Assignment 3

There is one specific intervention that I am continuously exploring with Bill throughout our time together which is known as cognitive behavioral therapy.  The goal throughout the cognitive-behavioral therapeutic process is to help Bill become more aware of his thought distortions which are directly related to some of his psychological distress.  One objective is to allocate where and what are the causes of the behaviors present and address triggers or patterns as a result of the distorted thoughts.  The client and therapist are encouraged to work together in order to compare these thoughts to those of reality and societal norms, functions and expectations (Mulhauser, An Introduction to Cognitive Therapy and Approach).  

Through research and readings, I have come to the conclusion that my attempt to change Bill's behavior will be unsuccessful unless I target the source of his distorted thoughts, as they are directly and consciously preventing him from exploring his social interactive possibilities. For example, during Bill's most recent hospitalization into a psychiatric ward, I along with many other staff members strongly encouraged Bill to attend group therapy sessions and activities.  We were aware that this would be unlikely, but are also aware that our encouragement is mandatory and crucial for his social explorations.  To our delight, Bill accepted our advice and attended a session where he met a nice woman who he fell in love with.  Bear in mind, that this behavior is one of his many frequent distorted thoughts, where he falls in love and later gets hurt by someone who is unavailable, but he fails to recognize this and believes that these women have feelings for him as well.  Soon after, the woman explained that she was married and stormed away by one of his brave propositions to express his want to become more intimate with her.  Bill immediately retracted and apologized but not before becoming emotionally and physically upset where it resulted in him returning to his room and refusing to return to any additional sessions at the treatment center.  When I asked him about this instance he explained that he had decided it would be better for him to stay in his room for ever so that he could prevent himself from getting hurt in the future.  


I have been exploring with the framework of cognitive therapy as it directly encourages the therapist to address the stimulus, thought, and emotion in the client.  This is also known as Ellis' ABC model where A is the event, B is the thought or belief about the event that occurred, and C is the feelings or emotions that result in the interpretation of the event and following belief (Mulhauser, 2010, An Introduction to Cognitive Therapy and Approach).  When applying this model to a person with a disability such as schizophrenia, and interpreting the client's distorted thoughts from the ABC perspective, delusions are B’s. "That is, they represent the erroneous belief about the antecedent event, and they may or may not be followed by an inappropriate emotional or behavioral consequence" (Malouf, 1996, Review of Cognitive Behavioral Therapy).   During my sessions with Bill, I have sat with him along with a piece of paper in front of us, where we attempt to identify the event that triggered his response.  I then ask Bill to explain as best as he can how that made him feel and how he responded.  We then return back to the segment where he is interpreting what happened and I put forth some scenarios and other possibilities that can contribute or be an underlying factor in the event.  Typically at this point, we discuss reality and what really happened, as many of his distorted thoughts are a result of his past experience and mental illness.  We explore additional options as to why this person could have reacted in that manner, which usually broadens his perspective on the event and elicits a different response as a result of having better understood the situation.  An example of this is when Bill and I are volunteering at a local nursing home where we visit with the residents and hand out books and magazines for entertainment.  Bill is a very friendly person who is always reaching out for someone to shake his hand or offer some physical comfort through a pat on the back, etc.  In the first months of our volunteer work, Bill would reach out his hand in an attempt to shake the other person's hand.  Some kindly accept as many are uncomfortable and reject this gesture.  Bill automatically reacts and withdraws himself saying that they hurt his feelings because they do not like him and do not want to shake his hand.  This leads to him refusing to continue and express his will to terminate future visits at this nursing home.  At this point I intervene asking him to share his feelings with me.  After he has vented I propose to revisit the thought as to why they did not shake his hand.  We explore possibilities such that maybe the person is religious and does not touch another person other than her spouse (since it is a Jewish nursing home), or the person is simply shy and uncomfortable in touching another person.  Some simply do not hear him when he greets them and are unaware that he even attempted to shake their hand.  After this, most of the time Bill can calm down knowing it was not a personal attack against him, but rather a private reason that may or may not involve him.  


There is significant evidence as to the positive effects this treatment can have upon a person who is capable of understanding and who possesses the will to accept treatment and ultimately a change. "Psychological treatment appears an effective procedure for reducing the impact of stressful psychotic experiences, improving patients’ social functioning and reducing family stress, in conjunction with psychopharmacological treatment" (Fernandez, O., Giraldez, S., (1999) Integrated Psychological Treatment in Schizophrenic Patients). The Brenner group conducted a study that tested the effect of integrated psychological theory (IPT), which is considered an offset of cognitive behavioral therapy, and reviewed the data to determine whether it impacted a patient's cognitive capacity and social perception.  The data showed that by adding cognitive and social therapy in addition to medication, known as pharmacotherapy, there are significant results in terms of improvement in cognitive abilities and growth as well as the ability to recognize and expand their cognitive patterns to avoid distorted thoughts.  "By connecting specific cognitive and social training subprograms to the cognitive and social deficits manifested by persons with schizophrenia, Brenner's group has provided hypothesis driven methods for the field and has brought new enthusiasm to practitioners and researchers alike who know that pharmacotherapy alone is inadequate to meet the comprehensive needs of individuals with schizophrenia"(Liberman and Green, 1992, Whither cognitive behavioral therapy for schizophrenia). 

Fernandez, O., Giraldez, S., (1999) Integrated Psychological Treatment in Schizophrenic Patients. Psychology in Spain. Vol. 3. No 1, 25-35

Liberman, R., Green, M. (1992). Whither Cognitive-Behavioral Therapy for Schizophrenia. VOL 18, NO. 1


Malouf, J. (1996). Review of "Cognitive-behavioral therapy for bipolar disorder" and" Cognitive therapy for delusions, voices, and paranoia". Psychotherapy: Theory, Research, Practice, Training, 33(4), 636-637. 


Mulhauser, G. (2010). An introduction to cognitive therapy and cognitive behavioral approaches. http://counsellingresource.com/types/cognitive-therapy/index.htmll. Accessed March 3, 2011.