Cognitive Behaviour Therapy in Clinical Practice - Term Paper Example

Cognitive Behaviour Therapy in Clinical Practice Introduction and overview In the first half of the study, the researcher conducted an audio-taped interview with a patient suffering from work related stress, which has eventually made him depressed. Through the use of open communication, probing questions, empathic, reflective and analytical reasoning the researcher was able to gather information from the patient about his belief system and his lifestyle. It has been found that record keeping is an essential part of understanding the medical needs of the patient. Therefore, the researcher conducted an audio-taped interview with the patient and later reflected on the conversation that he and the patient had to find out whether the patient demonstrated cognitive distortions and irrational beliefs. The researcher used various listening and reflective skills to find out relevant information from the patient. This helped the researcher to identify whether the patient suffered from cognitive distortions and irrational beliefs or not. Importance of record-keeping Clinical records are considered to be one of the basic and important clinical tools that provide a permanent account of a patient’s medical history as well as the caregivers’ reasons for deciding on a particular diagnosis. Although, clinical records are deemed important to initiate efficient communication and provide good health care facilities to the patient, it has often been found that clinical records are not maintained properly and not available easily. The quality of clinical records has often failed to meet the requirements of various health agencies and even court proceedings. Further, these records are often lacking in information and even critical data such as advices from health agencies and medical councils are provided very briefly. Thus, in order to attend to the patient’s safety and to provide him or her with good health care services it is imperative to create a comprehensive clinical record (Pullen & Loudon, 2006). The clinical record of a patient is used in the consultation almost always. These records help in providing an accurate and clear picture of the treatment that the patient has received so far. Further, it helps in giving the best possible medical care in the future as well, taking care of the past medical history. These records also help physicians to consult other physicians and healthcare professionals. For a psychiatrist, clinical records are the most important piece of evidence recording the progress of the patient. It may also help the psychiatrist in case of litigations. In court cases, the decisions and assessments made by the doctor as recorded in the clinical records of the patient is considered to be a major defense tool. However, the most important function of clinical record is to provide the doctors a tool to communicate with each other about a patient’s progress and treatment (Mann & Williams, 2003). In mental health treatment, it is imperative to keep complete records of the patient’s history to ensure good communication between all the agencies and doctors involved in the treatment of the patient (Royal College of Psychiatrists, 2004). Further, due to the growing demand in the mental health arena as well as increase in litigations involving psychological cases, it is important to maintain electronic data as well. Electronic records are easier to maintain and faster to access. It also provides real time information which can help in providing good communication between the patient and the doctors (Lewis, 2002). As good clinical record keeping is important to provide good health care services to the patient, the researcher took utmost care to record the interview with the patient. As the researcher was able to record the entire conversation with the patient, he was able to reflect back on the interview to find out whether the patient demonstrated cognitive distortions and irrational beliefs or not (Lewis, 2002). Using Micro Counselling Skills In order to understand the therapeutic needs of the patient, it is important to develop a few micro-counselling skills such as listening and reflective skills. These skills also helped the researcher to identify cognitive distortion and irrational belief in the patient (Egan, 1998). Some of the micro-counselling skills used by the researcher for this study are explained below with examples: Reflection of Feeling: This means that the counselor is attentive enough to understand the feelings expressed by the patient and repeat it to the patient in a similar manner or rephrase it to make the patient believe that the psychiatrics is able to identify with the patient (Senediak & Parham, 1995). For instance, in this case study, the patient is suffering from depression due to work related stress and kept looking wary and overwhelmed whenever office or work was mentioned. When the researcher asked the patient whether he is feeling overwhelmed due to the past week’s activities in the office, the patient answered in affirmation. This confirmed that the patient have work-related stress. Reflection of Content: In this case, the counselor listens carefully to the speech of the patient and repeats the essential facts either verbatim or after rephrasing them to establish a hypothesis or confirm a doubt. Reflection of content involves understanding the statements and facts presented by the patient (Senediak & Parham, 1995). For instance, in this case study, the patient describes his entire week’s office schedule and kept cribbing how he never had a moment’s peace or rest. Although, he did not use the word stressful, the researcher was able to deduce the fact that the patient was indeed in stress. Therefore, in order to establish his hypothesis, the researcher simply confirmed the patient’s week long work related complaints by telling him that he is under a lot of stress and had a stressful week. Questions: Although, patients are often questioned during a counseling session, they are never intimidating. Instead, questions are asked only to help the patient to explore or develop insights (Senediak & Parham, 1995). For instance, in this study, the researcher asked a few leading questions such as whether Monday mornings stress out the patient the most or not. The patient grunted at the question and said that he dreads Mondays and consider it to be worst day of the week. Summarising: This process includes understanding the feelings and words of the patient in its totality and rephrasing the entire session and giving a brief about the session to the patient. Summarising not only help in encouraging the patient to give more details about his or her condition but also establishes trust between the patient and the counselor as the counselor is able make the patient believe the he or she understand the