Psychotherapy Final Project
Rafael Ruelas
Sport Psychology
Capella University
Introduction to Theories of Psychotherapy PSY6310
Summer 2013
Dr. Mankoff
September 12, 2013

Introduction
According to Bateman, Brown and Pedder (2000), psychotherapy refers to the treatment of emotional or mental disorders and adjustment problems through applying psychotherapy techniques as opposed to chemical and biological interventions. Psychotherapy is dependent on verbal exchange between the therapist and the person seeking help-commonly referred to as psychoanalysis. Therapeutic relationships are characterized by mutual trust between the two players with the main objective of helping individuals to change unhealthy and/or destructive behaviors, emotions and thoughts. In this pursuit, therapists combine several techniques including psychodynamics, behavioral and cognitive approaches.

Anorexia nervosa
There are many and varied psychological disorders in this case, I will focus on anorexia nervosa and its treatment. Anorexia nervosa is a condition that is characterized by refusal to maintain a healthy body weight or intense fear of gaining weight. The patient feels inadequate when he senses he is fat. The condition mainly affects young women although other age groups can also be affected (Bateman & Holmes, 2005).
When a patent has anorexia, the desire to lose weight becomes one’s most important preoccupation. The patient does not appreciate his/her condition and cannot see himself as he or she truly is. The patient is very disgusted by the way her/her body looks and thought about dieting, food and one’s body take most of their days. The patient has little time for friends, family and other activities that they used to enjoy. The skinnier the patient becomes, the better s/he feels. Mealtimes become very stressful and the patient thinks extensively only on what he should and should not eat. The patient is not normally aware of the problem. The following is an interview of with a 19 year old woman who has several complications resulting from her desire to lose weight including attempted suicide:
Janet is 19 years old whose boyfriend of 2 years abandoned her following her decision to lose almost 60 % of her weight. She was previously weighing 120 pounds but has lost 60% of her weight and now weighs a paltry 48 pounds. Her parents have brought her to me to counsel her following the breakup of relationship with the boyfriend and identified that she was contemplating suicide. The following are is the interview;
Engaging with the patient at first instance
Psy: Hello Janet. I feel very sorry for your loss. How are you doing?
Janet: I am OK, I guess. I just cannot stop thinking about losing my relationship after having put so much in it.
Psy: I understand. I know it is real painful to break up with the one you love especially when you had big plans ahead. Can you tell me more about how you feel?
Janet: I just cannot help thinking ......(She stops and weeps )...........that if it was not for me, my boyfriend would be with me right now. I do not know how I will live with this guilt.
Psy: So you are not only dealing with the sudden break up of your relationship but you are also feeling guilty of it?
Janet: Yes .....( She weeps loudly).
Identifying the suicide ideation
Psy: You know Janet, at times when people experience a sudden break up and feel guilty about it, they contemplate suicide. Janet, (I ask while maintaining eye contact), have you contemplated suicide?
Janet: (She stops crying, pauses for a few seconds than lifts her head and says ...). Yes.
Inquiring about the reasons for behind suicidal thoughts
Me: I understand Janet. But can you tell me more about the reasons for your contemplating suicide?
Janet: I do not think I can live with this guilt any longer. All my friends are condemning me for having let my boyfriend down. . They all know that I have broken up with him. Not one of them can speak to me-they hate me one. Worst of all, my boyfriend switched off his phone. My parents too do not understand that I need to be thin and attractive. I try to be thin and they all run away, I gain weight and I stand condemned. I am convinced that everybody hates me because of my new looks. I wish I were dead. It can be a favor for them not to see me around.
Me: So then, you are really feeling lonely and let down right now. You are thinking that your boyfriend did not appreciate your sacrifices in order to look attractive to him and instead ran away.
Janet: You are right sir (Janet’ tears now turn to an angry resentment....). I will demonstrate to them in a while.
Me: What do you mean by that ?
Janet: (keeps Quiet then says)....If I commit suicide, they will rejoice that I am no longer around to stain their conscience. Then I will be happy in my grave with no-one to stare at me.
[I hereby identify that Janet is feeling very guilty. This is due to the fact that she is blamed by everybody for the breakout of the relationship that she did not intend in the first place. She does not understand the cause of the problems for the relationship but wonders why the selfless gesture to look slim to her boyfriend ended up in a sudden breakup. Yet, hers was a model relationship that they all looked up to for inspiration and could have ended up in a marriage. The boyfriend might have decided to quit after realizing Janet’s preoccupation with weights and anorexia. Having confirmed the suicidal thoughts, I need to assess the risk of engaging in such behavior ]
Assessing the level of risk of committing suicide
Psy: Janet, you said that you think suicide is the solution to the hard feelings you have on the breakup of your relationship? How do you intend to accomplish that?
Janet: Yes, But that is my secret. They might get the body or not.
PSy: Have you made arrangements of how you will do it?
Janet: Yes, That is my secret.
Me: So the guilt is so intense that you want to actually take your own life ? When?
Janet: Yes, Soonest
Me: Have you ever talked to anyone about this guilt before?
Janet: I thought about going to the therapist before but he has been away for a long time. I tried talking to my boyfriend but he said he has moved on as I was the one to blame. My mother too asked me to get serious with other undertakings and I forget about weight and food. I have tried and been unable to get over this problem.
Me: What problem had you visited the therapist for?
Janet: Depression.
Me: Janet, have you ever tried taking your own life before ?
Janet: No
Me: Is there any person that you know who you can talk to about this – I mean anyone who you think could solve such problems .
Janet: No (She slums into her chair. Her anger dissolves and she again starts to sob).
[Janet has settled on a suicide plan, but she is not sure of the mean she will use to execute it. her intense and guilty conscience have pushed her to the limits. She does not associate the problems with her anorexia disorder and draws no causality with the problem. She looks extremely emaciated, old and sickly but she feels she has no problem with her body. In her view, the people around her are the ones who have rejected her to the point of her contemplating suicide. However, she has no prior suicidal behavior herself and the fact that she has identified is as a potential solution to the problem places her at a very high risk. Additionally, she has no resources that she can utilize to move her from a suicide orientation. This further elevates her risk of depression. ]
Taking action to minimize the risk of suicide
Me: Janet, I understand how it hurts when it feels there is no way out and I believe I can help you if you let me.
Janet: What will you do (she becomes angry again and looks impatient-she threatens to leave )? I am leaving now.
[She gets up and leaves the office].
Me: How would you like us to proceed? Janet, we must get help right now. I ask as I follow her
Janet: I am through with all this?
Me: You see no hope but I do. Janet, I understand. Please follow me right now ( I ask her with a compassionate but firm voice).

