Cognitive Behaviour Therapy; the Treatment of Richard

Cognitive Behaviour Therapy; The Treatment Of Richard

Faulty or maladaptive cognitions are negative thoughts and beliefs about ourselves, others or situations that can reinvent themselves as a number of ways including depression, anxiety, self pity and manifest outwardly as negative or faulty behavior such as violence, extreme mood swings, eating disorders or substance misuse.

Cognitive Behavioral Therapy is an action therapy that focuses on current behavior, Corey (2001). CBT recognizes the connection between faulty cognitions and behaviors and through the use of a structured therapy aims to help the client recognize and restructure their automatic thought processes from negative to positive resulting in the desired behavioral changes. Corey (2001) states "it puts emphasis on personal responsibility for changing by developing clear plans for new behavior". In other words, change the way we think and we can change our behavior.

Using the case study of Richard, it appears that Richards core belief or schema, (Beck 1991) is that no one cares about him, it could also be that he feels unworthy of receiving love and friendship. He has resorted to alcohol to help him forget his problems, the more he drinks the better he feels. What Richard doesn't understand is the cycle that reinforces his maladaptive thoughts and beliefs. He drinks to feel good, arguments start with loved ones and friends, he feels good so it must be their fault. Richard becomes aggressive and violent, others get tired of his behavior and withdraw from his life. Withdrawing reinforces Richards' belief that no one cares about him, his feelings of rejection and abandonment surface as self pity or depression so Richard finds solace in alcohol.

Richards maladaptive behaviors are the result of faulty thoughts and feelings. CBTs' teaching approach can help him unlearn his old ineffective coping strategies and relearn new effective ways to cope with life. Because CBT requires complete commitment from both client and counselor and deals with the here and now, effective changes can be achieved in a relatively short time, 12 to 16 sessions (NIDA).

A functional analysis would be the first and most important step (NIDA). Client and counselor discuss thoughts, feelings and circumstances before and after the drinking episodes, cultural and other factors that are contributing to the situation. This encourages the client to make their own identification of faulty thought and behavior patterns.

It is also important to discuss the strategies that make CBT work so the client knows what's expected of them.

As with other therapies it's important to create a non judgmental trusting relationship with the client. Without a positive relationship it would be almost impossible to keep them motivated enough to learn the new skills needed to make changes in their life, they may even stop attending sessions. Optimism and motivation go hand in hand. If a client is optimistic about the changes in their life, they will be motivated to continue trying. Murray and Fortinberry (2004) have a seven step program for creating optimism and overcoming depression.

Meichenbaum (1985) describes a three phase process of change in which the three phases are interwoven. According to him, focusing on only one phase would probably be insufficient. The following is a brief outline.

Phase 1; self observation. To teach a client to listen to their internal dialogue and observe the feelings actions and reactions that result from that self talk when relating to others. Phase 2; starting a new dialogue. Once clients learn to notice their maladaptive thought and behavioral patterns, they will start to see opportunities for alternative processes.

Phase 3; learning new skills; Teaching a client more effective coping skills which are practiced in real life situations. As a client learns and practices new and better behaviors, others react in a more positive way reinforcing the new patterns to the client.

Coping skills could include relaxation techniques, monitoring their own anxiety levels, social skills training, discovering high risk situations and finding alternative activities

and fostering motivation by asking themselves what they stand to lose or gain from continuing or changing their current behavior when temptation arises.

Clients are encouraged to keep a diary in which they note thoughts, feelings and behaviors at the times when they feel anxiety, anger etc. This is brought into each session and allows the counselor and client to discuss the rationality of thoughts and behaviors that have occurred since their last meeting. It also helps monitor client progress and review goals and strategies if necessary.

Corey (2001) says goals should be within the limits, motivation and capacity of each client. Counselors help clients identify plans to achieve their needs.

Psychodynamic Therapy; The Treatment Of Richard

To look at the case study from a psychodynamic perspective we would also take into account Richards childhood memories because psychodynamic therapy focuses on the belief that the past, particularly childhood events, influence us as adults. And in the case of painful experiences we must revisit the past to resolve issues that have been repressed causing intrapsychic conflict in order to understand current behavior and the need or desire to use substance abuse, in Richards case alcohol.

Completing a lifestyle assessment at the beginning of therapy can identify

Emotions and feelings that are uncomfortable or frightening caused by unpleasant experiences result in anxiety. According to Fodiman and Frager (1977) it develops out of a conflict between the id, superego and ego over control of the available psyche. Psychoanalytic theory believes there are two ways to control anxiety. Resolve the problem by dealing directly with the situation or set up a psychic defense by distorting or denying the situation. There are several forms of defense but repression is at the base of most of them. Instead of facing the problem by overcoming obstacles, learning from what is useful and throwing out the rest, the painful emotions and memories are held inside, causing intrapsychic conflict.

As adults we try to protect our children from pain and suffering, with an illness, divorce or death etc, we hide our own feelings and tell them everything is fine and that the event isn't their fault, we don't give children credit for understanding. With that thought in mind, an interpretation I will make from the case study is that something similar happened to Richard when