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Rising Tide Therapist Notes
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Further Professional Support
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THERAPIST NOTES
Here you will find the background framework for the therapeutic sections of Rising Tide. There are suggestions for how to use the teacher and family therapeutic exercises as a therapist, and extensions for therapists to try in the therapy room. We have also provided something of a literature review to justify the therapeutic frameworks used and a short description of the research being conducted by Massey University. We welcome your feedback on this resource. Please contact us via our Facebook page www.facebook.com/TheWorryBug or the website www.theworrybug.co.nz |
Statement of Purpose:
Rising Tide is the third book in the Worry Bug project, produced in response to the Christchurch earthquakes. The books provide low-level intensity intervention to communities post-disaster. They use the format of a story with mental health themes that can be read as a class, family, or individually, and then provide exercises to address anxiety responses and build emotional resilience. The exercises are grounded in evidence-based therapeutic strategies and provided within the model of home and school scaffolding - a triangulated approach to children building on the attachment relationships of teacher-child-parent that already exist.
The approach is not intended to be a set of techniques, but rather an attempt at ‘second-order’ change - change that is long lasting and focused on changing beliefs which then lead to changes in the way systems (such as families and classes) function, causing different behavioural outcomes.
Rising Tide’s notes for teachers and families were written using a framework of cognitive behavioural therapy and social constructionist principles. The framework is set out below with reference to the therapy situation. It follows three stages. The extensions for therapists are in a similar framework.
Framework:
Stage 1. Exploring the stories and beliefs behind actions. Social constructionist theory is built on the idea that we define our realities through interaction with our particular context. We then build these realities further through language and sharing the ideas with others. Identifying the ‘story’ that a person has about themselves is the beginning of recognising that this story doesn’t have to be the only ‘truth’ that they function by. To extend this idea within the home-school scaffolding model, we ask children, teachers and families to think about the ‘stories’ around their families, their classrooms, schools and themselves as friends, daughters, sons, siblings, students etc. This encourages the child/family to think of all the different ways that they act/feel in all the different relationships that they have. i.e. What’s your story? Who are you and how are you defined? Who/What defines you?
This also aligns with the first steps in cognitive behavioural therapy - identifying thoughts and beliefs that underlie actions.
Stage 2. Examination of the old story, learning how it was built, thinking about the stories that others have of you and beginning to recognise the opportunity for new ways of being. This is the development and exploration phase, exploring how the story came about, the depth and breadth of it, being curious about any anomalies in it and from this conversation beginning to come across opportunities for new stories. Asking curious questions about the old story, without having the attitude that it should be different, allows the person to explore it less defensively. This stage also explores the consequences of these beliefs/stories. For example, Ari’s story of being “hopeless” has led him to a disaster situation and to emotional cutoff from his parents.
Stage 3. Intervention and Embedding change. Although intervention happens immediately you begin a relationship in therapy, this stage is more directly about building skills, exploring alternatives and consolidating these choices. By now the idea has been well sown that the stories we live by can be changed and challenged. New stories have been proposed or flirted with. These alternative stories can now be envisioned, enacted and practiced, both in the therapy room and outside it in ‘normal’ life situations. New stories can be shared with teachers, friends and family who can then act as ‘witnesses’ to new behaviour and consequences, and so complete a reinforcing cycle.
How to use this resource in therapy:
The exercises within Rising Tide, whilst written for use in the classroom and within the family, can of course be altered to suit the therapy room. As a mental health professional, you will know what will work best for the families or individuals that you are working with, and what will suit the context that you are in. It is very important that you change the material to suit, in consultation with the family or individual, so that you are collaborating and working in a strengths-based way.
Here are some ideas for how you might use the material.
Working with individuals: Use the teacher and/or family exercises, dip into the extensions as you see fit.
Working with families: Use the family exercises, either getting the family to lead them, or with you leading them, working as part of the system. Use the extension exercises as appropriate. When you work with a family, power is an issue - make sure that you reflect on your own power in the family therapeutic system, and enable the family to feel that they have control, rather than you. This will ensure more buy-in to change. Try to get permission to include teachers in feedback of these sessions as part of the implementation/embedding section.
Working with schools/groups in schools; use the teacher exercises, get permission to feedback to families about what you are working on. Use the family and extension exercises as appropriate.
Magical thinking, mind reading, catastrophising, dominant vs subjugated stories and avoidance
The ideas below, with the supporting videos, may help in understanding some of the psychological issues that come up when you are working with your children. It is important that, when you consider the ideas, you realise that children do not work as individuals, but in a system – that is, as part of a system with their family or their friends and their class. We cannot expect children to change by themselves. They need help to understand their worries and to understand how they might change. Then, they need adults to guide the change and help them to be consistent with it. Further, they often need the adults in their lives to change as well. Some of these ideas may apply equally to you as to your children.
