Psychological Counselling: CBT Treatment Plan for Richard's Depression

This report details a Cognitive Behavioral Therapy (CBT) treatment plan for a 49-year-old male patient, Richard, diagnosed with depression. The plan begins with an introduction to depression, its symptoms, and the initial assessment of Richard's condition, identifying his low inclination towards enjoyable activities and feelings of sadness. It then discusses the problem identification, emphasizing the use of behavioral experiments as a CBT technique to address Richard's depressive patterns, including steps like engagement, activity scheduling, and analysis of undesirable thoughts. The report also covers ethical considerations during therapy and the termination phase. The application of the Lewin–Kolb experiential learning circle and PETS model for behavioral experiments is also discussed. The plan aims to help Richard evaluate his thoughts and reduce his depression by restructuring his cognitive processes and promoting adaptive behaviors.

Running head: PSYCHOLOGICAL COUNSELLING
PSYCHOLOGICAL COUNSELLING
Name of the Student:
Name of the University:
Author note:

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Introduction
Depression is identified as a common mental disorder that instigates depressed mood,
lack of interest and excitement, poor level of energy along with feelings of low self-
importance and poor concentration. Moreover depression typically comes with certain
symptoms of anxiety. According to reports depression is considered as a major contributor to
the global burden of illnesses and tends to impact people in all communities around the world
(Zhai et al., 2015). In recent times depression is estimated to impact around 350 million
people worldwide. According to the study, conducted by the world mental health in 2019, in
around 75 countries, average of 1 in 20 people are reported to be suffering from depression
(Alhassan et al., 2018). Depressive episodes involve certain kinds of symptoms like a highly
depressed mood, loss of interest and excitement in addition to high levels of fatigue. Any
individual with a mild depressive episode tends to have high levels of difficulties in
continuing with usual tasks and social activities but they did not cease to function completely
(Madhav et al., 2017). The following treatment plan will involve a 49 year old adult who is
suffering from a depressive period and it is advised by his general physician to undergo
cognitive-behavioural therapy intervention treatment.
Discussion
Initial assessment
While treating a depression patient it is important to determine the level of assessment
according to the extent of symptoms shown. From the case of Richard, a 49 year old man, it
is evaluated that he is suffering from a moderate depressive episode. After gathering his
complete history and mental status evaluation it is identified that Richard nowadays shows
very low level of inclination and excitement towards activities which previously used to

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excite him. In addition to this, it is found that Richard frequently develops feelings of sadness
which at certain times result in high fatigue. In order to effectively evaluate and diagnose
Richard's depressive episodes specific symptoms of depression have been heard. In addition,
a range of standard questions are asked to him in order to screen for depression. During an
open communication, certain aspects of Richards’s behavioural characteristics are identified
such as his daily mood, lifestyle habits and behavioural patterns. During the initial
assessment, Richard seemed to withdraw into a state of apathy and also showed an irritable
nature. Nevertheless, by asking questions about feelings it has been evaluated that Richard
experiences sadness and depressed mood throughout the day. Furthermore, a severe loss of
excitement and enjoyment in things which were once pleasurable has been identified through
the initial assessment (Zhai et al., 2015). The outcome of the initial assessment of Richard
also shows that he is developing feelings of failure along with a loss of self-value which often
tends to create problems for him in concentrating on making decisions in critical times.
Identification of Richard’s Problem
It is often challenging to identify depression as a main mood illness in a patient with
a common medical condition as it may be seen as minor to the medical disorder itself. At
times when depression seem to be minor, symptoms might not resolve subsequently to the
conducted medical condition. While, evaluating Richard’s case, it is found that his major
depressive sign is frequent sadness which is creating recurrent depressive episodes in his life.
As per studies, sadness is deliberated as one of the basic symptoms of depression in the
domain of psychology (Laborde‐Lahoz et al., 2015). Its experimental significance for the
depressive condition is proved by numerous studies. By drawing relevance to these aspects, it
is noted that Richard’s case is not a case of mild depression. Furthermore, sadness seems to
be a key symptom of depression. It is also postulated that amount of sadness could be used in
order to clinically differentiate subcategories of patients (Harrison & Gibb, 2015).

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CBT technique-Behavioural Experiment
Currently, growing evidences have proposed that behavioural exposure as a CBT technique
can be highly effective component for treating depression. The technique of behavioural
experiment involves certain safety behavioural patterns along with attention manipulation
which show high efficacy in the treatment of depression as compared to traditional forms of
interventions. CBT technique of behavioural experiment will be used for treating Richard's
depression. According to Veenendaal et al. (2016), behavioural experiments enable
individuals to evaluate the strength and validity of their assumptions and views. This is a key
experimental technique for therapeutic improvement in cognitive behavioural therapy. This
particular technique will be used to assess and then reduce the depressive behavioural
patterns of Richard. This technique will be highly effective for treating Richard, as
experiments are designed with an aim of offering clients with new and different information.
The novel information possibly will serve Richard to confirm or disprove his current
thoughts and suppositions. It will also offer immense support towards a single hypothesis
over another. One of the key effectiveness of behaviour experiment technique of CBT is it
facilitates therapists with the opportunity to observe elusive sides of thoughts and behaviour
which might lack visibility to the patient and further not reported in the consulting room
(Haigh et al., 2018). In Richard’s treatment, experiments will reassure him in creating similar
observations for him. For example, he will be asked to perceive and record the effects of faith
of other people on his apprehensive anxiety with physical symptoms. Behavioural
experiments comprise three chief purposes such as explaining the formulation, analysing
undesirable cognitions as well as building and testing new, highly adaptive viewpoints. The
fundamental objective of behavioural experiment does not lie on changing thought and
perception thinking per se but on the other hand it focuses on cognitive change as well as to
change emotional conditions and enable problem solving (Karp, 2017). The Lewin–Kolb

