FOR ALL ONLINE STUDENTS WORK (UWS) 1. Complete this section Student Name LAUREN SAM Module Title CERTIFICATE IN COGNITIVE BEHAVIOURAL THERAPY SCQF Level (Level 8) Student Number 8808495 Course Title if different Your Tutors/Mentors name DR. NICHOLAS JENNER (Which may be the same) Date Submitted Email [email protected] Word Count As you are now submitting a piece of work to be assessed it must be clearly identified before your Mentor (Practice Portfolio Activity) or Tutor (Lesson Assignments, TMA) can give you feedback on it. Before emailing attach your piece of work to this front page. 2. Identify it as one of the following pieces of work, either 1. Practice Portfolio Activity Is it Activity 1, 2, 3, 4, and 5 Circle one. Or 2. Lesson Assignment Is it Assignment 1, 2, 3 Circle one. Or 3. Tutor Marked Assignment (TMA) Is it the final piece of course work Yes or No. Please note you must attach this page to the front of the piece of work that is being submitted to your Mentor or Tutor. If this front page is not attached to your work then your work will be immediately emailed back to you unmarked. This will delay your studies. I wish you every success with your studies. Neil Morrison Course Leader CERTIFICATE IN COGNITIVE BEHAVIOURAL THERAPY FINAL ASSESSMENT COGNITIVE BEHAVIOURAL THERAPY PRACTICE INTRODUCTION Cognitive Behvioural therapy (CBT) states it is a talking therapy. It benefits persons who suffer with different types of mental health issues. The way a person thinks can affect their thoughts and emotions. CBT practitioners assist every client in identifying and changing their irrational/ maladaptive thinking. This can help with breakthrough in the way a person may feel, think or react (Beck, 1964). It is said that CBT is the most effective type of psychotherapy for aiding gaming addicts. Cognitive and behavioural psychotherapies are a range of therapies based on concepts and principles derived from psychological models of human emotion and behaviour. They include a wide range of treatment approaches for emotional disorders, along a continuum from structured individual psychotherapy to self-help material (Beck, 1964). There are psychological problems associated with Internet gaming that are increasingly recognized as a global problem. In 2013 Internet Gaming Disorders (IGD) was recognized as a mental disorder similar to that of gambling. CLIENTS BACKGROUND 3 MARKS The consent statement, outlined below with the agreement of the client As the client for this exercise, I understand that I am not entering a contract for counselling. Rather, I am consenting to assist the student in their practice of counselling skills. I understand that he/she will help to explore one problem in this counselling exercise, with the clear goal of assisting the students learning. Clients Name Date 31/05/2018 Adams mother came to me asking for aid for her sons problem with video games. The mother stated her son was not going to school for the past month due to the amount of time he had been spending playing video games. Adam had been spending all of his time playing games where he was unable to get up for school in the morning and when he does not get his way he would throw a tantrum getting very angry, aggressive and make comments of wanting to kill himself. He spent less times socializing with friends/family and finds himself always in front of the computer. He is having problems differentiating the virtual world to reality. The mother had become very concerned whilst the father thinks it is just a phase and will go away as he gets older. His Mother asked him to attend the sessions and he agreed to seek help. Adam is a 15 year old adolescent who is an only child. He had a pretty normal childhood and growing up he had always gotten the attention of his parents being the only child. When he was 7 years old his parent became caught up in their careers which made them work late hours and that left Adam with a lot of free time, getting anything he wanted and losing the attention he got all along. He opened up about finding video games to be eccentric at first but gained a passion for what they stood for and it kept him occupied having no one else to play with. Adam said at first he enjoyed action/adventure and sporting games and his likening enhanced to more role-playing and simulation games which made him feel he was building his own world that gave him power and control. Adam is a very shy and quiet adolescent, he only speaks when he is asked a question other than that he would sit and listen. I could see from his demeanor he was very nervous and anxious and did not want to be in the room. I started the session by introducing myself and explaining matters of confidentiality. It took him a while to adjust and feel comfortable where he started off answering by saying what he thought he was expected to say and not saying how he actually felt. Some of the underlying problems with this client included he is a gaming addict he suffers with depression and anxiety which lead to suicidal thoughts. PRESENTING PROBLEM In using CBT the model of Ellis, (1996) rational emotive behaviour therapy (REBT) and Becks (1976) The A is the activating event. The C is the consequence that follows from A. The B is the belief of the person, recognizing their underlying maladaptive thinking. The activating agent and the belief trigger an emotional and behavioural consequence. Ellis (1996) proposes that the ability to change our thoughts, emotions and behaviours by choosing to look at our maladaptive beliefs. In this case Adam has a gaming addiction problem which is spiraling out of control. The transcript below reveals the