CBT and Person Centered Therapy for Depression Essay

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Case Conceptualization and Treatment Program

Part I: Client Conceptualization

General Background Information of Client

Jake is a 45 year old single white male. He has a degree in engineering but struggles to hold a job for longer than a few months because he is an alcoholic and inevitably shows up for work one morning drunk and is dismissed. He has good people skills and passes interviews easily and well, which is why he has very little problem finding new employment in spite of his employment history. The problem is that he cannot remain sober. He also has an addiction to marijuana. He is tall and well-groomed and in overall good health aside from his addictions with substance abuse. He is also a devout Catholic and feels that his faith is very important to him.

Client’s Presenting Concerns

Jake’s primary issue is combating alcohol addiction. He does not want to stop using marijuana as he feels it helps him with his nerves. He has been using marijuana since he was 16.

Deeper problems are Jake’s issues with responsibility. He talks quite a bit about his faith, about settling down, finding the right woman, and starting a family. However, he also fears that he may have missed the boat on this. He still dreams of being a musician and laments that his authoritarian parents did not encourage him to be an artist but instead pressed him into engineering. He is happy as an engineer and proud of his accomplishments, but at the same time he feels the need to self-medicate quite a bit with alcohol and marijuana. Whenever he gets a new job he always fears that people there are out to sabotage him and he has some paranoia over this.

Jake does recognize a need for change but the change he is proposing is, while not superficial, incomplete. He wants to stop drinking as much as he does—but he is not willing to give up alcohol altogether; nor is he willing to stop using marijuana. It appears that there is some trauma related to his childhood, as he has mentioned that his father abused him physically (not sexually), and when Jake was 20 he did attempt suicide. However, when he drinks through the night he begins to call friends and tell them that he wants to kill himself. One friend has recently tired of this and called the police on Jake. Jake was shocked and instantly showed more self-control. Nothing came of the incident, but it was something of a wake-up call to Jake. He lost his job the next day, as he showed up for work drunk. That also added to the wake-up call.

Behavioral Description

Jake is:

· Outgoing

· Friendly

· Proud of his accomplishments, which he enjoys talking about

· Nervous

· Negative at times without ability to shake negative thoughts/feelings

· Concerned about his alcohol addiction

· Worried about his state in life—single, unmarried, no children

The behaviors that are in need of change are his dependency upon alcohol and his tendency to let negative thoughts and feelings undermine whatever positive direction he is heading in.

Affective Manifestations

Jake reports experiencing:

· Depression

· Anxiety

· Negativity

· Paranoia

· Hurt when people seem out to get him

Unspoken emotions that Jake is not verbalizing and does not seem to be aware of are: anger, neediness, insecurity, fear, sensitivity, egoism.

Needs the client has that are not being met include the need to feel supported emotionally and socially, the need to be fulfilled creatively and work-wise, and the need to love and be loved in return. He is prevented from attaining self-actualization because he feels there are roadblocks that keep cropping up, preventing him from happiness. He recognizes that some of his behaviors are self-destructive but he does not seem to be aware of the extent of the dangers.

Cognitive Patterns

Three irrational beliefs in regard to Self, People, Problems and Life are:

1. Self:

a. believes he is extremely talented;

b. believes he is often slow at his work and that people get frustrated with his pace;

c. believes that people try to hurt him because they are jealous

2. People

a. believes people cannot be trusted

b. believes his friends love him

c. believes he wants to help others and can by talking to them about religion

3. Problems

a. believes his problems are his own fault

b. believes his problems are not his own fault

c. believes the devil is often trying to trip him up

4. Life

a. loves life

b. believes life to be too oppressive and often wants to get away

c. believes life is passing him by because he is unmarried and has nothing on the horizon

Jake’s general thought patterns are scattered, obsessive. Jake is both impulsive and restrained. He will do seem open to doing anything at the slightest suggestion so long as it is not what he would see as sinful—but if there is some hint of danger or impropriety he might refrain, or he might just begin to second-guess the initial impulse and back away from doing anything altogether, retreating into familiar areas in which he is comfortable—being alone, drinking, playing music. However, he is aware that too much of this is bad for him because he begins obsessing over the ones that got away andd so on. When he gets into a negative space in his head it is very difficult for him to move on from this. He will obsess over negative ideas and past injuries that he feels he has suffered unjustly from others.

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Interpersonal Patterns

Jake interacts well with other people. Jake is very outgoing, friendly, polite and sensitive to the feelings of others. He is hyper-aware of his environment and can switch from displaying extreme caution in his demeanor to be perfectly at his ease and laughing when he feels comfortable with where he is or who he is around.

He is happy to get to know people and he is very open and honest in his talks. He discloses a great deal of information that most people would resist disclosing so openly. He appears to do this without thinking and later, upon reflection, he is more guarded as he senses that he may have revealed too much about himself upfront. He displays some paranoia with regard to what one might do with the information he has disclosed and does not demonstrate ease and comfort until he is reassured that the person to whom he is talking will not share the information with anyone.

He has several friends from church; however, he is aware that given his latest meltdown some of them do not want to talk to him again until he gets help. He has a brother and a sister but both of his parents are deceased and his siblings live in other states. He does not have any very…

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…pushed or pulled in any one way. The decisions have to be made by him.

What is necessary for Jake to undergo therapeutic change is the realization that he is not who he thinks he is and that his ideal self can be attained but it would mean making serious changes to his life. He knows what goals he wants to pursue but he has deep insecurities that stem from his trauma and from years of substance abuse that prevent him from making those changes. Jake needs to realize this and find the will power to make those changes. He needs to build out a solid support system so that he is making these changes knowing that he has friends who have his back no matter what. He is too isolated as is and there is no one really in his corner. That needs to change and he needs to find a proper support system, perhaps through church.

Specific Techniques

Techniques that can be implemented using person-centered therapy include congruence, unconditional positive regard, nondirectiveness and reflection of feelings. Using the CBT method, one technique that could be used is guided discovery. While this may seemingly clash with nondirectiveness, it can actually complement nondirectiveness at times.

First, and most important for person-centered therapy, is congruence. This is a technique by which the therapist’s tone, words and body language are aligned. It is important that the client gets a consistent, coherent signal and message from the therapist. Congruence helps to build trust. It lets the client see that the therapist is whole and centered and is not saying one thing with his words and saying another thing with his body language. If there is no congruence demonstrated the client is going to think that there is something wrong with his own person that he is not connecting well with the counselor. The connection is vital and Jake needs it, so congruence has to be shown throughout.

Second, unconditional positive regard allows the client to feel accepted, respected and cared for, and that is important for Jake because he has felt neglected and abused in his life and now he is isolated. He needs to know his therapist is in his corner and is not going to judge him. This is something that the counselor must show for Jake especially since he is coming from a place of disconnectedness. He has to feel that he is not being judged.

Third is nondirectiveness and this is simply the technique of letting the client steer the therapy session. The therapist does not give advice or plan activities. However, I think that this can work some of the time and that other times it is necessary for guided discovery to take place, which is why that technique is also recommended here. Nondirectiveness can empower the client, and it is important that Jake feel empowered so that he can explore who he is—but it is also important that the counselor help steer Jake to the reality. The reality is not always going to be readily seen by the client when nondirectiveness is the only therapeutic technique used. It is helpful for exploring, but Jake will need some guidance. That is why guided discovery is also needed.

Guided discovery through asking the miracle question is a good way to get Jake thinking about how he might change. The miracle question is common in CBT and poses a situation in which all the client’s problems have been miraculously solved—what would he do? How would he act? It is meant to….....

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