Institute Inbrief - 03/12/2014
Welcome to Edition 215 of Institute Inbrief! This edition’s featured article is a case study about Jenny, a 48-year old woman who came to counselling with strong feelings of dissatisfaction with her life, and wants to find a new direction and purpose.
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How our brains make us anxious about things that’ll never hurt us
Modern life can feel defined by low-level anxiety swirling through society: Continual reports about terrorism and war. A struggle to stay on top of family finances and hold onto jobs. An onslaught of news coverage about Ebola. At the heart of issues like these lies uncertainty – the unknown likelihood of how ongoing crises will evolve over time.
When unpredictability or uncertainty prods us to consider the prospect of a bleak future, it fuels a state of apprehension that scientists study in the form of anxiety. Anxiety sits along a continuum of defensive behaviors we use when threats are somewhat remote from our current experience. It’s less extreme than the full-on fear elicited by direct, acute situations like an immediate physical attack.
Case Study: A Client Who Lost Direction
Jenny has come to counselling due to strong feelings of dissatisfaction with her life. She is 48 years old, unemployed and does not hold much hope of employment in the future. She has worked in the past at restaurants, in pubs and as a cleaner at a Motel. She said that she could not see any positive changes in her future and was concerned that she would live out her days caring for her son, having little income and no sense of direction. She felt that she lacked any control over her life and was just “marking time”. Jenny came to counselling because she wanted to find out about herself and to find her direction. For ease of writing, the Counsellor is abbreviated to “C”.
Essential Case Information
Initially, “C” asked Jenny to describe her family situation. Jenny had been divorced from her alcoholic husband for close to 15 years. She had a few relationships during this time; however these did not develop into any long-term commitments. Jenny was not involved with anyone currently.
Jenny’s son Brian is 26 years old and has been living with her for the past 5 years in a small flat out of town. Initially he had tried living with friends for a few years, before returning home. Brian is unable to drive and relies on Jenny to drive him to places he needs to go. Brian is also illiterate and his mother assists him by reading his mail, books and newspaper highlights. She also helps him to complete the paperwork to access unemployment benefits.
Jenny has a few close friends and reported that she used to enjoy going out with some of her single girlfriends on the weekends. At times her plans were hampered, as Brian would often wish to be taken somewhere. Jenny would usually drive Brian to his destinations, rather than see her “girlfriends” as she believed “that it was important that he go out with his friends”. Jenny experienced some frustration when missing her own opportunities for socialising. She said that she expected the driving to have stopped by the time Brian had grown up.
Session Content
After listening to Jenny tell her story, “C” decided that the best approach would be to help Jenny explore her beliefs about herself. For example: where her beliefs came from, how these beliefs affected her life, and how appropriate these beliefs were for her current circumstances and the future. To do this, “C” chose to draw from Glasser’s Control Theory (1985) and to use a process of ‘Mind Mapping’ and Cognitive Therapy to explore new possibilities with Jenny.
“C” explained to Jenny that we make choices about how we respond to events, people and other external stimuli. Jenny’s actions were not caused by external events, but rather by how she responded to those external events. These choices are not always conscious, perhaps because we have made these choices before and because we are meeting one of our five basic needs (Glasser, 1985).
Needs are at the basis of our motivation. As we experience different situations our basic survival needs are reinterpreted and wants added. In order to have needs met we take certain actions. We behave in a particular way. For example, a baby cries when it is hungry (hunger is a need) and crying is the behaviour to make that need known to those (the environment) that may satisfy that need. The environment responds and so provides a consequence to the behaviour. The consequence provides the child with feedback about the appropriateness of the behaviour in meeting his/her needs. The consequence may be that the child is picked up and fed.
Consequences also have effects, such as emotional/physiological/sensory effects on the individual. If we use the example of the baby then the effect may be that the child’s hunger pain has gone away and he/she feels physiologically satisfied. So, we have needs to begin with and these needs motivate behaviour. There are consequences to the behaviour and those consequences have an effect.
This experience is stored in our memory system as a pattern. The more a particular pattern is experienced the more it becomes our reality. “I need food, I cry, my hunger is satisfied”. We don’t actually sit and think this through. This happens by a process of association between need behaviour and outcome/consequences. From these experiences we start to create theories about “who” we are, what we are, how we should feel about ourselves and how we think the world sees us. We refer to these theories about ourselves as our “self-concept”. Once formed our self-concept dictates our life script and how we go about getting our needs and wants satisfied.
