Sunday, August 02, 2009

Thought Challenging

I attended a great seminar on Thursday: "When Life Doesn't Turn Out as Planned" led by Bonnie Artman, LMFT, RN, CADC. (Family Counseling Service in Aurora, IL puts together some great in-services so definitely get on their mailing list if you're in the area.) No one would ever add a terminal illness or hospice to their life plan. Some patients have been in treatment for years before starting hospice, others are diagnosed just days beforehand with no possibility of treatment. Regardless of circumstances, part of my job as a hospice social worker is helping patients and families identify their coping skills and drawing from their strengths. This particular seminar helped me evaluate my patients' coping style, identify and eliminate barriers to progress, and learn to help patients reconnect with their inner resources. The beauty of any mental health seminar is that we practice what we preach: we try all the exercises we learn and, if we're open to the experience, we benefit from doing so.

I was particularly interested in Thought Challenging. In fact, it was so interesting that I told my mom all the steps to add to her repertoire and then led a friend through the exercise later that day! Can you tell I like counseling people?

Thought Challenging
Developing your personalized cue cards. Take 5 notecards and label them with A, B, C, D, and E. Each card will correspond to a particular step outlined below. Think of a particular concern you currently have, i.e. illness, job loss, relationship difficulty, loss of loved one, work troubles, etc.
Automatic Thought: This is your default reaction. Where do you automatically go with self-talk?
Belief: What are the core messages you received about yourself as a child? This can be based on your role in the family, life events, people who were critical of you, etc. (This step is rooted in Attachment Style as developed by Milan and Kay Yerkovich in "How We Love.")
Challenge: Challenge the automatic unhealthy thought. Where is the evidence this thought is true? How likely is this to happen? What are the alternatives? There are a number of exercises that you can use here. For instance, use "Yes buts..." to intentionally state the positive and look at what is going right. "Yes, I have cancer but I'm in remission." You can also make a True/False column to examine the evidence.
Discernment: Sift through the evidence. Take a step back. Let it percolate.
Energize: Now that you've looked at this objectively, what is something you can do? Use any anger in a positive way to move you forward. We can choose to be bitter or better. Avoid wishful thinking.

Personal example:
Problem: The on-call schedule is encroaching more and more on my personal life. (In fact, I'm on-call right now.) I'm exhausted.

Automatic thought: I'm going to burn out (if I'm not already.) I will be ineffective to my patients and families. I'm going to get sick. If I say anything at work, I'll be fired.
Belief: You need to just work harder. Pray that God will give you strength. We all have to do things we don't necessarily like. Don't focus on the negative.
Challenge:
Evidence:
True:
-I can't force change at work.
-If I stay at this pace and don't take care of myself, I will burn out and I will get.
-God will give me strength.
-Focusing on the positive will help my outlook.
-There's no administrative level support but we do take of each other as coworkers.

False:
-I won't be fired for advocating for myself.
-I can still be effective if I take it one case at a time.

Discernment: I can only do what I can do. If this situation becomes truly intolerable, then maybe it is time to look elsewhere now instead of waiting to get my Thanatology certification.
Energize: Develop a self-care plan better than my current routine. Restructure my on-call hours (Do the weeknight on-call the same week?)

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