Student Number - 12240294 Coursework Submission Cover Sheet
Student Number: 12240294
Words: 3832
Due Date: 10/02/2014
Programme: MSc Cognitive Behavioural hera!"
Module Title: Continuing #ith Clinical Su!ervi$ion
Module Code: 0909
Assignment Title: Ca$e Stud" %&S'0024
Lecturer: (li)abeth Simon
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Student Number - 12240294 Table o Contents !"
#ntroduction...................................................................................3
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Pre Presen sentin ting the the case ase............................................................................3
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&ation &ationale ale or or the use use o Cognit Cognitive ive 'ehav 'ehaviou ioural ral Ther Thera( a() ) ....................................5
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Lea Le arnin rning g Theo heories ries.............................................................................6
+"
Assess Assessmen mentt and and Measur Measurem ement ent Tools.........................................................7
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-ormulation..................................................................................12
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Pro Problem blemss an and /oa /oals.........................................................................18
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#nterventions and Summar) o Treatment 0ered ........................................20
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Lite Litera ratu ture re &evie eview w...........................................................................25
!2" !2" &el &elec ecti tion onss...................................................................................28
!!" Conc Conclu lusi sion on...................................................................................30
!$" !$" &ee &eere renc nces es...................................................................................32
!%" !%" Transc anscri ri(t (tss...................................................................................44
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A((e A((end ndi3 i3 40n 40n Se( Se(ar arat atee Page Pages5 s5
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Student Number - 12240294 Table o Contents !"
#ntroduction...................................................................................3
$"
Pre Presen sentin ting the the case ase............................................................................3
%"
&ation &ationale ale or or the use use o Cognit Cognitive ive 'ehav 'ehaviou ioural ral Ther Thera( a() ) ....................................5
*"
Lea Le arnin rning g Theo heories ries.............................................................................6
+"
Assess Assessmen mentt and and Measur Measurem ement ent Tools.........................................................7
,"
-ormulation..................................................................................12
."
Pro Problem blemss an and /oa /oals.........................................................................18
8*
#nterventions and Summar) o Treatment 0ered ........................................20
1"
Lite Litera ratu ture re &evie eview w...........................................................................25
!2" !2" &el &elec ecti tion onss...................................................................................28
!!" Conc Conclu lusi sion on...................................................................................30
!$" !$" &ee &eere renc nces es...................................................................................32
!%" !%" Transc anscri ri(t (tss...................................................................................44
!*" !*"
A((e A((end ndi3 i3 40n 40n Se( Se(ar arat atee Page Pages5 s5
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Student Number - 12240294
!" #ntr #ntrod oduc ucti tion on
hi$ ca$e $tud" aim$ to highlight the cour$e o+ treatment o++ered to client ,* &e i$ a Cauc Cauca$i a$ian an male male re+err re+erred ed +or +or Cogn Cogniti itive ve Beha Behavi viou oural ral hera hera!" !" .CB .CB a+te a+terr recei receivi ving ng a diagno diagno$i$ $i$ o+ de!re$ de!re$$io $ion n and !er$on !er$onalit alit" " di$ord di$order er trait$ trait$ $!eci+i $!eci+icall" call" morbid morbid anger anger and ealou$"* o date the client ha$ had a total o+ ten eel" $e$$ion$* he $e$$ion$ too !lace in a !rivate !ractice here the author or$ a$ a rainee Cognitive Behavioural hera!i$t under the $u!ervi$ion o+ a Coun$elling $"chologi$t*
hroug hrougho hout ut thi$ thi$ ca$e $tud" $tud" the +ounda +oundatio tion$ n$ +or u$ing u$ing CB and learnin learning g theori theorie$ e$ ere highlighted* ,dditionall" the a$$e$$ment$ mea$urement tool$ and +ormulation$ that a$ able to re!re$ent a treatment !lan +or challenging behaviour$ are e5!lained* he $elected model o+ treatment deemed a!!ro!riate +or thi$ client incor!orated cognitive emotional and behavioral +eature$* hi$ lined ell ith the client a$ due to the co-morbidit" o+ the !re$enting !roblem$ the individual re6uired varied treatment intervention$* 7i$cu$$ion$ regarding the u$e u$e o+ nega negati tive ve auto automa mati ticc thou though ght$ t$ and and +ault" +ault" thin thini ing ng ere ere $u!! $u!!le leme ment nted ed ith ith the the im!le im!leme ment ntati ation on o+ cogn cognit itiv ivee re$tr re$truc uctu turi ring ng** ,ddit dditio iona nall" ll" a$$er a$$ertiv tivee $il $ill$ l$ and and ange anger r management management techni6ue$ techni6ue$ ere taught* hroughout hroughout the ca$e $tud" the$e model$ are !re$ented !re$ented hich are then $u!!orted b" a revie o+ the literature* ,dditionall" a re+lective account o+ the author$ e5!erience$ i$ !re$ented*
$"
Presenting the case
, i$ a 38-"ear-old male ho a$ re+erred +or CB b" hi$ $"chiatri$t a+ter being de$cribed a$ $u++ering ith 7e!re$$ion and er$onalit" 7i$order trait$ o+ morbid ealou$" and anger .,, 200 .See able 1*1* 7ue to hi$ aggre$$ive behaviour$ he a$ !re$cribed 20mg o+ a
3
Student Number - 12240294 mood $tabili$ing drug to be taen dail"* &e live$ ith hi$ i+e and $on in the +amil" home* he client re!orted +eeling$ o+ inten$e ealou$" and anger over both trivial and $eemingl" im!ortant $ituation$ hich have re$ulted in him being ver" aggre$$ive toard$ hi$ i+e and !h"$icall" violent on to occa$ion$* &e claim$ that due to hi$ inabilit" to control hi$ anger it mae$ him +eel ver" de!re$$ed* Sub$e6uentl" he i$ re!orted to have e5!erienced an5iet" hen he doe$ have $ocial !lan$* ,dditionall" he ha$ $tated that he become$ orried about $ituation$ that have not "et occurred hich con$ume hi$ mind and lead him to la$h out* hi$ either lead$ him to i$olate him$el+ and ruminate hi$ thought hich later lead$ to outbur$t$ o+ anger* :urthermore he o+ten contact$ hi$ i+e and accu$e$ her o+ $ituation$ he ha$ no evidence +or* hi$ ha$ re$ulted in !roblem$ at or ith colleague$ hi$ i+e and hi$ $on*
Table !"! 6 Demogra(hic details
Name ;ender ,ge (thnicit" Marital Statu$ 7iagno$i$ Medication =ccu!ation
Table !"! 7 Demogra(hic Details , Male 38 #hite Briti$h Married 7e!re$$ion Morbid
here are $everal a$!ect$ that a!!ear to be contributing to the client$ !roblem$ that ere highlighted through to generic +ormulation$ .ade$e" > ;reenberger 199? an anger $!eci+ic +ormulation .Novaco 19%? and a $ummar" conce!tuali$ation model ith a maintenance c"cle .'u"en ade$" > 7udle" 2011* B" u$ing the$e +ormulation$ it a$ ea$ier to mae a lin beteen the client$ !roblem$* #hile he !re$ented ith cla$$ic $"m!tom$ o+ de!re$$ion hi$ anger and ealou$" com!licate the overvie o+ hi$ treatment* ,$ main cognition$ included +eeling lie he i$ in+erior to other$ +eeling uncom+ortable in
4
Student Number - 12240294 hi$ on $in +eeling $tu!id and lie other !eo!le cant be tru$ted* &e ha$ noticed modi+ication$ in hi$ bod" $uch a$ becoming re$tle$$ +eeling hot and having racing thought$* ;enerall" , believe$ that !eo!le cannot be tru$ted and the orld i$ @+ull o+ rongen$A* ,$ a re$ult thi$ lead$ him to i$olate him$el+ ruminate hi$ thought$ and have angr" outbur$t$* he on$et o+ the e5i$ting !roblem$ o+ mi$tru$t/anger/ealou$" a!!eared to have $temmed +rom hi$ childhood here he had a ver" critical +ather ho !h"$icall" abu$ed him* ,dditionall" he a$ able to recall $ituation$ +rom hi$ childhood that cau$e him di$tre$$* :or e5am!le at the age o+ 13 hi$ girl+riend ho ended their relation$hi! over a micro!hone at a !art" had !ublicl" humiliated him* &e claimed that due to the$e e5!erience$ he ha$ develo!ed a $trong mi$tru$t +or !eo!le leading to hi$ ealou$ thought$* he client ha$ al$o re!orted that he +eel$ that hi$ de!re$$ive $"m!tom$ are due to him +eeling bad about ho he behave$ toard$ other$ and hi$ inabilit" to control it*
%" &ationale or the use o Cognitive 'ehavioural Thera()
7ue to the +eature$ o+ the client$ !re$enting !roblem$ it a$ !ro!o$ed that CB ould be a u$e+ul intervention a$ recommended b" the National n$titute +or Clinical (5cellence .NC( 2011 ;uideline C;%%* #ithin re$earch CB ha$ been demon$trated a$ an e++ective thera!eutic intervention +or both angel$ o+ the client$ !roblem$* here i$ e5ten$ive $ub$tantiation that !ro!o$e$ that CB i$ e++ective +or the treatment o+ 7e!re$$ion .Bec u$h Sha and (mer" 19%9* reviou$ literature b" 7ob$on .1989 identi+ied that CB +or de!re$$ion a$ a$ e++ective a$ medication* hi$ a$ al$o $u!!orted b" 7e ubei$ et al* .200? > Stun et al* .200% ho $tated that CB i$ Da$ e++ective a$ medication to alleviate de!re$$ive $"m!tom$D* a$t re$earch ha$ al$o been able to demon$trate the bene+it$ o+ u$ing CB +or anger* e$earch b" Novaco .19% ha$ $hon the e++ectivene$$ o+ the CB a!!roach to anger
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Student Number - 12240294 management* t ha$ been !ro!o$ed that thi$ cour$e o+ treatment can reduce anger hil$t im!roving motivation $el+-e$teem and inter!er$onal di++icultie$* hi$ a!!roach to an anger management !rogramme i$ able to +it ell ith the client$ !re$enting !roblem$* ;enerall" re$earch al$o demon$trate$ lo dro! out rate$ +or CB hich mae$ it an a!!ealing choice +or thera!" .Covin =uimet Seed$ et al* 2008E &unot Churchill Silva de Fima et al* 200%E &ab" 7onnell" Corr" et al* 200E Mitte 200?*
*" Learning Theories
Cognitive Behavioural Fearning heorie$ are able to !rovide a better under$tanding o+ the under!inning$ o+ ,$ behaviour and ho it ha$ e$tabli$hed throughout hi$ li+e* =!erant Conditioning e5em!li+ie$ that the !roce$$ o+ behaviour occur$ through learning b" reard$ and !uni$hment* hi$ theor" $u$tain$ that there i$ a crucial lin beteen a !er$on$ behaviour and the con$e6uence that re$ult +rom thi$ behaviour .Sinner 19?3* he client a!!ear$ to be negativel" rein+orced to avoid $ocial interaction a+ter he ha$ had an angr" outbur$t* B" engaging in $ocial interaction$ he +eel$ he ma" be !laced in a !o$ition here he a$ more liel" to e5!re$$ ealou$ thought$ hich could re$ult in an angr" outbur$t* hi$ limited interaction re$ult$ in , ithdraing and i$olating him$el+ +rom other$ hich cau$e$ lo mood* ,$ thi$ avoidance removed the un!lea$ant angr" outbur$t$ it a$ rein+orcing avoidance behaviour* ,lthough it increa$ed +eeling$ o+ lo mood it became hi$ !re+erred method o+ co!ing hen !laced in thi$ $ituation* 7ue to the$e e5!erience$ the avoidance o+ !lacing him$el+ in $ocial $ituation$ re$ulted in him ithdraing +rom $eeing +riend$ communicating e++ectivel" ith hi$ i+e and oring ithin a team at or maing him +eel even more lonel" angr" and de!re$$ed*
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Student Number - 12240294 &oever during the !eriod o+ attending CB $e$$ion$ he demon$trated a $hi+t in the o!erant conditioning* &e $hoed that b" changing the negative thought$ o+ @other$ cannot be tru$tedA to @it$ im!ortant to ee! an o!en mind about other$A he a$ !o$itivel" rein+orced to di$cu$$ $ituation$ calml" hen he +elt there a$ a !roblem* ,$ he continued to !ut him$el+ into $ocial $ituation$ here hi$ !roblem$ ma" ari$e he +ound the e5!erience ea$ier*
+" Assessment and Measurement Tools
he initial a$$e$$ment a$ conducted over +our $e$$ion$ .See able 1*2* hi$ !roce$$ +olloed the $trategie$ identi+ied b" Sander$ > #ill$ .200? and a$ com!lemented b" to di$order $!eci+ic a!!roache$ the Model +or 7e!re$$ion .Bec$ 198% and the Model +or ,nger .Novaco 19%?* n line ith Sander$ > #ill$ .200? the initial a$$e$$ment intervie included gathering in+ormation regarding the client$ !reviou$ e5!erience$ o+ thera!" and hi$ goal$* B" u$ing an integrative methodolog" throughout the $igni+icance o+ regulating angr"/ealou$ emotion$ ada!ting thought !roce$$e$ and a!!roache$ +or co!ing ith challenging $ituation$ a$ highlighted*
Table !"$ 6 Assessment Process
ASS8SSM8NT P&0C8SS Session ! •
•
• • • • •
Assessing diagnostic criteria or de(ression to see i client9s eatures meet the diagnosis" Assess (roblems with anger and ealous) to see i client9s eatures meet the diagnosis or (ersonalit) disorder or (ersonalit) disorder traits" Client com(leted (s)chometric assessment tools and take S;DS" /athering general inormation about client" 83(lanation rom client o what is causing his diiculties" 83(ectations o the sessions and (revious e3(eriences o thera() were discussed" 83(lanation o Cognitive 'ehavioural Thera()" 7
Student Number - 12240294
• • •
Discussed sce(ticism towards Cognitive 'ehavioural Thera()" #nstilling ho(e" Provided inormation to read or homework on what Cognitive 'ehavioural Thera() is in general"
Session $ • • • • •
S;DS to be taken rom client" /athering background inormation" Com(leted a lieline o signiicant lie events" #dentiied (roblems and goals" Provide inormation sheet or homework regarding de(ression and anger and how the) can be linked"
Session % • • • • •
S;DS to be taken rom client #ntroduction to the ive s)stems model Com(leted a to(ogra(hical anal)sis What is de(ression is like or )ou and how does it eel in )our bod)< 83(lain unctional anal)sis A'C and client this or homework
Session * • • • • • • •
S;DS and (s)chometric assessments to be taken rom client" Discuss need to com(lete homework" Continue with ive s)stems model" Com(leted a to(ogra(hical anal)sis" What is anger = ealous) is like or )ou and how does it eel in )our bod)< Socratic >uestioning to identi) core belies? rules and assum(tions" Set homework o identi)ing how core belies have im(acted behaviour"
o di++erent mea$ure$ ere u$ed to a$$e$$ the level o+ the client$ !roblem$ and !rogre$$ during thera!" the Bec$ 7e!re$$ion nventor" Second (dition .Bec Steer > Bron 1992 and Novaco ,nger Scale and rovocation nventor" .N,S- .Novaco 2003* he B7 i$ a 21-item $cale that mea$ure$ the $everit" o+ $el+ re!orted de!re$$ion in adult$* ,$ $core$ on the B7 +luctuated over the ten-ee !eriod .See able 1*3 1*4 and ;ra!h 1*1* =n average he demon$trated a moderate level o+ de!re$$ion* he $core$ that , demon$trated are congruent to hi$ !re$entation in the $e$$ion$ and a!!ear to re+lect ell on hi$ current
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Student Number - 12240294 $ituation* #hen anal"$ing the item$ in more detail it can be ob$erved that the area$ in hich , i$ e5!eriencing the mo$t di++icultie$ include$ agitation concentration $el+ di$lie and orthle$$ne$$ and $el+ criticalne$$*
Table !"% 7 'ecks De(ression #nventor) Classiications Score
Classiication
0-%
Minimal
8-1?
