Whether in school or in society, everyone has been exposed to papers, which can promote experience and exchange understanding. What kind of paper can be called an excellent paper? The following is a case paper on serious psychological problems that I have carefully arranged for reference only, hoping to help everyone.

A case of using cognitive behavioral therapy to solve serious psychological problems, using various technical methods in consultation, discusses the causes of the formation and development of psychological and behavioral problems of visitors, makes them realize their unreasonable cognition, and then shapes new behavior patterns with reasonable beliefs. At the same time, help clients consolidate the effect of consultation and encourage them to apply the self-regulation obtained in treatment to real life. In the final stage, the anxiety and compulsion of the help seekers have been greatly improved, and their interpersonal skills, social adaptability and psychological endurance have been further improved, and their personality has been further improved.

Keywords: serious psychological problems; Psychological counseling; Cognitive behavioral therapy; college student

I. General information

1. Population data

Zhang, female, 20 years old, Han nationality, a junior majoring in accounting in the Department of Economic Management, has no religious belief.

2. Personal growth history

The helper is introverted and doesn't like to talk. There are three sisters at home, and one sister gave it to someone else. She is the first child in the family and her mother is in good health. Did not take any special drugs during pregnancy, childbirth and lactation, and gave birth at term. I went to primary school at the age of 6, and got excellent grades in primary school, which was well received by teachers and classmates. Since the second day of junior high school, my grades have dropped sharply. I went to boarding school in high school, but my grades in high school were average. After the college entrance examination, my grades were not satisfactory. I wanted to repeat my studies, but my parents wouldn't let me. Then I went to Xingtai Vocational and Technical College to study. Living with my parents, my father has a bachelor's degree, my mother has a high school degree and my father is a sailor. He was busy at work, working for several months, and didn't discipline his children. My mother is a primary school teacher. She is very strict with her children and her family's economic conditions are average. After investigation and inquiry, parents have no personality disorder or other neurotic disorder, and the family has no history of mental illness.

When my mother gave birth to her, my father was in college and life was difficult. Mom often hits her easily. According to the helper, the neighbors even suspected that she was not her mother's own. When she was in primary school, her parents had a good relationship, and she felt that her family was very warm. In the second grade, she happened to find that her father was having an affair with her neighbor's aunt, and then she didn't tell anyone. After a while, my mother also had an affair, and my parents knew about it, but they still lived together and did not divorce. Help-seekers don't have friends of the opposite sex and think that friends of the opposite sex are unreliable.

The mental and behavioral state of the first visit: the visitor's face is handsome, his clothes are clean and tidy, his hair is rarely messy, his head bowed and his chest held out, and his spirit is sluggish; The voice is slightly lower than that of ordinary people, and he is good at speaking, speaking logically and in good mental state.

3. Mental state

Conscious, slightly poor attention, good memory, normal thinking and clear speech.

4. State of matter

Good health.

5. Formal social gatherings

Interpersonal tension, no contact with friends of the opposite sex. Learning is easy to get distracted.

6. Psychological test results

(1) SCL-90 showed that the scores of somatization, compulsion, depression, anxiety and interpersonal sensitivity were higher than the norm, among which anxiety factor was obviously higher, followed by compulsion factor.

(2) Self-rating Depression Scale (SAS) test showed moderate depression.

(3) The results of self-rating anxiety scale (SDS) showed that there was serious anxiety.

Second, the chief complaint and personal statement

1. Helper's main account

I have been preparing for the college entrance examination, and I can't see the book when I review. When I read a book, I read word by word, so I can't read normally like others. I mainly want to reduce the pressure of exams and turn to psychological counseling.

2. Personal statement of the helper

"In another month, I will be promoted to junior college. I really hope that I can be admitted to an undergraduate college. But when reading a book, I can't stand it. Let yourself calm down and read. It takes an hour to read a page, and it is still read word for word. My family has high expectations of me. I can't go on studying, but I force myself to study hard. I have a headache. Besides, I'm afraid others will overtake me. I am listless all day, can't do anything, can't sleep all night, my mind is in a fog, I don't trust my review, my class is not effective, and my thinking is incoherent, which greatly affects my study. Everyone else in the dormitory is looking for a job, and some of them are not bad. I also received an interview invitation from a good company. After hearing the news, I was more nervous and hesitant. I'm worried that I won't be promoted to the undergraduate course, I'll lose my existing job opportunities, and I doubt my ability. I'm afraid I can't learn well, I'm afraid I'll be laughed at by others, and I'm afraid I have no job. Although I tried many times to divert my attention, I couldn't do anything. It's getting heavier and heavier recently, and my heart is very painful. Sometimes I feel chest tightness, shortness of breath, palpitation, and even my hands will tremble involuntarily. "

Thirdly, what the consultant observed.

