THE ROLE OF THE RELATIONSHIP BETWEEN THERAPIST AND CLIENT IN COGNITIVE BEHAVIOUR THERAPY IN THE CONTEXT OF THERAPEUTIC TASKS CANDIDATE NUMBER: 12823707
Essay submitted for the award of Foundation Degree in Psychodynamic Counselling and Cognitive Behaviour Therapy, Birkbeck College, University of London CONTENT PAGE
Within this case review I will explore the relationship between client and therapist by identifying the role it plays within the following; establishing the boundaries of my work; assessment/diagnosis; the development and process of the relationship, including my own self awareness gained from the use of supervision. To achieve this I will also explore my use of the underpinning skills of the cognitive behavioral theory. This will be explored through work carried out with one of my clients. Place of work
I work as an Addiction Counsellor (qualified to Level three certification in counseling studies) for RAPt situated within HMP Wandsworth within the rehabilitation treatment unit. Male’s aged between 20 and 60 are referred for treatment displaying chronic substance misuse. A high percentage of those referred suffer mental health concerns relating mainly to depression; Anxiety, social and OCD; trauma; psychosis and anger. Therapy is delivered within group therapy, group sessions and within a one to one setting. My role incorporates an initial assessment, six one to one sessions, 90 psycho education sessions. The assessment is 90minutes with 50miuntes for therapy. The theoretical approaches used are brief Psychodynamic and Cognitive Behavioral Therapy; however this case study will be CBT based. Referrals are made from the Carat team (drug intervention team), healthcare, and St Giles and prison officers situated within HMP Wandsworth. The initial contact with a client consists of explaining the ethical framework laid out by The British Association for Counseling and Psychotherapies (BACP). I explain that disclosure of personal information is contained within the client-therapist relationship, however this agreement will be broken if; they are at risk of harming themselves or others, There is a risk to prison security or if there is deemed a risk to any child/children. I stipulate that all documentation are kept confidential and are placed within a locked filing cabinet during and outside of office hours.
Robert completed an assessment to assess the severity of depression, anxiety and suitability of the program. This is achieved by collaboratively discussing and identifying Roberts presenting concerns. Presenting concerns
Robert presents the following concerns; severe depression e.g., irregular sleep and loss of appetite, poor information processing and lack of understanding of perceptions of self, others and the world (Beck 1978) and anxiety e.g., dizziness, shortness of breath, nausea, sweating and shaking and panic attacks e.g. brief periods of intense fear, panic and discomfort. Robert also reported low self esteem (social, appearance and performance), feelings of hopelessness to his current situation (relating to substance misuse and homelessness). He also processed and recognized feelings of guilt around abandonment of his children which he often displays in anger as a way to manage. Paramount to the CBT theory is the concept that the client’s cognitive thought process direct the clients behaviors (Brewing, 1988) and it was acknowledged that Roberts were; “I am bad father”; “I am no good to anyone”, “I am a bad”; “I am hopeless; I am unlovable “; I am not strong enough” Onset and triggers
Robert processed that he first recognized the onset of his (recurring and severe) depression and anxiety (primary emotions) when his first partner left him, taking his two children with him. Robert recognized that his...
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