Session One: Assessment:

According to the Beckian CBT model, which is one of the most common models in cognitive therapy, there are major differences between cognition which includes appraisals, beliefs, and thoughts, emotional experience as well as overt behaviour. The model considers cognition as the most dominant suggesting that people’s feelings and behaviours are mainly dependent on their belief-based appraisals of occurrences. As such, for an accurate understanding of my client to unearth what mainly bothers her, I would have to conduct cognitive therapy. I would have to ask questions regarding her situation and relate it with the experiences in the vignette.

CBT treatment focuses on the problems that are happening at a specific moment. It analyzes the factors that could be maintaining the problems. Current difficulties are mainly known to reflect widely, and understanding the existing belief systems by tracing them from previous experiences. In cases where there are negative developmental experiences, there are underlying maladaptive core beliefs and secondary assumptions that make one feel inferior and unappreciated (Dawson & Moghaddam, 2015). Therefore, it is appropriate to come up with the appropriate measures or approaches that would bring forth the desired success or excellence.

Cognitive therapy is a simple but highly useful procedure in seeking to understand the behaviour or character of the client. In the case of my client, cognitive therapy would help in understanding the underlying problems by asking questions that are related to current experiences. For example, I would ask questions targeting her present thinking, behaviour, as well as communication. The three elements are an accurate illustration of one’s behaviour whenever they could be facing a problem. In my questions, I would ask her about her current thoughts seeking to understand the extent of the problems and how they bother her daily life. Also, as much as I may observe her behaviour, I would have to inquire about what she believes could have changed concerning her behaviour. I may request her to cite a specific behaviour that she considers could have changed. At the same time, I would be keen on the communication behaviours or patterns of the client. Communication is a critical element in measuring the behaviour of the individual.

Under the Beckian CBT model, logic is a paramount factor that I would use in the review of the problems that the client may be facing. A logical sequence of situational responses; emotions, cognitions, and behaviours help in the easier interpretation of the issues that the people face. It is possible to discern how one relates to a certain problem based on how they discuss it. The emotions would be expressed through speaking where they may use harsh words or alter voices when addressing different issues. Also, they may behave differently when addressing different issues. It would be paramount to analyze every issue logically by being sensitive to how people express themselves through action and words (Dawson & Moghaddam, 2015).

Also, a therapeutic alliance would be an outstanding approach to gathering critical information about the client. A therapeutic alliance is the development of a relationship between the client and the therapist as they work together in therapy. In this approach, the therapist and the client have contributions to bring to therapy. The two parties work together to attain the client’s goals. It dispels the idea that the therapist is superior and should be responsible for understanding the client’s situation and the problem that they could be facing. The parties work together to realize the best out of the process by ensuring that the client gets the desired value. The approach will be helpful since it would build the client’s confidence to cooperate so that it may be easier to find a common ground for discussing the issue (Easterbrook & Meehan, 2017).

Moreover, a successful therapeutic relationship is dependent on technical and interpersonal factors. The approach respects the CBT’s main characteristic of working with the principle of here-and-now, rationalization, behavioural activation, as well as solving problems.  Therefore, the therapist and the client have to agree that they are out to solve the problem together with each party willing to give their best at the specified time. This approach would be outstanding in creating a cordial relationship between the client and the therapist. It creates confidence between the parties allowing the therapist to discover more about the patient. I will use this approach where I would befriend the client to ensure she is confident to share everything that she could be experiencing (Easterbrook & Meehan, 2017). Approaching her as a confidant would make her confident to share information that they consider sensitive.

Additionally, CBT is structured with sessions and activities accurately outlined. It starts with the identification of directions and an outline of the procedures that parties must undertake. The approach gives the client direction and structure of the questions that they are expected to answer. It stipulates the time for sessions and ideas that are to be discussed. As such, it is an excellent way of ensuring that any client’s behaviour to stop action is eliminated. Negative behaviours such as procrastination, blame, avoidance, and assurance seeking are eliminated as they affect CBT sessions (Easterbrook & Meehan, 2017). I will structure my sessions with a timetable that I share with the client. The timetable has a list of events or activities that the client is supposed to attend. I would brainstorm with the client during the formation or stipulation of sessions to give her an opportunity to highlight the issues that she considers most paramount and should be included. It helps me to gather more details about the patient while highlighting the most critical issues that I must address during the therapy.

