Using the Cognitive Approach with Aaron, Client Profile 2
The cognitive approach has benefits for Aaron that include the immediate relief of some of his symptoms (Laureate Education, Inc., 2006). Cognitive therapy has been effective for adolescents in applications that include skills training and obsessive compulsive disorder as well as for eating disorders (Butler, Chapman, Forman & Beck, 2006; Lewin et al., 2005; Storch et al., 2010). This approach will teach Aaron cognitive skills with which he can challenge his faulty and irrational beliefs that contribute to his unhealthy behaviors. Cognitive therapy supports a flexible therapeutic process, which can be tailored to Aaron's needs (Corey, 2006).
Cognitive approaches do not ordinarily focus on clients' past emotional experiences, although painful ones that intrude into clients' present functioning must be recognized in the therapeutic process before they can proceed toward re-orienting themselves to more effective ways of thinking. This approach is not designed for deep, reflective self-awareness and understanding, and it tends to minimize emotions (Laureate Education, Inc., 2006). Aaron seems heavily invested in the use of ritualistic behavior that may represent an acute underlying emotional condition. His therapist will reevaluate Aaron's progress on an ongoing basis.
Aaron is a 17-year-old athlete of Syrian American descent and his religion is Judeism. The therapist will explore the affect of these cultural aspects as well as those of his parents and the foundational beliefs and the values with which he was raised. Considering Aaron's age and developmental stage is crucial because adolescents are typically contending with the unique consequences of self-identification. The therapist will consider Aaron's social culture of male athletes from whom he may have learned inappropriate measures of success for boys. He will explore Aaron's perspective of therapy as it relates to how his male/athlete culture might perceive it. If this causes conflict, especially with Aaron's motivation, it must be addressed.
Ethical or Legal Issues to Address
Although it is not apparent that Aaron's anxiety is contributing to suicidal ideology or his intent to hurt another person, but this must be addressed in the initial stages of therapy. As a minor, both Aaron and his parents will need to sign informed consent agreements with special attention to the amount of parental involvement versus privacy in Aaron's therapy (Remley & Herlihy, 2001).
Overall Therapeutic Goal
Cognitive therapy focuses on the idea individual's perceptions, not situations, cause maladaptive thoughts (Corey, 2009). This approach is designed to help clients become aware of how they think and develop more appropriate ways of thinking. Because many clients neither question nor identify their internal dialogs, creating an awareness is a crucial first step in changing irrational thinking (Laureate Education, Inc., 2006). One of the key components of Aaron's cognitive therapy will help him integrate rational thinking into his daily life. As Aaron becomes more aware of his perceptions, he will begin to have some control over his automatic thoughts which will, in turn affect the way he responds to them.
The Therapeutic Process
Aaron will benefit from a client-centered approach to help him perceive the therapist as a collaborator in his goal to regain and his health and athletic abilities. Initially, the therapist will want to explore several aspects of Aaron's history as well as his motivation for therapy because this will directly affect how he progresses (Laureate Education, Inc., 2006). Another important issue is Aaron's drug use. The therapist will want to identify any substance abuse or dependence. Collaborating on this issue with other health professionals may be helpful if the therapist is inexperienced (Laureate Education, Inc., 2006).
Goals of Therapy
The goals of Aaron's therapy will be a collaborative effort between him and his therapist. After developing Aaron's awareness of his irrational internal dialog, his therapy will include the use of cognitive tools, which will help him integrate rational and healthy perspectives into his current way of thinking (Corey, 2009). Aaron's therapist may enlist his parents' help to keep Aaron focused and progressing between therapeutic sessions. Ultimately, this approach will help Aaron develop rational thought processes, especially those related to his health, weight, and athletic performance. As Aaron practices more accurate perceptions, he will decrease his automatic responses and his ritualistic behavior (Lewin et al., 2005) .
Specific Strategies and Techniques
The therapist will use Socratic and self-talk discussions as well as debate Aaron's beliefs and values. The therapist will teach Aaron how to argue with his internal dialog and engage him in role playing. Homework will support Aaron in an ongoing therapeutic process outside of the therapy session (Corey, 2009). Cognitive restructuring will help Aaron reorganize and rebuild new ways of thinking. For example, rather than thinking he needs to lose ten pounds, he can realign his focus on creating more muscle to promote his athletic abilities. Restructuring thoughts and self-talk helps clients begin to perceive themselves and their lives more accurately.
Butler, A., Chapman, J., Forman, E., & Beck, A. (2006). The empirical status of cognitive- behavioral therapy: A review of meta-analyses. Clinical Psychology Review, 26(1), 17- 31. doi: 10.1016/j.cpr.2005.07.003
Corey, G. (2009). Theory and practice of counseling and psychotherapy (8th ed.). Belmont, CA: Thompson Brooks/Cole.
Laureate Education, Inc. (Producer). (2006). Case study: a CBT/behavioral therapy perspective In Counseling and Psychotherapy theories [Streaming Video]. Baltimore: Author.
Lewin, A. B., Storch, E. A., Merlo, L. J., Adkins, J. W., Murphy, T., & Geffken, G. A. (2005). Intensive Cognitive Behavioral Therapy for Pediatric Obsessive Compulsive Disorder: A Treatment Protocol for Mental Health Providers. Psychological Services, 2(2), 91-104. doi: 10.1037/1541-15188.8.131.52
Remley, T. P., & Herlihy, B. (2001). Professional practice in a multicultural society. In Ethical, legal, and professional issues in counseling. Upper Saddle River, NJ: Merrill Prentice Hall.
Storch, E., Lehmkuhl, H., Ricketts, E., Geffken, G., Marien, W., & Murphy, T. (2010). An Open Trial of Intensive Family Based Cognitive-Behavioral Therapy in Youth With Obsessive- Compulsive Disorder Who Are Medication Partial Responders or Nonresponders. Journal of Clinical Child & Adolescent Psychology, 39(2), 260-268. doi: 10.1080/15374410903532676