Cognitive Behavioral Therapy: A Case Study
Sonia is well suited for the Cognitive Behavioral approach. Cognitive behavior therapy also known as CBT integrates elements of two therapeutic approaches. It combines aspects of Behavior Therapy, which was developed, by Wolpe and his colleagues with aspects of Cognitive Therapy, which was developed by Aaron Beck in the early 1960s. The interesting fact is that CBT took birth while Beck was researching on depression and it was not until later that it became a popular approach for other psychological disturbances as well (Beck, 2011). CBT is based on the idea that there is an interrelationship that exits among an individual’s cognitive thoughts and behaviors. It is believed that cognitive thoughts can influence behavior and behavior can influence
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cognitive thoughts (Beck, 2011).
The cognitive principle of CBT studies an individual’s emotional reactions to events and the behavior principle of CBT studies the impact of behavior on an individual’s thoughts and feelings. CBT proposes that psychological problems stem from maladaptive thoughts and behaviors. Cognitive behavior therapists believe that when an individual has negative experiences, he/she develops maladaptive beliefs about their personality and this leads to psychological dysfunction (Clark, Beck & Alford, 1999). These maladaptive thoughts are also known as cognitive distortions. Cognitive distortions and behaviors must be changed to more adaptive and healthy ways of thinking and behaving in order for improvement to occur. A client’s basic beliefs about themselves, their environment and other people are examined in CBT. Modification of these basic beliefs results in longer lasting changes (Beck, 2011). Changing a client’s basic belief system can help change their perception of more specific situations that occur on daily basis. CBT focuses on the present instead of the past. CBT aims to resolve the current problem, it is short, structured and problem-focused (Clark, Beck & Alford, 1999).
There are three main levels of cognition that are essential to cognitive behavior therapy. These are; full consciousness, automatic thoughts, and schemas. Full consciousness is when an individual makes rationale decisions in complete awareness. Automatic thoughts are fast, autonomous thoughts that express private desires that were not thought through (Beck, 2011). These are the thoughts that flew in the head without any evidence necessarily supporting them. Automatic thoughts are often maladaptive opinions the client formed about their personality based on negative experiences. The client tends to over generalize themes of negativity and underestimate their ability to recover. Schemas are known as an individual’s core beliefs and they are also the deepest level of cognition in CBT (Dobson, 2001). People have a natural tendency to hold on to their core beliefs about themselves, their world and their future. The identification and modification of core beliefs typically results in longer lasting mood and behavior changes. A client’s automatic thoughts, schemas and core beliefs are corrected in CBT to help them develop a more effective style of thinking and behaving and improving their life style (Beck, 2011).
Current Problem in Theory
Sonia is a great candidate for the Cognitive Behavioral approach because she suffers from moderate level major depressive disorder. I want Sonia’s current depressive symptoms to disappear but also ensure that she does not experience a relapse later in life because it is pretty common. CBT allows me to study both Sonia’s negative thoughts such as “my dad does not love me anymore” and her negative behaviors like not paying attention in class or acting unresponsive when spoken to. It is obvious that Sonia was not born with a depressive personality and her current condition is situation specific. CBT focuses on the present and specific problems so I do not have to travel back in time and try and discover subconscious reasoning behind Sonia’s behavior. (Dobson, 2001). I can focus on her current condition. Sonia’s depression is the outcome of her faulty thinking and in CBT I can help her and her mother understand why she thinks this way. She is under the impression that because her parents split, her father does not love her anymore. She feels abandoned and even embarrassed to share her situation with friends. Her mother, it seems does not share bad news with her close ones and Sonia is acting in a similar manner. I can use CBT to teach her how her maladaptive cognitions impact her behavior. Once she is able to change this way of thinking, her behaviors will improve as well. Sonia is ignoring the specifics and perhaps over generalizing the entire situation. As mentioned previously, the approach of CBT is educational and so I can help Sonia monitor her negative thoughts about her parents divorce and learn to recognize how they have had and continue to affect her grades, social life and personal life. CBT is also short when compared to other approaches, this means I will not take too much of Sonia’s time. I can help her and also her with enough time to participate in other activities and this can benefit her because she will be able to practice what she learns in therapy outside. The best part about choosing CBT for Sonia is that I am not limited to a few strategies and concepts. CBT employs many different cognitive and behavioral strategies to help their clients and I can try them all (Smith, 2012). Sonia is only eleven years old and CBT can probably hold her attention more than other form of therapies. A recent study that compared CBT approaches with other psychotherapeutic approaches revealed CBT to be amongst the best treatment methods for kids suffering from behavioral impairments. CBT exhibited significant behavior improvement (Sivec & Montesano, 2013).
