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Question Description

Contribute to the conversation by asking questions, respectfully debating positions, presenting supporting information, or responding freely to the topic at hand.

1. Compared to previous chapters covered in this class, behavioral and cognitive therapy discuss a few new concepts. To begin, behavioral therapy is heavily supported by research. Both behavioral therapy and cognitive therapy (CBT) pride themselves on being the most thoroughly researched forms of psychotherapy (Wedding & Corsini, 2019). This is especially important for clients that deal with anxiety and depression as CBT is considered to be the most effective treatment for these problems (Wedding & Corsini, 2019).

Behavior therapy focuses more on maintaining factors than triggers that might have occurred during childhood (Wedding & Corsini, 2019). Behavior therapy is more concerned with changing current behaviors than identifying old ones. This could be important for clients that have a different cultural family dynamic and do not see their childhoods as determining factors for adult behaviors (Wedding & Corsini, 2019).

Furthermore, behavior therapy is defined as transparent (Wedding & Corsini, 2019). It is a main goal of behavior therapy for clients to learn and possess the skills they need to essentially become their own therapists (Wedding & Corsini, 2019). The client is more active in behavior therapy than in the other therapies discussed so far in this course. The client will contribute with treatment goals and plans (Wedding & Corsini, 2019). Clients that require structure or maybe even deal with OCD could benefit from behavior therapy. Clients working on independence may also benefit from this structure of psychotherapy.

In cognitive therapy, there is an idea called schemas (Wedding & Corsini, 2019). Cognitive schemas basically control processing of information and contain individual’s perceptions of themselves and others, dreams, goals, and memories (Wedding & Corsini, 2019). This could be important for clients that deal with dissociation or even ADHD or ADD problems.

Finally, in cognitive therapy, there is a concept regarding “modes” (Wedding & Corsini, 2019). Modes are essentially a network of different schemas that make up personality and interpret situations (Wedding & Corsini, 2019). For example, the anxiety modes are primal which means they are tied to instinct and survival (Wedding & Corsini, 2019). Understanding this concept can assist those with anxiety disorder.

2. Cognitive therapy shares many similarities with behavior therapy; however, it is unique to other therapy types (Corsini, 2018). A variety of diverse and effective approaches are practiced in behavioral therapy, which focuses on cognitive processes (Corsini, 2018). Both behavioral and cognitive therapy involves an active role of the client during treatment. The client is not only active in their role during treatment but is also given exercises to practice between sessions (Corsini, 2018). The cognitive approach’s general assumption is that mental illness stems from faulty cognitions about others, our world, and us. This faulty thinking maybe through cognitive deficiencies (lack of planning) or cognitive distortions (processing information inaccurately) (Corsini, 2018). Behavior therapy assumes that all behaviors “make sense” and result from patterns of reinforcement and punishment from the environment (Corsini, 2018).

Classical conditioning is a model frequently used in cognitive and behavioral therapy. Classical conditioning has three important components, namely a conditioned stimulus (CS), which signals the unconditioned stimulus (US), which causes an unconditioned response (UR) (Corsini, 2018). Classical conditioning explains why individuals have a variety of reactions to different environments and situations. URs result from the US, therefore, creating different emotions in unique situations (Corsini, 2018).

Operant conditioning is a model that focuses on frequent behavior and its consequences (Corsini, 2018). This approach is often used with children and is effective in changing negative behaviors with more appropriate ones. A common example would be the sticker system, a reward the child receives when appropriate. There is never a reward for negative behaviors; however, there are consequences, such as time out or a task like writing standards.

Another concept used in cognitive and behavioral therapy that is unique to other types of therapy is extinction. Extinction is an approach that presents the CS in the absence of the US to eliminate the occurrence of CR (Corsini, 2018). This approach may be used when your client is fearful of dogs because they have been bitten before; however, the fear of dogs can return when they are faced with one similar to the one that they were bitten by, which most likely requires more treatment.

Observational learning is another approach used when addressing behaviors, which is frequently used in the school therapist’s education process. The intent is to learn appropriate behaviors through vicarious learning. It is assumed that through observation, we can all learn new behaviors through the study of videos, others, discussion boards. For example, at the beginning of my academic journey, I was getting dinged for APA mistakes; even though I read the manual, I continued to struggle with the application; through the use of the discussion board, I was able to realize my mistake and correct them. Vicarious learning can be an effective form of learning new behaviors; however, the behaviors being demonstrated must be positive.

