Theoretical Approach Assessment: Cognitive Behavior Therapy
Cognitive Behavioral Therapy (CBTs) represents a convergence of cognitive processes and behavioral strategies that aims at achieving cognitive and behavioral change. At the core of Cognitive Behavioral Therapy are three propositions; first, cognitive activity may be monitored and altered; second, cognitive activity affects behavior; third, desired behavior change may be affected through cognitive change (Johnson, 2010). Cognitive behavior therapy focuses their treatment on cognition with the belief that behavior change will follow cognition. To be able to carry out CBT on a client or on a group, one need to understand the various treatment approaches that exist within the scope of CBT (Boyle et al., 2009). The approaches under CBT share the theoretical viewpoint that makes the assumption that cognitive activities mediate behavior change. Consequently, CBT theorist overtly argue that cognition alter behavior.
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Moreover, it is important to note that the outcomes of CBT vary hugely from one individual to the other. In the case of the client in question, the CBT is ideal since it aims at curing overt behavior such as anger and transforms it into a positive cognition. In carrying out CBT on this client, I will put into practice the therapeutic procedures that organized CBT into cognitive restructuring, coping skills therapies, and problem solving therapies. Series of past research indicate that CBT has been successful in curbing anger problems. For instance, Flanagan, Allen, and Henry (2010) established that rational emotive behavior, as a therapy, is successful in anger management. On the other hand, Morland et al. (2011) established that manualized cognitive-behavioral therapy is very success in anger management among veterans since it outlines all problems that an individual faces at an interpersonal level as ultimately affecting others.
The client is a 35 years old African American male, high school dropout, in a relationship, and currently a sailor in the US Military. He has been in the army for close to a decade as a sailor. The client’s commanding officer referred him for treatment, because of excessive violent temper that is interfering with his performance and relationship with other sailors. The commanding officer insisted that the client must be subjected to psychiatric treatment since the violent condition was recurrent. However, there is no record of the client having been treated for temper related condition in the past.
Reason for Social Work Involvement
The crisis of potential dismissal, demotion, fine, and restriction from duties forced the client to seek for treatment. Specifically, the commanding officer made it clear that the client would face severe consequences should he fail to seek for psychiatric treatment.
Family Background and Situation
The client has had a long history of violent temper, which could be attributed to his upbringing environment. From a tender age, the client has not known the love of family and was abandoned by his teenage mother, who was then serving time in jail. The client had to be taken to an orphanage but was not claimed by the mother upon finishing her time in jail. At the age of two years, the client was transferred to a foster home by his adoptive parents called the Tates. The new home was equally unfriendly to the young boy who had to endure physical and mental abuse from the Tates until the age of 14 years. After running away from hid foster parents, the client lived in the streets from several years until an opportunity to join the US Navy changed his life. As a result of the rough life while growing up, the client has had a very bad case of recurrent violent temper and he is always solving conflicts with fellow sailors through fights. The client is currently dating a female lady of middle age and has successfully traced the whereabouts of his biological parents.
Physical Functioning and Health
The client exhibits excessive violent temper and very confrontational in the work place environment. The client seems to have deep anger that is threatening to consume him. From appearance, the client seems okay but has a sad face and is always folding his arms across like a tensed person. There is no medication that the client is currently using apart from a confession of sometimes attending anger management classes. However, the client is not consistent and has unpredictable behavior.
Intellectual Functioning (mental status)
The client seems okay in mental status and can be engaged in an intellectual discourse. The client has can reason out and seems very articulate in expressing himself. Therefore, from the assessment, the client has an upright mental capacity of a normal person.
The client seems depressed and very sad. From physical assessment, the client has a very sad face and shaky voice. The client is very defensive and is struggling to keep up with any conversation. Lastly, the client is just putting a brave face to appear composed.
Interpersonal and Social Relationships
The client has poor interpersonal relationship with his co-sailors and other people he is related to. A part from his current girlfriend, the client is lonely and has not established any strong relationship with any other person. The client has poor social skills as evident in his confrontational and defensive nature when handling conflicts with co-sailors. Besides, the client is more than willing to face his problems through physical confrontation instead of dialogue.
The client is a high school dropout who has managed to reverse his misfortunes by joining the US Navy as a sailor. There is no any other evidence of further schooling or training by the client.
The client is an adult of legal age to make personal decisions and take consequences for them. The client does not have any history of criminal offenses or past records of serving jail time.
There is no history of substance abuse in the life of the client, despite having spent several years in the streets after running away from the foster care.