Techniques
There is no single technique used in CBT. The technique(s) used can be cognitive, behavioral or combination of both. The type of technique to employ depends on the client and their situation and so the techniques used are different for each client. A collaborative therapeutic relationship often defines CBT. The therapist and the client can work together as teammates to identify, test and modify maladaptive thoughts and behaviors (Dobson, 2001). This strong therapeutic relationship helps clients effectively identify their problems and learn to manage them in the future as well. The therapist in CBT can also use an agenda-setting process in which they break the client’s problem down in parts and assign assignments for each session (Hersen & Rosqvit, 2005). The patient can select what aspects of their condition they would like to focus on during each session and be more productive in therapy. Homework assignments are another technique common to CBT. They can help ensure the client is implying what they learned in therapy outside and provide longer lasting results (Beck, 2011). Psycho-education is also very popular in CBT because it helps the clients understand the cognitive behavioral model and employ it to themselves. The therapist can help the patient identify and explain their automatic thoughts and change them. The client can be encouraged to read self-help books and handouts to better prepare them for therapy. The patients can also use workbooks for specific problems such as depression (Dobson, 2001).
Therapists also use questions as a cognitive method in CBT. The two types of questions used in CBT are Socratic questions and guided discovery questions. Socratic questions are questions that help the client become more engaged in finding answers to their problems. Guided discovery questions are questions that help the client identify and amend maladaptive thoughts and behaviors (Beck, 2011). According to Hersen and Rosqvit, both type of questions are used to encourage the clients to discontinue maladaptive cognitions and adapt more adaptive cognitions. A therapist can help clients monitor their automatic thoughts by asking them to keep an automatic thought record. The client can write down each time they experience a negative automatic thought, question the evidence behind it and then change it with the help of the therapist (Smith, 2012). Systematic desensitization, skills training and behavior replacement are amongst some of the techniques used as a behavioral method in CBT. Therapists can help their clients reduce symptoms of fear towards a specific situation or object through gradual exposure in systematic desensitization (Beck, 2011). They may also train their clients to learn more effective coping skills and strategies. These skills and strategies are rehearsed in therapy sessions and practiced outside therapy to produce longer lasting results. The therapist helps the client replace their maladaptive ways of acting with more adaptive ones through identification and restructuring in behavior replacement (Klosko & Sanderson, 1999).
Sonia’s depressive pattern does not appear to require the employment of every single technique used in CBT. I would like to work with her as a teammate and help her identify negative automatic thoughts such as “my friends will make fun of me when they find out my parents are divorced”. I will use an agenda-setting approach and it will be her assignment to identify a negative thought about her parents’ divorce during each session. Sonia can keep an automatic thought record. Once these thoughts are identified, I would help her question the evidence behind them. “You think your father does not love you anymore Sonia?” I will ask. “What supports this belief of yours?” is another question. “If you woke up one day and found out things were different and changed like you wanted, what would you do?” is another type of question I would like to ask. Sonia is thinking of her father’s sudden departure in maladaptive manner but him leaving does not have to mean their relationship ended. I need to help her realize that. I will ask her Socratic questions about her viewpoint and perspective of the divorce situation. “What would be an alternative?” or ‘What is another way to look at your father leaving?’ are two questions I would ask her.
