Social workers need to understand theories that help explain the problems with their clients to determine the best assessment and interventions. A particular social issue may be approached using more than one theory. This paper will explore the application of theory to the assessment and intervention of a client with a depressive disorder during fieldwork.
Client Identification
The client whose case will be assessed and intervened through the application of theory is a single mother of two. Juana is a 41-year-old mother of girls. Her oldest girl, Cathy, is 9, and her second born, Marie, is six. She had divorced two years back, and she was living in a small apartment with her two children. The client is a member of the Orthodox Church. The first time one contacted Juana, she noted that she disliked talking much to people she did not know. She had low esteem and got angry quickly when asked about the mischievous behaviors of her two children. She seemed anxious and depressed, and during the conversation, she concentrated much on the negative issues. Her volume and tone were normal, but she was reluctant to answer some questions. However, after contacting her several, she became cooperative and answered questions precisely and clearly.
Theory Application to Client’s Case
Based on the behaviors of Juana, it was clear that she was suffering from moderate depressive disorder and anxiety. She was still disturbed by the thoughts of her broken marriage, and in one instance, she blamed herself. One theory that can be applied to address Juana’s case is cognitive behavioral theory. According to his theory, individuals’ responses to situations are influenced by their cognitive processes, such as the meanings and assumptions they make (Huguet et al., 2018). The individual response to these situations can be positive or negative depending on the meanings and assumptions they make about them. Cognitive behavioral theory can help assess Juana’s condition and develop the most appropriate intervention.
Assumptions of Cognitive Behavioral Theory
Cognitive behavioral theory has several assumptions which are agreed upon by experts in the field of psychiatry. One of these assumptions is that appropriate practice and training can eliminate cognitive problems even when the involved person is unaware of the specific beliefs and thoughts. The theory also assumes that the processing of information by humans can be faulty even though we are information processors. This assumption is crucial in the context of the client because the problems he is going through relate to how she processes information (Dobson & Dobson, 2021). The third assumption is that an individual’s thinking mediates one’s response to the environment. The theory also assumes that it is possible to modify an individual’s cognitions to make them balanced and rational (Dobson & Dobson, 2018). Cognitive behavioral therapy is based on these assumptions as it aims to alter a client’s cognition to make it more balanced and rational.
Application of Cognitive Behavioral Theory in Fieldwork
Cognitive behavioral therapy forms the foundation of many interventions that are applied in the field of psychiatry. Some of these interventions include cognitive behavioral therapy (CBT), rational emotive therapy (REBT), and mindfulness-based cognitive behavioral therapy (MCBH), among others. These interventions focus on helping the clinician overcome negative thoughts and behaviors that cause their mental health issues (Dobson & Dobson, 2018). They help clients learn how to deal with triggers, manage stress and anxiety, set realistic goals, engage in positive activities, and embrace a positive mindset.
The interventions based on the cognitive behavioral theory have been proven helpful in patients with cognitive disorders. These interventions are applied alone or with pharmacological ones, depending on the severity of the symptoms of the mental disorder. Many studies have been conducted to determine the effectiveness of CBT in the treatment of mental disorders such as depressive disorder, post-traumatic stress disorder (PTSD), and anxiety disorders, among others (David et al., 2018). David. Moderate depression and anxiety disorder have been treated successfully using CBT. In the case of severe depression, CBT can be used together with pharmacological options or with other nonpharmacological therapies, such as psychodynamic therapy. Most of the cases that one engages in during fieldwork involve counseling clients. The client in the case study suffers from anxiety and moderate depression, and the two conditions can be treated successfully using CBT.
Cognitive behavioral theory has some limitations, just like other theories. One limitation is that CBT is less effective compared to other treatments, such as the use of antidepressants. Most CBT studies have follow-ups of one year or less, making it difficult to ascertain whether it can treat mental illnesses in the long term. Another important limitation of CBT is how it requires patients to commit themselves to the treatment to succeed (Lake &Turner, 2017). In the case of patients without motivation or uncooperative ones, the treatment may not be successful. The mood changes, and attitudes associated with depression may make some patients unwilling to commit themselves to the treatment. CBT can exacerbate anxiety and emotional instability among clients as they attempt to confront them in the process of self-healing (Kazantzis et al., 2018). Lastly, the treatment does not address all mental health conditions, such as schizophrenia and other personality disorders, giving it limited application.
