Principle-Informed CBT in a Complex Case

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The current paper presents an example of conducting outpatient CBT with an emphasis on principle-informed conceptualization and interventions rather than using specific, manualized protocols. The case illustration highlights the manner in which the therapist conceptualizes and prioritizes the patient’s problems, targeting key areas of patient dysfunction that cut across diagnostic areas of concern. The patient (“Sue,” a single, American graduate student with Chinese heritage) presents with multiple interacting problems, including severe depression with habitual suicidal thinking, a history of sexual trauma and ongoing sense of vulnerability to harm, chronic anxiety with related avoidance, and occasional purging as a means by which to regulate affect. Cross-cultural issues factor into understanding the patient, solidifying the therapeutic relationship, and negotiating a treatment plan. The course of treatment described herein includes illustrations of the therapist's efforts to keep the patient objectively safe while also promoting her sense of subjective safety; conceptualizing the historical, environmental, and intra-personal variables pertinent to the development and maintenance of the patient’s problems; incorporating cross-cultural considerations in promoting the therapeutic relationship and collaborating on goals; and measuring and positively reinforcing the patient’s improvements in functioning, including promoting her personal strengths and areas of potential growth. Further, interdisciplinary matters (e.g., professional consulting and collaboration) are also addressed with regard to the patient’s concurrent pharmacotherapy with another mental health-care provider.