COGNITIVE BEHAVIORAL PERSPECTIVE

Assess the Patient Using the Cognitive/Cognitive-Behavioral Perspective

Marc Schoendorf

University of Connecticut

Table of Contents

Case Summary3

Agency3

Patient3

Initiation of Services3

Presenting Problem4

Brief Case Summary4

Medical Issues5

Mental Status Examination5

Current Living Arrangement, Relationship Status, Work/School Situation, and Support System5

Family History6

Introduction of Theory6

The Behavioral Approach6

The Cognitive Approach7

Underlying Cognitive Schemas of the Patient8

Emotional deprivation8

Abandonment/Instability9

Mistrust/Abuse9

Functional Dependence/Incompetence9

Antecedents and Consequences of the Patient's Behavior by the Use of Cognitive or Behavioral Approach10

Antecedents10

Consequences10

Overview of Practice with the Patient11

Cognitive Behavioral Interventions12

Process Recording12

Critical Analysis of the Intervention13

Personal Understanding of Cognitive / Cognitive-Behavioral Theory in the Context of Person Environment14

Issues that should be considered in addressing psychotherapy of older adults15

Cognitive behavioral interventions16

Other Approaches in Psycho Therapies16

Humanistic therapy17

Holistic or Integrative therapy17

Relevance of Cognitive Behavioral Theory to Social Work Practice18

Conclusion18

Assess the Patient Using the Cognitive/Cognitive-Behavioral Perspective

Case Summary

Agency

The patient is on an inpatient unit for co-occurring disorders in a major city hospital. My role in working with this patient is that of a therapist. The patient was voluntarily admitted to the hospital and subsequently assigned to my caseload.

Patient

The patient is a 58-year-old single male, Caucasian, in the upper middle class social strata. Patient is heterosexual and Catholic and has a high school diploma. The patient has been consistently employed by the same company for thirty years and his economic strata have been consistent.

Initiation of Services

Social Worker Intern's first interaction with the patient was May 25th, 2012

Presenting Problem

Brief Case Summary

The patient was admitted to the hospital voluntarily from our Emergency Room. He had suicidal thoughts and ideations. According to available information, the patient started to feel significantly depressed about two months ago. This coincided with his relapse with alcohol. The patient reportedly had been drinking up to a quart of vodka on a daily basis. He reported that the only stressor he had at the time was the fact that he had injured his back and was having back pain. However, he reports that prior to that he felt his medications were “not working”. He has been seeing a psychiatrist in the community. Patient reports that his medications had been recently adjusted because of the poor effectiveness of the drugs, Effexor and Abilify. He was discharged from this setting in November, 2011. The medications were being tapered. Patient was recently started on Lithium. Patient reports that there had been previous failures with other medications. Patient has had ongoing psychiatric care on an outpatient basis. He has weekly sessions as well as medication management.

Patient at time of admission was feeling suicidal. He was actively thinking of killing himself by either hanging himself or using carbon monoxide poisoning. He called his previous clinician in this unit who in turn called 911 because of the patient's inability to commit to safety. The patient was brought to the Emergency Room by EMS. The patient was happy to be admitted. He cannot identify any other stressors that could cause the increase in his depression, suicidal behavior and relapse to alcohol dependence. The patient's presenting diagnosis was of major depressive disorder, recurrent, severe with psychotic features and alcohol dependence. He presents with dual ...