activating agent is in fact rooted from his addiction which comes from not having his parents around to supervise him from a very young age, where he resorted to online games. To challenge Adams irrational beliefs the following techniques were used through homework exercises, Socratic questioning and keeping a daily record of dysfunctional thoughts – tracking his gaming time, behaviour and emotions. Although CBT has been proven to be effective with the treatment of gaming internet addictions, the standard nature of CBT does not allow the counsellor to target specific problems of the client. With Adam the problem of dealing with his gaming addiction would have been the main focus and after being resolved would he then be able to move on to resolve the other issues. His belief is the fact he thinks he does not have a problem which is common with clients. Self-denial is one of the first signs that would be encountered. He also thinks he isnt a good enough child to win the affections of his parents. Going through the process it is recognized that Adam is searching for love and affection and is not getting that from his parents so he focuses his attention on his video games. The consequences are, he will have issues communicating with his parents, socialising with others (Unsure of how to make friends apart from the virtual world), become isolated and suffer from anxiety and depression. I chose to use a CBT framework for intervention because it is a short-term, focused therapy (Fennell, 1989), has collaborative nature, and its highly structured and directive (Beck, 1964). I have confidence in that this would apply well to Adam, where he is missing organization and guidance in his everyday life. I would like Adam to change the way he feels about himself and the way he see his parents, help him to recognize his problem and reduce the urge to play video games and change the way he thinks by use of problem solving techniques and not getting angry when spoken to by his parents. CBT will help to modify Adams thinking and belief system (Beck, 1995) through making him aware of his thoughts, emotions and behaviours. TRANSCRIPT OF A PART OF THE COUNSELLING INTERACTION 30 MARKS MyselfAdam do you know why youre here todayAdamMy mom thinks I have a gaming problem but I dont. I only agreed to this so she would leave me alone.MyselfSo I hear you like games, how many hours do you game forAdamDont know could be 25-30 hours per week.MyselfDo you think that is a lot of time to be spending playing gamesAdamNo. Maybe a littleMyselfWhat are your favorite games What do you think you learn from gamingAdamMinecraft and Thief. I like Minecraft for the colors and creativity. It allows me to be better at problem solving and iteration. Thief on the other hand is all about stealth, quick thinking and again problem solving.MyselfDoes gaming make it easier to relate to other kids you know from school AdamWell, yes and no. It depends on who it is. If there are kids who enjoy gaming as I do, then yes but not always. On the other hand, like myself, it is a source of non-social interaction. I do not have any siblings, both parents are working and there is barely a conversation in the house. Those like me find relating to others difficult or simply not interested.MyselfWhat things in particular do you find fun about gamingAdamIt allows me to live a life in another world or a different time. I can become someone else and that is my escape from a reality that is sad and disappointing.MyselfWould you explain the way your favourite game works to me AdamThief is a fantasy game with a Gothic and Victorian setting. The main player is called Garrett master thief. He returns to his home city overrun and controlled by a tyrant leader. A plague has gripped the city and left it in a ravaged ruin. The rich continue to accumulate wealth and live in isolation while to poor struggle to survive. Missions include stealing wealth and gathering information about a seemingly unnatural plague. You can approach the game in a variety of ways from stealth to overt violence.MyselfWhat kinds of strategies are used AdamStealth, observation, problem solving and being cunning MyselfWhat are three non-gaming activities do you most like to do AdamI do enjoy reading fantasy books, gardening and going to museums.MyselfIf we were going to set up a schedule for the next week, what times would you think is reasonable AdamWell, I think a few hours on school nights are ok and I can play all weekend. MyselfWhat do you think you can do to help you cope better with you gamingAdamWell, ok, it would help if I had someone to do things together that we enjoy. I like going to museums. My parents on weekend are so busy and always on their phones. I think that might be a start.MyselfWhat are the things you do that help you be less upset when you have to stop gamingAdamI would go to my room and want to be alone or listen to music to calm down. I dont like when my mom tells me to stop playing I get very upset some times and I say things that I regret after but I feel like my parents dont understand me and only want to tell me what to do.MyselfAdam what I would like you to do for me next session, I would like you to do some homework fill out a questionnaire form and we will discuss your answers also I would like you fill out a table Daily Record of Dysfunctional Thoughts where you will log every time you game start time and end time and the feelings, emotions and behaviours. Are you clear Do you have any questionsAdamYes. Not at the momentEvaluation Beginning The Client is very anxious and agitated and does not want to be present at the session. He clearly feels he does