Integrating Cognitive-Behavioral and Cognitive-Interpersonal Case Formulations: A Case Study of a Chinese American Male

Abstract

This case study presents "TC," a mid-20s Chinese American male with Major Depressive Disorder and Generalized Anxiety Disorder, whom I saw in therapy for 41 sessions. Case formulation and treatment were based on an integration of three approaches: Beck and his group's Cognitive Therapy; Persons and Tompkins' Cognitive-Behavioral Case Formulation model; and Safran and Segal's model of Cognitive-Interpersonal Cycle. Specific interventions such as "cognitive restructuring" and "metacommunication" were implemented. The case is notable for its emphasis on the value of examining and constructively using a cognitive therapist's personal reactions to a client's dramatically negative interpersonal behaviors, and on the importance of using the here-and-now in the exploration and modification of the client's cognitions and behaviors. Further, it suggests the possibility of a culture-specific challenge in doing cognitive-behavioral therapy (CBT) with clients of Chinese origin. Specifically, the case shows how certain thoughts that were drawn from cultural values of achievement and humility (e.g., "Keep telling yourself that you are not good enough," and "Don't ever be satisfied with your accomplishments") may have contributed to this client's depression and anxiety, while at the same time these thoughts also seemed to motivate this self-disciplined individual to become a more successful person. Specific clinical implications are discussed.