CBT Case Study

For Pat’s service plan, I will be using CBT to meet the desired outcomes. I will have Pat record his thoughts, emotions, and behaviors in a daily log at least 5 times per week after completing psychoeducation. This will encourage Pat to be mindful and reflective about his how his moods influence his behavior in an effort to reduce the negative relationship between them. To improve Pat’s coping strategies with stress and anger, Pat will report his practice of mindfulness and relaxation techniques at least 5 times per week. To measure Pat’s medication adherence, Pat and I will design a schedule that he feels he follow and record when he goes to sleep, how long he sleeps, his diet, and when he takes his medication.

A. Evaluate Objectives

from Your Service Plan
Pat would make great progress with these objectives. For the objectives about Pat increasing his adherence to medication, change with be assessed by his report of taking his medication daily according to the prescription and will be deemed successful if he takes his medication daily. The objective of following a designed routine schedule, the intervention will be measured as successful according to Pat keeping track of his sleep, diet, and medication, and whether he follows his schedule at least 80% of the time. For improvements in communication skills, change will be evaluated through Pat’s reports of at least 3 positive interactions a week and what happened during these conversations.
A large amount of Pat’s objectives related to improving his coping skills. One objective was for Pat to identify his stressors, ways to avoid them when possible, and how to cope with them when it was not possible to avoid. The success of this will be evaluated by reviewing Pat’s daily mood journal, where he records his moods, triggers, and if/how he successfully coped with it. It will be deemed successful if he utilizes relaxation and coping techniques at least 5 times per week. This will work in unison with the objective for Pat to acknowledge his mood disturbances and their effect on his behavior. It will be deemed successful if Pat identifies and records his mood disturbances when they occur at least 5 times a week. To measure positive behavioral change to improving coping skills for stress and anger, Pat will report about his mindfulness practice at least 5 times a week and what that entailed. He will also report if he felt that mindfulness practice was effective. The success of improving his coping skills will be more or less the same for all objectives related to coping skill improvement.
It was helpful to have measureable goals on my service plan to determine the amount of change at termination. The measured goals allow for a way to evaluate whether or not a client has met the goals that you set together and to what extent thee goals were met. It makes it like a check list of areas of improvement. It would also be helpful to revisit the service plan throughout the intervention to evaluate what areas needed a little more focus to assist the client with achieving if they are not showing progress in a certain area.
B.

Self-Assessment of Your Work

Explore and reflect upon your clinical skills and work in the termination stage with your client. Where were you successful and where were you challenged? Were there personal/professional struggles? Counter transference issues? Make sure to also mention any challenges to self on ethnocentric, racist, heterosexist, ageist, classist, and any other assumptions that we all bring and must be tempered with our professional knowledge base.

It was difficult when Pat was in a manic episode to be able to communicate with him during sessions occasionally. When in a full manic episode, Pat would talk in a rapid, rushed manner that was difficult to understand and follow. It was best to work with Pat when he was euthymic. I was most successful at improving Pat’s medication adherence, which helped with many of his other problem areas. At times it was difficult to have the confidence that I was capable enough to provide the care that Pat needed because he came across as such an extreme that I was completely inexperienced and he was referred because of his violent behavior. I struggled a little bit with my concerns for Pat’s wife’s safety, which I was worried might influence my ability to be Pat’s

practitioner.
Pat’s tendency to ask inappropriate questions and difficulties with communication skills made for some issues with countertransference. Pat often asks inappropriate questions to people in his life and during sessions. He stated during session that people get angry with him sometimes when he is “just talking to them.” It was clear for me to see part of why people become angry with him is that he asks inappropriate questions, often questions that he was specifically asked not to ask. His questions irritated me sometimes and made me uncomfortable at times so I was able to see why he has problems communicating with people sometimes.
I do not think that I have any biases toward Pat.

I might have a bias towards in regards to my concerns for his wife’s safety. As a woman and someone who is passionate about preventing domestic violence and violence towards women, my concerns for Nikki’s safety is very prominent. Since he is a man it is harder to understand his violent, physical reactions to things. I was concerned that my thoughts about her safety could possibly interfere with my ability to properly care for Pat’s needs and problem areas. While I am concerned for Nikki’s safety, I am just as concerned with Pat’s safety as well. I would hope that Pat did not feel that I am more concerned with Nikki’s safety than his, because that is not true, but he could feel that I am more concerned about her because she is a

woman.