Individual Placement and Support Group

Narrator: Cognitive behavioural therapy is based on the belief that a person’s actions are influenced by how their thoughts, feelings and behaviours interrelate with each other. The conversation between Adam (social worker) and Jason (client) takes us through how CBT can be applied to treat a mental disorder. 

Adam : Please come on in. How are you today? 

Jason : I am fine ( looking disoriented ). 

Adam : Would you like some coffee or water to drink? (Attempting to create a relaxed atmosphere to make the client comfortable ). 

Jason : That is okay. 

Adam : This therapy session is about creating a safe environment where you can express yourself and your thoughts without judgment. 

Jason : Uuhm! Okay. 

Adam : I understand that you were referred to come to therapy by your parents. 

Jason : Yea, they think I am crazy… you know, no one understands me. That is why I do not want to associate with my high school friends… ( long pause ). They are negative people; I do not want their negativity around me. 

Adam : Why do you feel like your parents do not understand you? 

Jason : They keep saying there is something wrong with how I behave, but that is not true. I am unhappy but that is because of how my neighbors are behaving. Their actions make me uncomfortable and I do not like it. My high school friends also make me sad because they keep trying to send me their negative vibes even though I keep avoiding them. 

Jason : I am a cyclist. I want to join the national team and become a professional cyclist… but, my parents do not want to support my dreams. In fact I need emotional space so that I can repair my bicycle without the negativity of my parents around me. ( Looking amused while staring out the window ). 

Adam : Why do you say that? 

Jason : They are unsupportive and do not understand my ambitions and goals to take part in the Olympics. 

Adam: What are your goals? 

Jason: I want help in maintaining a life routine that will enable me to participate in the next Olympics, and for my parents to understand me. 

Adam: Presuming you get help with your goals, what implications would this have on your life? 

Jason: Uuuhm! I do not know… I will go to the Olympics and cycle… be great. I want to go home and repair my bicycle. Did you know that there is a mental difference between girls and boys who take part in the Olympics. Everyone is trying to send their negative energy my way. My friends, my family, my neighbours ( Smiling while looking down at his feet ). 

Adam : That is it for today. I will see you in our next session. 

Jason : There are people with bad intentions who want to stop me from achieving my goals. I keep telling them, but they do not want to listen to me. My neighbours are dangerous and there is a conspiracy. 

Adam : Our session is over, we will continue in the next session. 

Jason : Oh well! ( Appearing disoriented as he smiles looking at his fingernail ). 

Sustainment and Processing Distress 

Narrator: The thoughts, feelings and behaviours of a person are interconnected, therefore, the treatment intervention used to treat a mental disorder focus on addressing specific thoughts, feelings and behaviours – and are also expected to impact other thoughts. 

Jason: Do you think that there is something peculiar with how you approach things? 

Adam: No, I do not think so. The people around me have a problem with me and I think they do not understand me or my life experiences. 

Jason: What do you think we can do about that? 

Adam: I could use some helping formulating my life plan and combating the mental interference that I am facing from my old high school friends. My old high school friends are filling me with negative thoughts. This is why I have decided to stay away from them. 

Adam: how do you think you will be able to benefit from these sessions? 

Jason : I think I might learn a few techniques from you which will help me to be less reactive to the negative events that are presented to me. (This is an indication that the consumer is willing to look at the issue from a different angle) 

Adam: What are the main concerns that you have about your current lifestyle? 

Jason: I want everyone to stop; everyone thinks that I do not know what I am doing. My main focusing is training and ensuring that I get into the Olympics. 

Adam : When did you first begin feeling this way? ( Showing emotional attempts to empathize with the Jason’s situation ) 

Jason : When I was living with my brother in San Francisco. I liked it there and I really enjoyed my life, but then people began creating conspiracies against me. I got worried and anxious; I knew that I had to protect myself. I even had to stop working since my life was in danger. But my family did not believe me, they thought that I was crazy and needed medical help. 

Adam : How were you able to deal with the situation at the time? 

Jason : Well, my parents insisted that I had a mental disorder and it was important for me to see a specialist. I did not want to do it, because, you see… I am okay. I am here and I am focusing on my goal to become a professional cyclist. ( Appearing disoriented and in deep thought ). 

Adam : Do you think seeing a specialist helped you? 