Mild
1-2?
Moderate
Table !"* 6 'ecks De(ression #nventor) &esults 'D#
Score
Classiication
#ee 1
22
Moderate
#ee 4
21
Moderate
#ee %
18
Moderate
#ee 10
14
Mild
/ra(h !"! 6 'ecks De(ression #nventor) &esults
9
Student Number - 12240294
he N,S- tool a$ al$o $electedE thi$ i$ a $el+-re!ort 6ue$tionnaire that a$$e$$e$ an individual$ e5!erience and e5!re$$ion o+ anger* ,n individual$ $core re+lect$ their overall level o+ anger ith high $core$ indicating relativel" higher anger level$ .See table 1*? 1**
Table !"+ 6 Novaco Anger Scale and Provocation #nventor) Classiications
Deinitions o NAS7P# T7score &anges
G29 30-39 40-44 4?-?? ?-?9 0-9 I%0
Her" Fo Fo Fo ,verage ,verage &igh ,verage &igh Her" &igh
Table !", 7 NAS7P# &esults
NAS Total
Week !
Week *
Week .
Week !2
Her" &igh
Her" &igh
&igh
&igh ,verage
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Student Number - 12240294
Cognitive Domain Arousal Domain 'ehaviour Domain Provocation #nventor) Anger &egulation
&igh ,verage
&igh
&igh ,verage
,verage
&igh ,verage
&igh
&igh ,verage
,verage
&igh
&igh
,verage
,verage
&igh
&igh
,verage
,verage
Her" &igh
&igh
&igh ,verage
,verage
,$ $core$ +luctuated over the ten-ee !eriod* &oever it a$ evident that in all area$ hi$ anger level$ had decrea$ed over the cour$e o+ thera!"* Fie ith the B7 initiall" the $core$ ent u! and then ent bac don* =verall the N,S- $ugge$t$ that the re$ult$ obtained b" , a!!ear con$i$tent in the a" that he re!re$ent$ hi$ anger* ,+ter taing all o+ the$e $core$ together and anal"$ing ,$ current behaviour it could be $ugge$t that , generall" doe$ e5!erience de+icit$ in hi$ abilit" to regulate hi$ anger*
n addition to the$e mea$urement tool$ the Subective Jnit$ o+ 7i$tre$$ Scale .SJ7S ere taen +rom the client to a$$e$$ hi$ level o+ anger over the !reviou$ ee* he gra!h 1*2 demon$trate$ the re$ult$ +rom the SJ7S* =verall hi$ mood +luctuated over the ten-ee !eriod*
/ra(h !"$ 6 S;DS &esults
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Student Number - 12240294
SUDS Results
," -ormulation
he initial !art o+ the 10 +ormulation con$i$ted o+ to o!ogra!hical ,nal"$e$ Cognitive ,BC .ede$" > ;reenberger 199? .See :ig 1*1 1*2* :rom thi$ a$!ect o+ the +ormulation the 9
thera!i$t and client ere able to begin to identi+" the thought$ +eeling$ behaviour$ and 8
!h"$ical $en$ation$ hen the client a$ !laced in $ituation$ $uch a$ thing$ going rong at 7
or or being told that hi$ i+e ha$ $le!t ith $omeone el$e* he$e $ituation$ cau$ed the client to have angr"6outbur$t$* &e al$o $tated that he +elt $ad much o+ the time becau$e o+ $ituation$ lie the$e* 5 Score -ig !"! To(ogra(hical anal)sis 7 De(ression 4 3 2 1 0
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Student Number - 12240294
T oug ts
Sitution
"I
want to go home" "I cant get motivated" "Why do i feel like thi" "What i going on with me" "!veything #ad alway ha$$en to me"
When a $"o.ect at wo"k i not going to $lan
"h#sicl Senstions
Emotions %ealo& 'e$eed !m$y ( like omething i miing
,ot +acing -ho&ght -ene ,eat ate inceae
Beh!iours Woying a#o&t it )oaning Withdaw 'ont *$eak *&lking *hot tem$eed +ing Wife
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Student Number - 12240294
-ig !"$ To(ogra(hical anal)sis 6 Anger=@ealous)
Thoughts
Sitution
"I dont know if i ho&ld #elieve he o not"
It int t&e" "-he anwe that i am getting fom he aent good eno&gh" "I dont #elieve he" "!veything #ad alway ha$$en to me"
When omeone told me that omeone ele had le$t with my wife
Emotions
"h#sicl Senstions
/&tated 0ngy )i1ed &$ ( dont know what to think *ad
,eat +acing /eeling &$tight
Beh!iours 0k wife a#o&t it +&minate a#o&t what he tell me Withdaw fom eveyone 'itant fom wife
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Student Number - 12240294
:olloing on +rom thi$ generic +ormulation an anger ca$e +ormulation .Novaco 19%? a$ com!leted .See :ig 1*3* hrough thi$ model the thera!i$t a$ able to elicit the client$ cognition$
behavioural
reaction$
!h"$iological arou$al$
and
hat
environmental
circum$tance$ are liel" to trigger thi$* :or , o+ten hen he i$ at or and $omething ent rong he called hi$ i+e to di$cu$$ it* + $he i$ unable to an$er the !hone hi$ cognition$ cau$e him to thin negative thought$ $uch a$ @hat i$ $he doingA @ho i$ $he ithA* he$e thought$ mae him +eel out o+ control and leave him +eeling hot $eat" $ha" etc* ,$ a re$ult he o+ten re$!ond$ to $uch $ituation$ b" accu$ing hi$ i+e o+ doing thing$ that he ha$ no evidence +or and $houting at her or at hi$ colleague$* &i$ i+e then re+u$e$ to tal to him hen he i$ in thi$ highl" emotionall" angr" $tate and $ub$e6uentl" , begin$ to +eel bad and i$olate$ him$el+*
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Student Number - 12240294
%ognition& Structure ' "rocesses What i he doing Who ha he #een with Why wo&ld he love me when he can #e with omeone ele !ve"ything I do make he" &$et I wont tand fo" he" lying to me o(one ca"e a#o&t me Ive got no cont"ol ove" what I might do II cant cont"ol my ange"
En!ironmentl %ircumstnces t wo"k omething doent go my way call wife and he doent anwe" the $hone
Beh!iourl Rections
:!+ *ho&t at wife colleag&e void eeing $eaking to Wife i ang"y with me
"h#siologicl $rousl ,ot *weating &tte"ie in tomach -ene
-ig !"% Anger Case -ormulation
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Student Number - 12240294 ,dditionall" a collaborative ca$e conce!tuali)ation model ith a maintenance c"cle .'u"en ade$" > 7udle" 2011 a$ u$ed to bring the to !roblem$ together* B" ado!ting the method o+ u$ing an idio$"ncratic longitudinal +ormulation !roce$$ the individual$ li+e !re$enting !roblem$ and CB can be lined together* t$ al$o able to incor!orate the earl" "ear$ o+ the individual and ho the$e e5!erience$ develo!ed into core belie+$ .See :ig 1*4* Some o+ the client$ develo!mental e5!erience$ $uch a$ having a ver" critical +ather ho !h"$icall" abu$ed him led him to develo! core belie+$ $uch a$ @ am in+eriorA @ +eel uncom+ortable in m" on $inA and @ am $tu!idA* hi$ led to , develo!ing underl"ing a$$um!tion$ $uch a$ @+ tae control then can !revent bad thing$ +rom ha!!eningA @+ ant to be $een a$ com!etent then mu$t do ever"thing ellA @+ ant !eo!le to love me have to be able to do thing$ ellA and @+ !re!are +or the or$t am never going to +ailA* he $trategie$ that he u$e$ to achieve thi$ i$ to $hout at hi$ i+e hen $he doe$nt allo him to be in control or to a high $tandard con$tantl" orr" about maing mi$tae$ and avoid re$!on$ibilitie$ hen thing$ go rong or dont go hi$ a"* he on$et o+ the current emotional !roblem$ that he e5!erience$ are thought to be due to challenge$ at or $uch a$ thing$ going rong or !eo!le taling about hi$ i+e* hi$ cau$e$ him to +eel angr" and lo in mood* ,$ a re$ult he ha$ thought$ o+ @ +eel out o+ controlA @ hate it hen !eo!le do thing$ lie thi$ to meA @#h" doe$ no one re$!ect meA @ am u$ele$$ and $tu!idA* he$e thought$ originall" cau$e him to con+ront hi$ i+e and individual$ at or* &e then ruminate$ over hat he ha$ $aid to them and begin$ to avoid $ocial $ituation$* hi$ avoidance then maintain$ the negative thought !roce$$e$ leading to the c"cle continuing to occur*
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Student Number - 12240294 -ig !"* Colaborative Case Conce(tualiation -ormulation De!elo(mentl E)(eriences
"re*is(osing +ctors
;"itical /athe"
%ore Belie,s I am infe"io" I feel &ncomfo"ta#le in my own kin I am t&$id
Un*erl#ing $ssum(tions If I take cont"ol then I can $"event #ad thing f"om ha$$ening If I want to #e een a com$etent then I m&t do eve"ything well If I want $eo$le to love me I have to #e a#le to do thing well If I $"e$a"e fo" the wo"t I am neve" going to fail
Strtegies *ho&t at hi wife when he doent allow him to #e in cont"ol> Wo"k to a high tanda"d> ;ontantly wo""y a#o&t making mitake void "e$oni#ilitie when thing go w"ong o" dont go hi way
-nset Wo"k #ecoming mo"e challenging which ha "e<ed in him doing mo"e thing w"ong> inc"eaing alcohol con&m$tion
"resenting ssues
"resenting ssues
?ow )ood
nge"
Triggers *omething going w"ong at wo"k> $eo$le talking a#o&t o" looking at hi wife
/intennce
I want to go home I cant get motivated Why do I feel like thi What i going on with me !ve"ything #ad alway ha$$en to me c#cles If I ca""y on like thi I am going to end &$ alone
+&minate void
*ad nio& ?ow )ood
18
I dont t"&t my wife What i he doing it not .&t my wife no#ody ho&ld #e t"&ted *he doent give me the anwe" I want I dont #elieve what he ay
+&minate ;onf"ont $eo$le ng"y @&t#&"t
ng"y /"&t"ated
Student Number - 12240294
." Problems and /oals
he client$ !roblem$ and goal$ and a!!ro!riate intervention$ could be highlighted through a 9-bo5 model .hom!$on 2012 .See :ig 1*?* #hen com!leting thi$ the client and thera!i$t en$ured that the" ere in line ith the SM, goal$ model .See :ig 1** he$e made it ea$ier to identi+" both long and $hort-term goal$ +or thera!"* Some o+ the main thera!eutic goal$ include im!roving reduction o+ avoidance and more e++ective !roce$$ing and regulation o+ emotion$*
-ig !:+ 6 1 'o3 Model Problems and /oals 19
Student Number - 12240294 C0/N#T#B8 P&0'L8M
C0/N#T#B8 /0AL
@#hat i$ $he doingA @#ho ha$ $he been ithA @#h" ould $he love me hen $he can be ith $omeone el$eA @(ver"thing do mae$ her u!$etA @ ont $tand +or her l"ing to meA @No-one care$ about meA @ve got no control over hat might doA @ cant control m" angerA* -88L#N/ P&0'L8M
o be able to manage +eel com+ortable around !eo!le and manage m" racing thought*
Sad J!$et ,ngr" &ot Seating and acing hought$
o be able to manage the +eeling$ and $"m!tom$ o+ anger to +eel more in control and able to co!e
'8AB#0;&AL P&0'L8M
'8AB#0;&AL /0AL
Shout at i+e / colleague$ ,void $eeing / $!eaing to i+e #orr"ing about it Moaning #ithdra 7ont $!ea Suling Short tem!ered ing i+e*
-88L#N/ /0AL
Be able to attend the engage ith !eo!le at ea$e ithout being orried about ho ma" react or i+ ill have a violent outbur$t*
20
C0/N#T#B8 #NT8&B8NT#0N
Cognitive e$tructuring ,nal"$ing common +ault" thining roblem Solving de+ine !roblem$ more clearl" and $!eci+icall" ith $et goal$ and develo! under$tanding a$ to h" thi$ i$ im!ortant Cognitive ,voidance Sa+et" Behaviour$ -88L#N/ #NT8&B8NT#0N $"cho (ducation anger re$!on$e$ and the role o+ avoidance in maintaining anger ela5ation techni6ue$ !rogre$$ive rela5ation '8AB#0;&AL #NT8&B8NT#0N hought ecord ,nger log ,voidance Behaviour$ and umination ,nger hierarch" Stre$$ inoculation !lan$ ,$$ertive $ill$ 7i$tre$$ olerance Sill$ and Co!ing Strategie$ ole !la"$ SM, ;oal$
Student Number - 12240294 -ig !:, 6 SMA&T /oals
/E$SUR$BE A my $"og"e th"o&gho&t the eion will #e mea&"ed &ing the $
$%$BE A I
RE$ST%A I am going to inc"eae the amo&nt of time that I $"actice> &e and "eco"d the co$ing t"ategie that I lea"n each we
T/E A -he ho"t te"m $lan i to inc"eae the time
21
Student Number - 12240294 8* #nterventions and Summar) o Treatment 0ered he !ro!o$ed treatment !lan a$ in+ormed b" the ,nger reatment rotocol .Novaco 19%? and the Cognitive hera!" o+ 7e!re$$ion rotocol .Bec u$h Sha and (mer" 19%9* hi$ a$ directed b" the a$$e$$ment hich highlighted to main di++icultie$E managing emotional regulation and !roblem $olving .See able 1*%* ,+ter the com!letion o+ the +ormulation$ the in+ormation a$ di$cu$$ed ith the client* :rom thi$ a collaborative deci$ion regarding the treatment !lan a$ made .See able 1*8 > 1*9*
Table !:. 6 Treatment Plans
Domain
Treatment Plan
Cognitive 7omain
Cognitive e$tructuring ,nal"$ing common +ault" thining roblem Solving - de+ine !roblem$ more clearl" and $!eci+icall" ith $et goal$ and develo! under$tanding a$ to h" thi$ i$ im!ortant Cognitive ,voidance Sa+et" Behaviour$ $"cho (ducation anger re$!on$e$ and the role o+ avoidance in maintaining anger ela5ation techni6ue$ !rogre$$ive rela5ation hought ecord ,nger log ,voidance Behaviour$ and umination ,nger hierarch" Stre$$ inoculation !lan$ ,$$ertive $ill$ 7i$tre$$ olerance Sill$ and Co!ing Strategie$ ole !la"$ SM, ;oal$ evie all o+ treatment !rogramme Blue!rint $ill$ and $e$$ion content denti+" high ri$ $ituation$ denti+" mo$t e++ective co!ing $trategie$ learned (ncourage !ractice o+ $ill$ +or continual develo!ment
:eeling 7omain
Behavioural 7omain
ela!$e revention
Table !: 6 Session Content
Treatment
Aims o treatment 6 Session content 22
Student Number - 12240294 Session
Se$$ion 1
•
•
• • • •
• • • •
Se$$ion 2
• • • • •
Se$$ion 3
• • • •
•
Se$$ion 4
• • • • •
•
•
,$$e$$ing diagno$tic criteria +or de!re$$ion to $ee i+ client$ +eature$ meet the diagno$i$* ,$$e$$ !roblem$ ith anger and ealou$" to $ee i+ client$ +eature$ meet the diagno$i$ +or !er$onalit" di$order or !er$onalit" di$order trait$* Client com!leted !$"chometric a$$e$$ment tool$ and tae SJ7S* ;athering general in+ormation about client* (5!lanation +rom client o+ hat i$ cau$ing hi$ di++icultie$* (5!ectation$ o+ the $e$$ion$ and !reviou$ e5!erience$ o+ thera!" ere di$cu$$ed* (5!lanation o+ Cognitive Behavioural hera!"* 7i$cu$$ed $ce!tici$m toard$ Cognitive Behavioural hera!"* n$tilling ho!e* rovided in+ormation to read +or homeor on hat Cognitive Behavioural hera!" i$ in general*
SJ7S to be taen +rom client* ;athering bacground in+ormation* Com!leted a li+eline o+ $igni+icant li+e event$* denti+ied !roblem$ and goal$* rovide in+ormation $heet +or homeor regarding de!re$$ion and anger and ho the" can be lined*
SJ7S to be taen +rom client ntroduction to the +ive $"$tem$ model Com!leted a to!ogra!hical anal"$i$ #hat i$ de!re$$ion i$ lie +or "ou and ho doe$ it +eel in "our bod"K (5!lain +unctional anal"$i$ ,BC and client thi$ +or homeor
SJ7S and !$"chometric a$$e$$ment$ to be taen +rom client* 7i$cu$$ need to com!lete homeor* Continue ith +ive $"$tem$ model* Com!leted a to!ogra!hical anal"$i$* #hat i$ anger / ealou$" i$ lie +or "ou and ho doe$ it +eel in "our bod"K Socratic 6ue$tioning to identi+" core belie+$ rule$ and a$$um!tion$* Set homeor o+ identi+"ing ho core belie+$ have im!acted behaviour*
23
Student Number - 12240294
Se$$ion ?
