Depressed Patient

The paper analyzes a case study of Jane, a 50-year-old lady who comes to see me (as The Counsellor) on the advice of her GP, who has been treating her for depression. In Jane's case, the case study includes several purposes, including comparing, contrasting, and evaluating the relative effectiveness of two important therapeutic modalities, Cognitive Behavioural Therapy (CBT) and Existential Therapy. CBT is founded on a personality theory that states that people react to events in their lives through a combination of affective, cognitive, motivational, and behavioral reactions (Corsini & Wedding, 2011). On the other hand, existential therapy is apprehensive with human existence, and it further seeks to identify ways of helping individuals to cope with their current situation (Nelson-Jones, 2014, p. 180). In the case of Jane’s depression, existential psychotherapy which is a dynamic approach to experience, and is also designed to adapt to a person’s needs, desires, and also values, will be the most suitable modality for working with Jane.

Applying Cognitive Behavioural Therapy to the Case of Jane

Understanding Jane through CBT

Jane, a 50-year-old woman, has a depression problem, and her GP has referred her to me (The Counsellor) for psychotherapy. Jane’s case of depression has been attributed to the challenges she has gone through in her life. First, Jane is divorced, and just like any other divorced person, it is considerably difficult to deal with the problem. Besides, she has a paralysed mother, and not to forget that she lost her father in the same accident that paralysed her mother. Since Jane is committed to get on with her life and meet people but finds is as well anxious about leaving home for long periods, it becomes a challenge for her on how best to carry on with life. Besides, Jane intends to restart her career, even though she is concerned it might be too late, particularly due to the necessity to retrain so as to meet the new practice requirements.

Using the cognitive behavioural therapy will to some extent help in understanding Jane’s situation. As explained by Corsini and Wedding (2011), cognitive therapy aims to adjust information processing and also initiate positive change in all systems b acting via the cognitive system. The result of this modality can only be attained through an active collaboration between the patient and the therapist since it is considered a two-way process between the two. For such, the primary intention is to study and also examine the beliefs of the patient about himself or herself, as well as other individuals and the world in general (Corsini & Wedding, 2011). Therefore, in the case of Jane, I will set to fully understand how she views herself, other people and the world around. It is evident that Jane views herself as inferior as she believes it will be difficult for her to meet people and is also anxious to leave home for extended periods, even though she would like to have a relationship. Nonetheless, Jane has empathy as she has been taking care of her paralysed mother, and is also contemplating of restarting her career, but on the other hand, she finds herself less competent, hence fears to restart her nursing career. Therefore, it becomes evident that Jane’s cognition affects her behaviour (Fuertes, Spokane, & Holloway, 2013); hence the anxiety in meeting new people.

Application of Cognitive Behavioural Therapy

There are other significant features of CBT other than the collaborative relationship between the therapist and the patient. Cognitive behavioural therapies also apply the essence of disturbances in cognitive processes, and this is considered the fundamental factor in psychological distress or depression. In the case of Jane, disturbances such as divorce, the death of her father, and also the permanent condition (paralysis) of her mother contribute to her depression. Therefore, as a therapist, it is paramount to understand such underlying factors before engaging Jane. The other feature relevant in cognitive therapy is the understanding that cognition plays a significant role in behaviour, hence the way an individual behaves can be therapeutically changed or modified in the course of any efforts to change cognitions (Corsini & Wedding, 2011).

Applying Existential Therapy in Jane’s Case

Understanding Jane through Existential Therapy

According to Corsini and Wedding (2011), existential therapy is a dynamic approach to experience, and it relates to forces in conflict and motion. Nelson-Jones (2014) further explains that individuals struggle with many aspects such as their biological genetic substrate, their internalised significant adults who could be uncaring, their repressed instinctual strivings, with disordered ways of thinking, and also with current crises that pertain to their career and relationship with their significant others (p. 180). Such a description seems suitable to encompass the challenges faced by Jane as she is struggling with restarting her career, coping with a broken relationship with her estranged husband, and also caring for her sick mother.

According to Yalom and Leszcz (2008), existential therapy, which is suitable to address such challenges faced by individuals, is not just a freestanding ideological school. Yalom and Leszcz (2008) argue that a well-trained therapist to handle such a patient should have not only knowledge of and skills from many therapeutic approaches, but also should be trained to be sensible to existential issues (p. 202). Existential psychotherapy is fully adaptive to the values, needs, and desires of a person, and therefore, this modality is apprehensive with human existence and attempts to search for ways to assist people to cope with their challenging situations (Corsini & Wedding, 2011). Therefore, this type of therapy will be appropriate to assist Jane to find answers to issues pertaining to her disordered thinking, her current crises of thinking that she is incompetent to restart her nursing career, go on with life after the divorce, and also relate positively with people in the outside world.

Application of Existential Therapy

Existential therapy originates from existential philosophy, and thus it focuses on enhancing better health through increasing conscious awareness (Corsini & Wedding, 2011). In addition, the therapy further emphasises on the psychological and spiritual worthlessness which is prevalent in the contemporary society, particularly for mental health therapists.

