Case Conceptualization (Michael)

Case Conceptualization (Michael)

Cognitive Therapies

These theories developed independently by Albert Ellis and Aaron Beck are centered on the idea that people’s beliefs and about occurrences, people, and situations can be made to have a profound effect on their feelings and actions (Professor’s last name, 2006). Individuals might become obsessed with situations and worry themselves unnecessarily about a given scenario because of maladaptive or errant belief systems. These belief systems have often been founded on experiences of the past, and may include systems and structures of a particular society or assumptions that have been (tacitly or openly) acknowledged within a family setting. Conventions such as these often have the effect of limiting or somehow regulating the actions and/or desires of individual—often in an irrational way. The dominant term used by Beck to describe the resulting belief system or mindset is “maladaptive cognition,” while Ellis uses the term “irrational belief” (2006).

Each of these cognitive theorists has developed a therapeutic model that seeks to remove or alleviate the burdens of these beliefs. Rational Emotive Behavior Therapy (REBT), developed by Ellis, includes the ABC Model of Human Functioning/emotional disturbance. This model sees the problem as having an “activating event,” “beliefs” via which the events are processed, and finally a “consequence”—which proves to be unfavourable if beliefs are maladaptive. The intervention is centered on the identification and confrontation of the individual’s belief systems by the therapist. Beck’s reference to these beliefs is similar, though the interpretation of them is that they are often too absolute. Efforts made are therefore to slacken or lessen their effects. Intervention includes depression and anxiety inventories and confrontation treatments (Professor’s last name, 2006).

Conceptualization of Michael’s Problem

Having grown up in a nuclear family setting in the Midwest, a region usually considered conservative, Michael has been surrounded by influences that have affected his beliefs. As a homosexual, he is aware that such a lifestyle is not generally accepted within the communities to which he has been exposed. Because Michael is profoundly affected by the atmosphere of his surroundings and is able to sense the desires and moods of people, it is quite likely that that these conditions have contributed to his discomfort within his surroundings. Beck’s ideas of maladaptive cognitions might be brought to bear on Michael’s case, because it appears that his ability to sense people’s unspoken needs has often translated into a desire to fulfill them in order to create a favorable atmosphere. In addition to this, Michael has had the opportunity to live both the alternatives that his life has presented him: he has been married as well as openly homosexual. In each lifestyle he has found himself unhappy. Considering the profound effect that atmosphere has on Michael, it is likely that his sexual desires have in both cases come in conflict with his desire for an environment in which the atmosphere is one of acceptance.

Two scenarios (activating events) have existed in Michael’s life. He has tried both repressing his feelings and coming out as a homosexual. In both cases has felt uncomfortable. A probable reason for his discomfort in his marriage is that it failed to fulfill his sexual needs. One possible irrational belief he held was based on the fact that his marriage would have provided him and his family with a feeling of security within their conservative community—a feeling he desired to provide despite the fact that he felt little guilt as a homosexual. Another probable irrational belief is based on ideas behind Ellis’ Rational Emotive Behavior Therapy (REBT), which states that individuals have constructed belief systems founded on experiences of the past (Professor’s last name, 2006). According to this, Michael’s only firsthand past experience had been within a nuclear family, and as a virgin he had had no experience (with women or men). He therefore gravitated to the kind of relationship (heterosexual) with which he had had some experience. Yet this proved to be the result of an irrational belief that heterosexuality was appropriate for him because it had been for his parents and other elders in his community. He probably also felt that deviation from the norm would have proven disastrous. These beliefs were proven to be irrational through his inability to find fulfillment in his marriage.

Intervention

For whichever of the reasons described above, the nuclear family he created did prove itself unable satisfy him. In light of this fact, Michael’s current discomfort with his “outed” lifestyle demonstrates a further maladaptive cognition or irrational belief that the general disapproval focused toward homosexuality should have an actual bearing on his life. Though his parents might not disapprove, the conditions under which they are viewed by other members of society creates a general atmosphere of strain which likely affects Michael’s ability to relax in his new situation. Michael’s cognitive therapy should therefore involve his deep consideration of the true effects of these conditions that he so fears.