Also, negotiation is an outstanding approach to deal with the problem. However, it does not happen in isolation but requires a lengthy process in which the client’s problem is discussed by the client and the therapist. Negotiations would be more effective if there is a structured session as illustrated above. They include an accurate discussion of the underlying issues with the client being open to the therapist regarding the issues that they could be facing. Negotiation is a process that starts with the elaboration of the problem. At this point, the client opens up to share the issues that they consider to be the cause of the problem that they face. The most paramount thing in the negotiation is that the client is willing to go the extra mile to analyze their problem. It is an outstanding opportunity for me to seek clarifications and dig deeper into the issues that the client raises (Beckwith & Crichton, 2010). I will take the chance to take notes of the new concerns or issues that the client raises. During negotiations, the client is likely to disclose new information.

In conjunction with negotiations, I would use the strategy of personalizing the problem. As the client speaks and I realize that she seems to make generalized statements, I would put them into her context. For example, the client may indicate ‘I experience weird panic attacks’. The client indirectly illustrates that she is suffering from panic attacks. To ensure that I get her correctly, I would use a gist formulation and ask ‘so you are experiencing panics’? Through formulation, it becomes easier to centre problems on the client’s case. I would use the second person pronoun, ‘you’ to redirect the problem to the client. Since panic attacks are features of anxiety disorder, the formulation will have played a critical role in making me understand the underlying problem. It would be an outstanding way of confirming that the client is facing anxiety (Beckwith & Crichton, 2010). The magnitude of the problem would be clearer as I frame the client’s responses to reflect her issues.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Session Two: Case Formulation

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

The CBT Diagram is an outline or guideline of how to deal with the CBT case at hand. The formulation has a step-to-step procedure that illustrates the best ways of dealing with Hasret’s case. Several factors will be critical in this case. It starts with the identification of vulnerable factors which would be regarded as the patient’s weak points. In this case, Hasret’s vulnerability factors are anxiety, stress, and low mood resulting from the high expectations by the employer.  The factors expose the victim to greater challenges.

Moreover, vulnerability factors could be enhanced by faulty beliefs and precipitants. Hasret has certain beliefs that may make it difficult to deal with her situation. She believes she is not perfect and will always make mistakes at work. Secondly, she believes that she would not complete a task without the leader or supervisor complaining to her.  However, the beliefs could be a result of certain precipitants. The first one is fear of making mistake at work which would be followed with strict measures by the employer. The second one would be engaging in different tasks at the same time where Hasret’s mind cannot concentrate on her work. She wakes up at night worried that she may be fired the next day for failing to do her work as per the requirements.

Further, there are triggers and modifiers which lead to the problem. They include fear at the workplace, unexplained stress, and low mood from work experiences. Fear of making mistakes and losing her job triggers her to wake up in the middle of the night. She is extremely negative about her situation and she believes it cannot be resolved. The problems can be addressed through the adoption of suitable maintenance processes. The maintenance processes include safety behaviours, reduction of activity, scanning or hypervigilance, and perfectionism. Safety behaviours and reduction of activity would mean that she avoids tasks at work as she fears that she would make mistakes. In another case, the client may try to perfect their art. She would try to be perfect at the workplace to avoid the frustrations that would come with complaints from the authority at the workplace.

Lastly, there are the treatment goals. They mark the significance of the process with the formulation of the targets on behalf of the client. The first goal is to understand the thoughts causing anxiety and resolve them. The second one is to promote self-awareness and emotional pain. The third one would be to reduce anxiety symptoms. The last one would be the development of self-confidence. Each goal is paramount and would be analyzed critically to understand what should be done to guarantee the patient proper or excellent care.

Session Three: Goals and Treatment Plan

Goals of the treatment:

As I handle the client, I would have specific goals. The goals are in line with the problem that the client is facing. The first goal in the treatment process would be to reduce the frequency, intensity, as well as the duration of the anxiety. Since the client complains that the anxiety is constant and wakes her in the middle of the night. It interferes with her activities at work making it difficult for her to undertake responsibilities thoroughly. She fears that she would always make mistakes at work and she is likely to be fired for repetitive mistakes. Therefore, I aim to reverse the situation by reducing the frequency, intensity, and duration. The process is procedural with full recovery being a long-term goal.

