Tuesday, December 9, 2008

Identifying the Therapy

The first step in understanding a problem is to make an assessment. Sometimes problems are overwhelming and can be better understood if we break the problem down into five parts and understand these five areas first. This means becoming aware of how the five areas in a person’s life are connected and influencing each other.

Sometimes people have specific isolated problems, which may not necessarily lead to a mental illness. CBT offers tools that can help people to make an assessment of these also.

The aim of assessment is to understand a person’s story and to understand the context of that story and the precipitating factors (that is, those things which keep the problem going).

An assessment is helpful, not only for gaining a sense of aware
ness and understanding, but it helps to identify where the problem lies and what interventions can be made where. It is like a doctor hearing a story of symptoms and then being able to prescribe the right medicine. In CBT terms, we need to understand these five areas of thoughts, behaviours, feelings, physical reactions and environment, in order to identify where the problems areas are and where specifically change can be made – so that the chain can be broken.

For a general overview of a person’s life history, the following can be used.
You can begin to understand your own problem by defining what you are experiencing in these five areas of your life. Describe any recent changes or long-term problems you have experienced in each of these areas. You can use the Questions below to guide you.

Environmental changes/life situations: Have I experienced any recent changes ? What have been the most stressful events for me in the past 3 years ? 5 years ? In childhood? Do I experience any long-term or ongoing difficulties (including discrimination or harassment by others ?)

Physical Reactions : Do I experience any physical symptoms that trouble me, such as changes in energy, appetite, and sleep, as well as specific symptoms, such as heart rate fluctuations, stomach aches, sweating, dizziness, breathing difficulties, or pain ?

Moods: What single words describe my moods (sad, nervous, angry, ashamed)?

Behaviours: What things do I do that I would like to change or improve ? At work ? At home ? With friends ? By myself ? Do I avoid situations or people when it might be to my advantage to be involved ?

Thoughts : When I have strong moods, what thoughts do I have about myself ? Other people? My future ? What thoughts interfere with doing the things I would like to do or think I should do ? What images or memories come into mind ?

From Mind Over Mood by Dennis Greenberger and Christine Padesky.1995 The Guildford Press

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