Counseling Therapies: Case Conceptualization
Case One: CBT
What Are the Specific Areas of Concern?
Suicide and Stress
Stress has been found to play a major role in suicide risk, mental disorders, and mood swings. Stress is one term most people use synonymously with negative experiences they get in life. Negative events in life which confer depression risks, suicide thoughts and behavior, involve interpersonal, traumatic childhood and occupational events. Trauma, mostly childhood trauma, has important short-term and long-term effects on suicidal behavior risks. Particularly, child abuse (physical, emotional and sexual), parental mental illness, parental death, and witnessing home violence in childhood have all been connected to acute suicidal behavior for long intervals. Interpersonal events in life are also known to increase suicidal behavior risks. The death of a spouse or parent, serious disagreement with a staff, and social exit events (e.g. a child running away from home) have been connected to some suicide attempts by adults, while separation between one's parents and break-ups in relationships have been associated with suicide among young adults and adolescents. The interpersonal events considered to be most essential to suicidal behavior seem to be those that involve conflict or loss in current interpersonal relationships, instead of mere simple social isolation (Cornette & Busch, 2016).
What Are the Specific Symptoms?
Symptoms of Stress / Depression
Feelings of hopelessness and helplessness. A break viewpoint- things can never be better than they are now and there is nothing you or anyone can do to change your condition/situation.
Losing interest in everyday activities. Lack of interest in past hobbies, social activities, pastimes or sex. Losing your ability to feel pleasure and joy.
Changes in appetite or weight. Significant weight gains or weight loss- a change of up to 5% of body weight per month.
Changes in sleep patterns. Either insomnia, especially being awake in the early hours every morning, or sleeping too much (equally called hypersomnia).
Irritability or Anger. Feeling restless, agitated, or even violent. Low tolerance level, short temper, and everyone and everything tend to get on your nerves.
Energy loss. Feeling sluggish, fatigued, and drained physically. Your entire body may start feeling heavy, and small tasks may become exhausting and even take longer time to be completed.
Self-hate. Strong feelings of guilt and worthlessness. You criticize yourself harshly for any perceived mistakes or faults.
Recklessness. You take part in some escapist behaviors like compulsive gambling, substance abuse, reckless driving, or dangerous sports.
Lack of concentration. Difficulty staying focused, making important decisions, or remembering important details.
Unexplained pains and aches. Rising physical complaints such as back pain, headache, stomach pain and aching muscles.
Suicide:
Increased alcohol or drug use
Searching for ways to kill themselves, such as searching for materials or means online.
Withdrawing from activities
Acting recklessly
Staying away from friends and family
Sleeping too little or too much
Calling or visiting people to say goodbye
Giving priced possessions away
Aggression (American Foundation for Suicide Prevention, 2016).
How Has the Client Arrived at This Mental State?
The foundation of CBT model for suicide thoughts and behaviors were formed by A.T. Beck's cognitive triad. In A.T. Beck's opinion, suicidal patients suffering from depression see themselves as being inadequate, defective, diseased, or deprived and therefore undesirable and worthless; they see other people as being unsupportive and rejecting by demanding too much; and they see their future as a hopeless one since they lack the beliefs that they do not have the external or internal resources to get their problems solved. Their defective sense contributes to the inactive approach to providing solutions to problems that distress them; and they stop trying to solve their problems, hoping for an automatic solution. Since they think no one cares about them, and because it seems their problems are overwhelming, they give up trying to solve their own problems. Without the support of others and personal skills, they come to the conclusion that there can never be any future (Matthews, 2013).
Therapeutic Goals/Expected Outcomes
Suggested NOC Labels
Depression Control
Cognitive Ability
Impulse Control
Distorted Thought Control
Suicide Self-Restraint
Self-Mutilation Restraint
Will to Live
Client Outcomes
Does not harm self
Expresses reduced nervousness and control of hallucinations
Talks about thoughts; appropriate expression of anger
Gets no access to harmful objects
Yields access to harmful objects
Specific Interventions
Suggested NIC Labels
Anxiety Decline
Coping Enhancement
Crisis Intervention
Suicide Prevention
Surveillance
Nursing Interventions and Rationales
1. Create a therapeutic association with client
This study showed the significance of this association in the discovery and prevention of suicide
2. Observe, file, and report the potentials of client for suicide.
Habits...