Magical thinking and Mind reading
Many children believe in things that we as adults would not. For instance, if there is a noise from under the bed at night, children are more likely to think that there is a monster there. Or they might think that, because something bad happened last time they did a particular thing, they shouldn’t do that thing again. We call this ‘magical thinking’. The term covers a multitude of things and of course adults do it too, for instance, avoiding walking under ladders, or counting up to 10 and expecting a parking space to become free.
Ari worries that his teacher can read his mind and see all his secrets. He avoids meeting her gaze and has to change his behaviour so that she doesn’t challenge him. He has a belief that she can see into his mind and know his thoughts. As children learn empathy and develop an ability to distinguish themselves as separate to others, they are more able to resist this mind-reading mistake
The ideas below, with the supporting videos, may help in understanding some of the psychological issues that come up when you are working with your children. It is important that, when you consider the ideas, you realise that children do not work as individuals, but in a system – that is, as part of a system with their family or their friends and their class. We cannot expect children to change by themselves. They need help to understand their worries and to understand how they might change. Then, they need adults to guide the change and help them to be consistent with it. Further, they often need the adults in their lives to change as well. Some of these ideas may apply equally to you as to your children.
Magical thinking and Mind reading
Many children believe in things that we as adults would not. For instance, if there is a noise from under the bed at night, children are more likely to think that there is a monster there. Or they might think that, because something bad happened last time they did a particular thing, they shouldn’t do that thing again. We call this ‘magical thinking’. The term covers a multitude of things and of course adults do it too, for instance, avoiding walking under ladders, or counting up to 10 and expecting a parking space to become free.
Ari worries that his teacher can read his mind and see all his secrets. He avoids meeting her gaze and has to change his behaviour so that she doesn’t challenge him. He has a belief that she can see into his mind and know his thoughts. As children learn empathy and develop an ability to distinguish themselves as separate to others, they are more able to resist this mind-reading mistake
Catastrophising
When we have any kind of thought, we can respond to it in different ways. For example, you might be thinking about going to a wildlife park on your birthday with your best friend. You feel excited about this because you want to get to the lion cage and see those big cats close up. But your friend says that he is afraid to come because the lion might reach through the cage and get him. These are two different responses to the same situation. One of them is an example of catastrophising.
Ari makes a catastrophe out of not being able to spell “Theodore Street”. It links to his belief that his trouble with reading, writing and spelling means that he is stupid and he makes this an even bigger catastrophe by thinking his family will be angry about it. That means he can’t talk to anyone he trusts about his problems, and he has to find ways to hide them. This in turn leads to the situation with the boat, and nearly drowning: a real catastrophe.
Managing catastrophising requires a calm head. Using clear, logical thinking is one way. Testing the logic of thoughts by comparing them to other people’s experiences can be helpful. For instance: “Has anyone else I know ever been bitten by a lion at that park? What kind of precautions do they take to stop the lions getting people?” Or: “Do other people have trouble with spelling? Do my parents often get angry with me when I am having trouble with something?”
When we have any kind of thought, we can respond to it in different ways. For example, you might be thinking about going to a wildlife park on your birthday with your best friend. You feel excited about this because you want to get to the lion cage and see those big cats close up. But your friend says that he is afraid to come because the lion might reach through the cage and get him. These are two different responses to the same situation. One of them is an example of catastrophising.
Ari makes a catastrophe out of not being able to spell “Theodore Street”. It links to his belief that his trouble with reading, writing and spelling means that he is stupid and he makes this an even bigger catastrophe by thinking his family will be angry about it. That means he can’t talk to anyone he trusts about his problems, and he has to find ways to hide them. This in turn leads to the situation with the boat, and nearly drowning: a real catastrophe.
Managing catastrophising requires a calm head. Using clear, logical thinking is one way. Testing the logic of thoughts by comparing them to other people’s experiences can be helpful. For instance: “Has anyone else I know ever been bitten by a lion at that park? What kind of precautions do they take to stop the lions getting people?” Or: “Do other people have trouble with spelling? Do my parents often get angry with me when I am having trouble with something?”
