2.) of January 2012). I am interested in

Name of the film and why you chose it as a case study? (100 words)

The title of my chosen film is Shame,
directed by Steve McQueen (13th of January 2012). I am interested in
its central theme of addiction as it relates strongly to me due to past
experiences and I appreciated how authentic and raw Shame is, a true reflection
of addiction and I found myself feeling sorry for the addict. However, I was
disappointed by the ending of the film, I wanted to see how Sissy’s actions influenced
Brandon’s addiction. I have grown up with various addictions and mental health
problems in my family; I have insight into the many layers of addiction and
behavioural outcomes, impacting on home-life and working life, break-down of
relationships- the core themes during Shame.  

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 3.) Client presenting issue (200 words)

On the outside Brandon lives a
comparatively privileged life as a bachelor in New York. However, Brandon is a
sex addict and he battles with this on a daily basis; to the point that even
whenever he is not having sex, he is surfing the web for porn, or eyeing up
women in any situation, even at work, in the hope of making a connection with
them.  Brandon’s relationship with sex is
very meaningless; he shows no emotional connection whilst engaging in the act.
His longest relationship lasted only four months and Brandon appears to have
little friends or social circle, outside of sexual encounters or his work
environment. Brandon has come for counselling as he is a struggling addict and
wants control of his life; he is constantly trying to peruse sex encounters with
women wherever he goes. He engages in a lot of casual sex and even pays women,
however he cannot commit to a sexual act with a potential girlfriend once they
become close. Brandon becomes increasingly frustrated at the arrival of his
sister, Sissy, and has also come to counselling due to their turbulent
relationship and her suicide attempt. Brandon hides his sex addiction from the
few people in his life; however, his addiction begins unravelling to Sissy when
she moves in with him.


Client history and current situation (500 words)

Brandon is Irish, however moved to
Jersey and was raised there with his sister. He now lives alone in New
York.  There is no mention of Brandon’s
parents, however it is indicated several times that Brandon feels the need to
“look after” his sister, Sissy, and she expects this from him too. Sissy states
that they are supposed to “help each other.”It is suggested through the silence
of their childhood that it may have had a troubled. Brandon lives alone and
lives a concealed life. Brandon is currently battling a sex addiction.
Brandon’s life spirals out of control when Sissy re-enters his world and moves
in with him, despite him ignoring her calls for quite some time. He loses his
privacy and his sex addiction becomes harder to manage. Sissy begins an
intimate relationship with Brandon’s boss, enraging Brandon and fuelling his
desire for her to move out of his apartment. He cannot bear when they engage in
a sexual encounter in his apartment, and therefore leaves to go out for a run
in the early hours of the morning, later tearing off the bed sheets when he
returns and finds them gone. Sissy’s emotional baggage, combined with Brandon’s
addiction, weighs heavily on their relationship. It is obvious to the audience
that Brandon lives an extremely private life, and cannot handle Sissy invading
his space. On one occasion Sissy walks in on Brandon in the bathroom, and
Brandon becomes violent towards her and accuses her of spying on him. Sissy
also finds a pornographic webcam site on Brandon’s laptop, this
frustrates/embarrasses Brandon and he disposes of his laptop and pornography.  He describes Sissy as a “burden” to him.  There is the obvious issue of Brandon’s
dependence, but Sissy also displays symptoms of addiction as she is drawn to
men and situations that are unreliable and potentially harmful.  Both of these behaviours are
self-destructive, leaving the characters in vulnerable situations.

During the film, Brandon goes on a
date with a co-worker which ends unsuccessfully. His date, Marianne, mentions
her recent divorce and describes commitment positively; meanwhile Brandon
mentions his dislike of marriage and relationships, stating that his longest
relationship only lasted four months. They both go home separately. Brandon
attempts to connect with Marianne again at work, by taking her to a hotel.
However, Brandon is unable to engage sexually with Marianne, proving his fear
of commitment. Towards the end of the film we see Brandon engage in a final
argument with Sissy, and then leave his apartment. Brandon goes to bars and
makes advances to women. Going from bar to bar, Brandon is refused entry and ends
up in a gay bar where he engages in sexual contact with a male. Sissy attempts
to ring Brandon and leaves a voicemail; at this point Brandon is nearing
withdrawal from his addiction and ends up in a threesome with two other women.
Afterward, Brandon arrives home and feels something is not right, he finds
Sissy covered in blood in his bathroom after she has slit her wrists, she is
unconscious and Brandon is distraught. It is at this point Brandon comes to
counselling, and it is clear that that Brandon has realised he is in a personal




