Introduction
Cognitive Behavioral Therapy (CBT) is psychological and procedural care given to treat problems such as depression, drug use, anxiety disorders, marital issues, and acute mental illnesses among others. CBT has proven to be effective in improving human quality of life and functioning. Compared to other forms of psychological therapies and medications, CBT is better in giving results. The CBT treatment approach seeks to examine people’s thoughts and behaviors to understand their problems. This paper employs Elli’s ABC model and Beck’s cognitive approach to evaluate the conceptualization case. Various interventions, related perspectives, and CBT limitations are discussed in the paper in relation to solving an Instagram user’s sexual behavior and perceptions. The use of CBT, in this case, will provide an effective solution for the man to deal with his problem. Although CBT and therapists have their limitations, the approach is an effective treatment to resolve depressive and careless sexual behaviors of the client.
Case Analysis using Elli’s ABC Model and Beck’s Cognitive Theory
Elli’s ABC Model
The basic idea behind this model is that external events cause no emotions, but irrational beliefs do. In other words, people’s behaviors and emotions are not directly influenced by life events but how the events are cognitively processed and examined (Matweychuk & Dryden, 2017). The approach is based on three core aspects including, A for activating events or rather things that happen around an individual and B for belief or the causes of events that make an individual believe either rationally or irrationally (Bennett & Turner, 2017). The third concept is C for consequences or the results of the belief, either healthy for rational or unhealthy for irrational beliefs.
In this case, the external life events include the use of dating apps, working late as a salesman, and being left by a girlfriend. The Instagram user believes that he needs intimacy but not love and that he has to engage in sexual intercourse to feel at ease. He also believes that his urge for intimacy began after separating from his girlfriend and that he is addicted to sex. The consequence is the insatiable desire to engage in sexual intercourse and deteriorating health. Leaning on the ABC model, visiting the dating apps, or being left by the girlfriend does not make the male have sex with multiple partners but the belief that he needs intimacy without love. Therefore, the Instagram user could visit the dating sites and still not engage in sexual activities.
Beck’s Cognitive Theory
The theory states that the way people understand their experiences impacts their behavioral, psychological, and emotional reactions. Beck considers symptoms such as the negative perception of the world, future, and self are features of depression (Wills, 2021). The central idea of this theory is that human thoughts influence their behavioral and emotional experiences and vice versa. In providing the solution, the approach majors in changing one’s thoughts through altered behaviors and feelings (Wills, 2021). Its three core aspects include self, world, and future, which are posited negatively by a depressed person. The three aspects used negatively imply an individual’s thoughts which affect behaviors.
In terms of self, world, and future, depressed individuals believe that they are inadequate or defective, their outcomes are failures or defeats, and that their future is hopeless respectively. In the concerned case, the male feels that he is an ‘animal, a waste, and a fuck boy.’ He feels to have failed as a boyfriend and is also failed as a sexual partner. Furthermore, the man cannot see a clear future as he feels empty, suffering, and his health is getting worse. From Beck’s cognitive theory perspective, the client is showing subjective signs of depression.
Why CBT is a Good Choice for The Man
CBT examines one’s thoughts to understand their behavior and modify the patterns of thoughts to change concerning behaviors and moods. The therapy is suitable for the male because it is based on concepts that negative feelings and actions result in distorted thoughts and beliefs, mostly influenced by unconscious past events (Fowler et al., 2021). CBT blends cognitive and behavioral therapy to create a more effective form of treatment. Cognitive therapy focuses on thoughts and moods while behavioral targets behavior and action.
Beck’s cognitive theory recognized the man’s case to reveal symptoms of depression. CBT is used in depression treatment to provide more constructive and balanced ways to deal with stressors (“The cognitive-behavioral approach,” n.d (a)). The positive ways help to eliminate or minimize the troubling disorder or behavior. Furthermore, the principles of CBT can be applied outside the office setting, for example, online counseling. The therapy will be used for the man to help monitor and manage his depression signs and adopt new healthy behaviors and thoughts.
Setting Therapy Goals for Client
Setting the client’s goal involves four steps including identifying the goal, picking a start point, developing steps, and getting started. The goal here is to promote emotional intelligence and self-awareness through teaching the client to identify and understand their emotions to separate healthy from unhealthy ones (“The cognitive-behavioral approach,” n.d (b)). The counselor will alter and develop target behavior, a positive and healthy behavior. The counseling will help the client understand how perceptions and negative thoughts are attributed to suffering. The start point to follow in attaining the goal is to apply various treatment interventions. Various counseling sessions as determined by the therapist should seal as steps towards achieving the goal.
