Cognitive Behavioral Therapy

 

 Part one: The scenario

The patient's name is Alexander Grey, and he is a 37 years cocaine addict. By the time it was noticed that he is struggling with substance use disorder he was showing all the symptoms of withdrawal such as a running nose, stomach ache, his pupils were dilated, he was always experiencing chills even when the weather was sunny, his heart rate was elevated and his blood pressure was also high. He was in good physical shape and showed no psychological problems. His wife is a calm woman and works as a fulltime teacher. They have two children together. His wife describes him as a reasonably calm man from the beginning but for the last six months he has been violent. The wife narrates how the mood of her husband changes allover sudden, at one moment he is polite, and the next moment he is angry at everyone and gets irritated by slight mistakes. The wife was always wondering what could be the cause of her husband's bad moods but one weekend she came home and found her husband sniffing cocaine on their bedroom table.  From that day, she has been pushing him to attend therapy treatment. In a span of six months since he started using, he had been fired from two jobs as a result of being late and picking up fights with his workmates.

 The child, Tom who is 14 years old describes his father as a man who has always been there for them. He always attended all the parents-teachers' conferences and all soccer games but for the past few months that have passed his father has not shown up at any of his soccer games and when asked why he is irritated and makes excuses all the time. The child also reports that the father has shown hostility towards him when he is left at home with him.  Three months after he started using cocaine, the performance of Tom has deteriorated in school. The first-time Alexander walked into my office he admitted that he was struggling with cocaine addiction. He is afraid that he will lose his family if he is not able to stop using cocaine. He openly admitted that he needed my help.

Part two: therapy

Taking Mr. Grey and his family through treatment is an essential part of helping him recover from his addiction.  The Cognitive Behavioral Therapy model is the one I will use to take them through therapy.  As seen from the client's condition, he has destructive and harmful thoughts, which is very much prevalent in people with substance abuse disorder. These negative thoughts patterns are harmful and destructive. Cognition is responsible for affecting the wellbeing of an individual and therefore helping the client, and in this case, Mr. Grey organize his ability to think alternatively to reduce distress and harmful behaviors such as picking up fights with his workmates is important (Center for Substance Abuse Treatment,1999).  CBT is a useful treatment model for people dealing with substance disorder since it is an active therapeutic modality; it is present-oriented, focuses on the problem at hand. Lastly, it is goal-directed. Also, I choose this CBT therapy because I like to focus on the psychiatric part of a dilemma and to develop a better understanding of the problem at hand and then develop a treatment program. Helping the client to become their own therapist with a dab of interpersonal therapy as well.

CBT is appropriate and helps explore the beliefs that make the client resort to destructive thoughts. This model also allows the therapist and the client to work together in identifying the harmful negative thoughts and helps to seek other alternative positive thinking.  CBT sessions are accompanied by other activities that are outside the sessions that help the client embrace the changes they are about to undergo and help them through the process of recovery, which is a lifelong process. CBT sessions can also be provided to individuals and group therapy. The skills of CBT are helpful, useful, and also practical and are easily incorporated into the everyday life of the client. It helps clients formulate coping strategies so that they can be able to handle potential stressors or difficulties that arise as they are being treated (Center for Substance Abuse Treatment,1999). All the above are reasons why I find the CBT model suitable to use as I take Mr. Grey and his family through therapy. 

            As mentioned earlier, the CBT therapy model is goal-directed. Using the CBT therapy model to help Mr. Grey and his family, there are initial goals that I hope to achieve. Goals such as keeping the family engaged during treatment, the family to understand how the treatment works. To offer high levels of support after undergoing treatment (Center for Substance Abuse Treatment,1999). Making sure that the patient is equiped with both behavioral and cognitive coping strategies that will help reducew his chances of relapse even after completing treatment.