• • • • •
Se$$ion
• • • • •
• •
Se$$ion %
• • •
• • •
Se$$ion 8
• • • • • •
Se$$ion 9
• • • • • •
ae SJ7S +rom client evie homeor and !reviou$ $e$$ion :eedbac +ormulation to client Com!lete ,nger Ca$e :ormulation* Set homeor o+ ee!ing a diar" o+ negative thought$
ae SJ7S +rom client evie homeor and !reviou$ $e$$ion :eedbac +ormulation to client Com!lete Collaborative Ca$e :ormulation 7i$cu$$ed treatment o!tion$ and the rationale +or each treatment that a$ $ugge$ted a$ a re$ult o+ the +ormulation* 7ecided on SM, goal$* Com!lete !ro$ and con$ o+ having an angr" outbur$t +or homeor*
Client com!lete a$$e$$ment tool$ and tae SJ7S evie homeor and !reviou$ $e$$ion 7i$cu$$ anger a$ a normal emotion hat i$ anger and hat !ur!o$e doe$ it $erveK 7i$cu$$ rela5ation $trategie$ 7i$cu$$ $el+-monitoring o+ anger* :or homeor a$ client to de$cribe their +avourite rela5ing calming image or !icture*
ae SJ7S +rom client evie homeor and !reviou$ $e$$ion 7i$cu$$ ho high level$ o+ $tre$$ a++ect thining and behaviour* he !ur!o$e o+ rela5ation 7evelo!ment o+ rela5ation $trategie$ rovide client ith anger log +or homeor to record an" $ituation$ here the" +eel angr"*
ae SJ7S +rom client evie homeor and !reviou$ $e$$ion ,nger treatment deci$ion matri5 Co$t bene+it anal"$i$ Building on an anger hierarch" evie !rogre$$ive rela5ation and $et thi$ to !ractice +or homeor*
24
Student Number - 12240294
Se$$ion 10
• • • • •
ae SJ7S +rom client evie homeor and !reviou$ $e$$ion Continue to develo! the anger hierarch" ntroduction to $tre$$ inoculation !rocedure* ,$ client to continue to com!lete the anger log$*
Table !"1 6 -uture Session Content
Treatment Session
Se$$ion 11
Aims o treatment 6 Session content
• • • •
Se$$ion 12
• • • • • •
• •
Se$$ion 13
• • • •
•
•
Se$$ion 14
• • •
Client to com!lete a$$e$$ment mea$ure$ and tae SJ7S evie homeor and !reviou$ $e$$ion (5!lain and carr" out cognitive re$tructuring* :or homeor revie di++erent $ituation$ here the client ha$ +elt angr" and mae attem!t$ to !er$!ective tae*
Client com!leted a$$e$$ment tool$ and tae SJ7S evie homeor and !reviou$ $e$$ion 7i$cu$$ client$ +ault" thining 7i$cu$$ $ituation$ here +ault" thining occur$ Challenge N,$ to mae ,$ denti+" rating$ +or ho true the thought$ +elt at the time o+ the $ituation and at the time o+ cognitive re$tructuring Connect cognitive re$tructuring ith the client$ +ormulation (5!lain a thought record and !rovide +or homeor
ae SJ7S +rom client evie homeor and !reviou$ $e$$ion 7evelo! cognitive re$tructuring to include !er$!ective taing* 7i$cu$$ $cenario$ ith client and revie ho the" might co!e $ucce$$+ull"* 7i$cu$$ e++ectivene$$ o+ variou$ co!ing $trategie$ and role-!la" the$e* o$itive $el+-tal $et thi$ to !ractice +or homeor*
ae SJ7S +rom client evie homeor and !reviou$ $e$$ion evie and di$cu$$ !roblem $olving communication* 25
through
e++ective
Student Number - 12240294
• •
Se$$ion 1?
• • • • •
Se$$ion 1
• • •
•
• •
Se$$ion 1%
• • • • •
•
Se$$ion 18
• • • • • • •
Se$$ion 19
• • •
,$$ertive $ill$ di++erence beteen !a$$ive and aggre$$ive :or homeor $et the or$heet o+ e++ective communication in angr" $ituation$*
Client com!leted a$$e$$ment tool$ and tae SJ7S evie homeor di$cu$$ed h" it i$ im!ortant #or on $te!$ to !roblem $olving method 7evi$e an action !lan :or homeor a$ client to or on their action !lan*
ae SJ7S +rom client evie homeor and !reviou$ $e$$ion 7i$cu$$ dealing ith rumination and e$calation through attentional +ocu$* 7i$cu$$ h" u$ing co!ing $trategie$ i$ more di++icult in an e$calating $ituation* 7i$cu$$ $trategic ithdraal ,$ client to !ractice co!ing $trategie$ and record all tho$e that are u$ed*
Client com!leted a$$e$$ment tool$ and tae SJ7S evie homeor and !reviou$ $e$$ion 7i$cu$$ dealing ith re!eat !rovocation evie a!!ro!riate re$!on$e$ +or re!eat !rovocation evie ho to have le$$ aggre$$ive argument$ ithin relation$hi!$* ,$ client to com!lete the dealing ith anger incident$ !er$onal reminder $heet +or homeor*
Client com!leted a$$e$$ment tool$ and tae SJ7S evie homeor and !reviou$ $e$$ion 7i$cu$$ and role-!la"$ $a"ing Lno a$$ertivel"* 7i$cu$$ unhel!+ul belie+$ and a"$ o+ $a"ing Lno 7i$cu$$ dealing ith con$tructive and de$tructive critici$m* ole !la" giving each t"!e o+ critici$m :or homeor a$ client to revie hel!+ul and unhel!+ul thought$ in relation to critici$m*
Client com!leted a$$e$$ment tool$ and tae SJ7S* evie homeor and !reviou$ $e$$ion Com!lete the rela!$e !revention !lan 26
Student Number - 12240294
• •
Se$$ion 20
• • • •
•
Se$$ion 21
• • • •
(ncourage !ractice o+ $ill$ +or continual develo!ment Mae goal$ +or the homeor
ae SJ7S +rom the client evie homeor and !reviou$ $e$$ion* eca! on generic +ormulation com!leted eca! on $ome o+ $ill$ learned including !ro$ and con$ cognitive re$tructuring a$$ertivene$$ denti+" high ri$ $ituation$
Client com!leted a$$e$$ment tool$ and tae SJ7S* evie homeor and !reviou$ $e$$ion Com!lete the rela!$e !revention !lan (ncourage !ractice o+ $ill$ +or continual develo!ment
1" Literature &eview
he tem!e$tuou$ emotion o+ anger i$ a +eature o+ a ide$!read arra" o+ diagno$e$ .'oo! > Fundberg 1992E Novello Sho$" > :roehle 1992* he +undamental !roblem that individual$ tend to have hen $u++ering ith anger i$$ue$ i$ the inabilit" to regulate the emotion meaning that the initiation countenance and con$e6uence$ tran$!ire ithout a!t control$ .;old$tein > ;lic 1994* 7ue to anger o+ten being intertined ith other clinical i$$ue$ getting control +or behavioural change can be an intangible target .7r"den 198* =verall a$ anger +unction$ a$ a $entinel to $el+-e$teem it o+ten re$ult$ in interconnecting negative re$!on$e$ and can cau$e the individual to e5!erience de!re$$ive $"m!tom$ .enic Blac amm > Novaco 199% and #att > &oell$ 1999* er$i$tent anger i$ o+ten the re$ult o+ di++icult !a$t e5!erience$ and can undoubtedl" lead to d"$+unctional a"$ o+ a!!ortioning ith li+e$ encounter$ .Novaco > a"lor 2004 &an$ emin Machamer > 7imen 1999* he$e di++icultie$ o+ten cau$e individual$ to have !roblem$ ith !er$onal relation$hi!$ em!lo"ment and !h"$ical health .Mc'a" oger$ > Mc'a" 1989* hi$ a$ clearl" evidenced ith client ,* 27
Student Number - 12240294
hrough the $i5 main meta-anal"$e$ that have been carried out +or anger treatment$ in CB a moderate e++ect $i)e ha$ emerged .a+rate 199?E (dmond$on > Conger 199E Bec > :ernande) 1998E 7i;ui$e!!e > a+rate 2003E 7el Hecchio > =Fear" 2004* hi$ im!lie$ that a!!ro5imatel" %? o+ !eo!le ho undertae CB treatment +or anger demon$trate a $igni+icant change com!ared to tho$e in controlled condition$* &oever hen taing the$e +inding$ into account +urther $u!!ortive re$earch into thi$ area ould allo +or a more robu$t multi-model a$$e$$ment de$ign to be identi+ied .#att and &oell$ 1999* 7e$!ite the limited re$earch there are $everal non controlled ca$e $erie$ and ca$e $tud" re!ort$ that have been able to demon$trate e++ective CB treatment +or anger +or individual$ ith multi+ariou$ need$ .Novaco 199% > Stermac 198*
e$earch ha$ al$o $hon that individual$ ho have di++icultie$ in regulating their emotion$ have both cognitive and behavioural di++icultie$ .Bec > :ernande) 1998* :urthermore !eo!le ith anger/ealou$" !roblem$ o+ten e5!erience de!re$$ive $"m!tom$ in re$!on$e to their behaviour$ .Baer > #il$on 198?E Battle 1994* #ith the current client it a$ evident that he had both cognitive and behavioural di++icultie$* &oever ith regard$ to the treatment !lan it a$ a!!arent that due to the ri$$ that hi$ behaviour !o$ed it a$ +elt that it ould be more advantageou$ to or on the behavioural element +ir$t* he$e model$ ere $elected +or the current client a$ the" ere able to incor!orate treatment intervention$ that ere able to meet the client$ need$* t al$o alloed +or element$ o+ +le5ibilit" here !art$ o+ the Bec$ rotocol +or 7e!re$$ion could be introduced $o that the client and thera!i$t could re$!ond to all o+ the !re$enting !roblem$* #hen revieing the Bec$ rotocol +or 7e!re$$ion it a$ evident that a$!ect$ $uch a$ addre$$ing +ault" thining and cognitive re$tructuring ere able to overla! ith that o+ the ,nger reatment rotocol$ .Bla$h+ield 1990* he bene+it$ o+
28
Student Number - 12240294 u$ing to di++erent !rotocol$ ith co-morbid client$ allo$ +or more !roblem directed $olution$ .Cain 198%E a"el et al* 1999E Scott et al* 2002*
n line ith thi$ it $hould al$o be noted that hil$t the client demon$trated ith a co-morbid !roblem the underline i$$ue$ that emerged through the longitudinal +ormulation$ $ugge$t that hi$ !roblem$ ere all in $ome a" connected* ,$ a re$ult it a$ h"!othe$i$ed that a$ one a$!ect o+ the !roblem i$ treated it ill al$o hel! to alleviate other !re$enting $"m!tom$ .&un$le" Crabb > Ma$h 2004* hi$ e5!lain$ h" it i$ not nece$$ar" to com!lete to +ull treatment !rotocol$ +or each !re$enting !roblem a$ not onl" ould it be re!etitive but ma" not be an" more e++ective .Mahone" 1993E Fochman 198?*
,lthough the develo!ment o+ the client over the !a$t ten $e$$ion$ o+ thera!" a$ evident and it a$ a!!arent that the correct !rotocol$ ere +olloed there ere other noteorth" model$ that ere not u$ed* :or e5am!le the Jni+ied rotocol +or the ran$diagno$tic reatment o+ (motional 7i$order$ .Barlo et al* 2004* , +undamental +eature o+ thi$ model involve$ the u$e o+ underl"ing treatment ideologie$ o+ change that overla! di++erent treatment $t"le$ and diagno$tic cla$$i+ication$ .Bo$ell > ;old+ried 2010E Norcro$$ 200?* More $!eci+icall" thi$ tran$diagno$tic ideolog" i$ +ocu$ed on emotion and can be a!!lied to an" di$order that encom!a$$e$ a !rotuberant emotional con$tituent +or e5am!le mood di$order$ .Barrett Me$6uita =ch$ner > ;ro$$ 200%* he aim o+ thi$ t"!e o+ thera!" i$ to +ocu$ on de+icit$ in emotional regulation .Mennin &eimberg ur > :re$co 200%E ;reenberg 2008* ,$ a re$ult thi$ t"!e o+ thera!" aim$ to increa$e individual$ aarene$$ o+ their emotion$ and ho thi$ aarene$$ can change behaviour$ .;reenberg 2002a* ,lthough $ome a$!ect$ o+ thi$ model ould a!!ear to bene+it the current client there ere al$o a$!ect$ o+ it that did not meet 29
Student Number - 12240294 the client$ need$* #hil$t more recentl" the evidence ba$e +or CB ha$ been criti$i$ed .Nathan > ;orman 200% their e++ectivene$$ in treating $!eci+ic di$order$ i$ ver" good .a+rate 199?E (dmond$on > Conger 199E Bec > :ernande) 1998E 7i;ui$e!!e > a+rate 2003E 7el Hecchio > =Fear" 2004*
#ith regard$ to !articular intervention$ u$ed ith the current client one o+ the main +ocu$e$ a$ on $tre$$ inoculation +or anger control .Meichenbaum 198?* he conce!t o+ thi$ involve$ teaching cognitive behavioural co!ing techni6ue$
.(man 2003* 7uring thi$
training the individual learned to identi+" their on trigger$ +or anger and ho to deal ith thi$ e++ectivel" hen it occur$ .Sha!iro 1994E Find$a" =verend ,llan #illiam$ Blac 1998* hi$ !roce$$ i$ $imilar to that o+ $ocial $ill$ and a$$ertion training .Fiberman 7ei$i and Mue$er 1989* B" e5!ending a methodical a!!roach to !roblem $olving hen e5!eriencing anger individual$ are more able to e++ectivel" manage $ituation$ .Novaco 19%8* n $ummar" the $tre$$ inoculation a!!roach to treatment ha$ been +ound to be e++ective ith a ide range o+ !o!ulation$ .Novaco 1994b a+rate 199? (dmond$on and Conger 199 Bec and :ernande) 1998 a"lor 2002E Siddle
,enat 2003*
!2"
&elections
=ver the cour$e o+ thera!" that ha$ been carried out ith , $o +ar $igni+icant time ha$ been $!ent re+lecting on the content that ha$ been covered* =ne o+ the main !oint$ that emerged during m" on re+lection a$ that it a$ ver" im!ortant to di$tingui$h the lin beteen the to !re$enting !roblem$ o+ the client and ho the$e can be connected over the cour$e o+ hi$ li+e $!an* =verall the client$ re$!on$e$ to $ituation$ hich cau$e him to become angr" have
30
Student Number - 12240294 changed and he ha$ been able to learn more e++ective $ill$ +or regulating hi$ emotion$* ,$ a re$ult thi$ ha$ decrea$ed hi$ de!re$$ive $"m!tom$*
7uring thera!" there ere $ome !roblem$ that ere encountered* hroughout the $e$$ion$ the client a!!eared to be reluctant to com!lete homeor* Some o+ the rea$on$ that he !rovided +or not com!leting the homeor ere that he +ound it too di++icult he did not +ind the time ithin hi$ ee or that hi$ handriting a$ not ver" good* he$e i$$ue$ ere then rai$ed during the thera!" $e$$ion$* +ound that b" addre$$ing thi$ ithin thera!" e ere able to develo! an action !lan to or on thi$* B" doing thi$ a$ able to hel! overcome thi$ !roblem collaborativel" ith the client hil$t $till alloing him to under$tand the bene+it$ o+ com!leting homeor* nitiall" +ound that a$ getting +ru$trated hen the client a$ attending $e$$ion$ ithout having com!leted the homeor !reviou$l" $et b" oring through thi$ !roblem could deal ith m" on +ru$tration$ a$ ell*
,dditionall" ithin thera!" at time$ +ound it di++icult to em!athi$e ith the client* +ound that hen he a$ u$ti+"ing $ome o+ hi$ behaviour$ $uch a$ verbal aggre$$ion toard$ hi$ i+e the$e idea$ contradicted ith m" on !er$onal value$* +ound that m" !er$onal +eeling$ toard$ him at time$ ere ver" negative and thi$ a$ $omething a$ able to or on ithin m" $u!ervi$ion* B" bring thi$ to $u!ervi$ion a$ able to develo! a"$ o+ communicating m" vie$ to him in a con$tructive manner* al$o +ound that b" ee!ing a diar" about m" e5!erience$ a$ able to vent m" +ru$tration$ and e5!re$$ m" thought$ about our $e$$ion$ hich hel!ed immen$el"* al$o a$ able to reali$e that could com!lete e++ective CB even hen did not !er$onall" lie the client*
31
Student Number - 12240294 #ith regard$ to m" overall !ractice hen re+lecting on m" or a$ able to identi+" that during the concrete e5!erience $tage o+ 'olb$ Fearning C"cle .1984 a$ able to a!!l" m" academic under$tanding into !ractice b" ada!ting theorie$ to en$ure the thera!" carried out a$ individuali$ed* :olloing on +rom thi$ during the re+lective ob$ervation $tage a$ able to identi+" both the !o$itive and negative a$!ect$ o+ the thera!" hich contributed to the +ormation o+ the $e$$ion$* :or e5am!le a+ter com!leting the +ormulation $tage ith the client a$ able to identi+" that anger ealou$" and de!re$$ion ere the !roblem$ that ere cau$ing the client the mo$t concern* B" u$ing thi$ in+ormation hen revieed the literature a$ able to cla$$i+" model$ +or thera!" that a!!lied to the client$ need$* 7uring the ab$tract conce!tuali$ation $tage o+ m" learning +ound that revieing a$!ect$ o+ the $e$$ion$ that could have been carried out di++erentl" a$ ver" hel!+ul* ,dditionall" throughout the cour$e o+ the client$ thera!" +ound that a$ u$ing re+lection through active e5!erimentation* di$covered that b" regularl" revieing m" !ractice alloed me to generate idea$ +or ho to im!rove m" com!etencie$ in carr"ing out CB ith client$*
!!"
