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What would you fix to make this fit APA format? Highlight all changes. Treatment Plan: LisaSuzy Michaels

Current Presenting Problem: Lisa is a 23-year-old patient referred to unknown clinic for mental health counseling. Currently Lisa is employed part time who presents with no physical abnormalities. Lisa's aunt is currently assisting financially, and Lisa is employed part-time as a retail sales associate. Currently Lisa is being prescribed an antidepressant and an antianxiety medication by her primary physician. Lisa reports that she was quiet during most of her educational years. Lisa reports that she was an average student in school. Lisa plans to attend college next spring. At this time Lisa is residing with her biological mother and has been for the last 2 weeks. Lisa recently moved out of her boyfriend's home after being assaulted by him, suffering a broken nose and several broken ribs. Currently Lisa is seeking mental health treatment for finding ways to cope with her history of abuse, current abusive relationship with her partner, and learn how to develop self-esteem.

History: At 9 years old, Lisa was sexually and physically abused by her biological father. At the age of 13 she started having self-harming behaviors; at the age of 15 she attempted suicide. After Lisa attempted suicide, she told her aunt about the sexual abuse and her father was arrested. Lisa does not have a relationship with her biological mother because her mother holds Lisa responsible for her father's actions. Lisa reports engaging in several abusive relationships and the onset of self-inflicted injury started.

Theoretical Approach: Behavioral Therapy (Cognitive-Behavior therapy) was introduced by Beck, according to Wenzel and Beck. Using this theory with Lisa could develop the following problems Lisa could feel like her emotions are being down played by the therapy. Lisa may have difficulty trying to have a positive thought process because her history has a lot to do with her life currently. Lisa will need to realize that her thoughts affect her behaviors and emotions this is the triangular formation that cognitively Lisa is doing. According to cognitive behavioral therapy a problem can develop but it can be resolved if Lisa can take her focus off of the thoughts that trigger her and learn how to think differently which will affect her behaviors and emotions (Wenzel and Beck). Lisa is currently having cognitive distortions which leads her to the all or nothing thinking, disqualifying thoughts that have meaning, overgeneralizing situations in her present with her past, and is magnifying/minimizing things (Farmer and Chapman). Lisa initially may struggle with this approach because of the commitment she needs to make to herself not only in session but outside of therapy.

Counselor's Commitment: As a CBT therapist looking at Lisa she does have the ability to have rationale thinking. Lisa currently has some maladaptive thinking going on because of Lisa's traumas in her past, which have long lasting negative emotions and feelings that she has not dealt with. Lisa has the ability to change these thoughts and interpret them in different ways. Our interpretation of our accounts in life contributes to the way we live, and Lisa is not able to interpret good thoughts. Moving forward as a therapist I will commit to being an active listener, direct, problem oriented a present centered therapist that will take an empirical approach with Lisa. Lisa will assist in creating the behavioral exercises that will address the changes in her thinking and feelings. Lisa will learn how to evaluate her thoughts and behaviors independently. Activity scheduling has shown to be a component in both cognitive and behavioral therapies to provide effective treatment for depression.

Lisa's Commitment: Lisa agrees to assist in identifying the problem, dispute her irrational thoughts about her boyfriend, mother, and herself. Lisa will be assigned homework to address her problem. The agreement that termination will occur is when Lisa has met her structured goals. Using this approach with Lisa could help in the following ways. Lisa could gain some ability to think independently about her goals and the things that she would like out of her life. Lisa will have the ability to guide her therapy by looking at her own thoughts, feelings and behaviors.

