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Cognitive Therapy Case Conceptualization for Depression

Building a conceptualization of each case that comes before you as a therapist is an important skill. As each person will come to you with a different set of problems and issues that have caused his depression, and you must recognize them as a unique set of life struggles. The treatment plan should be based on the cognitive model of confronting irrational beliefs with rational and realistic ones. A cognitive therapy case conceptualization consists of three sections: a list of complaints and a problem mechanism hypothesis, a list of secondary issues and a treatment plan.

  1. Presenting Complaints and Problem Hypothesis

    • Create a list of problems verbalized by the patient. Cognitive therapy techniques will not work if the specific nature of the issue is not addressed by the therapy process. In cognitive therapy, depression is thought to be the result of irrational thought patterns. Cognitive techniques seek to replace these with rational thought patterns that actually reflect the actual experience of the person rather than the distorted interpretation of the experience. This distortion is considered to be the cause of the depression.

      These causal issues can be further broken down into primary and secondary problems. Normally, the problem list will contain issues that are related to one another in their root cause. Finding and hypothesizing the root cause or “mechanism" that underlies all problems listed is key. The cognitive therapist must identify the specific nature of this irrationality and devise methods to combat it.

    Secondary Issues

    • List all relevant secondary issues or problems. Different concepts can be used to further enhance and complete the initial steps in developing a treatment plan based on cognitive techniques. These are usually secondary issues, but are centrally important in certain cases, and may include childhood data, basic core beliefs of the person, secondary beliefs (i.e., not essential to the personality) and the nature of the compensatory strategies utilized. These secondary concepts are also important, but should be used only in relevant cases. Issues in section one, however, are to be used in every case.

    Treatment Plan

    • Outline a treatment plan. Deciding on a course of treatment is the ultimate purpose of the steps outlined above. The origins of the mechanism that causes the problems as described by the depressed patient are essential part to creating an effective cognitive therapy treatment plan for depression. The treatment plan should take into consideration possible obstacles and should consist of clear and realistic goals for replacing the patient's irrational beliefs with rational, realistic ones.

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