The Case of Gabriel: Treatment with Beckian Cognitive Therapy

Abstract

The case of Gabriel, an anxious and depressed young man struggling with facing and completing his academic requirements, is hypothetically described from within the orientation of Beckian cognitive therapy. In this approach, Gabriel's psychological difficulties are hypothesized to involve schemas of incompetency and entitlement that give rise to maladaptive beliefs, hindering his ability and willingness to study, write papers, and attend classes. In turn, Gabriel's habitual avoidance worsens his views of himself, prevents him from habituating to his anxiety, interferes with pursuing his goals, and keeps him in a state of low self-efficacy. The therapist emphasizes the importance of assessing and modifying Gabriel's problematic beliefs and counteracting his avoidance via self-monitoring, behavioral experiments, exposures to academic tasks, rational responding, and related therapy homework assignments. The criteria for ending treatment and improving maintenance are discussed in light of Gabriel's potential secondary goals, including improving assertiveness, communication skills, and interpersonal relationships.

Notes

1. In order to maximize collaboration, cognitive therapists strive to have equal give-and-take dialogues with patients whenever possible. However, owing to space limitations in this article, only the therapist's hypothetical comments will be quoted. In actual practice, the therapist would be interested in, and responsive to, Gabriel's thoughts and feelings about the therapist's comments.

2. Certainly the therapist must take into account the possibility that Gabriel's family members might fail to be supportive. The cognitive therapist's stance may be that it is unwise to make assumptions (either positive or negative) about such an important matter. Therefore, the therapist would encourage Gabriel to review the evidence for and against the idea that it would be helpful for Gabriel to disclose his secrets to his family—and to evaluate this issue one person at a time (rather than assume that they all think alike).