Topic 9b: Case Formulation & Treatment Plan [Part 2] {by 4/6}

[Case Formulation & Treatment Plan] – Watch PDA-2: CBT Assessment – Motivation to Change. (1) In general, how would describe Lindsey’s motivation to change? (2) What does she want to get out of therapy? (3) What is her perception of responsibility to change (i.e., internal vs. external)? (4) What hope or optimism does she have that therapy will help?

 

[Case Formulation & Treatment Plan] – Watch PDA-3: CBT Assessment – Measures. (1) How can information from Lindsey’s assessments (i.e., explaining and providing feedback) be helpful so early in therapy? (2) What does she want to get out of therapy? (3) How is providing an overall symptoms score helpful for Lindsey, considering her presenting problems? (4) Why was it helpful to review a few of Lindsey’s responses to individual questions from the assessments?

 

Your original post should be posted by 4/6.  Have your two replies posted no later than 4/8.  *Please remember to click the “reply” button when posting a reply.  This makes it easier for the reader to follow the blog postings.

40 Comments (+add yours?)

  1. Jessica Costello
    Apr 03, 2020 @ 11:38:50

    PDA-2: CBT Assessment – Motivation to Change

    1. Lindsey appears to have a relatively high motivation to change. She expressed distress over trying other forms of interventions that didn’t work. Her symptoms have become so severe, she is willing to try anything.

    2. Lindsey says that she wants to get her life back, specifically being able to take her dog on walks and go to the grocery store, seemingly normal activities that her agoraphobia has inhibited.

    3. Lindsey seems to be okay with taking most of the responsibility to change. She says she’s willing to try anything that will help reduce her agoraphobia and distressing symptoms. She was a little hesitant at the idea of going through therapy to change her own habits but expressed that she would be fine as long as she had the support of a collaborative relationship with her therapist.

    4. She seems to express hope that CBT will help, after trying medical interventions and other forms of therapy that didn’t help. As long as she has Dr. V’s support and assistance in practicing some of the perhaps more distressing exposures, she seems to be willing to try anything.

    PDA-3: CBT Assessment – Measures.

    1. Reviewing Lindsey’s assessments so early in therapy can both help the therapist get a sense of the specific symptoms she’s experiencing and also Lindsey’s general orientation and ability to complete assessments and reporting on her symptoms. These early, objective symptom measures provide a baseline that the client and clinician can use throughout treatment to track how the interventions are working with continuous assessments. Beyond this, reviewing assessments early in treatment can also help the developing therapeutic relationship by making sure that the client’s perceptions of her problems match what she reported on the assessment so the clinician has an accurate understanding of what she’s really experiencing.

    2. Lindsey wants to be able to reduce her avoidance behaviors and be able to complete regular activities like shopping in the grocery store, driving alone, or going to the movies. She seems ready to change and hopeful that CBT will help where other interventions had not.

    3. Providing an overall symptoms score could be helpful for Lindsey as she and Dr. V move towards interventions like behavioral exposure. Using a symptoms score will make it easier to track the frequency and severity of her symptoms after these interventions and throughout treatment.

    4. Reviewing and tracking some of Lindsey’s individual responses can help the therapist track if her actual thoughts and perceptions of her symptoms match what she reported on the assessment. This will be important as they select the best interventions.

    Reply

    • Melanie Sergel
      Apr 04, 2020 @ 19:29:08

      Hi Jess! I agree with you that reviewing the assessment early on can be helpful to the therapist in getting a sense of the specific symptoms the client experiences. In the video when Dr. V was reviewing Lindsey’s responses, he noticed that she had anxiety about driving and driving over a bridge which seemed like he did not know that until he read the responses. Also, like you said, it is important because it helps track if the interventions are helping the client by seeing if her symptoms have reduced at all. I like that you mentioned that it helps build the therapeutic relationship. I like that you mentioned this because it does by showing the client that you care and helps by having the therapist gain a better understanding of what Is happening with the client. Great job!

      Reply

    • Monica K Teeven
      Apr 05, 2020 @ 11:17:26

      Hey Jess! In your response to the first PDA- 3 question, you discussed an important point about how reviewing an assessment in the beginning of treatment can help the development of the therapeutic relationship. I did not mention this in my blog post. However, this is an important element that clinicians should remember when working with their clients especially when it is during the beginning of treatment. In your response to number 4 of the PDA-3 questions, you made an important point about how reviewing and tracking an individuals responses of an assessment is important because it can help aid in choosing the best intervention for the client. Great job on your post Jess!

      Reply

    • Renee Gaumond
      Apr 08, 2020 @ 12:22:24

      Hi Jessica,
      I agree with you when you say that Lindsay is motivated to change. I think she’s ready because she feels that with Dr. V’s help she will be able to make the progress that she wants to see. She has tried many different options before that haven’t worked for her, so she’s ready to try anything because her presenting problems have caused her a lot of distress.

      Reply

  2. Robert Salvucci
    Apr 03, 2020 @ 19:29:01

    PDA 2 – Motivation to Change

    1. Lindsey seems to have some reservations but is motivated to work through them. She notes that she is willing to do anything and wants to get her life back. She seems grateful to have the opportunity to do therapy and says she feels comfortable moving forward with Dr.V’s help

    2. Lindsey wants to regain control of her life and minimize her anxiety and agoraphobia-based behaviors. She wants to be able to return to doing activities she values like walking her dog, grocery shopping, and going out with friends.

    3. She showed some hesitation in taking responsibility, but stated she is motivated to work collaboratively to make changes. She seems anxious about, but acknowledges that the therapeutic techniques will slowly become more of her responsibility to practice over time.

    4. She stated that this is one of the better opportunities she’s been given and seems grateful for Dr.V’s support. There seems to be some skepticism but also a degree of hopefulness in her body language and the manner in which she responds.

    PDA 3: Assessment Measures

    1. Lindsey mentions that the assessment helped her see how much she has begun avoiding areas of her life, and illuminated the nature of her behavior more. She seems to feel validated and thankful for Dr.V.’s expertise and navigation of the assessments, which provides her with hope for treatment. This approach serves to build rapport as well as gain insight into the nature of presenting symptoms, while tracking progress over time.

