Case Summary
In the field of social work, a transdisciplinary model of evidence-based practice serves as the guiding framework for adapting clinical services to clients’ unique needs. It is worth delving into the application of this model in the example of a 33-year-old African American woman. She is the mother of two boys who are currently in foster care. Ms. AN’s involvement in the work of the Department of Social Services (DSS) is related to her concern about neglect, both in her history and as a parent. The main goal of a woman is to solve these problems and work to achieve a permanent life for her children. In this essay, it is important to consider two practical theories or models of therapy – cognitive-behavioral therapy (CBT) and psychodynamic therapy- and evaluate their effectiveness in solving Mrs. A.N.’s clinical problems.
Ms. AN’s case presents a multifaceted dynamic of benefits and challenges. On the bright side, she has a strong support network consisting of her biological family and her adopted family of sisters and brothers. According to Martin et al. (2021), “Through communication and the basic affective relationships established among family members, it also exerts a helping and supportive problem-solving function” (p. 2).
This provides her with significant emotional support and practical help. Furthermore, Ms. A.N. has unrestricted access to established therapy services that provide her with expert counsel and emotional support (Prilleltensky et al., 2022). It is important to note the long-standing trauma of the generation, which can lead to different emotional stress and behavioral patterns.
Cognitive Behavioral Therapy (CBT)
Description
The assumptions of the explanatory theory can be formulated to state that CBT is based on the relationship among thoughts, feelings, and behavior. Maladaptive thought patterns can lead to negative emotions and behaviors. CBT aims to identify and challenge negative thought patterns and develop coping strategies to change behaviors (Beck, 2021). Interventions include cognitive restructuring, behavioral experiments, and homework assignments. It also has strong research support for a variety of mental health issues, including depression and anxiety disorders.
The assessment process in cognitive behavioral therapy (CBT) involves probing various facets of patients’ thoughts, emotions, and behaviors. Research, such as the study by Etzelmueller et al. (2020), which reviewed guided internet-based cognitive behavioral therapy (iCBT) for depression and anxiety, indicates clinically significant improvements and supports its efficacy in managing similar mental health conditions. This evidence underscores the suitability of CBT for individuals facing challenges similar to those of Ms. A.N., including managing parenting stress and mental health concerns related to childcare displacement (Etzelmueller et al., 2020).
In practice, clinicians identify patterns in patients’ thoughts or behaviors that contribute to their difficulties and explore coping mechanisms during times of stress or challenge. Additionally, practitioners investigate individuals’ past experiences successfully managing difficult emotions or situations and inquire about their therapy goals and aspirations for their future relationship with their children.
Assessment Questions/Observations
In the assessment stage, the professional researcher, Ms. A.N., had a complicated history and current difficulties, which made it difficult to understand her needs fully. The application includes an examination of her thoughts, feelings, behaviors, and past experiences and an assessment of her coping strategies and aspirations regarding therapy. Proper assessment will guide the professional in identifying hidden patterns, strengths, and areas for development. The assessment, therefore, will provide the basis through which intervention plans for Ms. A.N. will be designed, incorporating the unique situation and, at the same time, fostering restoration and healing
- How do you perceive your current situation with your children in foster care?
- Can you identify any patterns in your thoughts or behaviors that contribute to your difficulties?
- How do you typically cope with stress or challenges in your life?
- Can you describe any previous experiences where you successfully managed difficult emotions or situations?
- What do you hope to achieve through therapy?
- How do you envision your relationship with your children in the future?
Intervention Plan
The cognitive-behavioral therapy (CBT) intervention program aims to enhance self-understanding, address maladaptive thought patterns, and promote healthier interpersonal relationships with Ms. A.N. The goals of the intervention will focus on increasing self-awareness, identifying negative thought processes, and developing coping strategies to manage past traumas and current stressors. The objectives will be to explore Ms. A.N.’s childhood experiences, attachment dynamics, and recurring themes in her dreams.
This intervention opens deep insight into the unconscious. It puts one on the way to psychological healing through processing past issues not resolved and proper development of ways of coping with emotional distress. Free association, dream analysis, and the interpretation of transference dynamics are some of the ways that practitioners guide one to self-awareness and interpersonal growth.
- Goal: Improve coping skills and emotional regulation.
Objective 1: Identify and challenge negative thought patterns related to parenting and self-worth.
Objective 2: Practice relaxation techniques and stress management strategies. - Goal: Enhance parenting skills and communication with children.
Objective 1: Implement positive reinforcement techniques for desired behaviors.
Objective 2: Develop a structured daily routine to promote stability and predictability for the children. - Goal: Address trauma-related symptoms and promote healing (Feldman, 2019).
Objective 1: Process past traumas through narrative therapy techniques.
Objective 2: Explore and address any unresolved grief or loss experiences.
