Conceptualization II: Cognitive Behavioral Theory Introduction 1 COGNITIVE-BEHAVIORAL THEORY Case Study of Nik Jones
Verified
Added on  2023/04/22
|15
|4692
|103
AI Summary
Contribute Materials
Your contribution can guide someone’s learning journey. Share your
documents today.
Running head: COGNITIVE-BEHAVIORAL THEORY1 Case Conceptualization II: Cognitive Behavioral Theory Introduction
Secure Best Marks with AI Grader
Need help grading? Try our AI Grader for instant feedback on your assignments.
COGNITIVE-BEHAVIORAL THEORY2 This essay will focus on the case of Nik Jones, a 40-year-old heterosexual Caucasian male who has contacted me concerning the management of his attention deficit hyperactivity disorder (ADHD), anger, anxiety, and reactive depression. Conceptualization of this case study will provide perspectives from the cognitive-behavioral lenses. Numerous studies have proved that cognitive-behavioral therapy (CBT) is useful in the management of anxiety and depression (Hauksson, Ingibergsdóttir, Gunnarsdóttir, & Jónsdóttir, 2017). The theoretical structure explored in this paper will be instrumental in the establishment of critical factors that have prevented Jones from attaining emotional well-being. Finally, I will develop a treatment plan both short-term and long term by collaborating with the client based on his need for relief and improvement. Part I: The Case Study Patient Name: Nik Jones | Age: 40 | Sex: Male Race: Caucasian | Relationship Status: Separated from wife - History and Background Information A: Identifying Information Nik Jones is a 40-year-old Caucasian man who identifies as heterosexual. He identifies himself as able-bodied but has a hard time managing his ADHD, anger, anxiety, and reactive depression. He has a five-year-old daughter from his marriage. He is separated from his wife of 7 years; she moved out in October 2016. He resides in the same home that he shared with his wife and in the same building where his girlfriend lives in Chicago. He was referred for individual therapy treatment by his couple’s therapist (that he sees with his girlfriend). B: Presentation/Behavioral Observations Nik Jones is not on time for most of his sessions; often in a rush; arrives with anxiety. He is well- groomed, and his dress is appropriate. He has clear speech that is at a steady rate with decreased volume at times. He tends to avoid eye contact during the sessions and crosses his arms at times. He maintains good cognitive processes and is oriented to person, place, and time. C: Presenting Problem(s)
COGNITIVE-BEHAVIORAL THEORY3 Nik Jones came to therapy because of anger outbursts, anxiety issues and unresolved emotions regarding his current life situations. His wife continually threatens using their daughter. He stated that she uses power to trigger his anxiety. He feels emasculated and is afraid of her. He is dealing with the stressful legal issues that relate to the business he owns. He admitted that he had thoughts of wanting to escape from all his problems. D: History of the Presenting Problem(s) Nik Jones reports that he and his wife have been married since 9/2011 and dated for 3years before getting married. He stated the wife became closed off when she had her mother move in from Russia soon after they moved into their new home he bought; the wife was six months pregnant (summer 2013). During the time that they all lived together (about 4years), Nik Jones indicated that his wife and mother-in-law avoided him and isolated him; constantly fought with him and shouted at him. He and the wife started to drift apart; they began to argue violently each time they saw one another. He noted she protected her mother. He would extend his business trips or stay “hidden” in his garage till the morning hours just to avoid going home. He stated that “if the mother-in-law had not moved-in then everything would have been fine.” Nik Jones noted his legal issues caused unforeseen stress and he had no support. He and the wife did not agree on household items and decisions surrounding their daughter (the mother-in-law took over the household; dictated the schedule for his daughter; did not allow him around his daughter). The wife showed no interest in providing the time to communicate. He felt both the wife and mother-in-law became emotionally abusive towards him, and the wife did not take his side. He reported that he gave up and agreed to her moving out with her mother was the best solution. The constant fighting became out of control; some of the fights became physical and extremely disruptive (to their daughter and neighbors). Nik Jones reported that he became depressed when the wife and mother-in-law moved out with his daughter because he felt he had nothing. He expressed that he had worked very hard to provided quality and a lavish lifestyle for his family and was not appreciated. He felt helpless and misunderstood; wanted to just end things; he would sleep for days on and hide in bed. He recalls only remembering increasing his prescription of Adderall to stay alert and numb. - Psychosocial History A: Family History Nik Jones grew up with his mother, father, a brother who is 37 and a sister who is 35. He is the oldest of 3 siblings. They grew up in an affluent town in Kansas City where neighbors held high powerful positions in business, including his father. He said that they had a “typical” upbringing (i.e., family vacations, parents with high academic expectations, family parties/gatherings). Nik Jones stated that his dad changed when he was undergoing a law-suit. He stated that he hated coming home during this period and being in the house because the father’s behaviors were