[ From this interview, the intervention will need to be very directive and the police will need to be contacted for assistance if needed . ]
Psychotherapy theories of intervention
In treating the above psychological problem, I will apply three theories of psychotherapy including Cognitive Behavioral Therapy (CBT), Gestalt Therapy and Person-Centered Therapy. To begin with, CBT addresses dysfunctional emotions, cognitive processes and maladaptive behaviors and contents through a number of explicit, goal-oriented and systematic procedures. The method combines cognitive and behavioral approaches to derive desired outcomes. According to Cepeda and Davenport (2006), the approach is most effective on treatment of conditions like mood disorders, eating disorders, psychotic disorders, etc. Gestalt Therapy is used to help patients understand their feelings in a deeper way. The idea behind this approach is the fact that every human being has to suppress some aspects about ourselves because they are not accepted or are not supported (Cooper, Watson & Hoeldampf, 2010). These include uncomfortable feelings, perception of others based on our experience as opposed to the reality, and many others (Henrik, 2001).These aspects end up in the back of a person’s mind and become unfinished business. Gestalt therapy helps people shed light on the unfinished business by making one focus on his/her feelings (or lack of them) from time to time. Once a person’s becomes aware of his/her shortcomings, one becomes better equipped to understand him/herself and is better able to understand the reasons for change or to remain the same. Lastly, person centered therapy that is also known as client centered therapy involves providing the patient with an opportunity to develop a sense of self. After developing such sense of self, they can thus realize how their attitudes, feelings and behaviors are negatively affected and thus make effort to realize their full potential. The therapist creates a comfortable non-judgmental forum that demonstrates genuineness, empathy and a general positive regard toward the client. All this is done in a non-directive approach. This way the patient is able to find solutions to his/her own problems.
Applying Cognitive Behavioral Therapy to Janet’s case

In Janet’s case, her eating disorder had led to breaking up of her relationship that she truly valued. Besides, her condition had severely eroded her self-confidence and made her develop suicidal thoughts. In this case, it is best to separate the two issues (anorexia and suicidal ideation) and deal with each of them separately. In this case, we apply the five areas model to understand her case (Maclennan, 2006).The five areas contribute to the development and maintenance of stress and depression and eventual suicidal ideation as follows;
Thoughts- she thinks she is not attractive enough- she was originally slightly overweight and for this reason, she embarked on a weight loss process. She had the support of the boyfriend
Feelings/ emotions –she feels let down after she lost weight but lost the relationship as well. The otherwise noble weight-loss program degenerated to a full-blown psychological disorder making her fear eating food. She has lost her original beauty and her boyfriend has given up on her after trying hard to save her.
Physical symptoms: She looks weak and emaciated from anorexia and depression.
Behavior: She is angry and dejected from the ordeal, feels lonely and hurt. As a result, she has lost most of her friends and thus feels unwanted
Environmental background factors: she does not have a supportive family that can help her rise from her situation.
Intervention using the CBT method
Induce change of thoughts and action through making her understand the problem and its interrelationship (Schneider, 2001).The therapist has to pinpoint the problem to Janet and explain it as the cause of all her troubles. In addition, the therapist has to indicate all other problems that might arise because of anorexia. These include low self-esteem, basing one’s self-worth on weight and body size and always feeling fat even when most people tell you that you are not (Yontef, 2003). The therapist has to insist on Janet’s accepting her current situation and changing it for the better little by little. In addition, the therapist has to encourage Janet to not just talk but also do what is supposed to be done such as increasing the food rations. The patient needs to be prompted to avoid triggers of anorexia and accept herself the way she is. According to Oberst and Stewart (2003), the therapist should make the patient feel at home in her own skin and nurture her self-esteem to the point that the patient will become self-assertive again. The following are five points that can help treat Janet’s condition: i) Help her face it as opposed to sinking in denial. Identify certain personalities with a similar physique and cite how confident they are in their own skin ii) Dig in- the best cure for lack of self-confidence is acting on it. This may entail learning to take charge iii) Buck Up- remind her that this will pass and remind her of the things she did well or those that generated a more desirable outcome iv) Reach out- help her understand how to look for supportive friends and mentors to shape her career v) Connect- having close mates distracts us from worries.

