Evaluating Client Profile 2 Using a Cognitive or RET Approach

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Evaluating Client Profile 2 Using a Cognitive or RET Approach

In this week's Discussion, you evaluated strengths and weaknesses of using a behavioral/cognitive approach with a client. In this Application, you are asked to evaluate a client using a specific behavioral/cognitive approach.

To prepare for this assignment:

  • Bring to mind what you have learned in the past two weeks about cognitive and RET theories and their respective theoretical approaches. Select one of these approaches on which to base this assignment.
  • Review Client Profile 2: Aaron in this week's Learning Resources, and think about how you might use your chosen approach with this client.
  • Review the course text readings and the media segments for this week, paying attention to how the experts use a specific theoretical orientation, or approach, to evaluate a client.

The assignment:

  • In a 1- to 3-page paper, critically evaluate the client in Client Profile 2 using either a cognitive or RET approach. Make sure you address:
    • The strengths and limitations to using this approach with this client
    • The specific cultural/gender/age issues that need to be attended to with this client
    • The ethical or legal issues that need to be attended to with this client
    • The overall therapeutic goal with this client
    • How you would proceed with this client:
      • How would you begin?
      • What would be the goals of therapy?
      • What specific strategies and/or techniques might you use?

Support your Application Assignment with specific references to all resources used in its preparation. You are asked to provide a reference list only for those resources not included in the Learning Resources for this course.