Jason : I had several appointments with different psychiatrists who did not seem to find any issue with me at the time. They gave me medication to deal with the stress I was facing from my family and high school friends. The medications seemed to help me cope with the stress from my family. But I did not see the need of continuing with them since I was okay. If I continued taking the medication they would make me sick so I stopped and I was fine. 

Adam : Why do you say that the medication was not of help? 

Jason : You see… to begin with, I only went to see the psychiatrists because my parents insisted that I should. I knew I was not having any mental issue and only the people around me made me act the way I did because they did not understand me. Going to see a psychiatrist was mainly because of my parents. 

Adam : Is this why you have been living in isolation? 

Jason : I prefer focusing on my athletic interests so that I can get into the Olympics. There are many neighbourhood conspiracies within my community. I would rather stay out of it and focus on myself. People are out there to get me that is why I prefer staying at home. ( Staring at the floor while smiling ) 

Adam : Has isolating yourself from the rest helped you cope better with the stresses? 

Jason : I think so. I am able to focus on my athletic practices and I have even attended several races in regional events. If it did not isolate myself I would not have been able to do it. 

Adam : I think psychopathic medication would be an effective alternative to assist you in dealing with the stress and help you manage how you respond to situations. 

Jason : No! Medication is toxic that is why I prefer not to take it. 

Adam : Why do you say so? 

Jason : I have been on medication before, I know what they do and I refuse to be put on them. 

Adam : It sounds like you have made your decision about medication. How would you describe your love life? 

Jason : I met my girlfriend at a bar. Although she thinks I am weird and not her type, I believe that it is just a misunderstanding. I think she misinterpreted my respectful intentions towards her. We have met on a couple of occasion and we really enjoy spending time together – she is the love of my life. You know, we went to the same primary and high school and I truly believe that we are meant to be together. Since our first date at the bar, I have just been seeing her around but we have not really spoken. I cannot wait for us to get married and start a life together. I need to be husband and a father by the time I am thirty years old. I am now twenty seven years old and time is running out. Everyone in my family was married and had a family by the age of thirty and that is what I want for myself as well. ( Staring into thin air, with a black look ) 

Adam : I am sure you would be a good companion and an even better father. 

Jason : Oh, that makes me feel better. Thanks for pointing that out. 

Expanding the Consumers perspective 

Narrator : The primary goal of CBT is to regulate, modify, or replace the thoughts, feelings or actions that lead to problematic behaviours, feeling or thoughts. Through CBT the therapist aims at helping the client to gain a more functional thought-feeling-behaviour pattern. 

Adam : When people look suspicious it does not necessarily suggest that they are criminals or have bad intentions. ( Referring to Jason’s cognitive distortion ) 

Jason : But sometimes I really think that some people around me are out to get me it gets me worried and stresses me so much. 

Adam : Have you re-considered your decision on taking medication? It would be a good idea if you could consider taking medicine as a way of controlling your stress. 

Jason : You are like the rest. You think I am crazy. Don’t you. ( Getting really angry and erratic ) 

Adam : Calm down Jason, that is not what I meant. 

Jason : No! We are done. ( Storming out of the office ) 

After one week Adam contacted Jason 

Jason : This is a collaborative practice with you and I am sorry for pushing you during our last session. 

Adam : Okay. I am still practicing for the Olympics and I look forward to moving to Europe. My family does understand me and I still have to put up with them. I am looking forward to getting a job at a repair shop so that I can pay for my trip to Europe. 

Jason : That is great news. I believe you will succeed as a cyclist in Europe. 

Adam : I have been thinking if there is a physician I can see to consult about medication. I would like to resume taking medicine. 

Jason : That is a good step. I am glad that you are open to taking medication. 

Adam : Yes I think it would be a great opportunity for me to learn how to cope with stress. 

Facilitating New Understandings and Introducing Possibilities for Action 

Jason : These sessions are really helpful to me. They help me gain a broader perspective of things and I amble to control my emotions and how I react to things that stress me. 

Adam : I am happy to hear that you are benefitting from these sessions. 

Jason : I want to improve my mental health so that I can be able to form health relationships with my nuclear and extended family members. 

Adam : That is a positive thing and I am sure that as you progress you will be able to be a better person for you immediate family and those around you. 

Jason : I want to actively start looking for a stable job to support myself. I think cycling is a competitive stop and I do not think I am physically fit to compete as a professional cyclist. Getting a job would be more appropriate. 

Adam : I strongly support your idea of getting a job. It will be a good start to regaining your financial freedom.