Applying Person-Centered Therapy to Janet’s case
The most important elements of Person centered therapy are congruence of therapist and client, unconditional positive regard and empathy towards the client (Rogers, Lyon & Tausch, 2013; Yontef, 2003). The following is a extract of Janet’s therapy using this approach:
Establishing congruence
Psy: I have been through this myself and I know the pain of losing a lover
Janet: It is the worst point of my life, losing all my relationships
Psy: But the good thing is, it is possible to change things for the better even after going through this as I did myself with the help of a counselor
Janet: Really?
Expressing unconditional positive regard
Psy: I do not find you lacking in as much as you think. In fact, you are no different from my daughter in terms of size
Janet: Really
Psy: Yes. Some of these thoughts are perceptual as opposed to real
Expressing empathy
Janet: That is what they keep telling me all the time
Psy: They are actually telling you the truth. Once you overcome eating disorders, you will be alright like any other person.
Janet: I do not believe this is possible
Psy: Of course Janet, I understand. It looks hard to accomplish in a single day especially after having suffered that long. But the good thing is that your condition can be overcome once you act on it.
Applying Gestalt Therapy to Janet’s case
This approach encourages a client to develop self-awareness and personal responsibility (Prochaska & Norcross, 2007). In Janet’s case, the following should be done:
Psy: Janet, by committing suicide, you will not have solved the problem. You will have created so many other problems on people that love you
Janet: No. I am better off dead than alive
Psy: Janet, think of those people that love you. Those that look up to you. How will they feel if they found out that you committed suicide? Most probably, they will feel the same way you are feeling now. And this will not help anybody.
Janet: There is not a single person who loves me
Psy: Your parents do. And even if they did not, your God does. Imagine the burden of pain and loss you will inflict on your parents just because of a treatable condition. Imagine how the feeling of loss will affect your precious little sister who holds nothing but admiration towards you. Isn’t it better and less painful to adopt a better way to change your condition as opposed to committing suicide?
Janet: It is not easy
Psy: You need to try as hard as you can. I am sure that with proper guidance and determination, you will surely make it.

References Bateman, A., Brown, D., Pedder, J. (2000). Introduction to Psychotherapy: An Outline of Psychodynamic Principles and Practice. London: Routledge. Bateman, A., Holmes, J. (2005). Introduction to Psychoanalysis: Contemporary Theory and Practice. London: Routledge..
Cepeda, L., Davenport, D. (2006). "Person-Centered Therapy and Solution-Focused Brief Therapy: An Integration of Present and Future Awareness". Psychotherapy: Theory, Research, Practice, Training. Vol. 43 (1): 1–12.
Cooper, M., Watson, J,. Hoeldampf, D. (2010). Person-centered and experiential therapies work: A review of the research on counseling, psychotherapy and related practices. Ross-on-Wye, UK: PCCS Books. Henrik, R. (2001). The Psychotherapy Handbook. The A-Z handbook to more than 250 psychotherapies as used today . New York: New American Library.
Maclennan, N. (2006). Counselling For Managers London: Gower. Oberst, U., Stewart, A. (2003). Adlerian Psychotherapy: An Advanced Approach to Individual Psychology. New York: Brunner-Routledge.
Prochaska, J., Norcross, J.(2007). Systems of Psychotherapy: A Trans-theoretical Analysis. Thompson Books/Cole: New York.
Rogers, C. (2001). Client-Centered Therapy. Cambridge Massachusetts: The Riverside Press.
Rogers, C., Lyon, H., Tausch, R. (2013) On Becoming an Effective Teacher -- Person-centered teaching, Psychology, Philosophy, and Dialogues with Carl R. Rogers and Harold Lyon. London: Routledge,
Schneider, K. (2001). The Handbook of Humanistic Psychology. London: SAGE Publications.
Yontef, G. (2003). Awareness, Dialogue, and Process. London: The Gestalt Journal Press, Inc