Summary of counselling approach (700 words)

I have chosen to use Cognitive
Behavioural Therapy as my counselling approach on this client. CBT is a
directive and active approach that was first discussed by Aaron Beck in the
1960’s who is known as the pioneer of Cognitive Behavioural Therapy. While he
was a psychiatrist at University of Pennsylvania, he designed and carried out various
experiments to test psychoanalytic
concepts of depression. However the research did not validate the fundamental
concepts he expected, however what Beck discovered was that by identifying and
evaluating a person’s automatic thoughts, they were able to think more
realistically. As a result, they felt better in the emotional sense and were
able to behave more rationally and with greater function. His therapy helped
patients to change their underlying self-beliefs about many aspects of life,
such as themselves, their world and other people, which resulted in
long-lasting change. This approach was called “cognitive therapy”, later to
become known as “cognitive behavioural therapy.” Cognitive principles date back
thousands of years.

It is widely recognised that many
psychological issues develop into addiction and can be influenced by habitual
thoughts and inner dialogue (Corey, 2012), therefore this psychotherapeutic
process may play a crucial role in re-tuning the thoughts of the Brandon’s
addictive mind-set and address other issues accompanying it. This cognitive Restructuring is a
psychotherapeutic process of learning to identify and dispute irrational or
maladaptive or cognitive distortions. For example: all-or-nothing
thinking, magical thinking, over-generalization, magnification and emotional
reasoning.  CBT coincides along a psycho-educational
dimension, using collaborative principles with the purpose of reorganising
their cognitive processes (McLeod, 2013), this involves various techniques,
such as, clients learning, and obtaining skills, to modify automatic thoughts
and cognitive processes (Wright, Brown, Thase, Basco, 2017; Toner, 2012).
During CBT sessions client’s issues are revealed through conversations with the
therapist, a treatment plan is then devised early on in therapy but is reviewed
and added to as sessions continue. The issues that a client presents are
recognised and how these issues are not only affecting the client emotionally
but also physically, as well as how their relationships with others are
affected and their general daily functioning.

CBT Techniques include Socratic
questioning, thought recording, identifying cognitive errors, examining the
evidence, labelling distortions, ‘decatastropizing’, reattribution, cognitive
rehearsal, guided imagery, and being able to list rational alternatives. It is
a structured approach that is often time-limited.  Some of the various methods include
collaborative empiricism, completing homework assignments, collecting data on
thinking mechanisms and incorporating new skills (Corey, 2013). This could work
well with addicts because it provides an opportunity to address and communicate
how they feel and their areas of distress and concern (Corey, 2013). CBT
focuses on current problems and methods to improve an individual’s state of
mind, rather than centring on issues from the past. The therapy is based upon
an open relationship between the client and therapist, the therapist works with
the client using explorative questions and various distinctive techniques and
methods. CBT involves taking a step back and seeing what is happening to you as
an individual and how a situation has been perceived. The therapy is based on
the perception that an interaction of feelings/ behaviour will be dependent on
how an individual interprets at any given situation, and not everyone will
interpret a situation in the same way. As CBT is goal orientated which can be
beneficial for certain clients, and not others but in Brandon’s case I feel he
would benefit from this learning premise and it would suit the nature of his


If you had to critique one thing about the counselling approach you have
chosen, what would it be? (300 words)

There are
limitations with Beck’s cognitive theory; some would argue it is not based upon
basic cognitive science. Others would claim that negative thinking can be a consequence not antecedent
of mental health problems. Also there can be a
problem with engagement and compliance with requirements of CBT approach, not
every client wants to carry out the homework element, some components of CBT do
not suit a particular personality type or their issues and life circumstances.  This individual understanding and reaction to
a situation can be explained when considering what an individual has been
through in their lives, such as their beliefs about themselves and others, as
well as their experiences. CBT works on the premise that what people believe
impacts on how they feel and how they act, it embodies the fundamental premise
of behavioural therapy and psychology, and has become a popular academic point
of reference among psychologists (Szymanska
& Palmer, 2015). However treating addictions can be very complex,
and what forms the basis of addiction may be rooted in and compounded by other
co-morbid disorders, this all needs to be taken into consideration. It does not
take into account historical factors, family background, why he has a
dysfunctional relationship with women. Cognitive therapy doesn’t draw any
differences between intellectual beliefs and emotional beliefs. As in all
therapeutic considerations there could be the application of the biological-psychological-social
model into the understanding of Brandon, his condition and circumstances.
Psychological treatment is for the person and all associated influences and not
just for a condition or diagnosis ( Engal,1977). CBT may too one-dimensional
and therefore ignore impotent factors in his addiction and environment. There
may be a need for incorporation of various therapeutic modalities and
techniques which may better ensure a positive long-term outcome.