COGNITIVE-BEHAVIORAL THEORY4 uncertain; at times erratic and aggressive towards his mom. He reported that he would hear his parents arguing during this period and sometimes would hide in his room because it caused him anxiety. He clarified that he felt this way because his dad would be screaming, his mom would be crying, and sometimes he would hear loud thumps or things being thrown. He felt helpless not being able to protect his mom. Nik Jones noted that he has always had a great relationship with his mom, and they talk frequently. He stated that his mom and dad were supportive when he told them about the separation (from his wife and child). He stated they drove from Kansas City to help during a fight he had with his wife that resulted in a physical altercation (Spring 2017). He expressed that the past 3years have been very stressful dealing with the separation and not having his entire family close by has been hard. Nik Jones stated that he and his siblings were very close, but now the brother lives in Dubai and the sister in Paris. He noted that he has not been as constant with communications with them due to the distance and the shame he has regarding personal issues that have been unresolved for so long. Nik Jones expressed that his 5year old daughter, Kyle, is his world. He expressed that he had a challenging time gaining access to his daughter during the initial separation period. He noted his current girlfriend gave him the strength and support to fight for his rights and the time with Kyle. He stated that she just began kindergarten at a British private school in Chicago and could not be happier to be in school. He stated that his mom helps a lot with taking care of Kyle by sending weekly gifts and his girlfriend often prepares food for Kyle. B: Developmental and Social History Nik Jones indicated he has a hard time maintaining quality friendships due to lack of time management and his forgetfulness to follow up with friends. He often feels alone. Nik Jones stated that he dated a variety of women in his youth and at one point lived in Brazil to run a business. He reported several romantic long-distance relationships; history of intimate relationships is often with females who are not available to him emotionally. After receiving his MBA from Northwestern he stayed in Chicago which is where he met his wife. He said that the wife was her ideal mate at first and could not have been happier to be with her. He also noted that they moved in within six months and barely saw one another for the next 3years but only on weekends due to a consulting job that demanded the wife to be out of town Sunday to Thursday weekly. He explained that he asked for her hand because he felt the time was right in his life. However, now he expresses that this was one of the worst decisions he ever made. Nik Jones notes he had two affairs after he was married. Both women were out of State; one he was involved with emotionally and sexually for 2.5 years; the other was emotional for about 1.5 years. He stated his wife did not provide him the emotional comfort in their marriage and he felt isolated throughout the marriage.
Secure Best Marks with AI Grader
Need help grading? Try our AI Grader for instant feedback on your assignments.
COGNITIVE-BEHAVIORAL THEORY5 Nik Jones stated that he met his current girlfriend in the neighborhood then saw her a year later at “their building.” He noted feeling alive again meeting a smart and unique woman; he pursued her, but she showed no interest at first; they connected romantically after establishing a friendship throughout four months. He stated that his girlfriend is supportive, loving, warm and communicative. He explained that the girlfriend is like his “best friend” because she is always there for him and never judges. He stated she comes from a great family whom he has met many times throughout this past year. He noted that she has not met or spoken to any of his family members and the wife does not know for sure if they are dating. C: Abuse/Trauma History Nik Jones does not report any other abuse other than what is noted above. He did note during boarding school he was bullied. On one incident he was severely beaten up, locked in a bathroom stall, and sprayed with cold water (during a cold winter morning). He fell sick and on bed rest for a week with a high fever. He noted he was not cared for at the boarding school. D: Educational/Academic History Nik Jones was sent to a private British boarding school during his youth in Switzerland than in London. He graduated with a BA in Business then move on to pursue a master's degree and an MBA at outstanding IVY League Universities (The Wharton