Professional Documents
Culture Documents
Higher Care - Unit 1 - Psychology For Care
Higher Care - Unit 1 - Psychology For Care
Support Material
August 2007
Acknowledgements
Breathing Space:
www.breathingspacescotland.co.uk
Janet Miller for permission to use the Adam’s Hayes and Hopson’s model of
transition in Janet Miller (2005) Care Practice for S/NVQ 3 London: Hodder and
Stoughton p 207
National Extension College for the list of Ellis’s Irrational Beliefs
National Extension College (1996) An Introduction to Counselling Theory
Prince and Princess of Wales Hospice, Glasgow for information from their
website: http://www.ppwh.org.uk/index.cfm/page/127/
Scottish Executive for the article on parenting
Scottish Executive (2007) How Small Children make a Big Difference in Well?
Issue 10: Spring/Summer 2007
Scottish Executive for information on services for drug users
Scottish Executive (2007) Review of Residential Drug Detoxification and
Rehabilitation Services in Scotland
http://www.scotland.gov.uk/Publications/2007/06/22094802/1
F17X 12
Introduction
These notes are provided to support teachers and lecturers presenting the
Scottish Qualifications Authority F17X 12, Psychology for Care. Copyright for this
pack is held by the Scottish Further Education Unit (SFEU). However, teachers
and lecturers have permission to use the pack and reproduce items from the pack
provided that this is to support teaching and learning processes and that no profit
is made from such use. If reproduced in part, the source should be
acknowledged.
Website: www.sfeu.ac.uk
Website: www.sqa.org.uk
Whilst every effort has been made to ensure the accuracy of this Support Pack,
teachers and lecturers should satisfy themselves that the information passed to
candidates is accurate and in accordance with the current SQA arrangements
documents. SFEU will accept no responsibility for any consequences deriving
either directly or indirectly from the use of this Pack.
Contents
Reference Section 8
What is the Care Course all about? 9
The Course in Care (Higher) 13
Unit Outcomes, PCs and Evidence Requirements 15
Tutor Support Section 18
How to Use This Pack 19
Question Types in Higher Care Assessments 20
Guidance on Specific Activities 21
Activity: Memorising Information 23
Guidance on Unit Delivery 30
Resources 31
Student Support Section 33
Key to Activity Symbols 34
Study Tips 34
Glossary of Terms: Psychodynamic Approach 35
Glossary of Terms: Cognitive Behavioural Approach 36
Glossary of Terms: Humanistic Approach 37
Outcome 1: Performance Criteria and Mandatory Content 38
Activity: What is Psychology? 39
The Influence of Nature and Nurture: Physical Health 40
Application to Care: The Influence of Nature and Nurture 42
Activity: The Relevance of Psychology for Care Workers 43
Outcome 2: Performance Criteria and Mandatory Content 44
Psychological Approaches: An Overview 46
Psychodynamic Approach 47
Anxiety and Defence Mechanisms 48
Application to Your Own Life: Parts of the Personality 49
Application to Your Own Life: Anxiety and Defence Mechanisms 50
Study Tip: Mnemonics 51
Reference Section
Summary of Course
The Course aims to provide the knowledge, understanding, and skills to enable a
candidate to recognise the role of sociology in fashioning care priorities and
practice. This is entwined with the role of psychology in providing evidence of
human behaviour and development. This will have an effect on how the person in
need of care responds to change in their life. The application of theories to these
clients enables us to account for specific behaviour. The Unit Values and
Principles in Care (Higher) examines the care relationship as well as how
legislation, values and principles underpin professional care practice and how we
plan to meet the care needs of individuals.
The mandatory content for this Unit is detailed in the Appendix to the Unit
Specification (www.sqa.org.uk). This mandatory content is sampled in both Unit
and Course assessment.
ASSESSMENT
To achieve the Course award the candidate must achieve the Units as well as
pass the Course assessment. The candidate’s grade is based on the Course
assessment.