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Client Profile #2 Name: Aaron B. Gender: Male Ethnicity: Syrian-American Age: 17 Religion: Jewish Relationship Status: Single Description of Presenting Issue: Aaron was referred for counseling by his physician. Aaron is a star athlete on the high-school track team and attributes all his symptoms to his efforts to be the best possible runner that he can. He eats little, limiting his diet severely, and now weighs only 120 pounds, even though he is 5'10" tall. He believes that if he can lose another 10 pounds, he will be able to run even faster. Aaron keeps lists of everything he eats, weighing each food item and computing its fat content. In addition, he tracks his daily training by keeping a record of how many minutes he runs and how many steps he takes, counting his steps as he runs. Aaron also has many other lists that guide his life, including a list of every possession he owns and every person he talks to each day. If he forgets to include an item on one of his lists, he becomes very anxious and only calms down when he has recopied the list with the forgotten item at the top of the list. He tends to check his lists repeatedly, making sure that words are in alphabetical and size order. Despite his youth, he has few friends and activities other than his running, but is able to work delivering pizzas. Occupation History: Part-time pizza delivery Education History: Currently attends high school; maintains a B+ average Medical History: Aaron acknowledges that he has developed osteopenia (thinning of the bones) and also tells you that he has knee and shin pain. Family History: Aaron is an only child. His mother and father divorced when Aaron was 10 due to his father’s infidelity. Aaron lives primarily with his mother. She owns a successful interior design business and travels frequently. Aaron describes his mother as hard-working, with high standards and expectations. Aaron’s father works in the finance industry, was remarried four years ago, and has two children (ages 1 and 3) with his second wife. Alcohol / Substance Use: Aaron does not smoke, drink alcohol, or use illegal substances. He occasionally takes Vicodin (a painkiller) prescribed by his physician for his knee and shin pain. Page 1 of 1 Rc-PSYC 8722 – M. Geyer Page 1 Transcribed 12/28/2006 - by Cyber-Com Transcription Services [00:00:00] – A MATTHEW GEYER : Hi, this is Doctor Matthew Geyer. I'm going to be sharing with you a little bit about the case of Aaron B. and how I kind of look at it as a cognitive therapist or as a cognitive behavioral therapist. [00:00:15] – B MATTHEW GEYER : We’re going to discuss some of the, the issues related to doing therapy with Aaron from this perspective. So, let's first start off by just kind of reviewing a little bit about Aaron. [00:00:26] – Can MATTHEW GEYER : Aaron is 17 years old. He's a male. His ethnicity is listed as Syrian American. His religion is Jewish and his relationship status is single. [00:00:41] – D MATTHEW GEYER : Aaron was referred for counseling by his physician and he's a star athlete on the high school track team and attributes all of his symptoms to his efforts to be the best possible runner that he can. He eats little, limiting his diet severely, and now weighs only 120 pounds, even though he is 5 foot 10. [00:01:01] – E MATTHEW GEYER : He believes that if he can lose another 10 pounds, he'll be able to run even faster. Aaron keeps lists of everything he eats, watching each food item and computing its fat content. In addition, he tracks his daily training by keeping a record of how many minutes he runs and how many steps he takes, counting his steps as he runs. [00:01:22] – F MATTHEW GEYER : Aaron also has many other lists that guide his life, including a list of every possession he owns and every person he talks with each day. If he forgets to include an item on one of his lists, he becomes very anxious and only calms down when he is reoccupied, or, I'm sorry – he has recopied the list with the forgotten item at the top of the list. [00:01:45] – G MATTHEW GEYER : He tends to check his list repeatedly, making sure the words are in alphabetical order and sight order. Despite his youth, he has few friends and activities other than running. Rc-PSYC 8722 – M. Geyer Page 2 [00:01:59] – H MATTHEW GEYER : Right now, it looks like he's a part-time delivery boy for a pizza place. He's doing pretty good in school. He has developed some thinning of the bones which is possibly due to his poor nutrition. I'll also tell you he has some knee and shin pains. He's been referred by his-his family physician and I'm pretty certain that what he's wanting here is that, he wants us to kind of consult on what's going on with Aaron. [00:02:32] – I MATTHEW GEYER : The strengths of cognitive behavioral therapy are several for the case like Aaron. First is we can actually go in and focus on symptom relief for Aaron. We don't have to worry about going back and analyzing or getting into the deep meaning of any of his problems. We can focus in immediately on getting him some symptom relief. The other nice part about cognitive behavioral therapy is it's pretty flexible and there's a built-in flexibility into any cognitive behavioral intervention to-to suit the client's needs. [00:03:10] – J The other thing I like about the cognitive behavioral orientation is we can pull in the use of family. We can pull in Aaron's family to help us out with the change process and family members can be such powerful allies during this course of care. [00:03:27] – K MATTHEW GEYER : Some of the limitations of cognitive behavioral therapy? Well, it's not designed for a whole bunch of depth of selfunderstanding. We're not going to start exploring the inner-sanctum of Aaron's psyche. It's designed primarily for the symptom relief and for behavioral change. Now, they'll-they'll be a little, a little bit you can do with some exploration of the core beliefs, but it's not going to be anything like the traditional psychoanalysis. [00:03:56] – L MATTHEW GEYER : The other limitation? Well, cognitive