Case Conceptualization Behavioral Therapy


CaseConceptualization: Behavioral Therapy


The case study isabout Alex, a woman seeking counselling intervention to help herovercome depression and fear of not conceiving. The theory chosen forthis paper is the behavioral theory, which explains better the issueof behavioral changes as a result of fear and depression. Accordingto the theory, there is a combination it with feeling and thoughtsthat causes them. Individuals practicing behavioral therapy tend topay more attention on the taught behaviors and the way theenvironment impact on these behaviors. The interventions are alsostudied, which are aimed at showing how the therapy plays a role inthe counselling sessions. However, the theory does not involve asingle method however, there are a wide range of interventions ortechniques used to offer treatment to a client’s behavioralproblems.

Behavioral therapy(BT) is a kind of psychotherapy developed in 1911 by EdwardThorndike. In his article “Provisional Laws of Acquired Behavior orLearning”, Edward Thorndike frequently used the phrase “modifyingbehavior”. However, it was until 1953 when the first possibleoccurrence of the term “behavioral therapy” was seen in aresearch project by Ameriacn developers Ogden Lindsley, Harry C.Solomon, B. F. Skinner, and Nathan H. Azrin. Their research projecttalked about an operant conditioning and the manner in which it maybe used to improve functioning of individuals diagnosed with achronic schizophrenia (Rasmussen, 2005). It can also be said thatearlier pioneers on the behavioral therapy are Hans Eysenck (UnitedStates) and Joseph Wolpe (South Africa). Each of the two also hadtheir unique way of viewing behavioral problems, which was interplaybetween behavior, personality characteristics, and environment.

The developers ofbehavioral therapy had a unique view of human nature and the processof counselling. First, they assumed that human nature is associatedwith their own psychological problems, which are more likelydeveloped as a result of a learning process that affect theirbehavioral development (Rasmussen, 2005). During a counselingprocess, behavioral therapy dictates that a counselor is not supposedto look at the behavioral disorders to be something which anindividual has, but to examine how the learning process influencesthem and the people around them in a specific way in particularconditions. The whole counseling process should be based on betterunderstanding of how research is carried out on classical and operantconditioning.

The efficacy ofbehavioral therapy is shown by a scientific research conducted.Scientific basis of this behavioral approach is based upon certainprinciples of conditioning, both classical (Ivan Pavlov) and operant(B. F. Skinner). The classical conditioning occurs when the neutralstimulus comes prior to another, which ends up triggering a reflexresponse. The basis of this is that if the neutral stimulus and otherstimulus are paired, a particular reflexive response is triggered(Rasmussen, 2005). Operant conditioning on the other hand, has initself gone to do with punishments and rewards, and the manner inwhich it aims at either weakens r strengthens particular behaviors.

Behavioral therapyhas been shown to be effective in fighting depression, anxiety, andother forms of human psychological problems through diagnoses. Apartfrom traditional psychoanalytic approach, which bases treatment ofthese mental illnesses to unconscious meaning of patients’behaviors for treatment, these disorders are treated with this theorythrough a strong relationship developed between avoidance responseand feared stimulus (Jones &amp Butman, 2011). The theory appliessymptom-based diagnosis by use of psychodynamic treatments.

Behavioral theoryis appropriate for my client and her presenting problems since thetheory influences human behavior, their experiences, and theirunconscious desire. Developmental process as is explained in thetheory, takes place in a specific stage, which is characterized by aseries of conflicts. These conflicts may pose an adverse effect onthe client’s behavior and personality (Burron et al., 1992). Thetheory is appropriate since its techniques are applied to deal withthe client’s phobias. With desensitization, this can also beapplied to deal with anger and anxiety. Over some sessions,desensitization helps treat depression through hierarchy, which makesa person less anxious and depressed.

Behavioral theorywhen applied during counseling session may result in potentialethical issues between the counselor and the client. Since the theoryaims at teaching manualized and simple skills other than creatingpersonal intimate relationship, some of the ethical issues may resultfrom making risky judgement of the client’s past life andexperiences (American Psychological Association, 1992). Other ethicalissues could revolve around abuse of power, client’sconfidentiality, and having intimate relationship.

