Resource-activation & Self-esteem in CBT

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1 Resource-activation & Self-esteem in CBT Dr. Anne Trösken De-Yong Jung Zentrum Überleben February 2018

2 Workshop Schedule Day 1: Getting started Some findings: importance of resource-oriented interventions How does it work: a quick look on resource activation as an active ingredient of CBT Some examples of resource-oriented interventions Resource priming Diagnostic tools Setting goals 2

3 Workshop Schedule Day 2: Behavior activation Challenges Pillars of self-esteem Interventions Challenging Situations Intervision Questions - Discussion 3

4 Goals for the Workshop Learn how to explore your patient s resources Get a resource-oriented perspective on your patients Learn how to implement resource-oriented values for yourself as a therapist Get to know and practice useful tools to activate, use and maintain resources Take a glance at self-esteem 4

5 Focus on the Therapist

6 Focus on the Therapist...the proof of the pudding is in the eating Should I focus on resources? Even if my patient is really challenging? Yes! 6

7 Some Findings: Importance of Resource-oriented Interventions

8 Resource Oriented Therapist The amount of therapist s resource-activation with easy or difficult patients in successful or less successful therapies. Regli,

9 Resource Oriented Therapist Should I focus on resources? Even if problems mount up like Gabal Katrîne s highest peaks? 9

10 Some More Findings Beginning and end of therapy sessions // amount of resourceactivation mean z-scores 0 mean z-scores z-values Anfang Mitte Ende Anfang Mitte Ende Anfang Mitte Ende -Session successful therapy - Session unsuccessful therapy Gassmann,

11 Steps of Intervention during Psychotherapy Stabilizing via resource activation Stabilization via resourceactivation Grawe,

12 Some Examples of Resource-oriented Interventions

13 Example 1 Patient: I often feel alone. I only have one friend. Problem-oriented intervention: So you really withdraw from people? Resource-oriented intervention: Your friend seems to be important to you. How do you connect? 13

14 Example 2 Patient: I hate my work, only during holidays I feel lifted and liberated. Problem-oriented intervention: How does your working experience affect your free time and holidays? Resource-oriented intervention: What did you cherish about your holidays? 14

15 Example 3 Patient: My problems rise up like a huge mountain. Problem-oriented intervention: Obviously you feel overwhelmed and devasted? Resource-oriented intervention: Right now it seems as if you look from too close so your problems appear to be overwhelming. Let us try to step back. 15

16 Priming Resources: The Role of a Resourceoriented Therapist

17 Priming Resources Effects on experiences of mastery in the first 20 sessions Flückiger et al.,

18 Priming Resources Gather together in groups of 3-4: Think about a difficult patient of yours what do you like about this person? Tell your colleagues about that and ask them about their impression. Do you manage not to talk about the difficulties? 18

19 Priming Resources Have a card with key resources of your patient Read this card before therapy session! What do you like, admire, cherish about your patient? What is just so cool about her/ him? Remember!!! Always 19

20 Diagnostic Tools

21 Diagnostic Tools Questionnaires: Bern Inventory of Resources (Trösken, 2002) Resource Checklist (Dick, 2007) 21

22 Resource Potentials Working - Loving - Learning Working Competencies in acting efficiently Stress resistance Autonomy in thinking and acting Self-worth Acceptance of own needs Loving Social competencies Social integration Familiy embeddedness Emotional openness Optimism, happiness and feeling of meaning Learning Self reflection Eagerness to learn Open communication Imagination and creativity Intellectual capabilites Hobbies and interests 22

23 Diagnostic Tools Half structured interview: Resource Analysis (Trösken, 2002) 23

24 Resource Analysis Resources Self rating Perspective of others Material resources Example: certificates,insurances, living space, working spaces, favourite pieces, clothing, vehicles Physical resources Example: physical characterists, I like or find attractive, any aspects of physical health: organs, fitness, enjoying sports Personal resources Examples: charcterists of ones personality, that one cherishes, signatures strengths: reliability, friendliness, assertiveness, experiences in overcoming hardships, resilience.. Social resources Examples: friends, family, doctors, relationships, internet contacts, networks 24

25 Diagnostic Tools Timeline, life span Genogramm 25

26 Life Span: Recurrent Depression Basic School Nice teacher Good friends Lots of fun Being part of the high school theatre group, great success, feeling integrated First love Beginning of university, living in studenthome Great holiday therapy 26

27 Diagnostic Tools Experimental techniques: Resource Cards Resource Zoo 27

28 Setting Goals

29 Identifying Goals A miracle : If a fairy enterd the room and ended all troubles at once what would happen then? Goal attainment: If my problem is solved, what will I do, think, feel? Positive identity goals: What kind of a person do I want to be? 29

