General situation: the helper, male, 43 years old, with high school education, is a company manager. He has been consulting for many years because of his uncontrollable long-term hand washing and excessive love for cleanliness.
The helper said: I feel that I have a "strange disease" and always feel that I am infected with germs and may get cancer. Therefore, it is very painful to wash hands and clothes for many times and for a long time every day. People also call me "wash my hands". I am very strict about my hygiene and cleanliness. People say that I am not like a senior manager of an enterprise, but more like a clerk in a deli. Yes, I can't tolerate the uncleanness of my office and home, just like I can't bring any bacteria into the operating room. Every day when I go to work, the first thing I do is to clean the office up and down, up and down ... more than three times, and then I can sit down and work with peace of mind. I have to clean it myself. It is not safe for aunt cleaner to clean for me. I always feel that others are not clean.
What I hate most is that subordinates come in to discuss or ask for instructions before they have finished cleaning for three times. I think it will be a waste of effort. I will clean it again three times. I'm going to sleep at night. I must not fall to the ground after washing my feet. What should I do? I usually sit on the bed and wash, dry after washing, and then get into bed and go to sleep quickly. If I have to go to the toilet in the middle of the night and my feet fall on the ground in slippers, then these feet must be washed again. What bothers me most is business trip. Even five-star hotels are dirty! Whenever I go on a business trip, I will check whether the toilet is clean first when I enter the hotel, regardless of other conditions. If the toilet is clean, don't care about anything else and wash your hands immediately. Before using the toilet, whether it is disinfected or not, I have to "process" several procedures by myself: first, I have to wipe the seat cushion ring twice with my own sterilized toilet paper, then wipe it twice with my own alcohol cotton ball, and then spread a layer of sterilized toilet paper along the seat cushion ring. This is not over. I was afraid that the water in the toilet would splash, so I had to float some toilet paper on the water to sit down safely.
I am always worried about the invasion of germs, and this worry is getting worse every day. When I saw people wearing mourning clothes and black veil in the distance on the road, I thought: someone in their family died, and there must be germs on them, and they have been passed on to me. I will go home soon. After returning home, I will not only wash my hands and wash my hair repeatedly, but also throw away my coat. Gradually, I am afraid to go out, listen to others talking about cancer or death, and go to the hospital because there are all kinds of germs in the hospital. My wife and daughter don't understand me, and they often quarrel about it, which makes family relations very tense. Over the past few years, I have been admitted to the mental hospital in this city twice for treatment. I have eaten Chinese and western medicines, but it has no effect.
The situation observed by psychological counselors is that the tutor of the helper is strict, and the helper is also strict with himself and is serious and responsible. Strong working ability, outstanding performance before illness. I can't go to work at present, my family relationship is also very tense, and my desire for help is very strong. The helper said that a close colleague died of cancer eight years ago, and he was very sad. This colleague took a nap in bed six months before his death, worried that he would get cancer, and immediately washed the bedding. I still don't trust in the future. I always feel that there is something carcinogenic on my body, and I have to wash my hands many times every day.
With the help of the psychological counselor, the helper finally overcame the cleanliness addiction and was able to return to work and have a good family relationship.
Please answer the following questions according to the above cases:
1. What is the initial diagnosis and diagnosis basis of this helper? (20 points)
Answer: (1) The client was initially diagnosed as psychological abnormality, neurosis and obsessive-compulsive neurosis.
(2) The basis of diagnosis is as follows:
According to the three principles of disease and non-disease, the subjectivity and objectivity of helpers are not unified, and their fear of germs is extraordinary. At the same time, the coordination and consistency of the helper's knowledge and emotion are also lost. Although he knew it was unnecessary, he couldn't stop his compulsion. Therefore, people who ask for help are psychologically abnormal.
② Help-seekers are self-aware of their own problems, take the initiative to seek medical treatment, and have no logical confusion, abnormal feelings, hallucinations, delusions and other mental illness symptoms. So rule out mental illness.
(3) Because of its strong initial reaction, lasting for many years, its content is generalized in an all-round way, and its mental pain can't be shaken off, which has seriously affected its social function and is generalized and evasive. According to Professor Xu Youxin's neurosis scoring standard, the patient had a long course of disease for many years, so he got 3 points. The degree of mental distress of the help-seeker is serious, and the score is 3. The social function of the help-seeker is seriously damaged, and the score is 3. The total score is 9, so the diagnosis of neurosis is established.