Assessment objectives
• Analysis
Candidates should be able to select from, interpret and analyse different
sociological and psychological theories and models of care planning in the context
of care practice. In so doing, candidates should be able to present information in a
balanced, logical and coherent manner, which focuses clearly on the issues under
review. Candidates should be able to use, with confidence, the language and
concepts of care and demonstrate a clear and in-depth understanding of the inter-
relationship between evidence and theory. Assessment of issues should be critical
and comprehensive and should reflect confidence in dealing with complex
arguments.
• Application
Candidates should be able to demonstrate the application of theories, concepts
and methods covered in the Units and apply them to a care situation. This will
centre on case study and simulated situations from key theoretical and practical
issues in sociology and psychology as applied in care practice, and values and
principles in care.
• Evaluation
Candidates should demonstrate the ability to make balanced evaluations of care
related theories and practical examples and base these upon justified and
sustained arguments. Explanations offered and methods used by care
professionals should be examined critically and the conclusions drawn should be
well developed and reasoned, reflecting clear understanding of the care topic
being assessed.
Unit assessment
Each assessment samples across the mandatory content for the individual Unit
and the nature of sampling is detailed in the Evidence Requirements within the
Statement of Standards within each Unit Specification. If re-assessment is
required, it should sample across a different range of mandatory content.
Further details about Unit assessment for this Course can be found in the Unit
Specifications and the National Assessment Bank (NAB) materials.
Course assessment
Paper 1:
• Section 1 set on content of Psychology for Care (Higher)
• Section 2 set on content of Sociology for Care (Higher)
The mark allocation for this paper is 50
Paper 2:
• Section 3 set on content of Values and Principles in Care
• Section 4 set on the integrated content of at least two of the three Units in this
Course
The mark allocation for this paper is 50
Further details of the Course assessment are given in the Course Assessment
Specification and in the Specimen Question Paper. (www.sqa.org.uk)
The Course consists of three Units and an additional 40 hours study. The Course
assessment tests the candidates’ knowledge and understanding of the content
covered in all three Units and their ability to demonstrate and apply knowledge
and skills acquired throughout the Course.
Unit and Course assessment complement each other. Unit assessment provides
evidence of a specific level of achievement in the psychology, sociology and
values and principles sections of the Course. The Course assessment confirms
and expands on this, providing sampled evidence of a range of skills exceeding
those required for Unit success, such as retention of knowledge. The Course
assessment at Higher requires that candidates demonstrate the ability to:
• retain knowledge and understanding from across all three Units of the Course
on a single occasion
• analyse and evaluate theories and applications to the care context from all
three Units on a single occasion
• apply theories and applications in a care context to a range of topics from
across the Units on a single occasion
• integrate knowledge and understanding of theories and applications in a care
context
• perform more complex analytical and evaluative tasks than required for Unit
assessment.
Course Rationale
Issues of health and social care are becoming increasingly important due to an
increase in the population of care service users. As a result, there is a growing
need for qualified health and social care professionals. The Higher Care Course
provides a strong foundation of knowledge and skills for candidates who wish to
progress to further or higher education or employment in this area.
The Higher Course in Care relates to caring for people in society, other than self
or family, in an environment or agency whose codes of practice are dictated to
and guided by legislation, policy and professional ethics. This includes formalised
personal care in the community or home. It is concerned with the holistic study of
the client in context.
The Course will form an important part of the menu of provision, not only for those
who have identified the field of care as their chosen career path, but also for any
candidates who wish to extend their educational experience.
Aims
SUMMARY
This is a mandatory Unit in the Care (Higher) Course but it can also be taken as a
free-standing Unit.
The Unit is suitable for candidates who wish to gain employment in the health and
social care sectors at support worker level or to progress to further study.
OUTCOMES
OUTCOME 1
Performance Criteria
(a) Explain the relationship between nature and nurture and their influences on
human development and behaviour.