Conclusion
he ide-ranging conclu$ion regarding the outcome$ o+ CB +or ,nger and 7e!re$$ion ba$ed on model$ b" Novaco .19%? and Bec .19%9 !ro!o$e !romi$ing re$ult$* More recentl" re$earcher$ have begun to divert their attention toard$ CB a$ a treatment +or anger and have been able to $u!!ort CB a$ e++ective in thi$ .(dmond$on > Conger 199E enic et al* 199%E Bec > :ernande) 1998E #att > &oell$ 1999E 7"er 2000E 7e++enbacher et al* 2000E 7i;iu$e!!e > a+rate 2003E Siddle et al* 2003E 7el Hecchio > =Fear" 2004* , revie o+ the literature b" a+rate .199? demon$trated that o+ ?0 $tudie$ o+ 140 !artici!ant$ an e++ect $i)e o+ 0*%0 a$ e$tabli$h* hi$ $ugge$ted that overall moderate treatment gain$ ere accom!li$hed ithin thera!"* #ithin the$e $tudie$ a ver" 32
Student Number - 12240294 diver$e grou! o+ !eo!le ere u$ed* Sub$e6uentl" the e++ectivene$$ o+ CB +or anger can be generali$ed acro$$ $everal !o!ulation$ .:ernande) > Bo"le 199E ;la$$ Mc;a > Smith 1981E o$enthal 1991* he$e outcome$ are con$i$tent ith +urther meta-anal"$e$ authenticating the e++ectivene$$ o+ CB .7ob$on 1989E Han Balom et al* 1994* n line ith the$e re$earch +inding$ the current ca$e $tud" +olloed the$e CB model$ o+ treatment in order to overcome the client$ !roblem$*
#hil$t recogni$ing the !o$itive re$ult$ demon$trated b" the current ca$e $tud" $o +ar the limitation$ o+ the treatment cannot go unnoticed* he treatment aim$ to la$t +or tent"-one ee$ o+ one-hour $e$$ion$ rather than the recommended telve ee$ o+ an hour and a hal+ +or thi$ !rotocol* hi$ i$ due to the +unctioning level o+ the client element$ o+ to di++erent !rotocol$ being u$ed and the com!le5itie$ o+ the comorbid !roblem$ that the client !re$ent$ ith* Moreover a$ the treatment ha$ not "et been com!leted no rela!$e !revention !lan or +ollo u! $e$$ion$ have been arranged* &oever at the current $tage it i$ a!!arent that the client$ vie$ o+ him$el+ other$ and the orld around him are beginning to change*
:or +uture re$earch regarding CB and the treatment o+ anger !rinci!all" b" 7e++enbacher et al* .2000 > Fochman > Fenhart .1993 it i$ liel" that +urther develo!ment$ ill enhance the e++ectivene$$ o+ the !rogramme$ that are made available* S!eci+icall" hen evaluating their e++ectivene$$ it ma" be intere$ting +or +uture $tudie$ to !a" +ocu$ to !articular variable$ $uch a$ $el+-e++icac" abilit" to control urge$ and im!ul$ivit"* B" +ocu$ing on $!eci+ic variable$ ithin treatment it ould allo +or more $!eciali$t !rogramme$ to become available hich ould be able to +ocu$ more directl" on individual$ need$* ;enerall" ,$ diagno$i$ deemed him $uitable +or CB* he thera!" a!!ear$ to have had a !o$itive im!act on the client$ thought$ +eeling$ and behaviour* hroughout the initial $e$$ion$ the mo$t 33
Student Number - 12240294 im!ortant maintenance +actor$ regarding the client$ !roblem$ ere em!ha$i$edE hich a$ able to +ormulate the treatment a!!lied* hi$ ha$ been able to contributed to the client beginning to achieve hi$ goal$ +or thera!"*
!$"
&eerences
,merican $"chiatric ,$$ociation .,,* .200* Diagnostic And Statistical Manual Of Mental Disorders. #a$hington 7*C*O ,merican $"chiatric ubli$hing re$$*
Baer ,* F* > #il$on * &* .198?* Cognitive Behavioural hera!" :or 7e!re$$ionO he (++ect$ =+ Boo$ter Se$$ion$ =n ela!$e* Behaviour Therapy* 1 33?-344*
Barlo 7* &* ,llen F* B* > Choate M* F* .2004* oard , Jni+ied reatment :or (motional 7i$order$* Behaviour hera!" 3? 20?e230*
Barrett F* : Me$6uita B* =ch$ner '* > ;ro$$ <* <* .200%* he (5!erience =+ (motion* Annual Review Of Psychology ?8 3%3-403*
Battle <* .1992* Culture!ree And Self"stee# $nventories %&nd "d.'( ")a#iner* S Manual. ,u$tin e5a$O ro-(d*
34
Student Number - 12240294 Battle <* .1994* Pro#oting Self"stee#( Achieve#ent And +ell Being, An "ffective $nstructional Curriculu# !or All -evels. (dmonton ,lbertaO
Bec * :ernande) (* .1998* Cognitive Behaviour hera!" n he reatment =+ ,ngerO , Meta-,nal"$i$* Cognitive Therapy And Research 22 3%4*
Bec ,** .1983* Cognitive hera!" =+ 7e!re$$ionO Ne er$!ective$* n *<* Cla"ton ,nd <*(* Barrett .(d$ Treat#ent Of Depression, Old Controversies And ew Approaches. Ne PorO aven re$$* !* 2?-84*
Bec ,** u$h ,*<* Sha B*:* > (mer" ;* .19%9* Cognitive hera!" =+ 7e!re$$ion* Ne PorO ;uil+ord re$$*
Bec ,* * Steer * ,* > Bron ;* '* .199* The Bec/ Depression $nventory0Second "dition. San ,ntonio QO he $"chological Cor!oration*
Bec ,** .198%* Cognitive Model$ =+ 7e!re$$ion* 1ournal Of Cognitive PsychotherapyO ,n nternational Ruarterl"E 1O?3%*
35
Student Number - 12240294 Bla$h+ield * '* .1990* Comorbidit" ,nd Cla$$i+ication* n <* 7* Ma$er > C* * Cloninger .(d$* Co#or2idity Of Mood And An)iety Disorders .!* 410* #a$hington 7CO ,merican $"chiatric re$$*
Cain <* ,* .198%* ,nger ControlO , Com!ari$on =+ Cognitive-Behavioural ,nd ela5ation raining #ith o$t-reatment :ollo-J! .7octoral 7i$$ertation Jnited State$ nternational Jniver$it" 198%* DisSertation A2stracts $nternational3 453 1804-180?*
Ca$tongua" F* ;* ;old+ried M* * #i$er S* aue * <* &a"e$ ,* M* .199* redicting he (++ect =+ Cognitive hera!" :or 7e!re$$ionO , Stud" =+ Jni6ue ,nd Common :actor$* 1ournal Of Consulting And Clinical Psychology* 4O49%?04*
Covin * =uimet ,*<* Seed$ *M* 7o)oi$ 7*<* .2008* , Meta-,nal"$i$ =+ CB :or athological #orr" ,mong Client$ #ith ;,7* 1ournal Of An)iety Disorders* 22O10811
7erubei$ * <* &ollon S* 7* ,m$terdam <* 7* Shelton * C* Poung * * Salomon * M* .200?* Cognitive hera!" H$* Medication$ n he reatment =+ Moderate o Severe 7e!re$$ion* Archives Of 6eneral Psychiatry7 2O40941*
7e++enbacher <* F* 7ahlen (* * F"nch * S* Morri$ C* 7* > ;oen$mith #* N* .2000* ,n ,!!lication =+ Bec$ Cognitive hera!" o ;eneral ,nger eduction* Cognitive Therapy And Research( &4 89-9%* 36
Student Number - 12240294
7el Hecchio * =Fear" '* 7* .2004* he (++ectivene$$ =+ ,nger reatment$ :or S!eci+ic ,nger roblem$O , Meta-,nal"tic evie* Clinical Psychology Review 24 1?34
7igiu$e!!e * a+rate * .2003* ,nger reatment :or ,dult$O , Meta-,nal"tic evie* Clinical Psychology, Science And Practice 10 %084*
7igiu$e!!e * a+rate * (chardt C* .1994* Critical $$ue$ n he reatment =+ ,nger* Cognitive And Behavioural Practice. 1O 111-32*
7igiu$e!!e * a+rate * .2003* ,nger reatment :or ,dult$O , Meta-,nal"tic evie* Clinical Psychology, Science And Practice 10 %084*
7ob$on '* S* .1989* , Meta-,nal"$i$ =+ he (++icac" =+ Cognitive hera!" :or 7e!re$$ion* 1ournal Consulting Clinical Psychology* ?%O414-9*
7r"den #* .198* =vercoming ,nger* FondonO Sheldon re$$*
7"er * .2000* Cognitive Behavioural ;rou! ,nger Management :or =ut-atient$O , etro$!ective Stud"* $nternational 1ournal Of Psychiatric ursing Research( 8 02-21* 37
Student Number - 12240294 (dmond$on C* B* Conger C* .199* , evie =+ reatment (++icac" :or ndividual$ #ith ,nger roblem$O Conce!tual ,$$e$$ment ,nd Methodological $$ue$* Clinical Psychology Review 1 2?1 2%?*
(man * .2003* (motion$ evealedO Jnder$tanding :ace$ ,nd :eeling$* FondonO hoeni5*
:ernande) (* > Bo"le ;* <* .199* Meta-,nal"tic rocedure ,nd nter!retation =+ reatment =utcome ,nd e$t Halidit" :or he ractitioner $"chologi$t* n M* Smith > H* Sutherland .(d$* $nternational Review Of Professional $ssues $n Selection And Assess#ent .Hol* 2 !* 109-12?* Chiche$ter J'O #ile"*
;la$$ ;* H* Mcga B* > Smith M* F* .1981* MetaAnalvsis $n Social Research. Beverl" &ill$ C,O Sage*
;lic B* > ;old$tein ,* * .198%* ,ggre$$ion e!lacement raining* 1ournal Of Counselling And Develop#ent3 983 3?-32*
;reenberg F* S* .2002a* (motion-:ocu$ed hera!"O Coaching Client$ o #or hrough heir :eeling$* #a$hington 7CO ,merican $"chological ,$$ociation*
38
Student Number - 12240294 ;reenberg F* S* .2008* (motion ,nd Cognition n $"chothera!"O he ran$+orming oer =+ ,++ect* Canadian Psychology 49 49?9*
&ab" M* M* 7onnell" M* Corr" <* Ho$ * .200* Cognitive Behavioural hera!" :or 7e!re$$ion anic 7i$order ,nd ;enerali)ed ,n5iet" 7i$orderO , Meta-egre$$ion =+ :actor$ hat Ma" redict =utcome* Australian 1ournal of Psychiatry. 40.1O 919*
&an$ * emin N* Machamer <* > 7imen S* .1999* (motional ,nd Behavioural ,du$tment* Archive Physical Medical Reha2ilitation. 80O 991-%*
&oell C* Beilb" <* urnbull 7* Brigg$ N* Mar$hall C* Nebur" #* .2008* reventing ela!$e =+ 7e!re$$ion n rimar" CareO , ilot Stud" =+ he L'ee!ing he Blue$ ,a" rogram* Medical 1ournal Australia.188OS13841*
&un$le" <* <* Crabb * > Ma$h (* <* .2004* (vidence-Ba$ed Clinical ,$$e$$ment* The Clinical Psychologist( 8: .3 2?32*
&unot H* Churchill * 7e Fima M* Silva ei5eira H* .200%* $"chological hera!ie$ :or ;enerali$ed ,n5iet" 7i$order* Cochrane Data2ase Syste#atic Review.
