C7458 Diagnosis and Treatment Planning
Dr. David Moore
A Case Formulation Example
The Dual Disorder CBT Treatment of a Childhood Trauma Survivor
I. Introduction to the Theoretical Model
The approach to this client’s evaluation and therapy is within the Behavioral Therapy domain of counseling theory. Within the behaviorist strand of counseling theory, Cognitive Behavior Therapy (CBT)
has been successfully used to treat Anxiety Disorders.
In this case study, theclient has Post Traumatic Stress Disorder [PTSD]; which is one of the most multi-problemmental health categories in the Anxiety Disorder cluster. The clinician uses CBT methodology.A leading CBT Theorist, Albert Ellis, has developed an enriched CBT model called RationalEmotional Behavioral Therapy (REBT)
that fit this client’s treatment needs. The client’ssubstance use disorder, separate but entwined with her PTSD, is the second component of her “dual disorder”. REBT is an effective behavioral therapy model for addressing thedevelopmental history model of addictions treatment; which is more commonly treated from aPsychodynamic Therapy domain of counseling theory. In REBT, like a Psychodynamic[sometimes called Psychoanalytic] method, the client’s historical awareness of her progressivedisease and its distortions in thinking [i.e. “problem denial”] is addressed through what Ellis callsthe ABC’s of irrational thinking.
The therapist assists the client with an REBT problem self-assessment; which is called a “First Step” in Minnesota Model chemical dependency treatment.
In the example transcript of the third session, used for explanatory purpose, the client brings her daughter to the therapist’s office which creates an enactment of mother—daughter dynamics.The therapist allows the family dyad to derail naturally between the multiple subjects of dysfunction that have existed within the family addiction and multi-generational trauma. In thesession, the therapist uses the framing model of REBT to exhibit the inability of the dyad toresolve here-and-now decisions due to long-standing irrational beliefs about their relationship.
II. Basic Demographic Client Information
Name: Laura ClientAge: 42Race: Bi-racial
Sex: FemaleMarital Status: Single, DivorcedEmployment: Pedicure, Cosmetology without formal educationReferral: Tacoma Indian Center Treatment: Outpatient Clinic, Individual counseling
Native American and European American