Discussion of Case Study: Esteban On the Disorder of Depression

7 pages
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Wesleyan University
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Case study
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Esteban is a 32-year-old man, who is self-referred to a Cognitive Behavioral Therapy (CBT) session. He is gay, works in sales and marketing and originates from Colombia, South America. Below are six questions that will be used in the evaluation of Estebans performance during his CBT period with a therapist.

Part 1: Discussion of Case Study Esteban

Question 1: Activities Throughout Therapy to Use for Estebans Termination and Relapse Prevention

Esteban stated that he believed that he felt better than before he started the CBT. To attribute this belief, as Estebans therapy, I investigated his thoughts of why he believed he felt improved. I then reinforced the thoughts Esteban offered to reinforce his belief in his progress. This activity was effective as it allowed me to promote Estebans sense of self-efficacy. Also, I taught Esteban to break down the problems he felt were big into small manageable components. Moreover, I encouraged Esteban to brainstorm solutions to any of his problems. Also, as part of Estebans near termination activities, I taught him how to administer self-therapy sessions and also responded sufficiently to all his concerns about termination.

Question 2: Techniques to Address Estebans Current Setbacks in CBT Treatment and Preparing Him for Future Setbacks

As a therapist, I used conceptualization of Estebans problems as a technique to uncover the clients difficulties. After uncovering the problems, I worked with the client towards a joint objective of developing effective solutions to such problems. Moreover, to avert future setbacks to such problems, I helped Esteban to categorize his problems, develop their diagnosis and later identify an effective intervention for such setbacks.

Question 3: Techniques to Use When Tapering Sessions and Getting Esteban Ready for Termination

To respond to Estebans concerns about tapering sessions, I expressed my genuine personal feelings as his therapist of why I needed to end the CBT sessions. I honestly told Esteban that I regretted ending out CBT relationship, but I felt much pride to what he had achieved in the therapy. Finally, I informed Esteban that I believed that he could now make it on his own. Additionally, to help Esteban to review what he had learned in the CBT, I asked him to create a synopsis of the key skills and points he had acquired in therapy. We then discuss the points during our next CBT sessions. More, I emphasized to Esteban to use self-therapy sessions as a way of preparing him for termination. The self-therapy session would help him to solve problems before they became major problems and also to help him avoid a relapse.

Question 4: Therapeutic Goals for the First Booster Sessions and Techniques to Use to Accomplish Such Goals

There are two therapeutic goals that were considered for the first booster sessions. The first goal was to ensure that Esteban was motivated to do his CBT homework and practice the skills he learned. The second goal was to ensure that Esteban could be able to tell whether his past modified dysfunctional beliefs had been reactivated. Also, there are three techniques that I used in helping Esteban accomplish his first booster sessions therapeutic goals. First, I motivated Esteban to schedule our CBT meetings ahead and even call to confirm the meetings. Second, I advised Esteban to plan his preferred topics for discussion before attending the sessions. Lastly, I advised Esteban to practice coming to our CBT meetings as a preventative measure for negative thoughts that may cause depression.

Question 5: Questions to Assess the Extent of My Therapeutic Alliance with Esteban

The first question was, is my therapeutic alliance with Esteban strong? Second, I asked myself, do Esteban and I understand his goals in CBT? Lastly, I asked myself, does Esteban truly believe in the CBT model?

Question 6: Methods That Should Be Used to Remedy the Clients View of Therapy and the Common Problems That Occur in the Course of CBT Treatment

The most effective method that should be used by the therapist should be to structure questions that are focused on determining the clients position in reference to the therapy being offered. Examples of such questions should include; does the client have a positive image of me as a therapist and the CBT? Does the client view me as collaborative, competent as well as caring? Moreover, there are three types of problems that occur during the CBT. These include the problems associated with diagnosis, conceptualization as well as treatment planning. There are also problems that are associated with the therapeutic alliance and problems associated with the structuring as well as the pacing of the therapy session.

Part 2: Disorder of Depression

Today, over 350 million persons in different parts of the world suffer from depression. This statistic was published in a medical news article by Nordqvist (2012) as a report made by the World Health Organization (Nordqvist, 2012). Additionally, this shows that depression is a major medical issue that requires an effective intervention medical strategy for it to be addressed. One of the most effective interventions for curing depression is to use cognitive behavioral therapy (CBT). This is a case study analysis of Esteban, a patient suffering from anxiety and panic attack episodes due to pressures in his social environment such as the poor acceptance of his sexual orientation. The cases study recommends the use of CBT as the most effective strategy for treating depression.