    2. Lindsey is hoping to return to the activities she enjoyed doing prior to the exacerbation of her anxiety and agoraphobia symptoms. She wants to regain a sense of control over how she responds to her anxiety.

    3. Assessing overall symptom score gives Dr.V. and Lindsey a reference point moving forward. It provides insight into the severity of anxiety and how it is impacting her life. Her anxiety can be tracked over time and progress can be consolidated and expounded upon.

    4. This helped identify specific areas of Lindsey’s life that are most affected by her symptoms. We learned that the grocery store, restaurants, theater, and driving were particularly stressful for her. This can help inform interventions and increases the likelihood that therapy is effective in reducing anxiety in the most relevant areas of her life.

    Reply

    • Jessica Costello
      Apr 04, 2020 @ 12:20:55

      Hey Bobby! You made a good observation about Lindsey’s body language and her bit of hesitation towards practicing behavioral exposures and taking some responsibility for her own distress. I agree that she seems grateful for Dr. V’s support through this process and is willing to try anything to get her life back, as long as he’s there to help.

      Something I didn’t touch on in my response was how reviewing Lindsey’s responses to specific assessment items can reveal the parts of her life that her symptoms most disrupt. I agree that knowing what areas to target will guide the choice of interventions and increase the chances that therapy will help. Good job on your post!

      Reply

    • Jenna Nikolopoulos
      Apr 07, 2020 @ 18:49:14

      Hi Bobby! I like what you said about how information from Lindsey’s assessments can be helpful so early on in therapy. I think having Lindsey see for herself how many things she goes out of her way to avoid is beneficial because it allows her to recognize how much her behaviors have changed her life; that she has changed the way she lives to accommodate her symptoms. I think this would give her even more motivation to change her behaviors because since she wants her life back, she doesn’t want to be controlled by her symptoms, she wants to be the one to control them.

      Reply

    • Renee Gaumond
      Apr 08, 2020 @ 12:29:16

      Hi Bobby,
      I like the one you said that providing a score gives Dr. V and Lindsay of reference point moving forward. It allows them to reference the score in future sessions. A way to track progress is to look at how the numbers change throughout each session. From session to session it would be nice to see those numbers going down and to see lower numbers becoming more normal.

      Reply

  3. Melanie Sergel
    Apr 04, 2020 @ 19:14:59

    PDA-2: CBT Assessment – Motivation to Change.
    (1) I think that Lindsey does have motivation to change. Her motivation is at a high enough level where she brought herself to therapy for the session. If she did not have that much motivation to change, she would not have reached out to set up an appointment for therapy. I believe she has enough motivation to work on changing things. She also states that she is willing to do anything to help fix her presenting problems and I think this shows how motivated she really is and that she is ready to finally do something about her distress.

    (2) Lindsey stated that she wants to get her life back. She explains that she just wants the basics and quality of life back, like being able to take her dog on a hike or go grocery shopping on her own.

    (3) Lindsey seems to be leaning away from taking responsibility. She states that if she had any say in what is happening to her that it would not exist, and it would just go away. I think this shows that her perception of responsibility to change is more external rather than internal.

    (4) She thinks that this is a better opportunity that was given to her to help her. She says that nothing in the past has helped her like her going to the doctors or hospitals. She is willing to do anything at this point and from that statement it can be seen that her hope and optimism are high.

    PDA-3: CBT Assessment – Measures.
    (1) Information from Lindsey’s assessments can be helpful so early in therapy because it can be used to compare what she said on the assessment and if it matches what she said verbally, which it does. It can also be used to track her symptoms. It can be helpful so early in therapy because assessments are given throughout therapy and this way, we can look back at the early assessment to track the effectiveness of treatment and the progress the client has made.

    (2) Lindsey stated that what she wants to get out of therapy is that she wants to get her life back. She would like to be able to reduce her maladaptive behaviors in order to be able to complete small activities like driving and grocery shopping.

    (3) On the assessment, Lindsey scored a 21 out of 28 showing that she is markedly distressed. After she heard this, she said she was not surprised. Providing an overall symptom score is helpful for Lindsey, considering her presenting problems. It is helpful because it validates what she is feeling since her score matched her anxious feelings. It also shows Lindsey the extent to what her symptoms are. Before she took the assessment, she probably did not know what her score would be but now with this assessment she can feel maybe a little better that what she feels is being validated and correlated with the assessment.

    (4) It is helpful to review a few of Lindsey’s responses to individual questions from the assessments. It is helpful to review the responses because it helps the therapist understand what places are causing her the most distress. When Dr. V. was reviewing the responses, he did not realize that she felt anxious when she was driving alone on the highway or over the bridge. Knowing this helps the therapist know what needs to be worked on and what is going to need the most work.

    Reply

    • Monica K Teeven
      Apr 05, 2020 @ 11:30:57

      Hey Mel! You made a great point that I did not mention in my blog post to your response to question one of the PDA-2 video. You mentioned that Lindsey has to have at least some level of motivation to change because if she was not at all motivated, she would never have made an appointment for a therapy session. In your response to the third PDA-2 question, we both agreed that Lindsey’s perception of responsibility is more external than internal. However, your reason as to why this is the case for Lindsey is different from what I said. Both my reason and your reason makes sense, so I am assuming in this case there are multiple examples as to why Lindsey’s perception of responsibility is more external.

      Reply

    • Jessica Costello
      Apr 05, 2020 @ 13:03:16

      Hey Mel! You made a great point about Lindsey’s motivation to change, specifically that if she wasn’t ready to make some changes in her life, she probably wouldn’t have voluntarily gone to therapy at all. She also has high hope for CBT based on her previous experiences with other treatments that didn’t help.

      You also pointed out that the assessments can highlight symptoms the client might not even be aware of until she answers the question. This is another benefit of using assessments early in therapy, so the clinician and client can work together to develop helpful interventions. Good job with your post!

      Reply

    • Robert Salvucci
      Apr 05, 2020 @ 15:00:59

      Heyo Melanie!

      It’s definitely important to give Lindsey credit for reaching out for help in the first place, and interesting how you saw that as a big indication of motivation for change in itself. It was also insightful to tie Lindsey’s wish that her panic would just go away to an avoidance of responsibility and maybe even avoidance of reality, as it’s not realistic for her symptoms to just completely vanish. I agree that it’s important to track symptoms and take note of the consistency in reporting them. Lindsey definitely seemed to feel validated after taking the measures as well.