CBT is the best intervention to address the mental disorders with Juana, the client in the case study. The client’s behaviors, including restlessness, suggest that she has anxiety and moderate depression. One had to ascertain the client’s demographic information, including social and economic status, gender, religious identity, and ethnicity, to apply therapy effectively. The intersectionality aspects of the clients were also obtained during the assessment (Sheehan et al., 2017). Juana’s risk factors for developing anxiety and moderate depression were contributed by the fact that she was not financially stable, had been divorced by her husband, and was struggling to raise her two children alone. She had no stable job and kept fearing what would happen to her children if she happened to get sick. These intersectionality factors contributed to the mental condition of the client. One applied CBT to the patient and established goals that she was supposed to achieve as part of the treatment. The patient has to take an active role throughout the therapy and provide all the resources and support the client needs to get well. Each goal was accomplished at a time to avoid overwhelming the client with too many tasks and exacerbating her condition or paving the way for other mental illnesses. The first goal was to help the client identify the factors that triggered her symptoms and learn to cope with them. After accomplishing this goal, the client was expected to connect her behaviors with her feelings and speak about them without fear (Lake &Turner, 2017). The next goal was to help the client improve her parenting skills, including how she talks to her children and responds to them when they misbehave. During the first contact with the clients, she was shouting at her children and used abusive language towards them when annoyed. Her poor parenting skills were the cause of their mischievous behavior.
The following steps were taken as part of the therapy to help the client:-
- Identify life situations troubling Juana, including the current and past.
- Helping her become open about these situations and talk about her emotions, beliefs, and thoughts without feeling ashamed.
- Identifying factors contributing to problems, including behavior patterns and negative thoughts.
- Stop perceiving situations wrongly and avoid negative thoughts.
Process Recording of a Session with Juana
Me: Hello, Juana. I want us to take a few minutes and discuss life situations troubling you to determine how your thoughts and emotions are connected.
Juana: I know you might take me wrong because of what I will say about life situations troubling me. I feel bad when my children annoy me. They make me remember the old days when we lived with their father. I am worried that they remind me of the bitter past instead of bringing happiness into my life.
Me: What makes you connect your children with your former husband?
Juana: I don’t know. I think it’s because they look more like them than I do. They remind me how their father mistreated and quarreled me.
Me: What thoughts do you have when that happens?
Juana: I think that I’m not a good mother at all. I think I’m an awful mother who does not like her children.
After Juana answered all the questions, the first intervention was applied. The intervention sought to help Juana identify the negative thoughts. “I think I’m not a good mother. I think I’m an awful mother”.
Me: Thinking that you are an awful mother is an automatic thought. This thought comes automatically and can affect how you act. It can manifest in many ways, including physically, making you cause harm to your children. Thinking that you do not do enough for your children can be emotionally devastating. We need to question the validity of that thought. So, tell me, how does thinking you are an awful mother affect you?
Juana: It makes me sad and stressed. I feel angry at my estranged husband or children. I feel that if it was not for them, my life would be better because I would have moved on after their father divorced me. My mood is mostly gloomy, and it feels like I want to spend time alone.
Me: Thank you. Now, just think about how it would be if you changed your thinking pattern.
Juana: If I think I was the best mother?
Me: Yes.
Juana: I would be happier and lively. The stress level would be reduced, and I would stop yelling at my children.
After the first intervention was complete, the next kicked off. The intervention included questioning the validity of the negative thoughts with Juana.
Me: Now I want to ask you something.
Juana: Okay. You are free to ask.
Me: If you are a terrible mother, would your kids be in school and healthy? Would they be happy?
Juana: No.
Me: If you do not love your children, you would not even consider yourself an awful mother.