How do you think your choice of counselling approach might help this person? Choose
two concepts from the counselling approach you have chosen and outline (1,000 words)

Therapists help the client to
recognize the thoughts that trigger their addictive behavioural patterns; this
is a very useful strategy for an addict. The psycho-educational elements can be
effective in delving into inner conflict, which can be the root cause of
addiction. As Brandon’s therapist I will need to take every aspect of Brandon
and his addiction into account. As research has proven not all are sex addicts
sex offenders, and vice versa, but the need for an excessive number of sexual
experiences may place the sex addict at a greater risk of crossing the legal border
line (Tays, Earle, Wells, Murray, Garrett, B.,
1999). Therefore the therapist must address the core themes that
contribute to his unhealthy lifestyle and addiction in an attempt to secure a
long-term positive outcome.

An addiction is a condition which is
presented by the persistent maladaptive use of a substance or behaviour and is
ultimately linked with considerable distress and disability. An addiction is a brain disorder, ranging
along the craving and compulsion continuum seeking a reward stimuli
in spite of adverse consequences. For that
reason the choice of treatment has many considerations and perspectives, and
creating an effective response to substance abuse is truly a challenge. The
bio-psycho-social model is multi-dimensional, and many psychologists believe
that addictive behaviour is influenced by all three factors (Engal, 1977). Cognitive principles date back thousands of
years, using beliefs from the stoic philosophers such as Epictetus, Cicero and
Seneca. It also shares characteristics with doctrine from Eastern religions such
as Buddhism, carrying the belief that the power of our conscious cognitive
processes can be mentally renewing and life-changing (Beck, 1963).  However treating addictions can be very
complex, and what forms the basis of addiction may be rooted in and compounded
by historical factors or other co-morbid disorders (Kranzler , 2003).
These may include other stressors such as Brendan’s childhood, his distorted
attitude and relationships, his lack of interest in having a proper
relationship with his sister and so on. 
I believe CBT would provide an adequate treatment for many aspects of
the complex condition of addiction.

Contextual factors in addictions play
a part, for instance, the societal and environmental dynamics of people’s lives
(Kendler & Gardner, 1998). It is widely recognised that many psychological
issues develop into addiction and can be influenced by habitual thoughts and
inner dialogue (Corey, 2012),   therefore
this psychotherapeutic process may play a crucial role in re-tuning the
thoughts of Brandon,  thought recording,
and seeking rational alternatives. It has core dimensions of problem-solving
coming from a change-focused position, this is very necessary in Brandon’s
case, his thought processes and attitudes particularly towards women are very
negative and destructive, and he rarely sees positive solutions or resolutions.

 CBT provides cognitive restructuring of mental
distortions including ‘all or nothing’ thinking, destructive thoughts and
negative over-generalisations. It is a problem-orientated therapy, with
structured, present-centred, and time-limited components (Corey, 2013). CBT
works along a psycho-educational dimension, using collaborative principles with
the objective of reorganising their cognitive processes (Fjermestad, McLeod, Tully, Liber, 2016), this
involves clients learning, and obtaining skills, to elicit and modify automatic
thoughts and cognitive processes (Wright, Brown, Thase, Basco, 2017; Toner,
2012). Some of Brandon’s automatic thought processes towards women and sexual
activities have become distorted and very unbalanced.  The cognitive approach explores the thought
processes behind an addiction, these cognitions can be badly distorted, and
therefore CBT may be beneficial for the addict to explore the validity of their
old belief systems, and restructure and replace them with more realistic and
positive cognitions and coping mechanisms when faced with sex addiction (Corey,
2012). Some of the various methods of CBT include collaborative empiricism,
homework assignments, collecting data on thinking mechanisms and incorporating
new skills (Corey, 2013). This should suit Brandon’s needs, his thinking
mechanisms and relationships are at a very low level and to incorporate new
skills would bring a much needed sense of achievement and fulfilment if he is
able to carry them out. This can work well with addicts because it provides an
opportunity to address and communicate how they feel and their areas of
distress and concern (Corey, 2013). The directive and active position, and
working alliance premise may help to gain Brandon’s trust and cooperation, an
issue of major importance to those in the grip of an addiction, (Andrusyna, Tang,
DeRubeis, Luborsky, 2001) and also an issue that Brandon appears to grapple

