The Philosophy of Cognitive-Behavioural Therapy - Case Study Example

? Role Play Write Intake Report *Confidential* Mrs. Stephanie Miller DOB: 08-15-1976 SSN: 123-45-6789 AGE: 37 INTAKE: 7/11/2008 SEX: Female INTERVIEWER: Janet Jung DATE OF REPORT: 7/15/2008 Identifying Information/ Reason for Referral Stephanie Miller (Mrs. Miller) is a 40-years old Caucasian female who has been married and have two children of 4 and 9 years old. She is currently working as a provisional staff in a private firm. The increasing workload along with mounting responsibility of her two children regarding their education and daily expenses, have led her to face traumatic condition. She had reported that her peers have asked her to obtain treatment as she works for a long time and often behaves roughly with the other people. Mrs. Miller described that she often feels herself in traumatic disorder syndrome that turns her to remain in seclusion and breach relationship with the neighbors and other people. Significant economic crisis, poor demographic condition as well as continuous conflicts in both family and personal life are the primary causes of Mrs. Miller that eventually made her to suffer from deep depression and anxious behavior. Moreover, breaching of relationship with her husband has also caused her to fall in depressions that had further led towards formation of critical challenges in her life. The social influences as well as contradictive voices of the people can also be considered as major factors that had driven Mrs. Miller to face anxiety and worthlessness feelings in her life. Behavioral Observations During the interview process, a messy dress-up was appeared with rough and untidy hair which merely described about her traumatic position. Moreover, she was also appeared to be feeling down and her stiffness was clearly observed. Her eye contact gesture clearly revealed that she is expecting to get rid of her stressful life. Her rate of speech was also indicating severe condition as she has heavy burden with numerous worries related with the maintenance of her two sons and their education. The client has also reported that she generally maintains a well-bred behavior with every individual including the professional staffs, family members and other individuals within the community. However, Mrs. Miller further revealed that she often feels anxious and uninterested to involve with people due to the increasing workload along with budding responsibility to support her children. The separation with her husband has further recognized as one of the primary causes of frequently changing behavioral aspects of Mrs. Miller. In this context, the client has reported that she usually get aggressive and uncomfortable with the events or activities that are performed around her. Moreover, the client often tends to involve in aggressiveness and frequently feels inadequate and excessive guilt due to her present condition. The intervention of aggressiveness also defines that the client is also having Social Anxiety Disorder syndrome that frequently changed her behavioral skills. Due to depression and mental illness, Mrs. Miller had taken various types of medicines to sleep properly. Mrs. Miller does not presently having any types of medications, however often feels to obtain effective treatment process which can enable to reduce her traumatic syndromes. History of Present Illness Mrs. Miller reported that she started feeling gradually “down” around seven months ago. She initially had extensive difficulty regarding her hypertension after getting divorced by her husband. The burden of family along with increasing workload accompanied with fear to lose business client had led her to sleep a minimum hours (4hr) during night. Mrs. Miller also reported that she often consumes alcohol to have proper sleep and always worries whether she will be able to bear the responsibility of her two sons along with their education and other expenses. Mrs. Miller often feels anxious and experience difficulties to sleep at night. During the last few months, she has also experienced weight loss (almost 12lbs). During the further questioning regarding her drinking habits, Mrs. Miller reported that she started drinking approximately 1 year ago when her husband threatened to divorce her and started living with other woman. Through the process of questioning about her previous life, Mrs. Miller reported that she used to spend a happy life with her family (husband with two sons) and never feel anxious or depression in her life. At the starting face of her depression and anxious behavior, Mrs. Miller reported that she was unable to recognize any specific stress that might have triggered her feelings of depression. In addition, the client has also clearly mentioned about her feelings of worry. In this context, she reported that she often feels worthlessness due to her inadequate capability to meet the needs and desires of her children and provide them adequate facilities. Past Treatment History According to the observation of the patient, it has been identified that Mrs. Miller has never tried to receive any mental health or psychological treatment process prior to visit today. Prior to her visit Mrs. Miller reported that she has consulted her depressions