Case Presentation of Overview of the Presenting Problem

Esteban has been experiencing anxiety and panic attacks for the last few years of his life. However, the panics and anxiety episodes have become more frequent lately, occurring at least once a day, and more so at night. The client cannot handle the episodes, and he feels embarrassed that they are out of his control. This occurrence is as a result of his fear of not being accepted by his friends and family due to his sexual orientation. Moreover, the client is always thinking of having the worst possible outcome in any given situation. Also, he at times changes his behavior due to the fear of how others might think about him.

Background Information

Depression is a form of mental health disorder that affects numerous persons in different parts of the world. In most cases, it is characterized as a mood disorder that lenders a patient to have persistently low mood accompanied by a sense of detachment of disinterest. Clinical research, in the past, has ascertained depression to be a persistent problem. In most people, depressive episodes occur at a period of 6 to 8 months. Nevertheless, depression is not the same as the temporary fluctuations in mood that most people experience in their daily lives. Ordinarily, such temporary fluctuations in mood may occur due to grieving after the death of a loved one and the loss of a job among other reasons.

Moreover, depression is caused by a broad range of factors. Such factors could be genetic, environmental, psychological or psychosocial and biological among others. Additionally, the high-risk factors for depression include childhood trauma, past head injuries, chronic pain syndromes, poor personality characterized by poor coping strategies and abuse of recreational drugs among others. Also, some prescription drugs such as corticosteroids, interferon as well as some of the beta-blockers have also been known to cause depression in people. Furthermore, depression can only be recognized through the observation of its prolonged symptoms. Such symptoms include insomnia, fatigue, psychomotor agitation, suicide contemplation and feelings of worthlessness among others.

CBT Treatment for Depression

The most effective method of treating depression is CBT. This methodology of treating patients is based on the assumption that the mood of a person is directly related to his/her thoughts. In such a case, dysfunctional thoughts distort a persons mood, his/her sense of sense, his/her physical state as well as behavior. As such, the primary focus of the CBT is to learn the process of recognizing negative thoughts, evaluating their validity and then replacing such thoughts with healthier ways of individual thinking. Moreover, therapists, through the use of CBT strives to change the patients behavioral patterns, which are mainly contributed by the existence of dysfunctional thinking patterns.

Moreover, the CBT methodology of treating depression can be classified into components. There are the behavioral and cognitive components. When using the cognitive component, both the patient and therapist work in investigating the distorted negative thoughts that may cause a negative emotion to a patient. The two parties then use the identified thoughts in developing new alternative balanced thoughts. On the other hand, when using the behavioral component of treatment, a therapist investigates a patients daily activities and then determines how such activities influences the patients moods. The patient also attempts to understand how such activities can promote the symptoms of depression in the patient.


In reference to the featured case study, Esteban is suffering from depression. This diagnosis can be made from the evidence of his change in behavioral patterns due to the various pressures affecting his in his social environment. In this case, the patient is gay and living with his partner in a healthy relationship. However, he is closeted, unlike his partner, and lies about his sexual orientation to close family members. For example, Esteban changes his behavior when his partner explains about their living situations to his parents. He also cheats his sister that he is gay and he also hides his sexual orientation to progress in his career.

From the diagnosis of the patients problem, he also experienced a bad childhood experience since his parents attained a divorce when he was still a toddler. Additionally, up to date, the patient feels an intense hatred towards his father for leaving them during his childhood. In addition, the clients mother has been diagnosed with multiple sclerosis, and as a result, she cannot function on her own. Ultimately, the patient is suffering from recurrent episodes of panic attacks and anxiety. These attacks have been prevalent for five years. However, recently, the panic attacks and episodes of anxiety have been occurring more frequently, once a day and especially at night.

All these are high-risk factors that could be placing Esteban at under immense pressure. Additionally, since factors have been prevailing for a long time, it is ideal for a CBT therapist to diagnose Estebans problem to be depression.

Relevant Literature

The effectiveness of CBT for the treatment of depression can be supported by a substantial amount of scientific publications that were authored in the past. Among them is the meta-analytical study that was conducted by Hofmann, et al., (2012). The research found out that CBT can be effective in treating depression among patients. According to the publication, CBT could treat different forms of depressions such as depression and dysthymia, substance use disorder, bipolar disorder, psychotic disorders and schizophrenia among others (Hofmann, et al., 2012). Also, in a different publication authored by Driessen and Hollon (2010), CBT can also be employed in the treatment of mood disorders (Driessen & Hollon, 2010). This is because it helps in the management of efficacy, mediators as well as moderator influencers of depression in persons.

Moreover, according to Flynn and Warren (2014), CBT is highly effective for the treatment of depression as well as...

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