Sft and Cbt

I. Introduction

The paper will be used to further explore intervention approaches and treatment options for the client I did my case presentation on and also a process recording, Amanda. The information presented about Amanda is information gathered during the intake assessment, family discussions, and individual family sessions. The two theories that have been researched and will be used throughout this paper are Cognitive Behavioral Therapy (CBT) and the Structural Family Therapy (SFT) because both theories are able to address the issues Amanda is presenting. These theories will be critiqued based upon research in journal articles and readings from class. Then the theories will be applied to Amanda's case based upon the empirical evidence found within the journal articles and class readings. Finally, the paper will conclude with discussion regarding the interventions and questions still needing to be answered.

Cognitive Behavioral Therapy is being explored because it is focused on an individual experiencing unwanted thoughts or feeling and this is causing the individual to feel a way they do not like and want to change. In Amanda's case, the presenting problem is that she is experiencing anxiety and depression related to school. The goal is for her to move past these feelings in order to be apart of a regular school setting for the next school year.

The other type of therapy that is being explored is Structural Family Therapy. This type of therapy looks at how families are structured and how this structure impacts the client. It provides the clinician an opportunity to see the family dynamics and interactions of the family members. In Amanda's case, her family has a significant impact on her mental health. This includes genetics, lack of a relationship with her father, and the abusive relationships her mother has been in and Amanda has witnessed.

II. Review and Critique of Intervention Models

Cognitive Behavioral Therapy is a form of psychotherapy that emphasizes the important role of thinking in how we feel and what we do (National Association of Cognitive-Behavioral Therapists (NACBT) online). Cognitive theory states that the problem originates in faulty congnitions or understandings that consequently lead to inappropriate or dysfunctional responses, behaviors, attitudes, or feelings on the part of individuals (Maguire 2002). Maguire further states that this can lead to a pattern of inappropriate and extreme emotions and responses. Essentially, the cognitive-behavioral approaches, building on social learning theories, suggest that how one thinks also interacts with one's behavior (Shulman 2006). This theory involves a collaborative therapeutic relationship between the client and the clinician. This type of therapy at times will be confrontational in that the clinician will verbalize to the client that the feelings they are having are false and distorted. It is important that the clinician does not overstep any boundaries and become overly controlling of the sessions and therapy in general. The clinician may also further challenge the client to further explore their feelings and perceptions. This type of therapy usually assumes that the client is ready and willing to change. At times, many questions can be asked by the clinician to better understand the situation and to also get to the bottom of what is causing the issue. According to NACBT the therapy is brief and fast paced and is on average sixteen sessions, which means the client must be sincere in their effort to change.

Other efforts to engage, empower, and be successful using this type of therapy is to give the client homework assignments.

The use of homework assignments completed outside of therapy is a hallmark of behavior therapy approaches. Completion of extra-session homework is hypothesized to be a critical mechanism for skill consolidation and generalization. The importance of controlling for, and better understanding, the impact of homework compliance has been emphasized for more than a decade (Jensen & Haynes, 1986; Primakoff, Epstein, & Covi, 1986).

Conceptualizing homework compliance as a stable construct appears

problematic because emerging data suggest clients' behavior in completing

homework tends to be inconsistent (Gaynor, Lawrence, Nelson-Gray 2006). In exploring a strengths based perspective this theory/model of therapy focuses on eliminating negative feelings and perceptions and use the strengths of the individual as a concentration in therapy. The clinician will help empower the client to overcome or manage the problems they are experiencing, head on and accentuate the positive characteristics of the client to improve chances of success.

In providing therapy it is important to have a tool to measure the success or need for improvement of treatment. For CBT there are a few ways to evaluate effectiveness. One could be a depression or anxiety assessment at the beginning of the sessions, half way through, and then at the end to note any changes or lack of. The client could journal on the completion of homework assignments and their reaction to the assignments in conjunction to the individual therapy sessions. Finally, self-report from the client is another tool that can be used for evaluation.

The other approach in working with this client is Structural Family Therapy (SFT). SFT provides a theory for family structure and family process. According to Schulman (2006), when working with families, one should take several factors into account. First families have a history that goes back many generations. Family members beyond the nuclear family both dead and alive, often affect the present. That is, the nuclear family's relationship-or lack of relationship-to the extended family or the community may play a huge part in functioning. Ackerman (1958) viewed family work as a special method of treatment of emotional disorders based on dynamically oriented interviews with the whole family. This looks at the who, what, where, when, why, and how of family. The goal is to bring to the surface all the "contributors" (person or thing) of the issue and map out ways to manage it.

In family therapy, the clinician is able to see the role each member plays within the family structure. The clinician can assist the family to develop a family tree to explore different trends or discover unknown facts. For example, in developing this tree of people the family can include cause of death, possible miscarriages, mental health diagnosis of members, illnesses, or any other trend of interest. This can also promote family