According to Glasser (1985) there are five needs that drive our behaviour; these needs are present for every person at any given time of their life. The first of these needs is physical – the need to SURVIVE – this includes the need to breathe, to eat, to sleep, to drink, to be warm, to be dry, to be safe from danger and to reproduce.
We have four psychological needs. These include Love, Power, Freedom and Fun.
- The need for love includes the need to belong – the need for friends and family, pets, community.
- Power refers to being important in some way – to your family, friends, and workplace – meaning something to someone.
- Freedom is about the opportunity to be creative, to make choices.
- Fun is to enjoy our lives, to delight in some part of our lives, to play, to be happy.
These needs are all important, however at different times one need may be stronger than another and this fluctuates throughout our life.
“C” asked Jenny which need she felt was most important to her just now, so that they could explore this, and then plan how to make the most of this need and its fulfilment. Jenny thought for a while and then decided that she would most like to explore her need for love. She said that she had spent some considerable time thinking about love and what it meant. “C” explained to Jenny that they would be doing some mind mapping. By this, “C” intended to explore all the thoughts that Jenny associated with the word ‘love’ to discover her beliefs and meanings about love, and the messages that she gave herself about love. “C” explained that the activity associated with the exploration of love was floor-based and asked Jenny how she felt about sitting on the floor. Please note that this could be done on an uncluttered table if your client could not manage the floor. Jenny replied that she would be very comfortable. “C” took a roll of paper and rolled it as far as she could across the floor. This gave them a length of paper around three metres to work on.
“C” then explained that what they would be conducting was a form of brainstorming, for Jenny to put all her thoughts about love on paper in a diagrammatic way. Along the paper Jenny wrote the words “survival”, “power”, “love”, “fun” and “freedom”. Circles were then drawn around these words to highlight them and make them the focus. “C” asked Jenny to write around the word in the circle, all the words she could think of that she associated with the word love. As Jenny wrote each word she talked about what it meant to her, such as the feelings and the memories the words conjured up and the people associated with the words. Some words she did not want to expand upon. “C” did not push her to explain these. Some of the thoughts that came to mind were memories of her childhood. Jenny revealed that she had grown up as the oldest child in a family of eight children. For most of her younger life she helped to bring up the other children. Her mother was constantly ill or pregnant and was unable to do the regular chores such as cooking, cleaning, washing and so on. Jenny was expected to do all this as well as go to school and succeed.
She said that her father was a harsh man, who drank heavily, and had very high expectations of her, the other children and his wife. He punished the children severely for small misdemeanours and they grew up in fear of him. Jenny said that he often drank all the housekeeping money and it was part of her responsibility to go to the neighbours to beg for food for the family. She felt very uncomfortable doing this and was embarrassed for herself and for her family. She said that she persevered though, because if she didn’t, everyone in the family would go hungry.
As Jenny spoke about her past, “C” drew her family genogram to clarify the roles and identities of the family members and to identify any transgenerational themes. Jenny’s genogram outlined themes of alcoholism and provided an avenue for her to further analyse issues of discipline and fear of reprisals.
In addition to exploring her past, this process of mind mapping assisted Jenny to identify some of her irrational beliefs using the Rational Emotive Therapy’s A-B-C Theory (Kidman, 1988). According to REBT, when we are confronted with a situation, our relevant beliefs are activated. This cognitive process happens instantly and is beyond our conscious awareness. What is conscious? It is the feeling, or the impact – the emotional consequence of our past experiences. Therefore, the only information that we are aware of is the feelings/sensations that we experienced in the situation. So in Jenny’s experience: The Activating Experience (A) was her ongoing responsibility to care for her son. The Beliefs (B) were:
- “I must protect and provide for all of my family to be loved, to be worthwhile, to have a place in the world”
- “To be loved I must constantly prove that I am capable”
- “I have to do what is expected of me to be loved”
- “To be loved I must not have wishes of my own”
- “To be loved I must not make a mistake”
- “To be loved I must not let my family down”
The emotional Consequences (C) were feelings of despair, depression and no direction. Disputing (D) the irrational ideas involved talking about the beliefs she discovered that she held and examining their usefulness in childhood. Jenny said that these beliefs kept her safe then. “C” asked Jenny about the usefulness of the beliefs now. Did they serve any purpose besides perpetuating unhappiness? Realistically and objectively, what would happen for Jenny if she maintained these beliefs?