Dominant vs subjugated stories
As we experience events in our lives, we interpret them according to our own set of beliefs. The same event happening to two different people can be interpreted in opposite ways. One reason for this is that we have each internalised “stories” about ourselves that we fit our experiences into. For example, if we are used to being told and responded to as if we are an academic failure, a one-off experience of succeeding will be “subjugated” or minimised by our pre-dominant story (of being a failure) and interpreted as a fluke. Our dominant story will dominate when we interpret events. If we want to reinvent ourselves, or develop a new dominant story, we must pay attention to our subjugated stories – those which we dismiss easily because they do not fit into our current way of thinking about ourselves. An example of this could be: Sarah was always a little scared of using the telephone as she couldn’t see the reactions of the person she was speaking to. She called herself shy and developed a story about not wanting to upset people if she had to be direct in a conversation. This meant that she would get other people to make calls for her about difficult issues. It also meant that she found it difficult to face conflict in business situations. When she considered that this could be a dominant story that was making life difficult for her, she began to experiment with making phone calls herself. She decided she could experiment with being a “brave” person and someone who could discuss difficult issues well. This decision led to her making some phone calls that she wouldn’t have made before, and managing them. This in turn meant that she had some evidence for herself that she could manage difficult situations and she could make phone calls. Her dominant story was then challenged and changed.
Ari has a dominant story that influences him in many spheres of his life. He finds it difficult to see any other stories about himself as true.
Just thinking about this concept may encourage you to identify some of the dominant stories that you or people in your family live by. The key idea here is that we do not have to be defined by these things, we may challenge them and thereby change our story. They are simply ideas that have taken root and grown branches.
Avoidance
Avoidance is one of the major factors that feeds anxiety. Whenever we face something scary or something that makes us nervous, one of our choices is to walk away – to avoid it. This is like self-sabotage: it means that we don’t do the job interview, or make the new friend, all because of the scary feeling that we have on the inside. We let the fear take control. In order to get rid of the fear, we avoid the situation. The next time we come across a similar situation we are more likely to avoid it again, thereby developing a pattern of avoidance. Ari is caught in an avoidance trap. He is desperately trying to avoid his teacher and family finding out how difficult reading and writing is for him. This leads to all sorts of avoidance behaviours, and eventually to a life-threatening situation.
Identifying what we do when we are scared can mean that we give ourselves choices about how we behave in these situations. Avoidance is a choice, but there are other choices too. You might like to think about the times people in your family avoid things and examine whether avoidance has become a way to cope with the world. Beginning to face your fears with support will mean that they decrease in intensity.
As we experience events in our lives, we interpret them according to our own set of beliefs. The same event happening to two different people can be interpreted in opposite ways. One reason for this is that we have each internalised “stories” about ourselves that we fit our experiences into. For example, if we are used to being told and responded to as if we are an academic failure, a one-off experience of succeeding will be “subjugated” or minimised by our pre-dominant story (of being a failure) and interpreted as a fluke. Our dominant story will dominate when we interpret events. If we want to reinvent ourselves, or develop a new dominant story, we must pay attention to our subjugated stories – those which we dismiss easily because they do not fit into our current way of thinking about ourselves. An example of this could be: Sarah was always a little scared of using the telephone as she couldn’t see the reactions of the person she was speaking to. She called herself shy and developed a story about not wanting to upset people if she had to be direct in a conversation. This meant that she would get other people to make calls for her about difficult issues. It also meant that she found it difficult to face conflict in business situations. When she considered that this could be a dominant story that was making life difficult for her, she began to experiment with making phone calls herself. She decided she could experiment with being a “brave” person and someone who could discuss difficult issues well. This decision led to her making some phone calls that she wouldn’t have made before, and managing them. This in turn meant that she had some evidence for herself that she could manage difficult situations and she could make phone calls. Her dominant story was then challenged and changed.
Ari has a dominant story that influences him in many spheres of his life. He finds it difficult to see any other stories about himself as true.
Just thinking about this concept may encourage you to identify some of the dominant stories that you or people in your family live by. The key idea here is that we do not have to be defined by these things, we may challenge them and thereby change our story. They are simply ideas that have taken root and grown branches.
Avoidance
Avoidance is one of the major factors that feeds anxiety. Whenever we face something scary or something that makes us nervous, one of our choices is to walk away – to avoid it. This is like self-sabotage: it means that we don’t do the job interview, or make the new friend, all because of the scary feeling that we have on the inside. We let the fear take control. In order to get rid of the fear, we avoid the situation. The next time we come across a similar situation we are more likely to avoid it again, thereby developing a pattern of avoidance. Ari is caught in an avoidance trap. He is desperately trying to avoid his teacher and family finding out how difficult reading and writing is for him. This leads to all sorts of avoidance behaviours, and eventually to a life-threatening situation.
Identifying what we do when we are scared can mean that we give ourselves choices about how we behave in these situations. Avoidance is a choice, but there are other choices too. You might like to think about the times people in your family avoid things and examine whether avoidance has become a way to cope with the world. Beginning to face your fears with support will mean that they decrease in intensity.