School and Northwestern University). He reported that his passion to be an innovator. He played football and ran track and excelled in both in high school. He stated that he received a full academic scholarship to college and was involved in various student organizations in college. E: Employment History Nik Jones is an entrepreneur and is currently involved in a couple of medical device projects that are associated with the FDA. He works from his home office. He explained that he has never had a 9 to 5 full-time job using his degree. He noted that he never had to worry about money until now. F: Medical History Nik Jones was diagnosed with ADHD in his youth before boarding school. G: Psychiatric History Nik Jones did not report any psychiatric history of himself. He reported that his uncle (mom’s brother) died of alcoholism and relatives who are depressed and/or have addiction issues. H: Substance Abuse/Dependence History Nik Jones reported that he had a substance abuse/dependence of Adderall to maintain productivity and at one time, to suppress his emotional pain surrounding his marriage. I: Medication History
COGNITIVE-BEHAVIORAL THEORY6 Nik Jones reports that he is not taking any over the counter drugs; he is taking prescription medication: 20mg Adderall average of 3 a day (60mg total per day), Testosterone Cypionate Injection and sleeping pills. J: Legal History Nik Jones reported that his wife still has access to the house, and she is often in and out without notice which is one cause to his anxiety. She has called the cops on him many times for a variety of reasons. She recently pressed charges on him on the evening of his daughter’s birthday. The daughter witnessed a fight between all three adults (Nik Jones, wife and mother-in-law). He was locked in jail for over 6 hours then had several court hearings with his attorney in order to have the case. He stated he has a DUI record from his mid-twenties. K: Religious/Spiritual History Nik Jones reports that he grew up Catholic and that his parents always took the family to the church which he enjoyed. He was exposed to a secure and warm community growing up with strong Faith. He recently started going to church to pray again. Part II: Counseling Theory and Case Conceptualization Cognitive-Behavioral Therapy (CBT) promotes the awareness of a client's negative interpretations and behavioral patterns which can reinforce distorted thinking. The counselor aims to develop alternative ways of thinking and behaving to reduce the client's psychological distress. Using CBT, the focus is on conditions the client’s thoughts to alter behaviors then empowering the client to make the changes in his faulty thinking. A counselor engages the client to collect the data then to examine the data by using the Socratic questioning approach. Then the counselor must invest time in engaging the process collaboratively with the client rather impose an immediate intervention. It is imperative to have the client monitor his automatic thoughts; recognize his relationship between thoughts, feelings, and behavior; test the validity of his automatic thoughts; substitute realistic cognition (over negative distorted thoughts); then identify underlying assumptions which lead to the client’s faulty thinking. Theoretical Structure
COGNITIVE-BEHAVIORAL THEORY7 Key Concepts The Cognitive-Behavioral Therapy (CBT) technique is employed by counselors to address behavioral disorders that could compromise the ability of the client to perform at his highest capacity. The centrality to the application of this therapy is that an altered state of the psychological setup induces a change in the behavior of an individual thus instigating optimal well-being. Primarily, the effectiveness of this theory depends on the willingness of the client to alter his behavior based on the professional suggestions by the therapist. Shafran, Wroe, Nagra, Pissaridou, and Coughtrey (2018) revealed that CBT has the potential to address depression and a myriad of anxiety disorders. However, the client needs to be the central figure in the process. The objective is to explain and introduce new values and behaviors in the client’s life in small steps while remaining true to the tenets of cognitive restructuring. The most significant concepts in CBT include the cognitive component, which refers to how individuals think and create meaning about events, symptoms, and situations in their lives and form beliefs regarding others, themselves and the world. Cognitive-Behavioral Therapy (CBT) utilizes various techniques to assist individuals to become more aware of how they reason (Fenn & Byrne, 2013). The three levels of cognition are automatic thoughts, intermediate attitudes, and schema. The techniques of CBT assist the client to become aware of the automatic thought that comes to mind and provide meaning. Cognitive interventions utilize a questioning style to probe for individuals’ interpretations and to utilize it stimulate alternative ideas and viewpoints. This technique is known as guided discovery. It entails reflecting and exploring about the thinking and reasoning style allowing the possibilities to think differently.
