The document outlines a case study on a perinatal mental health client, Tina, who was referred for treatment due to depression and anxiety related to past experiences. It describes her entry criteria, assessment process, cognitive behavioral therapy (CBT) approach, goal setting, and planned interventions aimed at addressing her fears and improving her self-care. The document emphasizes the importance of understanding client's core beliefs and the implementation of gradual exposure to enhance coping strategies and achieve long-term therapeutic goals.

1. PERINATAL MENTAL HEALTH
SERVICE
Jess Bacchus: Frames of Reference

2. CLIENT GROUP
Entry Criteria
Referral Process
Number of Clients
Multi Disciplinary Team (MDT)

3. CASE STUDY: TINA
DOB 01/06/1982 – 31YRS Data
collection
Referred 29/05/2013 by Thames Community Health . Early in pregnancy, tearful, low mood and diagnosis of
depression.
Initial Assessment, Mental State Examination, Mood rating, Informal interview
CBT information: Early experiences, relationships, possible triggers identifying thoughts,, bodily sensations,
behaviours
CBT specific information:
Early experiences/ relationships Core beliefs Assumptions/rules for living Triggers
Cognitions – Emotions – Physical experience – Behaviours – Cognitions. Consider how the environment
influences this.
Client
Strengths and
Concerns
• Protective factor: Children, pets, mother, sister, friend. Willingness to engage, readiness to learn,
motivation & self awareness
• Concerns: ex boyfriend, Mother, low self-esteem, strict cleaning routine, lack of self-care & leisure tasks.
Decreased productive occupations
Problem
Identification
Unable to go grocery shopping due to fear of seeing someone she knows and consequently feeling trapped
CBT informs: This became a problem due to her ex boyfriend’s beliefs – paranoia of affairs, mentally abusive,
manipulative.

4. CASE STUDY CONTINUED
Goal setting Short term: In 2 weeks Tina will enter the post office by use deep breathing and positive self talk to complete and
accomplish the task of sending a parcel.
CBT: In two weeks Tina will be able to identify 2 negative thoughts and argue for and against them to develop
personal awareness of unhelpful thinking
Long term: In 6 months Tina will be able to enter the local countdown and buy 3 items by using 3 anxiety
management strategies in order to challenge her fear of feeling trapped
A plan is set for a short term goal every visit (fortnightly)
Intervention
Plan
• Education on CBT, Anxiety, depression and strategies on how to cope with the physical ailments.
• Homework on challenging negative self talk (integration of CBT strategies)
• Graded exposure (Post office – Fruit shop – café - local countdown)
Planned
Outcome
• Tina will be discharged from occupational therapy after meeting her short term goals and long term goal.
OR if she decides she no longer wants OT input or other matters arising that put OT intervention aside
• Tina to be able to identify unhelpful thoughts and challenge them (2 weeks)
Evaluation Has Tina met her goals? Why or why not have her goals been met? Do we need to collect more information?
Have more issues been identified? Why or why not has the intervention not worked? If she has met her goals we
can discharge her from occupational therapy.

5. FRAME OF REFERENCE:
COGNITIVE BEHAVIOURAL MODEL (CBT)
Cognitive
• Based on how an individual interprets and assigns meaning to their experiences.
• How we interpret the world around us is variable depending on a person’s past experiences, learnings and
beliefs.
• These become our core beliefs (rigid & difficult to change).
Behavioural
• Behavioural activation strategies together with cognitive therapy help change underlying maladaptive core
beliefs.

6. COGNITIVE BEHAVIOURAL MODEL CONTINUED
1. Thinking influences behaviour
2. Thinking can be self-regulated
3. Desired behavioural change may occur through structured learning & acquired skills
Problem focused approach. Treatment is typically brief and succinct. Results in significant clinical improvement
Thoughts
Automatic thoughts and what
you are thinking
Bodily Sensation
Our emotions affect how our
body responds and reacts
e.g. sweating, shaking, tremor
Emotion
What we think affects how we
feel
e.g. anxious/nervous/angry/sad
Behaviour
Our thoughts, emotion and
body response affects how we
behave
e.g. avoidance, screaming,
fight/flight
EVENT

7. SPECIFIC SKILLS TO THIS SETTING
Characteristics
Patience
Empathy
Communication skills
Confidence
Open-minded
Continuous learning
Personal coping strategies
Professional abilities
Acceptance of professional team diversity
Various assessments e.g. MSE
Concise & accurate note- taking
Understanding Life Stage
CBT, ACT, Recovery Model, Mindfulness, Advance
Directives, Birth plan, Recovery plan
Knowledge of mental health disorders
 Therapeutic Use of Self

8. REFLECTION OF LEARNINGS
What did I learn about CBT?
What did I reflect that would be helpful when doing CBT with a client?
What are my strengths and weaknesses in relation to CBT and a mental health setting?
A reflection of an event: Tina

9. GIBBS MODEL OF REFLECTION

10. LEARNING GOAL
Research
Experience
Practice
Develop
By 3rd week of a mental health placement I will research and identify 3 skills that
help identify core beliefs from a client in order to prepare me for a one on one CBT
session with a client.