girlfriend’s. Current expectations associated with athletic activities connected to his childhood reluctance to participate in sports, which was one way he failed to meet his father’s expectations. Mr. C also reports repression of his creative outlet, playing the piano, and grief following the loss of his mother six years ago. Mr. C struggles to express his needs effectively, and to plan and effectively take action to meet goals in both his personal and professional life. The purpose of cognitive behavioral therapy is to work with a therapist to identify ABC’s that contribute to his probkems. The A, antecedents or triggers; B, the behaviors to be targeted for treatment; C the consequences of behaviors. Once Mr. C and his clinician have identified the ABS’s in Mr. C’s life, they can develop effective coping mechanisms to be used in a variety of situations correct maladaptive behaviors and beliefs. Through cognitive behavioral therapy, Mr. C will be able to identify goals and discover the causes for his inhibitions and maladaptive behaviors. Since cognitive behavioral therapy aims educate the client in the prevention relapse and regression, and to help the client to become their own therapist, homework and activities in addition to and beyond traditional talk therapy will help the client to learn to apply techniques independently. This meets Mr. C’s needs, as it will address the variety of his related presenting problems, and set him up for ongoing success in addressing future obstacles.

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CASE STUDY: COGNITIVE THERAPY FOR MR. C Potential Treatment Plan Cognitive behavior therapy “aims to decrease the frequency of maladaptive behaviors and increase the frequency of adaptive or helpful behaviors” (Wedding & Corsini, 2019, p.201). To achieve that goal, cognitive behavioral therapy should begin with assessment and setting specific and measurable goals and determining target behaviors. “Every client is assessed before treatment begins, and the assessment process continues throughout the course of treatment—and often after treatment has ended” (Wedding & Corsini, 2019, p.214). In the case of Mr. C, assessment would include the Beck Depression Inventory (BDI) to screen for depression and the results could be used to measure both the severity of his depression as well as any behavioral manifestations of depression (Beck et. al., 1961). The Career Beliefs Inventory (CBI) could be used to identify Mr. C’s beliefs and assumptions which may circumscribe his career promotion opportunities (Krumboltz, 1994). Subsequently, the “[d]ata collected during the course of behavioral assessment are readily shared with the client. The client is an active partner in the therapy process, including setting treatment goals and setting the agenda for each session” (Wedding & Corsini, 2019, p.201). The clinician would also conduct a psychophysiological and behavioral assessments. The results of all of the aforementioned assessments are to be used by the client and therapist who will collaboratively set goals for Mr. C to work towards. Following assessment, a behavioral interview would be conducted to “help the therapist understand both the form and function of behavior” (Wedding & Corsini, 2019, p.215). This information can identify behavioral deficits and excesses. The clinician will develop a hypothesis for addressing maladaptive behaviors, and work complete functional analysis and behavioral observations. The clinician will develop hypothesis about how to impact the

CASE STUDY: COGNITIVE THERAPY FOR MR. C maladaptive behaviors and create homework assignments for Mr. C to practice in order to achieve his treatment goals. Cognitive behavioral therapy would be effective for Mr. C because although he appears to be committed to therapy and working towards achieving his various goals and addressing his concerns, he needs the guidance afforded by the more active, confrontational, and directive role assumed by clinicians as part of cognitive behavioral therapy. Mr. C appears to be motivated enough to complete homework assignments, and to self-monitor his progress via diaries and other self-reporting scales. Cognitive behavioral therapy is driven by empirical evidence. Because none of Mr. C’s goals can be attained in a brief time period, documentation of his progress towards achieving his goals will serve as positive reinforcement for himself and his girlfriend. Treatment for Most Immediate Concerns Mr. C’s immediate and interrelated concerns appear to be depression, chest pains, and career advancement. Cognitive behavioral therapy has been empirically proven be effective in the treatment of all of these concerns. Cognitive behavioral therapy has “been found to be effective for both the treatment of unipolar depression and the prevention of future depressive episodes” (e.g., Cuijpers, van Straten, Andersson, & van Oppen, 2008; Piet & Houggard, 2011, as cited by Wedding & Corsini, 2019, p.213). Cognitive behavioral therapy is considered one of the most well researched, evidence-based counseling theories and psychological interventions used in the therapeutic treatment of depression. Cognitive behavioral therapy is highly effective in the treatment of depression and “suggests the learning of communication skills, learning social skills, self-