3. The vast importance and relevance of the subconscious mind is lost in both cognitive and behavioral therapies, particularly behavioral. Cognitive psychology’s targeted schema is incomplete without an acknowledgment of the Self that escapes conscious awareness. I think there’s a lot more to the human mind than CBT gives it credit for, I just think CBT is more practical and viable for most situations. Is insurance going to cover lengthy psychotherapy treatment plans for the purpose of dream analysis and exploration of the subconscious? Is the client even willing to take the time to do that, when they just want to be able to feel “normal” again? Empirical evidence equals reliable results in the shortest amount of time for the least amount of money and often insurance won’t pay for anything else (Windermere, 2018). Wedding and Corsini (2019) note the way randomized controlled trials carefully screen out comorbidities for the purpose of providing more clear-cut evidence, which reminds me somewhat of the addiction-as-disease model wherein everyone took to it immediately because it seemed more scientific and insurance covered treatment. I do feel Ego Psychology could be readily integrated and is missing from CBT, and that’s not quixotic or irrational to suggest since automatic thoughts are factored in. Ego-defense mechanisms are a product of psychoanalytic theory and helps to explain our reactionary instincts and behaviors in the interest of self-preservation (Danzer, 2012). It lifts the subconscious mind into view for interpretation, and it’s relevant to cognitive therapy. Schema therapy brings maladaptive core beliefs linked to early life development of schemas. This adds a few connected dots between the highly influential childhood years on one’s current thoughts and behaviors, even if not in a fully deterministic way. It would be difficult to use this method of therapy if there as any element of psychosis, like hallucinations or paranoid delusions, because an individual should be lucid enough to participate in collaborative therapy (Wedding & Corsini, 2019).

Behavioral psychology’s modeling concept is useful in creating functional individuals who may not otherwise experience a normal life, but it could also create human parrots. If individuals are not understanding why they are doing these things, they are simply mimicking what’s been demonstrated. Missing from behaviorism is self-actualization; you can be more than just what you’ve been conditioned to be. Mindfulness-Based interventions integrate a sense of self-acceptance and empowerment into therapy, and sustains the feeling of control over their outcome so that the client doesn’t feel so reliant on the therapist (Leeuwerik, et al., 2020).

4. The vast importance and relevance of the subconscious mind is lost in both cognitive and behavioral therapies, particularly behavioral. Cognitive psychology’s targeted schema is incomplete without an acknowledgment of the Self that escapes conscious awareness. I think there’s a lot more to the human mind than CBT gives it credit for, I just think CBT is more practical and viable for most situations. Is insurance going to cover lengthy psychotherapy treatment plans for the purpose of dream analysis and exploration of the subconscious? Is the client even willing to take the time to do that, when they just want to be able to feel “normal” again? Empirical evidence equals reliable results in the shortest amount of time for the least amount of money and often insurance won’t pay for anything else (Windermere, 2018). Wedding and Corsini (2019) note the way randomized controlled trials carefully screen out comorbidities for the purpose of providing more clear-cut evidence, which reminds me somewhat of the addiction-as-disease model wherein everyone took to it immediately because it seemed more scientific and insurance covered treatment. I do feel Ego Psychology could be readily integrated and is missing from CBT, and that’s not quixotic or irrational to suggest since automatic thoughts are factored in. Ego-defense mechanisms are a product of psychoanalytic theory and helps to explain our reactionary instincts and behaviors in the interest of self-preservation (Danzer, 2012). It lifts the subconscious mind into view for interpretation, and it’s relevant to cognitive therapy. Schema therapy brings maladaptive core beliefs linked to early life development of schemas. This adds a few connected dots between the highly influential childhood years on one’s current thoughts and behaviors, even if not in a fully deterministic way. It would be difficult to use this method of therapy if there as any element of psychosis, like hallucinations or paranoid delusions, because an individual should be lucid enough to participate in collaborative therapy (Wedding & Corsini, 2019).

Behavioral psychology’s modeling concept is useful in creating functional individuals who may not otherwise experience a normal life, but it could also create human parrots. If individuals are not understanding why they are doing these things, they are simply mimicking what’s been demonstrated. Missing from behaviorism is self-actualization; you can be more than just what you’ve been conditioned to be. Mindfulness-Based interventions integrate a sense of self-acceptance and empowerment into therapy, and sustains the feeling of control over their outcome so that the client doesn’t feel so reliant on the therapist (Leeuwerik, et al., 2020).

