TB-CBT: A Case Study

Constant assessment of the clients’ problems and cognitions is very important in evaluating if techniques are being effective. Often in the beginning there is an extensive interview process that can last several hours. This interview gives the therapist insight into the client’s past, what the current problems are, and client goals. The interview will allow the therapist to set up a structured plan for how the therapy will proceed.

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).

They both have a “positive view of human nature and view the individual as not necessarily being a product of their past experiences, but acknowledge that they are able to determine their own futures” (Holder, 2013). They both attempt to improve their client’s wellbeing by implementing a two-way therapeutic relationship where both client and therapist collaborate to enable the clients coping mechanisms (Holder, 2013). CBT and PCT both instil the three core conditions of empathy, unconditional positive regard and congruence but in CBT it is used mainly in the establishing of the working alliance (Holder, 2013). In both methods, the relationship between client and therapist is congruent and they both use the skills of reflection, paraphrasing and

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.

In the first session that was held with client Jane Smith it was to determine what the client was suffering from. Counselor agreed with community social worker that client exemplifies characteristics of Agoraphobia. The key characteristic that was identified in client’s behavior was that she does not leave her home. Client has a fear of being in public places. Client depends on her granddaughter to do all of her out of the home errands. After a multitude of characteristics were identified, intervention/treatment plan can be developed. Client alongside counselor will work together to develop an effective treatment plan. In reference to CBT a treat plan is “strategy between patient and therapist that gives direction to therapeutic process”. Client will be in charge of developing three goals that she will like to complete or work toward during sessions.

A Formulation can then be made to help the young person make sense of their problems and can be reviewed and modified when needed. This can be shared with the young person and their carers if agreed so they can begin to socialise others to the CBT model and formulation.

In clinical setting, the case formulation guides a therapist how to structure the sessions and by prioritising the client’s core problems, give rise to a plan and choice of intervention. Case formulation is an element of an empirical hypothesis testing approach to clinical work and has three main elements which are assessment, formulation and intervention. The process of case formulation starts with an unstructured ‘problem list’ (Persons, 1989), then proceeds to look for common themes which could suggest underlying beliefs, schemas and early life experiences. This supports CBT in standing up against criticisms made by psychodynamic theorists which states that CBT deals only with symptom reduction, having no underlying rationale (Persons et al., 1996).

The main goal of CBT is to help individuals and families cope with their problems by changing their maladaptive thinking and behavior patterns and improve their moods (Blackburn et al, 1981). Intervention is driven by working hypotheses (formulations) developed jointly by patient, his/her family and therapist from the assessment information. Change is brought about by a variety of possible interventions, including the practice of new behaviors, analysis of faulty thinking patterns, and learning more adaptive and rational self-talk skills. (Hawton, Salkovskis, Kirk, and Clark, 1989).

TB is a complex, chronic disease which induces immune dysregulation of several arms of the immune system. In this study, we analyzed the specific concentration of IFN-γ, TNF-α , IL-1β, and IL-10 cytokines from smear negative PTB(SNPTB) and smear positive PTB (SPPTB) to determine the effect of mycobacterial load on the cytokine concentration utilizing a simple whole blood assay stimulation with a whole sonicate MTB. Different concentration of cytokines(IFN-γ, TNF-α, and IL-10 ) detected in present study were associated with bacillary load of MTB in sputum from PTB patients. Our results demonstrate that , individuals with smear-negative PTB was associated with increased concentration in Th1 cytokine IFN-γ and decreased TNF-α ,IL-1β , as well as decreased concentration of specific Th2 cytokine IL-10 as compared with individuals with smear positive. These results strongly suggest that the sputum positive group had the lowest immune response (lowest IFN-γ levels, and highest IL-10 level) and indicate that the cytokine concentration is progressively impaired with increased mycobacterial load. In addition, PTB patients presented with a higher expression of IL-10 and TNF-α in contrast to the lower expression of IFN-γ and IL-1β as compared with healthy control. IFN-γ secreted in low concentration in two clinical PTB patient groups(SNPTB,SPPTB) as compared with health control(HC), but these levels insignificant between two

“The goal of CBT is to teach clients how to separate the evaluation of their behaviour from the evaluation of themselves and how to accept themselves in spite of imperfections” (Corey, 2009, p. 279). In CBT the clients are expected to change their current behaviour (normally full of automatic thoughts) to a more rational way of thinking. The clinician will challenge the client’s behaviour in order for the client to understand his or her behaviour and get alternatives to change his/her behaviour. When using CBT, the client’s behaviour changes when they are aware of the abnormal behaviour. This approach allows the client to focus on improving his/her wellbeing. This enhances the client’s awareness of an existing issue and that changes are necessary. The client will develop new coping skills to deal with the situation and develop a new way of thinking from negative (automatic thoughts) to positive (more realistic thoughts). Initially the client may not recognise that a problem exists, but through this process will get

CBT is an integrated approach using various combinations of cognitive and behavioral modification interventions and techniques (Myers, 2005). The aim is to change maladaptive patterns of thinking and behaving that impact clients in the present (Weiten et al., 2009). From a cognitive behavioral perspective Jane would be diagnosed as having faulty thinking and dysfunctional behavioral issues suffering from depression, and anxiety in the form of Agoraphobia (Weiten et al., 2009).

Jane is a 22 year old single white British female who lives with her parents in a house outside the city. She is heterosexual and has had a boyfriend for seven years. She feels unable to discuss her issues with her boyfriend. Her parents both have mental health issues and Jane does not feel able to talk to her mother about her problems. She has an older brother she has a good relationship who lives with his girlfriend, a four hour drive away.

In “Cognitive Behavior Therapy: Basics and Beyond”, Judith Beck (2011), the daughter of Aaron Beck, highlights ten basic principles that all CBT therapists should follow. The

Chapter 3 revolves around the individuals involved in the therapeutic process namely the therapist, child and parent. It describes foster care situation and its changeable nature these children have experienced, the need for the foster parent to have “considerable inner strength and maturity…” (pg44) and provide a “high degree of affective attunement”(pg45). The parent’s participation and the benefits are addressed throughout this book. An effective therapist must be compassionate, receptive to attunement and secure in their personal relationships. They consider the parent as a co-therapist, must have the ability to communicate effectively, be a facilitator for change and a role model, particularly in the instance of affective attunement. There is also a warning for any therapist undertaking the intensive deeply emotional work discussed, as the therapist you are in a position of power and so must not become complacent and remain vigilant, constantly monitoring the work delivered with supervision so no harm can be done to the child.