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Following the referral letter and based on the description of the Diagnostic and Statistical Manual of Mental Disorders ((DSM-IV, 1994), Mrs Tan is diagnosed with clinical depression. She suffers from insomnia, feelings of worthlessness and inappropriate guilt. Thus, the most suitable therapy for her is Cognitive-behavioural therapy. Aaron Beck’s ‘Cognitive Therapy’ (CT) is one main stream of source for Cognitive-behavioural theory. An obvious characteristic of depression is when a subject continuously sees things around him in a dysfunctional manner.
According to Beck (1967), this is called the ‘negative triad’. These negative thinking patterns bring about symptoms such as a depressive disorder, affective, behavioural, somatic and motivational; traits observed in Mrs Tan. Mrs Tan is observed to have perceived and evaluated behavior because of the assumptions she makes through experience. However, these assumptions are not enough to aggravate clinical depression. Problems only arise when activating episodes occur and coincide with aspects of an individual’s personal system of beliefs.
Upon activation, dysfunctional assumptions lead to an increase in ‘negative automatic thoughts’. These will in turn lead to depressive symptoms such as withdrawal, anxiety and, guilt. Hence, rational thoughts are disrupted. It is a common misconception that depression is caused by negative thinking. According to the cognitive model, depression contains negative thinking itself. Mrs Tan’s low mood and self-neglect compound the problem, creating further lowering of mood. Cognitive behaviour therapy is a directive, structured, and psycho-educational approach. There are three main assumptions underlying CBT.
Firstly, emotions and behaviours are determined by thinking, secondly, emotional disorders result from negative and unrealistic thinking, lastly, by altering this negative and unrealistic thinking, emotional disturbances can be reduced. CBT requires the following procedures to be taught to the client. It is important to monitor the client’s emotional upsets and activating events; identify the connections between thinking, emotions and behavior; test out maladaptive thinking and beliefs by examining the evidence for and against them; identify maladaptive thinking and beliefs; substitute the negative thinking with more realistic thinking. Trower & Casey, 1988, as cited in Nichols, 2001) Symptom-relief is the immediate target of CBT. Here, the ultimate priority is to solve Mrs Tan’s life-problems and prevent future episodes of depression. The major goal is to aid Mrs Tan in making the transition to a person with confidence and trust in herself. There is no therapy which better suits Mrs Tan’s condition because CBT encourages autonomy, self development, and positive feelings about oneself; helps to re-channel rage, minimises the power differential between therapist and client (Wolfe, 1975).
Following are the descriptions of some typical irrational, self-defeating beliefs that are most relevant to women. In Mrs Tan’s case, these include assertive difficulties whereby Mrs Tan feels useless because her mum is kept at a nursing home. Guilt and self-blame because she feels guilty for eight year old son’s theft case in school. The assessment phase should begin with Mrs Tan’s perception of what was wrong with her and her thoughts about being diagnosed with clinical depression.
The following must be examined: the severity of Mrs Tan’s clinical depression and the effect it is having on her life, including factors which contributed to her mother being kept in a nursing home and her son’s theft case, negative thoughts about herself, Mrs Tan’s personal and social history, personality factors such as overweight issues, general health status; history of substance abuse namely sleeping pills. Next, Mrs Tan should be introduced to the concept of CBT as a treatment method.
She should be made receptive to the idea of rational and irrational thoughts and recognize their relevance to her own experiences. Intervention would be to ensure particular care is taken to prioritise dealing with her feelings of hopelessness, and negative expectations of treatment. Intention must be to assess Mrs Tan’s self-confidence level and intervene appropriately. Mrs Tan’s activity level should also be increased for assessment. Furthermore, to help Mrs Tan deal with the constant worry, she should be introduced to the technique of ‘stimulus control’.
To help Mrs Tan develop a philosophical foundation, she should be introduced to the concept of ‘enlightened self-interest’. This concept is based on the principle of looking after one’s own interests as well as others’ (Froggatt, 1998, as cited in Nichols, 2001). Self help work is also a very critical approach in CBT. It requires the client to do work between therapy sessions. It greatly amplifies the effectiveness of CBT as it enables lasting change in a short period of time.
The main purpose for this assignment is for Mrs Tan to be able to alter her emotions and behaviors by modifying dysfunctional beliefs instead of merely altering activating events (Froggatt, 1998, as cited in Nichols, 2001). By now, Mrs Tan condition should improve and therapy sessions can be gradually reduced. In short, CBT is most appropriate for this type of psychological model as it relates to the aetiology and illustrates the rationale behind it all.