The homework element of CBT would suit
Brandon as it is more than an ordinary talking therapy.  A purely talking approach
would not entirely suit Brandon, as he appears to speak little to his sister
and have limited interpersonal skills. So the practical element of homework
assignments would suit his situation. Whilst there are various CBT
techniques, I have chosen the CBT technique self monitoring, which can be also
known as diary work.  This technique is
used to record the amount and the degree of thoughts and behaviours. This is
helpful for the client and therapist as it illustrates the degree of a client’s
issues. Because CBT is an active intervention
with an interactive approach, the client will be asked to do homework or
practice outside of sessions. As Brandon’s life at the moment appears to lack
structure and direction, this will perhaps suit his needs and give his daily
routine some a sense of organisation and purpose. Incorporating CBT
principles by substituting old interpretations, and faulty beliefs with self
instructional, stress management training and Socratic questions (Toner, 2012).
 The second technique chosen for Brandon
is the CBT technique Socratic questioning (Socratic
Dialogue) this would also help Brandon because this process starts out as an exploratory process, and
gradually becomes a more testing, change-oriented development, encouraging more
purposeful and adaptive ways of interpreting the important aspects of his life,
his attitudes to women and sexual activities and his relationship with his
sister and his circle in general. It helps to tease out answers particularly if
Brandon himself comes to his own personal answer and conclusion, it would be a
better one suited to him, and more empowering and fulfilling (Kazantzis,
Fairburn, Padesky, Reinecke, Teesson, 2014).


What difficulties do you think you might experience if you were to work with
this client in psychodynamic counselling, and why? (300 words)

I feel that if I was to work with this
Brandon in psychodynamic counselling it would be difficult. However,
therapeutic practices would provide a useful approach for Brandon in terms of
discussing his childhood, as the theory states that events which occur in our
childhood shape our future and our future personalities. It would be useful and
insightful to explore Brandon’s childhood with him as it is not always revealed
during the film. Nonetheless, as Brandon is such a closed character, this may
not have been easy or successful, perhaps proving more harm than good.
Psychodynamic is a less intense approach, and focuses on immediate problems in
order to find a quicker solution. As a counsellor, I also am concerned that this
approach may not be effective for Brandon and I during sessions, an addict
unfortunately cannot often find a quick solution.  However the other side of this is that it
would engage him for a time as addicts may lose interest very quickly if not
purposively engaged. I would have found it challenging to work with Brandon as
he is a cold character and at times I found him hard to relate to as an
individual. I sense that Brandon could be a manipulative character; and this
could make me uncomfortable during a session. As a counsellor, feeling
uncomfortable with a client is not in the best interest of anyone in the room,
as I am not giving my best to the client and distressing myself in the process.
This could compromise my therapeutic relationship with Brandon and affect his
treatment.  As I never work in complete
isolation I can ask my supervisor advice, and if the connection with Brandon
remains an issue then I would have to consider referring him onto another

Concluding remarks (200 words)

To conclude, my counselling knowledge
allowed me to view the film in a different light as I normally would. I became
aware of how I would attempt to treat Brandon’s addiction and what would be the
best counselling techniques quite quickly as I watched the film. However, I was
aware that I shouldn’t be so quick to make decisions, and so watched the film
several times, analysing Brandon and picking up on new characteristics each
time. I believe this is why CBT is the correct counselling approach for
Brandon, as at the beginning of a CBT session, myself as a counsellor would
compose a treatment plan, however keep adding to it as the sessions go on and
additional information about Brandon becomes available, just as I did whilst
re-watching the film.  I would adapt and
modify the treatment as the session’s progress.