Negatives into Positives
Final Roleplay Video and Reflection Paper
By Rickard Jean-Noel
December 14, 2020
Often times in life we find ourselves focused more on the negative things that this world has to offer, and we often look over life’s many blessings. The negativity of this world often times leaves us overwhelmed and drained, which often times causes distorted negative thoughts in our minds. At times we run with these thoughts and give power to them until they become a reality. That reality is often times distractive in nature and is harmful to those involved. This is why CBT is so important. CBT allows us to replace negative thoughts and behavior with positive ones. If we can correct the negative thoughts and behavior and transform them into positive ones, then we have a chance at changing the life of the individual and those around them. This alone shows the importance of this therapy and the importance of CBT skills.
During this particular assignment, my partner Samantha W. and I conducted a Role-Play assignment to demonstrate the use of CBT and how it could be applied to correct certain behaviors and thoughts. During my time as the councilor, Samantha stated that she had thoughts that her boyfriend was cheating on her due to a text message. We used the Cognitive Triangle to review the client’s thoughts, feeling, and behavior. We also zeroed in on the stimulating event and what resulted because of this. All of the information gathered was then placed on the thought record chart that helped us to even reach a resolution for the client.
During the role play assignment, the CBT skill that was demonstrated was cognitive restructuring. According to the Alleydog.com online glossary, cognitive restructuring is defined as a “therapeutic process used to identify and confront negative thought patterns and help people understand that these thoughts are ineffective or disruptive, with the goal to ultimately change negative behaviors. It teaches patients how to think differently by replacing adverse and illogical thoughts (“faulty thinking”) with more rational and positive types of thinking” (Cognitive Restructuring. (n.d.). In Alleydog.com’s online glossary). Using cognitive restructuring, we are then able to address the negative thoughts and challenge them. This allows us to disprove the negative thoughts and replace them with potentially positive ones.
According to “Cognitive Models of Depression”, “A.T. Beck’s cognitive therapy has made a substantial contribution to current evidence based cognitive behavioral therapy for a variety of psychiatric disorders, most notably depression” (Beck, A.T. (1987). Because cognitive restructuring is a process in which inaccurate and negative thoughts are changed, we know that those negative thought if not changed, would otherwise lead to depression. There are several studies that have been conducted that have shown the success of cognitive restructuring in helping to treat depression. To back up this claim, we will display several studies that were conducted in which CBT, particularly Cognitive restructuring, was used to treat depression.
In the article entitled “Cognitive Restructuring”, it statesthat “Cognitive interventions were excluded from the BA condition, but the CT condition presented the full range of CT interventions including CR and behavioral activity scheduling. At posttreatment, all three active treatments were equally effective for depression in the mild to moderate range of severity, but BA and medication were both significantly more effective in treating those with severe major depression than was CT. However, a 2‐year follow‐up revealed that CT may have a more enduring effect than BA, and both treatments were at least as efficacious over the long term as maintaining individuals on antidepressant medication (Dobson et al.,2008)” (Clark, D.A. (2013). The article ends by stating that “the component studies clearly indicate that CR is an effective treatment intervention for anxiety and depression, and in some cases may convey a distinct therapeutic advantage” (Clark, D.A. (2013).
Another study that was conducted that used CBT/CR would be “A Cognitive-Behavioral Treatment for Depression in Rural American Indian Middle School Students”. During this study, rural American Indian middle school students with depressive symptoms participated in the study. In the conclusion of the study, it was discovered that “students in the CWD-A group had a significant decrease in depressive symptoms at post-intervention, which was maintained at 3-month follow-up, as did students in the TAU group. In terms of clinically meaningful findings, we found that the number of students both groups that had clinically elevated CDI scores (T score > 65) decreased from pre-intervention to follow-up, with only 1 student in each group continuing to have clinically elevated scores at 3-month follow-up” (Listug-Lunde, L., Vogeltanz-Holm, N., & Collins, J. (2013). This therefore provided measurable proof that the CBT skills were affective.
