Cognitive Behavioral Therapy: A Case Study

structure, rather than the person talking freely about whatever comes to mind. At the beginning

As occupational therapy services diversified, serving a variety of clients in many different settings and with societal influences, the field began to evolve. During the 1990s occupational therapists began to shift away from reductionist medical model toward a more holistic client-centered approach. Services focused on enhancing individuals’ quality of life across the lifespan meaning before, during, and after therapeutic intervention. The profession began to better acknowledge the value of client education, injury and illness prevention, health screening, and health maintenance (Cole & Tufano, 2008). The field created more preventative initiatives, and focused services on improving quality of life and optimizing the independence of

The MOHO is a client-centered holistic conceptual model for practice while the OTPF emphasizes a client-centered approach in data collection identifying what is important and meaningful to the client. The MOHO uses an open system approach to assess: Input, Person, Occupational Performance, and the Environment. In contrast, the OTPF considers how Client factors (MOHO Volitional subsystem), performance skills, performance patterns (MOHO Habituation subsystem) and contexts and environment (part of MOHO) impact occupational performance. Both MOHO and OTPF emphasize client-centered analysis. The MOHO has specific assessment tools while the OTPF indicates the occupational profile should include information that is similar to MOHO, regarding client values, interests, daily routines, patterns of engagement and feelings related to occupational function (AOTA, 2014, p. S13). Additionally, MOHO indicates data is collected and discussed with the client to help the client gain an understanding of their subsystems and how these impacts occupational performance (Cole & Tufano, 2014). The OTPF indicates data is collected to create an occupational profile through analysis of occupational performance skills. While both, MOHO and OTPF support interventions that are specific, meaningful, and focused on occupational performance. Also, the OTPF expands interventions to include therapist skills related to clinical reasoning, therapeutic use of self and activity analysis (AOTA, 2014). Both reflect practice guidelines appropriate for use across age spans and varying levels of need. I feel MOHO works well within the OTPF based on the open system, use of Volition, Habituations, and Mind-brain-body subsystems. Additionally, MOHO’s consideration of both physical and social environments aligns with the

Cognitive therapy is one of the few theories that have been extensively scientifically tested and found to be highly effective in over 300 clinical trials. It focuses on the immediate or automatic thoughts the client has and how these thoughts affect their feelings and behaviors. The goal of cognitive therapy is to identify these thoughts that are poorly affecting the client. Then teach the client how to identify these automatic thoughts and how they can effectively change them. Through the very structured sessions of cognitive therapy, a client should essentially learn the tools to be their own cognitive therapist for future problems they may encounter. The therapy session will not make them an expert but they will be better prepared to

My role as the clinician is quite important. The primary task is to engage the client in identifying cognitive errors, refuting them, and replacing them with more adaptive thoughts. A sound therapeutic relationship is necessary for effective therapy, but not the focus of the therapy. Many forms of other counseling believe that the main reason people get better in therapy is because of the positive relationship between the therapist and client. Cognitive-behavioral therapists believe it is important to have a good, trusting relationship, but I know that is not nearly enough. We believe that the clients change because they learn how to think differently and they act on that learning. Therefore, CBT tries and focuses on teaching rational self-counseling skills. CBT is the teamwork that exists between the therapist and the client. This form of therapy is used to seek ways of learning what their clients want out of life and then helping their clients achieve those goals. The therapist's role is to listen, teach, and encourage, while the client's roles is to express concerns, learn, and implement that learning (Pucci1).

This link between occupation, health and well-being (i.e. the fact that people are occupational by nature and that engagement in meaningful occupation is essential to health) forms part of the core beliefs and values – the philosophy – of the occupational therapy (OT) profession (Kramer et al, 2003). OT has its foundations in both philosophy and science, but unlike other medical professions, it was the philosophy that came first

Occupational therapy was founded on the principle that participation in meaningful activity is important to the health of individuals. Mental health is very important to the well-being of an individual and those around them. 450 million people experience mental and neurological disorders around the world. These disorders are the leading 5-10 causes of disability worldwide. As services for individuals with mental illness have shifted from the hospital to the community, there has also been a shift in the philosophy of service delivery. In the past, there was an adherence to the medical model; now the focus is on incorporating the recovery model. (2) Occupational therapy’s focus that taking part in engaging and meaningful activities benefits the mental well-being of the individual.