Be alert for warning signs of suicide:
Verbalizations such as, "I can't continue," "Nothing means anything to me anymore," "I would have been better off dead"
Becoming withdrawn or depressed
Behaving in a reckless way
Arranging affairs and giving valued possessions away
Showing a distinct behavioral change, appearance and attitude
Abusing alcohol or drugs
Suffering a life change or major loss
Suicide is hardly a spontaneous decision. In the days and hours preceding suicide, there are always warning signs and clues (Befrienders International, 2001).
4. Evaluation of suicidal ideation when the history shows:
Alcohol and drug abuse
Depression
Other mental disorders
Suicide attempt
Recent unemployment
Recent separation or divorce
Recent bereavement
Chronic pain (Nursing Interventions and Rationales, 2015).
Role of the Counselor
The roles of the therapist in CBT-SP involve providing education for both patient and family in a number of areas during the early treatment stage. Explaining the nature of suicidal behavior, the role depression plays, and why it is important to secure potential dangerous tools to the patient and family as the first task of the therapist. The therapist equally explains the principles and goals of CBT-SP to the patient and family. Parents may equally help to provide further explanation on the series of analysis from their point-of-view and may make contributions to developing and implementing safety plans. Though there is parental contribution to the series of analysis and safety plan, the medical expert works with the young patient to ascertain which of the parental contributions are useful in improving their knowledge of the chain and improving safety. Conversely, the perception of the adolescent on the series of events is most essential (Stanley, et al., 2010).
Case 2 -- Solution Focused therapy
What Are the Major Areas of Concern?
Confusion and Uncertainty
Drug and Alcohol Addiction
Addiction to any activity or substance is among the most complex areas of psychiatric health. Treating addiction can be quite difficult, and there are a good number of controversies surrounding major causes of addiction and the best treatment approaches. Persons who experience addiction to alcohol or drugs often find mental health expert services quite essential for beating their addiction.
What are the specific symptoms?
Substance abuse has the tendency of leading to addiction or substance dependency when both the rate of use and the amount of substance used is on the increase. Individuals who suffer from alcohol or drug addiction feel they are unable to control their impulse to use it, and often experience some withdrawal symptoms when the substance is suddenly withdrawn. For example, alcoholism happens when individuals become chemically over-dependent on the use of alcohol, and the addicted ones may fall sick if they suddenly quit drinking. People may also feel psychologically dependent on such substances and continue to make use of it, especially under very stressful conditions or to reduce other psychological issues. Some people do not accept or do not know of their addiction problems, and sometimes an individual's dependency on a substance and its abuse may remain concealed from friends and family.
Some common signs of chemical dependency include:
Growing tolerance or the desire to consume more of the substance the individual is addicted to before reaching the desired level of intoxication.
Needing the substance all through the day.
Looking for the company of other addicted substance users and staying away from people who do not use these substances.
Resenting or dismissing expressions of worry from close friends and family members.
Avoiding important activities and not meeting obligations.
Having some withdrawal symptoms when the intake of the substance is stopped.
Concealing the use of the substance from family and friends.
Binging -- heavy use of the substance -- for several hours or many days.
Feeling the inability to quit the habit.
How has the client arrived at this mental state?
Biological, social, physiological, and psychological factors are all important determinant factors when it comes to whether a person will abuse drugs/alcohol or not. A substance abuse family history will make every individual more prone to addiction, and certain social factors such as ease of availability and peer pressure have the tendency to increase a person's possibility of developing drug / alcohol addiction and its related problems. Additionally, once a person begins the use of drugs or alcohol heavily, there are bound to be physiological changes and that individual may then develop physical dependence, which require him/her to continuously make use of the substance to avoid the withdrawal symptoms.
Some families are known to have alcoholism running in them, though not every child of addicted parents become addicted to alcohol; the degree to which alcoholism is genetic has remained a subject of debate among physiologists for some time. Some scholars have been searching for an alcoholism or addiction gene, and some point out that the mere act of seeing a parent drinking alcohol as a way of responding to stress raises the possibility of a…