      Reply

    • Shelby Piekarczyk
      Apr 05, 2020 @ 16:01:05

      Hi Mel,

      You made a great point stating that Lindsey has a high motivation for change, or at least high enough that she made an appointment and sought out therapy. I agree that this shows high motivation from Lindsey were she wants to change or at least has begun the process towards change by going to therapy.

      I also agree with your post that currently Lindsey’s perception of responsibility is more external than internal. I did not state this in my blog post but I do believe this is a valid statement. Lindsey shows that without the help of Dr. V she does not know that she would be capable or willing to make changes. However, because the therapeutic relationship is going to start as a collaboration between the two parties Lindsey feels more comfortable moving forward with therapy. This does show that currently Lindsey has more of external

      Reply

    • Mariah Fraser
      Apr 10, 2020 @ 22:50:24

      Hi Mel!

      I agree with what you said about her motivation being high enough for her to make the decision to make an appointment for therapy. She doesn’t realize it yet, but that may be the biggest and most important step in treatment because it shows that she has dedication to improving her quality of life. Just because the road ahead seems like it will have obstacles, that doesn’t take away from the fact that she made the call. Instead of continuing this pattern of avoidance and anxiety, she decided to take back some control in her life!

      Reply

  4. Monica K Teeven
    Apr 05, 2020 @ 11:07:09

    PDA-2 CBT Assessment-Motivation to Change

    1. Lindsey seems motivated to change. She stated she is willing to try anything at this point to reduce her current problems because what she has tried so far has not worked.

    2. She states that she wants her life back and to have a quality life. She does not want to have panic attacks anymore and to stop avoiding certain places she used to be able to go without experiencing fear.

    3. Lindsey’s perception of responsibility is external because she wanted to make sure Dr. V is going to be there with her through the process (social support). This is because she believes she can be successful in treatment as long as she is not alone and someone is there to help her when needed.

    4. She thinks that therapy may be able to help her since nothing yet has helped her such as going to the hospital to see if she was having a heart attack.

    PDA-3 CBT Assessment-Measures

    1. Providing information about Lindsey’s assessments can be helpful in therapy because it provides Dr. V and Lindsey an objective measure to track her progress throughout her treatment to make sure treatment is effective. In addition, it is also a good way to see if what Lindsey has told Dr. V matches what the assessment says.

    2. She states that she wants to lower her avoidance behaviors so she will be able to do activities she used to be able to do. She seems optimistic that CBT will help her because so far nothing else has worked.

    3. Providing Lindsey with her overall score which was 21 / 28, is labeled as someone who is markedly distressed, can help both her and Dr. V see if her overall score is similar to what she had told Dr. V so far. Furthermore, it can also be helpful to show the client that what their is currently experiencing is somewhat serious and should be dealt with.

    4. Yes, it was very helpful to review some of Lindsey’s responses to individual questions from the assessment because one of her answers on the assessment surprised Dr. V. He was unaware that driving alone over a highway or on a bridge was stressful for her. Having this new information will be helpful in making sure the treatment plan includes all situations that cause her to have significant levels of anxiety and to further discuss it in future therapy sessions.

    Reply

    • Robert Salvucci
      Apr 05, 2020 @ 14:44:23

      Hiya Monica!

      Good job highlighting Lindsey’s current reliance on Dr.V.’s support and tying in a degree of an external locus. As Dr. V. notes, over time Lindsey will feel more and more control if the therapeutic process is successful. You also made a point I didn’t think of in relation to the usefulness of assessment. You noted that the assessment can potentially pick up on discrepancies between what she reports on the assessment and what she reports to Dr. V.. This can potential highlight areas she forgets to mention, or areas she may have inconsistent feelings about, which is useful information. You also pointed out that assessment can help quantify her experience and highlight a novel area of fear in crossing bridges while driving.

      Reply

    • Shelby Piekarczyk
      Apr 05, 2020 @ 16:04:30

      Hi Monica,

      I agree that right now Lindsey’s perception of responsibility is more external because she does not feel confident in herself without the help and support of Dr. V. Because of this her perception of responsibility is external. I also agree with your statement that Lindsey does seem hopeful that CBT will help because the other outlets she has tried have not worked. Because of this she is hopeful in the CBT therapy process.

      Lastly, I agree with your comment that tracking Lindsey’s progress will be important throughout therapy to make sure the therapy is effective and to adjust in the areas if/ when needed. Great job!

      Reply

    • Melanie Sergel
      Apr 06, 2020 @ 16:19:51

      Hi Monica! Great job on your post this week and explaining Lindsey’s motivation to change. I agree with you that Lindsey’s perception of responsibility is more external rather than internal. She is not fully confident to change on her own. I also mentioned that it was important and helpful to review some of Lindsey’s responses because there were responses that Dr. V. seemed to be unaware of before seeing the responses. Like you said, it is also important to make sure that we are addressing all situations in the treatment plan.

      Reply

    • Mariah Fraser
      Apr 10, 2020 @ 22:50:03

      Hi Monica!

      I agree that discussing her score and what it means is extremely helpful when trying to put things into perspective. Being ‘markedly distressed’ is significant enough that Lindsey was right in seeking treatment. This likely gives her a bit of a boost in knowing that she knew herself well enough to recognize things were taking a turn for the worse and that she needed to do something about it. Understanding her score could also motivate her to engage and commit to therapy because of the severity of her symptoms.

      Reply

  5. Shelby Piekarczyk
    Apr 05, 2020 @ 15:55:28

    PDA-2
    1. Lindsey appears motivated to change and states that she is willing to do anything it takes. Lindsey has sought out other interventions that did not help in her recovery process. However, she had the motivation to come to therapy and try CBT. She explained with Dr. V’s help she has the motivation to move forward with therapy.

    2. Lindsey would like to take control back of her life. She wants to be able to take her dog on walks and go to the grocery store. She wants to gain control of her life and start doing her normal activities again.

    3. At first, Lindsey seemed hesitant about taking responsibility but once she learned that it will first be a collaborative relationship between her and the therapist, she became more confident. Knowing that therapy will be a collaboration between her and Dr. V she was willing to take responsibility.