Between thecounselor and the client, some of the cultural issues that may ariseare a broad range, which ranges from religion, race, culture,ethnicity, disability, and sexual orientation. Some of the treatmentprocess may at some point be assumed to be a stereotype that a clientmay feel discriminated. Again, the counselor’s culture may view theclient situation as a matter that can be easily handled by theirreligion or family in a different culture.

Behavioral theorycan be used in a crisis situation. This is because its application iseffective in restoring the patient’s original state. In a crisissituation, the client is subjected to graded and shaping taskassignments apart from flooding and virtual reality processes(American Psychological Association, 2007). This way, crisissituations such as clients dealing with suicide tendencies forexample, are subjected to this therapy, especially when the patientis feeling a sense of hopelessness.

CaseConceptualization: Interventions

From theprevious paper, a synopsis of the problem is about a woman, Alex, whois in need of counseling intervention with the intention ofovercoming depression for her inability to bear children. Herdecision to sought help from a counselor since her behavioralfeelings of anxiety and depression she is facing, is heightened andaggravated by the inability to have kids of her own. Decision to usein vitro fertilization led to her getting pregnant, but sheeventually miscarried. What contributed to her behavioral experiencesis her inability to continue with her job, withdrawal symptoms andstaying in bed for a number of days after she miscarried. Alex’sfear of never having kids of hers and the depression she experiencesafter miscarrying are some of the problems she encounters.

The previous paperhad three goals that purported the theory’s major factors. Thesethree goals are influences of human behavior, childhood experiences,and unconscious desire. These three goals take place in thepsychosexual stage, which is characterized by internal conflicts ofthe client. The conflicts likely to appear in every developmentalstage of these three goals are likely to have an effect on Alex’sbehavior and personality in the wrong run.

In pursuant ofbehavioral theory, and based on the theory explained above, thefollowing are three techniques/interventions:

Thought Records

Apart frombehavioral experiments, this technique thought records, are designedto handle a test for the validity of thoughts. It a technique, whichlooks at an objective evidences for and against thinking, side byside. Here, the idea is to come up with numerous balanced thoughts.The technique tends to assist in helping to change beliefs,especially on a logical level. Again, it also changes beliefs on afelt or gut level for example, what is emotionally felt is true,despite objective evidence. The intervention also gives an objectivefeedback on whether self-kindness or self-criticism is more effectivein trying to reduce future actions (Burron et al., 1992). As acounselor, one of the examples I would attempt with my client is tocarry out a balanced thought, which could be giving a sentence suchas “My senior supervisor thinks that I am useless”. Here, theclient could then do a thought record, aimed at studying theevidences of thoughts, for and against.

Pleasant ActivityScheduling

PleasantActivity Scheduling refers to a surprisingly effective intervention,which is particularly of importance to anxiety and depression. Thetechnique is done through writing on paper a weeks’ days andassigned each day with a pleasant activity that one rarely does. Itcould also be as simple as going through a chapter of an interestingnovel or taking lunch (Jones &amp Butman, 2011). An alternative tothis intervention will be to schedule each day with an activity,which offers a sense of competence, mastery, and accomplishment.Again, one could schedule at least three pleasant activities eachday. To do this activities will help produce high levels ofpositively experienced emotions in a client’s daily life by makinghim or her experience positive thinking and be self-focused. To applythis on my client, I would ask her to create a table to write all thedays of the week on. The client would then dedicate her time writingone pleasant activity that she likes doing on each of the days. Thiswill help her master her level of competence and mastery ofaccomplishing activities.

SituationExposure Hierarchies

Situationexposure hierarchies refers to placing things where one wouldnormally avoid putting it down on the list. An example of this iswhen a client experiencing an eating disorder, stand a higher chanceof listing forbidden foods. Here, a client experiencing socialanxiety may place someone during a date at the far top of the list,while a woman she asks for directions at the bottom of the her list.The idea here is to enable one work through the list created from thetop to the bottom (American Psychological Association, 1992). The aimof the technique is to experiment with the list for several timesuntil the anxiety and depression one feels while in that situation ishalf of the initial time one attempted it. I would ask my client tocome up with a scale, which she will be able to list items, some ontop and others on the bottom. Every theme on the list should be inposition to reflect each of her problems.


