Coursework: Clinical Formulation and Critical Evaluation.

Patient’s information and issues

 Patient's name: Peter.

 Age: 65 years approx.

 Occupation: Teacher for 45 years, currently retired.

 Marital status: Married.

 Spouse's name: Isabella.

 Current Problem: Peter feels extreme concern about his wife's cancer. He

expresses a feeling of worthlessness when seeing his children and grandchildren

do not seem to need it. The patient states: “The rest of my life is full of illness and

death. I feel half dead”

 History of the problem:

 12 months ago, Isabella was diagnosed with breast cancer.

 Sudden death of the best friend due to health problems.

Therapeutic Approach: Cognitive Behavioural Therapy (CBT).

CBT is the result of the second generation of behavioural therapy. This model

postulates that cognitions (beliefs, thoughts, expectations, attributions, among others)

are the causes of emotional and behavioural problems and, even more, that each

disorder has its condition, not to mention a specific cognitive deficit or dysfunction. The

treatment then focuses on the combination of cognitive and behavioural approaches,

building “a set of skills that enables an individual to be aware of thoughts and emotions;
identify how situations, thoughts, and behaviours influence emotions; and improve

feelings by changing dysfunctional thoughts and behaviours (Cully and Teten, p. 6).

From a therapeutic perspective, CBT usually focuses on working with the patient

to modify their dysfunctional thoughts, emotions, behaviours and physiological

responses to more adaptive ones to combat what is causing them discomfort. In this

way, it begins with guiding individuals to monitor and recognize their negative thoughts

that give rise to maladaptive behaviours and feelings. In the developed case, it is

possible to identify that the patient manifests a series of fatalistic thoughts related to the

death of his wife, in addition to distortions regarding his person of minimization and

handicap, which causes significant discomfort. For this reason, CBT has been selected

as a treatment model to dismantle these thoughts and distortions and change them for

adaptive schemes.

Case formulation

Peter exhibits signs of tiredness and lethargy, a sadness-oriented mood. He

shows emotional lability when talking about his wife's illness. Isabella, Peter's wife, was

diagnosed with cancer 12 months ago. Although she was treated on time and the

results have been favourable, Peter shows fatalistic thinking and hopelessness. There

are also signs of possible unresolved grief; Peter's friend of over 20 years, Carl, passed

away suddenly. Peter is angry because he thinks he could avoid the dead of his friend.

Peter has developed many maladaptive coping mechanisms for him, such as

blaming himself for the death of his best friend and excessively concentrating on

problem-solving. He has taken responsibility for his wife's treatment to such an extent
that it seems like an obsession. He developed extreme worry along with feelings of

worthlessness that he is not needed. He seems to have adopted a role of responsibility

in his family that generates anguish when responsibilities are diminished.

Succinct description and critical evaluation of the chosen modality

CBT has been selected as a treatment modality for Peter since the

predominance of his problems is the abundance of fatalistic thoughts, self-blame and

worthlessness. In this way, the following therapeutic objectives are proposed:

 Restructure maladaptive thoughts Socratic dialogue to verify them against reality.

 Learn and use thought testing and problem-solving to reduce discomfort caused

by unpleased situations.

 Plan and complete rewarding activities each week as part of behavioural

activation.

For the evaluation of the patient's progress, a series of tasks and assignments

will be proposed for the home that includes the record of the achievements obtained by

the patient, the difficulties that he has experienced and a record of thoughts and

feelings. In this way, the very experience of the patient will provide the fundamental data

for his progress evaluation.

References

Beck, J.S. (2011). Cognitive therapy: Basics and beyond (2nd ed.). New York: Guilford

Press; Chapters 3, 4.
Cully, J., Dawson, D., Hamer, J., & Teten, A. (2020). A Provider’s Guide to Brief

Cognitive Behavioral Therapy. Department of Veterans Affairs South Central

MIRECC, Houston, TX.

Cully, J.A., & Teten, A.L. (2008) A Therapist’s Guide to Brief Cognitive Behavioral

Therapy. Department of Veterans Affairs South Central MIRECC, Houston.

Eells, T. D., Kendjelic, E. M., & Lucas, C. P. (1998). What's in a case formulation?

Development and use of a content coding manual. The Journal of psychotherapy

practice and research, 7(2), 144–153.

Hertfordshire Partnership. (2012). Cognitive Behavioural Therapy (CBT) Skills

Workbook. University NHS Foundation Trust.

Jacobson, N. S., Martell, C. R., & Dimidjian, S. (2001). Behavioral activation treatment

for depression: Returning to contextualroots. Clinical Psychology: Science and

Practice, 8(3), 255–270

Kuyken, W., Padesky, C. A., & Dudley, R. (2009). Collaborative case conceptualization:

Working effectively with clients in cognitive-behavioral therapy. New York, NY:

Guilford Press.

Liese, B.S., & Beck, J. S. (1997). Cognitive therapy supervision. In Watkins, C.E., Jr.

(Ed.), Handbook of psychotherapy supervision. New York: John Wiley & Sons;

pp. 114-133.

Moreno, A. (2012). Third Generation Cognitive-Behavioral Therapies: Mindfulness.

International Journal of Psychology, 12 (1).

Persons, J. B. (2008). The case formulation approach to cognitive-behavior therapy.

New York, NY: Guilford Press.

Persons J. B. & Tompkins M. A. (1999). Cognitive-behavioral case formulation. In Ells,

T. (Ed.). Handbook of psychotherapy and case formulation. New York: Guilford

Press; pp. 314-339

Puerta, J. V. & Padilla, D. E. (2011). Cognitive-Behavioral Therapy (CBT) as a

treatment for depression: a review of the state of the art. Duazary, 8(2), 251-257.

Sperry, A. & Sperry, L. (2020). Case conceptualization: Key to highly effective

counselling. Counselling Today: A Publication of the American Counseling

Association.

Sullivan, M. J. L., Rouse, D., Bishop, S., & Johnston, S. (1997). Thought suppression,

catastrophizing and pain. Cognitive Therapy and Research, 21(5), 555-568.

Wilson, G. & Martin, A. (2015) Case Formulation in Cognitive-Behavioral Therapy: A

Principle-Driven Approach. Praxis. https://www.praxiscet.com/posts/case-

formulation-cognitive-behavioral-therapy-principal-driven-approach/
 Appendix
Case Conceptualisation
Clinical Treatment Plan and
Antecedents Behaviours Consequences
Hypotheses possible obstacles
12 months ago, Peter takes the Peter shows signs of Not feeling useful Restructure maladaptive
Isabella was responsibility for his tiredness and encourages the thoughts Socratic
diagnosed with breast wife's treatment to lethargy, a sadness- distorted thought of dialogue to verify them
cancer, and sudden such an extent that it oriented mood. He not being useful and against reality.
death of the best seems like an shows emotional necessary for his Learn and use thought
friend due to health obsession to her. lability, angriness and family and friends. testing and problem-
problems possible unresolved This in turn has solving to reduce
grief. been fuelled by his discomfort caused by
Peter used to help his He has stopped doing He developed helplessness in not unpleased situations.
sons with finances the things he likes, extreme worry along being able to help Plan and complete
and his grandchildren like fixing things and with feelings of his friend. rewarding activities
and friends with their pottery, feeling down worthlessness that he each week as part of
bike repairs. But that the most part of the is not needed. behavioural activation.
has stopped for a time. The patient may
while. generate resistance to
the strategies, so the
influence of his wife is
essential as the primary
circle of support
throughout the
therapeutic process.