San Pedro College

Graduate School Studies

CASE CONCEPTUALIZATION: COGNITIVE BEHAVIORAL THERAPY ON THE

CASE OF CF15

A Course Requirement on
Advanced Psychological Counseling and Psychotherapy

Submitted by:

KENNETH R. ALQUINO, RPm

Master of Science in Clinical Psychology

Submitted to:

DR. ORENCITA V. LOZADA, RP, RGC, CSCLP

Professor

A.Y. 2022-2023
 CASE CONCEPTUALIZATION

Date: March 15, 2023 Case/Client #: CF15 - Sahara

Clinician Name: Kenneth R. Alquino, RPm

I. Introduction to Client

CF15 or Sahara: CF15 is a fifteen (15) year old teenager who lived with her parents and
a younger sibling in Puerto Rico. According to the reports, she had asthma, used
eyeglasses due to poor eyesight, and was overweight. Aside from her physical problems,
she had poor self-concepts, problems maintaining or making interpersonal relationships,
and had poor academic remarks.

II. Presenting Problems

As a Puerto Rican, CF15 valued the integrity of her family. However, when problems
pertaining to her parents’ marital status occurred, her depression symptoms exacerbated.
It was evident how she became affected by the marital problems of her parents. For
instance, she started having failing remarks in school and difficulties getting along with
her peers. Apart from the aforementioned, her other symptoms include: frequent sadness
and crying, increased appetite or overeating, guilt, anxiety, irritability, insomnia, and
hopelessness.
Upon conducting assessment, it was found out that CF15’s mother had a history of
psychiatric treatment for depression and anxiety. Her father, on the other hand, was
diagnosed with bipolar disorder and had been hospitalized on multiple occasions in the
past. Putting this information into consideration, there was a high probability that CF15
acquired a genetic vulnerability to depression. Hence, symptoms related to mood
disorders manifested when she encountered an extreme stressful circumstance.
III. Background Information

a. Traumatic/Abuse History
There were no sufficient information that can be utilized as evidence that CF15
experienced any kind of traumatic event in the past. Although the marital status of her
parents appeared to be unstable, it was not stated if domestic abuse occurred. Hence,
this domain is recommended to undergo further evaluation to determine whether or
not CF15 had a traumatic history.

b. Precipitating or Perpetuating Events

There were two circumstances where CF15’s depressive episodes manifested. The
first episode occurred when she was rejected by a boy whom she had romantic
feelings. The marital status of CF15’s parents was considered as the second
precipitating factor that contributed to the onset of her cognitive, emotional, and
interpersonal problems. Her parents had been separated several times, which made
CF15 anxious of the irrational thought that her father would never contact her.

c. Predisposing Factor
Upon exploring the family’s medical history, it was found out that CF15’s parents
had histories of psychiatric treatment. Her mother was diagnosed with depression and
anxiety, while her father suffered from bipolar disorder. Putting this information into
consideration, there is a high probability that CF15 acquired a certain gene that made
her vulnerable to depression.

d. Related Historical Concerns

CF15’s medical history revealed that she had asthma and used eyeglasses due to her
poor eyesight. Furthermore, her mother reported that CF15 had been previously
diagnosed with Major Depression three years ago. She was treated intermittently for
two years with anti-depressants and supportive psychotherapy.
IV. Strengths and Diversity

a. Social: CF15 had supportive parents. It was evident that her parents did not deprive
her with her basic needs and when her symptoms manifested, she received immediate
psychological evaluation.
b. Personal/Spiritual: There were no information regarding the spirituality and
personal ability of CF15 since it was was not assessed or explored. Ergo, it is
recommended to assess this domain to identify potential protective factors that could
help or increase CF15’s prognosis.

Diversity: Resources and Limitations

Unique Resources: CF15 was diagnosed with depression when she was approximately twelve
years old. She was treated with supportive psychotherapy and anti-depressants for two years. The
history of CF15 with regards to psychiatric treatment can be regarded as one of her unique
strengths. The combination of pharmacology and psychotherapy can increase the probability of
CF15 to progress positively.

Potential Limitations: Considering CF15’s culture, Puerto Rican values their family
relationships (Familismo) and its integrity. Thus, when her parents’ marital status became
unstable, she started to have depressive episodes. Another potential limitation that needs to be
taken into consideration are CF15’s interpersonal relationships and negative self-perception. It
was not determined whether or not there was an association between her culture and her negative
self-perception or her relationship with her peers. Hence, further evaluation is necessary.

V. Cognitive-Behavioral Conceptualization

a. Baseline Assessment of Symptomatic Behavior

Depression: Difficulties in making interpersonal relationships; persistent negative thoughts

about her appearance and scholastic abilities; guilt pertaining to her parents’ marital problems.
Furthermore, frequent sadness and crying, increased appetite, anxiety, insomnia, and difficulty
concentrating were evident as well.
Frequency: Although the reports stated that CF15’s symptoms were frequently manifesting, the
specific occurrence or rate was not identified. Hence, this domain is for further evaluation.