Another example of CBT being used to treat depression was found in the article entitled “Cognitive–Behavioral Therapy for PTSD and Depression Symptoms Reduces Risk for Future Intimate Partner Violence Among Interpersonal Trauma Survivors”. In this article, women who were victims of IPV were treated with CBT. As a result, the article concluded that “Regardless of the exact mechanisms by which CBT for PTSD reduces IPV risk, the current findings suggest that enhancing available community and social services to include CBT interventions for PTSD and depression symptoms will improve interpersonal trauma survivors’ safety in intimate relationships. Therefore, outreach efforts aimed at identifying and treating individuals who experience PTSD and/or depression subsequent to interpersonal trauma may help to reduce the numerous cases of IPV that occur each year” (Iverson, K. M., Gradus, J. L., Resick, P. A., Suvak, M. K., Smith, K. F., & Monson, C. M. (2011).
In regard to the effectiveness at completing and teaching the CBT technique, I feel that it went well. I had a great partner in Samantha, who was very insightful and a willing participant. We started the session with the basic guidelines of therapy and we then dove into the details. It was discovered during the session that the stimulating event was the client finding a text message in her boyfriend’s phone. This event caused her to revert to a past event, where she was cheated on by a former boyfriend. This caused her to reach the conclusion where she did. We constructed a Cognitive Triangle to organize the different thoughts, feelings, and behaviors of the client. This provided a visual of what the client was currently going through so that she would be able to see it herself. She expressed that once the text messages were viewed, she automatic believed that she was being cheated on. This led her to believe that her boyfriend had a “side chick” by the name of Britany. Because of what she was assuming the client was now feeling hurt, angry, and disrespected.
When we dove deeper into the client’s life, we realized that her and her boyfriend did have some communication issues, and they felt distant at times. She also expressed that at times her boyfriend would go out without, which caused her to doubt his faithfulness. Client went on to express that her and her boyfriend were both living busy lives and there was a lack of intimacy between the two of them. She also admitted her participation in their distancing. This helped her to better under her feelings and emotions with the visuals provided by the thought record. After viewing the thought record, the client stated that perhaps her boyfriend was not cheating on her and perhaps Britney was simply a coworker or perhaps a mutual friend. This change in thoughts caused a decrease in negative thoughts and negative mood levels.
Applying cognitive restructuring with the help of the cognitive triangle and the thought record helped us to assist the client in making sense of her difficult experience. We did this by modifying her initials thoughts and providing her with alternate thoughts. In the video we witnessed what occurred and caused the initial thoughts. We also saw who emotions that were brought on and came up with an alternative way of thinking about what had occurred. Cognitive Restructuring works because it helped us to mentally organize thoughts. It also allowed the client space to slow down her thoughts and to replay the negative thoughts with positive ones. It helped her in becoming more aware of her situation and helped her to think more clearly. It also helped her in breaking bad mental habits, as in just because her ex-boyfriend cheated, that does not mean that every boyfriend will cheat on her as well.
One area that we can improve in is putting ourselves in the situation with the client and showing more empathy for the client. Often times we tend to just treat the experience as a job or an assignment and overlook the fact that there is an actual person in front of us and they are not just an insurance claim, a paycheck, or a chart in a desk. We must still maintain the client and therapist professional relationship, but we must also show more empathy to the client. That is one of the things that we could’ve did better during the session. Overall, it was a great session and there was progress made.
Based on the video of the recording, I would say that the most effective portion of the session with Samantha would be the beginning. Out the gate the client was very relaxed and open with me, which created an opportunity for the conversation to flow well. During the beginning of the conversation the client shared many intimate details with me, and she saw that I was listening based on the questions that I was asking. It did not seem that any of the questions that were asked made the client uncomfortable. The client was able to speak openly and was honest in what she shared with me.
In regard to empathy, the client felt some form of empathy from me based on my responses. Client was able to open up and state that she was cheated on in the past and that was one of the reasons for her current assumption. Client felt that the process was affective because we were able to go deeper in details about her relationship with her boyfriend and the problems that they have been facing. The client seemed incredibly open and comfortable with speaking to me about such personal details and it helped to move along the conversation.
In regard to having an affective interpersonal attunement, I believe that occurred when we were creating the cognitive triangle. It was as if the client was focused on completing the triangle and therefore was not too overly concerned about the information that she was providing. This helped to build a rhyme in the conversation and helped us to reach a certain comfort level. This is extremely important to the success of the session and I am happy that we were able to reach this pinnacle.
