Cognitive Behavioral Therapy (CBT) is an approach of psychotherapeutic. It basically aims at solving problems that concern dysfunctional emotions, cognitions and behaviors via systematic procedure and goal oriented in the present. It is a proven technique of psychotherapy and thus proposes that it is not the events themselves that leads to anxiety and responses of maladaptive but as well individual’s interpretations and expectations of certain events. It proposes that maladaptive behaviors can only be changed by directly dealing with an individual’s beliefs and thoughts. Basically, CBT is a generic term which constitutes varied approaches, more so Cognitive Therapy (CT) and Rational Emotive Behaviour Therapy (REBT) (Martin, 2011). In general, CBT holds a proposition of bio-psychological reason for causation. Accordingly, it postulates that the combination of psychological, biological and social factors largely contribute in the manner of behavior and feeling of people (Martin, 2011).Similarly, REBT holds that behaviors and emotions are simply caused by an individual’s believe about the situation she/he faces. Its focal point is the cognitive processes that intercede between the perceptions of the information of the environment and consequential responses to such information. Based on these explanations, the current paper is therefore devoted to the presentation of the case formulation of the case study. It outlines the goals of therapy, processes and the interventions that could be used to help Joanna overcome her problem. The CBT interventions occur in phases and begin with socialization, assessment and case formulation and moves to treatment interventions. It ends with the evaluation phase (Martin, 2011).
The case formulation is a stage in therapy but it simply seems from reviewing the literature of Joanna. As we conceptualize Joanna’s literature, a lot of confusion is noticed. Conceptualizing the case of Joanna shows that she is disillusioned and thus her performance is deteriorating with time. The same leads to the development of guilt and isolation. Her refusal to join her colleagues for lunches and breaks on the pretext that she had other plans simply signify maladaptive behaviors. From the case study, the case formulates that Joanna’s feelings, thinking, behavior and bodily effects and her environment or work are core connections between her perceptions and her framework of beliefs and dysfunctional assumptions. Joanna is depressed. She is a victim of facial tics, anxiety and phobias. Her arguments that her colleagues had been giving her “lame smiles” signify facial tics. Equally, she experiences mood shifts and sleep problems. It is illustrated from the case study that due to her sleeplessness and fatigue, Joanna was late for several morning meetings and was reprimanded by her supervisor. These imply that she is undergoing irrational thinking. She no longer achieves her goals, but rather creates a lot of emotions of distress which in effect leads to harmful behaviors, her reality is totally distorted, and she cannot logically evaluate herself, the world or her colleagues. These constitute to her irrational thinking.
Accordingly, her life events can, however, be traumatic or at the very least disappointing and can precipitate negative thinking and lower her mood states. Low mood in turn heightens the probability of more negative thinking, which reinforces the mood state and in time forms a negative circle which begins to influence her day-to-day living. In effect, Joanna’s state--negative thinking--stems from cognitive distortion. This is what makes her develop a negative view against herself, current experience in her environment as well as about her future and thus cognitive triad. Her cognition is majorly influenced by her behavior and mood. Correspondingly, Joanna’s behaviour and emotions are influenced by her beliefs and thoughts.
The processes that Joanna could use encompass socialization. Socialization the early phase where the CBT approach is explored by the client. The therapist will explain the principles of CBT, its evidence-based findings, how and why assessments are important, the method by which the case formulation model is contextualized and the potential interventions available to Joanna. Simply, it entails thorough explanation to the client the control and choice available. It is akin to gaining informed consent for the therapy to continue and it seems entirely reasonable therefore that the potential client should be in a position to decide whether it is the right type of therapy for them at that particular time (Ridgway, 2005). It will therefore entail discussing therapeutic agreements, basically entailing the discussion of as confidentiality, boundaries, trust, for the therapy and the role the therapist may play in a multi-disciplinary team or in liaising with other healthcare professionals. CBT can as well be explored with a discussion that focuses on Joanna’s input regarding activities, assessments, feedback and evaluation. According to Elli’s theory, we are generally what we think and cause disturbance to ourselves continuously sentences which are irrationally devised or learned from our backgrounds.
