Topic 9: Case Formulation & Treatment Plan {by 11/5}

[Behavioral Exposure] – Watch PDA-9: Behavioral Techniques – Modifying Anxious Thoughts.  Practice a Decatastrophizing Worksheet on yourself. Answer the following (you can be brief): (1) Was it helpful starting with the worst-case scenario and ending with the most realistic scenario? (2) Did assessing the probably for each scenario provide supportive “data” to help modify your negative automatic thought? (3) Did this technique provide enough “convincing” information to develop an alternative thought?

[Case Formulation & Treatment Plan] – For this discussion, share at least two main thoughts: (1) Why is a CBT case formulation important for effective therapy (i.e., how does it help clients get “better”)? (2) Why is it necessary to have specific, concrete, and measurable treatment goals whenever possible?

Your original post should be posted by 11/5.  Have your two replies posted no later than 11/7.  *Please remember to click the “reply” button when posting a reply.  This makes it easier for the reader to follow the blog postings.

30 Comments (+add yours?)

  1. Allie Supernor
    Oct 30, 2020 @ 14:24:28

    Part One- Behavioral Techniques:
    (1). In both Lindsay’s experience and my own, I did find it most helpful to start with the worst-case scenario first. I also felt like going to the best-case scenario next, also helped me see that the best-case scenario wasn’t really likely to happen either. Additionally, it was really helpful to write it out so I could visually see the three scenarios on a continuum and recognize the most likely scenario is what I was expecting. (2). Similarly, I found putting a percentage to be helpful in modifying my negative automatic thought. Although, like Lindsay, I went back and reevaluated my percentages afterwards. At first, my “likely scenario” was much too low and I had to give it a greater percentage. (3). Lastly, I feel like this technique alone wouldn’t convince me to develop a more adaptive alternative thought. It certainly helped me recognize that the worst-case scenario wasn’t likely to play out, however, it didn’t really help me replace it with another thought! I do believe further techniques would be helpful to include so the client can see the most likely outcome. And more importantly, change my thinking.

    Part Two- Case Formulation & Treatment Plan:
    Cognitive-behavioral therapy requires purposeful process in determining the most effective treatment approach. Therefore, there are assessment tools and process that come before developing a formal case formulation. A well-done CBT assessment will set the stage for developing a working cognitive-behavioral case formulation. CBT case formulation is vital for efficient and effective therapy. It is a cognitive-behavioral conceptualization of the presenting problems, associated symptoms, and contributing factors. This is something that should be evaluated and potentially modified throughout therapy. (1). The information gathered from your CBT assessment and integrating into your CBT case formulation becomes the foundation and driving force for your CBT treatment plan. (2). Goals in the treatment plan are therapeutic indicators for how therapy is going! It is crucial that these goals are realistic, objective and measurable. This allows for the therapist (and client) to accurately track progress and assess therapy. For example, “be more social,” although that is desired by the client that is very hard to assess what is more or less social and by what standards. Dr. V’s lecture offers “client will engage in at least two social activities per week” as a better alternative. This goal can be measured and tracked pretty easily!

    Reply

    • Madi
      Nov 03, 2020 @ 22:46:26

      Hi Allie,
      I totally agree with you that starting with worst case is definitely the way to go. I think in reading between the lines we were both saying that starting with best case or realistic scenarios invalidates what the person is feeling.

      Reply

    • Alison Kahn
      Nov 04, 2020 @ 19:26:57

      Allie,

      I like how you spoke about being able to accurately track progress towards treatment goals and how a solid case formulation is crucial in developing those treatment goals. I focused a bit more on the client’s understanding of his or her presenting problems and subsequent treatment goals so I really liked reading about your focus on needing to be able to accurately track progress once those goals have been formulated.

