CBT Case Conceptualization and Treatment

Case Conceptualization

The basic premises of all CBT models are • that cognition, emotion and behavior are reciprocally related; • that perceiving and experiencing are active processes that involve both experiencing the world as it is (sensory input, essentially) and interpreting the world (meaning-making); • that meaning-making is related to prior learning – often social learning; • that a person can learn to become aware of the interaction of cognition, emotion, and behavior; and that altering the ones that may be more directly under our control or influence – cognition and behavior – will impact the person’s responses on all levels. • Further, CBT models uniformly
• The final – but by no means the least important – area of antecedents is the person’s situation or what they are actually dealing with in their life – what might be coded as psychosocial stressors on Axis IV of the DSM-IV.

A case formulation should identify the client’s cognitive errors, and might identify • all-or-none/dichotomous thinking (If I don’t get straight As, I am a failure); • mind-reading (believing that they know how others see them or that others have specific expectations of them without checking it out); • overgeneralization (all men… all women… I always… they always…); • selective abstraction (attending to only some of the information, and ignoring other information); • catastrophizing (if I don’t do XX, the family will be destroyed; if she doesn’t graduate from college her life is over; if I get a C my entire future is screwed up); • emotional reasoning (if I feel worthless, I must be worthless), and so forth. • A case formulation will also identify the client’s “shoulds” or “musts”, what Adler calls “the moral imperative”.

From Ellis’s REBT position, one would describe the client’s dilemma in largely similar ways, but would present the data in A-B-C-D-E format thusly:

Activating Events: These are long-term or long-standing antecedents as well as immediate precipitants of the person’s maladaptive behavior or emotion.

Beliefs: These are the core assumptions, rational