ArtsAutosBooksBusinessEducationEntertainmentFamilyFashionFoodGamesGenderHealthHolidaysHomeHubPagesPersonal FinancePetsPoliticsReligionSportsTechnologyTravel

Medical therapy

Updated on December 16, 2018
TheMindandbeauty profile image

I am a graduate getting my bachelor degree in Education in 2006. I have worked as a teacher and trainer.


As Mike progressed through therapy with an increased sense of motivation on the ninth session we deemed that it was appropriate to work on his core beliefs. This was discussed in the supervision session and I have reaffirmed that a person cantered approach allows for a different pace of therapy delivery.

As a trainee therapist I utilised the recording opportunity to reflect on my clinical practice. In preparation for treatment, I enhanced my knowledge with Beck’s model, service protocols, and evidence based literature. It has come to my attention that I am required to adapt my style to a more collaborative approach. Although Mike’s specifically comments that he ‘felt challenged in a non-threatening way which is helpful” I believe that he could have benefited from a more Socratic stance. I intend to utilise this exercise as an opportunity to hone my clinical skills and ensure that my future practice reflects this.

I believe that my supervisor’s support and the knowledge gained at the university has allowed me to confidently proceed with the session plan and deliver it in a safe manner. Although there is always room for improvement and as a qualified therapist I will continue to strive to adapt my approach to suit individual clients I feel satisfied with the client’s and my supervisor’s feedback.

The session commenced by encouraging Mike to arrive at his conclusions at his own pace. However, as the session progressed less Socratic questioning was used and a more didactic stance was applied, as the therapist was conscious of the time and mindful of other agenda items that needed to be covered. For example, while exploring three pieces of evidence related to core beliefs I could have waited longer for the client to come up with his own examples. In future practice, the therapist would manage time in a more effective manner and utilise Socratic questioning to ensure a collaborative approach is followed and the client is in charge of his own recovery.

When reviewing MDS scores, I asked the client if these were capturing his low mood and anxiety. The client agreed, however, that this should have been explored further as his subsequent reports do not indicate this.

Although it could have been beneficial to explore the reasons behind the client’s incomplete homework in more depth, I recognised that this was progress regarding Mike’s rule and assumption ‘If I miss something it’s not good enough’ and hence was not explored further but related back to his formulation.

It is important to note that although I have endeavoured to elicit as much feedback as possible by asking specific questions it would have also been useful to check on Mike’s comprehension of the subject matter by subtly eliciting more frequent feedback by exploring the new material learnt during this session. Due to time constrictions, I felt that I was unable to provide as many summaries as would have been useful in order to recap on the discussed material and enhance client’s understanding.

One of the strengths of the session was that a good therapeutic relationship was evident throughout the session, and that the client is able to express himself and ask for clarifications. In addition to that, the longitudinal formulation was frequently referred to in order to consolidate learning. A further strength was that homework setting followed naturally from the session and sufficient time was taken to explore this.


Mike’s treatment plan complied with Beck’s (1967) model for depression. Treatment concentrated on reducing symptoms of depression by employing behavioural and cognitive strategies. This case report demonstrates that Beck’s (1967) model was appropriate to capture and treat Mike’s difficulties, as per literature review which guided treatment. This was evident in Mike’s treatment scores and his verbal reports.

As a developing therapist, I was slightly apprehensive about my competence to deliver therapy according to the protocol. This experience has increased my confidence in treating a disorder that at times can be overwhelming due to a multitude of negative thoughts expressed by a client.

Supervision has been helpful in working with and managing my doubts about therapy. An evidence based approach has allowed me to deal with constant exposure to the client’s negative thoughts with confidence. I had a good theoretical knowledge backed up with literature and research, which supported my belief in client’s recovery.

I questioned whether Mike’s accomplishments were true. Discussions about homework have allowed me to establish that he experiences were factual and the way he described his feelings and detailed the events have allowed me to understand that he was making progress. In addition to that, the client’s sense of accomplishment and his joy spoke volumes to me.

Mike was able to examine his overall activity levels through activity monitoring and identify activities that provided him with pleasure, closeness to others and achievement, and in turn contributed to the improvement in his mood. Activity scheduling allowed Mike to start addressing his treatment goals. He expanded his circle of friends, improved existing relationships and regained confidence in his appearance by establishing new hobbies and doing something for himself. He said that these activities and changing his unhelpful thinking styles improved his sleep, concentration, mood, energy levels and motivation to do things. Mike’s negative core belief of being ‘unlovable and not good enough’ was altered.

I believe that the client was ready to engage in treatment which facilitated his recovery. In hindsight, it would have been beneficial to adopt a more Socratic stance through therapy as this would have yielded more empowerment and encouraged elaborative thinking. Although Mike’s scores suggested mild levels of depression, according to research it was important to question his core beliefs in order to prevent relapse (Padesky, 1994).