      Reply

  2. Madi
    Nov 02, 2020 @ 18:50:26

    1. Behavior Exposure – PDA-9
    a. I think that starting with the worst case scenario is helpful because that thought is already very present in the mind so by talking about the worst case gets the thought out there. After that you can go to a more realistic scenario. In the video, with personal experience, I find that speaking thoughts out loud makes them lose their power.
    b. I find that when looking at the “data” the supports the negative beliefs helps a person realize that the belief is irrational and out of perspective. Once that is realized then modification can occur.
    c. I thought the technique did prove “convicing” information in which one could develop an alternative thought. This is the process of modifying one’s behavior. But, it is a process not a one time event. In the video, we saw Lindsay come to understand how her thought spiral was out of perspective. But this once instant isn’t going to erase all of her anxiety.
    2. Case Formulation & Treatment Plan
    a. CBT case formulation is not just important but necessary for effective treatment. With out a case formulation, without any template for the client and the case then no real work can be done. A client comes in with a presenting issue and goals. With out a case formulation a person cannot “get better” or achieve his or her goals.
    b. Specific, concrete, and measurable treatment goals are necessary for creating a treatment plan. For if a goal and intervention are not measurable then there is no way to tell if an intervention is done. If a treatment goal or intervention is vague then there is no way to make sure the client and the therapist is working on that goal or intervention.

    Reply

    • Allie Supernor
      Nov 03, 2020 @ 17:01:44

      Hi Madi, I liked your phrase “lose power” I tend to use that in the Addiction/Recovery community too. When we talk through triggers to use/etc. we use the language “giving up the power.” I also felt that talking through the scenarios felt silly, but hugely proved how unlikely they were to occur.

      Reply

    • Alison Kahn
      Nov 04, 2020 @ 19:23:47

      Hi, Madi!

      I completely agree with your thoughts about determining the worst case scenario first. I also found that the worst case scenario is most present in the mind and therefore the easiest to get on paper. I also felt a sense of relief when writing on paper the worst case scenario because seeing it almost made it feel a little less “scary”.

      Reply

    • Haley Scola
      Nov 05, 2020 @ 14:49:58

      Hi Madi,

      I agree that because the worst-case scenario is already in your mind its much easier and it also allows for the client to feel heard. You also make a great point about the client needing to be aware for modification to occur. I also completely agree with your statement that the case formulation is the template and is necessary for effective therapy. Without structure therapy is just a oasis of talking and more like “venting” which is not helpful. Overall, good post!

      Reply

    • Christopher LePage
      Nov 05, 2020 @ 19:03:31

      Hi Madi,
      I liked how you said that looking back on the data that supports negative beliefs may help a client realize these thoughts are irrational. I also really liked how you said after they see and understand these negative beliefs are irrational then you can start modifying these beliefs. I think this point really demonstrates why looking at the data is so important, especially for clients. By presenting them with this information, the client may have a better understanding of the situation as a whole.

      Reply

  3. Alison Kahn
    Nov 04, 2020 @ 19:21:07

    (1) Was it helpful starting with the worst-case scenario and ending with the most realistic scenario?
    a. Yes. I found it helpful to begin the exercise with the worst case scenario because not only was it the easiest to determine, it also helped to create perspective, in that writing it down in comparison to the realistic and best case scenarios made me realize that it was likely over exaggerated and even if it did happen it wouldn’t be as bad as I had initially believed.
    (2) Did assessing the probably for each scenario provide supportive “data” to help modify your negative automatic thought?
    a. Looking back over the probabilities after having determined them definitely provided me with supportive data to help modify my negative automatic thought. Although at first I struggled with determining the probabilities of each scenario, I did notice that I chose the highest probability for the realistic scenario and the lowest probability for the worst case scenario, which was extremely reinforcing.
    (3) Did this technique provide enough “convincing” information to develop an alternative thought?
    a. I think this technique very much helped to provide enough convincing evidence to develop an alternative thought. After completing the activity, I didn’t necessarily have a new and positive thought to replace the negative automatic thought, however, I did have a more realistic, less self-deprecating thought which felt more realistic which lead to the task feeling more attainable.

    (1) Why is a CBT case formulation important for effective therapy (i.e., how does it help clients get “better”)?
    a. CBT case formulation is important for effective therapy because it helps the client to better understand their presenting problems and the distress they are experiencing. As Dr. V discusses in his lecture, often times, clients do not come to therapy with a full understanding of why they are experiencing distress. Developing a case formulation provides the client with a concrete explanation of their presenting problems and what may be contributing to their distress. CBT case formulation also helps the client “get better” because it helps to determine an organized, tangible, and specific course of action that they can refer to. It also aids in the development of goals, which, when attained, provide clients with motivation, responsibility for change, and a sense of relief. Finally, CBT case formulation is driven by evidence-based and empirical research, which supports its effectiveness.
    (2) Why is it necessary to have specific, concrete, and measurable treatment goals whenever possible?

    a. It is necessary to have specific, concrete, and measurable treatment goals whenever possible because these goals are therapeutic indicators. As such, these goals/progress towards these goals should be easily and accurately trackable so that the client is able to clearly and definitively meet the goals.

