Case Studies / Activities
Within the chapter there is discussion of five key components involved in developing and maintaining therapeutic relationships. These are stated as:
- Recognising and picking up on the emotions and world view of the service user.
- Being aware of and understanding one’s impact on the service user
- Understanding, responding to and managing the emotions and reactions of service users.
- Being aware of one’s own thoughts, emotions and reactions and being able to separate them from the service users.
- Being able to manage one’s own thoughts, emotions and reactions.
Considering the above factors, and taking into account the importance of self-awareness (as discussed in Chapters 11 and 12), we would like you to undertake an exercise focusing on being aware of what is taking place in an interaction with another person. This exercise may be best undertaken during a practice placement when you will have numerous opportunities to engage with service users. The exercise is based on a form of process recording, a tool used to help student social workers gain insights into practice situations. Task: Choose a piece of work that you have been involved in with a service user. When undertaking this exercise for the first time it is best to choose a one-to-one exchange. As you become more proficient in process recording, group or family situations will become possible. Shortly after the exchange (when details are still fresh in your memory) write down what took place under the columns in the table below. The idea is to break down the exchange into a detailed step-by-step account. For longer exchanges with service users you may find it best to focus on one part of the interview. In the ‘what happened’ section you are aiming to detail exactly what was said/done by each party and the way the conversation/exchange developed. You then record your thoughts and feelings at each point. The final column about your learning is best completed at the end of the exercise when you have had an opportunity to reflect on what took place.
Activity 2 – Additional Ellis ABC(DE)
Within the chapter Albert Ellis’s Rational Emotive Therapy (RET) and Rational Emotive Behavioural Therapy (REBT) are discussed. Ellis is well known for his ABC model, which is used for assessment of distorted belief systems. The model proposes that there are links between an event, thoughts about the event and the resulting reaction (emotions and/or behaviours) to the event. Ellis subsequently developed the ABC(DE) model which adds the challenging/disputing stage and a new belief stage.
The stages are outlined below:
A is the activating event, that which happened to us and which can be objectively described.
B is the belief about the event which includes what we tell our self about the event (self-talk), our beliefs and expectations of others and the thoughts we have about the event.
C is the consequent emotion and behaviour.
D is the disputing stage where illogical beliefs are challenged. Part of this is identifying the shoulds, musts, awfulising and self-blaming and then debating logically with the negative beliefs and empirically questioning them in order dispute them.
E is the establishment of more rational thoughts. This may be done using reframing. For example re-evaluating bad events as ‘disappointing’, ‘concerning’, or ‘uncomfortable’, rather than as ‘awful’ or ‘unbearable’
During a period of practice learning, think about the service users you are working with. Do any of them have distorted belief systems? Try to identify the patterns of thoughts and resulting emotions/ behaviours, which give rise to the distortions. Consider how you can actively intervene to support service users to establish thoughts that are more rational.
Alternatively, think about events in your own life and the beliefs you impose on yourself. Do these beliefs lead to negative emotions and behaviours? If so, what can you do to shift these to more positive and rational interpretations?
Remember, whilst we cannot necessarily control all the things that happen to us, we can control the way we think about what happens to us. Control over our belief systems is very powerful because of the differing consequent emotions and behaviours that arise from our thoughts.
Joan is a 27-year-old woman with a history of depressive illness. She lives alone, but has regular contact with her family, who have been very supportive.
A – Event – Joan’s mother is unwell; however, Joan forgot to ring her last night.
B – Belief – Joan thinks a good daughter should never let her mother down so she is useless, hopeless and a bad daughter.
C – Consequence – Joan feels increased depression and anxiety. She sees herself as only taking support from her family and not giving anything back. This leads Joan to become more withdrawn.
D – Dispute – Joan is encouraged to recognise that she may not have rung, but it doesn't make her a bad person, just forgetful on this occasion. Joan has visited her mother regularly and phones regularly. Joan's mother has four other children who can also contact her.
E – Establish – In this case, a rational stance is that Joan has been forgetful on this occasion, but forgetfulness does not make her a bad daughter