④ The main clinical symptom of help seekers is compulsive behavior (compulsive washing); Help-seekers said that obsessive-compulsive symptoms originated from their own hearts and were not imposed by others or external influences; The symptoms of obsessive-compulsive disorder appear repeatedly, and the help-seekers think it is meaningless, unhappy and even painful, so they try to resist, but it doesn't work. According to these symptoms, the diagnosis is obsessive-compulsive disorder.
2. What are the general characteristics of psychological counseling objects? (10)
A: The general characteristics of psychological counseling objects are as follows:
(1) has a certain intellectual foundation.
Generally, the intelligence of help seekers needs to be within the normal range, because they need to be able to describe their own problems and other related situations, understand the meaning of consultants, and have certain comprehension ability. Therefore, a certain level of intelligence is necessary, otherwise, consultation will be quite difficult.
(2) the content is appropriate
Not all psychological problems can be solved satisfactorily through psychological counseling. Some contents are suitable for psychological counseling, while others are not. Generally speaking, psychological problems, especially maladjustment, emotional adjustment, psychological education and development related to psychosocial factors, are more suitable for the field of psychological science. Patients with severe neurosis and mental illness seek help during the attack and symptoms. Because of poor contact with the outside world and lack of self-knowledge and self-control, it is difficult to establish interpersonal relationships. Therefore, they generally do not belong to the category of psychological counseling.
(3) basically sound personality
Help-seekers should have no serious personality disorder. Because personality disorder will not only hinder the establishment of counseling relationship, but also affect counseling, and personality problems are persistent and need in-depth psychotherapy to be effective.
(4) Reasonable motivation
The motivation of consultation directly affects the effect of consultation. Those who lack the motivation to seek help after repeated work by psychological counselors are generally not suitable for psychological counseling, because they have no motivation to change their state and it is difficult to achieve curative effect. The stronger the motivation for consultation, the easier it is for the two sides to achieve close cooperation and achieve results.
(5) Have communication skills.
People who can express their problems clearly and clearly, understand the words of psychological counselors smoothly and take actions accordingly are more suitable for psychological counseling.
(6) Have a certain degree of trust in consultation.
The more clients think that the consultation is effective, the consultant is excellent, and the theory and method are advanced and practical, the more likely it is to achieve good consultation results. On the other hand, if the client has always been skeptical about consultation and consultants, the consultation effect will be very poor.
3. What do you think is the main reason for the problem of help-seekers? (10)
A: The problem of the seekers is the result of the combined action of biological factors, social factors and psychological factors.
(1) biological factors
The helper is a male, 42 years old.
(2) sociological factors
Under the influence of negative life events, a colleague who died of cancer once took a nap in his own bed.
(2) Family education factors, the helper's family education is strict.
As the manager of the company, the helper is very busy.
④ Lack of help from social support system, due understanding and attention, and correct guidance.
(3) Psychological factors
There is an obvious misunderstanding: I am too afraid of bacteria, thinking that colleagues who died of cancer will take a nap in their own beds and infect themselves. Lack of corresponding medical knowledge.
② Pursuing perfection in personality and being too strict with oneself.
③ Pay too much attention to your compulsive behavior.
4. What should I pay attention to when implementing shock therapy? (10)
A: Impulsive therapy is a kind of behavioral therapy, which allows visitors to be in a realistic or imagined stimulating situation that causes strong anxiety for a period of time without taking any action to alleviate their fears, so that their fears can be alleviated by themselves. The following problems should be paid attention to when implementing shock therapy:
(1) Impulse therapy is a severe treatment, and patients should undergo detailed physical examination and necessary laboratory tests, such as electrocardiogram and electroencephalogram. The following situations must be excluded: serious cardiovascular diseases, such as hypertension, coronary heart disease, valvular heart disease, etc. ; Central nervous system diseases, such as brain tumors, epilepsy, cerebrovascular diseases, etc. ; Severe respiratory diseases such as bronchial asthma; Endocrine diseases, such as thyroid diseases; Old people, children, pregnant women and people who are weak for various reasons; All kinds of mental disorders.
(2) From an ethical point of view, it is necessary to let the parties have enough knowledge about impulse therapy and understand that this method of relieving anxiety will cause anxiety during the treatment. This law can only be passed if the person seeking help agrees and signs an agreement.