    Reply

    • Eileen Kinnane
      Nov 05, 2020 @ 13:01:15

      Hi Alison,
      I had a similar experience with the worksheet where I wasn’t able to develop a new automatic thought to replace my negative automatic thought. However, I can see how with the help of a trained professional, this is something that can be accomplished when completed in session.

      Reply

    • Allie Supernor
      Nov 05, 2020 @ 16:03:01

      Hi Alison, I shared a similar experience with activity that I neglected to capture in my post. I also struggled with determining the probabilities of each scenario, I did notice that I chose the highest probability for the realistic scenario and the lowest probability for the worst case scenario, which was extremely reinforcing. I found it pretty difficult to figure out, especially for the most realistic scenario! That might be the point.

      Reply

    • Selene Anaya
      Nov 06, 2020 @ 12:57:45

      Hi Alison! I agree I thought it was helpful to begin with the worst-case scenario because it helps to put the thought into the perspective of a more realistic outcome. I also relate to how it was difficult to determine the probability of each scenario. I struggled because as soon as I wrote down the thought, that alone changed the probability than I had originally believed it to occur if that makes sense. I also found my alternative thought was not completely new, but it was more realistic while validating my feelings of uneasiness.

      Reply

  4. Eileen Kinnane
    Nov 05, 2020 @ 12:58:39

    (1a) It was definitely helpful to start with the worst-case scenario, but for me what really made an impact was determining the probability of the best-case scenario. After having a realistic expectation of the worst-case scenario, it was easier for my to see how unlikely the best-case scenario was for me. This was actually really helpful because it helped me set more realistic expectations for myself. That way, when the event occurs, I am not feeling let down by not experiencing the best-case scenario.

    (1b) I found assessing the probability for each scenario was really helpful in taking that extra step of setting realistic expectations. It can be easy to get caught up in the extremes. For me, I started to get nervous when I was imagining the worst-case scenario, but then taking time to think about how unlikely it would be for that to happen made me feel a lot better.

    (1c) Doing this worksheet on my own, it was hard for me to come up with an alternative automatic thought. However, I think that if I were in session with a therapist who could walk me through the scenario and help me focus on key point, then this activity could potentially provide me with enough convincing information to develop an alternative thought.

    (2a) Case formulation is essential for many reasons. One reason is that it helps the therapist begin to speculate how all of the client’s presenting problems are rooted and related. It is also used as a guide for making change. It clearly organizes the clients presenting problems and then uses that information to set goals for the clients treatment.

    (2b) It is crucial for goal to be specific, measurable, and concrete because it allows for the therapist and client to monitor the progress of therapy. For example, if a therapist includes the goal “be happier”, there really is no way to measure when a client has met that goal. It’s also important to have short-term goals, rather than just end goals, to help the client see that they are in fact making progress even if they’re working on some presenting concerns.

    Reply

    • Haley Scola
      Nov 05, 2020 @ 14:45:10

      Hi Eileen,

      I also thought the probabilities on the best-case scenarios were extremely helpful too. They helped me realize how likely it was. I also think that case-formulations are essential because they are the guide for making change. Having a clear and tangible “guide” to follow as well as collecting data is so important in therapy. I enjoyed your point about focusing on short-term goals rather than long-term goals because that can be discouraging to just look at the big picture rather than the little steps in between!

      Reply

    • Selene Anaya
      Nov 05, 2020 @ 15:52:35

      Hey Eileen! I liked how you mentioned that the worksheet allowed you to set more realistic expectations for yourself. I did not think of a client or myself possibly feeling let down when the best-case scenario also doesn’t occur, so it might be a clinical judgement to decide if that needs to be explained to the client as well. I also really liked how for the last question you mentioned that it is important to have short-term goals so that clients can feel the satisfaction of reaching goals. I think that idea kind of goes along with setting obtainable goals. Making it clear for clients that we can set both short- and long-term goals and ensuring they know the difference is super important because if they don’t know the difference they can become frustrated when it takes a long time for them to reach a goal or when they are unable to reach it.