Sonia’s maladaptive thoughts have led to her maladaptive behaviors. I will use thought reconstructing to help her replace them and look at what happened in an alternate and more effective way. Another example of a question I would ask her is; “how would you have felt if your parents stayed together but continued fighting?” Right now Sonia is only focusing on her father abandoning her and not thinking about how things could have been worse if her parents stayed together. I will use behavior replacement with Sonia as well. I will educate her on better ways of coping with her situation. Instead of remaining quiet and not eating properly, she can keep busy with new hobbies and divert her attention elsewhere. Sonia is young and embarrassed of what happened because it is not common with her culture. I can help her replace this pattern of thinking through exposure. I will help her separate herself from this situation and adopt more positive thoughts and behaviors. I will bring to her attention the fact that maybe her friends will there for her more now because her dad is there. She will not know until she tries to communicate with them and I will help her do that through social skills training and systematic desensitization.
Goals of Treatment
There are a few goals of treatment in CBT. The therapist tries to help clients reduce the symptoms of their disorder and prevent reoccurrence in future. CBT aims at identifying and changing maladaptive thoughts and behaviors. Another goal in CBT is to help clients adopt more adaptive beliefs and behaviors. As mentioned earlier, a strong therapeutic relationship is essential to CBT and can help achieve goals easily (Beck, 2011). CBT therapist typically set goals prior to the first session of therapy. They explain the techniques that they would like to use and also how these techniques will help the client achieve their goals and improve. The client and therapist in CBT make mutual decisions about how time will be spent in therapy and what goals to set (Hersen & Rosqvit, 2005).
My goals with Sonia are not any different from the general goals of CBT. I would like to help reduce her symptoms of depression and prevent relapse. I would like to reduce her maladaptive thoughts and behaviors. She will learn to stop thinking that she has lost her father for good and he does not love her anymore. Her parents are no longer together but she still shares a relationship with her father and I need for her to understand this. My goal will be to try and help her establish a relationship with her father. Perhaps her parents can figure out some sort of an arrangement where they can meet on weekends and Sonia can have both parents’ involvement in her life. I will help Sonia adopt more effective thoughts and behaviors. Another goal of mine will be to help her acknowledge what happened in a different light and continue to live in a more positive manner such as the one in which she lived before. I will help her eat and sleep properly and focus in school. I will also train her to communicate better with family and friends. Her over all lifestyle will improve and the symptoms of depression will disappear. I will teach her to express her feelings to her mother and social group while being considerate to her culture and religion.
Sonia’s problems have a lot to with her personality. The antecedent in her situation was her parent’s divorce. It was preceded by maladaptive thoughts and behaviors and the consequence is depression. Sonia does not have a health issue that requires a physician’s attention at the moment. She can be referred to a psychiatrist for additional examination of her depression and also prescription of anti-depressants to be used in combination with therapy. Research has found CBT to produce longer lasting results when used in combination with medicine than alone in the treatment of depression (Sivec & Montesano, 2013). Sonia will be asked to continue practicing what she learns in therapy and her family should understand her condition. I would like to conduct a family therapy session with both of Sonia’s parents if possible. It will help them better understand what is going on and how their divorce impacted the family and Sonia. It will also help them to see how their different familial and religious affiliations have caused Sonia confusion and what we can all do to resolve this.
Limitations and Alternative Model
CBT may not be a suitable approach for every client and condition. CBT requires commitment. A therapist can help the clients identify their maladaptive thoughts and behaviors but cannot change them without their cooperation. As mentioned earlier in CBT, the therapist and client work together as teammates (Hersen & Rosqvit, 2005). CBT and its assignments can be very time consuming. Not every client has enough time to devote and some may find themselves having a hard time keeping up with therapy. CBT is very structured and therefor, may not suitable with clients experiencing more complicated psychological disturbances (Beck, 2011). CBT focuses on the current situation and some critics argue that by doing so, CBT may ignore other important causes of psychological disturbances such as those stemming from childhood. CBT is also criticized for mainly focusing on the client and their beliefs and behaviors and not including other significant factors that may have impacted their condition (s) such as family (Smith, 2012).
