Case Analysis On Cognitive-Behavioral Interventions For Emotional And Behavioral Disorders

Presenting Problem - What do you see as the problem? Needs to be supported by the data in the previous sections and based in theory. Kaci is a smart, but very introverted 7th grade girl. She has very few friends and tends to keep to herself. Ali, her one true friend, turned on her over a boy, Jim, who asked Kaci out instead of her. Ali then proceeded to spread lies, rumors, and pictures of Kaci all over the school in retaliation. Since many students at the school do not know Kaci, they sided with Ali, who has a lot of friends at school. Distraught over the situation, Kaci went into a downward spiral. She tried to continue going to school but things just got worse. Kaci thinks other students continue to make fun of her, Jim dumped her for Ali, and she started having anxiety reactions--feeling sick to her stomach at the thought of having to go to school. She started skipping school, drinking, and starving herself. She felt like no one could help her.

Cognitive Therapy is based on the premise that our thoughts, feelings, and behavior are all connected. When we experience difficulties in life, or a skewed perception of a situation, we can develop problematic behaviors, maladaptive thinking and even unhealthy emotional responses or feelings about a situation, or ourselves. In this case study, Kaci’s thoughts that the whole school hates her and laughs at her has led to feelings that she isn’t worthy of friendship and is unlovable. It is by identifying and changing our response to these situations or feelings that we can meet our goals and develop positive thoughts, feelings,and behavior. Kaci’s cognitions, or how she thinks and what she thinks, could be due to maladaptive schemas she has developed over the years. Schemas are how we file all the information, feelings, and experiences into our brain so that when situations arise, we think, and process the new experience based on the information we know. If the schema is faulty, then the way we perceive the situation, and in turn how we respond, could be skewed as well.

Therefore, it is by changing the way we think that we can better learn how to deal with a problem and understand the cause of it in a healthy way. For Kaci, her experience with having people to help her through problems has been impacted by her family dynamics. Her father passed away when she was young, she has no family close by to help her develop a healthy sense of security, and her mother works many hours, expecting Kaci to be independent. Kaci feels like no one can help her because she does not have any experience with people she can truly rely on. In addition, since Kaci has an introverted personality, she may associate her best friend, Ali, as her only friend; now Ali has turned on her and, in her mind, taken the whole student population with her. Our beliefs are part of our schema; we have core beliefs--basic beliefs about life; we have intermediate beliefs--assumptions we make, rules we accept, and attitudes we exhibit; and then we have automatic thoughts--reflex reactions that are often very powerful in every situation. Kaci assumes that this incident will continue and get worse. Kaci is experiencing a type of automatic thought that is distorted based on her personal experience with family, and to an outside observer, unreasonable. Cognitive therapy also uses the concept of modes.

Modes allow a person to adapt to how he or she handles a situation and involve how we think, feel, and act regarding a situation. Since our modes are influenced by our schemas, a maladaptive schema can negatively influence modes. Our modes allow us to adapt to situations; there are three types of modes: primal, constructive, and minor. The most basic of our modes is the primal mode which helps us to meet our goal of endurance and sociability. For Kaci, her primal mode is impacted because she feels a threat from the situation, and a loss of her only, best friend. In her mind she is also a victim because she is being teased and views this as encompassing the entire student body. Her constructive modes are influenced by her life experience, and her minor modes, which are under more conscious control, can be focused on situations and everyday interactions. With Kaci’s experience, a change in her perception of the reality of the situation could help her to see the situation in a more positive light.

Lastly, our automatic thoughts are those that “pop into our heads. ” They can be very powerful in that they are a result of our core beliefs. Core beliefs are “should and must beliefs as well as conditional beliefs that are influential in creating meaning from experience” (Murdock, 2009). For Kaci, her belief is that everyone hates her and is talking about her; she feels like it is never going to end; therefore, her automatic thoughts influence her to perceive everyday situations as a threat and damages her ability to “get over it”-- as her mom thinks she should be able to do. With the problems that this student is experiencing how would you proceed with the student with this specific theory? b. Include the therapeutic process including goals and objectives, evaluation where appropriate, techniques, potential barriers, and counselor’s role.