Alex’sattempt to conceive for two years failed, and the couple is facedwith a challenge of whether to adopt two children or wait for a fewmore years. Alex’s husband, Frank, is impatient and he is ready toadopt and start a family, but his wife, Alex, is hesitant. She didnot feel it was a right thing to do. She even went ahead and consultsa fertility expert whereby she was given a recommendation to beginusing fertility drugs. After the procedure failed, they couple optedto go for in vitro fertilization. Fortunately, Alex conceived, butunfortunately, she experienced miscarriage later on in her pregnancy.

From the casestudy, there are spiritual challenges experienced. First, conceptionshould be natural, and it should not be induced. From the spiritualpoint of view, there is challenge that prohibits the idea of carryingout assisted reproduction instead of depending on natural conception.The challenges arise from strong religious legislation and spiritualopinions, which regards marriage and having children. In the case ofAlex and Frank in my opinion, the couple is facing serious spiritualchallenges. In real for example, in vitro fertilization has sincebeen publicly emphasize on the opposition, in that it replaces loveand affection between the couples. Masturbation is also opposed andis viewed to be illegal.

If the couple wouldbe interested in undergoing Christian Counselling to help them handletheir situation, I as the counsellor would have to alter mycounselling techniques to accommodate Christian treatment plan.First, I would try and bring out the truth from the scriptures of thebible into the counselling sessions in order to make sense of whatproblems they are going through. Secondly, I would employ emphaticlistening, practical strategies, and discernment of insights, and ofimportance, carefully applying the Word of God from the bible(American Psychological Association, 2007). Since there issue is thatof the inability to conceive and have their children, I would seekthe truth from within the context of Christian faith by giving anexample of Sarah in the Bible who was unable to conceive until oldage. In the counselling session, I would ensure that faith take thecenter stage.

Again, I would useassumptions, which will draw relevance from the scriptures during thecounselling session. For instance, I would make the couple be awarethat all the truth about their situation is the God’s truth.However, I would emphasize to them that the scriptures represent theonly fallible thing that is truthful in strengthening their practiceand faith. The couple should be aware that the scriptures are theonly foundational authority in what they are going through. Finally,the couple should be aware that their situation and the root of itall, is as a result of Adam’s sin. My goal as a counsellor will beto ensure that the Christian basis of this counselling session is tofree them of ignorance and ravages of sin. Through their intimateway, the power of the Holy Spirit would result in having whateverthey wish for.

Although it is notimposed, prayer, bible, and the church may be used during Christiancounselling sessions. Christian counselors are known draw upon theirresources and skills, which is often derived from their training,education, and experience, with careful avoidance of usinginterventions that are likely to contradict Christian concepts ofcounselling. Since the clients’ expressions and needs during acounselling session may be diverse, the bible is an integral part ofindicating their faith in solving their problems. Prayer is alsoused, especially before beginning every counselling session (AmericanPsychological Association, 2007). The prayer is used to highlight theclient’s problematic situation, while the church is a place wherecounselling may be done at the request of the client.

Apart from thethree prayer, church, and the Bible, there are otherreferrals/resources used during a Christian counselling. Thesereferrals are books, podcast, and video. First, books, for example,Collin’s Christian Counselling 3rd Edition, is usedsince it has everything need by a Christian counsellor (Jones &ampButman, 2011). The book is important for the counselor since some ofthe sections focuses on eating disorders, marriages, conception,children, and AIDS within marriage. The book is built on the biblicalfoundation and the best referrals from the bible.

With podcasts, aChristian counsellor is presented with another resource to use duringthe counselling sessions. Podcasts, for example, Ed Welch’sTheology Refresh podcast, is popular among the counsellors. Theclients are able to learn from a number of podcast topics of fear,anxiety, depression, and addictions (Jones &amp Butman, 2011).Videos are also resource materials used in Christian counselling.There are available videos used by counsellors in teaching theirclients on how to handle their situations by comparing with otherswho have gone through the same. The videos may show couples talkingwith their counsellors about their concerns, fears, and troubles, beit in their marriage or their inability to bear children. This way,the clients will be able to learn from others.

There are ways inwhich behavioral therapy is compatible with the Christian beliefs.The first compatibility with Christianity is through integration withbehavioral psychology. This is because there are thoughtful instanceswhereby both psychological and theological competences are able torecognize competence through integration and eclecticism, where itprovides explanation of how psychology becomes compatible withChristian beliefs through the Bible (Rasmussen, 2005). Christianpsychologists agree that psychological integration cannot involve anycompromise, especially that of a Christian world views. Thecompatibility is also evident through ultimate recognition of how theBible authorizes the willingness to learn God would allow humanbeings to identify it through psychological counselling.