    4. Lindsey seems hopeful that CBT will help with the collaborative efforts from the therapist. She explained other interventions that did not work so she is hopeful CBT will help her.

    PDA-3
    1. Reviewing Lindsey’s assessments so early in therapy can be extremely helpful throughout the therapy process. It first allows the therapist to explain to the client why they are completing these assessments (e.g. to see the scores go down throughout therapy) and shows the therapist if what the client has been telling them matches the scores on their assessments. It also gives direction for the therapist and client on what their main goals in therapy are and what they are looking to decrease.

    2. Lindsey wants to reduce her avoidance behavior and be able to do activities again (e.g. going to the grocery store). When Lindsey took the assessment, she stated that it made her realize how many things she is avoiding, and she would like to change this behavior.

    3. Providing an overall symptom score is helpful for Lindsey because it allows the therapist and client to track progress over time. It also allows both therapist and client to see the severity of each presenting problem.

    4. Going over specific questions helps the therapy process because it identifies certain areas of Lindsey’s life that are more stressful. This also can help direct the course of interventions and the best way to help Lindsey reduce her anxiety.

    Reply

    • Taylor O'Rourke
      Apr 05, 2020 @ 19:58:38

      Hi Shelby!

      I think that you touched on a really important aspect of early assessment in therapy – it allows the therapist to determine if the answers on the assessment match the client’s verbal answers during sessions. I think this is a great way to see how open and willing the client is to talk, and this will in turn help the rapport and collaboration between therapist and client. By determining whether or not the answers match, the therapist can use this information to track progress over time and this information can also be telling as to what goals should be focused on first. Assessments are a great way to track progress over time objectively, thus they should always be used throughout therapy, especially at the beginning and the end.

      Reply

    • Erin Wilbur
      Apr 06, 2020 @ 17:20:21

      Hi Shelby,
      I agree that going over assessments early in therapy is helpful for a variety of reasons. Providing the client with reasoning as to why they’re filling out these assessments can also be extremely helpful in building rapport because it shows that the therapist knows what they’re doing and has a reason for asking the client to do this.

      Reply

  6. Jenna Nikolopoulos
    Apr 05, 2020 @ 18:16:04

    PDA- 2

    1. I think Lindsey has high motivation to change. I think physically coming to therapy is the first indicator that she has motivation to change because she took the time to set up an appointment and come in for the session. She also said that she is willing to try anything at this point, as long as she has support, since she mentioned her past efforts to try and get help didn’t work out. Lindsey also mentioned that she wants to get her life back because her panic attacks and agoraphobia have really interfered with her everyday life. I think this indicates a high motivation to change because she just wants to be able to do the things that she used to.

    2. She wants to get her life back. By this, Lindsey means that she wants to improve her quality of life by being able to do things like taking her dog on a hike again and maybe going grocery shopping. She wants to do the things that she can’t do anymore and wants her panic attacks and agoraphobia to go away.

    3. I think Lindsey’s perception of responsibility to change is more external because she wanted to make sure that Dr. V was going to help her through this process as opposed to her doing it all by herself. However, once Dr. V explained that this was going to be collaborative relationship between the two of them and how he was going to be there to support her, especially more in the beginning, she seemed more confident and willing take some responsibility towards changing her thoughts/behaviors herself because she’s willing to do anything to get rid of her panic attacks and agoraphobia.

    4. Lindsey feels therapy is one of the better opportunities that she has been given since everything else she has tried (e.g., hospitals, doctors) haven’t seemed to help. She does seem a bit skeptical, probably because she has never done therapy before and is nervous about how this will work, however, she does seem to have hope that therapy will help her and is willing to try anything at this point as long as she has support from Dr. V along the way. Also, upon hearing that this will be a collaborative relationship between her and Dr. V made her feel better about therapy in general, which probably made her feel more hopeful about therapy being helpful.

    PDA- 3

    1. Information from Lindsey’s assessments can be helpful so early in therapy because it gives an objective baseline measures for tracking Lindsey’s progress throughout treatment. Once Lindsey starts to regularly fill out these assessments, Dr. V will be able to take her score and compare it with previous scores to see if her symptoms and behaviors are improving or not, which will indicate the effectiveness of treatment so far. Also, the information can be used to see if what Lindsey says verbally matches with what she says on the assessment. If it doesn’t, then this can be an area of discussion so Dr. V can get the full picture about what she is experiencing.

    2. Lindsey wants to be able to get her life back by getting rid of her panic attacks and agoraphobia so she can continue to do the things that she used to enjoy doing before her symptoms and behaviors started to interfere with her daily functioning.

    3. Providing Lindsey with an overall symptom score considering her presenting problems is helpful because it gives Lindsey insight into the severity of her anxiety. Lindsey scored in the markedly distressed range of the assessment, which didn’t seem to surprise Lindsey that much, most likely because she knows how much distress her symptoms cause her. The overall symptom score is helpful because it validates Lindsey’s feelings due to her score matching the distress that she experiences. Also, the overall symptom scores gives Dr. V and Lindsey a point of reference moving forward with treatment as this score can be compared to future scores to track how frequently she experiences these symptoms and how severe they are throughout treatment.

    4. It is helpful to review a few of Lindsey’s responses to individual questions from the assessments because it helps Dr. V understand which places in Lindsey’s life cause her the most distress. For instance, Dr. V did not know that driving alone over a highway or on a bridge caused Lindsey distress, but because he reviewed that question with her, he was able to ask her about it and gain a better understanding. The information Dr. V receives from Lindsey will help him figure out the best way to help Lindsey as it indicates which areas are a priority for treatment.

    Reply

    • Taylor O'Rourke
      Apr 05, 2020 @ 19:55:27

      Hi Jenna!

      I completely agree with you that Lindsey has a high motivation to change, and is willing to take the responsibility to do so. However, I also agree that a lot of the change she is expecting is aimed towards external factors, because she expects her therapist to help her along the way. Although this is not an unreasonable request, she needs to be able to guide herself to change and ultimately be the one making these differences in her life. She definitely is making steps in the right direction and I believe she has already overcome the most difficult one: committing to therapy of her own accord. She has already taken such a big step and admits that she is willing to try anything at this point so she can get her life back, so I think she has the motivation to accomplish whatever she wants to.