CASE STUDY: COGNITIVE THERAPY FOR MR. C observation, negotiation skills, and increasing pleasurable activities” (Fréchette-Simard, 2018, p.279). Such interventions and strategies would help Mr. C to recognize triggers as well as develop interventions for interrupting cycles that produce depressed feelings and replace them with more productive behaviors in order to achieve his goals. Mr. C could also benefit from c ognitive behavioral therapy to help him address his chest pain. Psychological distress, such as depression, has been found to be associated with non- cardiac chest pain (Webster et. al., 2014), and Mr. C’s chest pains are not caused by cardiac issues or medical complications. Although on intake, the client listed chest pains at the end, almost as an afterthought, but it is clear that this issue is troubling Mr. C because he sought medical attention for his chest pains before seeking counseling for his depression. In a study comparing the outcomes for patients experiencing chest pain who received cognitive behavior therapy to those who received treatment was usual, cognitive behavior therapy led to improved patient outcomes on the clinical global impression severity scale after 24 weeks, and showed higher rates of improved depression (van Beck et. al. 2013). In this study, patients received six sessions that of cognitive behavior therapy which consisted of a combination of psychoeducation, cognitive restructuring and influencing avoidance behavior, according to the basic concept of cognitive behavioral therapy that physical complaints can be cognitively mediated (van Beck et. al. 2013, p.672). Following in the treatment suggested by van Beck et. al., (2013), Mr. C’s somatic symptoms such as chest pain may be treated through cognitive restructuring of the automatic depressive mood-provoking cognitions and the use of behavioral interventions and psychoeducation, which allow the client to control or at least minimize the chest pain they experience.

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CASE STUDY: COGNITIVE THERAPY FOR MR. C Cognitive behavioral therapy can also teach Mr. C how to work towards goals of capitalizing on his career opportunities for promotion and advancement. Cognitive behavioral therapists who are trained to use check-in practices, action steps, accepting the challenges of employment and self-sufficiency, time management, and other methods to identify behaviors that hinder career success and job promotion help clients cultivate behaviors to reach their career goals; such “skills complement CBT approaches for modifying automatic thoughts and underlying assumptions that lead to problematic behaviors or interactions at work” (Carmel & Comtois, 2023, p.224). Mr. C could use these techniques to express himself more effectively to not only achieve the goal of earning promotions and capitalizing on career advancement opportunities, but would also help him redress the discrepancy between his salary and his girlfriend’s salary which is an obstacle in his romantic life. Useful Cognitive Behavioral Strategies Although a great variety of strategies and tools are available to a skilled cognitive behavioral therapist, some of the many strategies that may be effective for Mr. C include behavioral activation for depression, social-skills training, and problem-solving training. Behavioral activation may be an effective tool to effect the purposeful reintroduction of piano playing into the client’s life. This strategy is “the therapeutic scheduling of specific activities for the client to complete in his or her daily life that function to increase contact with diverse, stable, and personally meaningful sources of positive reinforcement” (Kanter & Puspitasari, 2012, p. 217 as cited by Wedding & Corsini, 2019, p.221). Increasing Mr. C’s positive activity through an activity he enjoyed before his mother’s death will function as positive reinforcement and affect mood by changing what behaviors he engages in. Not only

