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Sample Essay Paper on Applying CBT to a Case Study
Applying CBT to a Case Study
The problem case in this paper is that of Laura, a 47-year old woman who presents with symptoms of major depression. Laura is generally dissatisfied with her life despite having a good and stable job, a partner, and no children by choice. Normal stressors in life, including increased workload, reaching menopause, and responsibility for her 86-year old mother’s care, seem to have a more than normal adverse effect on her psychological health and wellbeing. These stressors have caused her sadness and worsened depressive symptoms. Additionally, she exhibits social anxiety in different social situations, and her depression has significant effects on her life and work. The depression has interfered with her abilities to network and keep speaking engagements. In her relationships, she keeps a distance and is uncomfortable with opening up and sharing her private thoughts and feelings, even with her partner, for fear of upsetting others or coming across as a complainer.
Family history is an important consideration in the case of Laura. Her early upbringing was unhealthy, thus caused her adverse emotional and psychological issues throughout her life. Along with her siblings, she witnessed her parents' frequent fights and anger at each other and underwent physical and emotional abuse. Indeed, her parents punished her by hitting her repeatedly and hard with boards and even locked her in a cold room in the basement. Moreover, Laura’s mother made her feel like a sneaky bad child who deserved such disciplinary actions to address her “natural” tendency towards malevolent behavior and dishonesty, and her father felt emotionally cold and distant, such that she felt she did not really know him when he died. These experiences, which occurred early in Laura’s life, before she was 14, promoted the perception or belief that she was unlovable.
The intervention model applicable in the case is Cognitive Behavioral Therapy (CBT). Identifying and challenging the individual’s dysfunctional perceptions, thought patterns, and beliefs that underlie adverse moods, outlooks, and understandings of the world is a critical element of the intervention. The rationale of using this approach is to recognize the deep interrelationship that exists among the thoughts, perceptions, beliefs, and behaviors of individuals. Essentially, identifying and challenging the dysfunctional beliefs, thoughts, and perceptions in individuals aim at empowering them to resist the negative belief and thought patterns, thereby promoting the individuals’ active roles and capabilities to address and manage adverse moods and depression and modify associated patterns of behavior.
This intervention model is suitable because of evidence in Laura’s case that previous experiences at the family level, particularly early in her life, may have had a significant influence on her moods and chronic feelings of dissatisfaction with her life. The family is the most fundamental unit of the society in which socialization occurs. Children obtain the most vital perceptions of others and the world from the relationships that they have and develop with parents at the family level. Such learning that occurs in the early years of life particularly influences the thoughts and beliefs of people in the long term. Laura recalls witnessing her parents fighting frequently and screaming at each other in front of her and her siblings. Her parents also meted out physical punishment on her, including in a cold room in the basement, using boards to hit them hard and repetitively (up to 50 blows). Following such abuse, Laura would feel “black and blue” for weeks. Besides, she notes her mother’s role in making her feel like a sneaky and bad child with a natural tendency towards malevolent behavior and dishonesty, such that she felt the need to overcompensate in her behavior to prove that she was not troublesome or devious. Laura's father neglected her emotionally and did not show her physical affection. To her, he was cold and emotionally distant, and when he died, Laura felt terrible sadness upon realizing that she had lost an opportunity to know him on a personal level. Generally, Laura considers that her upbringing never communicated to her that anyone would love her (that she was lovable).
This assessment shows the critical role that Laura’s dysfunctional early upbringing, devoid of parental love and emotionally and physically abusive, has played in her chronic feelings of dissatisfaction with her life. This early upbringing has nurtured a negative perception, interpretation, and experience of the world, thereby predisposing her to the chronic adverse feelings. The focus in the proposed intervention under CBT is on identifying and addressing the role of these experiences in her early upbringing in causing her depression, hence empower her to resist these perceptions, thoughts, and interpretations (and therefore address depression) from an active position. Focus on cognition in the intervention model is essential in this empowerment because thought and interpretation patterns serve as the basis of feelings and behaviors in human beings.
Key Features of the Intervention Model
The fundamental philosophical precursors of CBT were evident in ancient world traditions and philosophies, particularly Stoicism in 3-2 BC. This philosophical tradition explored the system of logic and logical views of the world. It featured the principle that one way of finding happiness is to use the mind to understand the world and accept the moment as it presents itself. Philosophers in the era, particularly Epictetus, believed in the critical role of using logic to identify and reject/abandon beliefs and thoughts that are false, and that could lead to destructive emotions (Cavanna, 2019; Mathews, 2015). This idea influenced the recognition of the ways in which cognitive distortions contribute to anxiety and depression. Turner (2017) observes that these influences were evident in the works and focuses of psychologists such as Albert Ellis and Aaron Beck in the mid-20th Century.
