course material

1. Principles of cognitive behavioral therapy
CASE STUDYS.is a 48-year-old divorced woman with one adult daughter and three
grandchildren. She is currently working as an LPN part time in a nursing home and also
works at a convenience store one or two days per week. She has had many jobs over the last
22 years, usually changing every one or two years. S notes that she has been called less
often to work in the convenience store and worries that they don’t like her anymore. She
reports being written up several times for arguing with customers. She also reports that her
supervisor at the nursing home “is a bitch”; although she really liked her supervisor at first,
she says “Now I hate her; she’s trying to get me fired.” S. reports that she has tried to get
fulltime jobs five times in the last four years, was hired for three, but only lasted one or two
weeks at each one.S. reports that she is currently not talking to her daughter because “she is
horribly mean to me and she needs to apologize or I won’t talk to her again”. She is upset
that she hasn’t seen her three small grandchildren in about a year. She sends them presents
and cards frequently that say “I still love you! Grandma”, but hasn’t called them since she
stopped talking to her daughter. She is considering reporting to the county that her
daughter is keeping her grandchildren from her.S. is very unhappy that she isn’t in a
relationship. She was abused by her ex-husband, and has a pattern of meeting and dating
men who eventually abuse her. She states that her last relationship was very good,
however; the man was not abusive and “I loved him very much”. The relationship ended for
reasons that S. doesn’t understand, although she does report many arguments that ended in
“scenes” such as her throwing chairs, stomping out of the house, making crank phone calls
to his family, and calling the police with false reports. But S. also reports that she “couldn’t
have loved him more and I showed it”. She gives examples of going to her boyfriend’s place
of work with flowers, buying him expensive presents, surprising him with tickets to Mexico
at the last minute – she was very upset that he wasn’t willing to drop everything and go
with her. S. reports asking him why he didn’t love her and what she was doing wrong on a
regular basis. When the boyfriend asked to break up, S. reports sitting outside his house for
weeks, crying; she called his mother, called his boss, and called and texted him until he filed
a restraining order. This occurred about 4 months ago.S. admitted herself to the mental
health unit when she felt suicidal. She reports that she had stopped her individual
psychotherapy 3 months ago and stopped going to DBT. She also stopped her anti-
depressant at that time, as she felt it wasn’t working, and missed her last two psychiatrist
appointments.Required:· How would you use therapeutic communication and principles of
cognitive behavioral therapy with the client?· Describe your assessment process. What are

2. some likely co-morbid conditions? List one nursing diagnosis and an appropriate nursing
intervention.· What interdisciplinary referrals might be appropriate?