behavioral interventions assume that the client is motivated for change. Now, motivation is not exactly very well defined here and sometimes that motivation may not be what we think it is, but, hey, the client may be and he may have or she may have her own ideas about change needs to look like. So, we need to keep that open. So, that-that is kind of a limitation for us and you've got to kind watch that. [00:04:23] – M Rc-PSYC 8722 – M. Geyer Page 3 MATTHEW GEYER : Well, there are some specific cultural, gender and age issues that we need to address with Aaron before even really getting into any sort of therapy. One of which is the cultural issue. Now, Aaron is listed as being a Syrian American and he's also listed as being Jewish. And, these, these two things can have some cultural impact, but we need to find out how much Aaron has invested into his Syrian culture or his Jewish culture. He may not even identify himself as being primarily Syrian, as primarily Jewish. We don't know. [00:04:59] – N MATTHEW GEYER : We also need to assess during the first several sessions how much his culture really does impact who he is, because there are a lot of folks out there – their belief systems, they don't really understand where they came from and the impact of that family culture can definitely still be with somebody who doesn't necessarily claim it. So, we're going to need to take a look at that. [00:05:24] – O MATTHEW GEYER : Gender issues. Well, there are some possible issues here related to male body image. We're not really sure yet going in but we're going to have maybe, oh, we're going to have to explore it, yeah. We're going to need to in the future to evaluate how Aaron kind of sees his role as being a man and some of those beliefs that are impacted from being labeled as a quote man and how he views himself. [00:05:48] – P MATTHEW GEYER : Age issues, well, we know that Aaron is preparing for high school graduation and adulthood. He's, you know, probably experiencing some of these same developmental issues that are related to adolescence and we're probably going to need to evaluate those. For instance, it's known that adolescents tend to feel pretty invulnerable. They feel like they can pretty much do anything, so he may not realize the impact of his behavior on his body and the longterm consequences associated with it. It may just be one thing that we need to kind of take a look at. [00:06:22] – Q MATTHEW GEYER : That brings us up to the legal and ethical issues that need to be attended to with Aaron. Well, going back to the whole age issue, well, confidentiality is a big issue at this point because, see, Aaron is 17, which makes him not quite yet an adult. So, we're going to need to really discuss what confidentiality means with Aaron and also with his parents because his parents actually hold the rights at this point. We're going to need to discuss the Rc-PSYC 8722 – M. Geyer Page 4 ... parent with parents about the privacy and what privacy means in the course of care. We're also going to need to explain to Aaron that in no circumstances would we-we keep our mouth shut about things like hurting yourself or hurting somebody else, or if you've been the victim of an assault, you know, as a kid. You know, we're going to have to report those things. Abusive things need to be reported. [00:07:12] – R MATTHEW GEYER : We're going to have to do that with the parents in the room and hopefully the parents would say – Hey, you know what, we're cool with some privacy here as long as, you know, these-these lines aren't crossed. And, we can, we can probably talk about those with the parents. If his parents do not grant Aaron the ability to have some stuff kind of private, that could be a real problem with the whole course of care, because I'm not sure how much Aaron, wouldwould trust the therapist if privacy wasn't kind of granted. [00:07:39] – S MATTHEW GEYER : We also need to discuss with the parents and with Aaron what information is going to be referred back or revealed back to the referring physician. What information does Aaron feel comfortable with sharing and what do the parents want shared. So, we're going to have to pretty much discuss those things and kind of explain how that's all going to happen. [00:07:59] – T MATTHEW GEYER : Of course, in dealing with the releases of information or where we're going to release information back to the referral source, we're going to have to do all the necessary forms to allow us to actually give that information back. The other thing that I've always found in my practice is I always use a confidentiality form where I write out absolutely everything and have all parties involved sign it. It's kind of like a contract. Kind of a good practice that I think kind of helps people understand what's going to happen. [00:08:31] – U MATTHEW GEYER : So, let's kind of move on now to the over ... the overall therapeutic goals with Aaron. The first thing I want to really stress is we're going to have to really kind of find out what Aaron wants. You know, and the goals are going to depend on what Aaron really wants and believes his need for care is. Aaron may have the initial goal for being something like, you know, I need to be a better athlete and this would entail getting everyone off my back. You know, and those kind of things can be really valuable. And, if you have a client who comes in like that and gives you that – hey, Rc-PSYC 8722 – M. Geyer Page 5 that's great information. [00:09:09] – V MATTHEW GEYER : So, you know, we could take a look at some of the things that keep him from being a better athlete like all those doctor's appointments and the parental attention and coming here to see this therapist. Wow. Those things distract him from his time practicing. So, that might be his actual goal for care is to get everybody off his back to free up more time, to go down and practice. [00:09:32] – W MATTHEW GEYER : I want to stress that we must remain flexible with Aaron. The goals of ongoing care might need adjusting and adjusting and readjusting and so on and so forth. We really don't know