CASE DESCRPTION AND CONCEPTUALIZATION
Carol is a youthful female of 26 years in age. She has undergone education in high school and 1 year in college. She grew up in middle class family that cherished accomplishment in education and career just as their Christian faith. Carol was third born in a family of five. She was excellent in her traits in class an at home, considered as giving her all to what she was doing and quite focused. Her social life was characterized by her shyness though with a number of friends and dated in fewer times.
After she graduated from high school education, Carol joined a college that was outside the state. Her success shown once again in her first year, however she started to undergo hallucinations and delusions. Her behaviour was out of the normal and separated herself from others. Due to this condition, Carol was in no position to work and got support from SSI. Her illness bizarre as it had not risen from her family past. Her family on the other hand gave all the support she needed be it financially or emotionally.
Carol got released from the psychiatric hospital two months later from inpatient treatment. Her diagnosis was schizophrenia, undistinguishable type, chronic. Carol’s Global Assessment of Functioning (GAF) when she was being discharged was 30. She stayed with her parents and was on the support of SSI. Her daily does comprised of 500 mg of thorazine and was medication bound.
Carol on her release from the psychiatric hospital, was supposed to undergo a continued psychotherapy so as to enable her to get used to the needs of staying with the community and handle her illness. Cognitively she underwent auditory persecutory hallucinations and delusions in addition to perceptions that were negative that were negative of her condition. Emotionally she experienced a flat emotional impact and nervousness that were connected to inner conditions, duties and the composition of hallucinations and delusions. Internally she was alone and kept a distant from the social setting. Her character was dormant; she could not do anything or live without the support from anyone.
Carol’s psychosocial aspect was in a big way harmed by the connection with her illness and her mode of handling it. The hallucinations, delusions and perceptions of her condition affected her daily life. Her way of handling through evading duties and inner conditions and the rise in negative signs to manage stress on the other hand elevated anxiety, negative cognitions and psychotic conditions.
ASSESSMENT MEASURES
The study made use of four resultant variables: symptomatology, active psychosocial, acquisition of treatment objectives and hospitalizations. Symptomatology was estimated through Global Pathology Index (GPI) that applied the Psychiatric Rating Scale from Hopkins (Derogatis, 1974). The GPI is a scale that is used to measure the behaviour of a patient by describing a number of symptoms. Psychosocial aspect was measured through Role Functioning Scale (RFS) (McPheeters, 1988). The scale is comprised of four sections: work, social, family and autonomous living. Every section is a composed of a 7-point behaviorally based scale. Both the RFS and GPI are scales that with regard to the rater. Hospitalization was estimated by the frequency a patient is hospitalized and sum of days they were in the hospital.
Meeting of the treatment objectives was estimated using the Goals Attainment Scaling (GAS) (Kiresuk & Sherman, 1968). In this form of scaling, the behaviorally attributes of the operation are acquired by the number of sections of goal successes and the ones met by the client. A score that varies from -2 (regression in objectives met) through 0 (meeting of goal) to +2 (surpassing the standards) is allocated for every goal with regard to the client’s accomplishment.
The GPI, RFS and hospitalization information were autonomously acquired by the case manager in 3 years treatment length on quarterly basis. This was with a follow up of 6 months and 1 year. GAS was applied as a pretest-post-test analysis of the whole success of treatment objectives.
THERAPIST CLIENT JOINING
The advancement of the therapeutic association is vital in engaging in activities with people with schizophrenia (Frank & Guncerason, 1990; Lamb, 1982). Rapport was advanced in 3 months and was acquired through constant application of the main factors of validity, respect and precise understanding. The process involved directive, active, friendly and application of response, repression of feelings, reality testing and opening up so as to advance a genuine connection and limit transferential issues. For instance, Carol had taken time and had fun playing softball and was a great fun of baseball. The moment the therapist had stated that he had a common interest to what Carol had said it was a point that enabled the two to engage in active discussion and made their connection stronger. Opening up was applied make the setting to be normal and advance discussion of actual life problems.
The period of the sessions were based on the client’s ability at the instance and could vary from 15 minutes to an hour. The therapist and the patient constantly got out for walks as the session was in session when Carol got disconcerted or weary.
SOCIALISATION PHASE
The objectives connected to this phase was to advance the therapeutic union based on the rationale of treatment, so as to manage the client’s awareness of the operation treatment and consensus if the objectives. The therapist educates the patient on the disease and procedure to be applied (normalizing destigmatising). This phase focuses on the biological aspect to stress with disease and significance to noting stress and elevating techniques of handling it.
The ABC method (Ellis, 1970) was applied so as to make enhance awareness of the treatment. The issues affecting the patient were noted so as to acquire the cognitive aspects of the patient’s attributes. The therapist and patient would tag the A (activating process) and C (emotional aspect) of an emotional period and the therapist assists the patient self-statements (B) that may have contributed to the emotional aspect or bring about additional emotional reactions. It was hard for Carol to apply this when she is under stress or using the ABC model to major cases. The ABC model was impressed upon by application of emphatic reflective comments that stated the cognitive underpinnings of the case in point. Constant repetition and personal instances from the therapist were useful in meeting a relevant consciousness of the cognitive model in three months.
ENDING PHASE
This phase comprised of thoughts and feelings based on ending treatment and strategies to sustain treatment advantages. Methods used involved review and termination strategy. The strategy agreed on a number of things for effective outcome.
FOLLOW-UP DATA
Based on information acquire, Carol underwent advancement in psychosocial operation, success of objectives, a drop in symptomatology and several hospitalizations kept at 6 months and 1 year follow up (cf. Table 1). Based on psychosocial operation she advanced in work, autonomous living and social connection. The general score showed the psychosocial functioning score. Carol’s score was 27 at the end of the study showing development in social connection.
Symptomatology was low. Carol’s score was 7 showing severe reading of the condition; hallucinations and delusions, error in judgment, inability to handle herself among others.
Table 1. Results
Year Follow-up
Variables Pretest 1 2 3 6 mos 1 yr.
Psychosocial 6 11 19 27 27 27
Functioning (RFS)
Symptomatology (GPI) 7 6 4 1 1 1
Hospital Days* 60 0 0 0 0 0
Goal Attainment (GAS)19.85 80.15 80.15
*In the 3-month period prior to beginning CBT.
The Goal Attainment value of 50 shows the anticipated value of goal attainment. In regard to Carol, she acquired 19.85 and after treatment she scored 80.15 showing major successes. Carol lacked any psychiatric re-hospitalization at her time. This connects to her past and the re-hospitalization rate of 35-50% (Anthony, Cohen & Vitalo, 1978).
CONCLUSIONS
This case has shown major successes in psychosocial functioning, meeting of objectives, lowering of symptomatology and hospitalizations. This states that the effectiveness of CBT in treatment of varied issues on people with schizophrenia. This study has to be copied so as to meet the utility of CBT of the condition.
The model shows the application of CBT on handling hallucinations and delusions to several issues in clients. This model is applied to note treatment mater and use interventions in treatment and recovery of the disease.
The study shows the relevance of being aware of schizophrenia. It is vital to study the connection in a person and the disorder so as to be able to handle the disease. It ought to be based on the life patterns and objectives. The process involved similarly the impact of illness on Carol’s persona. The application of evidence and data are vital to her effectiveness to picture and meet major successes in life.
