Introduction
This paper’s purpose is to conceptualize the case of a specific client, Justin, who has recently faced several mental difficulties. The work comprises the background and circumstances of the client, pertinent theoretical framework, evaluations, and descriptions of the client’s objectives and current problems. Moreover, research and evidence-based approaches are included to support decisions made while conceptualizing a case. Hence, the paper provides the client’s history, a description of counseling theory, theoretically-driven therapeutic goals, and specific techniques. Finally, the client’s presenting issue and background will be related to a topical literature review.
Client Background and Context
Justin is a young adult (20-year-old), male, and Euro-Canadian. Justin comes from a family with multiple children and a lower-than-average economic status. Although his father struggles with depression and takes an antidepressant, no other known family members have mental health issues. In addition to friends in the neighborhood, Justin has a supportive family. Justin did not appear to have had mental problems previously and did not experience any trauma during his childhood. The patient is not religious and recently started attending university. The transition from school to college was specifically stressful for Justin. Moreover, he had experienced stress due to the end of his long-term relationship with a woman. Currently, he is employed part-time in a pizza shop and lives with his parents.
The onset of the client’s presenting issues and concerns coincides with the beginning of the academic education and break up. Justin found it challenging to keep up with the workload and demands, and he frequently felt exhausted, overburdened, and unable to leave his room, which worsened his academic achievements. Moreover, he experienced fatigue, disengagement, and a lack of motivation and could no longer find interest in activities he had enjoyed, which corresponds to the symptoms of depressive disorder. Justin denies any suicidal ideas or prior efforts and does not abuse substances. During the counseling, Justin was friendly, agreeable, and forthcoming, but his effect was limited and he appeared exhausted. Justin reported that he could not move forward since he does not understand how to approach recovery, which leaves him feeling overburdened, uninspired, and afraid. Nevertheless, he states that his goal in counseling is to elevate his mood and create a strategy that will enable him to return to everyday life and feel better.
Theoretical Framework
After analyzing the situation and symptoms of the client, I have decided that Cognitive behavioral therapy (CBT) is the most relevant counseling theory that could provide the theoretical foundation for a further treatment plan. CBT is a talking therapy that may be used to address a variety of mental health issues in patients (Dobson et al., 2021). The foundation of CBT is the premise that cognition, emotions, and behavior are interdependent; namely, thoughts influence people’s feelings and actions. Thus, unfavorable and irrational ideas might upset individuals and lead to problems. When someone experiences psychological discomfort, their perception of events is distorted, which hurts the decisions they make. The goal of CBT is to make patients more conscious of their negative interpretations as well as the behavioral patterns that support them (Dobson et al., 2021). As a result, the focus of cognitive therapy is to help patients find more effective ways of thinking and accomplishing their goals to lessen their psychological discomfort.
According to the cognitive method, which underlines CBT, mental diseases and distress result from incorrect assumptions about the individuals’ selves, the environment, and other people. Cognitive inadequacies (lack of planning) or cognitive distortions may be the cause of this flawed thinking (processing information inaccurately), which leads to overwhelming or distress (Dobson et al., 2021). Furthermore, peoples’ perceptions are distorted as a result of these cognitions. Since they communicate with the world by using their mental images of it, their emotions and conduct may become disordered if their mental representations are unreliable or methods of reasoning are insufficient.
A fundamental idea of CBT is the patient’s active engagement in therapy. This problem-focused, goal-oriented strategy would only work with it. The effectiveness of CBT sessions depends on the client having a better awareness of the role that cognition plays in treating behavioral dysfunctions (Dobson et al., 2021). An essential element of this treatment is the deepening of the client-therapist connection, which is made possible by this instructional approach. In CBT, it is argued that cognitive distortions contribute to the emergence of psychological issues (Dobson et al., 2021). These distortions may be removed to produce a more realistic perception of what happened. Through this practice, a patient is better equipped to build the abilities necessary to digest exposure to life events appropriately.
This treatment was developed to address and is helpful for patients with a variety of psychological issues. The use of CBT to treat anxiety symptoms, psychotic symptoms, eating disorders, anger issues, and general stress is well supported by research (Kolubinski et al., 2018). Moreover, there is adequate evidence to demonstrate that CBT is more successful than other active therapies for depression than waitlist control conditions and treatment as usual (Kolubinski et al., 2018; Gozan & Menaldi, 2020). This type of therapy is best suited for young adults and adults of any gender (Kolubinski et al., 2018). Based on the patient’s unique personality and needs, the treatment is tailored for them. CBT holds that a person can transition from psychopathology to health by lessening the intensity of their negative emotions (Spinhoven et al., 2018). Positive emotions do not, however, automatically appear when unpleasant feelings arise. As a result, CBT uses positive psychology therapies in addition to techniques to lessen negative emotions.