(b) Explain the ways in which psychological insights can assist care workers to
understand human development and behaviour.
OUTCOME 2
Performance Criteria
(a) Describe theories from different psychological approaches which are used to
explain human development and behaviour.
(b) Apply different psychological approaches to behaviour in a care context.
(c) Evaluate the relevance of these approaches in a care context.
OUTCOME 3
Performance Criteria
(a) Describe theories of life change which are used to explain human development
and behaviour.
(b) Evaluate the relevance of these theories in a care context.
The mandatory content for this Unit can be found in the appendix at the end of this
Unit specification (www.sqa.org.uk).
Each assessment must sample across the mandatory content of the Unit and will
allow candidates to generate evidence which covers:
• the inter-relationship between nature and nurture and their influence on human
development and behaviour
• how psychological insights can assist care workers
• one theory from one psychological approach
• two applications of one approach to behaviour in a care context
• the relevance of one psychological approach to care
• describe one theory of life change
• evaluate the relevance of that theory in a care context.
This part of the Unit Specification is offered as guidance. The support notes are
not mandatory.
While the exact time allocated to this Unit is at the discretion of the centre, the
notional design length is 40 hours.
NB Centres must refer to the full Unit Specification for detailed information
related to this Unit.
A lot of materials have been provided for tutors and students and it would be
impossible to use them all within the 40 hours allocated to the unit. It is therefore
likely that some of the material will be used when students are revising for the
Care Higher external exam. Most of the case studies ask a question based on one
topic e.g. Murray Parkes model of loss or the Humanistic Approach, but tutors can
use each case study as the basis for assessing student knowledge and
understanding of other topics.
Keywords have not been highlighted in the text. This is because students are
encouraged to actively engage with their learning by highlighting the key concepts
of each page. This is explained to students on page 34. Tutors can use the first
few lessons as opportunities to discuss with students which words/phrases should
be highlighted. This could act as a useful revision exercise at the end of the class.
Question setters use Blooms taxonomy (below) as a guide to the type of question
that is asked. This shows how the level of complexity of a question moves from a
simple task which asks for Knowledge - ‘Define’ - to a much more complex task
such as ‘Assess’ which involves Evaluation.
Source: http://www.officeport.com/edu/blooms.htm
Students should be made aware of the different types of answers they should
give, depending on the command word in the question. Guidance is given to
students on page 113 about how to understand what is being asked in a question.
There are a number of sites on the internet which give more information about
Bloom’s taxonomy, such as http://www.educationforum.co.uk/HA/bloom.htm.
It is important that students get enough time, space and resources to draw their
tree without interruption.
Once students have put their pictures up on the wall, the class can have a look at
the differences/similarities and discuss what kind of ‘picture’ they show of the
person. If presented in a supportive environment, students can get a lot of
interesting feedback on what their picture shows about them. The tutor should
model giving constructive comments, and make points as suggestions rather than
facts. The speaker gives as much away about their own point of view as they do
about the person who drew the picture.
The points which tend to come up in this exercise are: are there strong roots, any
roots at all; what season is it – summer/winter; are there a lot of flowers/leafs/birds
animals in the tree; are there people/ swings etc around the tree; how big is the
tree in relation to the paper –a small tree in the middle, or an enormous tree that
pours out of the page; what colours have they used for the tree; what is the
sky/grass like – is the tree in a context, or floating by itself?
External question papers and marking guidelines can be found on the SQA
website. These can be used as practice for unit assessments and for the external
exam and student answers can be collected from these scripts for use with future
students.
1) Give the students one of the two ‘Memorising Information’ handouts and ask
them to memorise the information on it. They should not turn it over before you
give the instruction. You should make sure that all the people on one side of
the room get one handout, and the people on the other side get the other one.
2) Time: They should be given a short period of time to do this – perhaps two
minutes.
3) Ask them to turn the piece of paper over and write down as many of the names
as they can remember.
4) Class Discussion: did the students with the ordered information have better
results than the group with the random information?
