To respect client confidentiality, I will refer to my client as Julie throughout this case report.
Referral
Julie is a 19-year-old single female who was referred by her surgery based counsellor for Cognitive Behavioural Therapy (CBT), to help with recurring obsessive compulsive disorder (OCD) episodes. Whilst the referral did not identify any background history about Julie’s obsessions, the referral did suggest that these episodes ranged from mild to moderate in nature and had started when Julie was about sixteen years of age. The referral also indicated that Julie was not being treated by any type of antidepressants or other medication at this time.
Julie had no prior knowledge of CBT before attending therapy, but did have some experience of other forms of counselling and approaches to psychological interventions through the GP based counsellor. This she had found helpful in identifying that she had OCD tendencies, but believed the randomness of the counselling sessions available at the surgery failed to offer any real continuity or focus in helping her deal with her problem.
Assessment
Initial assessment began with determining that Julie met the criteria for OCD, as outlined in the National Institute for Health and Clinical Excellence (NICE) guidelines CG31 Obsessive compulsive disorder (2006). Here the assessment revealed that both obsessional and compulsive symptoms were being displayed that were causing Julie significant functional impairment and distress.
Next I looked at whether Julie was suitable for CBT. This I did by using a checking method based upon Safran and Segal (1990) and Scott, Stradling & Dryden (1995). This check offered me the opportunity to see whether Julie was able to access her thoughts, behaviours and feelings sufficiently to engage in therapy and motivated to do homework to help her manage her OCD. To do this I used the initial therapy session as a basis to explore what she experienced as an example when first
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