      Reply

  5. Haley Scola
    Nov 05, 2020 @ 14:12:35

    Behavioral Exposure:

    1. I did think for both Lindsey and I that it was helpful to start with the worst-case scenario. I think leaving my thoughts with the most realistic helped me to understand that my thinking may have been invalid based on previous evidence. I also think that since Lindsey kept saying in the beginning “yeah but its possible and I would be kicked out of my program” starting with her worries helped her feel heard and enhances the therapeutic relationship.

    2. Assessing the probability of each scenario provided supportive data because it allowed for me to see the chances (based on previous evidence) that each would happen. It showed me how hard both Lindsey and I are on ourselves despite our previous evidence that displays we will most likely do well.

    3. For me it helped me say “Ok just because I think this class is really hard and I could do bad on this one exam doesn’t mean I’m stupid or that I’ll fail. I do the rest of the work for this class and have gotten good grades. I also rarely do poor on exams because I know I put a lot of effort into studying”. I do think that this exercise did not get to the root of my problem, but it showed me that I am truly my worst critic and if I believe ill do bad, I most likely will.

    Case Formulation and Treatment Plan:

    1. Case formulation of CBT is guided by evidence-based and empirical research. The first reason a CBT case formulation is so important for effective therapy is because it take the clients information such as history, presenting concerns, goals etc. and gives the client a concrete way to map out their progress and is the driving force of the clients treatment plans. Without creating the case formulation both the client and therapist would lack structure and evidence for progress throughout therapy. The second reason the case formulation is so important for effective therapy is because the client may come into therapy not knowing exactly what is causing or triggering their distress. The case formulation provides the client with a tangible explanation of presenting problems identified through the collaborative therapy process.

    2. It is necessary to have specific, concrete, and measurable treatment goals whenever possible in therapy because it is a clear indicator of progress made and assessment of the therapy. Without this structure such as a measurable goal of “showering 3 times a week” verses “try showering more” it is completely subjective. Such as “do you think you have showered more” rather than tracking the specific and concrete amounts of times the individual showered since the beginning of therapy and being able to have data proving “you have increased you weekly showers by 20% since we began”.

    Reply

    • Christopher LePage
      Nov 05, 2020 @ 19:05:59

      Hi Haley,
      I enjoyed how in-depth you went in discussing what a CBT case formulation looks like. I specifically liked where you talked about how often times CBT tailors the treatment around the client. I think this is one of the most beneficial aspects of CBT since the treatment incorporates the client’s interests and strengths!

      Reply

  6. Selene Anaya
    Nov 05, 2020 @ 15:41:10

    [Behavioral Techniques]-

    (1) I think it was very helpful starting with the worst-case scenario. I found myself actually having to think of things worse than I originally thought which already made me realize that my negative automatic thought was probably invalid. By the time I got to the most realistic scenario, I found myself believing that was more probable than the worst case.

    (2) Although assessing probability always seems to be a tad difficult for me, I found that it was helpful to compare the different case scenarios using the probability. It made me feel more confident that the worst-case scenario was highly unlikely and kind of put it all into perspective for me.

    (3) It was hard to walk through this technique in my head on my own, but even then I was able to arrive to an alternative thought. My alternative thought acknowledged my fear but also acknowledged the reality of the situation and what the outcome is most likely to be. Breaking down the outcome and then assessing the probability of each was definitely convincing enough to help me develop an alternative thought.

    [Case Formulation & Treatment Plan] –

    (1) A CBT case formulation is important for effective therapy because it puts together all of the information that was gathered and more importantly it is specific to the client. It also allows the client to understand their distress more than they probably originally thought. Being able to formulate a case that revolves around the client’s information is super important for CBT and for providing effective treatment. If the case formulation was never tailored to each individual client, it is very likely that treatment will be ineffective. Case formulations are the driving force of the client’s treatment plan and having this allows the client to feel as though it is specific to them and allows them to understand their treatment and believe that they will improve when they see the plan that was made just for them and their presenting problems.