The dynamics of the client-therapist relationship in cognitive therapy is a collaborative effort. Cognitive therapists elicit patient’s goals at the beginning of treatment. They explain their treatment plan and interventions to help patients understand how they will be able to reach their goals and feel better. At every session, they elicit and help patients solve problems that are of greatest distress. They do so through a structure that seeks to maximize efficiency, learning, and therapeutic change (Robert & Watkins, 2009). Important parts of each session include checking the client’s mood, a connection between sessions, setting an agenda, discussing specific problems and teaching skills in the context of solving these problems, setting of self-help assignments, summary, and feedback (Robert & Watkins, 2009). The status that CBT has with insurers and funding agencies is a result of concrete and measurable goals, goal-focused processes and clear outcomes-based evaluations/results. Therapy is typically conducted in an outpatient setting by trained therapist in cognitive behavioral techniques. Treatment is relatively short in comparison to some other forms of psychotherapy, usually lasting no longer than 16 weeks.

Mental health, and especially the stigma surrounding it, is of critical importance and a core component of an integrated, responsive system. It has even been forecast that mental illness, especially depression, will be the leading cause of disability in the 21st century, and may be a key practice area for the occupational therapist.

Occupational therapy is a profession that is currently growing faster than anyone would have expected. Because of the increase in demands for occupational therapy services, therapists are having larger caseloads, needing the help of more occupational therapists. Occupational therapy in the mental health setting is one environment that has grown in popularity over the last decade. Knowing the benefits of occupational therapy in this setting, and the expansion of clients needing occupational therapy services, more funding needs to be established in this setting.

The occupational therapy field is frequently being left behind in the health care field because most of the public is uneducated or unaware of the Occupational Therapy practice and the research that is involved. The public also has a few concerns of OT which include the time commitment to the program, the availability of services, the impact of the therapy on other family members, and the cost involved in continued care. While there are drawbacks to Occupational Therapy, the benefits of the practice outweigh them. The value and purpose of occupational therapy is to support the health and participation of clients by engaging them in their desired occupations. Occupations are activities that reflect cultural values, provide structure to living and meaning to individuals. These activities meet human needs for self-care, enjoyment, and participation in society. There are many different types of therapy used for people with disabilities such as autism, people with limitations from strokes, sicknesses such as cancer, and they can even help prevent childhood obesity. The different types of therapy can range from interventions all the way to dolphin assisted therapy, whatever the therapist finds appropriate. The similarity is that the Occupational Therapist will research and pick the most beneficial type of therapy to proceed with for that certain type of disability or problem that person is having. I believe

With these attributes, they will have the fundamentals of creating a strong therapeutic alliance with their clients. The therapists should be encouraged in “treating new cases as unique and constructing new theories to fit them, rather than depending on categories of established theory and technique” (Safran & Muran, 2000). Although this does not mean that standard techniques are useless, flexibility and creativity in application of these theories is considered the most important skill of a good therapist.

Occupational therapy has been in the process of continued development since the 1900’s. With several contributors helping to build the groundwork for creating the awareness needed to bring occupational therapy into the field of health care. Continued research is contributing to the ongoing significance of how occupational therapy is a vital aspect in promoting increased independences in all aspects of healthcare. (Willard, Schell, 2014) With the incorporation of “Occupational Therapy Practice Framework Domain and Process (3rd ed.)” helps creates the foundation for occupational therapy clinicians as well as other health care providers in facilitating the core believe of occupational and the relationship of health and occupation. (AOTA 2014) Therefore, providing a uniform outline of the various aspects of each individual and how they are interconnected to create the foundation of each individual. With a greater understanding of the foundations of that induvial, the clinician can then facilitate the best therapeutic treatment plan for that individual to achieve their personal goals with unified foundations of care.

Therapeutic use of self involves using one’s personality, body language, active listening that is used to create and maintain a therapeutic relationship with others (Lowe et al., 2007). Establishing trust is also an important aspect of therapeutic use of self, to address the needs and goals of the client, which helps our scope of practice to remain client-centered. Using therapeutic use of self is beneficial for occupational therapists (OT), as it facilitates interaction with the client. It also encourages and allows the therapist to obtain necessary information, and to alleviate fear or anxiety that may take place during treatment session. During Level I Fieldwork at a SNF, I was able to apply these principles during a treatment session for a client diagnosed with dementia that was agitated and non-compliant with the activity. To divert her attention to the activity, and to get her to understand that I was

By examining the bond between a therapist and his client we can further understand how important the role of therapeutic alliance is in treatment outcome. The authors point out that therapeutic alliance plays a major positive impact on the outcome of therapy. Individuals who build good therapeutic alliances with their therapists experience more productive and effective therapy than individuals who do not.