CBT Case Study: African-American Client with Adjustment Disorder

Theoretical Orientation and Application

My theoretical orientation is cognitive behavioral therapy (CBT). As Newman (2013) points out, this theoretical orientation was developed in the 1960s. The primary contributors to its formation and establishment were Dr. Aaron T. Beck and Dr. Albert Ellis.

There are several aspects of CBT that resonate with me. To begin with, CBT advances the notion that a client's presenting concerns are largely rooted in the client's beliefs and behaviors (Sheldon, 2011). For this reason, CBT seeks to ensure that persons develop a greater understanding of those beliefs, behaviors, attitudes, and thoughts, with the goal of resolving the harmful ones. I am also in favor of the practical, hands-on approach to problem resolution that CBT takes. Furthermore, this orientation accounts for diverse personalities and can therefore be customized to address the specific and unique needs of various clients.

As noted above, the beliefs and behaviors of the client form the basis of the presenting concerns. With this in mind, a counselor in this case would need to guide the client not only in identifying, but also in challenging and modifying, the various behaviors and beliefs deemed maladaptive. There are several approaches that could be deployed to help the client identify automatic thoughts that are negative or unhelpful. One such approach is Thought Records, which is essentially a charting tool.

With respect to positive change, it is important to note that in the words of Sperry and Sperry (2017), "cognitive behavioral therapy (CBT) can be a powerful tool to promote positive behavior changes" (p. 79). As the authors further indicate, this is especially true given that CBT utilizes a wide range of strategies — such as self-awareness — to enable clients to rein in negative thought patterns and habits. According to the authors, this theoretical orientation posits that there is an intrinsic connection between an individual's thoughts, feelings, and actions.

This theoretical orientation would be valuable in making sense of RB's presenting problem by paying attention to his perceptions and thoughts, and how these impact both his behaviors and emotions. CBT can be deployed in directive and structured formats, making it possible to track the client's behaviors, feelings, thoughts, and mood — for example, through homework assignments. By identifying negative thoughts, healthier routines and more positive ways of thinking can be gradually introduced. RB would eventually come to recognize that the distress he experiences in the present moment is a reaction to his circumstances, rather than to the circumstances themselves.

We can contrast CBT with the psychodynamic approach, of which Sigmund Freud is the originator (Higdon, 2011). Unlike CBT — whose focus, as noted above, is the client's behaviors and emotions — the psychodynamic approach would make sense of RB's presenting problem by focusing on his subconscious, specifically his unconscious thoughts. In this framework, one would examine RB's early childhood years with the intention of assessing whether there are unresolved conflicts that could be affecting his present thoughts and behavior.

Treatment Planning

The treatment goals outlined below have been designed to be specific, measurable, attainable, realistic, and timely (SMART).

Approximate time range: 8–12 therapy sessions

Relieve symptoms: Some of the symptoms RB presents with include, but are not limited to, concentration difficulties, social withdrawal, feeling overwhelmed, loss of appetite, difficulty falling asleep, anxiety and worry, and feeling hopeless.

One intervention that could be deployed to achieve this goal is behavioral activation, which is an established component of CBT. This approach works to improve the client's emotional state through the deliberate use of behavior change.

Approximate time range: 12–18 counseling sessions

Improve coping skills: Coping skills RB is expected to develop during this phase include identifying negative thought patterns and maintaining a positive mindset.

An appropriate intervention at this stage is yoga meditation. A study conducted by Srivastava, Talukdar, and Lehan (2011) to assess the effectiveness of meditation in the management of adjustment disorder found a "significant improvement in patients in the experimental group after using Yoga Meditation" (p. 245). The authors further noted that these improvements included "positive improvement in mood" (Srivastava, Talukdar & Lehan, 2011, p. 245).

Approximate time range: Beyond the allotted therapy term (i.e., following the completion of therapy)

Improve functioning: Given that RB's current level of functioning cannot be considered healthy, it would be necessary to restore and improve function across multiple areas of his life. This includes improving his relationship with his wife and daughter, engaging in social activities such as meeting friends, and pursuing alternative income-generating activities while seeking employment suited to his qualifications.

One intervention that can be deployed here is maintenance therapy — conceived as long-term, ongoing work intended to ensure that RB remains in a stable condition and is able to sustain normal levels of emotional and mental functioning.