patient’s problem fully (Senediak & Parham, 1995). In this case, the researcher told the patient that due to work related stress the patient has not been able to comprehend his feelings properly and is feeling depressed. As the researcher has been able to do a proper diagnosis, the patient showed confidence in the counselor and agreed to come for another session next week. He also agreed to keep a diary detailing his day-to-day activities, which may help the counselor to understand the triggers for his depression attacks and irrational behavior. Identification of Cognitive Distortions Cognitive distortions are often called erroneous reasoning that leads to the occurrence of certain mental problems (Kaplan, Sallis, & Patterson, 1993). In traditional psychology, cognitive distortions are associated with 12 forms of irrational reasoning, which includes overtly generalising events or statements, emotional reasoning, jumping to conclusions even before hearing the entire statement, statements that includes should or must, abstracting selective information, not believing in positive information, minimising or maximising information, aggravating the situation to the limit of catastrophe, taking every event personally, labeling the events or people etc. Cognitive therapy is therefore based on identifying these cognitive distortions in the day-to-day thinking of the patient. Further, the therapy involves replacing them with reasons and positive behaviour (Balevre, 2001). In this case study, the researcher found that the patient suffered from various cognitive distortions. Through the in-depth interview conducted with the patient, the researcher found that patient is prone to jumping onto conclusions without even listening to the entire event. Further, he has the tendency to behave in a negative manner and aggravate the situations to the limit of catastrophe. He is also very opinionated and takes most of the things very personally. The researcher inferred that the patient is very sensitive about his image and often comes across to be arrogant and domineering in front of his colleagues. However, on probing further, it was found that the patient was very insecure and feared loosing his identity or command on his people. He wanted to be domineering to become successful, something his father always stressed to him, which became a part of his belief system. Irrational Belief Systems It has been found that our perceptions about the world and how we act is based on our belief system. This system starts developing from our early childhood and we keep adding to it our own experiences as well as influences of others. However, developing this belief system may not be always rational as we constantly receive both logical as well as illogical suggestions in our daily lives (Corey, 2009). The researcher found that in this case as well, the patient was suffering from an irrational belief system. He had developed certain beliefs from his childhood, which has become a part of his life, even when some of them are illogical. For instance, right from his childhood he believes that in order to become successful one has to be domineering. However, it was tough to detect these irrational beliefs as these beliefs are mostly internalised by the patient and the patient rarely share them with anybody. Thus, the researcher used the tools of detecting and debating to find out the irrational beliefs in the patient. Detecting: In the belief system, most people have very rigid limits. It has been seen that irrational beliefs are often accompanied by phrases such as should, must and ought to (Ankrom, 2009). When the researcher probed the patient about his ambitions, the patient promptly said that he needs to become successful. The patient also said that he should never show any signs of weakness to other people, otherwise they might think lowly of him. The researcher gathered that such statements are made due to the irrational belief system developed by the patient over the ages. Debating: Once the beliefs are identified, it is imperative to debate about them to find out whether they are logical or not (Ankrom, 2009). The researcher underlined various beliefs of the patient and debated with him to find out the source of the belief and make the patient understand that these beliefs are irrational. For instance, the patient firmly believed that one has to be successful in his career to show that he is ambitious. Further, he also believed that his colleagues should also think of him as a strong man and should never find about his weaknesses. On probing further, the researcher found that these beliefs were instilled deep within the patient since his childhood. He had often heard his father, a very domineering man, talk about his success. The father rated himself to be very successful and goaded his son to follow his footsteps. Further, he always emphasised on the fact that men should always be strong and should never show their weaker side to their friends or colleagues. The patient always thought of these beliefs as sacrosanct and over-worked himself to become successful. Further, he never trusted anybody and did not share his stress or problems with his colleagues. This resulted in his depression and stress. After identifying the irrational belief system in the patient, the researcher helped him to accept these beliefs as impractical. He asked the patient to accept his abilities and define his own limitations. He asked the patient to follow his own way of thinking rather than being influence by others. The patient agreed to reflect back on his belief system as it was a big revelation to him to understand that his belief system was irrational and a major cause for his problems. References: Ankrom, Sheryl (2009). Irrational Belief Systems: Are Irrational Beliefs Keeping Panic Attacks and Agoraphobia in Your Life? About.com. Retrieved April 9, 2010 from http://panicdisorder.about.com/od/understandingpanic/a/IrrationalBelie.htm. Corey, Gerald (2009). Theory and practice of counseling and psychotherapy. Belmont, CA: Thomson Brooks/Cole. Egan, G. (1998). The Skilled Helper: Sixth Edition. Pacific Grove: Brooks/Cole. Kaplan, R.M., Sallis, J.F.Jr., & Pattersn, T.L. (1993). Health and human behaviour. New York: McGraw-Hill, Inc. Lewis, A. (2002). Health informatics: information and communication. Advances in Psychiatric Treatment, 8, 165–171. Mann, R. & Williams, J. (2003). Standards in medical record keeping. Clinical Medicine, 3, 329–332. Pullen, Ian & Loudon, John (2006). Improving standards in clinical record-keeping. Advances in Psychiatric Treatment, 12, 280-286. Royal College of Psychiatrists (2004). Good Psychiatric Practice (2nd edn) (Council Report CR125). London: Royal College of Psychiatrists. Senediak, C. & Parham, J. (1995). Basic Assessment and Counselling Skills. Sydney: New South Wales Institute of Psychiatry. Read More