Duration and/or Severity: The duration or the severity of CF15’s symptoms was not
specifically determined. Although it was stated that she was treated intermittently with
psychotherapy and anti-depressants for 2 years, there was no enough specific information
pertaining to the exact duration or levels of depression CF15 experienced.

Contexts: There were no sufficient evidences or facts in which context the behavior took place.
However, it was stated that whenever CF15 experienced rejection and became aware of the
unstable marital status of her parents, symptoms of depression became apparent.

Events before: The first episode manifested when she was rejected by a boy, whom she had
romantic feelings. CF15’s most recent episode was when her parents’ marital status became
unstable.

Events after: To identify potential reinforcement to the occurrence of depressive episodes,

further evaluation is necessary due to insufficient information. The events after each episode
were not explored or assessed. Ergo, there was no enough information to clarify the triggers.

a.1. Baseline Assessment Chart

Below is a baseline assessment chart that will be filled by CF15 throughout the course of
the therapeutic intervention. The assessment chart below is specifically formulated in order to
monitor the progress and to evaluate the validity and reliability of the given interventions.

Note: CF15 will be asked to complete the chart (grey areas) throughout the whole duration of
the therapeutic session.

Symptom no 1: Depression – Inability to make or maintain interpersonal relationships; avolition;

lack of concentration; negative self-concepts; irritability; frequent crying and feelings of
hopelessness.
 Duration/
Session No Frequency Context Events Before Events After
Severity
Symptoms Severity: Triggers: Manifestations There was no
manifested unspecified (for Relationship - of Symptoms sufficient
frequently further depressive information
evaluation) symptoms often First: pertaining to
Specific rate or manifested if Romantic the events
occurrence was not CF15 received CF15 Rejection after each
Initial determined (for treatment for 2 experienced depressive
Assessment further evaluation) years rejection and Second: episode.
became aware Unstable Hence, to
of the marital parents’ clarify triggers
problems of her marital status of behavior,
parents further
assessment is
necessary
Sessions 1-3
Sessions 4-6
Sessions 7-9
Sessions 10-12

b. BASIC-ID

MODALITY ASSESSMENT/CLIENT’S FACTS

Irritability and overeating (atypical symptoms) were prominent behaviors to the case
Behavior
of CF15.
CF15 had depressive episodes, which were triggered by the unstable marital status of
Affect her parents. Her symptoms were avolition, feelings of hopelessness, and frequent
sadness and crying.
CF15 reported to have anxiety and irritability symptoms. She also had problems
Sensation
concentrating due to her heighten senses.
Although there was evidence that would support that CF15 viewed herself negatively,

Imagery further assessment is still vital to conduct. Thus, this domain is recommended for
further evaluation.
It is apparent that CF15 had cognitive distortions about herself. For instance, she
Cognition
would often jump into conclusions about the marital status of her parents. According
 to her, her negative thoughts were mostly related to the fear that her father would
leave and never contact her again. Moreover, it was specifically stated that she had
negative thoughts about her appearance. Thus, she displayed low self-concept.
CF15 presented difficulties in her interpersonal interaction. Although she tried to
Interpersonal engage into a romantic relationship, she was rejected in the past, which made her
Relationships
depressive symptoms manifest.
Antidepressants: CF15 was diagnosed with depression when she was approximately
12 years old. Hence, she was prescribed with antidepressants to deal with her

Drugs and Biology symptoms

Overweight, Poor Eyesight, and Asthma: CF15 was reported to be overweight. She
also wore glasses due to her poor eyesight and was diagnosed with asthma in the past.

KENNETH R. ALQUINO, RPM __March 15, 2023__

Psychologist-In-Training Date
CBT’s POPULARITY IN THE FIELD OF HELPING PROFESSIONS

Cognitive Behavioural Therapy is one of the psychotherapies that are widely known, even for
non-psychology majors or practitioners. Well, there are several reasons as to how this therapeutic
intervention climbed its way to popularity. For instance, many researches were conducted to determine
its efficacy. Hence, it became one of the psychotherapies that are well-researched and has robust
empirical bases. According to Brenner, Steglitz, and Witmer (2018), there were more than more than 325
clinical studies on CBT had examined how well therapy works for various diseases and demographics.
The therapy appeared to function in any age group and had scientific evidence supporting its capacity to
produce major, life-altering improvements in less time than other therapies.

Furthermore, Brenner and his colleagues’ findings supported Beck & Weishaar (2014) on their
statement that the popularity of CBT are due to the "excellent empirical support for its theoretical
framework and the enormous number of outcome studies involving clinical populations" are two factors
that contribute to its appeal. For instance, CBT has been shown to be beneficial for those with insomnia
as well as those who suffer from a physical condition that prevents them from falling asleep, such as pain
or mood disorders like depression (Trauer, Qian, Doyle, Rajaratnam, Cunnington, 2015). Moreover,
according to a 2018 meta-analysis of 41 trials, CBT assisted persons with anxiety and anxiety-related
illnesses, such as obsessive-compulsive disorder and post-traumatic stress disorder, by reducing their
symptoms.