at this earlier stage, at this early stage of the whole care process what's really going on with Aaron. So, we need to remain flexible. [00:09:50] – X MATTHEW GEYER : We also as therapists need to remain comfortable with that change. Sometimes the goals that we come up with as therapists just aren't the goals for the client. We need to be comfortable with that. [00:10:00] – Y MATTHEW GEYER : Now, there is another issue I have and that's his drug use or his substance abuse. We're going to have to kind of take a look and see where he, where he's at with this. If he meets the criteria for chemical dependence or substance abuse, we're probably going to need to evaluate the need for – well, substance abuse treatment. Now, if you're comfortable with providing that care yourself and you have adequate supervision too, of course, you can proceed. But, you also may need to refer on or you may need to get the physician involved with – with looking at some of the drugs that are being used. [00:10:40] – Z MATTHEW GEYER : So, we're going to have to take a look at that stuff and maybe get Aaron involved with it too. It might be kind of touchy there, so, probably want to proceed with a little bit of caution. [00:10:53] – AA MATTHEW GEYER : One of the neat things I think that comes up with therapeutic goals with clients in the cognitive behavioral realm is that what's kind of cool about the relationship is that the client Rc-PSYC 8722 – M. Geyer Page 6 comes to us as being, and is recognized as being the expert on their lives. And, they're coming to us the expert in psychology or selfchange. So, it's almost like a meeting of two experts and if you kind of look at it that way, it might make sense a little bit more when you start taking a look about the relationship in cognitive behavioral care, and this definitely would impact the goals because as a cognitive behavioral therapist and with any kind of therapist, really, you need to have a respect for your client and your client's wishes. And, sometimes that means letting a person be wrong, which is sometimes tough to do. [00:11:45] – BB MATTHEW GEYER : So, how would I proceed with this client? Well, at first, I’m going to kind of stress to myself and also probably to Aaron and his parents during the earlier stages here, that we're going to keep evaluating how he is doing. It's going to be an ongoing evaluation throughout the process. The initial diagnosis or proposed process might need to be reevaluated and it might need to be changed throughout the whole course of care. [00:12:10] – CC MATTHEW GEYER : During the first session, I'm definitely going to do a complete mental status and I'm going to get a really good personal and family history. I also really want to kind of to hone in a little bit on the physical history of Aaron's development, where he got involved with his athletic talents and what those mean to him – kind of tell me a little bit about where that came from. [00:12:32] – DD MATTHEW GEYER : I'm also going to need to figure out what is motivating Aaron to attend this session. Is he really invested in the change process? Does he believe he even has a problem? And, what are the consequences of his behaviors if not changed? And, more importantly, maybe, and something that maybe we forget is what are the benefits? What-what's there that's reinforcing this behavior for Aaron? And, we're probably going to want to find this out earlier on in the whole care process. May not be in the first session but definitely in the first couple we're going to want to find out what those benefits of the behaviors are. [00:13:06] – EE MATTHEW GEYER : Need to really focus on something that a lot of folks don't understand is important to the cognitive therapist and that is the relationship. Cognitive therapists and cognitive behavioral therapists realize that the trust is the actual foundation of any therapeutic relationship and without that trust, that's not Rc-PSYC 8722 – M. Geyer Page 7 really going to be a good therapeutic experience for our clients. [00:13:34] – FF MATTHEW GEYER : We're also going to need to communicate a belief in Aaron, that Aaron has the ability to-to engage himself in the change process and improve his life. We're going to, we're going to want to kind of really emphasize that with Aaron because giving a person the ability to change and know that somebody else believes that they can change is kind of a powerful experience. [00:13:56] – GG MATTHEW GEYER : Also, this earlier session, I'm going to probably try to elicit the assistance of the family. I want to know if the parents are really going to be allies in this process or not. If they are good allies, and I'm assuming they would be, I might eventually have to ask them to-to help me with setting up some contingencies for Aaron at home. For instance, if he doesn't do what he's supposed to do in the – in the whole care process, let's say he blows off a therapy – a therapy session. Well, maybe his parents could help out by saying well, if you're not going to go to therapy, then you don't get to go to your sporting events. Those kind of, those kind of things, the parents can really help out with and they really can be strong allies, so you might want to elicit them early. [00:14:42] – HH MATTHEW GEYER : What would the goals be of therapy? Well, at first, again we're going to stress this is going to be based on what Aaron wants and see how we can work that. But, we're going to focus on symptom relief. We're going to really want to look at reducing, hopefully some of the intrusiveness of the obsessions and the compulsions and hopefully get Aaron to the point where he is going to be able to resume some of his healthier habits and we're going to do these incrementally. We're not going to bombard him all at once – that's bad form and usually just overwhelms a person. [00:15:12] – II MATTHEW GEYER : We're going to need to be flexible. If the immediate issues or problems successfully resolve, we may want to start exploring some issues related to the development and reinforcement of his core beliefs and that can be a powerful