not have a problem. I will try to make him feel more comfortable so he can express himself freely. For it to be an effective session Adam must know that he can trust me and what he says is confidential. Middle Adam lit up when the conversation started on video games and he began to talk a lot. In conversation you can tell that he is beginning to identify his problem through his expressions and he pauses a lot when answering. He is a very logical adolescent and catches on very quickly. Cognitive distortions in his thinking identified were all or nothing thinking, overgeneralizing, mind reading, magnifying/minimizing and emotional reasoning. End The main focus was the problem of his addiction to video games, when this is dealt with then the other issues can be concentrated on. At the end of the session Adam has realized his faulty thinking at the same time it is difficult for him to accept change. This is where homework exercises and keeping a record would help him better understand his thoughts, emotions and behaviour. THEORETICAL UNDERPINNINGS CBT permits addictive feelings and actions while incorporating new coping skills. Internet addicts in the early stages of therapy focuses on specific behaviours and situations where the control is the hardest part for the client. As therapy advances, it focuses on cognitive assumptions and distortions that have developed within the client. In one of the first studies for internet addiction, Young (2007) postulated that persons with negative core beliefs through internet addiction have problems overcoming their and observing failures. The following CBT skills were used for the client Acceptance this would help Adam face problems where he can modify and adjust to dealing with what is reality as to the virtual world he has surrounded his life to. He has to recognize what he has control of and what he cannot control. In CBT, acceptance skills can guide Adam to modify the reality that he can change and help in shaping his life in a positive way. Adam has to be mindful of his problem, willing to change through cognitive restructuring and being aware of his behaviour. Cognitive Skills Adams thoughts influence his behaviour and feelings. From the games he plays it has changed his thought pattern to be destructive to him and his relationship with others. It would be helpful if he can change his thought process to being positive by changing the games in which he plays to ones that can impact his life positively. Cognitive skills with acceptance, mindfulness and a willingness to change can help in Adam recognizing the way he feels. Mindfulness is an acceptance method in CBT. It speaks to an emotional situation that cannot be changed. In Adams situation it is the distancing relationship with his parents that occurred over a period of time, feeling alone and rejected. He would have to turn negative thoughts into positive thinking. Exposure Through exposure you learn to focus on your goals. Emotions are easier to deal with, less disruptive, and it boosts confidence. Through using this skill Adam would learn that accepting and engaging strong emotions is a necessary step in life. When emotions are suppressed and avoided in Adams case they last longer and stir up anger and rage, which can be dealt with effectively through motivation and mindfulness. Behavioural Activation CBT will help the client accept what can and cannot be changed, accepting the time-frame in which he can see change, to be mindful and keep judgments to himself. Motivation Enhancement CBT is meant to enhance your confidence and change the way you think, feel and behave. It would be helpful for Adam to join a group that would help him socialize with other adolescents who are going through the same situation. Therefore, he would be motivated to better cope with his gaming addiction. Also, his parents would play an important role in encouraging him to participate in outdoor activities and also speak positive words into his life. This would effectively help him to not want to stay home to play video games but to be open to new experiences through motivational enhancement. In CBT the use of setting S.M.A.R.T. goals can be very effective at the same time it has to be practical and attainable for the client. The goals must be specific, achievable, realistic and have a timeframe. As said above, CBT has been the most effective type of psychotherapy for Internet Gaming Addition for the following reasons CBT is a form of psychotherapy that stresses how significant it is to be aware of our thoughts and emotions, identifying how situations, thoughts and behaviours impact our emotions. CBT is time restricted, reducing indicators in a short period of time. Compared with other forms of therapy, cognitive behavioural therapy is a fairly short-term treatment technique. CBT is a planned process it is problem solving focused, and solution dedicated. CBT is well thought out and includes activities such as homework, Rational Emotional Behaviour Therapy (REBT) and Cognitive Therapy. It concentrates on the change in mind-set of the client to feel a sense of relief of irrational beliefs, cognitive distortions and maladaptive behaviours. CBT requires a combined therapeutic relationship with other psychotherapies such as Dialectical Behaviour Therapy (DBT), Exposure Therapy and Interpersonal Therapy and family therapy. CBT is evidenced-based, has a strong record of data that it is proven to work. While CBT strengths outweigh the weaknesses for gaming addiction there are still disadvantages that need to be considered If the client is not cooperating and committing to the process, the goals would not be attainable