Michael’s thought processes in his first activating event (decision to marry) appeared to be the following: “If I don’t get married and choose a homosexual lifestyle, my family and I will come under ridicule by the conservative members of the community. This will bring an inordinate amount of discomfort to our lives and make it impossible to have a normal life.” However, according to the REBT method, Michael might be made to consider the truest and most rational effects of those actions and thereby effecting a disputation of the irrational belief (Professor’s last name, 2006)s. It would be necessary for Michael to learn how to accept himself unconditionally and not try to prove himself and his worth to others—which is virtually impossible. Therefore, using the ABC’s of the REBT method (2006), Michael would be asked the following questions:

·         What evidence exists that choosing homosexuality would incur the ridicule of the community?

·         If this ridicule should come, how can this make you and your family uncomfortable unless you choose to pay attention to it?

·         What evidence do you have that choosing a heterosexual lifestyle will make you less uncomfortable

·         How do you most desire to live?

Intervention would involve both one-on-one therapy with the cognitive therapy professional, but would go further to include his family and provide him with homework and group-work as a means of extending the scope of the therapy.

            In dealing with Michael’s current discomfort with his homosexual life, a cognitive therapy (CT) treatment would involve the administration of the Beck’s Anxiety and Depression Inventories (Professor’s last name, 2006). This would be used at different intervals throughout the treatment in order to gauge his state at baseline and compare it with future states as the treatment progresses. He would be presented with challenging questions such as

·         What evidence exists that people frown on your lifestyle?

·         How can we view the situation differently?

·         How would your life be different if you conformed to what others would approve of?

·         When you did conform to “societal beliefs” or your own irrational beliefs, didn’t it prove detrimental to your happiness?

The treatment would also involve educating him about how the arrangement of the ideas and beliefs learnt in the past can have a bearing on how he processes ideas in the present. When cognizant of the importance of schema in his decision making and though processes, he is expected to be induced to alter the processes by asking himself the hard questions that challenge maladaptive cognitions and irrational beliefs.

Outcome

The desired outcome of these intervention strategies would be that Michael would prove less dependent on others’ states of mind for his comfort. The moods of others would less dictate the overall atmosphere of a situation and, because he accepts himself unconditionally, he would become more comfortable in situations that he chooses for himself. He would also construct a mindset that critically examines his beliefs and assumptions about situations in which he finds himself. He would thoroughly consider results of situations he once thought devastating and rationalize whether the consequences are really as bad as he once believed. He would also routinely consider alternatives to his beliefs in order to emphasize that he is not bound to any one outcome in a given situation.

Reaction

The idea that belief systems have the ability to profoundly affect behavior resonates with me because I have had experience with persons (and even myself) whose ideas about the effects of certain desired actions have prevented them from doing something that might have made them happy. To me, it is almost impossible to grow up without gaining some restrictive schema that causes people to rule against alternatives that they would rather take. I prefer the term Ellis uses to describe this schema (irrational belief) because it identifies how a thorough and critical examination or prevailing beliefs might actually show them to have little or no foundation. Furthermore, the notion of challenging these beliefs makes sense, as it will reveal the ways in which persons’ minds have been narrowed to see only one of the many possible consequences of their actions.

The homework and group-work components of REBT are also a method that I think would be very effective. Therapy usually takes place for only a short period of the day—perhaps once a week. Homework allows the patient to extend that period of therapy over a much longer frame—an action that appears to magnify the effect of the treatment as well as to make it more consistent. Group-work allows the enlisting of families and friends in support of the individual’s commitment to challenging belief systems that are faulty. This constant support acts as a guide to the individual, and he or she will have the motivation of others to draw on, should his or hers at some point fail.

Reference

Professor’s Surname, Initial. (2006). Cognitive Therapies Lecture Notes [Handout]. Washington,           DC: George Washington University. Name of Class, eg. PSY 201



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