Through an examination procedure, the cognitive therapist instructs clients to spot erroneous cognitions. Hence, the patients get the ability to distinguish between reality and their ideas. They are taught to detect, observe, and keep track of their thoughts and the impact that cognition has on their moods. For example, setting homework (such as a diary of thoughts) for the client as part of the behavior treatment is common (Dobson et al., 2021). The client is given activities by the therapist that will encourage them to question their erroneous ideas to recognize and disprove them so that their beliefs start to shift.
I have chosen CBT as the theoretical foundation for Justin because it aids in identifying and modifying unfavorable ideas and the accompanying actions. It is supported by research that negative thinking patterns are a common cause and challenge for many people who experience depression (Spinhoven et al., 2018). Hence, these mental patterns have the power to affect how Justin acts, and his behavior then validates mental patterns. Since I have not spoken to Justin in person, I cannot assume specific cognitive fallacies that lead to negative patterns. However, maximization errors (breaking up with the girlfriend and failing university) may be present. As a result, the process of irrational thinking starts a vicious cycle of unhappy thoughts and low spirits (Kodukaran et al., 2022). Therefore, CBT therapy might assist the client in identifying his underlying assumptions, dealing with the troubling thoughts that result from them, and changing his behavior as necessary.
Diagnostic Impression and Assessment
During the preliminary assessment of the client based on the symptoms he is experiencing, I made a diagnostic impression. As such, I suppose that Justin suffers from major depression caused by the end of his romantic relationship and, later, his transition to college. As such, Justin described his feelings, which correspond to the reported symptoms of depression after breakups in Verhallen et al.’s (2019) study. For example, Justin mentioned that he could not enjoy the activities that he liked before. This behavior is called anhedonia, which is defined as a diminished capacity for pleasure and is accompanied by a lack of reactivity; it is a diagnostic indicator for major depression (Verhallen et al., 2019). Anhedonia is characterized by the client’s almost total lack of motivation, interest, and enjoyment.
The other emotions and concerns similarly indicate that Justin suffers from depression. Furthermore, Verhallen et al. (2019) state that sudden loss, which might cause depression, is significantly influenced by feelings of betrayal, rejection, and anger due to a sudden breakup. As a result, the symptoms of complicated grief can be experienced by patients who cannot adapt to it completely. Such symptoms include extreme melancholy that does not improve with time, emptiness, fatigue, and numbness, as well as continuing with the same routines (Verhallen et al., 2019). Justin was sad and betrayed by his girlfriend and described his exhaustion, lack of progress, as well as his everyday repeating process of work, which suggests that he has the symptoms of grief, leading to depression. The research confirms that heartbroken individuals report feeling sad or low in spirits and a lack of interest in everyday activities, which are the primary symptoms of depression (Verhallen et al., 2019).
Moreover, these symptoms might have been worsened by the feeling of rumination in college. According to Kneeland and Dovidio (2020), rumination is a type of persistent cognition that emphasizes unfavorable information, usually from the past and present, and causes emotional distress. The authors claim that students in their first year are adjusting to undergraduate life and demonstrate an increase in psychopathology due to rumination behavior, which correlates with depression (Kneeland & Dovidio, 2020). As such, Justin faced ongoing stressors in college that he could not control, which resulted in low academic achievement. The patient was worried about his grades and college life but could not do anything to improve them, which caused more significant distress and corresponded to rumination.
Furthermore, an essential component of evidence-based practice is careful assessment. Initial evaluations of depressed symptoms can assist in identifying potential treatment choices, and ongoing evaluations can direct care and monitor improvement. As such, the assessment process for Justin will comprise depression screening and diagnosis. For screening, I will use two questions from the Primary Care Evaluation of Mental Disorders to create a screening test for depression that is quite sensitive but not very specific (Kalinin et al., 2021). These questions include asking the patient whether he felt that little interest was bothering him and whether he felt sad, melancholy, or despairing this month. Only four further questions—sleep disruption, eating changes, poor self-esteem, and anhedonia—are required to verify a diagnosis of depression if a patient answers favorably to these first two inquiries. Therefore, the tool suits the case of Justin, whose main concerns correspond to those identified in the preliminary questions.
Next, I will use the Beck Depression Inventory (BDI) tool for diagnosis. The BDI-II is frequently used to assess the behavioral signs and severity of depression. According to Glischinski et al. (2018), ages 13 to 80 can utilize the BDI-II (p. 1111). Individuals fill out the 21 self-report items on the inventory using multiple-choice forms, which take several minutes to fill out (p. 1111). The BDI-II’s validity and reliability have been evaluated in populations all around the world. As a result, research demonstrates that the testing is reliable in a multicultural context and not biased by gender or sexuality (Rovira et al., 2022). Its high item difficulty is one of its flaws since it requires the patient to be able to read and understand the questions, but such a concern does not apply to the case. Hence, I have chosen this tool due to its high accuracy and applicability to any context, including adult males, which is the case of the patient. Thus, the quickest, easiest, and most accurate method for diagnosing major depression in an adult male is to use the PRIME-MD screening questions accompanied by the self-report BDI-II, including examination of anxiety by screening questions.
