Assignment 2: Applying Behavioral and Cognitive Behavioral Therapies

Codrina is a 40-year-old, divorced, white female seeking counseling at a community mental health center.  She is seeking counseling because she has been depressed, unable to sleep well and has lost her appetite since the sudden ending of her marriage one month ago.  Before leaving, her husband told her that he did not love her any longer and doubted whether he ever did. He told Codrina that he had felt lonely and distant from her for the entire three years of their short marriage. He now questions whether she is even capable of feeling love for another person.

Codrina was raised in an orphanage and her childhood years were characterized by isolation, hunger and scarcity. She describes spending many days just staring at the wall and rocking back and forth. After she left the orphanage at 16 years of age she worked in odd jobs and was in and out of abusive relationships with men for a few years until she met her husband about four years ago. She lived with him for six months before they got married. Even from the start she had a difficult time trusting him or any man for that matter. She showed little interest in sex, never cried, rarely laughed and had a very subdued mood most of the time. In the second year of her marriage, Codrina discovered that her husband was having an affair with a woman he worked with. Instead of being upset, she was almost relieved because it seemed to take the pressure off of her to engage in sexual intercourse with her husband.  Out of guilt, he finally told her about the affair. Upon hearing his confession, Condrina showed no emotion and didn’t even ask him to end the affair. From that point forward her husband spent few nights at home and one month ago announced he was filing for divorce. Now, in addition to her insomnia and poor appetite she is neglecting her self-care to the point that she is being shunned by others who come in contact with her, which deepens her sense of isolation. She’s coming to therapy to see if you can help her before she loses all hope that she can regain control of her life.

Assume that you are a cognitive behavioral therapist and have agreed to work with Codrina. Using principles and techniques from Beck’s Cognitive Therapy (CT), respond to the following questions:

• From a cognitive behavioral perspective, state at least three assumptions that you would make about the origin of Codrina’s behavioral problems? Be specific and detailed in your response.
• Describe at least two goals that you, as a cognitive behavioral therapist, would have for Codrina in therapy. Give a thorough rationale for each goal bringing in terms and concepts from CT.
• How might your goals differ from those that Codrina might have coming into therapy?
• Identify at least two cognitive distortions that Codrina might be experiencing. State each one and provide evidence from the information given about her life that would support each cognitive distortion you have mentioned.
• What CT techniques or methods would you use to achieve the goals mentioned in question 2?
• As a CT therapist, what would be your desired outcome for Codrina be as a result of your work with her?

IHP 505 Case Study:  The Deployment Flowchart PowerPoint Presentation

Course Objectives Met by this Case Analysis:

1.            Define, identify, and assess clinical microsystems

2.            Summarize strengths and improvement opportunities

3.            Utilize the Dartmouth Microsystem Improvement Curriculum to support improvement

4.            Identify leadership actions that support front line improvement

Program Outcome Met By This Assignment

1.            Synthesize and apply theories and conceptual models from nursing and other related disciplines to facilitate clinical practice decision making

2.            Integrate the use of communication skills, information systems, and standardized language in relation to clinical outcomes and continuous performance measures

3.            Develop collaborative interdisciplinary relationships and partnerships to improve the health care of the cohort population

Overview

Students will read and reflect upon the case study presented below.  Carefully read and review the information in the case study, and then reflect in a narrative upon the needs of the patient and the processes that must be in place surrounding this acute illness for a smooth and seamless transition for everyone involved.  Construct a voice-over PowerPoint presentation consisting of a minimum of 12 slides (including your title and reference slides) that will include the following information:

1.            Priority care needs of the patient at the center of the case study

2.            Priority care needs of the family care providers

3.            The disruption that this acute illness has caused for the patient, family members, and clinical microsystem

4.            The experiential features of acuity that are apparent in this case

5.            The elements that the clinical microsystem must possess in order to meet this patient’s care needs

6.            Potential barriers that may exist and must be managed in order to provide that care

7.            The communication strategies that were used in the delivery of care

8.            Well-defined (but flexible) roles within the clinical microsystem

9.            Potential strategies to plan for unexpected changes in care needs

10.          The Deployment Flowchart (see page 225, Nelson text) which must include:

•             Evidence-based core measure algorithms

•             Structured decision making and standing orders

•             Advanced access

•             Reliable handoffs

•             Effective communication

•             Rehearsal of coordinated actions

Once you have completed the PowerPoint for this assignment, you will present it using Tegrity technology and upload your presentation into the assignment drop box.  Students are expected to review the presentations posted by all of the other learners and provide feedback.  This assignment is due in Module Two.