The second goal will be for the client to learn and implement coping skills that reduce anxiety and worry. Also, the coping skills will be aimed at improving the client’s daily functioning. Coping skills would only be learned through close interaction with the client. As such, I would ensure that I create an excellent platform that allows the client to exercise ideas on how they should deal with certain issues. The focus is to ensure that the student gains the best skills and they are willing to utilize them maximally. I would insist that they practice the skills to test whether they are in line with the goal. The tests would prove whether the skills would work to the advantage of the patients.

Treatment Plan:

Cognitive-behavioural therapy is one of the most outstanding methods of treating anxiety. It is usually reliable when no medication is required for the client’s full recovery. It works through identifying and addressing the client’s thoughts as well as behaviours that cause anxiety. As such, I would enjoy using it for the treatment of anxiety disorders. However, its success is highly dependent on the procedure that I choose. I will be keen to ensure that I adopt a procedure that would fit the sessions that I consider most useful to the client. At this point, I would have to be extremely cautious to monitor the steps that ought to be followed for the full recovery of the client suffering from anxiety. I would be keen on the sessions to ensure that they are most suitable for anxiety disorders. It is my responsibility as the therapist to understand how negative thought patterns may affect the client’s behaviour and feelings.

Regarding Hasret, I will have to utilize a four-step procedure. Each step will be thoroughly expounded to explain its significance in addressing the anxiety problem that my client is facing. Each step will be in line with two or one of the goals. The steps are selected in line with the goals that I intend to attain in the process of handling the client.

Step One: Anxiety Psychoeducation

As the first step, it is a critical determinant of the client’s recovery process. Anxiety psychoeducation gives the client an opportunity to understand her problem. Unless the client is aware that she has a problem, it would be difficult to introduce her to the recovery process. However, education would start by understanding what they know about anxiety and determine whether they are aware that they are suffering from it. As such, in this process, I would be thorough to ensure the client is aware of what we are treating. It would be appropriate to discuss triggers or sources of anxiety, their perceptions on the state of the condition, and whether they are aware of how they would respond to the situation.

After the client has confirmed that she does not fully understand what she is suffering, it would be appropriate to explain anxiety to them. The definition of anxiety would be an outstanding thing to do. I would explain to the client that anxiety is a feeling of extensive discomfort that makes an individual avoid the feared stimuli. It would be an outstanding opportunity to make the client understand that she portrays anxiety whenever she seeks to avoid a situation. I would be keen to ensure that the client does not confuse anxiety with another psychological problem.

Yerkes-Dodson law would be an outstanding way to educate the client to understand why they have anxiety, how it affects them, and how a certain level of anxiety could be helpful. The Yerkes-Dodson law dictates whether anxiety is too much or too little, it can be harmful. It proposes that a person can only reach optimal performance on an activity with a moderate level of anxiety. I would use the model for explaining to the client anxiety creates little motivation and one is unlikely to perform exemplarily in specific tasks. However, with moderate anxiety, one would be motivated to prepare or concentrate on a particular situation without avoidance (Brewer & Williams, 2017).

Step Two: Challenging Client’s Negative Thoughts

I will start by explaining to the client the relationship between feelings, thoughts, and behaviours. The most critical approach would be to provide clients with personal experiences. As a therapist, I have come across people who have undergone major psychological challenges. It would be most appropriate to give the client examples of cases that I have handled previously.

However, the client would only resonate with the issue if I included a practicing session and complete a thought log. In the thought log, the client would be required to explain the situation that they experience, record the thoughts that they had during the situation, the resultant behaviour, and emotion. If the client does not practice how to identify the link between thoughts and emotions, the thoughts causing the anxiety would pass unidentified and unchallenged. However, I would only require the client to be keen on the thoughts that lead to anxiety.

Once my client has practiced how to identify negative thoughts and I realize she is proficient in recognizing them, it will be an opportunity to start challenging these thoughts. I will encourage the patient to start challenging the thoughts by asking whether they have evidence to support the thought or they are assuming that the thought had triggered the behaviour. Since I understand that dealing with long-held beliefs would be difficult, I ease the process by asking my clients to ask themselves various questions to evaluate their thoughts.

Having successfully challenged an old belief, I will have to ensure that my client replaces the new belief. I will insist that the new belief does not have to be about happiness alone. I would encourage them to replace their thoughts with less negative ones. However, the focus is to maintain neutral thoughts by minimizing or eliminating fear (Creswell et al., 2019).

