FaithWorks, Inc. deprives its treatment models from a compilation of cognitive behavior therapy (CBT), exposure and response prevention therapy (ERPT) and motivational interviewing (MI) put forth by the Child Mind Institute. The Child Mind Institute is an organization that specializes in the proper and effective care of children who have been diagnosed with various mental health and learning disorders. According to Corsini and Wedding (2008), cognitive therapy is based on a theory of personality in collaboration through cognitive, affective, motivational, and behavioral responses. These responses are based in human evolution and individual learning history.
By reprogramming the way of thinking, emotions can be changed. The most effective course of intervention begins with CBT and simultaneously incorporating ERPT. Exposure therapy is different from traditional talk therapy it is the foundation for the engagement techniques while exploring the roots of the anxiety to ultimately rid the client of fear. While exposing the client to their fears, ERPT systematically desensitize one to their fear. Motivational Interviewing is an evidenced based empathetic way of being. MI suggests that most people hold conflicting motivations for change, and go back and forth about their degree of motivation and ambivalence. Although MI, has showed evidence-based research of effective engagement and intervention techniques it is short termed.
The main intervention suitable for the client is CBT. According to Hofmann & Smits (2008), the primary premise of CBT is the way one is thinking and the affect of how it makes one feel. A limitation for MI practitioners is deciding the appropriate time for transition and proper planning phases.Strategy, Goals, and ObjectivesThe client will participate in a 2 month outpatient intervention of 16 (60 min.) sessions. The first month would consist of 8 sessions of CBT and the second month ERPT for 8 sessions. MI will be incorporated upon the clinician’s evaluation.
The support is considered involuntary however, if the client does not complete the sessions, it is a great possibility that a move to a psychiatric facility would be a better fit. The objective of the intervention was to guide the client into effective ways to handle emotions and external events.The focus of the first session, MI, will be to build rapport, filter in CBT and discuss treatment expectations using a Faith Works self assessed scale.
The self assessed scale allows for the client to express what the most important belief as well as, assist the clinician with knowing where to start. It also helps the client better discern what her goals for treatment are in the second session. During MI two, the client and clinician discuss/write down those goals as well as the client’s motivation for them and the steps she will take to achieve them. In the beginning, Bianca was not receptive to the interventions. She believes that if she was to go back with her family everything will be fine; thus, her main goal for treatment is to adapt to her present by letting go of her past. She and the clinician discuss objectives or what needs to happen in order for that goal to be achieved. Bianca thinks that it would be helpful for her to learn more about the Smiths and participate in the weekly game night.
Additionally, Bianca does not believe that the Smith’s are her family; yet, the lack of social support triggers her social anxiety. Therefore, she and the clinician discuss her need for others in this process of change and wants Bianca to participate in additional group therapy improving her communication with her peers a goal and talking with someone for 30 minutes once a week an objective. Bianca’s goals for treatment are to adapt to her present by letting go of her past and to improve her communication with her peers. She will achieve these goals through the objectives of learning more effective communication, conversation starters as well as, working on her thought patterns, and communicating with peers at least once a week for 30 minutes developing healthy self talk. Intervention SkillsThroughout the therapy sessions the following three practice skills were used to help Bianca gain an understanding of her obstacles; active listening, reframing and MI. MI, as was stated earlier, is the therapeutic technique of enhancing motivation through normalizing ambivalence, rolling with resistance, and addressing dissonance between desired outcomes and contrary thinking/behavior (Hepworth et al., 2013).
MI is essential to working with involuntary clients because it creates an atmosphere of acceptance, empowering clients to make their own decisions about change. By allowing the opportunity for the client to control the atmosphere typically, yields a high completion results. Active listening means, as its name suggests, actively listening. The clinician is fully concentrating on what is being said rather than just passively hearing the message of the client. In order to establish effective active listening, the clinician must use all senses.
In relation to Bianca, active listening is essential as she fears she does not have any family and/or friends which trigger her depression and loneliness. By assisting Bianca with utilizing her strengths and ambitions it could assist with her social anxiety. The three step process of receiving a message, processing the message, and sending the message back to the client allowed for the clinician to remain open and conscious to both verbal and non-verbal messages that she may have been displaying.
Reframing is a technique used in therapy to help redefine problems as growth opportunities. When the frame is shifted, the meaning changes, thinking and behavior often change along with it. The clinician would advocate for Bianca to look at her situation through a camera lens by helping her to identify that refocusing a lens can change the whole perspective of the picture. For example, during one of Bianca’s sessions, she had experienced how Mrs. Smith is overly involved in her life. In attempting to shift Bianca’s negative view of Mrs.
Smith, the clinican offers the reframe: “Isn’t it loving of Mrs. Smith to want to get to know you?” It empowers clients to engage in self-advocacy, believing that they have the power to create change. Intervention Strengths and WeaknessesAs mentioned above, CBT is a research-supported approach with distinct advantages with clearly defined goals and clearly defined techniques. CBT offers a short term instructive approach to change. The time limit can be strength and a weakness especially in an involuntary client.
However, CBT main focus is getting better rather than getting better. On the other hand, MI provides the client with a sense of ownership but, does not address urgency for change. This disadvantage limits the client and the therapist especially in involuntary clients. Throughout the intervention process, there were some obstacles that the clinician faced. Bianca was not receptive for change she entered into the session with fear and lack of motivation however, the use of the engagement techniques were beneficial.