5. Reformulate your diagnostic work-up of Bill, given the new information in Part 2 of his case study.

After ready the second part of the case study for Bill; I have come to a similar conclusion from my first diagnosis. I still believe that Bill is Bipolar with mood-congruent psychotic features but after reading the case I find myself seeking a differential diagnosis. It appears that Bill may be suffering from a personality disorder. I believe the correct personality disorder is Borderline Personality Disorder.

Describe your decision-making process in arriving at this reformation.

I believe that Bill is suffering from Borderline Personality Disorder because of the wat he describes himself as a war hero and that he has an imaginary persona of himself as being a great person. He also believes that his family’s love for him has turned to jealousy and has many conflicts with his children and in laws. The DSM 5 says that a person suffering from Borderline Personality Disorder will have five features in criteria A of the disorder. He appears to have these problems: Frantic efforts to avoid real or imagined abandonment. (Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.) (APA, 2013). A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation (APA, 2013). Identity disturbance: markedly and persistently unstable self-image or sense of self (APA, 2013). Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days) (APA, 2013). Chronic feelings of emptiness (APA, 2013). Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights) (APA, 2013). Transient, stress-related paranoid ideation or severe dissociative symptoms (APA, 2013). These signs and symptoms are perpetuated through Bills behavior and his reactions to his children and in-laws. The fact that Bill believes he superior to everyone else and it is causing stress in his relationship with his family and Bill sustaining a job.

Evaluate the difficulties in accurately diagnosing personality disorders.

The difficulties with diagnosing a personality disorder are that some of the symptoms mirror other disorders such as Bipolar disorder and schizophrenia. Making sure the person is accurately diagnosed can be a difficult task. Getting through to the client and obtaining a full mental health and medical history may make it easier to form a hypothesis about which disorder a client is suffering from. It is also detrimental to not try and diagnose a client after only one session with the client. It may take more than one or two sessions to get a decent picture of what is going on in a client’s life and trying to figure out what is going on with the client can be troubling as well.

Discuss the difficulties in obtaining accurate information about clients’ histories.

In a case like Bill’s, obtaining accurate information about the client from the client will be difficult because he believes he is superior to everyone else in his life. He has a false sense of self and because of that the information he is providing will be distorted at best. To get a better picture of what is going on with the client, a person should first get consent from the client to question family members and then talk with family members to get a better perspective of what is going on in the house hold. Another way of obtaining a proper history about the client could be from a medical physician, hospital visits, and any other psychological or medical person the client has seen. Always obtain consent from the client first, but this is a reliable way to obtain a history about a client.

6.Bill meets the criteria for Borderline Personality Disorder as he is constantly thinking that his children will betray him and his constant mistrust for everyone in his life in his job and family life. Bill meets the criteria with 7 symptoms of BPD, which he only needs to meet 5. Bill meets the criteria as he has a fear of being abandoned and chronic feelings of emptiness as explained in the first session. In the second session, it seems that Bill also experiences intense or unstable interpersonal relationships, identity disturbances (feelings of grandiosity), reactive mood, intense anger, and stress-related paranoia. Bill’s anger with his children and paranoia that they are plotting against him with no evidence of this happening explains his difficulty with his familial relationships, as well as paranoid behavior. When he cuts his children out of his life for doing things that he is threatened by, this explains Bill’s intense anger that has become uncontrollable. Also, Bill has extremely high, unattainable expectations for his children as he stated in the first session, which has caused a rift in their relationship. These symptoms are causing a great deal of strain on the relationships, and causes an even greater dilemma in Bill’s marriage as his wife has a lot of difficulty living with him.

At first it was a bit difficult to determine which personality disorder Bill should be categorized in, as Paranoid Personality Disorder was also one that seemed very appealing for Bill’s case. Yet, it was the anger and difficulty in familial relationships that led me to choose Borderline Personality Disorder instead. This section was very well organized and explained the differences very well within the diagnostic criteria sections (APA, 2013).

In Bill’s case, we were only getting some of the story from him compared to the extra information we received from his wife. His paranoia and anger toward his children would not have been expanded on if his wife had not come to the session with him. She gave insight into the other parts of Bill’s life that he does not see as a significant issue for what we are currently discussing. Bill’s bias about what is important and what is not important to disclose can significantly taint the accuracy of the information he is sharing. He also may not be fully truthful or see any problem in his behavior. I still wish to know more about Bill’s familial history with mental illness and how he was raised. I think that with understanding the type of environment Bill grew up around, this may explain some of the need for perfection from his family.