experience, too. And, now, that's not going to happen in the earlier phases of care. That will be probably be at least a couple months down the path at least before we can really start looking at core beliefs. But, it would probably be worthwhile with Aaron, especially with him entering into adulthood soon. Rc-PSYC 8722 – M. Geyer Page 8 [00:15:39] – JJ MATTHEW GEYER : So, what specific strategies or techniques might I use as a cognitive behavioral therapist? Well, I'm going to want to first work towards symptom relief and getting Aaron involved in the treatment process. I'm going to need to evaluate his interests and his purposes for being seen and attempt to get him motivated. Might want to take a look a little bit also at doing some motivational interviewing. That's a pretty powerful tool to get people invested who may not exactly be where we want them to be in the motivation spectrum. So, if you're interested in-in any sort of ... human services work, you know, picking up a book on motivational interviewing is a – is a must. But, that's a side note. [00:16:19] – KK MATTHEW GEYER : Another thing I'm going to do with Aaron is I'm going to offer him some psycho-educational information on self-care as it relates to athletic performance. Stuff is going to be coming off the Internet, anything I might have around the office that I can kind of key him in on – try to use that, too. [00:16:36] – LL MATTHEW GEYER : I'm going to continue to evaluate and reevaluate his progress and his treatment goals and that's going to be throughout the course of care. We're going to need to evaluate the inclusion or the need for inclusion of the family in Aaron's treatment. If Aaron's health deteriorates, that might be one of those things that we just are going to pull the family in and want to take a look at some good contingency, some behavioral stuff, basically. You know, if Aaron doesn't start getting better, then he starts losing some of the things that he likes and building in ways for him to get that back. Again, that's only if his health starts to deteriorate. Hate to go route but, you know, if a person's health is deteriorating and they're not going to be – they're not going to be too good psychologically in the future, either. [00:17:21] – MM MATTHEW GEYER : We're going to really want Aaron involved in some age-appropriate social activities and I'm probably going to use some homework to get him involved with that. Going to also use some homework to get him involved just with doing some other – some other stuff. Probably look at some, some scaling questions and maybe some journaling, and those kind of homework assignments to help him out. But, I'd really like to use homework to get him involved with some age-appropriate peer groups. [00:17:47] – NN Rc-PSYC 8722 – M. Geyer Page 9 MATTHEW GEYER : Techniques – going to use the self-rating scale to assist with progress monitoring. It's going to allow Aaron and myself also to see, you know, the benefits of improved self-care. May use, I'm probably going to say will use, the rational emotive behavior therapy format by Albert Ellis. This ABC model is really user friendly and it seems to, well, it seems to be well-received by many, many folks. So, I'm going to kind of teach him that, teach him how it works and hopefully that will facilitate the change process, too. [00:18:18] – OO MATTHEW GEYER : May also use some thought stopping techniques to assist him with the reduction of the obsessive thinking. I've used a rubber band on the wrist before. Whenever a client had the obsessive thought, he'd snap or she'd snap the-the wrist and kind of hopefully break him out of the cycle. I've also used a lot of journaling to help out with some of the obsessive thinking in the past. That helps me to kind of see what's going on also with the client, but that's a – a whole other discussion we'd have to have. [00:18:46] – PP MATTHEW GEYER : Again, I'm going to try to use the family to assist with the reduction of the symptoms and possibly for assisting with longterm change plans. And, if you're, you're hearing a theme there with me getting the family involved, well, it's one of my biases. I think families need to be involved with kid's care. [00:19:01] – QQ MATTHEW GEYER : And, of course, I'm going to use homework with feedback for each session. And, hopefully, give Aaron some positive reinforcement for completing that homework. [00:19:11] – RR MATTHEW GEYER : So, at this point, I'm pretty comfortable withwith the discussion so far and this is how I'm going to kind of view Aaron from a cognitive behavioral standpoint. Of course, these things will change. I've kind of stressed that through. There's going to have to be some flexibility. Thanks for listening and take care.
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Running Head: EVALUATING CLIENT’S PROFILE

Evaluating Client’s Profile
Student’s Name
Professor’s Name
Course Title
Date

1

EVALUATING CLIENT’S PROFILE

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Evaluating Client Profile 2 Using a Cognitive or RET Approach

The strengths and limitations to using this approach with this client

This Cognitive approach has several strengths. This approach is quite flexible and easy to
combine with a medication plan therefore making psychotherapy more effective. This flexibility
makes it more suitable to client’s needs. Its combination with the behavioral approach makes it
more effective and useful. It can be widely used to correct a person’s behavior for the better. It
also allows the individuals to be more involved in the process. The approach makes it possible to
highlight the clients thought process. It can help determine why Aaron does the things he does
which in a way hurts him. This way, it reveals how Aaron interprets and responds to the various
issues or stimuli he faces. This is unlike other approaches which ignore this factor. By
understanding the thought process it becomes easier to solve the problem (Beck, Davis &
Freeman, 2015).
The approach however ignores some ...


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