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experiential learning circle offers an applied framework aimed at planning behavioural
experiments. Furthermore, the learning circle proposes that learning as well as retention is
improved when clients follow a classification of steps. It is noted that each of these steps
constructs on its prototype as well as types of a foundation for the step that comes next.
Another framework for considering behavioural experiments is the PETS model (prepare–
expose–test–summarize) that is illustrated by Wells. It is important to note here, that two
models show great similarities and are equally important for treating mental disorders like
depression. Nevertheless, Wells’ model is developed specially in accordance to his S-REF
theory.
Steps to implement the technique
The key objective of this technique of behavioural experiment has allowed Richard to
evaluate the rationality of his current thoughts about himself or other individuals or the world
around which is making him develop immense feelings of sadness and depression (Harrison
& Gibb, 2015). These steps possibly comprise different forms, dependent on the belief being
confirmed.
Engagement
The primary step of initiating the behaviour experiment technique has been to
introduce the cognitive model of depression. As per studies, depressed patients tend to refrain
from accepting or undergoing a complete longitudinal case conceptualization (Haigh et al.,
2018). At this juncture, showing the links between undesirable thoughts and temper has been
comparatively effortlessly communicated. In this stage, Richard has been asked to emphasize
on few instants on the issues which he has described. Afterwards, he will re-rate his to what
degree he felt depressed.

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At this juncture, it is important to note that interruption experiments can be beneficial in
indicating016) the mood that is the thought association. According to Veenendaal et al.
(2016) distraction attention also known as redeployment tends to disturb depressive
rumination. Thus it is considered to be useful mechanism in the mood management
necessaries of depressed individual. However, it does not decide the problems essential to
depression. Thus, while treating Richard it has been important to keep in consideration to
guarantee that it is not utilized for circumventing issues that must be tackled.
Activity scheduling
The second step of activity scheduling has been considered a vital component of CBT
for depression. It involves monitoring as well as changing patients’ activity levels with
weekly activity schedule (WAS) that is an hour-by-hour record whereby activities will be
recorded as well as planned (Laborde‐Lahoz et al., 2015). This step has provided Richard an
unparalleled chance of categorizing as well as analysing an extensive range of undesirable
thoughts and countering obstructive cognitive processes. This step has been useful to identify
whether Richard’s thought precisely reflected with real events (Madhav et al., 2017). In this
step, it is predominantly significant in depression to formulate as well as practice homework
coursework in order to distinguish undesirable or destructive thoughts which tend to restrict
an individual in developing feelings of contentment and discovering ways of handling
negative situations (Alhassan et al., 2018).
Analysis of undesirable thoughts or cognitive triad
While conducting this step, it has been found that Richard in spite of having a good
rapport with his peers and associates is becoming socially withdrawn. He has been failing to
seek happiness or minimum satisfaction or happiness in any activity which he earlier used to
find pleasurable. At this step, it has been vital to keep in consideration that if sadness is
realized to have continuing effects for the self, the surrounding situations or the future,

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anguish or unhappiness has a tendency to transform into depression eventually. At this
juncture, while treating Richard’s depression, it has been vital to ensure is the basic problem
and not simply sadness. This step has been immensely important to reduce Richard’s
depression as it the powerful way of identifying those extremely significant predictions can
be incorrect (Karp, 2017). Thus, in the case of Richard, therapy has helped him to
successfully deal with whatever he has been thinking till present.
Relapse and return: preparation for the forthcoming days
In this last step, patients must be prepared from the beginning to encounter
obstructions. However, at the end of treatment it is significant to recognize conceivable
causes for deterioration as well as to create an action plan with specification of ways in
dealing with upcoming episodes (Bröer & Besseling, 2017). The last has combined ways of
aiding Richard to be attentive and well prepared to encounter initial cautionary signals of
depression as well as to circumvent increasing it by linking to similar patterns of negative
thoughts.
These small yet vital steps has improved Richard’s attitude and benefit him to move
in the direction of confronting critical issues as well as complications in life.
Ethical issues to be aware of during therapy
In order to gather awareness of ethical issues while treating depression patients it is
important to identify as well as select alternatives on the basis of values as well as
preferences. Furthermore, it is vital to conduct a process of adequately decreasing indecision,
insecurity and hesitation about alternatives treatments for permitting the patient to make
reasonable choice (Haigh et al., 2018). Under the Care-based principle, it is important to
show reverence for self-supporting conditions that tend to act deliberately after offering
adequate information as well as time to choose. While, treating Richard it is important to
guarantee his independence and make him realize the probable risks as well as benefits of his

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involvement in the treatment in addition to need to be free from any unjustifiable thoughts
which is affecting his judgements about his self-value.
Conclusion
Termination phase of therapy
While treating a depression patient it is important to determine the level of assessment
according to the extent of symptoms exposed.The termination phase of the therapy related
experiments with current knowledge structures. One of the key success of behaviour
experiment technique of CBT is that it facilitated with the opportunity to observe elusive
sides of thoughts and behaviour of Richard which lacked visibility to the patient and further
not reported in the consulting room. It is known as an effective way of guaranteeing
generality from the particular experimentation, chiefly if comprehensive cognitive structures
such as suppositions and thoughts are kept in consideration. The idea of principle of change
has also been important for Richard, as it aided him to establish upcoming experiments
positively and not only during this particular treatment. The termination phase has been
relatively shorter as well as more frequent, behavioural activation has continued for longer as
the major intervention. Furthermore, particular importance has been put on strong
organization as well as action plans and showing high specification as well as writing down
expectations as well as the outcomes of experiments.

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