and or reported her anxious feelings with any other individuals. Mrs. Miller had stated that she had never participated in any types of psychology development practice to reduce her depressions. According to the observation, it has also been identified that Mrs. Miller is not aware of any psychological disorder syndrome history in her family members. The client also reported that she had never visited to any psychiatrist to examine her changing behavioral and cognitive aspects. Moreover, Mrs. Miller reported that she was unable to recognize the cognitive and behavioral changes due to increasing workload and rising responsibility of her two growing children. Mrs. Miller reported that she used to consume alcohol or medication process to overcome her sleeping problem. . Relevant Medical History The client reported that she was only hospitalized during her pregnancies. It has also been recognized that Mrs. Miller was likely to have sleeping peels and other medication process to sleep properly after coming late from the job. Moreover, Mrs. Miller was habituated to consume a feasible amount of alcohol before sleep at night. Nonetheless, she denies intake of any types of medication process currently. According to the information of the client, it has been identified that she often feels disturbed and whenever she tries not to have medicine or alcohol before her sleep during the night. In order to reduce the symptom of depression and anxious behavior, Mrs. Miller had also reported that she visited twice in the last 6 months to a local physician who has prescribed her medication that helped her to sleep at night. The physicians had suggested her to visit psychiatrist and diagnose her problems. However, she had ignored the advice and continued with the medicines prescribed by the physician. Development History Mrs. Miller reported a usual development of her physical and behavioral aspects and stated a normal accomplishment of her cognitive and social goals. In her previous life, she used to highly involve in various social events during her school and graduation period. In relation to the social, cognitive and behavioral development, Mrs. Miller reported that she is quite busy than the schedules of other individual in the community where she lives and works. However, she reported that during her childhood to pursuing graduation, she used to move very naturally and managing time for each individual within her family and friends. Other than the graduation stage, the client has reported that she had effectively managed time for visits with friends and families into different places. The client had also shared various moments and experiences of visiting different places with her husband even after giving birth to her second child. However, the depression had come into her life after she realized the affair of her husband with another woman which conveyed various conflicts and unrest situations within the family. Due to such frequent domestic conflicts she started to work late at her office. Eventually, she started feeling depressed and began to keep herself always busy as she have major responsibility towards the education and daily expenses of her children. According to the information obtained from the client, it has been recognized that Mrs. Miller had gone through a normal development of her physical and behavioral aspects. Moreover, she had also experienced continuous development of her cognitive skills during her schooling, graduation and the time when she was engaged in a relationship with her boyfriend. Social and Family History Mrs. Miller had clearly denied having any psychological disorder syndrome in her family or any other member within the community. She also reported to have close relationship with every member and she used to involve in various celebrating events with the family and neighbors. She reported that there has been no single member with psychological or abusive behavioral nature and every individual in her family were likely to maintain good image and reputation in the society. During the early age of schooling, she used to have number of friends and she used to be busy in playing and chatting with them in school and other places. . Moreover, the identification process have also identified that there has been no physical or sexual abusive records of her family members. During the early period in graduation, Miller met her boyfriend who has recently joined in a financial company. After the completion of her graduation program, she and her boyfriend had decided to get marry and Mrs. Miller had also joined a private firm where she has been engaged in very low waged structure job. Over the past few years Mrs. Miller has been unsatisfied with the job profile and has been involved in frequently changing her profession across the different privately held firms. After the few years her being a mother of two sons, her husband started to build relationship with other woman and continuously threatened her to get separation from their relationship. In order to bear the responsibility of her two children, Mrs. Miller had joined a low waged based employment in a privately held financial institution where she is currently engaged. Current Situation and Functioning It has been clearly identified