39
Student Number - 12240294 'olb 7* ,* .1984* (5!eriential Fearning (5!erience ,$ , Source =+ Fearning ,nd 7evelo!ment Ne
'oo! C* (* > Fundberg ;* B* .1992* Hiolence n ,mericaO , ublic &ealth (mergenc"* ime o Bite he Bullet Bac* 1ournal Of The A#erican Medical Association( &9: 30%? 30%*
'u"en #* ade$" C* > 7udle" * .2009* Collaborative Ca$e Conce!tuli$ationO #oring (++ectivel" #ith Client$ in Cognitive Behavioural hrea!"* Ne PorO he ;uild+ord re$$*
Fiberman * 7eri$i #* > Mue$er '* .1989* Social Sill$ raining :or $"choiatric atient$* Bo$tonO ,ll"n Bacon*
Find$a" #* =verend &* ,llan * #illiam$ C* Blac F* .1998* J$ing S!eci+ic ,!!roache$ :or ndividual roblem$ n he Management =+ ,nger ,nd ,ggre$$ion* British 1ournal Of -earning Disa2ilities* 2O44-?0*
Fochman <* (* .198?* (++ect$ =+ 7i++erent reatment Fength$ n Cognitive-Behavioural ntervention$ #ith ,ggre$$ive Bo"$* Child Psychiatry And ;u#an Develop#ent "nt3 <93 4??* 40
Student Number - 12240294
Fochman <* (* > Fenhart F* ,* .1993* ,nger Co!ing ntervention :or ,ggre$$ive ChildrenO Conce!tual Model$ ,nd =utcome (++ect$* Clinical Psychology Review3 13 %8?80?*
Mahone" M* .1993* heoretical 7evelo!ment$ n he Cognitive $"chothera!ie$* 1ournal Of Consulting And Clinical Psychology 1 18%-193*
Mca" M* oger$ * > Mca" <* .1989* #hen ,nger &urt$O Ruieting he Storm #ithin* =aland C,O Ne &arbinger re$$*
Meichenbaum 7* .198?* Stre$$ noculation raining* Ne PorO ergamon re$$*
Mennin 7* S* &oloa" * M* :re$co 7* M* Moore M* * > &eimberg * ;* .200%* 7elineating Com!onent$ =+ (motion ,nd t$ 7"$regulation n ,n5iet" ,nd Mood $"cho!atholog"* Behaviour Therapy 38 284e302*
Mitte * .200?* Meta-,nal"$i$ =+ Cognitive-Behavioural reatment$ :or ;enerali)ed ,n5iet" 7i$orderO , Com!ari$on #ith harmacothera!"* Psychology Bulletin* 131O%8?-9?*
41
Student Number - 12240294 Nathan * (* > ;orman <* M* .(d$** .200%* , ;uide o reatment hat #or$* Fondon* =5+ord Jniver$it" re$$*
NC( .2011* ,nti$ocial er$onalit" 7i$order reatment Management ,nd revention* National n$titute :or Clinical (5cellence .NC( Clinical ;uideline C;%%* ;a$ell ,nd he Briti$h $"chological Societ" O Fondon*
Norcro$$ <* C* Beutler F* (* > Fevant * :* .(d$** .200?* (vidence- Ba$ed ractice$ n Mental &ealthO 7ebate ,nd 7ialogue =n he :undamental Rue$tion$* #a$hington 7CO A#erican Psychological Association *
Novaco * #* .19%?* ,nger ControlO he 7evelo!ment ,nd (valuation =+ ,n (5!erimental reatment* Fe5ington M,O 7*C* &ealth*
Novaco * #* > a"lor <* .2004* ,$$e$$ment =+ ,nger ,nd ,ggre$$ion n Male =++ender$ #ith 7evelo!mental 7i$abilitie$* Psychological Assess#ent. 1O 42-?0
Novaco * #* .1994* ,nger ,$ , i$ :actor :or Hiolence ,mong he Mentall" 7i$ordered* nO =iolence And Mental Disorder, Develop#ents $n Ris/ Assess#ent !* 210* ChicagoO Jniver$it" =+ Chicago re$$*
42
Student Number - 12240294 Novaco * #* .19%8* Therapist Manual !or Stress $noculation Training. Therapeutic $nterventions !or Anger Pro2le#s. Jniver$it" =+ Cali+orniaO rvine*
Novaco * #* .19%?* reatment =+ Chronic ,nger hrough Cognitive ,nd ela5ation Control$* 1ournal Of Consulting And Clinical Psychology( 48 00-08
Novaco * #* .199%* emediating ,nger ,nd ,ggre$$ion #ith Hiolent =++ender$* -egal And Cri#inological Psychology. 2O %%-88*
Novaco * #*.2003* he Novaco ,nger Scale ,nd rovocation nventor" .N,S-* Fo$ ,ngele$O #e$tern $"chological Service$*
Novello ,* Sho$" S* > :roehle * .1992* :rom he Surgeon ;eneral J*S* ublic &ealth ServiceO , Medical e$!on$e o Hiolence* 1ournal Of The A#erican Medical Association3 &9:3 300%*
ade$e" C* ,* ;reenberger 7* .199?* Clinician$ ;uide o Mind =ver Mood* FondonO ;uil+ord re$$*
a"el (* S* Scott <* ea$dale <* 7*
Student Number - 12240294 e$idual 7e!re$$ion B" Cognitive hera!"O , Controlled rial* Archives Of 6eneral Psychiatry. ? 82983?*
enic S* Blac F* amm M* Novaco * #* .199%* ,nger reatment :or :oren$ic &o$!ital atient$* -egal And Cri#inological Psychology 2 10311*
o$enthal * .1991* Meta-,nal"tic rocedure$ :or Social e$earch3 Nebur" ar C,O Sage
Sander$ 7* > #ill$ :* .200? Cognitive hera!" .2nd (dition* FondonO S,;(*
Scott <* .2002* =vercoming Mood Sing$* FondonO Con$table obin$on
Sha!iro 7* ,* Barham M* ee$ ,* &ard" ;* ,* e"nold$ S* > Startu! M* .1994* (++ect$ =+ reatment 7uration ,nd Severit" =+ 7e!re$$ion =n he (++ectivene$$ =+ Cognitive-Behavioural ,nd $"chod"namic-nter!er$onal $"chothera!"* 1ournal Of Consulting And Clinical Psychology 2 ?22?34*
44
Student Number - 12240294 Siddle *
Sinner B* :* .19?3* Science And ;u#an Behaviour. Ne PorO Macmillan*
Stermac F* (* .198* ,nger Control reatment :or :oren$ic atient$* 1ournal Of $nterpersonal =iolence3 <3 44-4?%*
Strun 7* * 7erubei$ * <* Chiu ,* #* > ,lvare) <* .200%* atient$ Com!etence n ,nd er+ormance =+ Cognitive hera!" Sill$O elation o he eduction =+ ela!$e i$ :olloing reatment :or 7e!re$$ion* 1ournal Of Consulting And Clinical Psychology %? ?23-?30*
a+rate * C* .199?* (valuation =+ reatment Strategie$ :or ,dult ,nger 7i$order$* n &* 'a$$inove .(d* Anger Disorders, Definition3 Diagnosis3 And Treat#ent .! 109-130* #a$hington 7CO a"lor > :ranci$*
a"lor <* .2002* , evie =+ he ,$$e$$ment ,nd reatment =+ ,nger ,nd ,ggre$$ion n =++ender$ #ith ntellectual 7i$abilit"* 1ournal Of $ntellectual Disa2ility Research. 4O ?%-%3*
45
Student Number - 12240294 Han Balom ,* <* F* M* Han =!!en * Hermeulen ,* #* ,* Han 7"c * Nauta M* C* (* > Hor$t &* C* M* .1994* , Meta-,nal"$i$ =n he reatment =+ =b$e$$ive Com!ul$ive 7i$orderO , Com!ari$on =+ ,ntide!re$$ant$ Behaviour ,nd Cognitive hera!"* Clinical Psychology Review3 <43 3?9-381
#att B* 7* > &oell$ '* .1999* Sill$ raining :or ,ggre$$ion ControlO (valuation =+ ,nger Management rogramme :or Hiolent =++ender$* -egal And Cri#inological Psychology 4 28?-300*
!%" Transcri(ts
he +ir$t +ive minute$ o+ the $e$$ion ere $!ent com!leting the !$"chometric a$$e$$ment$ T hera!i$t C T Client ?% minute$ and 44 $econd$ !lu$ ? minute$ com!lete the !$"chometric a$$e$$ment$ be+ore the $e$$ion* S(eaker
Session Berbatim
CTS7& Skills
= alright $o $hould e $tart b" ma"be $etting an agenda +or toda"$ $e$$ion
C
;o on
$o u$t that e ind o+ no here e are going ith it*
(rm i$ there an"thing that "ou anted to bring to the erm $e$$ion
46
Comments = &elections
,genda Setting
B" $tarting the $e$$ion $etting an agenda it give$ $tructure to the $e$$ion*
Collaboration
B" a$ing the client i+ there i$ an"thing the" ould lie to bring a$ able to en$ure that it i$ not u$t me
Student Number - 12240294 engaging in the $e$$ion* C
No not toda" $orr"
Nothing in !articular
C
No
= $o ma"be "ou could have a thin about that
o $o ma"be e can have a loo at the homeor
C
No havent dont it have been naught"
= $o e can tal about that
C
ight
So e can tal about that that can be the +ir$t thing e tal about
(rm and ma"be loo over hat e did la$t ee do "ou remember do "ou remember hat e did la$t ee*
C
(rm "eah and no to be hone$t
= ell e can loo at that
C
Peah
,nd a$ thining o+ erm continuing on ith the +ormulation $tage here e ere maing a !icture maing $en$e o+ hat e have been doing
So la$t ee e $!oe about the de!re$$ion $ide o+ thing$ $o ma"be thi$ ee e could loo more on the ealou$" angr" $ort o+ $ide
7o "ou thin that ould be oK
C
Peah that i$ +ine
&omeor
evie the !reviou$ ee$ homeor*
,genda Setting
rioriti$ing hat order thing$ ill be done in
:eedbac
B" a$ing the client their o!inion regarding hat ha$ been $aid am able to con+irm that the" agree
hen e can tal about the homeor and $ee here e are ith that that$ +ine
&omeor $etting
B" !lacing the $etting o+ the homeor on the agenda it en$ure$ that it i$ com!leted
= $o +ir$t thing hat hat ha!!ened ith the homeor hat ent hat ent rong
,genda $etting
&ighlighting to the client the +ir$t item on the agenda
C
(rm dont no to be hone$t didnt thin about
47
Student Number - 12240294 doing it dont no h" u$t dunno
= erm do "ou remember hat it a$K
C
No dont to be hone$t havent looed at it
Pou dont remember hat it a$
+ $aid to "ou an ,BC ould "ou hat ould "ou
C
Peah an ,BC "eah that$ $omething to do ith it
= $o hen $a" ,BC to "ou hat doe$ that mean
C
learned it hen a$ to
C
.Faugh
= $o "ou brought the $heet ith "ou that$ a good thing$ $o "ou havent lo$t it
C
!ut it on the $ide and to be hone$t u$t le+t it loo at it a cou!le o+ time$ !robabl" looed at the !a!er not o!ened it u! and u$t thought ve got to do it but
#hat do "ou thin made it di++icult to do it
C
(rm dont no !robabl" didnt no hat to !ut don
Not reall" $ure hat to !ut
C
Peah "eah
=
#e can loo at that
(rm .!au$e no "ou $aid be+ore e le+t la$t ee erm "ou ere a bit ind o+ an5iou$ a bit orried about doing thi$
C
Peah "eah
#a$ it becau$e it a$ a bit too it +elt a bit too much hat a$ it that made "ou +eel an5iou$ about it*
C
(rm dont no u$t +elt an5iou$ about it +elt a but $ill" la$t ee to be hone$t becau$e "ou a$ taling and a$ li$tening but a$nt and
hat $ometime$ ha!!en$ to u$ though
C
Peah "eah it ha!!en$ 6uiet a lot
48
nter!er$onal e++ectivene$$
roviding the client ith !o$itive rein+orcement
Student Number - 12240294 C
.laugh
#hich i$ e5actl" h" "ou are here
C
Peah
So did "ou +ind hat $o let$ $tic ith that +or a minute did "ou +eel "ou ere beating "our$el+ u! about it or hat
C
(rm !robabl" +or a little hile but
#hat hat ere "ou doing in that little hile
C
#a$ there an" !art o+ "ou that a$ thining $houldnt be +eeling thi$ a" there i$ no rea$on +or me to +eel thi$ a" or a$ it more that "ou ere u$t ind o+ tr"ing to blan it out and avoid it*
C
(rm thin !robabl" u$t blaned it out and avoided it
= ho di++icult .erm ould it be +or "ou no to thin to thin @it didnt reall" matter it a$nt a $igni+icant !art o+ m" li+e it a$nt going to mae an" di++erenceA ho di++icult i$ it +or "ou to thin lie thatK
C
Sometime$ it it can thin that a" and other time$ cant it u$t !la"$ on m" mind and !la"$ on m" mind and dont no h"
=
.erm hat do "ou thin a$ triggering "ou having that ind o+ blan mind la$t ee and not being able to +ocu$ too much*
C
robabl" hen "ou are taling to me !robabl" had $omething to $a" but didnt manage to get it out and then it a$ u$t going over and over in m" head
#hat a$ it that made it di++icult +or "ou to get it out
C
dont no !robabl" didnt +eel a$ though it come u! in the right conver$ation to be able to bring it in
=
C
7o "ou no hat mean
49
(liciting e" cognition$
($tabli$hing hat the client a$ +eeling hen in an an5iou$ $ituation
(liciting behaviour$
($tabli$hing hat the client a$ doing at the time o+ +eeling an5iou$
(liciting e" cognition$
,$ing the client about their thought$
Student Number - 12240294
Peah that mae$ $en$e
C
ather than u$t be taling and then ill go totall" o++ about $omething el$e and then u$t +elt a bit $ill" and then tr"ing to get it in to
thin it i$ reall" im!ortant +or u$ to be able to hear ever"thing that "ou have got to $a" a$ "ou are the e5!ert o+ "our !roblem and actuall" hat "ou have got to $a" i$ reall" reall" im!ortant
C
Peah
So thin ma"be e could come u! ith $ome $trategie$ here i+ "ou thin "ou have $omething that "ou
C
eall" $hould rite it don but am not ala"$ in the !o$ition to be able to do that might be u! a $ca++old and am oring aa" and $ometime$ m" mind i$ doing a hundred mile$ an hour and im ith it a$nt reall" ith it toda" thi$ a+ternoon $o made a cou!le o+ $ill" mi$tae$ nearl" +ell o++ a cou!le o+ time$
#hen hat a$ maing "ou aare that "ou a$nt reall" ith it toda"
C
dont no it a$ .erm
#hat did that +eel lie hat a$ going through "our mind
C
#h" do "ou thin it a$ that "ou couldnt concentrate
C
.erm dont no ma" !robabl" an5iou$ about coming here on m" mind
=
C
(rm that hadnt dont thi$ a$ !robabl" there and that and obviou$l" lie toda" i$ lie that da" lie d da"
Peah mean one thing about the homeor i$ that the rea$on e give homeor i$ becau$e !racticing the$e thing$ mae$ !er+ect
C
Peah "eah
50
nter!er$onal e++ectivene$$
Building a ra!!ort ith the !atient
;uided di$cover"
,$ing the client 6ue$tion$ to hel! them under$tand hat a$ going on ith them*
(liciting e" cognition$
&el!ing the client to recogni)e their thought$
&omeor $etting
7i$cu$$ing the bene+it$ o+ homeor $etting
Student Number - 12240294
So +or u$ it i$ "ou are able to move a lot 6uicer in the !roce$$ i+ "ou !ractice them mean "ou no that in "our ob "ou mu$t have had to have done a lot o+ !ractice to get to the $tage that "ou are at no
C
Peah onl" .erm have been collage +or to ee$ and then +or 4 da"$ to do hat am doing no
So mainl" all o+ it i$ !ractical !ractice
C
Peah "eah and in cant cant go no +urther than hat am ell can u$t go in the o++ice or $u!ervi$ing but am a$ good a$ "ou no lie that
Peah
C
But
mean it $ound$ lie "ou are ver" noledgeable about "our ob and "ou no hat "ou are doing and "ou are +ocu$ed
C
Peah
C
am entitled to be have been doing it +or long enough
(5actl"
C
have been doing it +or 2% "ear$
2% "ear$ $o "ou mu$t no a +e loo! hole$ to do thing$ 6uicer and all the$e di++erent thing$
C
Peah
ight $o that i$ the $ame thing ith the homeor here mean dont ant "ou to +eel !re$$ured to do it thin ma"be a$ ell that a$ a bit too much but $ometime$ hen e hen e di$cu$$ lie decide on $ome homeor it i$ u$t literall" to reiterate $ome o+ the thing$ that e have been taling about in the $e$$ion $o
C
thin thin the rea$on h" am not ver" +orard in the reading and riting i$ becau$e dont have to do it in m" ob
Peah $o it i$ a bit alien reall"
C
Peah on the odd occa$ion "eah it i$ to me it i$ reall" alien becau$e toda" had to u$t rite out a variation $heet o+ hat had done and got $omeone to $ign it and m" handriting i$ terrible and lie iit$ here have u$t +ini$hed or and dont no "ou "our adrenaline i$ $till going a$ though lie am riting and 51
Student Number - 12240294 have got reall" no control $o it$ lie a little id i$ doing it
Peah
C
can rite alright i+ am u$t $itting there and chilled out and riting but it$ u$t here "ou have been oring and "our adrenaline i$ going and "ou have been oring it$
a$ going to $a" the la$t homeor "ou did "our riting looed reall" reall" neat
C
t can be but it can be reall" thing" it all de!end$
7o "ou thin that i$ "ou !utting a negative $!in it again
C
Ma"be .erm dont no !robabl" !ut the negative $!in on a lot o+ thing$ $u!!o$e lie mae thing$ into bigger i$$ue$ than hat the" reall" are