Jenny explored these ideas, and “C” encouraged her to talk about other ways she felt loved, and loved in return. She decided that even if she was unable to provide Brian with his every need, that she was still a worthwhile person; that she still had a place in the world and she was still lovable. Importantly she could still love Brian without having to constantly prove her love. The new emotional consequence or Effect (E) was a feeling of relief that she did not have to be responsible for Brian’s every need or wellbeing.
According to REBT, how we perform and interact with other people very much depends on what we bring with us to a situation, that is, the kind of beliefs we hold about ourselves. We tend to go through our lives being dictated to by the theories and associated emotions that we made up about ourselves. These beliefs become our limitations. We need to keep in mind that we learned these beliefs. We were not born with these beliefs. If we were able to learn these particular beliefs, then we can learn others and so change how we see ourselves.
Jenny and “C” uncovered her core beliefs (in relation to love) that shaped her perceptions of reality and helped to shape her reality itself. When our experiences and our beliefs do not match, our natural tendency is to misinterpret our experiences rather than to change our beliefs (McMinn, 1991). Jenny’s core beliefs affected her perceptions of reality and ultimately caused the situation she disliked the most, that is, being the sole carer for her adult son.
At this stage Jenny became very excited as she could see that she would be able to have more control over her own life if she could learn to change her beliefs. She very happily set about deciding what she would prefer to believe about herself in relation to love. Jenny chose the following beliefs to take the place of her irrational beliefs:
- “I am lovable just the way I am”
- “I don’t have to prove anything in order to be loved”
- “I can have wishes of my own and still be loved”
- “I can make mistakes and be loved anyway”
- “Sometimes I will let my family down. I am not perfect. I can be loved anyway”
In just an hour, Jenny had learned how her beliefs were formed; what her beliefs were; how they impacted on her life – and she chose a new set of ideas to work from. The next step for Jenny was the real challenge. How would she change from one belief to another? How could she make this transition?
McMinn (1991) explains the process of change as a series of rehearsals whereby the client consciously practices her new beliefs. “C” explained that initially Jenny would continue to listen to her old beliefs and notice them after she experienced the associated feelings of hopelessness. This was a good time to rehearse her preferred beliefs. As her awareness developed she would realise she was enacting an old belief more quickly and could then replace this old belief with the appropriate one. Gradually she would become more conscious of her self-talk before it happened and so could ensure that her belief and thoughts were of her choice. Eventually her chosen beliefs would replace her original irrational beliefs. “C” and Jenny discussed the use of prompts, to help her developing awareness of the irrational beliefs. “C” gave Jenny some bright orange stickers. She wrote some of her preferred beliefs on these and planned to put them in prominent places as a visual reminder.
End of Session
At the end of the session Jenny felt highly elated in her new knowledge and understanding. “C” observed that her posture was straighter, with her shoulders back and head held high. This was an improvement from her presenting body posture of rounded shoulders, eyes down, and slumping in her seat. “C” made this observation to Jenny to highlight the positive work she had attempted. “C” also cautioned Jenny that these new feelings of motivation would be temporary, until she had more fully developed and implemented her new beliefs.
“C” reiterated to Jenny to enjoy the feelings she was currently experiencing and reminded her that she was in control of her own life. Jenny took with her the butchers paper so she could remind herself of the session and to share her experience with one of her close friends.
In the next session, Jenny brought back the butchers paper and, together with “C”, followed a similar process focussing on one of her other needs. At the end of this session, having gained confidence, Jenny decided that she would be able to continue the process on her own, choosing to phone “C” in a few weeks time to discuss her progress.
Concluding thoughts
On a personal note, I (“C”) experienced this session as particularly dynamic. We worked well together, probably because I had spent some considerable time in listening to Jenny at the beginning of the session. I felt that we connected, used the same language, and had a lot of fun in the process. I enjoyed the opportunity to use an eclectic approach encompassing elements of family therapy (use of genogram), Control Theory (needs), Rational Emotive Behaviour Therapy (disputing irrational beliefs) and Cognitive Therapy (cognitive awareness of new beliefs).
Case study written by Lin Fielding
References:
Glasser, William. (1985). Control Theory, Harper and Rowe Publishers: New York.
Kidman, Anthony. (1988). Tactics for Change, Biochemical & General Services Publishers: Australia.
