• Join over 1.2 million students every month
  • Accelerate your learning by 29%
  • Unlimited access from just £6.99 per month
  1. 1
  2. 2
  3. 3
  4. 4
  5. 5
  6. 6
  7. 7
  8. 8
  9. 9
  10. 10
  11. 11
  12. 12
  13. 13
  14. 14
  15. 15
  16. 16
  17. 17
  18. 18

Cognitive and Behavioural Psychotherapy for Distressing Thoughts in Work.

Extracts from this document...


'Reputation is an idle and most false imposition; oft got without merit, and lost without deserving.' Othello Act 2, Scene 3 Case Study: Cognitive and Behavioural Psychotherapy for Distressing Thoughts in Work Introduction The Community Treatment Service (CTS) in Pwllheli is a team of 5 nurses and a social worker offering intensive support, therapies and can provide out-of-hours support for patients open to Care Managers from the Community Mental Health Team and the North West Wales NHS Trust GP Counselling Service. Her General Practitioner referred Ellen to the GP Counselling Service. A brief telephone call described Ellen as suffering from work related stress and anxiety. The only further information given was her telephone number and address so that an appointment could be made at the local GP Health Centre. This is indicative of the extent of pre-contact information given about patients referred and other information about her is obtained after initial assessment sessions. Ellen is 43 years old and lives in Pwllheli with her husband and daughter. She is currently employed part time by a well-known local supermarket, and also part time by a shoe store in town. Along with seven other people Ellen had been dismissed from her previous job as an assistant in a well-known national store for allegedly stealing sweets. This occurred two years ago and the incident actually made front-page news in the local press. The store management had installed close circuit cameras in the store and had alleged that the members of staff were eating from the "Pic'n'Mix" sweets. Ellen maintained her innocence and had involved her union. After some legal battles she actually received �1000 compensation in an out-of-court settlement providing she did not go to the press with the story. ...read more.


She had already discussed this with her current manager who told her that doing this would "just reinforce her worries and make them worse" and that she was a good worker and wanted her to stay. We did discuss the relationship between her distressing thoughts, resulting physical feelings, behaviour and that avoiding issues would indeed reinforce her thoughts. The use of a small portable whiteboard to provide diagrams of this idea and later for use in describing a formulation proved invaluable in this case. As part of Ellen's assessment she was given her first homework exercise as being to go in to the store in question in another town. Ellen described that her fear was centred on the store in her hometown where this incident occurred, and that this was not a problem in any other store. Ellen said, for example that she had not been to this store at all in any location for the past three years, but was visiting the town of Caernarfon this week. It was decided to confirm this by asking Ellen to go in to the store to see if this was a problem for her. Guided imagery (see Padesky and Greenberger, 1995) was used in this session to practice and predict how she would feel going into the stores in Caernarfon and in Pwllheli. Using self-rating scales again Ellen predicted that there would be no problem at all going in to the store in Caernarfon but felt that going in to the store in Pwllheli would be very stressful. Indeed, Ellen reported back to the next session that there was no problem with going in to the store in Caernarfon at all confirming that her fears and anxiety symptoms seemed to be specific to the store where the incident took place. ...read more.


The Role of Supervision The use of supervision with this case was very important. The justification for adaptation of an existing model by Ellen to fit with her feelings was useful. Pwllheli is also in a rural area, where there is a shortage of supervisors. Whilst it was possible to arrange face-to-face supervision on a monthly basis there was also use of Internet (MSN Messenger) and e-mail supervision. This is something that has been discussed by the professional body BABCP - Lewis (1999). The use of guided imagery/discovery and prediction scores was an aspect of this case that was borne out of supervision sessions. The importance of this is described by Milne (2003) who concluded that supervision in CBT was effective, and that transfer of skills from supervision to therapy sessions was marked. Conclusion This is an example of a case referred by general practitioner with no more information pre-initial meeting than name and address. In many ways this was not a disadvantage and as a practitioner this author feels comfortable with that, given that there is adequate supervision in place and the confidence of the general practitioner in question. Indeed, it could be said that there is something of an advantage with a referral unsullied by previous opinion, which may tempt one into following red herrings. Ellen had not come to the attention of the psychiatric services but left untreated the stress could have continued to build and she could have ended up as such, or perhaps being placed on medication. Instead, Ellen's prognosis is hopeful and she is continuing to do well in treatment. This case also shows the importance of supervision in developing an idiosyncratic formulation, keeping track of time management, keeping the momentum of therapy and using co-workers. Providing it can be justified, collaboration with the patient in this way can lead to adaptation of existing models and finding something unique. ...read more.

The above preview is unformatted text

This student written piece of work is one of many that can be found in our AS and A Level Healthcare section.

Found what you're looking for?

  • Start learning 29% faster today
  • 150,000+ documents available
  • Just £6.99 a month

Not the one? Search for your essay title...
  • Join over 1.2 million students every month
  • Accelerate your learning by 29%
  • Unlimited access from just £6.99 per month

See related essaysSee related essays

Related AS and A Level Healthcare essays

  1. Research In Clinical Practise

    Patients in the intervention group were treated in dedicated community clinics by 'clinic coordinators' who had undertaken special training and used specific bandaging techniques and materials. Treatment of ulcers was followed by a standard protocol of fitting stockings and surveillance.

  2. Complementary Therapies

    It may be even more than this, especially if the homeopath is medically trained. Further appointments are usually shorter so cost less - about �20 to �60. Your homeopathic remedy will usually be included in the consultation price, but do check first.

  1. Physiological disorder

    as they both have to be considered that has been frustrated by the GP or doctor. Prognosis of coronary heart disease and asthma Coronary heart disease Asthma The prognosis is variable from one individual to another because coronary heart disease is serious.

  2. Physiological Disorders

    process: it is hard for her to adjust to; he forgets when to take his medicine, he has missed some insulin injections. Difficulties in adjusting to the presence of breast cancer My patient has difficulties in adjusting to her disorder because she is now after operation and she is very

  1. P2 - Physiology of fluid balance

    'Membrane receptors are specialized protein molecules in the membranes of cells, to which external molecules (hormones, neurotransmitters, drugs) attach, triggering changes in the function of the cell.' http://www.answers.com/topic/membrane-receptors The membrane receptors bind specific messenger molecules on the external surface of the cell.

  2. Cognitive Behavioural Therapy and Family Interventions for Psychosis.

    Notwithstanding some notable exceptions in the UK, such as Bath (Smith & Velleman, 2002) and Somerset (Stanbridge et al, 2003), increasing the availability of family work remains a challenge for most service providers. The aim is not to provide a comprehensive academic review of family interventions and CBT for serious mental illness.

  1. Can CBT make a meaningful contribution in the treatment of schizophrenia, bipolar disorder and ...

    who found patient depression levels to be greatly reduced after CBT treatment. CBT has been found to be useful not just in treating patients, but in insuring they continue with their long term medication. This was found by Kemp et al (1996, 1998).

  2. Human Anatomy and Physiology

    It is made up of collagen fibres and elastic fibres. Adipose tissue is known as fatty tissue this is because it is made up of fat. It commonly locates under the skin and around the major organs, for example, kidneys, breasts and digestive tracts; it is also a very useful storage place for high energy.

  • Over 160,000 pieces
    of student written work
  • Annotated by
    experienced teachers
  • Ideas and feedback to
    improve your own work