#hat doe$ it +eel lie to thing about that
C
dont no $ometime$ get m" head around it and thin h" a$ orr"ing in the +ir$t !lace and then other time$ it reall" get$ to me and reall" !la"$ on m" mind reall" and u$t and then ever"thing u$t e$calate$ and then $omething el$e ill give me and then hen "ou are +eeling a bit don it u$t give$ me the hum! and it u$t e$calate$ and evolve$ +rom there and it$ turn$ into a big thing hen reall" $hould have u$t di$mi$$ed it and .!au$e
hat doe$ it +eel lie +or "ou to hear me $a" ell actuall" "our riting i$ reall" good and it i$ com!letel" illegible and
C
Peah no can rite it$ u$t hen !ut m" heart to it it$ the $ame lie at $chool
Fie under !re$$ure
C
Peah "eah could rite hen anted to but dont no it$ being la)" $u!!o$e
Sometime$ that could be the ca$e
C
mean ever"one i$ la)" in there on little a"
= $o i+ e loo at the $econd thing that e !ut onto the agenda it a$ to revie la$t ee
52
,genda $etting
ointing out to the client that e are moving onto the ne5t agenda item
Student Number - 12240294 C
Peah
#hat do "ou remember about la$t ee hat e did la$t ee
C
.erm .!au$e cant
t$ ind o+ gone out o+ "our mind
C
Peah
hat$ o
+ $ho "ou thi$ thi$ +ormulation
C
Peah remember that
So e had about certain time$ o+ the da" that "ou are doing a ob and it doe$ go to !lan $o that a$ ind o+ our +ocu$ o+ a $ituation that mae$ "ou +eel de!re$$ed $ometime$
C
Peah
So that a$ an e5am!le
C
=r +eel a$ though have too much o+ a con$ciou$ at time$ hen $hould hen loo at other !eo!le and the" dont $eem to hold thing$ the" u$t lie
(5!lain that to me a bit more hat do "ou mean b" that
C
dont no .!au$e dont no it$ u$t lie leaving $tu++ and it might be +or being tid" or having thing$ done a certain a" or $omething lie that but
So "ou +eel "ou do more than other$
C
.erm +eel a$ though do but !robabl" dont it$ !robabl" u$t me thining out dont no dont no
hat mae$ $en$e .erm
#hen "ou +eel lie "ou do more than other$ hen "ou are in a $ituation and "ou thin am going to $ee thi$ out $ee thi$ through to the end
C
Peah tr" and do it tr" and do a bit e5tra tr" and do it the be$t !o$$ibl" can 53
Conce!tual integration
evieing the !reviou$ +ormulation that ha$ been com!leted*
;uided di$cover"
,$ing the client 6ue$tion$ in a Socratic a" to hel! develo! a dee!er level o+ under$tanding into their !roblem$*
:eedbac
Summari)ing hat the client ha$ $aid
Student Number - 12240294
#hat doe$ that mae "ou thin about the other !eo!le
C
7ont no lie the" have got a bit o+ a bla)e attitude toard$ thing$
So the" are not a$ dedicated
C
But at the end o+ the" da" the" are $till getting !aid $o hat$ $o thin to m"$el+ $o hat$ the h" am getting m"$el+ in a $tate hen the" are not orried
So the" are not orried about it $o h" am
C
Peah h" $hould be orried about it
So hen "ou thin that thought o+ @there not orried about it h" $hould beA hat behaviour$ do "ou do hat doe$ that lead "ou to do
C
.erm +or a little hile have a little bit o+ a bla)e attitude
So "ou are ind o+ lie oh hat the hell
C
Peah "eah
,nd doe$ that lead "ou to $to! oring or tae a brea or hat do "ou do
C
Peah u$t lie an"thing or u$t .erm but then thin to m"$el+ h" have got to be lie them and then not care and that but at the end o+ the da" .!aur$e there i$ not a lot o+ caring in the orld $ometime$ and $ome o+ u$ have got to care do "ou no hat mean
$ it bad to care
C
Not it$ not bad to care it$ not but e can !robabl" care too much $u!!o$e and let it !la" on "ou
So it i$ lie tr"ing to +ind a balance
C
Peah a ha!!" medium ith it and obviou$l" havent got it*
= $o that i$ hat e are looing at
So
.erm
54
;uided di$cover"
&el!ing the client to under$tand ho the" vie the orld*
:eedbac
e!eating to the client hat the" have $aid to en$ure clarit"*
(liciting behaviour$
,$ing the client to identi+" hat behaviour$ the" $ho in certain $ituation$*
Student Number - 12240294
;o on
C
=ver the la$t ee havent had a bad ee to be hone$t it$ been 6uiet good have had a cou!le o+ moment$ a +e moment$ but
7o "ou remember hat tho$e moment$ ere
C
Peah that i$ true
C
,nd dont no didnt +eel a$ though it a$ right or it a$ rong the a" a$ +eeling do "ou no hat mean
Peah that mae$ $en$e
#hat thing$ have "ou orried about can "ou !in !oint an"
C
No dont u$t in general u$t an" $im!le thing dont no u$t
t doe$nt matter i+ "ou cant remember
C
Peah u$t becau$e obviou$l" am at or a lot and it$ the onl" thing can reall" relate to at home it ha$ been lovel" it$ lie m" $on ha$ been reall" lovel" and a cou!le o+ time$ e have had to tell him o++ but at the end o+ the da" he i$ a teenager
Peah that going to ha!!en
C
Peah he i$ going to !u$h hi$ luc but overall he i$ lovel" he i$ he i$ a reall" good id and m" i+e ha$ been +ine and been reall" hel!+ul and under$tanding and thi$ and that and $o
#hat ha$ $he been under$tanding about
C
,nd ho doe$ that mae "ou +eel
55
(liciting e" cognition$
,iding the client in identi+"ing hat their cognition$ and thought$ are*
(liciting e"
denti+"ing the individual$
Student Number - 12240294
C
t mae$ me +eel lovel" but i+ could +lic a $itch and it ould be done that ould be great but it$ not lie that
Pou +eel lie it i$ 6uiet a long time
C
But !robabl" thin it i$ going to get to $tage here am doing it ithout even reali)ing it and then dont no and then thin to m"$el+ ho do no am not going to be doing thi$ +or the re$t o+ m" li+e am going to have to tr" and +ind a ha!!" medium "eah but .!au$e dont no
thin "ou are right in 6ue$tioning am going to be doing thi$ +or the re$t o+ m" li+e and the thing i$ ith the $ill$ that "ou are going to learn through CB "ou ill be doing tho$e +or the re$t o+ "our li+e but the" ill become a !art o+ "our li+e
C
Peah Peah
So changing the a" that "ou thin about thing$ and changing the a" that "ou behave
C
Peah "our hole attitude toard$ thing$
Pe$ that change ill be a !o$itive change +or the re$t o+ "our li+e it ont be thi$ i$ a real drag lie being on diet ive got to $tic to thi$ it ill be a !art o+ "our li+e that i$ maing "our li+e better
C
Peah
So that$ !robabl" a hen "ou thin o+ i$ thi$ going to be me +or the re$t o+ m" li+e "ou need to thin o+ the good thing$ about it $o it i$ going to mae "ou +eel a lot better*
C
Peah "eah
= $o i+ e u$t .erm revie again .erm +ini$h revieing hat e did la$t ee e came u! ith lot$ o+ di++erent thought$ that ere going through "our mind $o hen "ou are in thi$ $ituation here thing$ are not going to !lan at or "ou ant to go home "ou cant get motivated
C
Peah
Pou are not reall" $ure h" "ou +eel the a" that "ou do or hat i$ going on and the$e and that mae$ "ou behave in a"$ that here "ou $tart to orr" about it 56
cognition$
+eeling$
:eedbac
evieing hat a$ com!leted in the !reviou$ $e$$ion*
Student Number - 12240294 moaning "ou ind o+ ithdra and go into "our$el+ C
Peah "eah
ing "our i+e thin the or$t o+ ever"one and get 6uiet $hort tem!ered*
C
Mmm
.erm ,nd then in "our bod" it +eel$ lie "our heart rate increa$e$ "our get ind o+ racing thought$ and hot and that lead$ to +eeling$ o+ elou$e" $o hen "ou are calling "our i+e "ou are ondering hat $he i$ doing here i$ $he
C
Peah "eah
'ind o+ +eel em!t" in$ide ma"be lie $omething i$ mi$$ing
C
Mmm
Can "ou relate to thatK
C
hat i$ me don to a t
#eve got that o $o that i$ the de!re$$ion $ide o+ thing$
C
ight
So i+ e can ma"be loo at the anger and ealou$" can "ou thin o+ an" $ituation$ in "our mind no that here "ou have +elt angr" or ealou$ that "ou can tal about*
C
.erm .!au$e to be hone$t have had a cou!le o+ ealou$ thought$ latel" but not to an" e5treme
hat$ +ine
C
Com!ared to hat it ha$ been
So ould "ou !re+er to tal about an e5treme time or one o+ the one$ that "ou have had more recentl" it i$ u! to "ou "ou can decide
C
.erm .!au$e
#hat one$ have cau$ed "ou the mo$t !roblem$
C
.!au$e load$
r" and ma"be !in !oint a $!eci+ic $ituation
57
:eedbac
ara!hra$ing hat the client ha$ $aid*
:eedbac
e!eating hat the client ha$ $aid*
:eedbac
,$ing the client i+ the" agree*
Student Number - 12240294 C
.!au$e .erm hen $omeone at or .erm $aid their +riend had $le!t ith m" i+e
=
C
hat cau$ed a big !roblem
So the $ituation a$ $omeone at or .!au$e
C
Said that there +riend had $le!t ith m" i+e
=
.!au$e in hat conte5t a$ thi$ a$ it in a oe" conte5t or a$ it that the" had !ulled "ou a$ide
C
No no no u$t $aid
So here ere "ou
C
dont no cant remember no
, the time hat thought$ ere going through "our mind
C
dont no didnt no eather to believe it or not
ight @ dont no eather to believe thi$ or notA hat el$e
C
.!au$e .erm +ru$trated .erm
(liciting e" cognition$
,$ing the client hat thought$ ere going through hi$ mind at the time o+ the identi+ied $ituation*
:eedbac
e!eating hat the client ha$ $aid +or clarit"*
So that ould !robabl" be a +eeling or emotion +ru$trated $o ill !ut that in that bo5 .erm hat el$e ere "ou thining at the time ho did "ou no "ou ere +ru$trated hat a$ going through "our mindK
(liciting emotional e5!re$$ion
,lloing the client time to identi+" emotion$ e5!erienced*
So e have got dont no eather to believe thi$ or not
:eedbac
e!eating hat the client ha$ $aid*
C
dont no a$ u$t angr" $u!!o$e
= $o "ou +elt the +eeling o+ anger
,nd hen "ou +eel angr" hat do "ou thinK
(liciting e" cognition$
ara!hra$ing hat the client ha$ $aid to hel! them to identi+" their thought !roce$$e$*
C
.!au$e
=+ten hen e are in the$e $ituation$ are mind$ are reall" reall" bu$" and lot$ i$ going on "ou have even 58
Student Number - 12240294 $aid that "ou e5!erience the racing thought$ C
Pour head i$ doing overtime
So "ou have to tr" and grab one o+ them and +igure out hat i$ it that i$ going on hat am thining .!au$e ma"be even no i+ "ou thin bac and re+lect on the $ituation hat do "ou thin about itK
C
.!au$e dont thin nothing about it dont thin that it i$ true
So @it might not be trueA
C
Mmm
C
.!au$e
=r @it i$nt trueA
C
Mm .!au$e
#hat el$e i$ going through "our mind
C
dont no
t i$ 6uiet tric" to ca!ture hat i$ going through our mind$
C
a$ed her eather it a$ true and $he .erm obviou$l" denied it and .erm dont no didnt thin that that an$er a$ good enough
= $o "our thought a$ @the an$er$ am getting arent good enoughA
C
Peah
= "eah that i$ good
C
t$ lie di$belie+
@ dont believe herA
C
Mmm .!au$e
= $o $ome o+ the thought$ that "ou have come u! ith are @ dont no eather to believe her or notA @it i$nt trueA @the an$er$ am getting arent good enoughA @ dont believe herA* So it i$ ind o+ a mi5ture o+ all the di++erent thing$ that are ha!!ening in thi$ inten$e $ituation .erm i+ "ou could thin bac to that $ituation and the +eeling o+ ealou$" ith 0 not being 59
(liciting e" cognition$
e!eating the 6ue$tion$ a$ed to gain more detail +rom the client*
(liciting emotional e5!re$$ion
B" a$ing the client to rate their emotion$ it demon$trate$ ho inten$e the emotion i$ currentl" and at the time o+ the $ituation*
Student Number - 12240294 ealou$ at all and 10 being ver" ealou$ here ould "ou $a" that "ou are C
10 "eah
10 out o+ 10 right
.erm $o "ou heard thi$ ne$ $omebod" at or $aid that there +riend had $le!t ith "our i+e hat behaviour$ did "ou do hat did "ou do in that in$tance
So "ou $aid that "ou a$ed "our i+e i+ it a$ true
C
Peah it u$t !la"ed on m" mind didnt $a" an"thing to them
So "ou ind o+ ruminated it
C
Peah and it u$t !la"ed on m" mind and !la"ed on m" mind and !la"ed on m" mind and a$ u$t going into m"$el+ and brain had a $hut don
So "ou ind o+ ithdre +rom ever"one
,nd a$ u$t thining over and over and over
#a$ "ou doing all thi$ at or
C
Peah hile m $till at or a$ u$t carr"ing on ith normal thing$ becau$e it reall" doe$ m" head in u$t all thi$ a$ going on in m" head but can $till carr" on do m" or and carr" on carr" on living a normal li+e ell it aint a normal li+e u$t going through the motion$ o+ o+ leading a normal li+e but dee! don there$ $omething obviou$l" rong
= $o "ou +eel lie there i$ $omething rong
,nd i$ that $omething rong ith "ou or $omething rong ith other !eo!leK
C
#ith me
= .erm o $o thining bac to thi$ $ituation .!au$e hat did "ou do hen "ou ent home hat a$ "our behaviourK
C
.erm a bit di$tant .!au$e a$ though lie am !icing +or an argument or
hi$ i$ ith "our i+e
60
(liciting behaviour$
denti+"ing hat behaviour$ the client e5!re$$ed in re$!on$e to hi$ thought$ and +eeling$*
;uided di$cover"
J$ing $!eci+ic 6ue$tion$ to get a dee!er under$tanding o+ the client$ vie$*
Student Number - 12240294 C
Peah "eah "eah
&o did "ou tell her
C
a$ed her eather it a$ true
#hat out right "ou u$t $aid thi$ i$ hat "ou have heard
C
Peah "eah
,nd i$ thi$ true
C
Mmm
,nd then hat ha!!ened
C
She a$ obviou$l" den"ing it and and er e il go and $ee the !er$on and thi$ and that $o $aid h" involve other !eo!le in their argument ant to $ort it out beteen u$
C
Mmm
C
,nd erm $he a$ going o++ her head and
,nd ho did that mae "ou +eel
C
.erm dont no reall" u$t +ru$trated and mi5ed u! and .!au$e
= hat doe$ mi5ed u! +eel lie
C
Peah that mae$ $en$e .!au$e .erm o $o e have got 6uiet a lot o+ behaviour$ e have got that "ou a$ed "our i+e i+ it a$ true "ou ere ind o+ ruminating ith it it a$ !la"ing on "our mind thining about it a lot ithdre +rom ever"one el$e and 6uiet di$tant +rom "our i+e and !icing argument$ ith her* #hen "ou had the$e thought$ that e have got and the$e behaviour$ hat a$ going on in "our bod" hat did it +eel lieK
C
.!au$e obviou$l" the heart racing again
Peah
C
,nd +eeling u!tight and .!au$e 61
(liciting behaviour$
,ttem!ting to identi+" hat it i$ the" client did hen !laced in $ituation$ that made him +eel angr"
(liciting e" cognition$
B" a$ing the client ho it made him +eel e ere able to get to a dee!er under$tanding o+ hat a$ going through hi$ mind*
:eedbac
Summari$ing hat ha$ been $aid*
Student Number - 12240294
,n"thing el$e an"thing el$e ha!!ening in "our bod"
C
No no
= $o have been riting don a +e +eeling$ and emotion$ that "ou have been $a"ing a$ e have been going along $o "ou have got +ru$trated angr" mi5ed u! becau$e "ou are not reall" $ure not noing hat to thin reall" have "ou got an" other emotion$ or thought$ going on ith the ealou$"K
C
=bviou$l" angr" but not in a violent a"
#hat a" i$ itK
C
dont no u$t $torming around and u$t tr"ing to $ho that am angr" and not ha!!"