(3) During the implementation of pulse therapy, it is very common for clients to stop treatment because they can't stand it. A consultant will accomplish nothing if he is quick-witted. The purpose of pre-treatment agreement is to increase the self-discipline of customers to ensure the smooth progress of treatment. Nevertheless, if the client repeatedly requests to withdraw from the treatment, or the family members propose to cancel the treatment, the treatment should be stopped immediately after being persuaded by the psychological counselor to be ineffective. Consultants must not rely on the agreement and go their own way.
(4) Under any of the following circumstances, treatment should also be stopped and symptomatic treatment should be given. One is hyperventilation syndrome, the other is syncope or shock.
5. Briefly describe the similarities and differences of cognitive behavioral therapy and several representative theoretical viewpoints. (15)
A: Cognitive behavioral therapy is a short-term psychotherapy method to change bad cognition by changing thinking and behavior to eliminate bad emotions and behaviors.
(1) Similarity of Cognitive Behavioral Therapy
(1) Help-seekers and consultants are cooperative;
② It is believed that psychological pain is largely the result of cognitive process dysfunction;
③ Emphasis on changing cognition, leading to changes in mood and behavior;
④ It is usually a short-term and educational treatment for specific and structural target problems.
(2) The representative theoretical viewpoint of cognitive behavioral therapy.
( 1) Ahlport？ Ellis's rational emotional behavior therapy. Rational emotional therapy is a psychotherapy theory and method initiated by the famous American psychologist Ellis in 1950s, and it has also been translated into "rational emotional therapy" in many works. This method aims to change the irrational concept of the helper through pure rational analysis and logical speculation, thus helping him solve his emotional and behavioral problems. This theory emphasizes that the source of emotions is individual thoughts and concepts, and individuals can change their emotions by changing these factors.
(2) the cognitive therapy of Allen T. Baker and Remy. The basic premise of cognitive therapy of Baker and Remy is the same, that is, they both think that the root cause of uncomfortable behavior and emotion is the wrong cognitive process and concept. Baker's theory focuses on the wrong cognitive process and the wrong ideas produced in this process, while Remy's theory mainly emphasizes the existing state of these wrong ideas, that is, what kind of harmony these ideas are.
The order and manner of expression and function.
3 Donald? Mckenbaum's cognitive behavioral correction therapy. Donald? Meikenbaum's cognitive behavior correction technology focuses on the changes of self-verbal expression of help seekers. Meikenbaum believes that a person's self-statement can influence personal behavior to a great extent like other people's statements. A basic premise of CBM is that the helper must pay attention to how he thinks, feels and acts, and his influence on others, which is the premise of behavior change. To change, help-seekers need to break the stereotype of behavior and evaluate their behavior in different situations.
6. How to evaluate the long-term efficacy of psychological counseling? (10)
A: The methods for evaluating the long-term efficacy of psychological counseling are:
(1) Social Acceptance Assessment
① Evaluation content. When evaluating the degree of social acceptance, it mainly evaluates the behavior of the helper and its adaptability to the surrounding environment. The content includes communication with people, performance in study or work, getting along with family members, or the way and ability to deal with problems. According to these behaviors, we can comprehensively judge the adaptability of social life as one of the indicators of counseling effect.
② Evaluation method. First, observation of family members or people around them. Whether the long-term effect of consultation is satisfactory depends on the observation and comments of family members, spouses, relatives and friends, or teachers, leaders and other people around. Especially family members, they are very important judges. Second, the consultant's own audit. Its advantage is that the consultant is very clear about the target direction of consultation and can make a professional evaluation of the expectation of consultation.
(2) Self-acceptance evaluation
① Evaluation content. First, relieve or eliminate the symptoms and problems of self-report. This is the most basic consideration. It depends on whether the severity of the mental symptoms or problems complained by the help seekers has been alleviated or eliminated after receiving counseling. Second, the maturity of personality. Whether the whole person's personality becomes more stable and mature is another measure of self-acceptance.
② Evaluation method. First, the person who asks for help makes an oral report. Whether the consultation effect is good or not depends first on the subjective report of the person seeking help. Second, the scale evaluation. Whether there is significant difference in the evaluation results of clinical scale before and after consultation can be used as a more objective evaluation index of curative effect.
(3) Follow-up investigation
① Follow-up. After the consultation. According to the objective conditions and the wishes of both parties, they can be followed up for 3-6 months or even longer.
