Describe what comprises a comprehensive CBT case study – Evaluate the use of case studies in therapy.
Cognitive Behavioural therapy is a based on the fundamental idea that emotions are experienced as a result of our interpretation and appraisals of events (Dryden 2004). Case studies are a method of inquiry used in theory development, education as well as client evaluation. Case studies in CBT therapy help document the therapeutic process for both the client and therapist, as well measures, tests interventions, and evaluates practice for the therapist, and for the client in terms of measuring success or not (McLeod 2010). This essay will describe what comprises a comprehensive CBT case study and concludes by evaluating their use in therapy.
Referral in CBT can come from the individual themselves, GP’s, social services, probation/prison service or another therapist and may include information of diagnosis or medication. Referral can also be used to help prepare for the assessment interview. If the client needs to be persuaded to start CBT, it’s most likely an indication that it is not for them at this time (Sanders and Wills 2005).
Simmons and Griffiths (2009) suggest looking for a number of pointers during a general assessment to see if referral for a CBT assessment might be relevant, these include accessibility of automatic thoughts; awareness and differentiation of emotions; the client’s ability to make use of therapy and the clients’ ability to remain focused on the problem in hand, although this may be something that the client has to work towards. Barriers to therapy can be if someone is ‘floridly psychotic’, if someone is in a current manic phase, or if clients are cognitively impaired, this may make therapy more difficult but not impossible. An effective therapist-client relationship is important for treatment, with good evidence relating to quality of relationship and therapeutic outcome (Westbrook et al 2011).
According to Westbrook et al (2011) success of CBT is in the development of a formulation (case conceptualisation). This details a clients profile and provides an understanding and explanation of specific problems which then informs treatment. As well as opening up new ways of thinking for the client, formulation can also help predict difficulties in the therapeutic process. It is a collaborative and dynamic process which will continuously be adapted; it reflects on the here and now of the client by repeatedly building and testing hypotheses based on how emotions and behaviour are influenced by perception (thoughts) of an event rather than the event itself. It is within this triangulation that inherent meaning is made clear for both parties. Grant (2011) describes how client’s beliefs, or schema, often have their basis in past events, and a ‘longitudinal’ analysis of vulnerability (predisposition included) precipitating and protective factors are another tool within formulation. A cross sectional analysis will focus on what trigger’s problems and what the resulting symptoms are as well as modifiers, for example, what contextual factors make a difference to how severe the problem is when it does occur. These triggers or modifiers can cover situational, social and interpersonal variables as well as affective variables, such as the problem being worse when the client is bored or depressed (Westbrook et al 2011).
An essential part of assessment and formulation is trying to identify maintenance patterns, psychological processes which keep problems going. The maintenance cycle is the interplay of thoughts, feelings, behaviours and bodily reactions (Wilson 2010). For example, cycles may include safety behaviours, such as adapting behaviour around a problem rather then changing to a healthier perception; or where the client tries to avoid or escape a situation rather than learn coping strategies or expose beliefs. As well as helping both the client and therapist to understand important processes they...
References: Beck, J S. (1995) Cognitive Therapy: Basics and Beyond, London: The Guilford Press.
Dryden, W. (2004) Counselling Individuals: The Rational Emotive Approach, London: Taylor Francis
Grant, A, Townsend, M, Mill, J and Cockx, A
McLeod, J. (2010) Case Study Research in Counselling and Psychotherapy, London: Sage Publications
Neenan, M and Dryden, W
Sanders, D. J. and Wills, F. (2005) Cognitive Therapy - An Introduction, London: Sage Publications
Westbrook, D, Kennerley, H. and Kirk J. (2011) An Introduction to Cognitive Behaviour Therapy: Skills and Applications, (2nd ed.) London: Sage Publications
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