She describes that there is many things she should accomplish and complains about being unable to form effective working and personal relationships. She reports that she was always nervous, had much more anxiety in adolescence, and got worse in late adolescence when parents divorce. Also, she recently broke up with her boyfriend and become more worried. My literature review on Generalized Anxiety Disorder (GAD) showed that Cognitive-Behavioral Therapy (CBT) is the most effective technique in the treatment of GAD, therefore I will use CBT in the treatment of Susan.
There are some other factors that will affect my treatment plan: patient and problem characteristics. Susan will have psychosocial treatment because her symptoms don’t require medicine. I don’t expect that she resist to the therapy, therefore it can be a therapist-directed therapy. It will be a task focused and a supportive therapy. She will join a short-term individual therapy in outpatient setting.
Basic goals of the treatment are to teach her the role of maladaptive thoughts in behavior, recognizing when she engage in maladaptive thoughts, replacing her maladaptive thoughts with more adaptive ones, modifying maladaptive behaviors and getting physically relaxed. In therapy, I should be educative to teach these to her and directive to create a change on her. Since a good therapeutic relationship is a very important part of CBT, I should also be empathetic and supportive to her feelings like anxiety, worry, or fear.
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I will use psychoeducation, thought recoding, and cognitive exposure techniques; problem solving and relaxation trainings in my treatment. First, psychoeducation is educating the clients about the roles of cognition in disorders, teaching the facts of their disorders, and making them collaborators. Second, thought recording is an activity in which clients fill out a table about unpleasant thoughts. When they experience an unpleasant situation, they write the event, what it makes feel, their explanations for it, most realistic explanation for it, and what this new explanation makes feel.
Third, cognitive exposure is desensitization through being exposed frightening stimuli. Fourth, problem solving training teaches to focusing on a problem, defining it and the goal, creating alternative solutions, and decision making. Finally, in relaxation training clients learn tensing and releasing various groups of muscles while focusing on relaxation in order to relax themselves and lower their arousal. Susan will have 14 weekly sessions which takes 1. 5 hours. At first week, I will gather information about her.
First, to have her biographical information, I will ask her contact information, age, education, marital status, with whom she is living, and economic status. Then, I will ask questions about her counseling, medical, and family history. In first two sessions, I will give information to the client about the facts of GAD, roles of maladaptive cognitions and behaviors in disorders, basics of CBT, and importance of her collaboration for the treatment. After I inform the client, I will start to intervention. First, I will give her a worksheet as homework.
When she feels worry, she will note what it is about, how it makes feel, and what she can do for this situation. With this exercise, she will learn to recognize when she engage in maladaptive thoughts. Second, I will give problem-solving training in order to replacing her maladaptive thoughts with more adaptive ones. Training will teach focusing on her problem, defining the problem and the goal, creating alternative solutions, and decision making. When she learned enough about problem solving, we will return to her worksheet and she will find alternative solutions or thoughts for the situations she wrote.
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Third, she will take relaxation training to learn relaxing herself and lowering her arousal. In this training, she will learn tense and relax various muscle groups, how anxiety works, and how to cope with it. Fourth, after she learns relaxation training, I will use exposure technique. We will record a video while she telling her worst scenario in her mind. Then, she will watch it every day until she doesn’t feel anxiety. At the end of 14 weeks, I expect that Susan is more relax and has less physical complains.