Step three: Exposure therapy

The main idea of exposure therapy is to ensure that the client faces her fears. When my client learns how to understand and interpret her fears, anxiety reduces. I would help the client to first create a fear hierarchy. I would list the fears that the client would wish to address and ask them to rank them in a range of 1 to 10.

The goal is to ensure that the client can rank the fears and their stimuli. The process aims at helping the client understand the stimuli causing them to develop excessive fear for something. The ranking helps the client to identify the most challenging situations and the level of fear that they cause (Creswell et al., 2019). Later, I initiate the exposure process where the client will start facing each situation. In the process, the client would start facing less fearful situations before advancing to the complex ones. In the process, I will focus on understanding and interpreting their reception for specific situations. The gradual process would ensure the client continually masters how to deal with their fears.

Step Four: Relaxation Skills

Relaxation skills are techniques that enable the client to start the calming response within the body. In the case of the current client, I would use deep breathing and progressive muscle relaxation. For deep breathing, I would help the client to take conscious control of her breathing. Deep breathing is critical when handling anxiety. In general, it is a suitable way of reducing stress. I will encourage my client to continue exercising deep breathing especially when the situations that would trigger anxiety.

Progressive muscle relaxation would be the second exercise though it requires more effort. The exercise requires the client to focus on the muscles (Creswell et al., 2019). Clients learn the best ways to identify the right muscles to focus on during relaxation. I will ensure the client understands the value of progressive muscle relaxation. I will advise the client to have regular intervals for relaxation. I will suggest that she stretches her muscles whenever she feels anything associated with anxiety.

Session Four: Alternative formulation and intervention:

How ACT Would Conceptualize Clients problem.

ACT allows the therapist to consider alternatives in the process of treating a patient. Conceptualization in the ACT is different since the therapist is supposed to engage in a collaborative approach with the clients seeking to find the most suitable solution. The therapist is expected to listen to the patient’s needs and experiences before coming up with a solution. The patient is expected to be transparent with the therapist to ensure they share the most accurate or relevant details. The patient should share the details of the problem without a doubt that they would receive exclusive assistance (Davey, 2019).

Since it is collaboration, the therapist is expected to review the available options with the client. As such, the therapist should ensure that she gets accurate information concerning the issue at hand. With extensive discussion of the underlying issues, it becomes easier to find solutions. The therapist would have to come up with ideas based on the client’s experiences with the problems at hand. In such a case, there has to be an outstanding approach that specifies the needs of the client. At the same time, the therapist calls for the client’s attention giving her opinions of what should be done at any point. The alternative is selected based on its viability and ability to address the underlying issue (Kuyken et al., 2011).

Also, conceptualization in ACT helps in determining the most cost-effective interventions. In most cases, clients will be looking for cost-effective options. The client is not willing to spend on alternative procedures or processes that they consider more expensive. They would prefer procedures that would be helpful to them and affordable. It is upon the therapist to allow the clients to select the most suitable intervention. Cost is a major factor when a client is looking for alternative cognitive therapy. Cheaper alternatives are most likely to be adopted because they play a similar role with the expensive ones (Davey, 2019).

In another case, ACT conceptualization can identify client strengths and propose ways that would help build the client’s resilience. Conceptualization seeks to understand the client’s response to questions. The idea is to ensure that the client is given the best alternative based on their response to specific questions. Mostly, understanding the client’s resilience or adaptability to the problems would make it easier to evaluate the available solutions. Understanding the client’s potential would help in understanding the client’s strengths and using them accordingly (Kuyken et al., 2011). There has to be an accurate choice that befits the clients’ needs or expectations.

Lastly, in the case of ACT, conceptualization would be helpful in the identification of proper selection, focus, and sequence of interventions. The most crucial function of conceptualization is to support the therapy. As such, conceptualization in ACT ensures that the therapist continues and in favour of the client. In the analysis of ACT, there would be a need to agree on the most suitable action to adopt. Conceptualization helps the therapist to select the most suitable interventions. It gives the client understanding of why they are doing a certain thing and the value that it would bring to them. Once there is an agreement for action between the therapist and the patient, an opportunity for greatness is assured. Therapists and patients work towards realizing success where the patient gets the most suitable alternative (Kuyken et al., 2011).