WRITTEN CONTRACTS: STRENGTHS AND LIMITATIONS

A "counselling contract" (sometimes known as a "counselling agreement") is an understanding

between the therapist and the client that outlines the therapeutic working partnership. A counseling
contract guarantees that the counseling process will be carried out in a safe and professional way and
emphasizes the obligations of the counsellor toward clients as well as the obligations of the client towards
the counsellor. Another clear foundation for informed consent is a counseling contract (Darcy, 2021).

Strengths of Behavioural Contracting

Purpose: In cognitive behavioural therapy, therapist would use contracting as a technique. Behavioural
contracts, also known as contingency contracts, often take the form of written agreements that include a
treatment plan that must be followed by the client as well as any positive or negative actions that will be
taken in response to that plan's compliance or noncompliance. The fundamental ideas of operant
psychology serve as the intellectual underpinnings of behavioural contracts. The majority of behavioral
contracts are built on the A-B-C method, which involves identifying and changing "antecedents" to the
target behavior (A), the target "behaviors" (B), and the "consequences" or reinforcers that shape and
sustain behaviors (C) (Houmanfar, Maglieri, Roman, Ward, 2008).

Empirical basis: the effectiveness of behavioural contact was explored by Hunainah, Tarihoran,
Muslihah, and Riswanto (2020). According to their findings, Behavioural Contract had the ability to
improve psychological power in general, including Psychological Needs, intrapersonal competence, and
interpersonal competence. Based on the outcomes of these tests and the post-test findings, it can be stated
that behavioral contract counseling is helpful for developing students' psychological power.

Limitations

Ethics: Despite the benefits of behavioural contracts, it has its potential limitations. Behavioural contracts
were introduced into clinical practice due to “difficult patients” behaving inappropriately toward
healthcare providers. However, it has been pointed out that behavioural contracts pose ethical issues.
Understanding the psychology of individual patients and the weight of their mental illness is required to
comprehend why patients are obliged to act in unpleasant ways. Since they ignore these elements, use
unsuitable behavioural models, and promote stigmatization, behaviour contracts can disrupt the
physician-patient relationship. Ethically, the usage of behaviour contracts is unacceptable. From the
standpoint of patient-cantered care, healthcare practitioners must collaborate with diverse experts to ease
the obstacles that patients face in the healthcare context. Healthcare practitioners, in particular, can
consult with healthcare ethics committees and engage with social workers to respond properly while
taking cultural and social determinants of health into account. Such cooperative engagement would
reduce the likelihood of patients being seen as "difficult," but "difficult" patients might arise and escalate
their conduct to physical or sexual harassment even with such treatments. In these circumstances, urgent
action, including police involvement, is required to preserve the human rights of medical personnel (Ino,
Nakazawa, & Akabayashi, 2023).
REFERENCES

Brenner, B., Steglitz, J., & Witmer, J. (2018, November 20). Cognitive behavioral therapy: An in-
depth view. Therapy Group of NYC. Retrieved March 16, 2023, from
https://nyctherapy.com/therapists-nyc-blog/cognitive-behavioral-therapy-an-in-depth-view/

Carpenter, J. K., Andrews, L. A., Witcraft, S. M., Powers, M. B., Smits, J. A. J., & Hofmann, S. G.
(2018). Cognitive behavioral therapy for anxiety and related disorders: A meta-analysis of
randomized placebo-controlled trials. Depression and anxiety, 35(6), 502–514.
https://doi.org/10.1002/da.22728

Corey, Gerald. (2016). Theory and Practice of Counseling and Psychotherapy. 10th ed. BROOKS/COLE
Cengage Learning. Canada

Gehart, D., (2016). Theory and Treatment Planning in Counseling and Psychotherapy. 2nd ed. Boston:
Cengage.

Houmanfar, R., Maglieri, K. A., Roman, H. R., & Ward, T. A. (2008). Behavioral contracting. In W. T.
O'Donohue & J. E. Fisher (Eds.), Cognitive behavior therapy: Applying empirically supported
techniques in your practice (pp. 53–59). John Wiley & Sons, Inc..

Hunainah, Tarihoran, N., Muslihah, E., & Riswanto, D. (2020). Effectiveness of Behavioral Contract
Counseling in Improving Student Psychological Strength.

Ino H, Nakazawa E, Akabayashi A. Behavior Contracts in Psychiatric Practice and Everyday Situations:
A Psychological and Psychiatric Viewpoint. Psychiatry International. 2023; 4(1):12-17.
https://doi.org/10.3390/psychiatryint4010002

Trauer JM, Qian MY, Doyle JS, Rajaratnam SMW, Cunnington D (2015). Cognitive behavioral
therapy for chronic insomnia: A systematic review and meta-analysis. Ann Intern
Med.163(3):191. doi:10.7326/M14-2841