that due to continuous family worries and threats from her supervisors and other higher authority within the organization, Mrs. Miller is determined to work hard as she has no other option to maintain the daily living expenditures as well as educational expenses of her two growing children. According to increasing workload and stress associated with her job along with rising responsibility towards her family, Mrs. Miller has been identified to feel anxious and depressed in her life. Since the separation from her husband along with refusal from her husband to provide adequate monetary support to them, Mrs. Miller had started to have alcohol to sleep at night as a measure to relief and overcome her trouble. Correspondingly, Mrs. Miller does not recognized drinking as her problem, she is willing to seek counseling regarding developing behavior and attitude that would facilitate her with confident to execute her responsibility effectively and also to get rid of worries she has been entertaining since last few months. It has been recognized that Mrs. Miller is suffering from major depressive disorder which led her to face anxious and depressive behavior. In relation to the observation of the client, the worries related to divorce with her husband has also increased her depression level which had further led her to face psychological disorder syndrome. Therefore, it can be stated that the divorce with her husband caused her to face Separation Anxiety Disorder (SAD). Moreover, the increasing workload from profession along with rising responsibility of her two children has significantly disrupted her sleep which has ultimately led her to be alcoholic. The continuous consumption of alcohol has also caused Mrs. Miller to face Mood Disorder syndrome. The Major Depressive Disorder syndrome of a client can be identified through different physical and behavioral changes of the individual. In this syndrome, the individual is likely to act as depress mood most of times. Moreover, the syndrome also tends to diminish interests as well as pleasure of the activities performed by the individual. The unintentional loss of energy and weight along with exhaustion over daily activities considerably impose the individuals to face Major Depressive Disorder syndrome. The symptoms of major depressive disorder syndrome can also be diagnosed through observing the concentration level of the individual or her decisiveness towards performing any activity. Feeling worthlessness or excessive guilt regarding the present condition is also potential syndrome of Major Depressive disorder in an individual. The diagnostic criteria of the syndrome also impact on thinking and feeling anxious while performing any tasks or events (Rosenthal, n.d.). In accordance with the different observation of the psychotherapeutic approaches, it has been recognized that the increasing level of depression often tends to convey various types of mental disorder syndrome to an individual. In relation to the psychotherapeutic approaches, mental disorder significantly grounds excessive distress or anxious feelings on the individual. The possible psychiatric disorders that are generally caused by the depression can be identified into different types. Few of the major psychiatric disorders raised by the excessive depression are categorized as Posttraumatic Stress Disorder (PTSD), Personality Disorder, Anxiety Disorder and Schizoaffective Disorder and Schizophrenia among others (Robertson, 2010). Diagnostic Impressions The overall information reported by Mrs. Miller revealed the presence of various psychologically distorted behaviors in her including depression, anxiety, Major Depressive Disorder along with Substance Induced Mood Disorder syndromes. Considering the use of alcohol to overcome trouble of sleep during night, it is likely to be mention that the drinking habit of Mrs. Miller is comparatively better accounted for reducing her anxious behavior and depression. Mrs. Miller is generally experiencing clinically psychological disordered syndromes of feeling anxiety and depression. As per the observation of the client, it has been clearly identified that the Mrs. Miller has neither anxiety or depression related behavior prior to developing a habit of drinking alcohol. Although, the symptoms of Mrs. Miller signified Major Depressive Disorder, however, the symptoms may be effectively accounted through implementing Substance-Induced Mood Disorder. The symptoms of feeling worthlessness along with indecisiveness of an individual can only be observed in the patient suffering from Major Depressive Disorder syndrome. Additionally, the constant depressed mood unintentional loss of weight along with fatigue and loss of energy for doing daily activities can be considered as the major symptoms of depressive disorder (Rosenthal, n.d.). Therefore, the practice of an effective treatment facility is can be promoted to implement nursing activities that would help to improve the depressive and anxious behavior of Mrs. Miller. The identified symptoms, physical and psychological changes in Mrs. Miller can be identified as a reflective representation of the problems faced by Mrs. Miller. Correspondingly, the Diagnostic and Statistical Manual of Mental Disorders edition 4 (DSM-IV) codes