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Please respond to the prompt below and to two classmates’ posts before our next class session.
Using the chart below (from page 110 of the textbook), identify and explain 3 cognitive distortions from the case study of Dan (college student). Please note Dan’s case study is available on page 104 of the text and is copied below.
Exhibit 4.5 Common Cognitive Distortions
Cognitive Error & Descriiption
Absolute thinking – Viewing experiences as all good or all bad and failing to understand that experiences can be a mixture of both
Overgeneralization – Assuming that deficiencies in one area of life necessarily imply deficiencies in other areas
Selective abstraction – Focusing only on the negative aspects of a situation and consequently overlooking its positive aspects
Arbitrary inference – Reaching a negative conclusion about a situation with insufficient evidence
Magnification – Creating large problems out of small ones
Minimization – Making large problems small and thus not dealing adequately with them
Personalization – Accepting blame for negative events without sufficient evidence
CASE STUDY: Dan
Dan Lee is a 24-year-old single Chinese American male undergraduate student working toward admission into medical school who came to the university counseling center to get help with his feelings of anxiety, tension, sadness, and anger and for some ongoing interpersonal conflicts. Dan was having difficulty concentrating on his studies and was in danger of failing a course he needed to pass in order to stay on track for medical school. He was specifically preoccupied with perceived personal slights from several friends, his sister, and his mother. Dan told the social worker that he needed help learning how to get these significant others to behave more responsibly toward him so that he could focus more intensively on his own work. Dan reported that he also had been diagnosed several years ago with an auditory processing disorder, which meant he was slow to process other people’s verbal communications at times and prepare his responses to them.
Dan is the older of two children (his sister is 22) born to a couple who had grown up in Taiwan and moved to the United States before the children were born. His father, a surgeon, and his mother, a homemaker, had divorced when Dan was 7. He and his sister had lived with their mother since then and only had occasional contact with their father. Dan had internalized the values of his family and culture; he understood that he needed to assume primary responsibility for the well-being of his mother and sister while also achieving high social status for himself. He also exhibited the cultural value of obedience to authority and saw himself as the family’s primary authority figure, being the only male member. While a student at the diverse university, Dan maintained cultural ties through his membership in a church that served the Chinese American community.
Dan tried hard to be a good son and brother but held a firm position that others should always accede to his directives. He believed he was always right in decisions he made about his mother and sister (regarding where they lived, how his mother spent her time, and what kinds of friends and career choices his sister should make). Regarding his friends, who were mostly limited to casual contacts at school and at his volunteer job at a community health center, Dan felt that whenever there was a conflict or misunderstanding, it was always their fault. He felt disrespected at these times and became so preoccupied with these “unjust sleights” that he couldn’t concentrate on much else for days afterward. Dan gave one example of a friend who had arrived more than 20 minutes late on two occasions for scheduled social outings. The second time, he demanded that the friend apologize for being irresponsible and insensitive, and when the friend did not do so to Dan’s satisfaction, the relationship ended. These kinds of relationship disruptions were common in his life. Dan’s family and friends often did not accept his admonitions, and he wanted to learn from the social worker how to better help these other people see that he was always rational and correct in his thinking. Dan had warmer feelings toward his peers at church, all of whom were Asian Americans. He spent most of his Sunday afternoons there, participating in social events and singing in the choir. Dan was also in regular contact with an ex-girlfriend, mostly by email but occasionally by phone. He had broken up with her six months ago, and although she hoped they would resume a romantic relationship, Dan did not think this would happen.
Spencer, the social worker, is a U.S.-born Caucasian male, several years older than Dan, who had some understanding of the Chinese value system in which the client was raised. He liked Dan, appreciating his intelligence, his motivation to get help, and his ability to articulate his concerns, but he also observed that Dan demonstrated a striking rigidity in his attitudes toward others. Still, he initially validated Dan’s perspective on the presenting issues. Spencer easily engaged Dan in substantive conversations each time they met, reflecting back to Dan the difficulty of his competing demands and desire to help his family lead safe and productive lives. Before long, however, Dan began challenging Spencer’s nondirective feedback: “I want to know what you think I should do here.” “How can I approach my sister so she won’t be so defensive about my input?” “I tell my mother she shouldn’t speak to my dad so often, but she keeps doing so anyway. How can I get her to stop?”