The final interventions involved challenging the client’s belief that she is an awful other. I reshaped her negative thoughts and introduced new ones to make her perceive things from a different perspective. The main purpose of the recording above was to make Juana express her thoughts, identify the triggers, and question the validity of her thoughts. By the end of the sessions, the client verbally expressed her feelings and identified the possible things that troubled her. She identified the triggers and negative thoughts, and she was then ready to cope with them. More sessions were needed to help the client deal with her situation more effectively. Clinical interventions such as interpersonal, group, and individual therapy were necessary to facilitate the recovery of the client. It was also necessary to provide the clients with resources such as self-help books and internet resources to give them more ideas on how to deal with their condition. Another important thing that should be incorporated into the intervention is to connect the client with patients with similar problems who are taking the therapy (Karyotaki et al., 2021). Interacting with other patients with moderate depressive disorder and anxiety enables the client to share ideas with people facing similar challenges in life and understand their condition as not being unique to them alone.
Suggestion of Cognitive Behavioral Therapy (CBT) by the Agency
CBT is a major therapy applied in social work in the agency where one works. Many of the clients that one serves suffer from anxiety or depression. These clients are mostly found in the family therapy section. Therefore, the intervention aligns with the philosophy of the agency. CBT is considered the best therapy for depression and anxiety in the agency because it can be used in group and individual settings, making it available to family and persons (Lake &Turner, 2017). All the therapies applied by the agency must be approved by the relevant professional organizations such as the American Psychological Association (APA). The agency does not utilize some approved therapies if deemed less helpful to the clients. The psychodynamic theory is another theory that can be applied in place of cognitive behavioral theory. The psychodynamic therapy has been proven effective in the treatment of severe depression. The focus of the therapy is to help the client gain self-awareness. Psychodynamic theory also helps the client understand how the past influences current behavior. In the case of Juana, the theory can help explain how Juana’s husband’s inability to connect with her could be the reason for her poor emotional connection with her kids. Despite the benefits of the therapy in treating severe depression, the agency does not use it because it cannot provide long-term treatments for mental illnesses.
In conclusion, psychological theories provide the foundation of assessments and interventions for mental health illnesses such as depression and anxiety. The theory helps explain the interplay between various factors contributing to a client’s condition. The theory applicable to the client’s case discussed in this paper is cognitive behavioral theory. This theory was chosen because it is linked to the most effective short-term intervention for moderate depression and anxiety. CBT has been proven effective in treating the mental health condition of the client. Another therapy that could have been used in place of CBT is psychodynamic therapy. However, this is not suitable for short-term treatment of Psychiatric disorders. CBT can also be administered together with pharmacological interventions to increase its effectiveness.
References
David, D., Cotet, C., Matu, S., Mogoase, C., & Stefan, S. (2018). 50 years of rational‐emotive and cognitive‐behavioral therapy: A systematic review and meta‐analysis. Journal of Clinical Psychology, 74(3), 304-318.
Dobson, D., & Dobson, K. S. (2018). Evidence-based practice of cognitive-behavioral therapy. New York: Guilford publications.
Dobson, K. S., & Dozois, D. J. (Eds.). (2021). Handbook of cognitive-behavioral therapies. New York: Guilford Publications.
Huguet, A., Rao, S., McGrath, P. J., Wozney, L., Wheaton, M., Conrod, J., & Rozario, S. (2016). A systematic review of cognitive behavioral therapy and behavioral activation apps for depression. PloS one, 11(5), e0154248.
Karyotaki, E., Riper, H., Twisk, J., Hoogendoorn, A., Kleiboer, A., Mira, A., … & Cuijpers, P. (2017). Efficacy of self-guided internet-based cognitive behavioral therapy in the treatment of depressive symptoms: a meta-analysis of individual participant data. JAMA psychiatry, 74(4), 351-359.
Kazantzis, N., Luong, H. K., Usatoff, A. S., Impala, T., Yew, R. Y., & Hofmann, S. G. (2018). The processes of cognitive behavioral therapy: A review of meta-analyses. Cognitive Therapy and Research, 42, 349-357.
Lake, J., & Turner, M. S. (2017). Urgent need for improved mental health care and a more collaborative model of care. The Permanente Journal, 21.
Sheehan, D. V., Nakagome, K., Asami, Y., Papadopoulos, E. A., & Boucher, M. (2017). Restoring function in major depressive disorder: a systematic review. Journal of Affective Disorders, 215, 299–313.
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