For Joanna to overcome her problems, CBT interventions are required. The whole process occurs in phases beginning with socialization, assessment and case formulation, moving into treatment intervention and ending with evaluation.
It is the initial phase of therapeutic process in which CBT is basically thoroughly explored by the client herself. It is simply evidence based finding, assessment, and the understanding of the interventions that are accessible to the client (Ridgway, 2005). Accordingly, it entails detailed explanation about the therapy itself. Also, a lot of emphasis is laid of control and choice elements which are available to the client. It is similar to gaining an informed acceptance for the continuation of the therapy. Thus, Joanna should be left with the decision to make herself as to whether it is the best therapy for her at the time. This can be facilitated by use of educational materials, or demonstrations to highlight the links between the cognitive triad or to show how thoughts, feelings, behaviour, physical symptoms and the environment interact.
Assessment
This is the point where data is gathered so that valid ideas are developed regarding Joanna’s irrational thinking. This information obtained from the assessment aids in informing the treatment, for instance, whether the experienced problems are core level, intermediate or immediate. This data will also offer information that regards problems severity, i.e. whether they are severe, mild, complicated or moderate by co morbidity and e.t.c. (Ridgway, 2005). From the assessment, Joanna is likely to gain understanding of the principles of CBT like the cognitive triad as well as interaction between her modalities of behaviour, feelings, thoughts, environmental influences and physical sensations. Basically, the assessment will give a structure of gathering information and thus development of conceptualization which later aids in presenting the findings in formulation. While carrying out assessment, two forms can be employed, i.e. comparative and explorative.
This is the next phase. It is the conceptualization of the case. Conceptualization entails carrying out diverse assessment means, origins, problem development and maintenance (Ridgway, 2005). Formulation refers to the presentation of conceptualization by use of diagrammatic forms or pictorials. Domains examined here include thinking, behaviour, feeling, environment and physical/bodily effects which underlies belief frameworks and dysfunctional assumptions.
Treatment interventions
This is implemented subsequent to the outcome of the discussions from the presentation of formulation. For Joanna’s case, CBT intervention will follow idiosyncratic approach and generic approach as opposed to protocol driven. Thus, it will be upon the therapist to outline the most appropriate type of interventions (Martin, 2011).
The general goal of the treatment is to educate Joanna new ways of thinking, coping and approaching her perceived problems in a manner that she has all the abilities to cope and not engage in irrational thinking.
Evaluation
It simply evaluates whether the goals have been met.
Learning to cope with skills
Through CBT, she will be capable of learning how to deal with her problem ones the problem is identified. For instance, to avoid anxiety, she may learn to avoid situations that fan her fears. To cope well, she should confront her fears in a manageable and gradual way to give her faith in her own ability. She may learn to record her thoughts and have a look at them more realistically. This will help break down the spiral of her mood downward. Joanna may also learn to check her assumptions concerning other people’s motivation as opposed to making negative assumptions the way she does (Martin, 2011).
References
Baker, A., et. al. (2012). Cognitive–behavioural therapy for substance use disorders in people with psychotic disorders. Randomised controlled trial. Retrieved 30 Mar. 2012 from http://bjp.rcpsych.org/content/188/5/439.full
Froggatt, W. (2001). A brief introduction to Rational Emotive Behaviour Therapy. Retrieved 30 Mar. 2012 from http://www.anapsys.co.uk/files/Brief%20Introduction%20to%20REBT.htm
Martin, B. (2011). In-Depth: Cognitive Behavioral Therapy. Retrieved 30 Mar. 2012 from http://psychcentral.com/lib/2007/in-depth-cognitive-behavioral-therapy/all/1/
Ridgway, I. R. (2005). Rational-Emotive Behaviour Therapy. Retrieved 30 Mar. 2012 from http://myauz.com/ianr/articles/lect6rebtellis.pdf
Wright, J. H. (2006). Cognitive Behavior Therapy: Basic Principles and Recent Advances. Retrieved 30 Mar. 2012 from http://focus.psychiatryonline.org/article.aspx?articleid=50521