It appears that Sonia is willing to offer commitment in therapy. Things may still become difficult because she has school and other commitments. I would like to not overburden her with assignments and tasks. Sonia is only eleven years old and may not understand everything I say to her. I will try and use a language that suits her cognitive abilities. Sonia may be a little reluctant at start to share all of her feelings. This may require some additional time. Sonia’s mother is a single mom and so she may not be able to bear complete cost of therapy. There is a slight chance of therapy being cut short. Sonia is usually home alone or with her grandma who keeps busy with personal work and so it may be difficult to ensure she is doing all her homework and practicing her skills on a regular basis. On a brighter note, Sonia is young and so it will be easier for her to unlearn old behavior and thoughts and learn new ones. Her depression is not at the severe level yet. She has no suicidal ideation and is willing to improve. She would like to make change happen and her mom is very encouraging. Her prognosis for treatment looks really good.
An alternative approach I would use with Sonia is Adlerian Therapy.
It was founded by Alfred Adler in the early 1960s and is often referred to as a growth model. Adler proposed that individual behavior is goal oriented and a client can be best described in terms of how they go about achieving their goals. Each individual has a unique lifestyle that is based on his or her lifestyle, early life (childhood) experiences, birth order, family constellation and environment (Smith, 2012). Psychological disturbances are the outcome of faulty beliefs about achieving goals and they interfere within an individuals’ perception of reality and goal achieving. Adlerian therapy involves forming a secure and strong therapeutic relationship with the client and assessing their lifestyle and mistaken beliefs about goals. Assessment procedures involve childhood recollections, family dynamics and interviews consisting of questions that help bring light to faulty beliefs and lifestyle (Dryden, 2002).
The Adlerian approach focuses on the strengths and resources a client brings to therapy. Each individual strives to achieve three life tasks: love, friendship, and work. The treatment goals in Adlerian therapy are to increase social interest and constructive action and help the client set more effective goals (Smith, 2012). Treatment interventions include but are not limited to, early recollection analysis, encouragement, constructive action and paradox, Clients are encouraged to modify mistaken beliefs and avoid discouragement through interpretation and support (Dryden,
2002).
I recommended Adlerian Therapy as an approach for Sonia because I feel that her current depressive symptoms may be the outcome of discouragement. She may be disappointed that her “picture perfect” life does not exist anymore. Her parents have split, she is no longer the center of attention and the current situation is so much different than what she recalled from childhood. I can use lifestyle assessment to help Sonia identify what went wrong and where she would like to stand in the future. I can use encouragement techniques to encourage het to change her current behavior and realize that change is a constant part of life. Perhaps Sonia became depressed because she is the only child and she feels lonely after her father left. Adlerian therapy can help me study that aspect of her personality. Sonia is seeking social acceptance when she displays fear of letting her friends in on what is going on with her life and I can use the Adlerian approach to help her modify this behavior. Adlerian therapy may be comforting for Sonia because it involves a lot of support and includes her family dynamics within it. It is definitely worth a try if CBT does prove to be too efficient.
References
Beck, J. S. (2011). Cognitive behavior therapy: basics and beyond (2nd ed.). New York: Guilford Press.
Clark, D. A., Beck, A. T., & Alford, B. A. (1999). Scientific foundations of cognitive theory and therapy of depression. New York: John Wiley.
Diagnostic and statistical manual of mental disorders: DSM-5. (5th ed.). (2013). Washington, D.C.: American Psychiatric Association.
Dobson, K. S. (2001). Handbook of cognitive-behavioral therapies (2nd ed.). New York: Guilford Press.
Dryden, W. (2002). Handbook of individual therapy (4th ed.). London: Sage Publications.
Hersen, M., & Rosqvist, J. (2005). Encyclopedia of behavior modification and cognitive behavior therapy. Thousand Oaks [Calif.: Sage Publications.
