Laura86 wrote:Hi Messymind,
I haven't worked with this before, and as Eponymous85 stated your supervisor would be first port of call. I am really interested in this though, and I've worked a lot with anxiety problems which I think it may be related to? If it was me, I'd probably integrate CBT and Narrative ideas - CBT for some of the practical techniques such as experiental work, and Narrative to trace the history of the problem, when it first entered the person's life, how the problem effects them and those around them and the consequences of this, and how the person affects the problem and times when the problem hasn't been around or they've overcome it and what was different then etc. It may also be worthwhile considering Mindfulness-based CBT, or some systemic work with their support network? Let us know how you get on!
I'm going to be grouchy about this and say that as a qualified CP this is not what I would recommend because basically you've suggested to use narrative to formulate the problem and CBT to treat it (see also: how to fail a case report). It would be better to have an overarching formulation based on a sound coherent theoretical model and a treatment plan based on that.
So in CBT I may formulate how this person's life experiences have led them to hold certain beliefs about themselves (e.g. I'm not acceptable to others, people will be critical/mocking of me), leading to high levels of anxiety and to the development of compensatory strategies to avoid/reduce the threat (e.g. not speaking so as to avoid being criticised or laughed at). Then the treatment plan can be ways to test the belief that people are critical or the person is unacceptable and more importantly develop new beliefs that the person is acceptable/can cope with criticism/ that most people are not punitive/ that criticism says more about the very critical person than the person being criticised etc.
Obviously the above may or may not be part of the formulation for the particular individual Messymind is working with and it would have to be developed collaboratively with that person and under supervision from a suitably qualified person. Perhaps other people can suggest ways of working with this within other models.
This isn't meant to come across as critical - but being a CP is all about being able to make sense of problems using psychological theory and to use this understanding to inform suitable interventions. It is really important to be coherent about how you do this, especially imho with more complex cases where it is so easy to become muddled. Having a formulation and treatment plan based on one sound theoretical model is very steadying for the therapist, the client and also anyone else involved (e.g. client's family, other MDT members etc).
Hope this helps.
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