[A cognitive-behavioural therapy case study]
Mark Anderson was an average guy, working a normal factory job, with a typical family. With no formal education beyond high school, Mark took the first good job he found after his discharge from the military when he was 22. He had been working at the same factory for 16 years when he started to develop chronic arthritis from the constant machine work with his hands. This caused Mark major joint pain and discomfort, so he went to his doctor to find a solution. All the treatments that Mark’s doctor prescribed him were unsuccessful in getting rid of, or even minimizing, the joint pain. A colleague of Mark’s suggested he try marijuana as a treatment. Mark had experimented with marijuana in high school intermittently but never really came into contact with it after he joined the armed forces, especially not in a treatment manner.
After more failed treatments, Mark decided to give marijuana a shot, even though it was not medically prescribed. Mark sought his co-worker who gave him the advice, and asked if he could help Mark get a hold of some marijuana, which he did. Mark garnered some more information to help him with his new medicine and was ready to use that night.
The results were outstanding for Mark as his joint pain was reduced in half and full movement of his hands and fingers were restored. Mark immediately gave way to the benefits, ignoring any possible consequences. In his mind, the negative aspects were a small price to pay for the pain relief achieved. After around 6 months of use, Mark started to wonder if there were more powerful drugs that could eliminate 100% of the pain. He again went to his colleague who replied that marijuana was just the tip of the iceberg and that there were plenty of drugs to help Mark.
Mark tried many drugs such as cocaine, opium, and morphine, but ultimately ended up addicted to heroin. It was cheaper than cocaine and easier to acquire than morphine, and gave Mark pain relief he never thought possible. In fact, the drug not only helped with physical pain, but emotional pain as well.
What started off as a solution, the drug use quickly became the problem. His marriage was starting to fall apart and Mark knew nothing more than to resort to his only way of relieving pain, drugs. This furthered the problem and ultimately made the addiction cyclical; the more pain Mark felt, the more and harsher drugs he would use, which furthered the problem, inducing more pain for Mark. When Mark started missing work shifts and not coming home at night, things really started to unravel. Mark lost his job and his wife filed for divorce, leaving Mark very alone. He, once again, turned to drugs.
Without a source of income, Mark started committing petty crimes to sustain his expensive addiction, specifically trafficking heroin. Furthermore, he turned to prostitutes to fill the emotional void left by his wife. When prostitution services became too expensive for Mark’s budget, he turned to crime again; but this time, it was not to acquire funds to pay for his vice but to simply force women into sexual acts with him.
Mark’s tirade of criminality came to an end when one of the women he sexually assaulted identified him. Mark plead guilty to a summary conviction regarding Section 271 of the Criminal Code and was sentenced to 6 months in prison. As a first time offender, Mark was able to plea bargain and avoid the indictable level of punishment, receiving a summary conviction and sentenced to serve his 6 months in a medium-security prison.
It was negotiated that Mark would only have to serve 3 months if he enrolled in a sexual abuse prevention program as well as Narcotics Anonymous. These programs were implemented into Mark’s conditional release as well.
While on release after serving his 3 months, Mark’s parole officer suggested he try psychotherapy, and although it was not mandatory, Mark agreed. Mark knew he needed to change his ways but was still very much attached to the drugs as it was his only form of release. Working with his parole officer, Mark decided that cognitive-behavioural therapy would be most effective as it has successfully been applied to drug and sex offences respectively. Furthermore, it can be in individual or group therapy settings and is very adaptive overall to different people with different circumstances.
Cognitive-behavioural theory essentially emphasizes the importance of individual cognition in creating behaviour. It is grounded in the proposition that behaviour is modifiable through the systematic use of empirically supported learning principles (Smith, 1990). Research has shown that cognition is a crucial factor in forming behaviour with regards to things such as beliefs, problem solving, expectancies and others (Kendall & Braswell, 1985). These cognitive factors can go either way as they play a role in both functional and dysfunctional behaviour.
Freeman (1983) argues that the level of behavioural functionality is directly related to one’s distortion on reality. An individual may have very little distortion on reality and thus behave in a normal societal fashion, whereas a person with major distortion likely has very little connection to society or the social contract.
Distortions can manifest themselves in many different ways depending on the individual; however, this paper will look at the some of the most common distortions and possible solutions, as identified by Alexander (2000). The first is all or nothing thinking which means the individual is grading themselves on a pass or fail basis; there is no middle ground. The individual will either succeed based on their standards, or fail completely. The individual must realize that life is not polar in such fashion, and thus it is illogical for someone to think like that. The counsellor must convince the client that he or she can fall short of a goal and still be successful.