Miss Celie is a 51-year-old African American woman. She lives on a plantation with her sister, Nettie, and her children. She was married for 30 years to Albert Booker, described as violent, dependent on alcohol, and physically abusive. Miss Celie has experienced multiple symptoms of PTSD and Dysthymia that impact her daily life. A conceptual analysis of her situation reveals that using cognitive behavioral therapy (CBT) can facilitate her healing. Cognitive Behavioral Therapy (CBT) is a therapeutic technique where the counselor strives to identify faulty thinking, negative schemas, and irrational thoughts. Cognitive Behavioral Therapy can be applied to Miss Celie’s case to analyze negative schemas and automatic thoughts while focusing on her change and healing.
Case Conceptualization
Using cognitive behavioral therapy can play a big role in developing the best treatment plans for a patient. Miss Celie’s symptoms of PTSD can be investigated through CBT to analyze her situation and perceptions, spontaneous thoughts and images, and her behavioral, emotional, and physiological reactions. Cognitive-Behavioral Therapy (CBT) is a general term that incorporates multiple elements to improve counseling and treatment. The theoretical framework of CBT focuses on individual perceptions that are often dysfunctional and distorted when distressed. It enables one to identify and evaluate automatic thoughts that occur during verbal or imaginative cognition. The framework can be applied to correct one’s thinking to ensure that it resembles reality. The approach can be applied to help a client develop problem-solving and coping skills.
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The cognitive model can be applied to further understand the cause of the mood disorder due to distorted thinking. The core of cognitive-behavioral therapy involves a cognitive model that considers one’s situation, automatic thoughts and images, and reactions. The theory involves first analyzing a situation and describing how one’s thoughts and perceptions can influence one’s life. The next step involves evaluating automatic thoughts and images to identify whether a shift in one’s thinking can lead to healthier living (Mahali et al., 2020). A person’s reactions can then be analyzed by considering emotional, behavioral, and physiological reactions
Schemas are cognitive structures that organize the information processed daily. The schemas shape how one processes, encodes, and retrieves information from the brain. One of the integral components of schemas is that it contains core beliefs (Bourdon et al., 2019). Transforming and changing one’s core beliefs can be applied in the therapeutic process of CBT to realize healing. Miss Celie needs to change her schemas by altering her core beliefs. Her experiences with physical and sexual beliefs could have made her believe that the world is a dangerous place. Growing up, she did not receive adequate support from her parents as her stepfather mostly mistreated her. She was married to Albert, who did not protect her from emotional or sexual abuse from other men. For a very long time, Miss Celie grew up in a world where those supposed to protect her abused her. The result was that she developed negative schemas about her self-worth and the world around her.
Etiology of Symptoms
The presenting concerns in Miss Celie’s case involve problems of Posttraumatic Stress Disorder (PTSD) and Persistent Depressive Disorder (Dysthymia). The etiology of the symptoms can be traced back to her abuse when growing up and her marriage for 30 years. Miss Celie experienced physical, emotional, and sexual abuse from her stepfather. Her stepfather impregnated her at thirteen, and the child was taken away. She became married to Albert Booker at 17, and she experienced physical and sexual abuse. Albert used to bring other men home with him, and they would take advantage of Miss Celie. She ultimately left her marriage, but her past trauma negatively impacted her as she experienced PTSD and Dysthymia. Miss Celie’s symptoms of PTSD can be investigated through CBT to analyze her past and how it influences her current thoughts and perceptions. PTSD is associated with experiencing multiple challenges and traumas over an extended period.
Redefining Presenting Problem
Nettie described her issues as “darkness,” where she showcases nightmares, fits of nerves, and melancholy that overwhelmed her sister. She once woke up from a dream as she screamed and pulled her hair. Her horrific nightmares had lasted for several years, a clear indication of PTSD (Schwitzer & Rubin, 2014). Cognitive Behavioral Therapy (CBT) can be used to analyze Miss Celie’s situations and perceptions. One of the indications is that she perceives any possible situation as dangerous as it reminds her of her past. While her current situation does not present physical, emotional, and sexual abuse, she sometimes has dysfunctional thinking, and her processing of information gives distorted thoughts. Her beliefs and ways of interacting are largely shaped by associating most of her thoughts with her past. Miss Celie also showcases a persistent depressive mood due to her difficult past.