Religion and Spirituality
The client was raised in a Christian family environment. However, there is no evidence of him subscribing to these religious beliefs. The client has free spirituality with no specific inclination to either of the religious doctrines.
The client is currently undergoing anger management treatment by Dr. Jerome Davenport, a psychiatrist. There is no any other history of treatment for the violent behavior exhibited by the client.
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Strengths and Problem-Solving Capacity
The client’s primary strengths are admitting that he has anger management problem, the will to overcome challenges, and the spirit to learn. Despite being discrete at the beginning of the therapy, the client opened up and poured out his heart to the doctor. Besides, the client was able to locate his parents despite several setbacks in the process. This is an indication of a strong will and determination to accomplish a task at hand.
Use of Community Resources
The client has not used any available community resources such as physical exercise center, counseling units, and religious institutions to facilitate management of his condition.
Impressions and Assessment
The first impression of the client is a person who needs to be motivated to overcome high physical violent nature. By coming for the therapy, the client has acknowledged that he has a problem and has the will to pass through the treatment. Since the client has a steady relationship with a girlfriend, the treatment process would be successful because of her support and presence. The client urgently needs a comprehensive Cognitive Behavior Therapy to overcome the anger management problem.
Goals for work with client
- Cognitive restructuring: Focus on the thoughts of the client to identify and erase emotional distress.
- Cognitive coping therapy: Reviews the potential skills that can be modeled to facilitate coping with difficult situations.
- Problem-solving therapy: Harnessing the overt behaviors through therapeutic procedures such as problem solving and coping skills.
In my practice of the cognitive restructuring therapy, I will focus on the client’s thoughts since according to this perspective; emotional distress is assumed to result from maladaptive thoughts. CBT stipulates that different emotions are often associated with different thoughts (Flanagan, Allen, & Henry, 2010). For example, depression is associated with thoughts such as ‘I am worthless’, ‘the future is bleak’, or ‘nothing will change’, while anxiety is associated with thoughts such as ‘I am in danger’ or ‘something terrible is going to happen’.
Likewise, anger is associated with thoughts such as ‘I have been disrespected’ or ‘it is unfair’ amongst others. Therefore, in my therapy on the client, I will have to establish the sources of such thoughts and help the client understand how to tackle them through a guided self-help approach. The aim here will be to replace the client’s presumed distorted thoughts of life events with more adaptive and realistic appraisals (Johnson, 2010). This self-guided approach is based on proactive approach towards creating strategic experiences that can be modeled to suit automatic thoughts that the client might have. Through this, the clients will be able to identify and manage positive relationships to with realistic cognition.
Cognitive Coping Therapy
Applying the cognitive coping skills therapy on the client will require an in-depth analysis of the triggers of maladaptive thoughts and offers the alternative responses to such thoughts. It focuses on the development of a range of skills that is designed to help the client cope with a variety of life situations (Boyle et al., 2009). In this scenario, therapist find that repetition is indispensable to the learning process of the client in order to develop expertise and to make certain that newly acquired behaviors are available when needed. Therefore, I will emphasize behavioral rehearsal by use of wide-ranging, practical case examples to improve generalization to real life settings. In therapy, especially during the rehearsal periods, I will ask the client to identify signs that might indicate high-risk situations, and the ask him to employ his newly learned coping skills to address the situation at hand.
Furthermore, I will employ the problem-solving therapies in my practice on the client appropriately. The approach is necessary in situations where the client has been unable to cope with the problematic situations facing him. Considering the social and personal consequences associated with the inability to cope with the problems, it is necessary to carry out a therapy that can offer the most effective response if not a permanent solution (Morland et al., 2011). This approach may be described as a combination of both coping skills training procedures and cognitive restructuring techniques.
Boyle, S. W., Hull, G. H., Smith, L. L., & Farley, O. W. (2009). Direct practice in social work practice. Boston, MA: Allyn & Bacon.
Flanagan, R., Allen, K., & Henry, D. J. (2010). The impact of anger management treatment and rational emotive behavior therapy in a public school setting on social skills, anger management, and depression. Journal of Rational-Emotional Cognitive-Behavior Therapy, 12(4), 87–99.
Johnson, S. L. (2010). Therapist’s guide to clinical intervention: The 1-2-3’s of treatment planning. Amsterdam, Netherlands: Academic Press.
Morland, L. A., Greene, C. J., Grubbs, K., Kloezeman, K., Mackintosh, M. A., Rosen, C., & Frueh, B. C. (2011). Therapist adherence to manualized cognitive-behavioral therapy for anger management delivered to veterans with PTSD via video-conferencing. Journal of Clinical Psychology, 4(6), 629-638.