The least effective moment would be towards the end of the video. The reason why I say that is because it did not flow like the previous part of the conversation. There were parts towards the end when there were slight pauses and that could have been better. There were also parts of the session where more empathy could have been displayed. The format of question could have also been better at certain points in the conversation. Additional sessions with the client would provide an opportunity to strengthen the relationship between the client and the therapist. I as the therapist could have also shown more emotions during the conversation to show that client that I do sympathize with her.
There are many ways that my personal values, beliefs, assumptions, and biases could have affected the intervention process. Perhaps I had a similar experience as the client, in which I had a spouse that cheated on me and was texting other people, then I would react differently. We are all human, and as much as we would like to be professional 24/7, it is not always possible. When it comes to affairs of the heart, this portion of life tends to be very tricky. If I was an overly religious person, I might judge the client for living in sin since she was currently living with her boyfriend and they were sexually active. Certain people of certain religions feel that sex should only be between two married people. On the other side of the conversation, some would say that the boyfriend was not cheating because he is not married to the girlfriend. Some would go as far to say that she was not respecting her boyfriend’s privacy and therefore overstepped her boundaries when she went into his phone with his permission. Perhaps that was why she had not brought up the conversation to him.
One possible assumption that I could have had about the client is that she is extremely insecure and that perhaps she was cheating and wanted to find something on the boyfriend to feel less guilty. This would have been a question to ask about her own faithfulness, however that question was not asked. There could have been some biases in regard to race and gender as well. Some tend to feel that women tend to blow things out of proportion. There has been a recently epidemic of “Karen’s”, which is a name given to white women that exaggerate things and call the police for everything. All biases that could have been applied, depending on the person conducting the session.
In regard to power, privilege, identity, and oppression affection the intervention, again that would be based on gender and race. Often times women feel that they are overlooked or treated poorly because they are women. Some might feel that they are not being heard or that their opinions are not respected. We must correct this issue and make they feel that their voices are heard and that their opinions do matter. In regard to privilege, that would be debatable only because I am a black male, and the client was a white woman. There are plus and minuses on both ends and both were oppressed in America at different times and are still being oppressed in America. The black man does not have the same luxury’s or opportunities as the white man at times, unfortunately. In regard to power, some may say that a man has more power than a woman in regard to physical strength and perhaps other areas, however I do not believe there were any of those issues during this particular session. During this particular session, everyone was treated with love and respect and there were no biases displayed whatsoever.
- Cognitive Restructuring. (n.d.). In com’s online glossary. Retrieved from: https://www.alleydog.com/glossary/definition-cit.php?term=Cognitive+Restructuring
- Beck, A. T. (1987). Cognitive models of depression. Journal of Cognitive Psychotherapy: An International Quarterly, 1, 5–37.
- Clark, D.A. (2013). Cognitive Restructuring. In The Wiley Handbook of Cognitive Behavioral Therapy, S.G. Hofmann (Ed.). https://doi.org/10.1002/9781118528563.wbcbt02
- Dobson, K. S., Hollon, S. D., Dimidjian, S., Schmaling, K. B., Kohlenberg, R. J., Gallop, R. J., … Jacobson, N. S. (2008). Randomized trial of behavioral activation, cognitive therapy, and antidepressant medication in the prevention of relapse and recurrence in major depression. Journal of Consulting and Clinical Psychology, 76, 468–477.
- Listug-Lunde, L., Vogeltanz-Holm, N., & Collins, J. (2013). A Cognitive-Behavioral Treatment for Depression in Rural American Indian Middle School Students. American Indian and Alaska Native Mental Health Research: The Journal of the National Center, 20(1), 16–34.
- Iverson, K. M., Gradus, J. L., Resick, P. A., Suvak, M. K., Smith, K. F., & Monson, C. M. (2011). Cognitive-Behavioral Therapy for PTSD and Depression Symptoms Reduces Risk for Future Intimate Partner Violence among Interpersonal Trauma Survivors. Journal of Consulting and Clinical Psychology, 79(2), 193–202.