The secondcompatibility with Christianity is through self-actualization ofChristian psychology. Compatibility is coined from a focus , whichinvolve helping a client clarify better constructive life goals,create proper social concerns for others, and a better understandingof the client’s style, which relates to Christian development(Rasmussen, 2005). Since the human beings through humanisticpsychology focus mostly on observable behavior, compatibility is seenby the manner in which Christians emphasizes on scientific methods ofassuming mental states of Christians.

The finalcompatibility with Christianity is through the aspect of eclecticismbased on a Christian conceptual approach, which aims at identifyingcompatibility between the two. Eclecticism builds flexibility,whereby Christianity builds a quasi-system based on a biblicalapproach with that of behaviorism. As much it does not apply to everytherapy, nor is it to every degree, it goes ahead to explain biblicalworld view. Again, it demonstrates clear Christian compatibilitythrough biblical techniques. According to Jones &amp Butman (2011),eclecticism is important since it provide a reflection on a broaderapproach within the Bible, which aims at improving development ofChristianity.

On the other hand,the first incompatibility with Christianity is a person’sbehaviorism. Strict behaviorism completely rejects any slight idea ofthe Supreme Being or God or the immaterial aspect of a person. Withbehaviorism, there is no eternal, ultimate, or infinite personal Godfrom whom we were created by. Behaviorism dictates that we, asindividuals, are not individuals, minds, are spiritual beings withbodies, but we are simply bodies with the bodies (Barron et al.,1992). The incompatibility is also emphasized by behaviorists whenthey claim that human beings are understandable, but only when basedon the empiricist perspective.

The secondincompatibility with Christianity stems from humanistic psychologies.This humanistic ethical system is based on a subjectively relativityrather than drawing it from the Supreme Being or God’s holy nature,which is often viewed to be human kind’s absolute standard ofconduct. Here, the incompatibility is rested upon self-centrism, butunfortunately not on the fact that every individual was created byGod (American Psychological Association, 1996). From suchpreoccupation of thoughts, this narcissistic feel reflects oncultural contexts. The context values life, but only to an extentwhere well-being and pleasure appears to an unavoidable setback,which is something that is easily avoided.

The finalincompatibility with Christianity is through deterministicnaturalism. Deterministic naturalism does not allow any justificationfor responsible biblical decision, absolute ethics, and responsibledecision making, which makes any sense to existence of God orspiritual nature of individuals (American Psychological Association,2007). The dynamic psychology in this case becomes prone toincompatibility with Christianity through dysfunctional therapists.Additionally, the client may experience subjective victimizationfeelings. Deterministic naturalism reflects an anti-Christian andbiasness to how behavioral therapy is incompatible to Christianity.


The theorythat was chosen is behavioral theory because of the fact that itentails behaviors, which result from conflicting situations duringdevelopmental stages of an individual or a couple. In Alex’s case,the situation lies in the inadequacy of not having one’s ownchildren. The inadequacy feeling from Alex’s case is that of theinability to bear children. The situation triggers a sense of fearand depression to a point where she chooses to have an in vitrofertilization.

While pursuingbehavioral therapy, the paper studied three interventions ortechniques, which included: Thought records, pleasant activityscheduling, and situation exposure hierarchies. These threetechniques are applied to help assist in changing beliefs, lesseningthe effect of depression in a patient, and reminding the patient ofher pleasant activities. Finally, positive outcomes of behavioraltheory come as a result of several studies conducted over time.Christian counselling was also examined, and apart from the bible,prayer, and church, the use of books, audio, and videos are also partof the Christian counselling. The Christian counsellor was describedto be a specially gifted collaborator, while the creator does thereconstructive work.


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American Psychological Association. (1996). Psychoanalyticperspectives on behavioral psychology. Washington,DC: American Psychological Association.

Barron, J. W. &amp Eagle, M. N., Eds. (1992). The Interface ofPsychoanalysis and Psychology. Washington, DC: AmericanPsychological Association.

Jones, S. L., &amp Butman, R. E. (2011). Modern psychotherapies:A comprehensive Christian approach. Downers Grove, Ill: IVPAcademic.

Rasmussen, P. R. (2005). Personality-guided cognitive-behavioraltherapy. Washington, D.C: American Psychological Association.