for the client. Not being present at the sessions and not attempting the homework exercises can restrict the client from receiving progress. CBT can be effective in the client recognizing their maladaptive thoughts, emotions and behaviours, this can cause stress and discomfort to the client preventing the client from progressing. CBT emphases on specific problems but cannot source the issue of someone who has experienced an emotional childhood. This is the issue of Adam his problems stem from years of isolation and parental guidance. The following core conditions were used on the client based on Carl Rogers (Roger, 1957) Empathy the counsellor must feel empathy towards the client. Through empathy, the counsellor can better understand the thoughts and the feelings to know what the client is going through. Silence is used as an essential tool to help the counselling process. Silence provides time that can effectively help in the process of listening instead of speaking too quickly. This can allow the client to see progress in their sessions also allowing the client to open up to the counsellor saying exactly what they are feeling and thinking. Congruence the counsellor must be genuine and be positive towards the client. This is important as it allows a bond to be built with the client. It also helps the client in changing the way they may think to being sincere and genuine. The client must feel valued, encouraged and be able to make decisions on their own. Unconditional Positive Regard for the client it can be a helpful to talk about their problems. Unconditional Positive Regard allows the client to open up and speak about their issues without feeling criticised or judged. EVALUATION On reflection, I have seen where I could have improved the session with the client by means of using more socratic questioning, being more direct in the questioning and allowing the client to take more initiative during the session. The therapeutic goals achieved were challenging Adams thoughts and restructuring his maladaptive beliefs for him to reduce his use of video games and build his social relationships. Also, achieved were coping techniques through scheduling and homework activities. Therapeutic relationship is used as a safe environment to establish effective results in the client. Through collaboration, is having a relationship with the client based on an equal organization. The therapist would use skills and processes, theories and techniques that would aid the client. The therapist should not have ideas or opinions on the status of the therapy session. The general goal is for the client to acquire results through the assistance of the therapist. Formulation of the issues and problems, through assessing of information within the CBT framework in compiling hypotheses and inferences from evidence based practice. Socratic questioning it is used to help the client think outside the box and reflect on his reasoning and thinking. It does not demonstrate that he is wrong rather the he discover new ways of thinking and recognizing the problems on his own. Homework helps the client when he is outside of the therapy, practicing what he has learnt to notice changes with his thought patterns, emotional thinking and behaviour. In closing, Cognitive Behavioural Therapy (CBT) is the most commonly used therapeutic approach for Internet gaming disorders. This therapy focuses on questioning and changing negative and destructive thoughts and beliefs to positive thinking by finding the behaviours and core emotions that lead to uncontrolled gaming. The therapy objectives are to track the gamers use and help him to reduce his usage of computers rather than in virtual realities. CBT Counseling can also identify impulse control issues and any other core mental health issues. Information was gathered through course material, online journals, websites and textbooks. REFERENCING Beck, A. T. (1964). Thinking and depression II. Theory and therapy. Archives of general psychiatry, 10(6), 561-57l. Beck, A.T. (1967). Depression Clinical, Experimental and Theoretical aspects. New York Harper Row. Beck, A. T. (1976). Cognitive therapy and the emotional disorders. New York International Universities press. Beck, A.T., Rush. AJ. Shaw, B.F., Error, G. (1979). Cognitive therapy of depression. New York Guilford Press. Beck, A. S. (1995). Cognitive behaviour therapy Basics and beyond. New York Guilford Press. Clark (Eds), Cognitive Behaviour Therapy for Psychiatric Problems. Oxford Oxford University Press. pp. 169-234. Cooper, M., McLeod, 1. (2007). a pluralistic framework for counselling and psychotherapy Implications for research. Counselling and Psychotherapy Research, 7(3), 135-143. Ellis, A. (1996). Better, Deeper, and More Enduring Brief Therapy The Rational Emotive Behaviour Therapy Approach. New York Brunner/Mazel. Fennell, M. J. V. (1989) Depression. In K. Hawton, P. M. Salkovskis, J. Kirk and D. M. Hollon, S.D., DGiuseppe, R. (2011). Cognitive theories of psychotherapy. In1. C.Norcross, G. R. VandenBos, D. K. Freedheim (Eds.), History of psychotherapy.Continuity and change (2nd Ed, pp. 203-241). Wills, F. (2008). Skills in Cognitive Behaviour Counselling and Psychotherapy. London Sage. Young K. S. Cognitive-behavioural therapy with Internet addicts Treatment outcomes and implications. Cyber-Psychology Behaviour. 2007 10671-679. This piece of coursework is my own original work and has not been submitted elsewhere in fulfilment of the requirement of this or any other award. Lauren Sam – 8808494 PAGE MERGEFORMAT 16 Page BUPNG j27VZUxSkooW9WzDyMURkzb_hh7F5QOZUkMD
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