Dan was having difficulty balancing his desires for personal development with his need to care for two adult family members in the manner he felt appropriate. He seemed to have internalized conditions of worth related to his family responsibility and, due to having begun doing so at such a young age, had become quite rigid in his approach to helping the family. Dan’s defensive posture involved distorting the motives of others as oppositional rather than expressions of their own personal inclinations. Further, he never seemed to be able to relax and have fun, except when at church. In recognizing Dan’s rigidity as a defense, Spencer helped him reflect on the possibility that the behaviors of others toward him might not be intentionally oppositional but reflective of differences of opinion and that perhaps Dan could feel good about his well-meaning efforts while recognizing that one’s influence over others cannot be absolute.
Spencer was patient in his responses to Dan: “It’s a difficult situation you are in, and you’re trying your hardest to do the best for your family, and it’s frustrating that you can’t find ways to help them understand your concern.” “It hurts you to see other people move in directions you believe are not good for them.” “You feel strongly that certain people should do what you suggest even though they disagree.” Still, despite these empathic responses that Spencer believed reflected positive regard, Dan became increasingly frustrated with the social worker. “I thought you were a professional. I thought you were trained to help people. Why can’t you come up with some new ideas for me to try?”
Dan’s emotions were not always evident beneath his rigid exterior. The primary feelings he expressed to the social worker were anxiety, anger, sadness, and frustration. Over time, Dan continued to function with his rigid perspective. He tried to consider his situation from the points of view of others, but he always came back to the position that he was rational and others were irrational. He occasionally accused the social worker of being incompetent for not answering his questions concretely enough. Spencer himself became frustrated with his inability to help Dan broaden his perspective on interpersonal differences and Dan’s inability to distinguish disagreement from disrespect. During the course of their year of working together, Spencer employed the following interventions, which alternately focused on Dan’s thinking and emotions: cognitive therapy (restructuring), behavioral change, and psychodynamic therapy (so that Dan might become more aware of the range of his feelings and how the sources of his anger might be based in his family history and early upbringing). Although Dan noted little progress for several months, Spencer was encouraged by the fact that he continued coming in faithfully, week after week.
Spencer’s work with Dan experienced its most success with a series of behavioral interventions. Spencer helped Dan to use relaxation techniques and to consider the environments in which he was best able to focus on his studies. They determined, for example, that Dan was best able to concentrate during the middle of the day and when there were people around him. They set up a schedule of study in the medical library, where Dan could sit at a table with other students (whom he did not necessarily know). Spencer rehearsed deep-breathing activities with Dan, which helped calm his anxieties, and he further suggested that Dan study after a physical workout, when his body was calmer (Dan enjoyed swimming). Spencer also suggested that physical activity might help him release some of his anger after an interpersonal conflict.
Dan never articulated openly that his ideas about the appropriate behavior of others were anything but correct, but over time, he reported fewer conflicts with his sister, mother, and peers, and his study habits and grades improved to the point that he was admitted to medical school. After a year-long weekly intervention Dan finally decided to terminate because of his busy medical school schedule. During their final session together, he said to Spencer, “I don’t know how much I’ve gotten out of this, but I know you tried to help, and I appreciate that.”
Reviewing the intervention with his supervisor, Spencer regretted that he had felt such frustration with Dan, but he felt he had been able to contain those feelings. Further, despite Dan’s ongoing misgivings about the quality of the intervention, he had continued meeting with Spencer for a full year and eventually demonstrated behaviors evident of improvement. It seemed that Dan had reached a higher level of adaptability even though it wasn’t as apparent to him.
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