    (2) It is necessary to have specific, concrete, and measurable treatment goals whenever possible so therapists and clients can track improvement and see if their treatment is working. Giving concrete and specific goals can make it very clear what needs to be done especially for clients who are distressed. The concrete goals can be increased over time and percentages of improvement can be tracked as well which can be helpful for the client and therapist to see. Being able to track these goals can also ensure that the assigned tasks are completed or if it is too hard, then they can talk about ways to make it easier for the client such as reducing the number of times the client must perform a said activity.

    Reply

    • Madi
      Nov 05, 2020 @ 16:11:05

      Hi Selene,

      I agree with you that it is helpful to start with worst-case. I think that if you don’t start with worst case scenario then a therapist invalidates what the person is feeling, which is not what you want to do. I agree with you that CBT case formulation is necessary for effective treatment.

      Reply

  7. Francesca DePergola
    Nov 05, 2020 @ 15:41:57

    Behavioral Exposure
    (1) Was it helpful starting with the worst-case scenario and ending with the most realistic scenario?
    It was helpful starting with the worst-case scenario and ending with the most realistic scenario. Although it might be a very stressful experience thinking of the worst-case scenario there’s a relief knowing it’s not probable it will happen. Looking at things realistically allows someone some relief while also acknowledging that worse or better could happen. Then if or when the worst-case or similar occurs, it might not be as surprising or damaging because it was thought of and processed. Looking at things realistically also allows room for things to go better as expected, which would be great. Overall, the idea is that some to no disappointment will occur because all outcomes have been explored on both sides of the spectrum.
    (2) Did assessing the probability for each scenario provide supportive “data” to help modify your negative automatic thought?
    Assessing the probability for each scenario provides supportive “data” that did help to modify my negative automatic thought. I found that the negative automatic thought I mentioned at first was not severe enough to go decatastrophize since the percentage of the worst-case scenario was so low. So, I feel like after I re-evaluated the negative automatic thought and assessed it, I was better able at decatastrophizing a thought that I was having the cognitive distortion in which I was catastrophizing.
    (3) Did this technique provide enough “convincing” information to develop an alternative thought?
    This technique did not provide enough “convincing” information to develop an alternative thought at first. I think it was harder since I was alone and did not have the guidance of an actual therapist to help me reach an alternative thought, but eventually, I came to one on my own. I feel like if the exercise went a little deeper, it could have been more helpful to develop an alternative thought.

    Case Formulation & Treatment Plan
    (1) Why is a CBT case formulation important for effective therapy (i.e., how does it help clients get “better”)?
    A CBT case formulation is important for effective therapy because it provides a structure for therapy, the therapist, and the client. Without a CBT case formulation, it will be hard to help the client who came in with presenting problems to leave with the proper skills to reach more adaptive routes to their thoughts, emotions, and behaviors. Through the case formulation, a counselor and client can come to an agreement to achieve these goals in an attainable way that will, in the end, be effective for the long-term.
    (2) Why is it necessary to have specific, concrete, and measurable treatment goals whenever possible?
    It is necessary to have specific, concrete, and measurable treatment goals whenever possible because it is important for effective long-term change. If treatment goals are not created in this fashion there is no way to know whether the interventions a therapist puts in place are working and if changes need to be made.

    Reply

    • Trey Powers
      Nov 07, 2020 @ 15:27:50

      Hi Francesca!

      I really like your points about considering the worst-case scenario during this activity. While it is one thing to be ruminating over this possible scenario, actually taking some time to process it by writing it down, picturing it happening, and anticipating the likelihood that it will actually happen is a useful way of both checking your own reality, while also preparing yourself if it does actually come to that situation.

      Reply

    • Brigitte Manseau
      Nov 07, 2020 @ 22:34:12

      Hi Francesca,
      I agree, it was most helpful to start with the worst-case scenario. Ending with the most realistic scenario makes it easier for the client to find middle ground between both extremes. Also, I like that you mentioned the importance of processing the worst-case scenario overall. It validates clients’ emotions and thoughts while preparing them in case the worst situation actually occurs.