      Reply

    • Ashley Foster
      Apr 06, 2020 @ 11:26:56

      Hi Jenna! I like how you mentioned a key component of what makes this client motivated to change is that she is physically coming to therapy as a first indicator in her motivation. I think a lot of us look over the importance of the client just coming to session in what that means to our clients and the therapeutic relationship. Especially in this scenario, Where the client is experiencing agoraphobic symptoms that are distressing to go out on her own. This validates the motivation that this client has as even though she is experiencing symptoms of distress in a severe level, she still decided to come to therapy on time and even just set up the appointment on her own. Great job with the posts!

      Reply

  7. Taylor O'Rourke
    Apr 05, 2020 @ 19:39:31

    1. In general, how would you describe Lindsey’s motivation to change? (PDA-2)

    In general, I would argue that Lindsey’s motivation to change is quite high. She voluntarily started therapy and sought it out because she wants to gain control of her life back and wants to be able to have a higher quality of life again. Although her avoidant behaviors get in her way sometimes, she truly is willing to do whatever it takes to get better (as long as she has some help along the way), so I believe that she is definitely willing and ready to change at this time. She is not resistant or ambivalent in any way, based on what I have seen so far.

    2. What does she want to get out of therapy?

    What Lindsey wants out of therapy is to get her life back. To her, this means having a better quality of life that includes going grocery shopping and taking her dog for walks/hikes. Her ideal scenario would be no more panic attacks or agoraphobia.

    3. What is her perception of responsibility to change (i.e., internal vs. external)?

    Lindsey questions if her therapist will help her along the way, and she says that as long as she has help, then she is willing to put in the work. She will be more on her own in the end and be fully responsible, but her therapist will guide her through all of the beginning stages. This comforts her to know she will not be going it totally alone. In other words, she is internally ready to change, but externally is still looking for assistance and guidance to do so.

    4. What hope or optimism does she have that therapy will help?

    Lindsey admits that nothing in the past has worked before (e.g., medical doctors/hospitals) so she knows that this is probably the best option for her right now. She has a bit of hope that therapy will help and she is willing to do anything at this point. She has already taken the first step by calling and beginning the process of therapy.

    5. How can information from Lindsey’s assessments (i.e., explaining and providing feedback) be helpful so early in therapy? (PDA-3)

    Information from Lindsey’s assessments can be very helpful so early in therapy because it raised her awareness of things that she has been avoiding (and she did not realize how many things she was avoiding). This is also a great way to help track Lindsey’s symptoms over time in a very objective manner. She will continue to fill out these measures every few sessions so she and the therapist can see how her scores change over time.

    6. What does she want to get out of therapy?

    Lindsey is looking to decrease her panic and agoraphobia symptoms so that she can return to an adequate level of adaptive functioning. She has trouble going shopping, driving alone in her car, etc. and this clearly causes distress in her daily life.

    7. How is providing an overall symptoms score helpful for Lindsey, considering her presenting problems?

    Providing an overall symptoms score is helpful for Lindsey because it shows how she is progressing over time. By beginning each session (or every couple sessions), she is able to get the positive reinforcement and motivation to continue working when she sees improvement. Having objective measures is the best way to track progress for sure.

    8. Why was it helpful to review a few of Lindsey’s responses to individual questions from the assessments?

    It was helpful to review a few of Lindsey’s responses to individual questions from the assessments because she was able to gauge how surprised she was by her answers. Also, this shows herself and the therapist what situations may be the biggest problem areas for her. This also brings awareness to situations, for example, that her therapist was not aware of previously. Lindsey scored driving in her car alone highly on the agoraphobia scale, so this was able to surface for the first time.

    Reply

    • Ashley Foster
      Apr 06, 2020 @ 11:39:32

      Hi Taylor! I like how you mention in the hope and optimism portion of your post of what she has done for medical interventions in her past and knowing this is best option for her in her current state. The client in the scenario gills with many biological symptoms that can be hard to discriminate. These symptoms caused great distress to this client, but she is medically sound. In light of this, the client can be reassured that she is not going to die due to a heart attack or her symptoms. This approach will hopefully help the client become more autonomous within her treatment, and consequently validate the hope of being able to cope with his symptoms independently in the future. Great job with the post!

      Reply

    • Erin Wilbur
      Apr 06, 2020 @ 17:09:25

      Hi Taylor,
      I like that you mention positive reinforcement and motivation as a reason to provide a symptoms score to Lindsey. By having her fill out the scale every few sessions and providing her with a new score, it would definitely motivate her to keep going to therapy and collaborating with her therapist because the score provides “proof” that the interventions are working. This would be a good tool to use with clients who are skeptical or don’t believe in their ability to get better with interventions.

      Reply

  8. Ashley Foster
    Apr 06, 2020 @ 11:23:54

    Motivation to Change

    1.In general I believe that the client is motivated to change. She is in high distress with the symptoms she is experiencing. Due to this distress, she wants to be able to go out and do her every date pass such as taking the dog out for a walk or going to the store. She does show some signs of hesitation as she anxious about what is to come throughout session and through the change process.

    2. What the client wants to get out of therapy is to be able do not live with her fear up going out and feeling like she is dying. The client and sometimes wants her life back in the sense of being able to go outside go for a car ride finish task independently. She also would like to regain control of her anxiety to be able to do these tasks.

    3. Although the client is hesitant to change and shows signs of being anxious of this process, she is willing to take on the responsibility of change. She is anxious of what is to come but reassured by the clinician that she will work on these tasks and these anxious thoughts and emotions through a collaborated relationship.

    4. The client shows a significant amount of hope and optimism about the help she is going to receive in therapy. Especially so, working through these issues with the collaborative approach from her therapist. She is goal oriented within this session and has to the motivation to do so with some hesitations.

    Measures

    1. The information that is being explained to the client is called psychoeducation. This gives the client a better understanding of why symptoms are happening and also gives hope That there is treatment to help with these distressing symptoms. Furthermore, especially in this case the client does not understand that her symptoms that looks biological are actually mental. This can help the client better understand what is going on and possibly decrease the level of anxiety a feeling that she is going to die or have a heart attack.

