Assessment Requirements Presenting Problems Assessment of Client Developmental Processes Maintenance Processes Case Conceptualization Goal Setting Intervention Plan Organisation & Clarity References...

Case Identification:
Case Report on CBT
Biographical Information:
Client: Mr. S. D. (changed name) was a 30-year (early adulthood) old married male Australia. He belonged to and Christian family. Nothing was known in detail in relation to his educational background including scholastic history and performance in higher education, developmental history, family background, interpersonal relationships in family, occupational selection, performance and satisfaction which could be quite important in investigating the psychosocial aspect of his personality and behaviour as the same might provide some directions in diagnosis and intervention. S.D. got married before two years but there was no information whether he has child till date.
He appeared insightful with good interpersonal relationships with other people. He was eager about an established and quality marriage for satisfaction in present and prospective life as well. Furthermore, he was aware of his current problem and difficulties in married life to be intervened by the means of professional and social support. He was aware of his current problems and difficulties in developing new relationships. However, he has faith and believes in psychological / professional intervention.
Presenting Problems of the client: Currently, S.D. was facing some interpersonal problems related to his marital dissatisfaction. He appeared to be hopeless and worried about his future of present married life. However, the sanguine part of problem was that his marital relationships did not appear on the verse of separation or planning / officially pending for divorce.
Desirable Assessment of the Client:
Since comprehensive information about the client has not been provided, therefore, the following issues and aspects are required to be investigated in detail for additional information which could be immensely helpful in formulating the present case for proper diagnosis and treatment. These are:
(I.) Inquiry and assessment of all aspects of the current problem includes history of the problem, detailed case history for case formulation, as well as, assessment on cognitive-behavioural model of intervention comprising following points:
(i.) History of the present problem:
(a) Chronological development of current marital problem, family history of marital discord, separation or divorce etc.
(b) Reasons for and consequences of previous failures in courtship with several partners.
(c) Treatment history: It is also important to enquire whether the client received similar kind of psychological treatment previously before consulting the present clinician, type and number of times of treatment (e.g., psychiatric, psychological etc.); how much successful or unsuccessful, possible reasons of failure if any.
(d) The client must be sent for medical laboratory examination with the consent of psychiatrist to rule out any possible biological / organic dysfunctions (e.g., brain dysfunction in relation to problem-solving approach, self-control, hormonal abnormalities etc.).
(ii.) Developmental history/Biographical information about Steve:
(a) Birth and childhood histories including whether S.D. was a wanted child, physical and mental state of the mother during pregnancy, history of miscarriage related to mother, achievement of initial developmental milestones and parental responses on them; physical and mental status, personality and behaviour of the client during infancy and early childhood.
(b) Late childhood and adolescence: Inquiry and comprehensive assessment of S.D's parental upbringing, initial schooling; interpersonal relationship with male and female peers and siblings at home, school and society with age mates, elders and youngsters; development of interest and attitudes toward opposite sex during adolescence, interpersonal relationships with same- and opposite sex parents, siblings, peers and friends during adolescence; parental control on the child, problem-solving approach with special relevance to interpersonal problems.
(It could be implicated that the client might have tried to fulfill those desires and interests as compensation which he failed to accomplish in childhood and adolescence in heterosexual relationships.)
(c) Adulthood, higher education, marriage and occupation: Assessment of interest, planning, success and failure in higher education; occupational selection, success and failure/s in occupation/profession; affairs and incidents of emotional attachment with opposite sex, related problem-solving and conflict resolutions.
(d) S.D’s relationship with parents, interpersonal relationships between father and mother, the same among the family members and relatives etc.
(II.) Assessment of current problem based on Cognitive-Behavioural Model
It requires to be completed based on the guidelines provided by the ‘A-B-C-D-E model’ of cognitive-behavioural technique of intervention. The following inquiries and assessment are required for clinical understanding, case formulation and intervention:
(a) What were the antecedent events/ factors led to S.D's current marital problems? What were impacts of the discord? What is the latest example of discord? What did he think about the incidents and possible psychological, familial, social, emotional, interpersonal effects of discord with his wife?
(b) What did the client think about ‘his role / contributions’ in previous disruptions as well as his options, skills and techniques used for negotiation? Did he try to compensate his occupational / professional failures, rather than, being ‘kept on searching’ for marital partner?
(c) Perception, interest and attitudes to marriage (as the client was in courtship for five years with various partners and thereafter got married).
(d) Assessment of marital satisfaction through a standard ‘marital satisfaction scale’, ‘family satisfaction scale’; level of depression (as he was very much in distress) through a scale like ‘Beck Depression Inventory’, and anxiety through a anxiety scale like ‘Hamilton Anxiety Scale’. It would help the clinician to know about the nature and severity of present problem of the client.
(e) Did S.D. think and plan for a kind of ‘satisfying’ married life OR ‘perfect partner in life’? Did he want a kind of ‘perfect’ marital partner (as both are two different concepts)? What were other concepts, misconception, and validity of current beliefs in relation to married life?
(f) What could be done for solution to the problems and how the client could approach for the same (as it is evident that he has returned to his wife several times after apologies over discord?
(g) What are S.D’s expectations from wife, how she can fulfill these (in the client’s opinion)? How was he facing daily life situations in such conditions related with home life, work, joint social life; and fulfilling hobbies and interest? (These issues are related with likely avoidance behaviour). Similarly, assessment of possible modulating factors and contexts are also required which to be related to familial/interpersonal situations, behavioural skills, cognitive strategies, emotional feelings affecting his marital relationships.
(h) Relevant queries on psychosocial situations related to family, accommodation, occupation, social relations, interests, hobbies and support systems must be raised before S.D. to be used in intervention. Similarly, for avoiding failure of prospective intervention, Clarification of client’s beliefs about homework assignments and its role in treating his marital problems, progress of other factors revealing new facets of the current crisis, e.g., external interference, extramarital affairs etc are also important.
(i) All the abovementioned issues must be raised and clarified from wife of the client also. Thus, in addition to biographical history, the assessment in relation to the current interpersonal problem must be completed in accordance with the ‘A-B-C model’. In addition, the ‘marital satisfaction scale’ as well as scales of anxiety and depression is advisable to be administered to know about the psychological status of the wife and prospective role to be played on her part during sessions of cognitive-behavioural treatment.
Developmental and Maintenance Processes:
In case of S.D. several factors could be implicated for development and maintenance of his lack of harmony and adjustment in marital relationships. These are as follow:
(I) Cognitive errors: The client appeared to have some cognitive errors in thinking which might have increased his marital disruptions. These errors are as follow:
(a) Selective abstraction: S.D. appeared to selectively perceive that his wife is unconcerned, cold and self-centered despite sexual satisfactions as well as sharing many interests and hobbies with her related other aspects of happy married life.
(b) Magnification: Often he was found to think after fights, discords with wife and occasional rejection and disapproval that he was going to be separated forever / divorced and won’t get another person for such relationships
In fact, this fear compelled him to come back to her rather than finding solutions or having problem-solving communications with wife.
(c) Absolute thinking: S.D. has a polarized thinking that he was a kind of person who couldn’t be satisfied in life. It indicated that he is not suitable for satisfying married life as he faced several dissatisfactions and separations during courtships and marriage.
(II) Indecision and some negative life events: The client experienced several separations and scuffles during his courtship and married life for seven years. Although its...