Specific ACT Interventions

Alternative cognitive therapy would be suitable for reversing the client’s beliefs on how to address anxiety. Metacognitive therapy (MCT) would be a suitable alternative therapy for anxiety disorder. The theory states that psychopathology arises because of preservative thinking known as a cognitive attentional syndrome (CAS). CAS is made of dysfunctional strategies that the client could have employed in managing distressful feelings and thoughts. Clients are likely to adopt thought control strategies, avoidance, as well as reassurance-seeking, which may not guarantee success. The client may believe that they do not have control over fear. They may not be aware that something could be done to address the problem (Normann & Morina, 2018).

In MCT, there are metacognitive beliefs that could be causing the anxious feeling, low mood, and fear that the client portrays. The first step would be to conceptualize an idiosyncratic case formulation for the client and socialize her with the maintaining processes. It would include sensitizing them on the effect of worry or anxiety and the ineffectiveness of the current coping strategies. The client gets to understand that there are complex situations that would not be addressed without a proper understanding of the means or ways of maintaining the current situation.

Further, there would be a need for specifically designed therapeutic techniques like attention training and detached mindfulness. The attention training technique is an auditory task that calls for the patient to participate in selective attention, divided attention, as well as attention switching. The technique would be helpful to the client since it allows her to control and acquire attentional flexibility. The client would have to find ways of dealing with specific issues that engulf them. They are ready to change their ways by changing what they consider to be the cause of their problems. It reverses their thinking by making them understand that worry and rumination can be reversed. The patient develops new ways of responding to situations by ensuring that they are handled in the most professional manner (Normann & Morina, 2018).

The other ACT method would be collaborative empiricism. Collaboration ensures that the right ingredients are in place and they are mixed appropriately. In this alternative, the client and the therapist would have to agree on the relevant terms. The patient would have an opportunity to present their opinions through the engagement that they would have with the therapist. Patients agree with the therapist on the current situation and the best solutions. It is an opportunity to ensure that the client’s ideas have been heard and discussed with the therapist. It ensures that the right procedures are followed in seeking ways to accommodate the client. Collaboration is mainly teamwork and teammates have to exercise their responsibilities accordingly (Davey, 2019).

The collaborative conceptualization process between the therapist and the patient could be an outstanding learning platform. It provides an opportunity for curiosity and guided discovery that the client can adopt for self-practice.  It would mean that the client is in a learning process where they would apply the lessons to improve their current situation and handle a different one that may arise in the future. Collaboration calls for combined effort and the involved parties play an equal role as they seek to attain certain value. The idea is to ensure that the therapist befriends the client to make them open to other ideas that would make the recovery process easier. The patient unknowingly contributes to her recovery. She gives an opinion over what should be done while weighing the ideas that the therapist gives.  At the end of the day, the collaboration is in favour of the client since the therapist would only accept the strategies that he considers viable as per the relevant guidelines (Kuyken et al., 2011).

 

 

 

 

 

References

Beckwith, A., & Crichton, J. (2010). The negotiation of the problem statement in cognitive behavioural therapy. Communication & medicine, 7(1), 23-32.

Brewer, N., & Williams, K. D. (Eds.). (2017). Psychology and law: An empirical perspective. Guilford Publications.

Creswell, C., Parkinson, M., Thirlwall, K., & Willetts, L. (2019). Parent-led CBT for child anxiety: helping parents help their kids. Guilford Publications.

Davey, G. C. (Ed.). (2019). Clinical psychology: revisiting the classic studies. SAGE Publications Limited.

Dawson, D., & Moghaddam, N. (2015). Formulation in action: applying psychological theory to clinical practice. Walter de Gruyter GmbH & Co KG.

Easterbrook, C. J., & Meehan, T. (2017). The therapeutic relationship and cognitive behavioural therapy: A case study of an adolescent girl with depression. The European Journal of Counselling Psychology. 6(1), 1-24.

Kuyken, W., Padesky, C. A., & Dudley, R. (2011). Collaborative case conceptualization: Working effectively with clients in cognitive-behavioral therapy. Guilford Press.

Normann, N., & Morina, N. (2018). The efficacy of metacognitive therapy: a systematic review and meta-analysis. Frontiers in psychology, 9, 2211.