    2. In a perfect world the client does not want to have her agoraphobic feelings and thoughts. Examining this statement, she wants control of her life back. Examples of this is she wants to be able to go to the store, go for rides, and be able to walk her dog independently.

    3. The number itself on the score is not what is important to the client. Rather, what is helpful is the score in the sense of severity in congruence with the assessment. An example of this is that one of the assessments showed that her anxiety is at a very severe level. This means that she’s experiencing high levels of distress and it gives the clinician a better idea of what to work on and what needs to be done. In another assessment, the examination of Where her symptoms of agoraphobia were coming from. This gives the clinician a better understanding of where and how these symptoms of distress are affecting the client. Furthermore, this helps the client have a baseline on what to look back at while she is going through therapy and see the growth that she is going to have for what she has had so far. It also gives the clinician a better understanding on if treatment is working or if something needs to change within session.

    4. It was helpful to review the client’s responses in the individual classes as the clinician was able to pull out more information than the client actually gave him. It gave a better understanding of what is going on, where is going on, and triages what should be worked on and importance to the client.

    Reply

    • Tim Keir
      Apr 08, 2020 @ 22:38:38

      Hey Ashley!

      It feels like you got a good grasp of what Lindsey’s approach to therapy. She definitely wants to change, and is willing to put in the work to make it happen. I thought she seemed a little discouraged from having so many medical tests come up with no concrete answers, so I personally saw her optimism as a little shaky in that regard. I think your interpretation could be closer to the truth, especially seeing as how willing she is to fully engage in the process.

      I agree that the best use of assessments is as a baseline and contextualization of symptom type and severity. Lindsey seems to appreciate not only having the information but being walked through it by Dr. V, a skill we should all try to imitate in our own sessions. Good post!

      Reply

  9. Madison Armstrong
    Apr 06, 2020 @ 15:15:02

    [Case Formulation & Treatment Plan] – Watch PDA-2
    (1) In general, how would describe Lindsey’s motivation to change?
    I would say that Lindsey appears to be motivated to change. She mentioned that she wants to get her life back and would be willing to try anything. However, she does seem to be a little apprehensive because no other interventions (e.g. ER visits, medical doctors) have worked for her in the past, but she did take the first step and came to therapy.
    (2) What does she want to get out of therapy?
    Lindsey mentions that she wants to get her life back and hopefully see a decrease in her agoraphobic behavior. She mentioned she wants to be able to take her dog on a hike and maybe even get to the point where she can go grocery shopping. She said that she wants to see an increase in her quality of life.
    (3) What is her perception of responsibility to change (i.e., internal vs. external)?
    When she first got to therapy, she may not have recognized her responsibility to change but with Dr. V’s help and an explanation of the cognitive behavioral model, she was able to see that she does have a role in changing. She seemed to feel more comfortable with the collaborative nature of CBT and seemed relieved when he mentioned he would help her through the process.
    (4) What hope or optimism does she have that therapy will help?
    When asked about her optimism that therapy will help, she mentioned that this is the best opportunity she has been given because nothing she has tried before has worked. She mentions that she is willing to do anything so it could be assumed that her hope and optimism levels are high because she wants to see a change.
    [Case Formulation & Treatment Plan] – Watch PDA-3
    (1) How can information from Lindsey’s assessments (i.e., explaining and providing feedback) be helpful so early in therapy?
    Information from Lindsey’s assessments can be helpful in the early stages of therapy because these measures allow both Dr.V and Lindsey to track the treatment progress. This measure can be given consistently throughout treatment so they will be able to compare to the initial assessment and see if progress is being made and what areas still need to be targeted. This also opens up more communication about her experiences and may show Dr. V symptoms that may not have been mentioned. It can also serve as a way to help build a rapport early in treatment.
    (2) What does she want to get out of therapy?
    Lindsey wants to get her life back, meaning she wants to see an increase in her quality of life. She wants to be able to take her dog for a hike and go grocery shopping and decrease her agoraphobic behaviors.
    (3) How is providing an overall symptoms score helpful for Lindsey, considering her presenting problems?
    Providing an overall symptom score is helpful to Lindsey because it validates her current distress. This can also serve as a motivation for her to want to change and eventually lower her score throughout therapy.
    (4) Why was it helpful to review a few of Lindsey’s responses to individual questions from the assessments?
    It was helpful to review Lindsey’s responses to individual questions because it is beneficial to be able to see which areas she struggles with the most. It was mentioned that the supermarket, restaurants and driving on a highway or bridge are things that cause her distress. This is helpful to know because some of these things were not mentioned previously and it is important for the therapist to be aware of this so they can target the right treatment goals.

    Reply

    • Tim Keir
      Apr 08, 2020 @ 22:37:30

      Hey Ashley!

      It feels like you got a good grasp of what Lindsey’s approach to therapy. She definitely wants to change, and is willing to put in the work to make it happen. I thought she seemed a little discouraged from having so many medical tests come up with no concrete answers, so I personally saw her optimism as a little shaky in that regard. I think your interpretation could be closer to the truth, especially seeing as how willing she is to fully engage in the process.

      I agree that the best use of assessments is as a baseline and contextualization of symptom type and severity. Lindsey seems to appreciate not only having the information but being walked through it by Dr. V, a skill we should all try to imitate in our own sessions. Good post!

      Reply

    • Tim Keir
      Apr 08, 2020 @ 22:46:08

      Hey Madison!

      I noticed the same apprehension in Lindsey’s approach to treatment! Especially when the symptoms are so physiological, it is tough for a person to admit that the cause is purely psychological. I’m sure it was a difficult pill for Lindsey to swallow that therapy was the answer to her symptoms, but her dedication to a solution can be seen in her attendance. Her goal to return to her normal lifestyle definitely seem to be her motivation.

      As for assessment use, I agree in the value of using it to track progress through time. I appreciate your consideration of the assessment validating Lindsey’s feelings about things – the test does recognize her concerns as alarming and in need of attention. Excellent point!

      (Sorry for the double comment, please ignore the first one!)