Case Conceptualization
After the assessment and measurement of the severity of depression, the treatment will begin with the following plan. Since short-duration interventions were less effective than those of medium or long duration (over ten sessions), I propose conducting at least ten counseling sessions over six months (Greene et al., 2022, p. 14). To lessen depression, CBT combines cognitive and behavioral strategies. Depressive thought patterns that result in inactivity or self-harming activities may be challenged by the long-term goals of the therapy. The first aim of the therapy will be to identify the patient’s erroneous thought patterns and educate him on how to change his cognition and corresponding actions. The second goal of the therapy is to establish positive thoughts and behaviors so that the patient feels motivated and can continue to enjoy his everyday life. These goals are sufficient for the patient’s concerns since they aim to change the client’s negative patterns of thinking, which is the core mechanism behind his distress, and reinforce further positive emotions. The goals are feasible since Justin can describe his emotions clearly, is motivated to get better, and is counseled by a CBT specialist.
In the initial consultation, I will create a cordial therapeutic alliance, outline specific problems and their corresponding goals, and inform Justin about the depressive cycle and cognitive model. Such a starting meeting is recommended by the literature for the appropriate realization of CBT treatment. As such, this strategy aims to pinpoint the patient’s issues and objectives (Gautam et al., 2020). Adjusting treatment objectives is aided by verifying this list after the first session. The patient’s data can be used to shed light on behaviors and show the patient how cognitions influence his emotions and actions (Gautam et al., 2020). Additionally, the meeting enables the patient and therapist to reach a therapeutic alliance agreement, which is crucial in CBT. Finally, it is necessary to give the patient the proper homework assignment by the predetermined objective.
The other treatment sessions will include a dialogue exploring the client’s homework and several behavior activities. For example, minimizing ruminations is necessary since the patient has been spending a lot of time and energy dwelling on his shortcomings and failures. It is possible to teach Justin how to become conscious of these negative thoughts and purposefully focus on particular positive aspects (Gautam et al., 2020). This intervention aligns with changing negative thought and behavior patterns, which is also the aim of CBT. Moreover, such cognitive restructuring is the most appropriate intervention for Justin at the moment since it can allow him to accept that he can change.
Next, observing activities might help with the client’s loss of interest in routine tasks. Early behavioral intervention has been shown to boost patients’ feelings of autonomy (Gautam et al., 2020). The patient will be instructed to note each activity on the activity plan hour by hour. He should treat himself when he schedules low-level activities that promote self-care and positive respect. Hence, he will learn to motivate himself to perform required duties even when you are feeling down by arranging these activities and rewards. Such an intervention is aligned with both goals and corresponds to CBT methodology while providing Justin with greater motivation and practicing what he learned. Meditation for mindfulness, visualizing the most significant portion of the day, and organizing enjoyable activities are additional crucial behavioral practices that will increase the patient’s positive emotions. These interventions align to build motivation and CBT concepts, as well as needed for Justin’s anhedonia.
Literature Review
In the paper, I used research to support my decisions and considerations of the relevancy of treatment for Justin. The core themes in the case are anhedonia, negative thought patterns, grief, fatigue, inability to maintain well-being, and everyday life routine due to these emotions and behaviors. These themes suggest that the client has major depression, supported by the studies mentioned in the work. As such, Kolubinski et al. (2018) claim that undergraduate college students with depressive episodes struggle with significant mental health conditions resulting in a pervasive sense of despair and lack of interest in life. Stressful life experiences that result in emotional, functional, and physical issues may be the starting point for these, which corresponds to Justin’s situation. Moreover, Gozan and Menaldi (2020) support the idea that relationships might seriously affect the mental health of young adults. The conditions of these patients are worsened by the prior history of communication and social adjustment issues.
The correlations between the client’s case, the theory chosen, the components of the treatment plan, and the interventions can be observed in the studies employed. For example, Greene et al. (2022) accentuate the effectiveness of CBT treatment for young adults who face mental issues caused by romantic relationships and transition from home to college settings. Moreover, the authors describe the frequency of the treatment and interventions, which were included in the current treatment plan. They establish their efficacy for the specific population of young adults.
Conclusion
To conclude, Justin’s case concerns the topic of depression due to his present symptoms and concerns. It has been identified that CBT therapy sessions will provide practical and evidence-based care, which is aligned with the patient’s goals and identified aims of the counseling. The described interventions are appropriate for a young adult male suffering from the experienced breakup and failure at college, which is specifically relevant for the patient.
References
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