= "eah
C
But to be hone$t u$t go in m"$el+ and dont $!ea and
#a$ there an" $adne$$
C
Peah obviou$l" a lot o+ $adne$$ +eel a$ though am $ad a lot o+ the time and dont no h" u$t go in m"$el+ and .!au$e
=
.erm hen "ou came here "ou $aid one o+ the bigge$t !roblem$ that "ou had a$ ealou$" hen i$ thi$ the +ir$t $ituation that "ou can recall being ealou$
C
No there i$ load$
#hen a$ the +ir$t time that "ou can recall +eeling lie ealou$" a$ a !roblem +or "ou
C
.erm !robabl" all through relation$hi!$ ith other !eo!le !a"ing attention to ho ever am ith and obviou$l" them !a"ing attention to them bac and obviou$l" i+ it ee!$ occurring the attention u$t cant under$tand and it mae$ me +eel elou$
C
So
C
t mae$ me .!au$e dont no
7oe$ thi$ ha!!en ith "our i+e that "ou are ith noK
C
Peah "eah "eah
,nd did thi$ ha!!en be+ore thi$ $ituation
62
Student Number - 12240294 C
Peah "eah "eah
So even be+ore thi$ $ituation there ere time$ ere "ou ere out and !eo!le ere !a"ing her attention
C
hi$ ha$ ha!!ened a +e time$ "eah
So other !eo!le !a"ing "our i+e attention
.erm becau$e the onl" thing am 6uiet mind+ul o+ i$ that thi$ $ituation $o $omeone at or $a"ing that "our i+e ha$ $le!t ith $omeone el$e it ould !robabl" de!end on the conte5t but it ould !robabl" be 6uiet normal +or "ou to be ealou$ o+ that $ituation
C
Peah o+ cour$e "eah
t de!end$ on the conte5t though $o i+ it ere ma"be in a oe" a" not $o much a$ $omeone con+identiall" telling "ou a $ituation
C
Peah "eah "eah
7o "ou remember an"thing about the conte5t that it a$ inK
C
No cant remember not reall" it ha!!ened a little hile ago to be hone$t and tr" not to thin about it
So i+ e $tic to lie ma"be other !eo!le !a"ing "our i+e attention rather than "ou doe$ that ha!!en no
C
.erm er .!a$ue $u!!o$e it doe$ lie hen $he goe$ out or hat
,n" time$ that "ou can thin o+
C
Peah but $ometime$ it $eem$ a little bit more more cant !ut it into ord$
More !rominentK
C
Peah more !rominent $ometime$ lie obviou$l" !eo!le are going to $mile at each other and u$t but $ometime$ it tend$ to go on a lot more
7o "ou thin it i$ going on a lot more or "ou are noticing it a lot more
C
Pou are noticing it a lot more
= .erm
C
But $a" to m" i+e about it and $he $a"$ there i$ nothing there or $he i$ not doing it and dont no 63
Student Number - 12240294 h"
So i+ "ou thin o+ "our$el+ in thi$ $ituation $o "ou have got other !eo!le !a"ing "our i+e attention and $he i$ !a"ing it bac to them hat thought$ are going through "our mind then
C
.erm angr" hurt
= $o the" are the emotion$ good
he emotion$ are that "ou are angr" and hurt .!au$e "e! hat are the thought$ hat are "ou thining at the time$ $o "ou have got thi$ $ituation here "ou +eel lie that "our there i$ $omebod" looing at "our i+e and "our i+e i$ looing bac at them hat i$ going through "our mindK
C
dont no cant reall" !ut m" +inger on it
Pou cant reall" !ut "our +inger on it that$ o
So e have got "our +eeling$ a$ being angr" and hurt hat hen that ha!!en$ hat do "ou do "ou $aid to me that "ou $!ea to "our i+e
C
Peah but $he u$t denie$ it and then 6ue$tion m"$el+ eather am reading more into it or dont no
So "ou 6ue$tion "our$el+ "ou might $a" $omething to her hat $ort$ o+ thing$ might "ou $a" to her
C
.erm challenge her on on the attention that $he i$ been giving $omeone el$e
So "ou challenge her can "ou thin o+ hat "ou might $a"K
C
No no
No
.erm do "ou thin that "ou ould do it in an aggre$$ive a" or not
C
Peah !robabl" a little bit aggre$$ivel"
= and then hat ha!!en$ doe$ $he get de+en$ive
C
Peah "eah
7oe$ that end u! in an argumentK
C
Peah it u$t e$calate$ and then u$t goe$ all u! in the air
64
(liciting e" cognition$
denti+"ing the client$ thought$
Student Number - 12240294 and**
&o doe$ it di$a!!ear
C
.erm u$t .erm e dont tal about it and then u$t blan it
So "ou ind o+ avoid it
C
Peah avoid it
= $o hat ould it mean to "ou i+ other !eo!le ere looing at "our i+e
C
.erm
,nd $he a$ looing bac at them
C
n a a" it i$ u$t being +riendl" but $ometime$ dont $ee it a$ that dont no hat $ee it a$
But hat ould it actuall" mean to "ouK
C
dont no reall"
So imagine thi$ $ituation ere true e are in a $ituation e are in a bar "our i+e there i$ a gu" acro$$ the room ho $miled at "our i+e and "ou i+e $mile$ bac hat doe$ that mean to "ou*
C
.erm no nothing be becau$e ob obviou$l" !eo!le ar are $m $miling bu but i+ it ee!$ ha!!ening and dont no it u$t
#hat i$ it about the $ituation that mae$ "ou +eel unea$"
C
.erm dont no it could be that +eel a bit in+erior that +eel a bit .erm dont no
Peah that mae$ $en$e that mae$ !er+ect $en$e
.erm do "ou thin it i$ true that "ou are in+eriorK
C
No but that i$ !robabl" the a" that +eel a little bit dont no a$ though the" have got $omething that havent it loo$ lie
= $o the" might have $omething that "ou havent
= $o there i$ thought$ going on that @the" might have $omething that haventA hat i+ the" have hat i+ the" have got $omething better than "ou* #hat ould that mean
65
;uided di$cover"
Jnder$tanding the dee!er meaning behind the client$ core belie+$*
Student Number - 12240294 C
.erm .!au$e
he" are 6uiet tric" 6ue$tion$
C
Mmm
C
#ell th the" have ob obviou$l" done .e .erm e ell it it al all de!end$ i+ it i$ material or or dont no or the" are better looing or hatever and that dont no
#hat ould it mean to "ou though
C
.erm
So e have got that it might mae "ou +eel in+erior an"thing el$e
C
.!au$e "e "eah ould u$t +e +eel in in+erior to to them that i$ i$ al all lie u$t
= $o imagine that "ou are in thi$ $ituation here there i$ a gu" looing at "our i+e and "our i+e i$ looing bac at them "ou +eel in+erior becau$e o+ that $ituation hat doe$ that $a" about "ou
C
hat am not com+ortable in m" on
So "ou dont +eel com+ortable in "our$el+ or
C
Pe "e in m"$el+ in m" on $in i+ "ou no hat mean lie
C
.!au$e
= ho are "ou able to recogni)e thi$ thi$ $o thi$ +eel o+ in+erior and thi$ +eeling o+ not being com+ortable hen do "ou thin that $tartedK #here did that come +romK
C
do dont no re reall" dont no !r !robabl" +elt li lie it it +or a reall" long time to be hone$t
So a$ a child or more a$ an adult
C
robabl" more a$ an adult
Can "ou recall an" $ituation$ that might have led "ou to +eel that a" in the !a$t other than the one$ that "ou have mentioned $o +ar
Can "ou thin o+ an"
C
No
66
Student Number - 12240294
Not reall"
hat$ +ine
= $o thi$ belie+ o+ being in+erior +eeling uncom+ortable in "our on $in i$ that $omething that "ou +eel all o+ the time i$ it
C
No no u$t
=r i$ it in certain $ituation$
C
Peah !robabl" in certain $ituation$ and cant and that$ acro$$ the board not nece$$aril" u$t ith m" i+e it$ !robabl" dealing ith $ituation$ and !robabl" not being able to an$er or an$ering in the right a"
ell me a bit more about that hat do "ou meanK
C
.erm .erm $omebod" ill $a" $omething and $hould have an an$er and about +ive minute$ later have thought o+ the an$er but it$ !robabl" too late
#h"
C
m !robabl" a bit $lo
#h" $hould "ou have an an$erK
C
.erm
$ that a rule +or living that "ou haveK
C
No it$ u$t +eel a$ though need to
So hen $omebod" $!ea$ to me have to an$er themK =r have to have the right an$er
C
No no
#hat i$ it
C
hat$ +ine
+ +or e5am!le a$ed "ou a 6ue$tion no and "ou didnt have the right an$er or "ou didnt have an an$er to give ho doe$ that mae "ou +eel
C
(rm o becau$e no "ou ill rite about it .laugh
C
.erm
;uided di$cover"
67
denti+"ing rule$ and a$$um!tion$
Student Number - 12240294
So hat i$ it about thi$ $ituation and other $ituation$ that i$ di++erentK
C
hi$ i$ am here +or "ou to train me to thin otheri$e
=
C
,nd obviou$l" am going to mae mi$tae$ am going to be thi$ am going to be that and until can gra$! it am not going to +eel the a" that $hould do
= $o it i$ o in $ome $ituation$ not to have the an$er$
C
Peah "eah
But the re$t o+ the time "ou $hould do
C
Mm
=
C
M" i+e i$ reall" 6uic lie e ent to lae$ide la$t night .erm ent in a $ho! and anted to get a ca$e +or m" !hone becau$e .erm lo$t m" other one and there a$ a ca$e there +or U3*99 and thought "eah ill get that and too it to the man and he $aid U*99 but it a$ !riced u! rong and challenged him and $aid it a$ U3*99 and er he $aid no the" the" are U*99 hen reall" $hould have had that or at that !rice becau$e it a$ !riced u! and u$t $aid ell i+ a$nt rude or an"thing u$t $aid i+ it a$ U*99 a$nt going to have it and $aid erm goodb"e and thing" and $aid it to m" i+e and $he $aid oh "ou $hould have $aid thi$ and that but at the time !robabl" didnt thin o+ it !robabl" didnt ant to be rude to him or thing" or tr" not to be rude to him
Peah
C
But thining about it a+ter $hould have been 6uicer but a$nt
= $o it $ound$ lie that "ou +elt lie "ou $hould have
C
Peah dont no +elt a little bit $ill" and $he ill be on the !hone and ill thin 6uicer on her +eet and
Some !eo!le are a lot more a$$ertive than other !eo!le
C
Peah
#hich i$ de+initel" $omething that e can loo at a$ ell
68
Student Number - 12240294 C
Peah "eah
C
.erm
C
,nd thin i+ a$ a little bit better at that could be a lot ha!!ier a$ ell
So ma"be looing at $ome a$$ertive $ill$
C
Peah "eah
hat i$ de+initel" $omething e could do ma"be e could do $ome role !la"$ on ho e can get "ou to act more a$$ertivel" in certain $ituation$ !articularl" one$ that mae "ou +eel a bit uncom+ortable
C
Peah and a$ thining about it and thining about it and then $aid oh am being $ill" reall" and thi$ and that and tried to di$mi$$ed it mean ended u! bu"ing one at U*99 an"a" $o it a$ u$t $omething and nothing reall" do "ou no hat mean
Peah
= ell e can de+initel" loo at that
C
Peah
So i+ o $o u$t thining about that $ituation 6uicl" hat thining bac on it ho ould "ou behave di++erentl" hat ould "ou have done
C
ould have $aid it i$ !riced +or that $hould be able to bu" that at that it i$ not m" +ault it i$ "our !roblem obviou$l" $a" that ithout being rude obviou$l" get "our !oint acro$$
So not aggre$$ive not
C
Peah "eah
Peah u$t getting the !oint acro$$ that $ound$ lie a good idea
C
can be lie that but can !robabl" $ound aggre$$ive
thin getting in beteen the line o+ being !a$$ive and aggre$$ive and then getting to the in beteen bit hich i$ a$$ertive i$ reall" di++icult
C
Peah and havent ma$tered that
thin it i$ a real $ill
Conce!tual integration
69
Maing goal$ and !lan$ +or +olloing $e$$ion$*
Student Number - 12240294 C
,nd beat m"$el+ u! over that to be hone$t and thin about it
So that i$ another thing that "ou might beat "our$el+ u! about
C
Peah
#hat hen "ou thin about not being able to be a$$ertive hat doe$ that mae "ou +eelK #hat doe$ it mae "ou thin o+ "our$el+
C
.erm it$ $ill" reall" a bit $tu!id
So am $tu!id
C
Peah "eah
So it$ lie cant do that mu$t be $tu!id
C
Peah "eah u$t !utting m"$el+ don
Peah o $o !utting "our$el+ don about it .erm o e have come u! ith 6uiet ith regard$ to lie the anger and ealou$" it +it$ reall" ell ith the de!re$$ed $tu++ that e ere doing la$t ee it ind o+ all connect$ together and lin$ u! becau$e e get the +eeling$ o+ $adne$$ hen "ou do have the$e $ituation$ here "ou +eel ealou$ hich can !robabl" lead to acting in the de!re$$ed a"$ that "ou do
C
Peah "eah
,nd in the $ame $en$e "ou $aid that hen thing$ arent going ell at or "ou might call "our i+e and i+ $he doe$nt !ic u! "ou get ealou$ hich lead$ to the other thing$
C
Peah tr" not to call her no unle$$ can be ha!!" and chatt" and that becau$e a cou!le o+ time$ have $!oen to her and $he ha$ $aid oh .erm $a"ing oh "oure her being $arca$tic and $a"ing oh "ou have cheered me u! no end ith her being all nice and chir!" but $ometime$ e cant be chir!" all the time
Peah e cant be ha!!" all the time
C
,nd obviou$l" it i$ nice to hear a +riendl" voice and lie and a +riendl" and under$tanding voice and lie tr" not to give her a +eeling that m a little bit $hitt" and that