CBT is a talk therapy that takes the format of a partnership between the therapist and the patient. CBT is based on the idea that human thoughts, perceptions, and behaviors have deep interrelationships, such that targeting one has a direct effect on the others (Fenn & Byrne, 2013). Additionally, it considers human perceptions and thoughts as the origin of problems in the emotional and psychological experiences of individuals. The basis of problems in the mental states and health and wellbeing of individuals is dysfunction in their thought and belief patterns, which is necessary to target in an effort to heal these problems effectively and sustainably (Redhead, Johnstone, & Nightingale, 2015). As a therapy, CBT involves collaborations between therapists and patients with the aim of identifying and challenging beliefs and thought patterns that the patients that are dysfunctional exhibit and that underlie their negative moods and perceptions and interpretations of the world. The focus in the talk therapy is on enabling the patient to identify, know, and become conscious or aware of the dysfunctional nature and influence of these thought and belief patterns in his/her perceptions, outlooks, interpretations, and understanding of the world (Bieling, McCabe, & Antony, 2013; Thoma & McKay, 2014, 2014). Based on such consciousness, the patient can then acquire the capacity to confront these beliefs and thoughts and counter their influence in his/her life actively.
Applying the Model to the Case
As noted, CBT involves the format of a partnership or collaborations between the therapist/expert and the patient. The focus of the application of the intervention os to influence Laura’s understanding of the role of her dysfunctional thought and belief patterns relating to the experience of her childhood upbringing in her experience of chronic dissatisfaction with her life. This understanding shall then help her to confront and address/counter these dysfunctional beliefs and thought patterns, therefore counter her chronic problem with depression from an active position.
The way of applying this intervention is a combination of one-on-one sessions of therapy and group sessions. In the first session, Laura shall receive a self-reflection journal and guide questions to help her evaluate her thoughts, beliefs, and perceptions in relation to her childhood upbringing experiences. Self-evaluation and monitoring are important to help clients to grow conscious of the influence of personal thoughts and beliefs on interpretations and experiences of the world. This step could involve the encouragement of Laura to keep a journal of her thoughts, emotions, perceptions, and interpretations of life and the world. In the next two sessions, furthermore, Laura will engage one-on-one with the therapist, who shall allow her to express her emotions, feelings, and experiences in childhood and guide her through them to stimulate her awareness and understanding of their influence on her sense of the self, relationships with others, and experiences of life and the world. In the next five sessions, this format of therapy will alternate with group sessions, in which Laura shall interact with other patients with similar problems. Group sessions shall help Laura to share her challenges and experiences with other patients and learn to confront her dysfunctional beliefs and perceptions of the world relating to her upbringing and replace them with more rational ones.
Helpful Aspects of the Model
The value of CBT and the intervention described above in Laura’s case concerns its promotion of an active role in confronting and overcoming depression. The intervention presents an effective, practical, and sustainable model of addressing problems such as depression by offering individuals an active position in confronting and addressing the fundamental causes of these problems (Coady & Lehman, 2016). By targeting the dysfunctional thought and belief patterns in Laura’s life, the intervention promises to empower her to take an active personal, and hence sustainable, role in overcoming her depression because it shall help Laura to identify the causes of her depression and create in her an awareness of her personal capacity to overcome it by confronting these causes directly and effectively.
It is essential to note the need for personal commitment to Laura's part if the intervention is to be effective. Personal commitment, in terms of complete honesty, trust in the therapist and the therapy, the desire and determination to heal, the determination to confront sensitive personal feelings and experiences, and the personal effort to learn and apply the intervention’s skills, is an essential component of the success of CBT. The effectiveness of the therapy is highly dependent on the patient’s readiness to transform personal life, health, and wellbeing.
This paper has proposed the application of CBT in an intervention to address Laura’s chronic problem of dissatisfaction with her life. The focus of this intervention is on recognizing and challenging the dysfunctional thought, perception, and belief patterns relating to her abusive and unhappy childhood upbringing experience that underlie her problem. CBT recognizes deep interrelationships between human thoughts, beliefs, and behaviors. The focus in the intervention on helping Laura to recognize the role of her dysfunctional thoughts and beliefs relating to her childhood upbringing experience in her depression shall empower her to confront the root cause of the problem, and hence avail an active personal and sustainable solution for the problem.
Bieling, P., McCabe, R., & Antony, M. (2013). Cognitive behavioral therapy in groups. New York, US: Guilford Press
Cavanna, A. (2019). Back to the future: Stoic wisdom and psychotherapy for neuropsychiatric conditions. Future Neurology 14(1): 1-4.
Coady, N. & Lehmann, P. (2016). Theoretical perspectives for direct social work practice: A generalist-eclectic approach (3rd edition). New York, US: Springer Publishing.
Fenn, K., & Byrne, M. (2013). The key principles of cognitive behavioral therapy. InnovAiT 6(9): 579-585.
Mathews, J. (2015, December 6). Stoicism and CBT: Is therapy a philosophical pursuit? Virginia Counseling. Retrieved from http://www.vacounseling.com/stoicism-cbt/
Redhead, S., Johnstone, L., & Nightingale, J. (2015). Clients’ experiences of formulation in cognitive behavior therapy. Psychology and Psychotherapy: Theory, Research, and Practice 1-16.
Thoma, N., & McKay, D. (2014). Working with emotion in cognitive behavioral therapy: Techniques for clinical practice. New York, US: Guilford Publications.
Turner, F. (2017). Social work treatment: Interlocking theoretical approaches (6th edition). New York, US: Oxford University Press.
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