Therapeutic Process Cognitive

Therapy is a short term, problem-oriented therapy lasting ten to twenty sessions. The sessions will contain both informal and formal assessments so that we can get a clear picture of Kaci’s thought process. Informal assessments will be done during the sessions by asking Kaci questions and by interpreting her dialog. Homework is also an assessment tool that can be used in Cognitive Therapy. Formal assessments will be given throughout the therapy to assess her progress in the way she is thinking. Examples of formative assessments that could be used are: Beck Depression Inventory, The Automatic Thought Questionnaire, Dysfunctional Attitude Scale, and Beck Cognitive Insight Scale (Murdock, 2009). This will involve a collaborative relationship with the counselor to guide Kaci to identify and then apply problem-solving techniques and a change to her thought process. In addition, when treating depression, a family approach to include Kaci’s mom could also be implemented (Vernon, 2009). This would help the mother to have a better understand how Kaci is feeling and how much the situation has influenced her daughter.

Goals and Objectives

The overall goal is to change the maladaptive thoughts Kaci is having through the techniques of Cognitive Therapy to help her recognize her negative emotional reactions, identify her own negative cues, and evaluate her thoughts in order to develop healthier responses to the situation in which she finds herself. Kaci’s automatic thoughts just pop up, so the goal is to identify the thoughts that are dysfunctional and distorted, increasing her awareness of her emotions, and to identify, evaluate, and respond to these automatic thoughts in a more positive way. While we want to help Kaci cope with the current situation, we also want Kaci to develop effective cognitive skills that she can then apply to future challenges. By changing her through patterns, Kaci will gain better control of her feelings and reactions.

Evaluation

As the counselor and Kaci continue working together, the counselor can evaluate Kaci’s progress by first assessing if and how her attitude towards the counseling is changing. The first two sessions, Kaci had a fixed mindset that no one could help her. As the counselor works with her to change her cognitions, an easy indicator of her progress will be how her attitude towards the counseling progresses. As she starts to become more open to the process, Kaci will be more successful in the therapy. From there, other useful areas to determine growth would be her academics and attendance. Also, comparing and checking her cognitions from session to session to determine if she is becoming more capable of developing healthier thought processes.

Techniques

The first step would be to identify the emotions Kaci is feeling and to have her describe how these emotions are influencing her feelings and thoughts. This could be done through the technique of questioning. By asking Kaci leading questions, it will help Kaci understand the problem and reflect upon how she is processing the situation. Socratic questioning is where the counselor starts the thought process by asking a leading question. These questions are effective in helping the client test automatic thoughts (Murdock, 2009). Examples would be: What is the worst that could happen? Could you live through it? What is the best that could happen? What is the most realistic outcome? What happens when you believe these automatic thoughts that pop up? How would you feel if you could change what you think when these thoughts pop up? Another technique could be to have Kaci record her thoughts as she has them and to write out positive alternatives to her maladaptive thoughts. This problem-solving technique will help her not only with the current thought she is having, but it will also start to train her to deal with future challenges. Assertiveness training to help Kaci advocate for herself could also be done through role-playing and modeling to help her respond to the ongoing situation. Even though Kaci is very shy, it is important for her to learn how to take a stand to end these taunts.

Potential Barriers

Culture plays a role in a client’s self-image and their perspective on a situation. Therefore, it is important to consider the cultural aspects of Kaci’s situation and adapt the therapy to be sensitive to the client’s needs. Another possible barrier could be a lack of parental support, especially involving Kaci’s therapeutic homework. If Kaci’s mother thinks she should “just get over it,” then she may not see the value of Cognitive Therapy and sabotage any progress Kaci might make.

Counselor’s Role

The relationship between Kaci and the counselor needs to be collaborative in nature. Initially the counselor will need to ask many questions of Kaci to get her thinking of the situation in a way that allows her to effectively communicate her feelings. It is important that the counselor not let Kaci become passive, so having Kaci participate through homework, role playing, and other techniques is important. It is also imperative that the counselor accept the thoughts and feelings that Kaci discusses and not make her feel invalidated. Throughout the process, Kaci should start taking more of a lead and ownership of the sessions. The counselor can utilize formal assessments throughout the therapy to assess Kaci’s progress.