TB-CBT: A Case Study

Clients and Therapists work together to form a therapeutic relationship and to identify the relation between thoughts and feelings on their behaviour. This includes the identification of Core Beliefs, Dysfunctional Assumptions and Negative Automatic Thoughts. This initial assessment can sometimes be difficult with children as may have been told to come along to therapy by a parent/ carer and may not be ready or motivated to engage in therapy (Stallard, 2005).

Counselling psychology has been referred to as a “paradigm” due to its many therapeutic models and has been argued by the philosopher Thomas Kuhn (1962) that it is a “scientific community which is comprised of theories and concepts, experiences” (Woolfe, Dryden & Strawbridge, 2003). The humanistic paradigm is one that

Katie Empson S00191137 Assignment 1: Essay COUN222 What treatment approaches (if any) would you consider for these characters and why? Cognitive Behavioural Therapy (CBT) is a form of psychotherapy that explores the notion that an individuals thoughts, beliefs and interpretations about themselves and the situations they are placed in are directly associated with their emotional responses and behaviour (Otte, 2013); that is, an individuals cognitive functions have a strong influence over their feelings and behaviours surrounding specific situations rather than external factors such events or other people and so, CBT follows the belief that by changing or challenging the way in which an individual perceives their thoughts and feelings can significantly reduce their symptoms and improve their overall functioning and quality of life (Hofmann, Asnaani, Vonk, Sawyer & Fang, 2013). In CBT the patient is an active participant in the therapeutic process, collaborating with the therapist to modify their problematic behavioural patterns and to build new, healthy schemas.

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.

TF-CBT is comprised of following eight phases: Psychoeducation and parenting skills, relaxation techniques, affective expression and regulation, cognitive coping and processing, trauma narrative, in vivo exposure,

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).

A series analyses of covariance appears to have indicated that children assigned to TF-CBT, compared to those participants who were assigned to child-centered therapy, demonstrated significantly more improvement with regard to PTSD, depression, behavior problems, shame, guilt, and other abuse-related attributions. (Cohen, Deblinger, Mannarino, & Steer, 2004, p.400). Similarly, parents or guardians who were assigned to TF-CBT showed greater improvement with respect to their own self-reported levels of depression, abuse-specific distress, support of the child, and effective parenting practices allowing them to parent more effectively. (Cohen, Deblinger, Mannarino, & Steer, 2004, p. 401). TF-CBT assists both the primary caregivers along with the child to ensure everyone in the situation who experiences negative symptoms are addressed and helped therapeutically, to create an outcome where children and their families can live successfully together. This can also include communities as whole TF-CBT helps bring empowerment to its participants and allows them to face their issues head on.

CBT also may include efforts to improve coping behavior and other skills (Wright 6). 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).

Evidence-based research suggests trauma focused cognitive behavior therapy (TB-CBT) is a particularly effective model to use with individuals who has experienced childhood trauma. TB-CBT is evidence-based; it is a treatment model that was designed to assist children, adolescents, and their families to overcome the damaging effects of traumatic experiences.

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).

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.

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.

Cognitive behavior therapy (CBT) perspective 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).

CBT - Case Study Identifying Information For the purposes of the case study the client will be called Jane. 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.

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.