McMinn, Mark. (1991). Cognitive Therapy Techniques, Word Publishing: Melbourne
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The Institute has a list of recommended textbooks and DVDs that can add great value to your learning journey - and the good news is that you can purchase them very easily. The AIPC bookstore will give you discounted prices, an easy ordering method and quality guarantee!
This fortnight's feature is...
Name: Theories and Strategies in Counselling and Psychotherapy, 5th edition
Author: Gilliland
AIPC Code: JONES
AIPC Price: $92.10 (RRP $109.95)
ISBN: 978-020-534-3973
This is text that operates in “real time”. It puts the student directly into psychotherapy as it is being practised today through the latest theoretical research and delivery systems.
A Case Using Brief Psychodynamic Therapy
Wendy is a 54 year old woman who has two adult children and has been married for twenty-nine years. Her husband, Steve, has recently and unexpectedly informed her that he no longer loves her and that he wants a divorce. Wendy was shocked to hear this, and she now reports that she is constantly crying and feels extremely anxious. Wendy has not told anyone about this situation, although she and Steve have agreed to explain his decision to their children within the week. In this scenario, the counsellor will be using a brief psychodynamic approach. For ease of writing, the Counsellor is abbreviated to “C”.
Fostering Resilience: In-session boosters to help clients bounce back
Suppose someone asks you, a mental health practitioner, “What is the most important thing you do as a counsellor (psychotherapist/psychologist/social worker) for your clients?” Your response might go along the lines of “helping them sort out their problems”, “educating them and inspiring them to make their lives work,” or possibly “providing support and a safe container while they explore new [presumably more effective] ways of being”.
Whatever your particular way of framing the answer, the chances are that you have identified a role of supporting and helping build your clients’ resilience, even if you never call it that when you are with them. Indeed, fostering resilience – the great art of helping others to bounce back – is the foundation of what we do as mental health professionals. But just how, exactly, do you do it? What tools or techniques have you got in your bag of tricks to foster resilience at the very practical level of in-session work?
Mental Health Academy – First to Knowledge in Mental Health
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Have you visited Counselling Connection yet? There are over 650 interesting posts including case studies, profiles, success stories, videos and much more. Make sure you too get connected (and thank you for those who have already submitted comments and suggestions).
Panic disorders: Symptoms and diagnostic considerations
For most of the two percent of Australians affected by panic disorder, the onset was during their teens or early twenties. It is twice as common in women as men. Not everyone who has panic attacks will develop panic disorder, as some people will have just one attack and never have a recurrence. The tendency to incur panic attacks appears to be inherited (The Royal Australian and New Zealand College of Psychiatrists, 2009).
The symptoms, stated below, can be very disabling, and sufferers of attacks are advised to seek help as soon as possible after an attack, or the recurrence of an attack, because the tendency is to avoid increasing numbers of places or situations where attacks have occurred (NIMH, n.d. – b). We list below the nested hierarchy of symptoms by which are defined first panic attacks, then panic disorder, and finally agoraphobia.
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"We tend to overestimate what we can do in a short period, and underestimate what we can do over a long period, provided we work slowly and consistently. Anthony Trollope, the nineteenth-century writer who managed to be a prolific novelist while also revolutionizing the British postal system, observed, “A small daily task, if it be really daily, will beat the labours of a spasmodic Hercules.” Over the long run, the unglamorous habit of frequency fosters both productivity and creativity."
~ Gretchen Rubin
Many students of the Diploma of Counselling attend seminars to complete the practical requirements of their course. Seminars provide an ideal opportunity to network with other students and liaise with qualified counselling professionals in conjunction with completing compulsory coursework.
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Below are upcoming seminars available for the first semester of 2015.