Klosko, J. S., & Sanderson, W. C. (1999). Cognitive-behavioral treatment of depression. Northvale, NJ: Jason Aronson.
Sivec, H. J., & Montesano, V. L. (2013). Clinical process examples of cognitive behavioral therapy for psychosis. Psychotherapy, 50(3), 458-463. doi:http://dx.doi.org/10.1037/a0032597
Smith, E. (2012). Theories of counseling and psychotherapy: an integrative approach. London: SAGE Publications.
cognitive thoughts (Beck, 2011).
The cognitive principle of CBT studies an individual’s emotional reactions to events and the behavior principle of CBT studies the impact of behavior on an individual’s thoughts and feelings. CBT proposes that psychological problems stem from maladaptive thoughts and behaviors. Cognitive behavior therapists believe that when an individual has negative experiences, he/she develops maladaptive beliefs about their personality and this leads to psychological dysfunction (Clark, Beck & Alford, 1999). These maladaptive thoughts are also known as cognitive distortions. Cognitive distortions and behaviors must be changed to more adaptive and healthy ways of thinking and behaving in order for improvement to occur. A client’s basic beliefs about themselves, their environment and other people are examined in CBT. Modification of these basic beliefs results in longer lasting changes (Beck, 2011). Changing a client’s basic belief system can help change their perception of more specific situations that occur on daily basis. CBT focuses on the present instead of the past. CBT aims to resolve the current problem, it is short, structured and problem-focused (Clark, Beck & Alford, 1999).
There are three main levels of cognition that are essential to cognitive behavior therapy. These are; full consciousness, automatic thoughts, and schemas. Full consciousness is when an individual makes rationale decisions in complete awareness. Automatic thoughts are fast, autonomous thoughts that express private desires that were not thought through (Beck, 2011). These are the thoughts that flew in the head without any evidence necessarily supporting them. Automatic thoughts are often maladaptive opinions the client formed about their personality based on negative experiences. The client tends to over generalize themes of negativity and underestimate their ability to recover. Schemas are known as an individual’s core beliefs and they are also the deepest level of cognition in CBT (Dobson, 2001). People have a natural tendency to hold on to their core beliefs about themselves, their world and their future. The identification and modification of core beliefs typically results in longer lasting mood and behavior changes. A client’s automatic thoughts, schemas and core beliefs are corrected in CBT to help them develop a more effective style of thinking and behaving and improving their life style (Beck, 2011).
Current Problem in Theory
Sonia is a great candidate for the Cognitive Behavioral approach because she suffers from moderate level major depressive disorder. I want Sonia’s current depressive symptoms to disappear but also ensure that she does not experience a relapse later in life because it is pretty common. CBT allows me to study both Sonia’s negative thoughts such as “my dad does not love me anymore” and her negative behaviors like not paying attention in class or acting unresponsive when spoken to. It is obvious that Sonia was not born with a depressive personality and her current condition is situation specific. CBT focuses on the present and specific problems so I do not have to travel back in time and try and discover subconscious reasoning behind Sonia’s behavior. (Dobson, 2001). I can focus on her current condition. Sonia’s depression is the outcome of her faulty thinking and in CBT I can help her and her mother understand why she thinks this way. She is under the impression that because her parents split, her father does not love her anymore. She feels abandoned and even embarrassed to share her situation with friends. Her mother, it seems does not share bad news with her close ones and Sonia is acting in a similar manner. I can use CBT to teach her how her maladaptive cognitions impact her behavior. Once she is able to change this way of thinking, her behaviors will improve as well. Sonia is ignoring the specifics and perhaps over generalizing the entire situation. As mentioned previously, the approach of CBT is educational and so I can help Sonia monitor her negative thoughts about her parents divorce and learn to recognize how they have had and continue to affect her grades, social life and personal life. CBT is also short when compared to other approaches, this means I will not take too much of Sonia’s time. I can help her and also her with enough time to participate in other activities and this can benefit her because she will be able to practice what she learns in therapy outside. The best part about choosing CBT for Sonia is that I am not limited to a few strategies and concepts. CBT employs many different cognitive and behavioral strategies to help their clients and I can try them all (Smith, 2012). Sonia is only eleven years old and CBT can probably hold her attention more than other form of therapies. A recent study that compared CBT approaches with other psychotherapeutic approaches revealed CBT to be amongst the best treatment methods for kids suffering from behavioral impairments. CBT exhibited significant behavior improvement (Sivec & Montesano, 2013).
