Internalizing Disorders: A Case Study

Internalizing disorders such as anxiety and depression as well as personality disorders can occur when change does not accurately follow the developmental timeline (Beck, 1976). Over-distortion and one-sided patterns of speculation cause maladaptive development. These negative patterns of the cognitive system are; arbitrary inference, selective abstraction, overgeneralization, magnification and minification, personalization, and dichotomous thinking (Wenzel, et al., 2006). Arbitrary inference is drawing conclusions without supporting evidence or proof. Selective abstraction is conceptualizing a circumstance based on a single detail of an event while disregarding other information. Overgeneralization is applying extreme beliefs, which are

based on a single event, to every situation. Magnification and minification are identifying situations in a greater or lesser light than they truly are. Personalization is ascribing outside events to oneself without proof supporting a causal association. Dichotomous thinking is classifying events in all or nothing terms; something is either all good or all bad. All of these negative patterns cause maladaptation in the formation of self and can lead to personality disorders, anxiety, and depression. These faulty errors in information processing are used to support the validity of automatic thoughts and core beliefs of the individual even though there may be proof indicating differently. (Beck, 1976)
Cultural and contextual variables. When working with all clients, regardless of culture, it is important to keep in mind these cultural and contextual variables; age, developmental and physical factors, cognitive, sensory and psychiatric disabilities, religion and spiritual orientation, ethnicity and racial identity, socioeconomic status, sexual orientation, and gender (Nelson, et al., 2014). Techniques in CBT that are found to be helpful across cultures and may hold universal value are; goal setting, problem-solving, identifying negative thoughts, connecting thoughts to emotions, behavioral experiments, changing negative thoughts to those that are positive (Nelson, et al., 2014). Another aspect of CBT that works well for a broad range of cultures is the idea of setting personal goals and finding own ways to correct problems. This may, however, pose an issue for individuals who come from collectivist cultures.
Cognitive-behavioral therapy has the potential for practical application for a diverse range of client populations. With that said, the approach does not seem to hold the same clinical potential for overly intellectualized clients, who may possess schemas that are relatively impervious to this approach (Weinrach, 1988). Instead, CBT is more effective for clients who are of a lower socioeconomic status or those who are less educated; their approach to life is based on street smarts that allow them to better grasp a more practical type of therapy (Weinrach, 1988). When incorporating CBT into clinical treatment, some adaptations may be needed when providing therapy to clients from different cultures. Some cultures may view looking at worst-case scenarios as offensive or insensitive. In cases like this, the therapist may need to adapt the approach to the situation and ask if the client is comfortable pressing further into specific topics.
Another cultural consideration of cognitive behavioral therapy is the concentration and the amount of time spent in the here and now (Nelson, et al., 2014).

This concept is typically viewed as one of the positive aspects of cognitive behavioral therapy because this approach to therapy focuses on the client’s immediate problems and by staying in the present moment rather than having the client recollect past experiences. However, to some cultures, it can feel that by staying in the present there is an abandonment of cultural influences significant to the client if the therapist does not take the time to explore and reflect the client’s past (Nelson, et al., 2014). By spending large amounts of time in the present the therapist can neglect to learn about the history of their clients by not examining where the client came from and other important cultural factors that would be found by looking at the clients past and obtaining a full history of the

client.
Cognitive behavioral therapy is also culturally limited because of the importance of individuality as opposed to other cultures that are more collectivist and emphasis the importance of the family and the group as a whole (Nelson, et al., 2014). CBT encourages individuals to use assertive communication styles where other cultures may use a more restrained means of communicating. In CBT talking is crucial to the therapeutic process, however, in other cultures non-verbal communication such as listening, and silence may be viewed as equally if not more important and helpful for clients. Lastly, cognitive behavioral therapy uses a linear style of therapy and is highly structured whereas other cultures use non-linear forms of communication such as storytelling. All of these factors should be considered in order to provide culturally sensitive therapy. Adaptations and adjustments may need to be made throughout therapy in order for this to happen. (Nelson, et al., 2014)
The therapist can correct these cultural errors in therapy by becoming culturally responsive and aware by educating themselves about the client’s culture on their own time. A therapist who is sensitive to culture searches for cultural information about a client then uses this to better appreciate and understand the client’s experience from a particular cultural lens. It is very important for therapists to recognize and be aware of own cultural biases’, attitudes, and beliefs that may affect working with clients who come from cultures different than their own. One way a therapist could gather cultural information about clients in the therapy room is to have clients create a genogram or family map in order to better understand the client’s cultural roots and background. Because it is unrealistic and essentially impossible for a therapist to understand every culture, cultural learning is a process that should be done throughout the entire career of a therapist. Cultural competency is a skill that is never complete or ever truly mastered. (Nelson, et al., 2014)
Goals of Counseling
Cognitive behavioral therapy emphasizes the importance of strategies for guided discovery in order to help the client recognize' and test their own beliefs through individual awareness and evaluation (Ellis, 2005). The goal of counseling in CBT is to gain awareness and change maladaptive thinking and dysfunctional behavior with the intention of alleviating internalizing problems and to teach the client how to become their own therapist (Johnson, & Friborg, 2015). The aim is to restore the overall functioning of the client by reducing the effects of the symptoms; or present problems (Mennin, et al., 2013). The efficacy of CBT is based on both client and therapist factors. Important factors that are distinct to the client are; personality traits, temperament, the motivation for treatment, and important life events that happen to the client throughout the time spent in the therapy process. The significant factors distinct to the therapist are; gender, age, education and training, personal style, competency, the ability to build rapport, and use of therapeutic techniques (Johnson, & Friborg, 2015). Cognitive behavioral therapy is problem-based therapy and the goal of treatment is to alleviate problems in cognition or thinking.
There are three types of problems that Aaron Beck recognized; the first is a long-standing problem that led to the creation of the internalizing disorder and still exists, the second is a problem that is caused by the internalized disorder itself and impacts the person’s ability to function, and the third type of problem is the internalized disorder itself; which creates distorted thinking and inhibits the development of the person (Mennin, et al.

2013). In order to correct or repair the problems, three things must happen. The first is to promote context engagement by utilizing new experiences to counteract old habits of maladaptive connections that have been reinforced. The second is changing attention by encouraging the client to refocus attention in various settings. Lastly, there must be a cognitive change in so that the client can adapt perception of various events in order to change the assigned meanings. (Mennin, et al.

2013).
Process and Techniques
Cognitive behavioral therapy is highly structured and has a very specific process of how a cognitive behavioral therapist should approach and conduct therapy. CBT helps improve the influences thoughts have on emotions and behavior through a variety of techniques. Cognitive behavioral therapy aims to complete three tasks throughout therapy; behavior modification, challenging automatic thoughts, and evaluating and changing core beliefs (Lorenzo-Luaces et al., 2016). Different cognitive and behavioral techniques are implemented into therapy to help clients in the process of restoring blind spots, distorted perceptions, and deceptions about themselves, others and the world (Beck, 1976).
There are specific factors that are commonly used in every cognitive behavioral therapy session. When using cognitive behavioral therapy the therapist should keep these factors in mind. The first is that the formulation of the problem or conceptualization of the case is constantly changing and adapting throughout the entire therapeutic process. The therapist begins to conceptualize the problem by looking at the client’s current patterns of thinking and how these patterns perpetuate the emotional disturbance. The therapist then examines the precipitating factors that influenced the client’s perceptions when the client began to feel the emotional dysregulation. Next, the therapist begins to make a hypothesis about important developmental