So "ou might tr" and avoid taling to her
70
Student Number - 12240294 C
Peah and tr" and avoid taling to her and u$t tal to her hen it i$ nice $o it i$ a nice memor" +or her
C
o thin about
C
Peah to thin about rather than u$t being all doom and gloom
Peah no that ould mae a lot o+ $en$e thin it ha$ been reall" good +or u$ to get to the core o+ $ome o+ the belie+$ that "ou have $o "ou have all the$e di++erent thought$ and behaviour$ and +eeling$ going on but the rea$on h" "ou are having tho$e there ala"$ ha$ to be lie a central !oint o+ here tho$e come +rom and +or u$ thin toda" e have ind o+ come u! ith that "ou +eeling in+erior in $ituation$ and "ou +eeling uncom+ortable in "our on $in and $ometime$ +eeling $tu!id in $ituation$ i$ !robabl" here it route$ +rom mean there i$ !robabl" lot$ more a$ ell
C
Peah
But that i$ $ome o+ them ould "ou agree that i$ $ome o+ them
C
Peah "eah erm m" le+t e"e i$ been a !roblem +rom hen a$ "ounger and have got la)" e"e and that reall" !la"$ on m" mind lie con+idence
So becau$e o+ "our la)" e"e hat do "ou thin
C
(rm dont no dont no a$ though !eo!le tae the mic" out o+ me and lie u$t dont no .!au$e
&ave the" taen the mice" out o+ "ou +or it
C
,nd then other time$ "eah "eah and then other time$ can u$t di$mi$$ it and u$t get on ith it and not but thi$ i$ u$t cant thin
#hen !eo!le have taen the mice" out o+ "ou hat have the" $aid
C
.erm .erm .!au$e dont no
Not reall" $ure
C
Peah dont no or ma"be it i$ u$t me being !aranoid or dont no
So "ou cant reall" thin o+ an"thing it might be "ou u$t being !aranoid
71
Student Number - 12240294
ill be hone$t did not notice at all and $till cant notice no
C
Peah
So it might be "ou being !aranoid or
C
Peah might be "eah
Pou cant remember an"thing $omeone$ $aid
C
$!oe to m" i+e about it and $he $aid dont orr" it i$ thi$ and that have even er gone to er gone to go !rivate to have it done but the" $aid it i$ not bad enough +or $ome rea$on
Peah
C
But obviou$l" hen am tired or have had a drin it come$ out more
Peah o but "ou havent had a drin $till
C
No on Sunda" no on Saturda" e ent out Saturda" ent out and had a cou!le o+ !int$ o+ $hand" but a$nt drun
#hat a$ it lie to drin
C
.erm it a$ alright e had a bit o+ a late night oe u! ith a bit o+ a headache and that and to be hone$t it a$nt ver" nice and a$ thining "ou no hat am not reall" mi$$ing a lot $o
C
.laugh o thin although "ou have $truggled ith the homeor* .erm $orr" i$ there an"thing "ou anted to add to thi$ hat e have been through $o the angr" $la$h ealou$ $ituation e $aid that e had ind o+ got to $ome o+ the core belie+$ .erm
C
.erm u$t .erm m" i+e had a lie detector te$t and !a$$ed it but erm $till didnt believe that
= $o "ou a$ it "ou ho told her to have the lie detector te$tK
C
Peah "eah "eah .!au$e it co$t a lot o+ mone" a$ ell
So $he had a lie detector te$t !a$$ed it and "ou $till dont believe thatK
C
#ell didnt but do and dont no
Pou $till +eel a bit con+u$ed about it 72
Student Number - 12240294 C
Peah "eah "eah
So $ometime$ "ou +eel lie "ou do and $ometime$ "ou +eel lie "ou dont
C
Peah and the +ella that $he even !honed the +ella u! that done it but $aid the +ella ho done it i$ not going to $a" it$ not becau$e he ha$ had our mone" and
So "ou are ind o+ doubting the $ituation ind o+ tr"ing to !ut a negative $!in on that
C
Peah "eah
C
dont no
hining the man ouldnt tell "ou i+ it a$nt real
C
No cour$e he aint becau$e he ha$ had "our mone" and
So can !eo!le not be tru$ted
C
Peah "eah
C
.erm
C
Peah am not a ver" tru$ting !er$on to be hone$t
So "ou ind o+ $ee other$ a$ !eo!le ho cannot be tru$ted
C
Peah "eah
&o do "ou vie the orld
C
.erm dont no there i$ a lot o+ rongen$ out there in m" e"e$ but in other $ee a lot o+ na$t" thing$ during the da" and a lot o+ thing$ that !eo!le are doing and that "ou have got to o!en "our e"e$ but to be hone$t nothing reall" $hoc$ me becau$e .!au$e it dont $ur!ri$e me u$t thin that$ u$t !eo!le that$ u$t the $ociet" that e live in
hat i$ 6uiet negative but that$ +ine e can loo at that o $o do ant to a$ i+ ill have got an idea o+ ho e can $et $ome homeor that might be ind o+ related to hat e have done in the $e$$ion toda"
ight $o
a$ thining ma"be "ou could rite about ho "our core belie+$ a++ect the a" that "ou behave u$t a little !aragra!h $o $ome o+ the core belie+$ that "ou came u! ith ere that "ou +eel uncom+ortable in "our on $in 73
&omeor
7i$cu$$ing the homeor idea$ ith the client and ho the" relate to the $e$$ion*
Student Number - 12240294 $o i+ !ut them on her C
Peah then can relate bac to them
(ven i+ "ou can u$t bullet !oint it .!au$e dont +eel !re$$ured
C
ight
C
.laugh$
7ont +eel !re$$ured to rite $o much becau$e no that riting i$ obviou$l" not $omething that "ou lie doing
C
Peah $ometime$ can rite a lot and then other time$ it i$ u$t the bare minimum and that$ it
C
.!au$e
,nd +eel $tu!id $o hat have done have ritten don $ome o+ "our core belie+$ there and hat hat thought ould be a good idea i$ +or "ou to loo at the a"$ that the$e core belie+$ have a++ected the a" that "ou behave do "ou do "ou under$tand hat mean b" that
C
Peah "eah
&ave "ou got an"thing that "ou thin might $to! "ou +rom being able to do the homeor
C
Peah that cant be bothered
So motivation might $to! "ou +rom doing it
C
Peah
So hat can e do to mae $ure that "ou +eel more motivated can e $et ma"be a $!eci+ic time
C
Beat me ith a $tic .laugh
ouldnt be able to do that am a+raid .laugh
So do "ou thin e could $et ma"be a$ide a bit o+ time +or "ou to be able to +ind a bit o+ time +or "ou to be able to do it
Ma"be i+ "ou could thin o+ a da" "ou might have le$$ on that "ou might be able to $!end even +ive minute$ u$t thining about it 74
&omeor
7i$cu$$ing an" !roblem$ that the client might have ith com!leting the homeor*
Student Number - 12240294 C
Peah can tae time out to do it i+ aint doing an"thing am u$t $itting atching tell"
= $o even i+ "ou thin u$t +ive minute$ o+ an evening u$t have a re+lect on hat e have $!oen about and ho that the$e belie+$ that "ou have have a++ected the a" that "ou behave and u$t get tho$e don becau$e it can reall" hel! u$ in erm the ne5t bit that e do hen e are tr"ing to loo at "our goal$ +or thera!" and hat it i$ "ou ant to achieve
C
Peah
,nd thin ne5t ee it ould be a reall" good idea i+ e can ind o+ !ut the$e to big !icture$ that e have got together and bridge the ga! and $ee ho the di++erent !roblem$ relate to each other
C
Peah doe$ it all evolve +rom one thing or i$ it $e!arate thing$
t$ liel" to come +rom mean even no the core belie+$ that e have got e have three di++erent one$ here $o it i$ liel" that a bit o+ thi$ and a bit o+ that have all re$ulted in the a" that "ou are +eeling no
C
Peah
But am more than $ure that i+ e or together e can get through $ome o+ the$e thought$ and +eeling$ and behaviour$ that "ou are having and the im!act that the" are having on "our li+e e can
C
can get +ru$trated indoor$ a$ can get home and have got a lot to $a" and but dont get a chance becau$e cant and then .!au$e
$o that $ound$ lie $ome real a$$ertive $ill$ are reall" going to be hel!+ul +or "ou
C
Peah and hen do get a chance to $!ea +eel a$ though cant u$t bring that conver$ation in becau$e it doe$nt
:lo
C
Peah
7oe$ it have to +lo
C
#ell no but it u$t $eem$ a bit random to me becau$e it ha$ u$t been going around and around
75
Student Number - 12240294
'ind o+ a bit lie hat "ou ere $a"ing at the beginning o+ the $e$$ion that it doe$nt +it ell ant "ou to no that in here "ou are o!en bring u! an"thing e can u$t !o! it onto our agenda
C
Peah "eah
,nd $!ea about and +ind a !lace in our $e$$ion to $!ea about it becau$e here e need to $!ea about all o+ the thing$ that "ou are thining about
C
Peah have got load$ o+ thing$ going on in m" head and becau$e dont ant to dont no it $eem$ though it i$ eird lie "ou tal about $omething and then "ou go on about $omething el$e
Peah
=r u$t coming in $a"ing lie a random thing have got a dog and lie i+ it a$ it +eel$ lie that $ituation
Peah but "ou no hat that i$ o right and e ill rite that don right
C
Peah
So "ou have got a dog and e ill get to that
C
Peah but havent got a dog
Peah no that a$ u$t an e5am!le
C
Peah it$ u$t obviou$l"
&o that im!act$ on h" ha$ that come u! +or "ou and h" i$ that a $igni+icant thing and e are able to loo at tho$e thing$ and e can teach "ou a"$ to be able to o!en "our$el+ out and be able to $!ea about that hen "ou are ith "our i+e
C
Peah
.erm "eah $o there i$ the dreaded homeor
C
.laugh
$ there an"thing that "ou ant to a$ about it i$ there an"thing that "ou thin might mae it di++icult +or "ou to do other than "our motivation level$ that ould mae it di++icult +or "ou to be able to do it
C
.!au$e
C
No it i$ o 76
Student Number - 12240294
No
C
No it i$ +ine
= $o toda"$ $e$$ion obviou$l" e looed at $ome o+ the rea$on$ h" "ou ere not able to do the homeor hich i$ +ine that no "ou $aid riting i$ $ometime$ 6uiet di++icult
C
Mmm
.erm e looed at the !reviou$ $e$$ion $o all about the de!re$$ion $ituation$ here "ou +elt de!re$$ed and ho that had im!acted on "our thought$ "our +eeling$ and "our behaviour$ and then toda" e ind o+ looed at the anger and ealou$" $ide o+ thing$ and di++erent $ituation$ ith that and ith that e ere able to come u! ith $ome o+ "our core belie+$
C
,l$o am doubting m"$el+ about being +eeling mad becau$e the a" +eel and lie doing thi$ but .!au$e dont no lie hat i$ made dont no
#hat do "ou mean b" that
C
dont no dont no it i$ hard to e5!lain
Peah it $ound$ it
C
Peah
#hat "ou mean "ou are doubting coming here or
C
No am not doubting coming here but have u$t +eel a$ though am mad lie dont no
hat "ou $houldnt be +eeling thi$ a"
C
Peah "eah
C
dont no but cant reall" !ut m" +inger on it
= $o "ou $houldnt reall" be +eeling thi$ a"
C
No "eah
=
So that i$ !robabl" a common +eeling in thi$ $ort o+ $ituation here "ou have got lot$ and lot$ going on
Peah and there ha$ been a lot o+ thing$ .erm going on at the moment about mental health i$$ue$ and ve obviou$l" li$tened to them and thi$ and that and dont
77
:eedbac
Summari$ing on the $e$$ion
Student Number - 12240294 no u$t thin the rea$on that "ou are hearing $o much about it i$ becau$e it i$ $o common C
Peah "eah "eah even u$t atching the $omething obviou$l" 999 emergenc" the other night it a$ erm the" a$ dealing ith mental health !atient$ and the" are u$t $itting here taing load$ o+ tablet$ in +ront o+ them and the" are hearing voice$ and dont hear that but +eel a$ though lie becau$e the a" am +eel a$ though am cla$$ed a$ the $ame a$ that !er$on
= $o there i$ a lot o+ $tigma around it
C
Peah "eah lie that
mean lie it i$ the $ame a$ lie hen lie i+ "ou loo at it in term$ o+ criminal$ there i$ a ma$$ive long $!ectrum "ou $ee it a$ the" are all criminal$ but then "ou could $ee it a$ thi$ !er$on ha$ done thi$ to get out o+ hat the" have done or the" have +ini$hed their treatment $o doe$ that $till mae them a criminal it i$ u$t the a" that "ou are looing at thing$
C
Peah it i$ u$t the a" that inter!ret it
Peah inter!ret the $ituation
C
Peah inter!ret
.erm there i$nt there e cant get aa" +rom the +act that there i$ a $tigma around mental health
C
Peah "eah
But
C
he nur$e$ are de+initel" the ambulance $ta++ are de+initel" not trained +or it and the" $houldnt be !ut in that $ituation to be hone$t it$ terrible
Peah mean e have come a long a" but there i$ obviou$l" more that need$ to be done a$ ell
C
Peah "eah "eah
.erm o $o i$ there an"thing that "ou +eel e havent touched on toda" that "ou anted to $!ea about an"thing that e have mi$$ed out +rom the $e$$ion e have ind o+ run through hat e have done toda" and e have reall" been able to +ormulate lie get a real !icture o+ here e are $o ne5t ee hen e can +eed
78