Help-seekers take the initiative to come to consult, behave appropriately, dress neatly, speak softly, voluntarily reveal the pressure they have encountered in their six-month study, and show obvious motivation to change. At the same time, I am not shy about talking about some of my anxious behaviors. Peace of mind is easy to win the favor of consultants. Zhang wants to change his anxiety about learning, calm down and study, and enhance his ability to cope with learning pressure. Through several consultations, the counselor has a deeper understanding of Zhang's situation and found that Zhang's anxiety is not as simple as the anxiety about academic pressure on the surface. This anxiety has deep roots, and some physical behaviors are responses to this anxiety.

Four. Evaluation and diagnosis

1. Assessment: Serious psychological problems

Evaluation basis: it is triggered by strong realistic stimulation to individuals; Time course is more than two months; Strong reaction, the pain can not be solved by itself; The content is generalized, and the help seekers have similar emotional reactions in other aspects; The damage of social function is obvious; Hospital examination ruled out organic lesions.

2. Differential diagnosis

(1) Differentiation from mental illness: According to Guo Nianfeng's three principles of illness and non-illness, the clients' knowledge, attitude and behavior are consistent, they are self-aware of their own psychological problems, take the initiative to seek medical treatment, have no logical thinking confusion, and have no symptoms of mental illness such as abnormal feelings, hallucinations and delusions, so mental illness can be ruled out.

(2) Differentiation from neurosis: The psychological conflict of the help-seekers is normal, with obvious moral color, and the course of disease is only over two months, so neurosis is not considered for the time being.

(3) Differentiate from general psychological problems: In this case, the life events that induced psychological and behavioral problems were highly stimulating, with a long course of disease, and the social function was obviously damaged for more than two months, so general psychological problems were excluded.

Cause analysis of verb (abbreviation of verb)

1. Biological reasons

Help-seeker Zhang, 20 years old, female in early adulthood, has no organic pathological basis, no history of central nervous system diseases and no genetic history of familial psychosis.

2. Social reasons

My parents always wanted to have a boy, but they gave birth to four girls. She is the oldest child in the family. In primary school, families were more harmonious. Her grades are excellent, and her parents are proud of her. Achievement has become an important way for her to recognize herself. Both parents are having an affair, the father doesn't care much about the children, and the mother is too strict with the children. After she found out that her parents were having an affair, she developed symptoms of anxiety and compulsion, and her study declined extremely.

3. Psychological reasons

Zhang has a strong personality and self-esteem since childhood. She thinks that parents prefer boys to girls, and as a boss, she wants to prove that women are not worse than men, so she is very strong and has achieved very good results since she was a child. Especially when a younger sister was sent out, she felt that it was her own fault and that she was unable to protect her sister. After the parents had an affair, the family situation appeared and the academic performance plummeted.

Sixth, the formulation of consulting objectives.

Through consultation between both parties, the negotiation objectives are determined as follows:

1. Targets

Have a concrete analysis of the real family and adopt a correct attitude to realize that the family will not be discordant because of her Excellence. Even if she is admitted to the undergraduate course, there is still no way to change the family structure and correct her wrong cognition. Sexual behavior that reduces anxiety.

2. The ultimate goal

Promote the mental health and development of visitors, make them form correct self-cognition, enhance their self-confidence and social adaptability, and finally achieve the goal of perfecting their personality.

Seven. Formulation of consulting scheme

1. Main consultation methods

Cognitive behavioral therapy was used in this case.

2. Principles and techniques of use

Cognitive behavioral therapy: the external manifestation of psychological problems of help seekers is that they are afraid of exams and that they will not be admitted to undergraduate courses. The internal reason is to link family relationship with one's own performance. I think only if I behave well, my parents will be harmonious, my family will be harmonious, and my incompetence will lead to the breakdown of my family. I also know that I'm not cut out for undergraduate study, and I'm very anxious and have a headache in my study, and I also have compulsive behaviors such as washing and bathing repeatedly.

3. Responsibilities, rights and obligations of both parties

Responsibilities, rights and obligations of customers in the consultation process:

(1) Help-seekers should truthfully provide real information related to psychological problems to psychological counselors.

(2) In psychological counseling, the parties are free to quit or change counselors.

(3) Have the right to know, negotiate and choose the consultation fee and consultation time.

(4) Comply with other relevant provisions of the consulting framework.

Responsibilities, rights and obligations of consultants in the consultation process:

(1) Abide by the relevant regulations of consulting institutions, professional ethics and national laws.

(2) Strictly abide by the principle of confidentiality and explain the confidentiality exceptions.

(3) Understand the personal data related to the psychological problems of the parties.

