Cognitive Therapy Case Conceptualization

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The client: Elena

Elena is an adolescent female, coming to the therapy process demonstrating through actions and words a great deal of anxiety and overall apathy for her situation. Elena is a smart, socially engaged Mexican American attending public high school. She opens the session with presenting problems regarding conflict over what she might do after high school. Preliminary conceptualization from a cognitive perspective

Overall, there is an obvious feeling of disempowered regarding her right and or ability to make life decisions. She comes from a close-knit family, though some of her siblings have moved away to seek out goals beyond those that they may feel their parents are putting upon them. She has recently begun to disengage academically and socially as she feels the urgency of choosing to adhere to family tradition or to go out on her own, like her peers. Though she says she has not yet made a decision, know that cognition mediates affect and behavior (Friedburg 101). From this perspective a therapist might conclude that her recent apathy toward academics and isolating herself from her peers show that she indeed is letting the thoughts of “I must listen to my parents” drive her life perspective. It is promising from a cognitive standpoint, that she shows some jealousy toward her boyfriend and others: Perhaps the anger when discussing her family dynamics and recent history is most telling that Elena could benefit from Beck’s Socratic dialogue. The pluralistic views that come from her own identity within her biculturalism are strongly embedded, and the therapist demonstrated this by demonstrating lots of open questions. Letting Elena focus on herself as an individual rather than a Mexican-American could lead to meaningful exploration and collaborative cognitive change to help Elena feel more empowered. When counseling adolescents from a cognitive perspective the counselor must remember that under any circumstances this may be the first time that these clients might see their actions and behaviors, and question the beliefs that may have become embedded during childhood. Elena obviously needs a relatively short-term look into these feelings due to her grades slipping and applying for colleges, if she so chooses. Asking a client “what is going through your mind right now” (Murdock 337) is one of the base approaches to beginning to help the client recognize their individual thought patterns. This is a question that is difficult for many adults, and though adolescents in general can be more open to change, Elena’s worldview as a bicultural young woman is overpowering any other automatic thoughts that she might have; it is culturally appropriate for a young Mexican American to disregard her own thoughts and needs for the good of the family—which Elena does in fact voice (Rochlen 2009). As an observer to this case scenario, the challenge, due to age and culture, seems very difficult. The video demonstrates this strong schema Elena has developed that exudes this overwhelming disempowerment.

I believe this schema of overall disempowerment is deeply embedded and will be difficult to challenge through cognitive therapy. Additionally, Mexican culture tends to see the counselor as “expert” and the collaborative aspect of cognitive therapy may prove to be at the least uncomfortable for Elena, if not ineffective. Elena may continue to rely on others’ to make decisions for her, to give her an unconditional guarantee (Corey 107), if this base belief cannot be penetrated due to adherence to cultural tradition, fear of change, or if Elena is unable to begin to identify these automatic thoughts. Possible cognitive strategies

In general, Latino Americans traditionally have strong family bonds and honor generational wisdom (Sue 377) Through the current political venue of the United States and popular culture, Mexican-Americans may fall prey to stereotypes and inherently feel a disconnect or poor self-image:...
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