      Reply

  8. Brigitte Manseau
    Nov 05, 2020 @ 16:00:20

    1a. It was helpful to fill out the worst-case scenario first because that was the most pressing scenario in my mind. It felt good to write out what I was thinking because I had several bad scenarios in my head. Ending with the most realistic scenario allowed me to find the middle ground between my worst-case scenario and the best-case scenario. I think it takes a bit longer to get to a realistic scenario without processing the worst-case and best-case scenarios first.
    b. Assessing the probability for each scenario helped modify my negative automatic thought. I believe it helped put my thought into perspective. Yes, the worst-case scenario could happen, except the likelihood of it occurring was relatively low.
    c. Yes, this technique provided me with enough “convincing” information to develop an alternative thought. I believe once you decatastrophize several thoughts the technique becomes easier to implement. This technique was used when I was in therapy and it was extremely helpful. Once I had worked through several thoughts with my therapist in session, I was able to modify negative automatic thoughts on my own which was empowering. If this technique works for the client, it can encourage them to continue doing “the work” and make more progress.

    2a.CBT case formulation gives the therapist and client the conceptualization of the client’s presenting problems, associated symptoms, and contributing factors. Sometimes clients are unable to recognize exactly what they are struggling with and why. The case formulation allows the client to gain a better understanding of his or her distress. Also, CBT case formulation lays down the ground work which outlines what the CBT treatment plan will tackle.
    b. The therapist and client are able to track the client’s progress when treatment goals are specific, concrete, and measurable. The therapist can see what is and is not working for the client in terms of interventions and treatment goals. Therefore, the therapist and client may collaboratively adjust certain treatment goals to better fit the client throughout the therapy process. Also, measurable treatment goals allow the therapist to show managed care how progress is going for clients under the therapist’s care. If client goals are too vague the therapist is unable to track clients’ progress. For example, in Dr. V’s book an example of a poor goal is “be more social.” That could include a lot of different things. A better goal would include what activity the client will engage in and the frequency of partaking in that activity.

    Reply

    • Trey Powers
      Nov 07, 2020 @ 15:24:04

      Hi Brigitte!

      I like how your description of the importance of a case formulation shows how essential it is for the process. The way you described it shows how very foundational it is to therapy, as well as for the client’s success. I also like how you highlight the collaborative nature of the goal-setting process. Working together throughout the therapy process is important for both involved parties in order to increase the likelihood of success for the client.

      Reply

  9. Trey Powers
    Nov 05, 2020 @ 18:49:10

    Behavioral Exposure
    1.
    I believe that beginning with the worst-case scenario is beneficial when attempting to modify anxious thoughts, especially when catastrophizing is at play. For me, I find that these highly negative thoughts often overwhelm other, more reasonable thoughts that I may have, making it so that I am only focusing on the negative. Addressing these thoughts immediately, and then beginning to examine more realistic scenarios is good, therefore, as it provides an opportunity for me to lay the “louder” negative thoughts to rest so that I can effectively address other thoughts.
    2.
    I found that assessing the probability of each scenario taking place to be somewhat helpful for the process of altering anxious thoughts. I think that the most helpful part of this process is the relief that comes from writing down that something like the worst-case scenario is very unlikely to happen, and instead that more realistic outcomes are far more likely.
    3.
    I think that this process did not necessarily allow me to replace my negative thought with an alternative thought, but rather it served as a reality check with regard to how likely it was that a terrible outcome would be the result. Although it did allow me to feel better in the moment, I would not say that the negative thought was gone completely, or reduced to the point that I no longer thought about it.

    Case Formulation & Treatment Plan
    1.
    A case formulation is essential for providing effective therapy. A counselor must obtain a complete understanding of where the client is in order to properly determine what their problems are, what strengths can be capitalized on, and which interventions are appropriate given the unique situation that the client is in. This extends beyond simply obtaining a diagnosis, and instead incorporates things such as the client’s support system, medical history, past experiences with therapy, employment status, significant relationships, and many other elements of the client’s life that may potentially impact their progress.
    2.
    Having specific treatment goals when possible is important for the therapy process because they serve as indicators of progress that has been made by the client. Relying on subjective indications of mood between sessions is not necessarily an accurate or reliable measure of whether they are experiencing true therapeutic progress. Instead, this can be measured based on whether or not they are meeting the various treatment goals that were previously established. This also provides the client with a sense of pride and accomplishment when they do meet their goals, which can serve to motivate them to further invest themselves in their recovery.