(4) Introduce yourself to the helper.

(5) Any relationship other than consultation can be created and established between psychological counselors and visitors. Try not to establish consulting relations with acquaintances, relatives, friends and colleagues, and never use the trust of the parties to seek personal gain.

4. Consultation time

Once a week, each time 1 hour.

Eight. Negotiation process

1. Consultation stage

First and second consultations

Objective: To collect basic data; Through conversation and observation, we can understand the main symptoms, development process and reasons of the problem of help-seekers, and establish a good consulting relationship through respect, enthusiasm, affection, sincerity, positive attention and neutrality.

Second and third consultations

Objective: To help customers analyze their current situation; A deeper understanding of the causes of anxiety symptoms and anxiety behaviors of help seekers.

Methods: (1) Interview was used. By asking open questions, listening, feeling, etc. Discuss the relationship between family structure and anxiety behavior with the help seeker, so that she can realize the irrationality of her cognition. Excellence in study has nothing to do with family. No matter how she behaves, her family will not change. (2) Zhang talked a lot about himself and his family, which made the counselor realize the complexity of Zhang's family structure.

Homework: Think carefully about the counselor's talk and write your experience.

Third and fourth consultations

Objective: To change the cognition and misconception of the help-seekers and turn them into correct cognitive styles.

Methods: By asking questions and reflecting, let Zhang pay attention to those specific problems and observed facts, and guide him to experience and reflect on his own cognitive concepts appropriately. The counselor told Zhang with certainty that no matter how hard he tried, the relationship between his parents was cold in the end. Then analyze the relationship between wrong cognitive concept and anxiety behavior with Zhang; Assign homework.

Fifth consultation

Objective: To adhere to the effect of consultation and make corresponding adjustments according to some conditions.

Methods: Talk with Zhang to find out her inner experience in recent weeks. Check the operation and evaluate the effect; Through talking, I found that Zhang has changed a little, but it is still not very big, and it is still difficult to control himself. Praise Zhang's efforts in recent weeks and hope that she will continue to maintain and consolidate.

Homework: (1) Continue rubber band therapy. (2) Encourage her to chat with the same classmate every day, even if it's just to say hello, so as to enhance her interpersonal skills. (3) Try to express your views on the family with your parents and see their reactions. (4) Continue to praise yourself every day.

Sixth consultation

Objective: To understand the performance of help seekers in recent weeks and test the effect of counseling.

Methods: Through talking with Zhang, it was found that Zhang had made progress in anxiety behavior. She described that she accidentally discovered the friendliness of her classmates in the process of forcing herself to talk to them. The communication with her parents also made her feel that she should try to think from her parents' point of view and think that parents also have their own reasons.

Seventh to ninth consultations

Continue the development stage, discuss homework with Zhang and guide Zhang to form a correct cognitive concept.

Homework: write down the feelings of these days; Start greeting strangers; Continue to praise yourself; She recalled her previous successful experiences, which prompted her to experience more and deeper happiness.

2. Consolidation and termination phase

(1) Through talking, I learned that Zhang has changed a lot. He thinks that studying hard will not change his family much, and he hopes to see himself as an adult.

Family.

(2) Feedback from others: The mood is obviously improved, and I am willing to communicate with you, and a smile reappears on my face. I pay more attention in class than before, and my face and complexion are obviously better.

(3) Counselor's evaluation: Anxiety and depression have been relieved, mood is basically stable, attention stability has been improved, mental fatigue has been reduced, and people are full of confidence in continuing their studies.

(4) Psychological test: SAS: standard score 47; SDS: standard score 50; SCL-90: total score 146, anxiety 1.8.

Nine. abstract

The anxiety of help-seekers is due to the wrong idea in cognition: as long as you study hard, the relationship between parents will get better. This misunderstanding leads to depression and poor interpersonal relationship. The case was diagnosed as a serious psychological problem. Cognitive behavioral therapy, supplemented by homework, greatly improves the anxiety and obsessive-compulsive mood of help seekers, further improves their interpersonal skills, social adaptability and psychological endurance, and further improves their personality. Although the consultation has achieved certain results, due to the possibility of anxiety recurrence, it is necessary to continue follow-up.

References:

[1] China Employment Training Guidance Center, sponsored by China Mental Health Association. Psychological counselor (level 2) [c]. Version 1. Ethnic Publishing House, 2005-08.

[2] China Employment Training Guidance Center, sponsored by China Mental Health Association. Psychological counselor (level 3) [c]. Version 1. Ethnic Publishing House, 2005-08.

[3] Zheng Xiaobian. Psychopathy and health. Version 1. Anhui people's publishing house, 200 1-06.

[4] money. Psychological counseling and psychotherapy. Peking University Publishing House, 1992.

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