Paraphrase This Document
Need a fresh take? Get an instant paraphrase of this document with our AI Paraphraser
COGNITIVE-BEHAVIORAL THEORY8 Another critical concept in CBT is the behavioral component, which entails how the individuals respond when distressed. Responses such as reduced activity, avoidance and unhelpful behaviors can act to keep the problems of the person to continue or worsen regarding on how the personfeels (Hedman et al., 2014). Practitioners of CBT aim to assist the individual to feel safe enough to test out their fears and assumptions and change their behaviors (Matusiewicz, Hopwood, Banducci & Lejuez, 2010). For instance, this might include assisting individuals to face avoided or feared situations gradually as a method of lowering anxiety and learning new skills of behavior to handle the problems. Characteristics of a Health Personality Personality describes the interactions and way of thinking of an individual. Consequently, personality has a significant bearing on the ability to sustain interpersonal relationships. An individual with a healthy personality has a good understanding of what is expected of him in certain environments and situations. Furthermore, a person with a healthy personality is aware of the negative and unrealistic thoughts that dampen moods and feelings(Easterbrook & Meehan, 2017). Psychologists and behaviorists agree on the observation that environmental, epigenetic, and genetic factors are the principal factors that influence personality development (Bleidorn, Kandler, & Caspi, 2014). These researchers opined that non-shared environmental and genetic influences are the central variables that affects the changes and stability in personality traits among individuals. Based on these arguments, the application of CBT requires an understanding of the environmental influences on the client’s personality before formulating a collaborative approach to treatment. Factors that Contribute to Jones’ Problems
COGNITIVE-BEHAVIORAL THEORY9 Macaulay, Angus, Khattra, Westra, and Ip (2017) revealed that application of CBT could help determine the factors influencing the observed behavior in a client. Exploring Jones’ past experiences from a cognitive-behavioral lens reveal crucial factors instrumental in explaining his emotional and mental state. Jones was not very close to his parents at a developmental stage when emotional support was warranted; he was sent to study in foreign countries and was bullied at the boarding schools. Furthermore, he was mediocre at time management, could not create and maintain interpersonal relationships, and had numerous sexual relationships with women with whom he lacked emotional attachment. All these factors are mirrored in his adult personality. These factors fall under Negative Automatic Thoughts (NATs) which are thoughts that are activated involuntarily in particular situations. In depression, NATs center on themes of low self-esteem and uselessness(Sanatinia et al., 2016). The process of development can hinder when problems are not addressed (i.e., avoiding social situations or pass up opportunities for advancement at work or school). Significant Development Stages in Client’s Life CBT focuses on challenging negative feelings, thoughts, and behaviors and that the childhood stage of development has a significant bearing on the behaviors of an individual. Apart from the formulation of new behaviors, therapists suggest practical steps that are crucial in implementing cognitive restructuring. The steps are carried out by first identifying the troubling conditions or situation in the client’s life. Therapists ensure that the person is aware of the emotions, thoughts, and beliefs about these problems by encouraging the client to share about them(Stark & Hiltunen, 2016). Thetherapists then identify inaccurate or negative thinking and then reshapes these thoughts.
COGNITIVE-BEHAVIORAL THEORY10 Contributors to Clients Life Development of an individual from childhood to adulthood requires an integration of several factors and contribution from different people in each stage. According to Bleidorn, Kandler, and Caspi (2014), genetics and environmental variables are at the core of an individual’s development. In this light, these researchers argue that childhood and middle adulthood are the most crucial stages in life. During these stages parents and peers are the most significant influence in a person’s life; these stages determine personality development. In our case, during Jones’ developmental stages of life shortly after being diagnosed with attention deficit hyperactivity disorder (ADHD), he was isolated from his parents and peers by being sent to off-shore boarding schools. Important Tenets in CBT The Cognitive-Behavioral Therapy (CBT) has several tenets that must agree to ensure an individual has the total control of his disorders. However, these tenets vary in their degree of importance to this theory. According to CBT, the most to least essential tenets are as follows: cognition (that embodies three levels; automatic thoughts, intermediate attitudes or beliefs, and schema), behavior, emotion, interpersonal relationships, and physiological symptoms. Integration Accounting for the Problem and How Theory Accounts for Other Aspects of the Situation
Secure Best Marks with AI Grader
Need help grading? Try our AI Grader for instant feedback on your assignments.
