A Sense of Doubt blog post ##3817 - THEORIES CLASS - Counseling - Cognitive Behavioral Therapy
Another of my assignments and that's all.
Week Six - Main Discussion - COUN6722 -
Cognitive Behavioral or Rational Emotive Behavioral
Case
Conceptualization
Theory: - Cognitive Behavioral - Case of
Mike
Presenting Problem: A fourteen-year-old Asian American
male, Mike has been referred for counseling by his math teacher due to low
grades. Mike is withdrawn and shows signs of anxiety and depression. Mike
reports that his father verbally abuses him for his grades and a “lazy American
teenage attitude.” Mike has agreed to counseling to help his family and find a
way to live up to his father’s expectations. Mike is also bullied at school and
has no close friendships at school. Mike enjoys working on cars with his one
friend, a seventeen-year-old high-school dropout, with whom he might like to
open an auto shop, something of which his father disapproves. Mike feels
inadequate and isolated because he does not want to be an engineer like his
father, and he feels responsible for the tension in his household.
Hypothesis: Mike has internalized his father’s
harsh criticism for his low math grades causing his feelings of isolation and
inadequacy. He sees his interest in auto work as a failure of his father’s
expectations for him to be an engineer further perpetuating his feelings of inadequacy.
The cycle of verbal abuse from his father and Mike’s isolation has become a
“conditioned response” resulting in “cognitive distortions” and negative core
beliefs (Shaw & Green, 2022, pg.195-199).
Goals: The primary goals for Mike are to
learn to cope with or even eliminate negative core beliefs internalized from
his father’s verbal abuse. Through Cognitive Behavioral Therapy (CBT), Mike
will be able to identify and challenge his negative thoughts and learn coping
skills that will reduce his anxiety and self-perception of inadequacy. If
successful, Mike will have greater social interest and better self-image. These
dysfunctional behaviors or irrational beliefs could be changed or disrupted by
changing Mike’s cognition. Through “functional behavioral assessment,” Mike can
be taught to track the ABCs of his situation – “antecedents, behaviors, and
consequences” – to understand what is “sustaining the behavior” and change
these “maladaptive patterns” (Shaw & Green, 2022, pg.201).
Interventions:
Cognitive Defusion: To address Mike’s negative thoughts about himself, the counselor will guide Mike through the “leaves on a stream” technique, a third-wave technique in acceptance and commitment therapy, that falls within the broad category of CBT (Shaw & Green, 2022, pg.204). The counselor will encourage Mike to practice the activity outside of the session. The counselor will debrief with Mike after each use of the technique in session to emphasize how he will train his mind to “not get caught up in negative thinking” but to observe negative thoughts and continue to live with the positive values of the present moment (Shaw & Green, 2022, pg.204). Through use of debriefing with Socratic questioning, the counselor will help Mike to feel more comfortable experiencing negative thoughts and yet decrease their believability and frequency. For instance, by asking Mike “What is the worst thing that could happen,” Mike may feel that this is his father following through in his threat to kick him out of the house. With continued questioning, the counselor can lead Mike to identify the underlying negative core belief – perhaps “I will have nowhere to go and be homeless” (unlikely as Mike is a minor) – and then helping Mike to adapt and focus on positive outcomes (Rosenthal, 2017, pg. 655) to cope with fears about this worst case scenario.
Self-Monitoring Thought Record: The counselor will teach Mike to
increase his awareness of how his automatic thoughts have emotional/behavioral
consequences. This activity will be another homework assignment for Mike to
focus on adaptive responses when experiencing triggers by increasing his
awareness of his negative thoughts and helping him intervene before they
perpetuate his feelings of isolation, inadequacy, and anxiety. As Shaw &
Green (2022) explained citing J.S. Beck (2021) client’s language, such as “I
feel that I am a failure” – something Mike may say – reflect thoughts and not
feelings. By “detailed use of the thought record” (pg. 203), Mike can identify
these thoughts to develop adaptive responses for positive outcomes. For
instance, if “feeling like a failure” results in the emotion of insecurity
(feeling inadequate), the adaptive response can be focusing Mike on parts of
his life that are not failures, such as working on cars with his one friend.
Expected Outcome: If Mike is successful with the
interventions in coping with his negative thoughts, his anxiety and isolation
should diminish, he will feel better about himself, and he will be able to
resist internalizing his father’s negativity. Mike should feel less isolated
and better able to navigate abusive situations both with his father and the
bullies at school. As John Krumboltz explained in the “Cognitive Behavioral
Therapy” video from Psychotherapy.net, he said “we [CBT counselors] are
results-oriented. We want to help people improve, and we want to do it as
quickly and easily as possible. And we want to keep learning to do it better
and better (1:30:45-59). These interventions should help Mike achieve the
therapeutic goals as quickly and easily as Kromboltz suggests.
References
Psychotherapy.net. (Producer). (1997a). Cognitive behavioral therapy with John Krumboltz. [Video file]. Mill Valley, CA: Author.
Rosenthal, H. (2017). Encyclopedia of counseling: Master review and tutorial for the National Counselor Examination, state counseling exams, and the Counselor Preparation Comprehensive Examination (4th ed.). Routledge.
Shaw, S. & Green, J. (2022). Cognitive-Behavioral theories. In D. Capuzzi & M. D. Stauffer (Eds.), Counseling and psychotherapy: Theories and interventions (7th ed., pp. 193-216). American Counseling Association.
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- New note - On 1807.06, I ceased daily transmission of my Hey Mom feature after three years of daily conversations. I post Hey Mom blog entries on special occasions. I post the days since ("Days Ago") count on my blog each day, and now I have a second count for Days since my Dad died on August 28, 2024. I am now in the same time zone as Google! So, when I post at 10:10 a.m. PDT to coincide with the time of Mom's death, I am now actually posting late, so it's really 1:10 p.m. EDT. But I will continue to use the time stamp of 10:10 a.m. to remember the time of her death and sometimes 13:40 EDT for the time of Dad's death. The blog entry numbering in the title has changed to reflect total Sense of Doubt posts since I began the blog on 0705.04, which include Hey Mom posts, Daily Bowie posts, and Sense of Doubt posts. Hey Mom posts will still be numbered sequentially. New Hey Mom posts will use the same format as all the other Hey Mom posts; all other posts will feature this format seen here.
