Cognitive Behavioral Therapy Case Summary

Cognitive Behavioral Therapy for Treating Grief

Marsel Shamouelian

University of Maryland, Baltimore

Case Summary /Presenting Problem

Emma, 35 years old, requested outpatient mental health services following the death of her husband from a sudden car accident ten months earlier. She is the mother of two children, a daughter aged nine and a daughter aged eight. She has began to work as an accountant to provide for her children. Emma appeared tearful as she described her twelve years of happy marriage to her late husband. She described her husband as loving and a devoted father to the children. Since the sudden death of her husband she has difficulties in functioning. She cries a lot and worries that she as single

parent the children will suffer. she feels angry with herself. Emma presented with self defeating belief such as I will never be able to move on. I should be over this. "I can’t pull myself together,.
Following the death, she told the children that life will go on and she made efforts to return to the usual routine but alas with no success: "I can’t take it any longer". She reports difficulties in sleeping, lost appetite and lost interest in her work. I lost my best friend and life lost its meaning, why did it happen to me". She feels guilty as she reported that her daughter is who is mirroring her anxiety. They have since lost their house due to foreclosure. She reported that she has moved back in with her mom and the move has created a lot stress for their daughters to adapt to a new school.
History
Emma describes her childhood as happy one. She comes from an intact family who lived in middle class neighborhood. She has an older brother and an older sister who both are both very successful. She reported that both her parents held high degrees with her dad being doctor and mom had degree in law. She describes growing up success was a an ingrained value that was often implicitly and explicitly communicated. She described that success was the norm in their house. She struggled with academic achieving throughout her school years. She reports that “B was not allowed in our house.” She describes her mom as the superhero who always had everything organized and planned. She said whenever I made mistakes my mom’s response was “Mistakes were unacceptable and forbidden in our house." when I failed the frist examination of a course it was precise I felt be overcome or as a horrible loss. Each of these views will lead to significantly different emotions and behaviors.
Case conceptualization
Emma is, 35 year old; Caucasian widowed who was referred to outpatient mental health agency due to depression and anxiety due to the loss of her late husband.

Emma suffers from feelings of low-self-esteem and personal efficacy. She does have a prior history of perfectionism and rigid belief system. Emma views herself as failure widow who cannot keep her family together. Her robust beliefs on gender roles and the idea functionging family dynamic. She has assumptions that women should not “get angry: women must be the nurtures and keep things under control.” These thoughts inhibit her ability to proper grieve. These beliefs are rooted in perfectionist thinking that “if you work hard enough then you will successes” “failure is unacceptable despite the circumstances. If you don’t accomplish things you are worthless. As she constantly criticize herself for not being able to care for her children as she used to. she strives to be the perfect mother, but feels like she is failing. She is supportive mother who is their for her child. She provides for her attends her school events is tentative to her emotional well being. Communicates with the school about her daughters well

being.
Yet her cognitive distortions such and strict beliefs about roles of women and men that are making her grieving very difficult. Despite her negative thinking she continues she has high intellectual and functional competencies. Emma is as hard worker and tentetive mother. Emma is verbal intellegint in distress, and motivated to seek help. Emma seek counseling due to her concerns about her child poor academic performance and acting out in school . She contributes their behavior following the death of her father. She views herself to be inadequate as a woman as a mother. She is guilt for not being a competent parent.
She presents rigid perfectionist thinking , tradition sex role streytoypes.
Emma is depressed , anxious , and suffering from feelings of self-esteem and personal efficacy. Due to maladaptive thinking she has difficutly perciing anything positive about herself and her child. Emma is highly functioning and competent women.

She has a background in education which will be helpful to her in treatment. Emma has no prior history of depression and she has great motivation for treatment, and her prior history of adaptive function predicts a good prognosis.
Treatment overview- Emma maladaptive belief systems will be explored in her relationship with herself and her children.
Long term goal- She will become aware of her negative belief system and how they are affecting her ability to grieve.
Short –term goal
1. Emma will develop new ways of thinking
Domain of Gender
The domain of gender is most pertinent for treatment case. Traditionally streyotybes of women include depening on someone. The traditional mother role has been to take responsibility for raising the chidren and caring for them. Emma's husband was the sole the provider financial supporter for the family. . She must be able to continue to take care and nurture her children as in the past. Emma is functing well considering the loss of husband. she is tentative mother and attends to children both physicsl and emotional needs. Her distorted cognitions inhibit her from properly grieving leaving her depressed and anxious and depressed. These believes also presvent her undersand why her child’s grades are slipping. She fails to understand expects high stastdsrand at this time is not realistic. He perfectionist tendencies impede her ablity to function at this time. The predominant culture in the does not encourage women to be angry, and crying and other ways of expressing strong emotions can be seen as a sign of weakness.

Treatment plan overview.

Emma maladaptive belief system will be explored within her roles as a widow nad mother.

Long term goal 1.

Emma will become aware of her cognitive schemas about herself as a newly widowed women and how theye are leading to her stress.

Short-Term goals

1. Emma will become awre of her self-talk around the issue that a good woman is never angry and how its oor not helping her cope realistically wih the sudden death of her husband.

2. . emma will become awre of her self-talk around the issue that a good woman is deos not lose control and how it imeding her from relasticaly dealing with loss of her husband.

3. she will remove perfectosit and unrealist thought with more relatist one base her greater knowled of grief issues in her her

.

Long-term goal 2.
Emma will become more aware of her belief system around hersesef as mother as adult how these are exhaserbering stress for her.
1. Emma will become aware that behavior her chld and whether it represten as realist appraiseal of the behavior of recently losing a parent.
2. emma will hypothesis test around self-talk through reading about grief and young children, and discussion with clinican.
3. she will substitute adaptive self-talk for negative sle-talk. Which will supore more positive emotion and adaptive , flexile behabior free of prefectionishm.

Goal
Treatment will focus on assess and modifying Emma cognitive distortions by reappraising her automatic thoughts. Some psycho-education about role of distorted cognitions and her current difficutlites. treatment will be with the perspective of CBT we focused on her representations of this event and not the death of her husband or the outcome.

Intervention
As a CBT therapist I served as an educator and hypothesize generator who directed and guided treatment by helping Emma identify her cognitive distortions. I initiated our therapy process with psycho-education where I taught her about the model and help her realized how her maladaptive thinking was negatively impacting her functioning. Following I investigated with her to helped her to become aware of her distorted cognitions are impacting her. I did this by complete this task by asking her question pushing her to test out her conclusions. Questions include her expectations from herself and her attributions she made about herself.
Emma explore her thoughts in a hybrid way both in session as well as out of sessions. She will have homework assignment such as a, thought log that will be an asset to become more recognized her thinking is correlated to her depression and anxiety . ultimately she will recognize her maladaptive thinking direcltly impacts her current life stresss.