② Common return visits. The ways of follow-up include directly taking the helper as the investigation object and interviewing people who are familiar with the helper. The ways to pay a return visit to help seekers are: tracking card, communication, interview and telephone.
7. Please describe the common types of cognitive misinterpretation. (15)
A: Common types of cognitive misinterpretation include:
(1) Absolute thinking of black or white
Patients who insist on an unrealistic standard and think that they can't meet this standard are losers. This way of thinking leads to perfectionism and fear of any mistakes and shortcomings. For example, a teacher thinks that "it's all over now" and "I'm worthless" because he made a mistake in class.
(2) Arbitrary inference
Arbitrary inference refers to the lack of factual basis and hasty conclusion. "Where did I offend him? Is he angry with me? " Actually,
(3) selective generalization
For example, I saw a colleague pass by in a hurry in the street without saying hello, so I thought that this colleague had something on his mind and didn't notice him.
Selective generalization only draws conclusions about the whole event according to individual details, regardless of other circumstances. If a young man asks a female classmate to go to a concert, but is politely declined, he thinks that he is hated by the female classmate and there will be no more young women to associate with him. This is a kind of "generalizing the whole with the partial".
(4) excessive extension
Excessive extension refers to drawing a conclusion about the whole life value on the basis of a small mistake. If mother accidentally breaks the bowl,
I don't think I'm a good mother.
(5) Excessive exaggeration and excessive reduction.
Over-exaggeration and over-reduction refer to exaggerating the importance of one's mistakes and defects and belittling one's achievements or advantages. Occasionally, a mistake, such as shaking hands when taking a photo or a broken photo, will make me feel terrible, and others will regard her as useless. Of course, this is also an excessive extension. And when you do something, you feel insignificant, which is purely a fluke.
(6) Personalization
Individualization means that patients take the initiative to take responsibility for the faults or misfortunes of others. All misfortunes, accidents or other people's diseases are attributed to their own mistakes and blamed on themselves. If a friend dies of illness, the patient blames himself for being busy with personal affairs and not taking care of his friend's health, so he feels guilty.
(7) Selective passive gaze
Selective negative gaze refers to choosing a negative detail, always remembering this detail and ignoring other aspects, so that the whole situation is stained with negative colors. For example, a student answered several questions wrong in the exam, so she was obsessed with these questions, and even thought that the school might let her drop out of school. In fact, she did well in the exam. It is precisely because of this negative information selection tendency that patients only filter negative information under certain circumstances, causing unnecessary trouble.
(8) Emotional reasoning
Think that your negative emotions must reflect the real situation, such as: "I feel like a failure, so I am a failure." "I feel very disappointed, so my problem can't be solved." "I feel guilty, which means I must have done something bad." This kind of emotional reasoning of "following feelings" hinders the understanding of the real situation of things and makes people fall into cognitive misinterpretation and cannot extricate themselves.
(9) "Should be tilted"
"Should be inclined" means that patients often use words such as "should" or "must" to demand themselves and others, such as "I should do this" and "I must do that", which means sticking to a standard for themselves. If the behavior does not reach this standard, they will blame themselves with words like "shouldn't" and feel guilty and regret. If what others do doesn't meet their expectations, they will feel disappointed or resentful and think that "he shouldn't do that."
(10) Labeling indiscriminately
This is also a form of generalizing, thinking that you can label your own problems at will. For example, "I am a born loser." "I am so greedy, so ugly, so hateful, just like a pig." In fact, this is to confuse the evaluation of the whole person with some behavioral mistakes of others. "People are not equal to people's mistakes."
The cognitive misinterpretation of the above 10 type is more common, in addition, some can be listed. It should be pointed out that several types of cognitive misinterpretation may occur in the same patient. By analyzing the relationship between objective facts and negative automatic thinking, logical errors can often be revealed.
8. What kind of psychological test should I choose to check this case? Please explain the reasons. (10)
A: The psychological tests that this helper can choose and their reasons are as follows:
(1) MMPI test can be used to understand the pathological personality characteristics of clients, and can also be used as a basis for distinguishing mental diseases.
(2) EPQ test can be used to understand the personality characteristics of help-seekers.
(3) You can choose SCL-90 test to know the physical self-evaluation and degree of help seekers.
(4) SAS test can be used to understand the anxiety level of help seekers.
(5) SDS test can be used to understand the degree and mood of depression.
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