The case of Jane is a proof of the psychological worthlessness of patients in the modern society which ultimately makes them depressed. In addition to attempting to assist people to transform, this type of therapy is significant in helping the individuals find out who they are as well as find their own truth and meaning in a world (existence) that is transitory and fragile (Geldard & Geldard, 2012). Another aspect of existential therapy is that it suggests and implies a method of being concerned with topics of responsibility, meaning and death, freedom, contingency and time, joy and despair, and also imagination and spirit (Corsini & Wedding, 2011).

Such concepts are evident in Jane’s case as she is struggling with issues of responsibility as she feels the need to restart her career as a nurse, freedom since she is contemplating on getting on with her life and starting a relationship, and also despair as she perceives herself as lacking the requirements of modern nursing career. The focal point of existential therapy is to develop the self-awareness required by people (Jane in this case) so as to meet their potential and also deal with internal issues pertaining to death, responsibility, freedom, meaningless, and also existential isolation (Nelson-Jones, 2014).

Similarities between Cognitive Behavioural Therapy and Existential Therapy

Even though the two modalities have considerably more differences than similarities, there exist some resemblances between the named therapeutic methods. A significant similarity is that both approaches have a structured collaboration that involves the therapist and the client, and in most cases, it calls for homework (Prasko, Mainerova, Jelenova, Kamaradova, & Sigmundova, 2012). For instance, the case of Jane involves, her as the client, and I, as the therapist, thus it is collaboration between the therapist and the patient. The other similarity between CBT and existential therapy is that they both encourage clients to face their issues head on and further initiate their own decisions, and most importantly, focus on the future rather than the past (McLeod, 2009).

In addition, both therapeutic modalities acknowledge the choice of the client in creating and also transforming his or her view of the world (Larsson, 2007). In the case of Jane, either the modality applied in assisting her get over the problem of depression, I (The Therapist) am inclined to acknowledge her decision regarding the choice of either getting on with her or life and starting a new relationship or not, or even whether to restart her nursing career or not.

Differences between Cognitive Behavioural Therapy and Existential Therapy

Even though the two therapeutic modalities are applied to address psychological issues of clients, they have significant differences from the way each method is structured to the issues addressed by each. One of the differences between the two methods is existential therapy is considered a philosophical approach that is different from CBT which has well-defined techniques. The next difference is that existential therapy emphasises on fundamental conditions of human existence i.e. responsibility and freedom in order to shape a person’s self-determination and life (Corsini & Wedding, 2011). In Jane’s case, there is an emphasis on the basic issues of human existence, particularly joy and despair after losing her father and also responsibility as she seeks to restart her career. In addition, the issue of freedom is addressed as Jane is committed to getting on with her life after the divorce and be in a relationship. On the other hand, CBT is a practical method that attempts to define specific goals and apply active approaches to attain the goals (Larsson, 2007).

The most Appropriate Therapeutic Modality for Working with Jane

Jane’s case has been presented as one involving conditions in human existence. In the case study, it is evident that Jane is depressed as a result of issues of responsibility, freedom, and also worthlessness. In addition, Jane is faced with challenges of relating with her ailing mother, she has issues coping with the divorce, and also the death of her father through the accident that rendered her mother paralysed.

In that light, the most appropriate modality for working with Jane would be existential therapy. The modality is suitable as it addresses the issues of human existence that are faced by Jane. In addition, existential therapy is the most appropriate as it will assist Jane in developing the self-awareness and further meet her potential. Lastly, the approach will help her deal with internal issues of death, responsibility, freedom, meaningless, and also existential isolation, which necessitates Jane to get on with her life and be in a relationship.

References

Corsini, R. J., & Wedding, D. (2011). Current Psychotherapies. Belmont, CA: Brooks/Col.

Fuertes, J., Spokane, A. R., & Holloway, E. (2013). Specialty competencies in counseling psychology. Oxford; New York: Oxford University Press.

Geldard, D., & Geldard, K. (2012). Basic personal counselling (7 ed.). Frenchs Forest, Australia: Pearson Australia.

Larsson, B. (2007). Similarities and differences between the schools of psychotherapy. Psychotherapy, 1 (36), 1-41.

McLeod, J. (2009). The social and historical origins of counseling. In An introduction to counselling 4th Ed (pp. 21-47). Maidenhead, UK: Open University Press.

Nelson-Jones, R. (2014). Nelson-Jones' theory and practice of counselling and psychotherapy. Los Angeles: Sage Publications.

Prasko, J., Mainerova, B., Jelenova, D., Kamaradova, D., & Sigmundova, Z. (2012). Existential perspectives and cognitive behavioral therapy. Act Nerv Super Rediviva, 54 (1), 3-14.

Yalom, I. D., & Leszcz, M. (2008). The Theory and Practice of Group Psychotherapy. New York City: Basic Books.