Techniques
There is no single technique used in CBT. The technique(s) used can be cognitive, behavioral or combination of both. The type of technique to employ depends on the client and their situation and so the techniques used are different for each client. A collaborative therapeutic relationship often defines CBT. The therapist and the client can work together as teammates to identify, test and modify maladaptive thoughts and behaviors (Dobson, 2001). This strong therapeutic relationship helps clients effectively identify their problems and learn to manage them in the future as well. The therapist in CBT can also use an agenda-setting process in which they break the client’s problem down in parts and assign assignments for each session (Hersen & Rosqvit, 2005). The patient can select what aspects of their condition they would like to focus on during each session and be more productive in therapy. Homework assignments are another technique common to CBT. They can help ensure the client is implying what they learned in therapy outside and provide longer lasting results (Beck, 2011). Psycho-education is also very popular in CBT because it helps the clients understand the cognitive behavioral model and employ it to themselves. The therapist can help the patient identify and explain their automatic thoughts and change them. The client can be encouraged to read self-help books and handouts to better prepare them for therapy. The patients can also use workbooks for specific problems such as depression (Dobson, 2001).
Therapists also use questions as a cognitive method in CBT. The two types of questions used in CBT are Socratic questions and guided discovery questions. Socratic questions are questions that help the client become more engaged in finding answers to their problems. Guided discovery questions are questions that help the client identify and amend maladaptive thoughts and behaviors (Beck, 2011). According to Hersen and Rosqvit, both type of questions are used to encourage the clients to discontinue maladaptive cognitions and adapt more adaptive cognitions. A therapist can help clients monitor their automatic thoughts by asking them to keep an automatic thought record. The client can write down each time they experience a negative automatic thought, question the evidence behind it and then change it with the help of the therapist (Smith, 2012). Systematic desensitization, skills training and behavior replacement are amongst some of the techniques used as a behavioral method in CBT. Therapists can help their clients reduce symptoms of fear towards a specific situation or object through gradual exposure in systematic desensitization (Beck, 2011). They may also train their clients to learn more effective coping skills and strategies. These skills and strategies are rehearsed in therapy sessions and practiced outside therapy to produce longer lasting results. The therapist helps the client replace their maladaptive ways of acting with more adaptive ones through identification and restructuring in behavior replacement (Klosko & Sanderson, 1999).
Sonia’s depressive pattern does not appear to require the employment of every single technique used in CBT. I would like to work with her as a teammate and help her identify negative automatic thoughts such as “my friends will make fun of me when they find out my parents are divorced”. I will use an agenda-setting approach and it will be her assignment to identify a negative thought about her parents’ divorce during each session. Sonia can keep an automatic thought record. Once these thoughts are identified, I would help her question the evidence behind them. “You think your father does not love you anymore Sonia?” I will ask. “What supports this belief of yours?” is another question. “If you woke up one day and found out things were different and changed like you wanted, what would you do?” is another type of question I would like to ask. Sonia is thinking of her father’s sudden departure in maladaptive manner but him leaving does not have to mean their relationship ended. I need to help her realize that. I will ask her Socratic questions about her viewpoint and perspective of the divorce situation. “What would be an alternative?” or ‘What is another way to look at your father leaving?’ are two questions I would ask her.