Psychodynamic Therapy
The explanatory theory of psychodynamic therapy focuses on delving into unconscious conflicts and past experiences. The key principles of psychodynamic therapy involve a deep exploration of early relationships with caregivers, significant life events, and recurring themes in dreams and fantasies, using a more exploratory approach than the structured approach of CBT. Research, such as that conducted by Dworschak et al. (2022), has found that internet-based psychotherapy effectively reduces depressive and anxiety symptoms in adults.
Additionally, while psychodynamic therapy may not have as extensive empirical support as CBT, studies like those by Panchal et al. (2020) show its effectiveness in treating certain mental illnesses, affirming its applicability to cases involving deep-seated emotional conflicts and mental health challenges. This evidence supports the use of psychodynamic therapy in clinical presentations similar to those observed in general populations with related mental health issues.
Assessment Questions/Observations
The current assessment is necessary to gauge the client’s psychological functioning and relationships with others. The following questions can be helpful in terms of investigating Ms. A.N.’s interactions with caretakers and coping strategies. Also, there are opportunities to collect more information about relationship patterns and recurring dreams. By addressing these, the practitioner will be able to uncover unresolved issues from the past and help the client change maladaptive patterns within the framework of a targeted intervention plan.
- Can you describe your relationship with your caregivers during childhood?
- Have you noticed any recurring themes or patterns in your dreams?
- How do you typically respond to conflicts or stressful situations?
- Can you recall any significant life events or traumas from your past?
- What emotions do you experience when reflecting on your childhood experiences?
- Have you noticed any patterns in your relationships with others that resemble those from your past?
Intervention Plan
Based on the assessment findings, the intervention plan utilizing Psychodynamic Therapy is structured around three overarching goals with corresponding objectives:
- Goal 1: Enhance self-understanding
Objective 1: Identify unconscious conflicts and unresolved issues from the past.
Objective 2: Explore the underlying motivations and emotions driving current behaviors. - Goal 2: Resolve internal conflicts
Objective 1: Process and work through unresolved traumas or childhood experiences.
Objective 2: Develop coping strategies to address emotional distress stemming from past conflicts. - Goal 3: Foster healthier interpersonal relationships
Objective 1: Recognize and modify maladaptive relationship patterns rooted in past experiences.
Objective 2: Practice effective communication and boundary-setting within relationships.
Integration and Evaluation
Both Cognitive Behavioral Therapy (CBT) and Psychodynamic Therapy offer effective methods for addressing the intricate needs of Ms. A.N., with each highlighting distinct advantages suited to her demographic and cultural context. It is essential for me, as an African American mother dealing with socioeconomic and mental health issues, to comprehend Ms. A.N.’s particular condition, requirements, beliefs, and choices. The diversity-related issues encompass her gender, color, financial position, and the specific pressures associated with being separated from her children. CBT, which targets recognizing and correcting unhelpful thinking patterns and behaviors, is well-suited to her need for practical coping mechanisms and emotional control.
This strategy is highly beneficial due to its robust empirical evidence in treating mental health conditions such as depression and anxiety disorders, which are common in her contemporary environmental and socioeconomic circumstances. It is crucial to ensure that therapeutic techniques align with the values and beliefs of both the client and the practitioner, while respecting and being sensitive to Ms. A.N.’s cultural background and personal experiences. This customized method not only addresses her current psychological needs but also fosters a therapeutic connection grounded in mutual understanding and respect.
On the other hand, Psychodynamic Therapy delves into unconscious conflicts and past experiences, aiming to improve self-understanding and resolve unresolved issues from Ms. A.N.’s past. This method may be particularly beneficial for her, considering her complex history and deep-rooted traumas. The exploratory nature of Psychodynamic Therapy, although less empirically supported than CBT, facilitates a deeper understanding of how Ms. A.N.’s age, race, and past experiences influence her current mental health and parenting challenges (Bryant-Davis, 2019). The intervention plan developed from this framework focuses on enhancing self-understanding, resolving internal conflicts, and fostering healthier interpersonal relationships, which is crucial given her isolation from her children and her reliance on a broader support network.
Practitioners’ proficiency in administering Cognitive Behavioral Therapy (CBT) and Psychodynamic Therapy is essential in the therapeutic context. The success of therapies is substantially influenced by the therapeutic setting, organizational context, accessible resources, and the therapist’s knowledge of culturally acceptable methods. Considering these factors ensures that therapy aligns with Ms. A.N.’s expressed needs, preferences, values, and beliefs, fostering a therapeutic relationship that honors and integrates her cultural and personal identity into her treatment plan.