Did anyone in the group with ordered information realise that the local areas
were ordered alphabetically? Did this help them?
Did anyone use any other study technique e.g. make a mnemonic?
Did the people with the list see the connections between the words and make
any attempt to make links or group ideas together?
a) Tutors could give a list of key concepts from the different psychological
approaches and ask students to group them into relevant topic areas, as a
revision aid.
Memorising Information: 1
Memorise the following information:
Auchinyell
Kincorth
Mastrick
Mugiemoss
Torry
Aberdeen
Memorising Information
London Glasgow
Barnes Baillieston
Brixton Carntyne
Chelsea Shettleston
Knightsbridge Battlefield
Walthamstow Penilee
Memorising Information: 2
Memorise the following information:
Barnes
Aberdeen
Auchinyell
Baillieston
Walthamstow
Battlefield
Torry
London
Carntyne
Brixton
Kincorth
Knightsbridge
Penilee
Mastrick
Glasgow
Chelsea
Mugiemoss
Shettleston
This pack can only deal with points 1 and 2, but tutors will get an opportunity to
develop their skills in point 3 through SQA and SFEU workshops. A number of the
exercises in this pack will encourage the learner to reflect on their own work and
to assess other learners work, in order to build them into more independent
learners. This will include the use of formative assessment in hopefully preparing
learners to produce a more confident performance in summative assessments
and external exams.
• ‘Comment Only’ Marking i.e. they don’t get a mark, but do get feedback on how
to improve their answer. This is intended to encourage the learner to think
about what they can do to improve their work rather than just think: ‘Great. I’ve
scraped a pass.’ followed by turning round to ask the mark of the person sitting
next to them. This type of feedback ties in to promoting the learner’s intrinsic
valuing of their work and taking pride and responsibility for achievement and
progress, rather than the extrinsic pass/fail mentality.
• Peer- or Self-Assessment. These skills help the learner to develop an
awareness of what makes a good piece of work. It asks them to independently
judge what is strong or weak in an answer, rather than to rely on the tutor. The
tutor needs to support learners to achieve the confidence and ability to do this,
but it is a very useful technique once developed.
The two techniques could be used together, with the student awarding themselves
a mark after considering the comments from the tutor. They can then match this
with the mark that the tutor would have awarded them.
For this reason, all the answer sheets to the worksheets and formative
assessments are at the end of the pack. This means that tutors can copy the
whole pack to give out to students, if desired, but keep the answer sheets
separate and decide when it is most suitable for them to be handed to the class.
http://www.ltscotland.org.uk/curriculumforexcellence/index.asp
The Curriculum for Excellence Report aims to ensure seamless education for
children and young people (CYP) in Scotland, aged 3–18. The Care Course can
contribute to this by directly or indirectly meeting the aspects in bold below. This
subject area and the methods of teaching that are used are ideal for meeting
these aims.
Teaching activities
• Activity based
• Creative/innovative
• Direction of travel: do students know where they are going. Do they know how
to get there?
• Narrative: what is the story you want to tell? Not how difficult it is, but how
relevant/interesting it is.
http://www.hmie.gov.uk/documents/publication/cisc.pdf
This HMIe report states that the development of skills for citizenship in education
is a priority in Scotland and throughout Europe. Citizenship involves the
development of skills and attributes to enable young people to participate in the
making of decisions, within the political, economic, social and cultural contexts of
their lives. Other aspects of citizenship education include the development of
knowledge and understanding; a focus on values and citizenship issues; and
opportunities for engagement in, and reflection on, citizenship activities.
This unit enables students to develop skills for citizenship through course content
which encourages awareness of individual difference and understanding of the
needs of a range of people. The unit also provides peer and self assessment
activities which help learners develop independence in learning and critical
thinking.