have been illustrated hereunder. Axis I: 296.24 Major Depressive Disorder, Single Episode, Severe With Psychotic Features Axis II: V71.09 No Diagnosis on Axis I Axis III: V61.9 Relational Problem Related to a Mental Disorder or General Medical Condition Axis IV: 303.90 Alcohol Dependence Axis V: Occupational and Marital Problem Axis VI: GARF: Not enough Information obtained Case Conceptualization & Treatment Plan In relation to the information obtained from present psychological changes, the depressive and anxious behavior of Mrs. Miller stems due to the breaching of relationship with her husband and rising responsibility towards her children. In order to effectively address the anxiousness and depressive disorder syndrome of Mrs. Miller, it would be essential to implement appropriate nursing process to reduce depression of the client. Moreover, the treatment process would also enable Mrs. Miller to avoid alcohol consumption and other anxious feeling. The continuous traumatic disorder and depression faced by the Mrs. Miller can also be correlated with various psychological factors. In general, there are basically four types of psychological factors that lead an individual to face anxiety and other types of psychologically disordered syndromes. The major types of psychological factors predominately include learning and personal experience, attention and memory, beliefs regarding the social situation along with avoidance and other anxious behavioral aspects (Anxiety Treatment and Research Center, 2002). Concerning with the treatment procedure of Mrs. Miller, the safety of the clients is an utmost essential practice for the practitioners while addressing her anxious and depressive behavior. In relation to Mrs. Miller, her depressive nature and psychotic syndromes would be considered as a primary goal for her treatment process Moreover, the goals of the treatment process would be further extend in order to develop alternatives for coping skills which might help Mrs. Miller to improve her psychological disordered behaviors. Before, implementing the required psychotherapy, the client will be provided certain formal physical treatment process to make her stable and increased her potential to obtain the treatment process. Once the goal associated with psychological development is achieved, Mrs. Miller will be provided adequate skills development practices to address different anxious and depressive behavioral substances. Treatment Plan Planning and executing effective treatment program for the clients with depressive symptoms is essentially a major step for any practitioner or healthcare institution. With regard to the different psychotherapeutic approaches, the implementation of new program or element tends to have consistent impact on the policies and procedures. In this context, the psychological service providers will be highly focused on complying with the institutional guidelines that assist to the development of the clients with depressive symptoms (U.S. Department of Health and Human Service, 2005). An effective practice of depressive treatment program generally involves different policies and procedural guidelines in order to proactively develop the depressive or anxious feelings of the clients. Various disorder symptoms have been identified from the overall intake report of the client. Correspondingly, it is essential to frame appropriate program so that Mrs. Miller can effectively surmount herself from her present psychological condition. Hence, the rehabilitation program designed to address the problem faced by Mrs. Miller would be focused on few major policies in order to effectively deal with the depressive symptom of the client. Training and supervision of the clinical staffs Screening along with referrals of the client regarding the use of substances for the depressive symptom Treatment planning, recording procedures and ensuring continuity care facilities Evaluation of the overall treatment procedure and monitoring improvement records of the client The primary objective of the treatment plan is to build an effective care framework that enables the client to reduce her depressive and anxious behavior. Moreover, the integration of an effective psychotherapeutic approach and medication plan would also be implemented to reduce the worthlessness feelings and harvest self-confidence and interests to deal with different psychological factors that lead to create depressive and anxious behaviors. In order to clearly address the psychological problems or concerns faced by Mrs. Miller, an appropriate practice of Cognitive Behavioral Therapy would help the practitioners and staffs to effectively address the depressive and anxious behavior of the client. Moreover, the integration of pharmacological process would further help the client to increase her potentialities and innate feelings to effectively deal with various challenging situations. The following treatment plan chart would enable the practitioners and staffs of the nursing institution to diagnose and implement appropriate therapeutic and pharmacological process and develop the present psychologically disordered syndrome of Mrs. Miller. Treatment Plan Chart Problem or Concern Objective Treatment Intervention Expected Achievement Time