The research findings align with the demographic traits and preferences of Ms. A.N., who is an African American mother with a background of trauma (Bryant-Davis, 2019). Environmental factors, such as the physical distance between a mother and her children, greatly impact the practicality of treatments. Practitioners need to tackle systemic issues such as racism and make sure that solutions align with Ms. A.N.’s objectives. Comprehensive therapies are tailored to Ms. A.N.’s needs, thereby improving the therapeutic relationship and outcomes.
To choose the most suitable strategy for Ms. A.N., one must take into account research findings, client characteristics, geographic location, specifications, values, preferences, and the broader environmental context. Combining elements of both Cognitive Behavioral Therapy and Psychodynamic Therapy might be the most efficient approach, considering her specific needs and cultural background. This integration helps address Ms. A.N.’s immediate need for practical coping skills and emotional regulation through Cognitive Behavioral Therapy, while also exploring underlying unconscious tensions and past traumas, which are highlighted in Psychodynamic Therapy (Bryant-Davis, 2019). This dual approach ensures that therapies are culturally competent and inclusive by considering diversity-related characteristics such as race, ethnicity, and socioeconomic status. Being sensitive is crucial for creating a supportive and impactful therapeutic environment that aligns with Ms. A.N.’s own values and cultural identity.
Ethical Considerations
Ethical considerations hold significant importance in Ms. A.N.’s case within the framework of evidence-based practice. Several potential ethical concerns and dilemmas arise, necessitating careful attention from practitioners. Firstly, maintaining confidentiality is challenging, particularly when balancing the need to protect Ms. A.N.’s privacy with the need to ensure the safety and well-being of her children in situations involving child protection (Kiili & Moilanen, 2019). Secondly, obtaining informed consent may be complex due to Ms. A.N.’s mental health challenges or potential difficulties in fully comprehending the therapeutic process.
Balancing these ethical considerations entails prioritizing Ms. A.N.’s welfare and autonomy while upholding ethical standards and legal obligations. Approaching these dilemmas with honesty, care, and integrity fosters a therapeutic environment grounded in trust, respect, and ethical integrity, ultimately enhancing the effectiveness of therapeutic interventions and promoting Ms. A.N.’s overall well-being (Kiili & Moilanen, 2019). Practitioners must maintain confidentiality, obtain informed consent, and navigate boundaries while considering the potential impact of power dynamics in the therapeutic relationship, ensuring that Ms. A.N. feels empowered and respected throughout the treatment process. Furthermore, addressing resources, including practitioner expertise, as well as the environmental and organizational context, is essential for providing comprehensive and effective care.
References
Aziz, M. O., Mehrinejad, S. A., Hashemian, K., & Paivastegar, M. (2020). Integrative therapy (short-term psychodynamic psychotherapy & cognitive-behavioral therapy) and cognitive-behavioral therapy in the treatment of generalized anxiety disorder: A randomized controlled trial. Complementary Therapies in Clinical Practice, 39.
Beck, J. S. (2021). Cognitive behavior therapy: Basics and beyond. (3rd ed.). The Guilford Press.
Bryant-Davis, T. (2019). The cultural context of trauma recovery: Considering the posttraumatic stress disorder practice guideline and intersectionality. Psychotherapy, 56(3), 400-408.
Dworschak, C., Heim, E., & Maercker, A. (2022). Efficacy of internet-based interventions for common mental disorder symptoms and psychosocial problems in older adults: A systematic review and meta-analysis. Internet Interventions, 27.
Etzelmueller, A., Vis, C., Karyotaki, E., Baumeister, H., Titov, N., Breking, M., Cuijpers, P., Riper, H., & Elbert, D. D. (2020). Effects of internet-based cognitive behavioral therapy in routine care for adults in treatment for depression and anxiety: Systematic review and meta-analysis. Journal of Medical Internet Research, 22(8).
Feldman, M. (2019). A CBT-based stress management intervention for work-related stress. (Publication No. 10973417). (Doctoral dissertation, Palo Alto University). ProQuest Dissertations Publishing.
Kiili, J., & Moilanen, J. (2019). Participation as a methodological and ethical issue in child protection research. Journal of Children’s Services, 14(3), 143-161.
Martin, A. B. B., Jurado, M. M. M., PĂ©rez-Fuentes, M. C., Ruiz, N. F. O., MartĂnez, A. M., Márquez, M. M. S., & Linares, J. J. G. (2021). Interpersonal support, emotional intelligence, and family function in adolescence. International Journal of Environmental Research and Public Health, 18(10).
Panchal, R., Rich, B., Rowland, C., Ryan, T., & Watts, S. (2020). The successful impact of adapting CBT in IAPT for people with complex long-term physical health conditions. The Cognitive Behaviour Therapist, 13(36).
Prilleltensky, I., Di Martino, S., & Ness, O. (2022). Editorial: Psychology for the common good: The interdependence of citizenship, justice, and well-being across the globe. Frontiers in Psychology, 13.