Shannon Johnson Intro to Counseling - Howard 05/09/13 Case Conceptualization Assignment Cognitive Behavioral Therapy (CBT) is a therapy often

used for those with irrational thoughts and behaviors. Out of all psychotherapies, CBT is one of the only therapies that is supported through research to be effective. One of the reasons CBT is so effective is because it has standardized intakes and treatment protocols. CBT's main goals are to identify the irrational thoughts proposed by the client, question the legitimacy of the thought, and work on extinguishing negative thoughts that are preventing the client from leading a fulfilling life. The idea is that once the irrational thought is gone, the cognitive training will allow the client to behave in a healthier, more productive manner. CBT is effective for clients with anxiety and depression, personality disorders, PTSD, severe depression, and phobias. In the show, "It's Always Sunny in Philadelphia" one of the main characters is Dennis Reynolds. Dennis Reynolds plays the brother to Deandra Reynolds and is a key member to the "gang" that owns the bar where most of the scenes take place. Although Dennis presents himself to be very confident and aware of his surroundings, his inner self is constantly ruminating about things he is unhappy about. Dennis' presenting concerns are: his inability to create lasting relationships, his inability to relate to others, a tendency to drive people away, and lack of overall achievement in comparison with his aspirations. Due to these concerns, Dennis has been stuck in limbo the last 8 years of his life, achieving little in comparison to what he did back in his "glory days" in high school and undergraduate. Dennis used to get all the pretty girls back in high school and college and feels he still has the capacity to get decent looking girls these days, but he is unable to find a girl that matches up to his standards. Dennis has comprised the D.E.N.N.I.S. system for the girls he dates: D- Demonstrate Value E- Engage Physically

N- Nurture Dependence N - Neglect Emotionally I - Inspire Hope S - Separate Entirely Dennis claims this system works for seducing any girl, and he is proud of the work he has been able to produce thus far. Dennis still hasn't found the right girl yet and doesn't know if he needs to. Dennis has admitted to keeping a stash full of sex tapes of girls he's filmed, unknowingly, while they were engaging in sexual matters. He has also admitted to showing these tapes to multiple friends of his, all of which seem to underappreciate his art. Dennis' parents are divorced; His mother recently passed away from a plastic surgery gone awry, and his father has been single for awhile now staking "any meat that may come his way". Dennis, on the exterior, seems extremely confident and recounts experiences in a way that makes him the star of each event. This is the extent of the background I have on Dennis at the moment. At this time, I think it is safe to say that Dennis has Narcissistic Personality Disorder. This is evidenced by his delusions of grandeur, his lack of empathy, and failure to sustain relationships. From the CBT perspective, Dennis has a laundry list of irrational thoughts that are interfering with his ability to lead a healthy and successful life. Dennis' thoughts are a direct contributor to his inability to behavior properly towards women, develop healthy long-standing friendships, and move on with his life in a manner that he always imagined. If I were Dennis' therapist, I would first work on getting a thorough background summary. It would be beneficial to have a set list of thoughts that Dennis currently possesses that are not actually supported in fact. Some including: The D.E.N.N.I.S. System, the thought that it's okay to film women in vulnerable positions when they least suspect it, the thought that he is admired and adored by everyone, and the thought that he needs to give up on previous dreams and aspirations due to lack of achievement. Once I got a thorough set of irrational thoughts, I could confront Dennis in separate sessions, focusing on one major irrational thought at the time, asking him how this thought works for him in reality.

Is it beneficial to think of women as transient creatures that he can neglect and separate from at the drop of a hat, when really he yearns to be with a woman that is compatible with him? Is it beneficial to work in a bar that he's actually losing money on and his dad has to help out (and eventually ends up 100% owning) when he could be finishing up his education and going for dreams that he always had? Is it beneficial to humiliate friends and constantly be thinking of ways to undercut them when he struggles with forming long-term friendships? Once I could get Dennis to realize some of the things he's doing to sabotage his own goals, I could start helping him brainstorm ways of behaving alternatively. Maybe instead of engaging in the D.E.N.N.I.S. system every time he meets a woman, he could come up with a new, more respectful acronym that would allow him to get to know the girl on a less shallow basis. It could be beneficial to ask him what he looks for in a friend and then focus on ways he can offer those same qualities to the type of friends he's searching for. In summary, I would try to find common ground with Dennis and get him to see how he's sabotaging his own life; Then, I would suggest behaviors to replace the maladaptive ones. I would have to realize that Dennis has a very thin skin and is also very intelligent, so there would need to be creative ways of demonstrating to him that these thoughts are maladaptive. Perhaps, I could have Dennis run experiments in his own lifejournaling the outcomes of treating women with respect vs treating him the way he has and see if it has any personal effect on the way he feels about himself. Of course, I would have to phrase it as "This week, let's try the S.H.A.N. system: Shared Thoughts, Hugs, Autonomy, and Nurturing." I feel the journaling aspect of these experiments would be crucial, as it would give Dennis a way of recording the feelings he experienced right after these "social experiments" instead of giving him time to reflect overnight and undermine the experience. In addition to journals, I would have friends and family of Dennis come in and reflect on Dennis' behavior. Although Dennis mentions an inability to form long lasting relationships, he and his sister have managed to hold on to a couple of high school friends that are indicative of some mental illness as well; But, it couldn't hurt to get second opinions from both Dennis' family and friends. Both of the suggestions would get Dennis out of his cyclic loop of irrational thinking and force him to see things outside of his own

methodologies. Lastly, I would try to figure out if there are any self-esteem issues that may serve as underlying causes feeding into this personality disorder. Low selfesteem is commonly associated with Narcissistic personality disorder, despite the presentation of the person. The "cocky" aspect of narcissism can often be developed as a defense mechanism for very low self-esteem. By getting these issues out in the open, Dennis can become aware of his subconscious and realize how it is affecting him. Some benefits of using CBT with Dennis would include the structured aspect of it and the relatively shorter span of its treatment time. Dennis is still a young guy, and it may be beneficial for him to participate in a treatment that he can see working as the sessions progress. Also, the faster he can see the results, the more likely he is to stick with the treatment. Some drawbacks may include the shorter span of the treatment time and the decreased attention to areas that may be influencing the problem, but may not be the problem itself: Maybe Dennis' poor upbringing bears a significant effect on the way he has learned to carry himself: CBT may not reach far enough to compromise that fact. Besides using CBT as a treatment, I could see DBT (Dialectical Behavioral Therapy) being an effective alternative to CBT despite being commonly associated with the treatment of Borderline Personality Disorder. The confrontational therapist, group setting, and set of mindfulness skills may be just what Dennis needs to realize and change his maladaptive thoughts and behaviors.