Treatment/Intervention Plan
The client expects the counselor to provide solutions that meet his goal of recovery. The client’s primary goal is to understand his behavior, thoughts, and state of his health. Mainly, the client needs help in structuring the main problems which are the insatiable desire for sex and the recovery of his health. The therapist should take the lead in teaching the client some problem-solving skills to help him navigate his situation (Fowler et al., 2021). Furthermore, the client needs to find a way of structuring his thoughts, so they cause less suffering. A piece of advice from the counselor will guide the client on which health care he needs for his worsening health condition. The following three interventions will be used to deliver solutions to the client’s problems.
Cognitive Restructuring
Cognitive reframing involves thoroughly examining patterns of negative thoughts while aiming at changing the way one thinks. Mainly used to manage stress, the goal is to replace cognitive distortions with balanced thoughts that do not produce stress (Waterman et al., 2019). This CBT technique shows the understanding that negative thoughts may grow entrenched and interfere with the achievements, relationships, and general well-being of individuals (Waterman et al., 2019). By combining several tactics, cognitive reconstruction provides ways of interrupting and redirecting self-defeating and destructive thought patterns through several steps.
The first step involves examining the validity of the client’s beliefs and thoughts. Positive therapy encourages counselors to validate clients’ thoughts by listening and reflecting without judgment. Validating clients’ thoughts and beliefs create a positive counseling environment for the client (“The cognitive-behavioral approach,” n.d (c)). In this case, the counselor will reflect the client’s information without sounding judgmental. The second step entails examining clients’ expectations and how they interpret their behaviors as well as those of others. At this point, the therapist allows the individual to self-monitor and self-evaluate while evaluating other people’s behaviors.
The next step involves exploring the possible cause of the client’s reactions and behaviors. The counselor reflects on the client’s problem and lists possible causes of their behavior while narrowing it down to the most probable causes (Wills, 2021). In the client’s case, the therapist will determine the possible cause of sex addiction and negative feelings towards self. After realizing the possible causes, the counselor teaches the client about making effective attributions of the causes. Instead of allowing the causes to lead to negative beliefs, the client learns how to positively make them productive (Wills, 2021). Finally, there comes a need to change the distorting ways of thinking. The therapist trains the client in positive ways of thinking about self, present, and the future.
Guided Discovery
Guided discovery therapy involves dialogues formulated to help clients find solutions to their problems. This problem-solving method helps people to develop skills to cope with challenging situations (Waterman et al., 2019). The counselor allows the client to reflect on their way of processing information. By answering questions and reflecting on thinking processes, a range of alternative ways of thinking is opened for the client. Here, the therapist assumes the perspective of the client and asks them questions that challenge their beliefs while broadening their thinking approaches (Waterman et al., 2019). Evidence to support the client’s assumptions and that which does not support them are given to the client. The aim is to let the client know that they can switch to various actions while relying on the same way of thinking. Thus, the clients are helped to choose more helpful paths, hence avoiding the harmful ones.
In the case of the Instagram user, guided therapy would be used to help him find other ways of reasoning and acting. The therapist will ask him questions like, “What do you do on the two days of the week when you have no sex? “Can you read other materials other than sex-related ones? And “can you have intimacy without being in love with someone?”, such questions are meant to challenge beliefs like, to feel at ease, the client must engage in sex, that he is looking for intimacy in sex and not love, and that he is always interested in reading sex-related materials. By answering such questions, the client will have a different perspective and way of thinking.
Exposure Therapy
Exposure psychological intervention is effective in treating fear and phobias. The client is encouraged to face his fears as many times as possible to end the related anxiety. Traditionally, exposure therapy was used to examine habits to understand the client’s problem (Schwellnus et al., 2020). The approach encourages the client to face their fears until their level of anxiety or fear is suppressed. The therapist also guides the client on how to cope up with the fear hence feeling more confident and less vulnerable.
In the case here, the client is afraid of dating and believes that if he dates, he will end up hurting the partner. He, therefore, prefers finding intimacy in the wrong place, in sex partners he never wants to see again. Fulfilling intimacy could only be found in love and it is the intimacy from his girlfriend he still seeks. Therefore, the counselor should encourage the man to get to a single relationship to fall in love and find intimacy. The client should face the fear of dating until he overcomes it, and until then will he be healed (Stefan et al., 2019). Healing will entail having one sex partner and thinking positively regarding self.
