Clinical Case Study: Bess
Cognitive behavioral therapy (CBT) would be an appropriate intervention to assist Bess in overcoming her OCD by targeting the psychological foundation of the disorder. Bess’s neurosis is related to a strong, overbearing impact from her mother in her childhood, now verging on agoraphobia, which is having a negative effect on her social and psychological life. Her symptoms do not appear to have a strong biological basis, thus CBT should be an effective intervention.
The rationale for selecting CBT is that it provides a goal-oriented strategy for overcoming negative behaviors and replacing them with positive ones. Because Bess is a goal-driven person, who has been highly motivated in the past to accomplish tasks, this strategy should be helpful in re-orienting her with a more positive focus. Her confused sexual experience followed by the forced abortion on her mother’s orders have substantially deprived Bess of any ability to function autonomously or with any real connection between her interior life and the world around her. She feels disconnected and deprived of an ability to “fix” herself: she is the same girl who struggled with the concept of being “saved” and being a “sinner” when learning religion under her Methodist tutors. This anxiety is manifested in an extreme manner by her obsessive-compulsive disorder, related to the rituals of undressing and cleaning. She is unable to “clean” something inside of her that she cannot even identify or be certain is there. Thus, the constant conducting and re-conducting of the same tired and “absurd” rituals become an overwhelming part of her daily existence. CBT could help to alleviate her of the obsession she feels by engaging her in a positive manner that will allow this burden in her mind to be lifted. It could also assist her in re-focusing her psychic energies towards more rewarding and fulfilling goals in both her private and social life.
Bess also suffers from clear signs of depression as she has always struggled to be happy under a mother who could not understand or tolerate her unhappiness. CBT could also be employed to assist in this case. During the cognitive therapy sessions, the therapist would be able to use “congruent” traits to help the patient deal positively and effectively with her “incongruence” — in this case, Bess’s inability to stop her rituals even though they are preventing her from being productive (McNeil, 2013, p. 8). Becks’s “empirically validated treatments” using cognitive therapy in this case would be instrumental because of the depressive feelings that Bess is experiencing (Jones, Lyddon, 2000, p. 342). Likewise there is the study by Asamsama, Dickstein, and Chard (2015) that shows how CBT is a good approach to dealing with serious issues of depression and why it can be a beneficial treatment modality because of its focus on altering client behavioral patterns.
What would be done and who would be involved would be the therapist and the patient and the goal being to identify positive traits and negative traits and establish a motive for aligning behavior with positive goals so as to reduce the OCD incidences. The setting could occur in an office or in the home of the patient — wherever Bess is most comfortable receiving this treatment. The treatment is targeting Bess’s OCD and depression — both of which are psycho-socio factors in her life.
Family-centered therapy could also be utilized if Bess’s father and/or mother would like to participate. This would target Bess’s mother’s OCD as well and help the two to recognize how they are impacting one another. The three family members would be involved and the setting would likely be the therapist’s office, with the target being the family relationship-social dynamic. This may prove a much less effective intervention than CBT, however, especially if Bess’s mother is unwilling to see how there is anything destructive about her own behavior.
Asamsama, O., Dickstein, B., Chard, K. (2015). Do scores on the Beck Depression
Inventory-II Predict Outcome in Cognitive Processing Therapy? Psychological Trauma: Theory, Research, Practice and Policy, 7(5): 437-441.
Jones, J., Lyddon, W. (2000). Cognitive Therapy and Empirically Validated Treatments.
Journal of Cognitive Psychotherapy: An International Quarterly, 14(3): 337-345.
McNeil, A. (2013). Person-Centered Therapy and Transgenerational Family Therapy.
HTP 2025-Systems of Pscyhotherapy.
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