I will be analyzing a hypothetical case of anindividual suffering from an anxiety disorder using the Cognitive behavioral therapy(CBT). I will start by introducing the client (Craig), definewhat interventions I would use, and clarify how to build a therapeuticrelationship with Craig. I will also evaluate CBT, as well as present anytherapeutic sensitivity in view of what might go wrong.
Furthermore, I willoutline ethical problems in the appliance of theory to practice. I will alsoinclude critical contrast made between CBT and other approaches. I will thenfinish with a conclusion.Craig, wants to seek CBT, as he finds itdifficult to keep a job due to his anxiety, as responsibility escalates hisstress and predictable failure in work, leading to a loss of the job. (seeappendix a for full description) Craig found a new part-time job, and isn’tcurrently on any medication.Craig has difficulty talking about his anxietyand feel stuck. He socializes on Internet sites. Craig fears he will be exposed as incompetent.
He sees himself as weak, hasthe belief that he is not as smart as others and is afraid that if he losesthis job he won’t get another. Craig feels anxious when he meets new people.He has spoken about a recent incident in which he felt anxious when meeting hisnew colleagues (see appendix B for vicious cycle one) Craig also finds it problematicwhen he is criticized (see appendix C for vicious cycle 2). Craig is suffering from social anxietydisorder (SAD), also referred to as social phobia.
SAD iscategorized by a substantial amount of fear in social situations. This fear causes the individual high levelof stress, worry and leading to a reduction in capability of functioning insocial activities (Hofmann & Otto, 2018). The CBTintervention I would apply to Craig is Acceptance and commitment therapy (ACT),as Craig has described to be feeling stuck, therefore he has tried to get ridof his anxiety, and it is still there, therefore rather than trying to get ridof Craig’s negative thought.
ACT will help Craig accept his undesirable andnegative thoughts and commit to live a meaningful life (Ciarrochi & Bailey, 2008).ACT is a third wave CBT intervention that aims to teach the client skills to copewith thoughts and feelings that are negative (Hayes & Strosahl, 2004). The goal of ACT is tohelp the clients live a significant life, while tolerating the expecteddistress that comes with it, through six core processes (Contact with thepresent, acceptance, cognitive diffusion, self-as-context, values, committedaction) (Hofmann & Reinecke, 2010).
Therefore, ACT will aid Craig by teaching him skills to live life to thefullest whilst tolerating the negative energy and pain that comes with it, thushelping him tolerating negative thoughts that occur to him while in socialsituations and continue to have a good work-related experience in which he completeshis tasks without the fear of failure (Hayes & Strosahl, 2004). The therapeutic relationship, betweenthe client and the therapist, in CBT has been argued to be an importantfunction in facilitating positive results in therapy and aids therapeuticchange (Easterbrook & Meehanb, 2017).As ACT understands the therapeutic relationship as performing an important partin the capability of clients to be tolerant of their problems (Gilbert & Leahy, 2007).To build an effective therapeutic relationship with Craig, I will follow theBACP ethical principles such as being a trust worthy therapist to Craig (BACP, BACP Ethical framework: Ethics, 2017). Honoring the trust Craig has placed inme, overtime I will strengthen the therapeutic relationship, making it easierfor therapeutic change to occur in Craig (Easterbrook & Meehanb, 2017). In addition to that, to create aneffective therapeutic relationship, I will be bringing in my technical andpsychological skills to the relationship by applying the components of ACT notonly to the clients but to myself. For instance, by applying the therapeuticmethod to myself, I will not be presenting myself as fake or manipulative tothe client.
(Gilbert & Leahy, 2007). This will thencreate a relationship by showing Craig that I am a competent therapist who hecan learn from, thus encouraging him into engaging in the therapy leading to apositive change (Ciarrochi & Bailey, 2008). One thing of importance in CBT principles,is the structure of the intervention (Beck, 1995). The counsellor musttake into count what needs to be accomplished at the beginning, middle and theend of therapy (Wills & Sanders, 2013). At the beginning oftherapy, the therapist and client get acquainted with each other, and thetherapist must aim to educate the Craig about the CBT intervention and what thetherapy aims to do including the emphasis on the use of continuous feedback,this is known as psychoeducation (Milne & Reiser, 2017).As well as assessing Craig’s current anxiety level to determine how much workneeds to be done. This also helps Craig receive the best care suited for him,as the therapy can be tailored to his needs (Gilbert & Leahy, 2007) this is known as theassessment process.
During this the therapist must also create a formulationwith the client to determine the level of intensity of his anxiety (Wills & Sanders, 2013) (refer to appendix Dfor formulation template for anxiety). In the middle of the therapy the clientmust be reviewed as well as during other sessions. Since Craig has 8 sessions,Craig should be reviewed during the third and fifth session, during this reviewCraig’s level of anxiety should be assessed to determine whether the CBTintervention is working for Craig, also seeking feedback from the client todetermine if they are engaging in the therapy (Milne & Reiser, 2017), as well as settinghomework tasks for them to complete outside of the therapy sessions (Wills & Sanders, 2013), so that Craig canapply the interventions learnt to real life situations.