    Reply

    • Francesca DePergola
      Nov 05, 2020 @ 20:00:13

      Hey Trey,
      I felt similarly to you in your points in the behavioral exposure answers. I think that it is beneficial beginning with the worst-case scenario and then move to more realistic ones because it can really shed light on some highly intrusive negative automatic thoughts. I also agree with you about how, when assessing the different scenarios as a “reality check.” I also thought your answers regarding the CBT case formulation were right on point. I thought your answer to number two mentioning progress is crucial and something I missed mentioning in my post. Progress is very helpful for both client and counselor and can be used in many ways to help the client achieve their goals.

      Reply

    • Eileen Kinnane
      Nov 06, 2020 @ 14:05:50

      Hi Trey,

      I like what you said about needing treatment goals to be objective and measurable. It’s especially important not to use mood as a measure since it is something that can vary day to day. It’s also really important to set measurable goals, like you said, so the client can see their progress, even if they haven’t yet met their end goal.

      Reply

  10. Christopher LePage
    Nov 05, 2020 @ 18:59:40

    1) It was beneficial to work from the worst-case scenario to the best-case scenario. The reason being, is that in the moment thinking of the worst-case scenario is much easier since you are already in that frame of mind of thinking the worst-case scenario is realistically going to happen. I also thought it was beneficial to choose this way to do it, because you are working yourself through the situation. By going from worst-to-best you start making yourself think about realistic scenarios that can occur. This is also beneficial in subsidizing your anxiety over a situation because you start to realize that it may not be as bad as you originally had thought.
    2) I think when looking back at the data in how I evaluated the situation, it did modify my negative thoughts for them. I found myself returning to the data and changing it as I kept changing my perception of the event, because I really gave myself time to think about the probabilities of the event occurring.
    3) I do think that this technique helps create alternative thoughts. With this process I feel that you really do have to work in all the probabilities and your expectations of these events, and by doing this you are subsidizing your anxieties towards the event. Overall, by really breaking down the event you get a more realistic look view of the event and it gives you an opportunity to truly assess how to react.
    4) One reason that CBT case formulation is crucial, is it allows you as a clinician to know what presenting problems you are working with. CBT also helps formulate a treatment plan based off of the client’s strengths and interests, which has proven to work effectively with how well a client does in treatment. CBT uses a lot of evidence-based treatments as well, which research also shows that these treatments are more effective overall. CBT also provides the client with psychoeducation which also strengthens the effectiveness of the sessions.
    5) It is necessary to have concrete, tangible goals for several reasons. One of them, is that in order for the treatment to be effective, the client needs to be able to complete the treatment on their own. If the client has low self-efficacy, they may feel that they cannot complete the tasks on their own and may not partake in the treatment. It is also important to create concrete goals, because it helps the client know what they are working towards, which helps motivate them to continue their treatment and their sessions. Having these goals helps keep track of the progress your client is making throughout your sessions with them.

    Reply

    • Francesca DePergola
      Nov 05, 2020 @ 20:08:24

      Hi Chris,
      I think how you mention someone’s “frame of mind,” when connecting their negative automatic thought into already worst-case scenario thinking. I think you are right because starting at the best-case scenario might be counter-productive in that it dismisses the thought and is not assessed from worst, to realistic, to best. I feel like this is the most beneficial way of doing this exercise. I like your answers involving the CBT case formulation, especially in your answer to question one when you state “how well a client does in treatment.” I think sometimes we think the CBT case formulation is mostly to benefit and help structure therapy for the therapist, but we neglect to see how it helps the client and their role in it, itself.

      Reply

    • Brigitte Manseau
      Nov 07, 2020 @ 23:15:54

      Hi Chris,
      I agree, it is beneficial to start with the worst-case scenario because that is usually what’s already on the person’s mind. Processing the worst-case scenario first allows the client to later focus more on the other scenarios because the client will not be as preoccupied thinking about the worst-case scenario.

      Reply

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Adam M. Volungis, PhD, LMHC

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