30 Identifying Goals Video example: the miracle question 30

31 Activation of Behavior and Resources

32 Behavior Activation Painting positive and favourite activities 32

33 Behavior and Resource Activation Painting is more fun! especially for patients suffering from depression Painting adds more to mood than working on a list of positive activities Painting positive activities leads to better recall Only painting leads to better resource realization two weeks later 33

34 Resource Activation Implementation in daily life: Diaries: 3 positive experiences Experiencing positive feelings One goal a day building up self-esteem 34

35 Some Challenges

36 Some Challenges Self complexity of the cognitive network of resources: Torch vs. Sudden blinks 36

37 Some Challenges Using the torch: only with patients with high self complexity in resource networks High positive self complexity Low positive self -complexity Mood before and after the interview lower values = better mood 37

38 Some Challenges Resource analysis is part of the individual case conception. Resource activation facilitates the process but working on key issues is nevertheless necessary. 38

39 Some Challenges Don t expect too much change too quick! Even if the solution seems obvious to you. 39

40 Some Challenges Don t skip validation of emotional pain and hardship. Resources are not problem plasters 40

41 Some Challenges Too much of good things 41

42 Changes in Resource Realization Psychosomatic rehabilitation (6 weeks) End of therapy 60% improved 31,5% worsend 10% 42

43 Pillars of Self-Esteem

44 Pillars of Self-esteem Definition of Self-esteem Potreck-Rose & Jacob,

45 Pillars of Self-esteem Intrapersonal Dimension Self-acceptance Self-confidence Potreck-Rose & Jacob,

46 Pillars of Self-esteem Interpersonal Dimension Social skills Social network Potreck-Rose & Jacob,

47 The Four Pillars of Self-esteem Self-esteem Self-acceptance Positive attitude towards oneself - satisfied with oneself - agreeing with oneself - cherish oneself - be one with oneself - feel at home in oneself Self-confidence Positive attitude towards ones own skills and achievements - being good in sth - doing sth well - achieve sth - being able to leave sth Social skills Experience of interpersonal skills - getting along well with people - feeling up to difficult situations - capable of flexible reactions - feeling positive responses - capable to regulate proximity and distance Social network Involvement into positive social relations - satisfying loverelationship - satisfying family relationship - having friends - capable to rely on sb. / to be reliable - being important to others Intrapersonal dimension Interpersonal dimension Potreck-Rose & Jacob,

48 Interventions for Therapy

49 Interventions for Therapy Pillars 1 and 2 can be adressed in one-to-one sessions Pillars 3 and 4 should idealy be adressed in group therapy 49

50 Basic Assumptions The base of self-acceptance and self-confidence is a positive self-care: Become attentive for yourself, be mindful Encounter yourself caringly Care for yourself Selfacceptance & -confidence 50

51 Interventions for Therapy Mindfulness an attentive, nonbiased observation of everything perceive things/situations/... and see them as they are, without distorting them emotionally or intellectually to be here and now as you are 51

52 Interventions for Therapy Mindfulness regarding: senses body needs 52

53 Interventions for Therapy Caring encounter Choose a caring companion Identification of inner critic Encounter yourself caringly in everyday life 53

54 Interventions for Therapy Care for yourself Implement self-care into daily routine Commitment to self-care Identifying obstacles 54

55 Interventions for Therapy A path to self-confidence Set goals Plan steps Determine expectation of success and use of energy Plan self-gratification Check results 55

56 Challenging Situations in Therapy

57 Questions?

58 THANK YOU

59 Gassmann, D., & Grawe, K. (Writers). (2006). General change mechanisms: the relation between problem activation and resource activation in successful and unsuccessful therapeutic interactions [Article], Clinical Psychology & Psychotherapy: John Wiley & Sons, Inc. Flückiger, C., Caspar, F., Grosse Holtforth, M., & Willutzki, U. (2009). Working with patients strengths: A mircoprocess approach. Psychotherapy Research, 19(2), Flückiger, C., Frischknecht, E., Wüsten, G., & Lutz, W. (2008). Ressourcenpriming. Veränderung der Aufmerksamkeitsfokussierung bei Novizen und erfahrenen Therapeuten zu Therapiebeginn. Zeitschrift für Psychiatrie, Psychologie und Psychotherapie, 56(1), Grawe, K. (2005). Psychological Therapy. Göttingen: Hogrefe. Potreck-Rose, F. & Jacob, G. (2008). Selbstzuwendung, Selbstakzeptanz, Selbstvertrauen. Stuttgart: Klett-Cotta.

Problem Situation Form for Parents

Problem Situation Form for Parents Please complete a form for each situation you notice causes your child social anxiety. 1. WHAT WAS THE SITUATION? Please describe what happened. Provide enough information