Interventions: Lisa will begin to realize that her past experiences have created a filter which her thoughts are formed now when an experience does not fit with the filter that she has created her thoughts become distorted. Lisa thinks that she shouldn't be treated well because this is the message she received in the past. Wenzel and Beck say that it's not the event which causes our emotions, but how we interpret that event what we think or what meaning we give that event or situation. CBT can help to break vicious cycles of negative thinking, feelings and behavior. When Lisa can see the parts of the vicious cycle clearly, she can change them and therefore change the way she feels. It can also be helpful for Lisa to pay attention to her thoughts and feelings affect our bodies. Lisa needs to make a commitment to want to change, create a safety plan, create a survival kit, create a reason for living card, utilize a treatment journal and be able to discuss the homework assignments.

Lisa will understand mindfulness vs. exposure, acceptance and mindfulness versus change. Lisa will learn not to have such intense feelings. Lisa has sought therapy with the goal of changing various aspects of her emotional experiences with the desire to experience less intense or less frequent "negative" emotions, and have more positive emotions.

Goals: Lisa will change her thinking and plan for future situations that will lead her to behaviors that are not safe. Lisa will have new ways to process her thoughts. In the end Lisa will learn how this thought process can lead to unsafe behaviors occurring and what she will do when her thoughts lead her to these feelings.

Case explanation based on CBT: Lisa's history of abuse physically and sexually has caused Lisa to have a poor ideal of her. Lisa's mother's denial of Lisa's abuse to left Lisa feeling guilty and ashamed. These thoughts have contributed to Lisa's poor self-esteem and her feelings of suicide. Lisa has not had appropriate therapy since her traumatic event she has also not dealt with her feelings surrounding her relationship with her mother. Lisa is now allowing herself to be physically assaulted by her partners because she cognitively believes that this is acceptable and she deserves it. Lisa has allowed her thoughts to control her behaviors. A form of operant conditioning would be effective with Lisa. Lisa has been taught that abuse in any form is acceptable and that she should feel guilty for the actions of others. Reinforcement, punishment, extinction, discrimination learning, and generalization are conditions that need to be changed. Utilizing problem solving training, social skill training, and mindfulness-based treatment in conjunction with the medication should help Lisa. Operant -Conditioning strategy that should be utilized changing the patterns of reinforcement and punishment, but add reinforces such as every time Lisa makes the decision not to self -inflict injury Lisa will give herself a reward that she chooses. Lisa will complete social skills training. The goal of the training will be to help Lisa learn new skills to be able to handle situations with an individual when in the past Lisa would have not stood up for herself and said what she was thinking she will now in an assertive manner. Lisa will be educated during her first session on depression, PTSD, and anxiety. Lisa will also learn about the treatment for her current behavioral and cognitive state.

What will change look like for Lisa: Lisa will be able to think about her feelings and realize that her emotions surrounding her thoughts will ultimately lead to behavior. Lisa wants to make change and will commit to her change by utilizing her safety plan. Lisa's safety plan includes using a thought record. Lisa will describe the situation, emotions/moods from 0-100%, the physical sensations, the unhelpful thoughts and images, Alternative/realistic thought, more balanced perspective, what I did what I could do in the future. This should be written out at night like a diary card. During the day Lisa will carry a written safety plan in her wallet. The safety plan lists 4 different things that Lisa will utilize as an immediate intervention to the thought. The safety plan can change as Lisa feels that things are changing for her and her needs change.

Outcomes: Lisa will continue to work towards becoming independent in her life. Lisa will continue to stay with her mother until she can financially support herself. Lisa does not want to build a relationship with her mother at this time, but is willing to address the things in her life and how she will move forward. Lisa will begin to become accepting of her thoughts and feelings and address them. Lisa will remember that all things are possible and some things can be replaced with positive thoughts, which will ultimately have better behavioral outcomes. 


Sources


In Behavioral interventions in cognitive behavior therapy: Practical guidance for putting theory into action. In Practical guidance for putting theory into action, by R.F Farmer and A. L. Chapman. , 2008, p. 251-278.


A cognitive model of suicidal behavior: Theory and treatment. In Applied and Preventive Psychology, by A. Wenzel and T. Beck., 2008, Volume 12, p. 180-201

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