Theory Appropriate Terms
The basic theoretical terms identified are cognitive behavioral therapy, the cognitive model, schemas, the social cognitive theory, and the emotional processing theory. Cognitive-Behavioral Therapy (CBT) is a general term that focuses on individual perceptions that are often dysfunctional and distorted when distressed. The cognitive model considers one’s situation, automatic thoughts and images, and reactions . Schemas are cognitive structures that shape how one processes, encodes, and retrieves information from the brain. The social cognitive theory incorporates personal beliefs about an individual to help understand perceptions and experiences (Venta et al., 2017). The emotional processing theory is an aspect of CBT people with previous traumatic events can develop associations where safe reminders of an event can alter meaning and responses (Alpert et al., 2021). The analysis of the given theories can provide additional information regarding the appropriate treatment plan.
Treatment Plan
Treatment Course
The treatment course can be established by analyzing the goal of CBT intervention. The intervention aims to identify and change faulty thinking and faulty processing of information. The emotional processing theory is an aspect of CBT that states that those that have experienced traumatic events can develop associations where safe reminders of an event can alter meaning and responses (Alpert et al., 2021). Such associations of traumatic events can lead to mild depression. The goal of counseling for Miss Celie will thus strive to identify any reminders of events, the possible meaning associated with those events, and automatic responses to events. The other objectives are to help Miss Celie gain a sense of control, self-predictability, reduce avoidance behaviors, and learn more about her condition.
The course of counseling will also focus on changing the emotional processing procedure. It involves identifying trauma narratives and reminders of trauma or emotions associated with the treatment. Miss Celie’s traumas were identified to be triggered whenever she has nightmares and being startled by loud noises. The two situations made Miss Celie experience agitation, a racing heart, and jitters. Miss Celie can be exposed to the situations that trigger the associations with the trauma in a controlled way. She can further explore her nightmares by describing her dreams. Exposing her to loud noises can also help her deal with anxiety issues whenever she experienced such situations. Education about the impact of the trauma can also be applied as an instruction method to further facilitate relaxation. Managing stress and depression will also be an important part of the treatment.
Treatment Intervention
The treatment will involve delving into Miss Celie’s core beliefs and automatic thoughts and reactions. The social cognitive theory suggests that people who have experienced traumatic situations can incorporate it into existing beliefs about themselves and have unhelpful understandings about perceptions and experiences (Venta et al., 2017). Gentle Socratic questioning can be applied to the situation to investigate her beliefs and reactions. The approach involves verbally asking the client a series of probing questions to identify possible irrational thoughts. Any irrational thoughts or reactions can then be challenged along with CBT interventions. The approach should also help Miss Celie learn to evaluate and respond to automatic thoughts and beliefs by herself. Engaging with the evaluation process can help the patient continually improve her condition even after the therapy session has been completed.
Comments & Conclusion
Cognitive Behavioral Therapy can be applied to Miss Celie’s case to analyze and treat her problems with PTSD and dysthymia. The case conceptualization revealed that Miss Celie encountered multiple physical, emotional, and sexual abuse when growing up and her adult life when married. Her encounters with multiple traumatic situations led to the development of PTSD. Various models and theories in CBT can be applied to facilitate healing and treatment. The case conceptualization showed that various theories like social cognitive processing, the cognitive model, and emotional processing theory will reveal information about the problem and possible treatment. The recommendation for treatment was identified that it should focus social cognition to distorted views and beliefs. Further treatment should also focus on emotional processing to identify how past traumatic events can impact one’s perspectives. Education about PTSD and the impact of past traumas can also help Miss Celie further understand her situation.
References
Alpert, E., Hayes, A. M., Yasinski, C., Webb, C., & Deblinger, E. (2021). Processes of Change in Trauma-Focused Cognitive Behavioral Therapy for Youths: An Approach Informed by Emotional Processing Theory. Clinical Psychological Science , 9 (2), 270-283.
Bourdon, D. É., El-Baalbaki, G., Girard, D., Lapointe-Blackburn, É., & Guay, S. (2019). Schemas and coping strategies in cognitive-behavioral therapy for PTSD: A systematic review. European Journal of Trauma & Dissociation , 3 (1), 33-47.
Mahali, S. C., Beshai, S., Feeney, J. R., & Mishra, S. (2020). Associations of negative cognitions, emotional regulation, and depression symptoms across four continents: International support for the cognitive model of depression. BMC psychiatry , 20 (1), 1-12.
Venta, A., Hatkevich, C., Mellick, W., Vanwoerden, S., & Sharp, C. (2017). Social cognition mediates the relation between attachment schemas and posttraumatic stress disorder. Psychological Trauma: Theory, Research, Practice, and Policy , 9 (1), 88.
Schwitzer, A.M., Rubin, R.C. (2014 ). Diagnosis and Treatment Planning Skills: A Popular Culture Casebook Approach (DSM-5 Update). Sage Publications