Sonia’s maladaptive thoughts have led to her maladaptive behaviors. I will use thought reconstructing to help her replace them and look at what happened in an alternate and more effective way. Another example of a question I would ask her is; “how would you have felt if your parents stayed together but continued fighting?” Right now Sonia is only focusing on her father abandoning her and not thinking about how things could have been worse if her parents stayed together. I will use behavior replacement with Sonia as well. I will educate her on better ways of coping with her situation. Instead of remaining quiet and not eating properly, she can keep busy with new hobbies and divert her attention elsewhere. Sonia is young and embarrassed of what happened because it is not common with her culture. I can help her replace this pattern of thinking through exposure. I will help her separate herself from this situation and adopt more positive thoughts and behaviors. I will bring to her attention the fact that maybe her friends will there for her more now because her dad is there. She will not know until she tries to communicate with them and I will help her do that through social skills training and systematic desensitization.
Goals of Treatment
There are a few goals of treatment in CBT. The therapist tries to help clients reduce the symptoms of their disorder and prevent reoccurrence in future. CBT aims at identifying and changing maladaptive thoughts and behaviors. Another goal in CBT is to help clients adopt more adaptive beliefs and behaviors. As mentioned earlier, a strong therapeutic relationship is essential to CBT and can help achieve goals easily (Beck, 2011). CBT therapist typically set goals prior to the first session of therapy. They explain the techniques that they would like to use and also how these techniques will help the client achieve their goals and improve. The client and therapist in CBT make mutual decisions about how time will be spent in therapy and what goals to set (Hersen & Rosqvit, 2005).
My goals with Sonia are not any different from the general goals of CBT. I would like to help reduce her symptoms of depression and prevent relapse. I would like to reduce her maladaptive thoughts and behaviors. She will learn to stop thinking that she has lost her father for good and he does not love her anymore. Her parents are no longer together but she still shares a relationship with her father and I need for her to understand this. My goal will be to try and help her establish a relationship with her father. Perhaps her parents can figure out some sort of an arrangement where they can meet on weekends and Sonia can have both parents’ involvement in her life. I will help Sonia adopt more effective thoughts and behaviors. Another goal of mine will be to help her acknowledge what happened in a different light and continue to live in a more positive manner such as the one in which she lived before. I will help her eat and sleep properly and focus in school. I will also train her to communicate better with family and friends. Her over all lifestyle will improve and the symptoms of depression will disappear. I will teach her to express her feelings to her mother and social group while being considerate to her culture and religion.
Sonia’s problems have a lot to with her personality. The antecedent in her situation was her parent’s divorce. It was preceded by maladaptive thoughts and behaviors and the consequence is depression. Sonia does not have a health issue that requires a physician’s attention at the moment. She can be referred to a psychiatrist for additional examination of her depression and also prescription of anti-depressants to be used in combination with therapy. Research has found CBT to produce longer lasting results when used in combination with medicine than alone in the treatment of depression (Sivec & Montesano, 2013). Sonia will be asked to continue practicing what she learns in therapy and her family should understand her condition. I would like to conduct a family therapy session with both of Sonia’s parents if possible. It will help them better understand what is going on and how their divorce impacted the family and Sonia. It will also help them to see how their different familial and religious affiliations have caused Sonia confusion and what we can all do to resolve this.
Limitations and Alternative Model
CBT may not be a suitable approach for every client and condition. CBT requires commitment. A therapist can help the clients identify their maladaptive thoughts and behaviors but cannot change them without their cooperation. As mentioned earlier in CBT, the therapist and client work together as teammates (Hersen & Rosqvit, 2005). CBT and its assignments can be very time consuming. Not every client has enough time to devote and some may find themselves having a hard time keeping up with therapy. CBT is very structured and therefor, may not suitable with clients experiencing more complicated psychological disturbances (Beck, 2011). CBT focuses on the current situation and some critics argue that by doing so, CBT may ignore other important causes of psychological disturbances such as those stemming from childhood. CBT is also criticized for mainly focusing on the client and their beliefs and behaviors and not including other significant factors that may have impacted their condition (s) such as family (Smith, 2012).