In view of Mike’s presenting difficulties, it would have been useful to administer the Beck Depression Inventory (Beck et al., 1961) as this is a disorder specific measure and would capture the depth of his difficulties and subsequent recovery in a clearer way. However, this was not feasible as the service does not hold a licence for this.

In hindsight, therapy could have run at a slower pace. During future practice I will carefully plan the content of the sessions in advance. This experience has allowed me to consolidate my learning and apply new CBT techniques such as continuum work for the first time.


    0 of 8192 characters used
    Post Comment

    No comments yet.


    This website uses cookies

    As a user in the EEA, your approval is needed on a few things. To provide a better website experience, uses cookies (and other similar technologies) and may collect, process, and share personal data. Please choose which areas of our service you consent to our doing so.

    For more information on managing or withdrawing consents and how we handle data, visit our Privacy Policy at:

    Show Details
    HubPages Device IDThis is used to identify particular browsers or devices when the access the service, and is used for security reasons.
    LoginThis is necessary to sign in to the HubPages Service.
    Google RecaptchaThis is used to prevent bots and spam. (Privacy Policy)
    AkismetThis is used to detect comment spam. (Privacy Policy)
    HubPages Google AnalyticsThis is used to provide data on traffic to our website, all personally identifyable data is anonymized. (Privacy Policy)
    HubPages Traffic PixelThis is used to collect data on traffic to articles and other pages on our site. Unless you are signed in to a HubPages account, all personally identifiable information is anonymized.
    Amazon Web ServicesThis is a cloud services platform that we used to host our service. (Privacy Policy)
    CloudflareThis is a cloud CDN service that we use to efficiently deliver files required for our service to operate such as javascript, cascading style sheets, images, and videos. (Privacy Policy)
    Google Hosted LibrariesJavascript software libraries such as jQuery are loaded at endpoints on the or domains, for performance and efficiency reasons. (Privacy Policy)
    Google Custom SearchThis is feature allows you to search the site. (Privacy Policy)
    Google MapsSome articles have Google Maps embedded in them. (Privacy Policy)
    Google ChartsThis is used to display charts and graphs on articles and the author center. (Privacy Policy)
    Google AdSense Host APIThis service allows you to sign up for or associate a Google AdSense account with HubPages, so that you can earn money from ads on your articles. No data is shared unless you engage with this feature. (Privacy Policy)
    Google YouTubeSome articles have YouTube videos embedded in them. (Privacy Policy)
    VimeoSome articles have Vimeo videos embedded in them. (Privacy Policy)
    PaypalThis is used for a registered author who enrolls in the HubPages Earnings program and requests to be paid via PayPal. No data is shared with Paypal unless you engage with this feature. (Privacy Policy)
    Facebook LoginYou can use this to streamline signing up for, or signing in to your Hubpages account. No data is shared with Facebook unless you engage with this feature. (Privacy Policy)
    MavenThis supports the Maven widget and search functionality. (Privacy Policy)
    Google AdSenseThis is an ad network. (Privacy Policy)
    Google DoubleClickGoogle provides ad serving technology and runs an ad network. (Privacy Policy)
    Index ExchangeThis is an ad network. (Privacy Policy)
    SovrnThis is an ad network. (Privacy Policy)
    Facebook AdsThis is an ad network. (Privacy Policy)
    Amazon Unified Ad MarketplaceThis is an ad network. (Privacy Policy)
    AppNexusThis is an ad network. (Privacy Policy)
    OpenxThis is an ad network. (Privacy Policy)
    Rubicon ProjectThis is an ad network. (Privacy Policy)
    TripleLiftThis is an ad network. (Privacy Policy)
    Say MediaWe partner with Say Media to deliver ad campaigns on our sites. (Privacy Policy)
    Remarketing PixelsWe may use remarketing pixels from advertising networks such as Google AdWords, Bing Ads, and Facebook in order to advertise the HubPages Service to people that have visited our sites.
    Conversion Tracking PixelsWe may use conversion tracking pixels from advertising networks such as Google AdWords, Bing Ads, and Facebook in order to identify when an advertisement has successfully resulted in the desired action, such as signing up for the HubPages Service or publishing an article on the HubPages Service.
    Author Google AnalyticsThis is used to provide traffic data and reports to the authors of articles on the HubPages Service. (Privacy Policy)
    ComscoreComScore is a media measurement and analytics company providing marketing data and analytics to enterprises, media and advertising agencies, and publishers. Non-consent will result in ComScore only processing obfuscated personal data. (Privacy Policy)
    Amazon Tracking PixelSome articles display amazon products as part of the Amazon Affiliate program, this pixel provides traffic statistics for those products (Privacy Policy)
    ClickscoThis is a data management platform studying reader behavior (Privacy Policy)