conrad cbt

An Theory Integration Presentation by… Katherine Ashe, Victoria Adamczyk, Bobby Aiello, and Nick

Abdelahad

Conrad's brother Buck died in a boating accident and he blames himself for not being able to save Buck. He feels so guilty about it that he tries to kill himself and gets sent to the hospital for a few months to recover. It is recommended that Conrad continue to see a therapist outside the hospital now that he is back home and recovering. His father is more supportive of the idea than his mother is, who refuses to acknowledge anything that happened with Buck or Conrad in the past. Conrad, like Buck, is on the swim team, but doesn't seem to be enjoying it much anymore. He becomes interested in a girl at school, Jeanine, but isn't quite sure how to approach a relationship with her.

Mood check Setting the agenda Bridging from last session Today's agenda Homework Summarize the session Feedback from client

Goal = teach clients to change dysfunctional/irrational thoughts and behaviors, unconditional self and other acceptance

Make connections between irrational beliefs and how they lead to emotional disturbances

Teach clients to reframe their negative thoughts into more positive ones

Clients need to work actively outside of therapy – homework assignments

Self defeating behavior Knowingly do things that will cause him to fail

or start trouble

- Conrad keeps practicing with swim team even though he thinks he's become too slow

- starts a fight with a former teammate after a meet

Rational emotive behavior therapy Emotions stem from beliefs and reactions to

situations Dispute irrational beliefs

- believes he's responsible for Buck and Karen's death

- needs to be more like Buck, always living in his shadow

Self acceptance Needs to be able to accept himself before he

can accept others

- accept that he cannot change what happened with the accident, wasn't his fault

- once he realizes that, he can start having relationships with other people again

- accept his mother for who she is – doesn't show emotions, or talk about what happened

Activating event → belief → consequence

- Buck dies in boating accident → Conrad believes he could have saved him → tries to commit suicide because of his guilt

- Karen kills herself → Conrad blames himself for not seeing warning signs → becomes depressed and remembers how it felt when Buck died

- boys disturb talk with Jeanine → the date is ruined → Conrad doesn't open up to her anymore

Cognitive homework

- create a schedule for the week with events that he enjoys doing

- put himself in risk taking situation, trying to talk to mom about not opening up even though he may get blown off

Change language- re-frame sentences so they're not so negative

- Role-playing Act 1

Rational-emotional imagery

- imagine the worst things that could happen

- Conrad having to live with just his mother, he could have died in accident too

Role playing and Shame attacking exercises

- take a risk on something Conrad is afraid to do

- asking Jeanine out on a date, talking with mother about why she doesn't seem to love him

Role-playing

Activity scheduling/monitoring Allows for evaluation of automatic thoughts

and/or emotional shifts Can plan for specific events at specific times

that can bring pleasure to depressed clients

Role-playing Act 2

Creator of the Beck Depression Inventory (BDI) and the Beck Anxiety Inventory (BAI) Would have Conrad take the BDI after initial

session

Therapy is insight-focused: want to change the way clients think

Therapeutic relationship is necessary, but NOT sufficient

Therapist wants to encourage client to take an active role in self-discovery

Teach client how to be their own therapist

Emphasize how thoughts influence emotions and behaviors

“Personalized notions that are triggered by particular stimuli that lead to emotional responses” CBT therapist wants to identify and challenge

automatic thoughts

Some of Conrad’s automatic thoughts: Mom: “hates” him Buck: guilt/anger Blames himself when others feel negatively

about him

Personalization Conrad’s constant blaming of himself

Overgeneralization Buck’s death sends Conrad spiraling into a

world of guilt, blame, and depression

Selective Abstraction Janine laughing while on her date with Conrad

ruins his entire night

Should Statements “I should have died…” “I should have saved Karen…” “I should have held on to Buck…” “I should have told my parents I quit the

team…”

Correct dysfunctional thinking Buck’s death is Conrad’s responsibility Mother’s hatred is Conrad’s fault Conrad should have saved Karen Conrad is feeling survivor guilt

Modify erroneous assumptions If Buck had been stronger and held on he

would have lived If I had been with Karen I could have saved her

“What evidence do you have that supports your claim that your Mom’s treatment of you is your fault?”

“What do you think you could have done differently to help Buck? “…to help Karen?”

“How could you look at this situation so you would feel less responsible for Buck’s death?”

Role-playing Act 3

Main focus is the internal dialogue of the client…

Role-playing Act 4

Why Conrad would benefit -focus on how we interpret and react to events –

change the way that he viewed the accident and his relationships with his mother and Jeanine

continue with own therapy outside of sessions – homework assignments would be helpful to fit in activities he enjoys doing, making a schedule to get things back to “normal”

Why he wouldn't -not much focus on the past – he needs to talk about

the accident and figure out his feelings behind what happened and why