COGNITIVE-BEHAVIORAL THEORY11 Several aspects of Jones experience fit the various tenets of CBT. Exploring Jones’ past social and psychosocial life points to the possibility that his early experiences are related to his ineptitude to manage his emotional well-being. Jones had numerous sexual relationships with women with most of them lacking emotional attachment; this behavior is accounted in the theory where an individual experiences low self-esteem. Having multiple sexual relationships from different women would have contributed to pervasive poor self-esteem that led to depression and anxiety. His maternal side has a history of people with substance abuse, and this is manifesting in his life. Furthermore, his experience at the hands of the bullies in boarding school germinated internal hate that seems to have grown into anger and reactive depression. Essentially, the symptoms manifested in Jones social life have compromised his ability to establish healthy interpersonal relationships. He lacked emotional support from his parents then his wife of seven years did not fill the void (Jones’ wife was away most of the week due to the demands of her consulting job). The gap widened following the arrival of his mother-in-law with the failure of the marriage being the culmination of their repeated altercations. All these factors led to the feeling of uselessness because Jones was unable to care for himself safely. Most of the time he felt lonely and isolated since he was a child and in his marriage. Changes that Need to Occur Effective management of the symptoms experienced by Jones would require the occurrence of behavioral changes. As pointed out earlier, the effectiveness of Cognitive- Behavioral Therapy (CBT) depends on the willingness of the client to take a central role in the treatment process. Jones is affected emotionally by the opinion and actions of others and often, due to his anxiety not able to regulate his feelings and emotions. The changes can be facilitated by the counselor in building awareness on how particular thoughts lead to unpleasant emotions
COGNITIVE-BEHAVIORAL THEORY12 for him. Maintaining interpersonal relationships with other people would be another way for Jones to identify his emotions. The help of a Professional The counselor must take measure to introduce the Cognitive-Behavioral Therapy (CBT) structure in a conversation by assembling thoughts, feelings and behaviors for the client. Provide a combination of cognitive restructuring and coping skills techniques, emphasize the development of strategies for dealing with problems that is a collaboration between client and therapist. The primary goal for Jones is to promote change in his behaviors by cognitive restructuring. It is necessary for Jones to adopt a new set of beliefs that will enable new behaviors that are suitable in eliminating the symptoms described. Recognizing Improvement Change in behavior is the primary approach adopted to recognize improvement in Jones’ life. Self-reports from the client will be a crucial indicator of the progress he is making. Further, the counselor should assess Nik during sessions. His presentation and response to previously identified problems would indicate whether he is recording any therapeutic improvements. Also, the therapist should keep a record of Jones’ Mental Status Examination (MSE) and compare the results to see improvement over time. To obtain specific feedback, the counselor should give Jones standardized tests to assess his improvement for anger, anxiety, and depression. Part III: Treatment Plan Behavioral Definition
COGNITIVE-BEHAVIORAL THEORY13 1. ADHD, anger, anxiety, and reactive depression 2. Inability to foster and maintain close interpersonal relationships Long-Term Goals 1. Coping skills for management on ADHD, anger, anxiety, and reactive depression 2. Establish and maintain healthy interpersonal relationships Short-Term Objectives (What the client does/will do) 1. Track emotions by journaling and highlighting the emotions 2. Start a daily activity monitoring log to connect patterns 3. Form and maintain interpersonal relationships with friends and family Therapeutic Interventions (what counselor will do) 1.Collaboration with the client to build awareness on thoughts that lead to unpleasant emotions 2.Reformulate client’s thoughts to be more accurate; necessary adjustment to make that is truer to prevent destructive behaviors References
Paraphrase This Document
Need a fresh take? Get an instant paraphrase of this document with our AI Paraphraser
COGNITIVE-BEHAVIORAL THEORY14 Easterbrook, C., & 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. Fenn, K., & Byrne, M. (2013). The key principles of cognitive behavioral therapy.Innovait: Education and Inspiration for General Practice,6(9), 579-585. Hedman, E., Andersson, G., Lindefors, N., Gustavsson, P., Lekander, M., & Rück, C. et al. (2014). Personality Change following Internet-Based Cognitive Behavior Therapy for Severe Health Anxiety.Plos ONE,9(12), e113871. Matusiewicz, A., Hopwood, C., Banducci, A., & Lejuez, C. (2010). The Effectiveness of Cognitive Behavioral Therapy for Personality Disorders.Psychiatric Clinics of North America,33(3), 657-685. Sanatinia, R., Wang, D., Tyrer, P., Tyrer, H., Crawford, M., & Cooper, S. et al. (2016). Impact of personality status on the outcomes and cost of cognitive–behavioral therapy for health anxiety.British Journal of Psychiatry,209(03), 244-250. Stark, V., & Hiltunen, A. (2016). Affect at the different phases of cognitive behavioral therapy: An evaluation of psychotherapy provided by candidates.Scandinavian Journal of Psychology,57(1), 36-41.