      Reply

  10. Erin Wilbur
    Apr 06, 2020 @ 16:52:29

    PDA-2
    1. Lindsey has pretty high motivation to change. She tells Dr. V that she is willing to do “anything” to get her life back on track and appears ready to start working to minimize her anxiety and agoraphobic behaviors.
    2. Lindsey states that she wants to get her life back through therapy. She describes that she wants to be able to do what she used to, like grocery shopping and taking her dog for a walk. She hopes to stop her panic attacks and overcome her agoraphobia.
    3. Lindsey is a bit hesitant in her perception of her responsibility to change, and asked Dr. V if he’ll be there to help her. Once he reassures her that he will, she says she’s ready to work with him on the things she needs to.
    4. Lindsey says she is fairly optimistic about therapy being helpful to her. She is hopeful that this is her best hope in getting better because she has tried so many other things and they haven’t worked for her.
    PDA-3
    1. Information from Lindsey’s assessments can be helpful this early in therapy because it helps the therapist track the symptoms throughout therapy to make sure that progress is being made. It also familiarizes Lindsey with the assessments so she can get used to taking them, and gives the therapist a good amount of information about the symptoms Lindsey is experiencing, helping to fill in anything she may have missed when they discussed it originally.
    2. Lindsey hopes to decrease her anxiety and agoraphobic symptoms through therapy. She wants to be able to go out on her own again and do simple things like bring her dog for a hike.
    3. Providing a symptom score for Lindsey is helpful because it lets her know the level her anxiety is at currently and gives her a baseline to try to improve on, to make the score lower as she learns to cope with her symptoms. Providing a simple number score also makes it easier to understand for the client. Rather than going into depth about how her coping skills will improve with each intervention, it simplifies the concept, that she just wants to make the number lower.
    4. Reviewing some of Lindsey’s responses to individual questions was helpful because it supports what she has reported about certain scenarios earlier in therapy, and also gives the therapist a look at her most feared situations and severe symptoms. It helped the therapist to determine the parts of Lindsey’s life that have been most affected by her panic attacks and agoraphobia, like going to the grocery store or driving alone over a bridge.

    Reply

    • Madison Armstrong
      Apr 08, 2020 @ 20:41:12

      Hi Erin,
      I agree with you that it is important she becomes familiar with the assessments they will be using early on in therapy. I also think that providing a symptom score is helpful to measure her level of panic and agoraphobic symptoms to see if the treatment plan is working for her and to make sure they are addressing the right goals. As she sees the number get smaller, this could increase her motivation and her belief that therapy will work for her.

      Reply

  11. Renee Gaumond
    Apr 06, 2020 @ 18:23:15

    (1) In general, how would describe Lindsey’s motivation to change?
    Lindsey appears to be highly motivated to change. Her symptoms and presenting problems have become so distressing for her that she wants to try anything that will help. This shows her motivation to change and she seems willing to try the interventions that Dr. V has in mind for her.
    (2) What does she want to get out of therapy?
    Lindsey wants to get her life back on track. She wants to do things that she used to do like going to the grocery store, spending time with her friends, and taking her dog on walks. She would like to have control over her anxiety and agoraphobic lifestyle.
    (3) What is her perception of responsibility to change (i.e., internal vs. external)?
    Lindsey seemed uncomfortable taking the responsibility for the change showing an external locus of control. She appeared to be more confident when she felt that Dr. V was going to help her through her presenting problems. Though she still held onto the external locus of control because she feels like she needs the help from Dr. V to make a change instead of having confidence in her own abilities to change.
    (4) What hope or optimism does she have that therapy will help?
    She appears to be hopeful for CBT and Dr. V’s help. She didn’t find any benefit from the other types of treatment she has had before, so she’s very hopeful that CBT will help her. She is especially hopeful having Dr. V guide her through her therapy and give her support.
    1) How can information from Lindsey’s assessments (i.e., explaining and providing feedback) be helpful so early in therapy?
    Information from the assessments is helpful because it allows the therapist to see exactly what symptoms Lindsey is experiencing. They also allow to see the presenting problems and symptoms before treatment. Once treatment is in progress the assessments can be re-administered in order to see how much progress has been made. If progress has been made, then clinician and client can confirm that the treatment has been working. If there was no progress shown, then they can assess what needs to be changed in treatment in order to get the desired outcome.
    (2) What does she want to get out of therapy?
    Lindsey wants to see progress with her avoidance behaviors. She wants to be able to go out to the grocery store and the movies and not have to worry about when her next panic attack will occur. Being in control of her anxiety is a major goal for her therapy.
    (3) How is providing an overall symptoms score helpful for Lindsey, considering her presenting problems?
    It allows some objectivity to therapy. Using numbers lets Lindsey reflect on the intensity of her presenting problems in the moment. Comparing these scores across sessions will allow Lindsey to see the progress she has made during therapy as the numbers decrease from session to session.
    (4) Why was it helpful to review a few of Lindsey’s responses to individual questions from the assessments?
    Looking at the specific responses that Lindsey had on her assessment allows Dr. V to gauge what is most distressful for her in order to focus on those aspects during therapy and set relevant treatment goals. It also allowed Lindsey to discover more about herself such as her anxiety around driving alone on the high way or a bridge.

    Reply

  12. Mariah Fraser
    Apr 06, 2020 @ 19:22:07

    PDA-2

    Lindsey has at least some motivation to change because not only did she verbally state that she’s willing to do anything at this point in her life, but Dr. V pointed out that she has already made some significant steps toward change. Making the phone call and scheduling an appointment for therapy, in addition to actually showing up to the first session is very important.

    Lindsey said that she wants her life back; which to her means that her quality of life is restored and she can get back to things she used to do, such as taking her dog for hikes and going grocery shopping. With some probing, she said that she would like for her panic attack symptoms and agoraphobia to go away. Dr. V explained that although there are no promises that she will be completely free of these problems, they will work together to determine how to become more comfortable during exposure exercises and what skills to practice to do so. Dr. V also mentioned that it is normal to have at least some anxiety, therefore working towards decreasing the intensity and frequency of the symptoms are more realistic and should be expected.

    Her perception of responsibility within this first session seems to be more external. She seemed a bit hesitant and concerned when Dr. V asked about her thoughts regarding her role in therapy and taking responsibility for modifying her thoughts and behaviors, and felt at ease when he confirmed that he would be with her every step of the way. This seems to be an external perception because she depends upon the presence and guidance of others, and may not have confidence in her own abilities independent of others. She said that as long as she has help she thinks she will be OK, and Dr. V clarified that in the beginning he would be the one to lead the way, but as time goes on, she will gain more responsibility.