CASE STUDY: COGNITIVE THERAPY FOR MR. C will he gain a positive activity to dispel some consequences associated with his depressed moods, but the positive benefits of doing something that brings him pleasure, joy, and gives him a creative outlet is life-affirming. This might also give Mr. C an access point for redressing his grief following his mother’s death, as she was the one who supported and encouraged his playing the piano in the first place. Social skills training will be introduced when a cognitive behavioral therapist is able to reframe Mr. C’s problem in which he perceives some quality, like the inability to earn a raise or warrant a promotion, as an intrinsic quality that is inherently wrong to a problem characterized by social skills. Mr. C’s cognitive behavior therapy would train him to express himself in the workplace more effectively in order to progress his career. Through problem-solving training, Mr. C would learn to 1) define problems, 2) identify feasible solutions, 3) evaluate available solutions, 4) select the best possible solution, and 5) implement the solution (Wedding & Corsini, 2019, p.222). This training would foster the effective solutions for some of Mr. C’s noted problems such as the conflict in his romantic relationship avoidance of sports, and other obstacles to effective communication. Conclusion Cognitive behavioral therapy is an ideal treatment for Mr. C because it is so effective in the treatment of depression, and would be effective in allowing the client to examine his beliefs regarding income disparity between the sexes and marriage. “Behavior therapists adopt a scientific, hypothesis-driven approach in their work. They speculate about the variables that contribute to a problem behavior, and they test out their assumptions through a range of behavioral-assessment methods” (Wedding & Corsini, 2019, p.200). This empiricism would be

CASE STUDY: COGNITIVE THERAPY FOR MR. C effective for Mr. C, because as he works towards achieving his goals, the evidence of his growth can be used as he progresses to prepare him for inevitable future obstacles at such time as, for example, a promotion opportunity may arise, as well as for the purposes of documenting his progress for his girlfriend as they work through their current and future relationship issues.

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CASE STUDY: COGNITIVE THERAPY FOR MR. C References Beck, A.T., Ward, C.H., Mendelson, M., Mock, J., Erbauch, J. (1961). An Inventory for Measuring Depression. Arch Gen Psychiatry 4 (6):561–571. doi:10.1001/archpsyc.1961. 01710120031004 Carmel, A., & Comtois, K. A. (2023). Integrating dialectical behavior therapy-accepting the challenges of employment and self-sufficiency (DBT-ACES) strategies into cognitive behavioral therapy. Journal of Contemporary Psychotherapy, 53 (3), 217-225. https://doi.org/10.1007/s10879-023-09580-z Fréchette-Simard, C., Plante, I., & Bluteau, J. (2018). Strategies included in cognitive behavioral therapy programs to treat internalized disorders: A systematic review. Cognitive Behaviour Therapy, 47(4), 263-285. https://doi.org/10.1080/16506073.2017.1388275 Krumboltz, J. D. (1994). The career beliefs inventory. Journal of Counseling and Development, 72(4), 424-428. https://doi.org/10.1002/j.1556-6676.1994.tb00962.x van Beek, M. H. C. T., Oude Voshaar, R. C., Beek, A. M., van Zijderveld, G. A., Visser, S., Speckens, A. E. M., Batelaan, N., & van Balkom, A. J. L. M. (2013). A brief cognitive- behavioral intervention for treating depression and panic disorder in patients with noncardiac chest pain: A 24-week randomized controlled trial. Depression and Anxiety, 30 (7), 670-678. https://doi.org/10.1002/da.22106 Webster, R., Norman, P., Goodacre, S., Thompson, A. R., & McEachan, R. R. C. (2014). Illness representations, psychological distress and non-cardiac chest pain in patients attending an emergency department. Psychology & Health, 29 (11), 1265–1282. https://doi.org/10.1080/08870446.2014.923885

CASE STUDY: COGNITIVE THERAPY FOR MR. C Wedding, D., & Corsini, R. J. (2018). Current Psychotherapies (11th ed.). Cengage Learning US. https://bookshelf.textbooks.com/books/9781337670555

Case Study Paper - COUN 835

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