BRISBANE (9.00am – 5.00pm)
The Counselling Process: 07-08/03, 16-17/05
Communication Skills I: 01/02, 12/04, 14/06
Communication Skills II: 21/02, 26/04, 20/06
Counselling Therapies I: 28-29/03, 27-28/06
Counselling Therapies II: 07-08/02, 09-10/05
Legal & Ethical Framework: 22/02, 31/05
Family Therapy: 22/03, 13/06
Case Management: 28/02-01/03, 23-24/05
GOLD COAST (9.00am – 5.00pm)
The Counselling Process: 16-17/01, 17-18/04
Communication Skills I: 21/02, 15/05
Communication Skills II: 28/03, 20/06
Counselling Therapies I: 20-21/03
Counselling Therapies II: 22-23/05
Legal & Ethical Framework: 12/06
Family Therapy: 20/02
Case Management: 23-24/04
SUNSHINE COAST (9.00am – 5.00pm)
The Counselling Process: 31/01-01/02, 16-17/05
Communication Skills I: 28/02, 13/06
Communication Skills II: 01/03, 14/06
Counselling Therapies I: 14-15/03, 27-28/06
Counselling Therapies II: 11-12/04
Legal & Ethical Framework: 14/02, 30/05
Family Therapy: 18/04
Case Management: 28-29/03
MELBOURNE (9.00am – 5.00pm)
The Counselling Process: 10-11/01, 14-15/02, 28-29/03, 06-07/03, 23-24/04, 09-10/05, 05-06/06, 20-21/06
Communication Skills I: 17/01, 21/02, 13/03, 11/04, 16/05, 27/06
Communication Skills II: 18/01, 22/02, 14/03, 12/04, 17/05, 28/06
Counselling Therapies I: 24-25/01, 28/02-01/03, 18-19/04, 23-24/05
Counselling Therapies II: 31/01-01/02, 07-08/03, 25-26/04, 30-31/05
Legal & Ethical Framework: 31/01, 14/03, 10/04, 06/06
Family Therapy: 01/02, 15/03, 08/05, 07/06
Case Management: 07-08/02, 21-22/03, 02-03/05, 13-14/06
DARWIN (9.00am – 5.00pm)
The Counselling Process: 15/03, 14/06
Communication Skills I: 22/02, 24/05
Communication Skills II: 22/02, 24/05
Counselling Therapies I: 19/04
Counselling Therapies II: 08/02, 28/06
Legal & Ethical Framework: 01/03
Family Therapy: 17/05
Case Management: 29/03
ADELAIDE (9.00am – 5.00pm)
The Counselling Process: 14-15/02, 11-12/04, 13-14/06
Communication Skills I: 31/01, 28/03, 09/05
Communication Skills II: 01/02, 29/03, 10/05
Counselling Therapies I: 21-22/02, 02-03/05
Counselling Therapies II: 14-15/03, 30-31/05
Legal & Ethical Framework: 07/02, 16/05
Family Therapy: 08/02, 17/05
Case Management: 21-22/03, 23-24/05
SYDNEY (9.00am – 5.00pm)
The Counselling Process: 29-30/01, 05-06/03, 30-31/03, 16-17/04, 07-08/05, 28-29/05
Communication Skills I: 26/02, 21/03, 20/04, 22/06
Communication Skills II: 27/02, 28/03, 04/05, 23/06
Counselling Therapies I: 23-24/02, 27-28/04, 29-30/06
Counselling Therapies II: 02-03/02, 19-20/03, 18-19/05
Legal & Ethical Framework: 04/02, 21/04
Family Therapy: 02/03, 05/05
Case Management: 09-10/03, 22-23/05
LAUNCESTON (9.00am – 5.00pm)
The Counselling Process: 12/03, 11/06
Communication Skills I: 21/02, 23/05
Communication Skills II: 21/02, 23/05
Counselling Therapies I: 18/04
Counselling Therapies II: 05/02, 25/06
Legal & Ethical Framework: 07/03
Family Therapy: 14/05
Case Management: 28/03
HOBART (9.00am – 5.00pm)
The Counselling Process: 15/03, 14/06
Communication Skills I: 22/02, 24/05
Communication Skills II: 22/02, 24/05
Counselling Therapies I: 19/04, 09/08
Counselling Therapies II: 08/02, 28/06
Legal & Ethical Framework: 01/03
Family Therapy: 03/05
Case Management: 29/03
PERTH (9.00am – 5.00pm)
The Counselling Process: 10-11/01, 28/02-01/03, 28-29/03, 25-26/04, 30-31/05, 27-28/06
Communication Skills I: 17/01, 14/02, 07/03, 02/05, 06/06
Communication Skills II: 18/01, 15/02, 08/03, 03/05, 07/06
Counselling Therapies I: 31/01-01/02, 11-12/04, 13-14/06
Counselling Therapies II: 03/01, 14/03, 09/05
Legal & Ethical Framework: 03/01, 14/03, 09/05
Family Therapy: 04/01, 15/03, 10/05
Case Management: 24-25/01, 21-22/03, 23-24/05
Important Note: Advertising of the dates above does not guarantee availability of places in the seminar. Please check availability with the respective Student Support Centre.
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