Evaluation Major Depressive Disorder To diminish the present anxious thoughts and depressive behavior of the client Therapeutic nursing intervention program using Cognitive Behavioral Therapy (CBT) along with effective medication process to stabilize cognitive development and behavior of the client 3 Months Effective cooperation and participation of the client Ensuring clinical staffs are competent to provide required treatment process in time Substance Induced Mood Disorder syndromes Reduce innate anxiety and uninterested feelings along with formulating strong psychological belies Intervention of CBT and appropriate medication process and other anti-depressants will be effectively implemented to develop the problem or concern of the client 3 Months Ensuring cooperation of the client with accomplishing different practices and homework suggested by the practitioners and staffs Depressed mood due to family conflict and continuous and increasing responsibilities Alleviate client’s attitude to normal position on Beck Depression Inventory Medicating Antidepressants along with talk therapy in order to reduce worthlessness feelings and build strong mindset to accept and effectively address challenges 2 Months Ensuring active participation of the client and completing prescribed medication Enable the client to continuously practice of the therapeutic process and medication instructions Psychotic disorder and Schizophrenia Reduce worthlessness behavior and formulate interests of the client towards daily activities Intervention of motivational enhancement therapy to increase self-confidence and accountability of managing different situations 2 Months Active cooperation and participation of the client Proper support and assistance of the qualified practitioners and staffs Social Anxiety Disorder To enable the client to generate adequate beliefs and interest to get herself involved in different social events The continuation of CBT approach and medication process will be practiced in order to effectively develop cognitive behavioral skill of the client 1 Month Continuous encouragement and support of the practitioners and staffs Active participation and cooperation of the client Ensuring client to successful completion of the homework MENTAL STATUS EXAM (MSE) Client Name (First, MI, Last): Mrs. Stephanie Miller Client No.: NOTE: Record level of severity next to abnormal findings. 1= Mild, 2= Moderate, 3= Severe, X= Normal Finding General Observations Appearance  Well Groomed Unkempt  Disheveled Stated Age  Younger  Older Build  Average  Thin  Overweight Eye Contact  Average  Hostile  Mistrustful Withdrawn  Preoccupied  Demanding Activity  Average Agitated  Slowed Speech Clear  Slurred  Rapid Pressured  Perseveration  Clang Thought Content Delusions None reported  None reported  Grandiose  Persecutory  Somatic  Bizarre  Nihilistic  Religious Other  None reported  Autistic  Obsessional  Guarded  Phobic Guilty  Ideas of Reference  Preoccupied  Other: Self-Abusive None reported  None reported  Suicidal (assess lethality if present):  Intent  Plan  Self-mutilation Aggressive None reported  None reported  Aggressiveness (assess lethality if present):  Intent  Plan Perception Hallucinations None reported  Auditory  Visual  Olfactory  Gustatory  Tactile Other None reported  Illusions  Depersonalization  Derealization Thought Process Logical  Concrete  Incoherent  Circumstantial  Tangential  Loose  Racing  Blocked  Flight of Ideas Mood  Euthymic  Euphoric  Anxious  Angry  Irritable Depressed Affect  Full Constricted  Flat  Inappropriate  Labile Behavior Cooperative  Resistant  Agitated  Impulsive  Over-Sedated  Assaultive  Aggressive  Hyperactive  Restless  Loss of Interests  Anhedonia  Withdrawn  Dystonia  Tardive Dyskinesia Cognition Impairment of: None reported  None reported  Orientation  Memory  Attention/Concentration  Ability to Abstract Intelligence Estimate  MR  Borderline Average  Above Average Insight/Judgment (If more space is needed, use reverse side) Client displays depressive and anxious behavior along with worthlessness feelings Limited insight about alcohol dependence Elaboration of Positive Mental Findings (If more space is needed, use reverse side.) Client reported that she is depressed and often feels worthlessness due to the continuously increasing work load and family responsibilities. Moreover, she also confirmed to experience anxiety along with frequently feel uninterested towards the actions of others and is reluctant to get herself involved within the community. Provider Signature/Credentials Janet Jung Date: 7-15-08 References Anxiety Treatment and Research Center. (2002). Social anxiety disorder (also known as social phobia). Retrieved from http://anxiety.stjoes.ca/socialphobia.htm Robertson, D. (2010). The philosophy of cognitive-behavioural therapy (cbt): stoic philosophy as rational and cognitive psychotherapy. United Kingdom: Karnac Books. Rosenthal, R. N. (n.d.). Managing depressive symptoms in substance abuse clients during early recovery. Treatment Improvement Protocol (TIP) Series 48, pp. 1-157. U.S. Department of Health and Human Service. (2005). Substance abuse treatment for persons with co-occurring disorders. A Treatment Improvement Protocol (TIP) Series 42, pp. 1-561. Read More