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 attending therapy. Once suitability was established, an in-depth assessment was carried out to build a framework of information in order to help me understand Julie’s problem in more detail. This main assessment drawn from Kirk (1989) and included in the development and maintenance formulation Beck (1995), looked at Julie’s problems in more detail and explored her goals and strengths along with any risks and other issues that were affecting her. Presenting Problems
When asked at assessment what had led her to seek therapy and treatment at this time, Julie identified that she had begun to feel more anxious and agitated over certain situations going on in her life. She described feeling disturbed and upset over persistent thoughts regarding her friends and boyfriend, especially since his traffic accident and pending rehabilitation to help with drug misuse. The thoughts she described could be quite violent and horrific in nature, normally involving death or harm especially if she felt that her friends, boyfriend or family were doing activities without her. Julie mentioned that when she became aware of these thoughts, she would start to do certain rituals. These rituals included grooming her hair or dressing a certain way, tidying her room ensuring everything was in exactly the correct place, checking the contents of her handbag every time she needed to use it and setting the volume on television to specific numbers. Julie had also noticed that she had started avoiding doing certain things which appeared to provoke or increase her intrusive thoughts. Here Julie explained that looking for prolonged periods in the mirror at herself or at images in a magazine about hair styles would increase thoughts about altering her appearance. This in turn would raise her anxiety and make her think that something awful would happen to someone if she did alter her appearance. Unfortunately for Julie this belief was confirmed when her boyfriend was involved in a traffic accident the day she...