    Lindsey hopes that this will help her, because nothing she has tried in the past has worked out. She’s tried hospitals and medical doctors without any luck. When Dr. V talked about how the techniques that will be implemented have worked for people in the past with similar problems, I’m sure it helped to put Lindsey’s mind at ease and to instill a little more hope.

    PDA-3

    Providing an explanation helps the client understand the purpose for filling out the assessment. It is also important to have this conversation with Lindsey because she will know what to expect when she takes the assessment again later on in therapy. This also provides the client the opportunity to ask questions and express concerns. Reviewing assessments can help to build a therapeutic alliance because it gives the therapist an opportunity to check the understanding of the client’s presenting problems to ensure accuracy.

    Lindsey wants her life back, meaning she would like to return to enjoyable activities, as well as having the ability to accomplish tasks that are necessary in her day-to-day life (e.g. hiking with her dog; going grocery shopping). She hopes that therapy can help her to decrease these symptoms.

    The score gives the therapist a frame of reference so that there is a better understanding of what’s going on, where the client’s baseline is, and helps to track progress over time. Her score revealed that she is markedly distressed, and having that discussion may provide some relief in the sense that this tool confirms the way she’s feeling.

    It was helpful to review a couple responses because it helped to clarify her symptoms and it even provided a bit of information that could be used later on when developing a hierarchy when implementing exposure techniques. Additionally, Dr. V wasn’t aware of the fact that driving alone over bridges and on the highway was something that was difficult for Lindsey to do, therefore going over responses that stand out can help to clarify minor details and also make the therapist aware of situations that were not previously mentioned.

    Reply

    • Jenna Nikolopoulos
      Apr 07, 2020 @ 18:26:46

      Hi Mariah! I like how you mentioned what Dr. V told Lindsey in regards to her wanting her panic attack symptoms and agoraphobia to go away. I think it’s important to be transparent with the client about the effectiveness of treatment. In the case for Lindsey, even though the exposure exercises and relaxation techniques will help decrease her panic attacks and agoraphobia considerably, it’s important for her to know that there is no guarantee that all of her symptoms will completely go away. I think this helps put the idea of therapy more into perspective for the client to start developing more realistic goals and expectations. So instead of hoping to completely rid herself of her symptoms, Lindsey, like you said, should start by focusing on decreasing the intensity and frequency of her symptoms, which is a more realistic goal that can be accomplished with therapy.

      Reply

  13. Tim Keir
    Apr 06, 2020 @ 21:16:58

    1. How would you describe Lindsey’s motivation to change?

    She describes herself as willing to do anything to change her position, so the motivation seems to be pretty high.

    2. What does she want to get out of therapy?

    Lindsey wants her “life” back; she wants to regain her independence and ability to explore the world without fear of panic attacks. A complete cessation of her symptoms is the perfect outcome.

    3. What is her perception of responsibility to change?

    The idea of taking charge is initially disconcerting, but Lindsey seems significantly relieved when Dr. V describes the amount of assistance he will be providing to her improvement, especially at the beginning. With the knowledge that she will not be working alone, Lindsey describes herself as capable of putting in the work. She knows that she is responsible for her own change in thoughts and behaviors, as long as she is given the proper structure and teachings to do it right.

    4. What hope or optimism does she have that therapy will help?

    She is more hopeful for therapy than other options she has taken, mostly medical responses to the problem. However, she specifically puts therapy in the context of the best option currently available to her, as all others have failed. So there seems to be a layer of defeatism or at least weariness towards the idea of therapy, while still maintaining a level of hope and openness to the process.

    1. How can information from Lindsey’s assessments be helpful so early in therapy?

    Such assessments exist as the initial data point, the reasonably objective measurement of the severity of Lindsey’s symptoms. It is through repeated presentations of the assessment throughout therapy that progress is observed, which gives both parties the certainty that the treatment is on the right course. It’s also a great way to confirm that what the therapist has heard through the client’s own words was accurately understood. In Lindsey’s case, her expression of panic attacks and agoraphobia were ratified by the assessments given.

    2. What does she want to get out of therapy?

    Lindsey is seeking to decrease the intensity of the fear she experiences in different environments, and the physiological and anxiety responses she feels from her panic attacks. While she did not initially understand what part the assessments played in those goals, she was explicitly grateful to Dr. V for explaining their purpose in detail. Lindsey seems on board with using them if they help her achieve her ultimate goal of getting her life and independence back.

    3. How is providing an overall symptoms score helpful for Lindsey, considering her presenting problems?

    Especially for anxious clients like Lindsey, it is important to begin getting the client to think in terms of scales and rankings of symptoms. For her treatment, an important aspect is creating a hierarchy of feared events, so that each fear can be faced from least to greatest. Furthermore, the numerical score for her panic attack assessment give a hard number for her to consider, which will be relieving when the number decreases over the span of weeks of treatment.

    4. Why was it helpful to review a few of Lindsey’s responses to individual assessments from the assessments?

    Especially when the the scale so plainly lays out the symptoms the client is suffering from, such as the PDSS in this vignette, the way the client processes the overlap between their experiences and what is on the assessment can be revealing. Lindsey has a high level of self-perception and admits that the test was revealing; there could have been many other ways to respond to the test, from resistance to feigned ignorance. Furthermore, allowing time for review gives the client time to ask questions or clarify answers that they gave. Finally, actively having the client participate with the scores brings them closer to the therapy itself; by involving them with the scoring and laying out the nature of the assessments, the clinician is giving psychoeducation to the client on the spot about incredibly relevant information. It’s a fantastic way to increase engagement when done correctly.

    Reply

    • Madison Armstrong
      Apr 08, 2020 @ 20:49:28

      Hi Tim,
      I also think that it is important to note Lindsey’s feelings of uncertainty that therapy will work for her and that she has a responsibility for change to happen. Some clients are going to have some skeptical thoughts about starting therapy and I think that Dr. V did a great job of reassuring her that he would be helping her along the way. It was beneficial for him to mention that the eventual goal would be for her to be able to do this independently because this allowed for her to have realistic expectations about what the therapy process will look like.

      Reply

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Adam M. Volungis, PhD, LMHC

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