It appears that Sonia is willing to offer commitment in therapy. Things may still become difficult because she has school and other commitments. I would like to not overburden her with assignments and tasks. Sonia is only eleven years old and may not understand everything I say to her. I will try and use a language that suits her cognitive abilities. Sonia may be a little reluctant at start to share all of her feelings. This may require some additional time. Sonia’s mother is a single mom and so she may not be able to bear complete cost of therapy. There is a slight chance of therapy being cut short. Sonia is usually home alone or with her grandma who keeps busy with personal work and so it may be difficult to ensure she is doing all her homework and practicing her skills on a regular basis. On a brighter note, Sonia is young and so it will be easier for her to unlearn old behavior and thoughts and learn new ones. Her depression is not at the severe level yet. She has no suicidal ideation and is willing to improve. She would like to make change happen and her mom is very encouraging. Her prognosis for treatment looks really good.
An alternative approach I would use with Sonia is Adlerian Therapy.
It was founded by Alfred Adler in the early 1960s and is often referred to as a growth model. Adler proposed that individual behavior is goal oriented and a client can be best described in terms of how they go about achieving their goals. Each individual has a unique lifestyle that is based on his or her lifestyle, early life (childhood) experiences, birth order, family constellation and environment (Smith, 2012). Psychological disturbances are the outcome of faulty beliefs about achieving goals and they interfere within an individuals’ perception of reality and goal achieving. Adlerian therapy involves forming a secure and strong therapeutic relationship with the client and assessing their lifestyle and mistaken beliefs about goals. Assessment procedures involve childhood recollections, family dynamics and interviews consisting of questions that help bring light to faulty beliefs and lifestyle (Dryden, 2002).
The Adlerian approach focuses on the strengths and resources a client brings to therapy. Each individual strives to achieve three life tasks: love, friendship, and work. The treatment goals in Adlerian therapy are to increase social interest and constructive action and help the client set more effective goals (Smith, 2012). Treatment interventions include but are not limited to, early recollection analysis, encouragement, constructive action and paradox, Clients are encouraged to modify mistaken beliefs and avoid discouragement through interpretation and support (Dryden,
2002).
I recommended Adlerian Therapy as an approach for Sonia because I feel that her current depressive symptoms may be the outcome of discouragement. She may be disappointed that her “picture perfect” life does not exist anymore. Her parents have split, she is no longer the center of attention and the current situation is so much different than what she recalled from childhood. I can use lifestyle assessment to help Sonia identify what went wrong and where she would like to stand in the future. I can use encouragement techniques to encourage het to change her current behavior and realize that change is a constant part of life. Perhaps Sonia became depressed because she is the only child and she feels lonely after her father left. Adlerian therapy can help me study that aspect of her personality. Sonia is seeking social acceptance when she displays fear of letting her friends in on what is going on with her life and I can use the Adlerian approach to help her modify this behavior. Adlerian therapy may be comforting for Sonia because it involves a lot of support and includes her family dynamics within it. It is definitely worth a try if CBT does prove to be too efficient.
References
Beck, J. S. (2011). Cognitive behavior therapy: basics and beyond (2nd ed.). New York: Guilford Press.
Clark, D. A., Beck, A. T., & Alford, B. A. (1999). Scientific foundations of cognitive theory and therapy of depression. New York: John Wiley.
Diagnostic and statistical manual of mental disorders: DSM-5. (5th ed.). (2013). Washington, D.C.: American Psychiatric Association.
Dobson, K. S. (2001). Handbook of cognitive-behavioral therapies (2nd ed.). New York: Guilford Press.
Dryden, W. (2002). Handbook of individual therapy (4th ed.). London: Sage Publications.
Hersen, M., & Rosqvist, J. (2005). Encyclopedia of behavior modification and cognitive behavior therapy. Thousand Oaks [Calif.: Sage Publications.
Klosko, J. S., & Sanderson, W. C. (1999). Cognitive-behavioral treatment of depression. Northvale, NJ: Jason Aronson.
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