The Case of Sydney: Cognitive Behavior
Introduction
As a cognitive-behavioral therapist, I would begin with a thorough analysis of Sydney and then implement the most appropriate cognitive-behavioral intervention. Using Easden and Fletcher’s (2020) conceptualization model as the foundation for this discussion, I began by exploring key observations which enabled me to provide the problem list.
Observations
Sydney’s thoughts about the world, self, others, and the future include:
- “…the future is hopeless…”
- “…others are demanding and don’t understand me…”
- : I am inadequate, irresponsible, inferior, ashamed, and guilty…”
The onset of her issues appears to be linked to the abuses she suffered from her former husband, the termination of her marriage, and the lack of support from her family during these difficulties. Sydney’s coping mechanisms, which involved excessive dedication to work, resulted in problems arising between her and her children.
When Sydney was confronted with taking more responsibility for her family and herself, she started feeling “…less than…”. This cognitive representation of shame, inferiority, irresponsibility, guilt, and inadequacy resulted in depression, and the progression of her depression into diminished self-care has made it challenging for Sydney to perceive an end to this sad and stressful life.
The assets and strengths to be considered with respect to Sydney’s case include the fact that she is caring, resilient, well educated, and intelligent. She has both family of origin and children who can be introduced into her treatment plan to offer additional social support; furthermore, Sydney is part of a community which values social groups and the family.
Presenting problems
Sydney appears to be suffering from Major Depressive Disorder (MDD), as evidenced by suicidal ideation, weight loss, crying, and difficulty in sleeping (Otte et al., 2016). Depression is evidenced by disturbing dreams, sleep disturbances, and sad affect. Sydney own words “… I have nothing to live for. No one cares about me. I’ve ruined my life and the lives of two families, and I am currently hurting my children…” are indicative of her sense of hopelessness and depressing effect. She also depicts interpersonal challenges, especially with her children and other members of her extended family. Sydney is also incapable of sustaining relationships with potential mates. Moreover, she has problems at work, including absences and difficulty concentrating, which are unacceptable to the employer. In addition, there are acculturation issues. Specifically, Sydney is a Hispanic woman who was brought up in a neighborhood that was culturally encapsulated.
Primary goals
The main goals are to mitigate depressive symptoms, increase her confidence and self-esteem, proliferate her social support via family as well as friends support.
Techniques
This will be achieved using two key modalities, including individualized cognitive behavioral therapy, which is founded on cultural sensitivity and a group-based cognitive-behavioral therapy involving women with a history of abuse. The initial intervention will focus on her current situation by assessing her level of depression and suicidality. This will be done using a clinical interview and the Beck Depression Inventory (Dobson & Dobson, 2018). This will then be followed by the establishment of a social support system for her via the group treatment program. It will also be necessary to introduce meditative relaxation.
As a cognitive-behavioral therapist, I will formulate a plan to work with Sydney, which will focus on increasing an understanding of the responsibility of her thoughts on her existing situation. Sydney can be challenged to recognize the thoughts which surround her mind at home and at work, especially thoughts that are fundamental to depression. Thought patterns can be grouped into broad categories of cognitive distortions, including disqualifying the positive, overgeneralization, or all-or-nothing thinking (Dobson & Dobson, 2018). As Sydney discovers the process of identifying her thoughts, she may begin to elucidate about her feelings and realize that her feelings and thoughts are related to her challenges. It is the main role of the therapist to establish the interrelated nature of behaviors, feelings, and thoughts, and the counseling process will focus on altering the maladaptive thoughts.
Once an understanding of Sydney’s thoughts has been established, I will begin the process of changing her thoughts. Using questions such as: what is the evidence? Is there another way of looking at your situation? And what if it actually happens? will be applied. Self-monitoring thoughts will be utilized as a homework assignment to assist Sydney focus on her thoughts and how they affect her feelings and behaviors.
It is apparent that Sydney deals with depression through withdrawal from social contacts. Even though withdrawal is a product of depression, it ends up increasing her depression thoughts and feelings. There are other issues in Sydney’s case study, which should also be addressed, such as her relationships and her suicidal tendencies. I have examined her depression because it appears to be the main problem that requires to be addressed to solve the other issues. Once Sydney manages her depression, it will be easy to deal with the other challenges she is facing.
Personal thoughts about using this week’s theory with Sydney
Cognitive-behavioral therapy, as used in Sydney’s case, illustrates understanding the nature of the existing issue from a social, cognitive, affective, and behavioral perspective. This implies that Sydney’s development in counseling can be monitored and measured. The interventions utilized in cognitive-behavioral therapies are perceived in terms of behavioral and cognitive interventions, which are effective in addressing Sydney’s case (Hayes & Hofmann, 2017). However, I found this therapeutic approach failing in some areas as it did not provide ways for exploring the unconscious factors in the process of determining Sydney’s behavior and the marginalization of key behavioral factors such as insight and ego strength.
References
Dobson, D., & Dobson, K. S. (2018). Evidence-based practice of cognitive-behavioral therapy. Guilford Publications.
Easden, M. H., & Fletcher, R. B. (2020). Therapist competence in case conceptualization and outcome in cbt for depression. Psychotherapy Research, 30(2), 151-169.
Hayes, S. C., & Hofmann, S. G. (2017). The third wave of cognitive-behavioral therapy and the rise of process‐based care. World Psychiatry, 16(3), 245.
Otte, C., Gold, S. M., Penninx, B. W., Pariante, C. M., Etkin, A., Fava, M., … & Schatzberg, A. F. (2016). Major depressive disorder. Nature reviews Disease primers, 2(1), 1-20.