Communicating to the Client
The therapist should communicate with the client in a way to develop a healthy relationship between them. The aim of a healthy relationship is for the client to feel comfortable and at ease to open (Fowler et al., 2021). The therapist should also take time to create a strong relationship with the client by being honest to earn his trust. The counselor should avoid being judgmental by managing emotions to not be too excited or withdrawn during their conversations with the client (Fowler et al., 2021). Talking about what the client wants and asking many questions is key to achieving healing. These are among many ways in therapist should communicate to the client, but the goal is to create and maintain a professional relationship.
Sociocultural Factors, Clinical, and Ethical Issues
There are no ecological and feminist aspects but are several cultural perspectives shown in the case including online dating, and general dating culture. Online dating culture is shown whereby the client is uses dating sites to lure his sex partners. The culture of moral decay is also depicted by the fact that the client easily finds different-sex partners in these apps, yet they are not dating. There is also a culture of dating shown when the client says he had a girlfriend with whom they broke up.
Ethical issues are closely related to the various cultures as shown above. Ethics involves determining what is right and wrong and, in this case, most of the client’s actions are morally wrong. The act of engaging in sex with multiple partners is wrong and unethical. Finally, the act of leaving his girlfriend without reason is morally wrong considering that she loved him. Clinical issues include the deteriorating health of the client, sick of contracting STDs, and depression.
Evaluation of CBT and its Limitations in the Case
The evaluation process is critical because determines whether the applied interventions are effectively working or not. Based on various questions to assess the achievement of the goal, three major key components are used in evaluation (Kazdin, 2013a). Assessment is one of the elements used to determine whether the intervention is offering the intended effect. For this case, the main goal is to change behavior and way of thinking. Assessment involves considering the current client’s behavior and considering which intervention played a huge role.
Depending on the current way of thinking and behaviors of the client, one can tell which intervention had the highest impact. Amongst the three interventions, guided discovery is more likely to work for the client because it challenges the beliefs and thoughts of the client hence forcing him to adopt alternatives (Kazdin, 2013b). Assessment as a component of the evaluation is the most effective or this case because it allows the therapist to conveniently observe the client’s thoughts and behavior without involving more complicated measures as ones used in research design and data evaluation.
The CBT interventions have several limitations which may prevent the client from achieving his goal. The first limitation is that the counselor may not know whether the intervention alone made a change or other aspects were included (Pybis et al., 2017). If the client incorporated other aspects towards change or strictly followed the intervention strategies may be a mystery to the counselor. It may also be challenging to tell which intervention worked most and which one worked the least (Pybis et al., 2017). All interventions aim at one goal, hence separating the failure or success of the goal from means of achievement is hard. Furthermore, knowing whether the client will continue living the changed behavior or thoughts for a long time is challenging.
For successfully attaining and maintaining the goal, the client needs to be committed to the change process. Therefore, there is no guarantee that the client will cooperate with change needs post counseling period. CBT requires time and taking much of the client’s time may cause him inconvenience and decide to drop out (Pybis et al., 2017). Therefore, it is challenging to convince the client to keep attending the therapy even when it causes inconvenience to his operations.
Personal Strengths and Limitations as a Therapist
One of my major strengths as a therapist is the ability to listen and understand. Being able to actively listen helps in reflecting major thoughts, remembering critical events and feelings as conveyed by the client (Bartholomew et al., 2020). My listening skills are well developed to listen to what the client is not saying. In this case, listening ensured that the client is at his emotional endpoint although not mentioned. Another strength is that I have good and social communication skills. Good social skills are essential in creating a positive environment for the client especially if he is shy or uncomfortable with new people. Excellent communication skills help to convey the right message in a way the client understands (Bartholomew et al., 2020). Good communication skills also give me confidence and assertiveness when communicating with clients. I had the confidence to ask the client more challenging questions about his beliefs. I however have a major weakness that may prevent me from being an excellent counselor.
I have a limitation of the ability to show empathy especially when for sensitive matters like the one for this case. I am highly sensitive to sexual exploitation matters like the one with the concerned client. Although I am supposed to validate his actions, I find it tough to do so and show empathy for his suffering. I found difficulties not judging the client because of his behavior of having many sexual partners. I suppose the client could tell I was not happy or entertaining of his actions. Being judgmental is wrong for a therapist because it could influence the process of treatment delivery.
Conclusion
CBT for the depressed and sexually addicted client involved three distinct interventions for healing. Cognitive reconstructing, exposure therapy and guided discovery interventions will deliver healing to the client. Multicultural perspectives, clinical and ethical issues are also reported in the case. CBT approach evaluation involves determining how well the applied interventions are effective or not. Several limitations prevent the interventions from effectively working because they are out of the counselor’s control. The strengths and limitations of the therapist may lead to CBT success or failure.
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