During the initial session, I will explore the reasons Mr. Grey is seeking treatment and the extent to which his reasons to seek treatment are intrinsic or influenced by other factors. Using the information I will obtain from this initial session I will be able to come up with a treatment plan and identify behaviors to address during treatment. This session will give me an opportunity to asses the most dominant behaviors so that I can intervene with them first. This session will also allow me to know Mr. Grey's readiness to start his recovery journey. During this session, I will also go in-depth and learn the stressors that are pushing him towards using cocaine. During this session, I will negotiate with Mr. Grey to accomplish the goals that have been set.  The homework assignment of the first session is asking him to keep a journal like record of  how he feels when using the substance (Center for Substance Abuse Treatment,1999).

            During the sessions that follow I will introduce cue exposure training which will involve placing Mr.Grey in situations that have emotional cues associated with the substance he was using in order to bring about a robust physiological arousal reaction that brings about cravings, this I will do during one of our sessions. Cocaine dependent people such as my Client Mr. Grey have a habit of showing prototypical arousal and response the first time the drug-related cues are presented to them. Around the third session is when I will introduce the drug-related cue so that as we approach the 7th  session Mr. Grey will no longer be showing any physiological withdrawal and towards the 10th session he will no longer be experiencing cravings when cocaine is presented to him (Center for Substance Abuse Treatment,1999). I believe after presenting Mr. Grey with Cocaine related cues lowers his chance of dropping out of the treatment and will increase his chances of having cocaine-free days. In the later sessions, I will introduce the two significant people in his life, which is his wife and son in a few sessions. Since they are the people who are around him, and they need to be taught to positively reinforce Grey's addiction and also help him stay away from the substance. I will involve Mr. Grey and his family in developing a contingency contract that will help him reinforce positive behavior.

Also, in the sessions that follow, I will introduce coping strategies. These strategies can be in various dimensions; emotional focused or focused on avoiding the problem. These strategies will help with coping with urges, cravings, and temptations that arise when he is in an environment that will bring back the memory of how he used to feel when abusing the substance. I will also make sure I take him through anticipatory coping strategies so that he can deal with upcoming situations. This I will do by making sure that his coping skills are not, and thus, he will not be at risk of continuing to use the substance or relapsing. I will integrate both behavioral and cognitive coping strategies so as to strengthen his ability to resist using cocaine. Throughout all these sessions in the middle, I will make sure I bridge them together, and this I will do mostly using homework assignments (Center for Substance Abuse Treatment,1999). Homework assignments that I will give him in these sessions include collecting information on his feelings everyday and to test new beliefs.

 The therapy will last for 12 sessions, and each session will be carried out for in duration of one hour.  During the last session, we will tie all the loose ends and learn what the future holds for Mr. Grey and lastly help him get closure. End of treatment planning is very important, and it is something that I will have started in in the initial session. During this last session, we will review all the cognitive and behavioral skills Mr. Grey has learned. I will also take him through the tools he has learned in therapy and how he can use them to deal with potential stressors.  I  will also make sure I do not introduce anything new during this session since it may make it difficult to terminate the session. I will give Mr. Grey credit for his efforts in agreeing to come and getting through the therapy. The homework assignment for this session will be for him to plan a self-management time. Where he will be required to set a few minutes aside each week to check his mood and use the skills he has learned to solve his negative feelings to influence positive thinking. I will also take the opportunity to schedule booster sessions for him, which will be approximately one month after we have terminated the treatment (Center for Substance Abuse Treatment,1999). Over these booster sessions, I will help him refresh on the skills he had learned in therapy and check in with him about his self-management time and how he is managing stressors. 

 

 

References

Center for Substance Abuse Treatment. (1999). Brief Interventions and Brief Therapies for          Substance Abuse. Rockville (MD): Substance Abuse and Mental Health Services       Administration (US)(Treatment Improvement Protocol (TIP) Series, No. 34.) Chapter           4—Brief Cognitive-Behavioral Therapy.Available from:   https://www.ncbi.nlm.nih.gov/books/NBK64948/