The report notes the need for ‘Programmes of learning that contribute to the
continuous development of the social services workforce’ and which ‘Support the
establishment of career pathways and career progression, in line with emerging
policy needs’. This course, based at SCQF level 6, enables learners to enter into
the social service workforce at care assistant level, or to develop further
underpinning knowledge by advancing to HNC care Courses.
http://www.scotland.gov.uk/learningtogether/
Please note that the materials and activities contained in this pack are not
intended to be a mandatory set of teaching notes. They provide centres
with a flexible set of materials and activities which can be selected, adapted
and used in whatever way suits individual centres and their particular
situations.
Although centres will deliver this unit in a number of ways, a timetable for an 18
week course with 2 hour classes is provided below. As the unit is a nominal 40
hours, this implies that there are at least 4 hours for self study. Apart from revising
their notes, students can be expected to carry out some of the activities in their
own time and bring their work back to class for discussion/marking.
Week Content
1 Introduction to unit: Definition of psychology;
Relevance of psychology to care;
Discussion of importance of nature and nurture
2 Overview of psychological approaches
Psychodynamic approach
3 Psychodynamic Theorist: Erikson and Lifespan Theory
18 Unit evaluation
Resources
Book
Miller, J. and Gibb, S. (Eds) (2007) Care In Practice for Higher (2nd Edn) Hodder
and Stoughton
Murray Parkes, C. (1996) Bereavement: Studies of Grief in Adult Life (3rd Edn)
Penguin Books
Worden, J. W. (2003) Grief Counselling and Grief Therapy: A Handbook for the
Mental Health Practitioner (3rd Edn) London:Routledge.
Hough, M (1998) Counselling Skills and Theory London: Hodder & Stoughton
Your college or local library might subscribe to these. If not, look them up on the
internet. They have up to date information about the ways in which the
approaches and theories discussed in this unit are applied in care settings.
www.careappointments.co.uk/
Care Appointments is an online resource for people involved in the caring
professions. It has relevant news, features and interviews, as well as information
about jobs and training courses.
Community Care
www.communitycare.co.uk
Nursing Times
www.nursingtimes.net/
The Guardian: They have a special ‘Society’ section on Wednesday which covers
relevant issues for this unit.
society.guardian.co.uk/societyguardian/
The Herald: They have a special ‘Society’ section on Tuesday which covers
relevant issues for this unit.
www.theherald.co.uk/heraldsociety/
The Scotsman
thescotsman.scotsman.com/health.cfm Click on ‘Health’, ‘Education’ and
‘Scotland’ topics.
http://webspace.ship.edu/cgboer/perscontents.html
Dr. C. George Boeree, a professor in the Psychology Department at an American
University has produced a very readable site.
New sites are created all the time and you may be able to find better and more up
to date sites. Check that they have a ‘.edu’ tag, as this means that they will come
from a college or university. Other sites may also have good information, but
always check your source.
Group Investigation
Study Tips
In this support pack, the key words on each page have not been put into bold, as
it will be more educationally useful for you to be actively involved in highlighting
these words. Your tutor will discuss with you the best way to do this in the first few
classes. If you don’t already have some, go and buy yourself some highlighter
pens!
The point of highlighting each keyword is so that when you read over your notes,
the main points on each page jump out at you. Therefore, it is crucial that you only
highlight one or two words at a time. If you highlight too many words, then nothing
will jump out at you and you’ll need to wear sunglasses to read your notes!
2) There are other study tips throughout the pack. They are relevant not only for
this unit, but for all the units you are studying.
Intrinsic Reward A reward which comes from inside the person e.g. a
feeling of pride or satisfaction
Irrational belief A belief that doesn’t help us achieve our goals in life.
A self-defeating belief.
Learning Behaviourists believe we learn by making
associations between an event, our response and the
consequences. (ABC model)
Modelling Copying the behaviour of someone else, generally
someone we admire and look up to.
Reinforcements Something that is more likely to make a person
repeat a behaviour. It could be an intrinsic or extrinsic
reward.
Response The way we act in relation to a stimulus, or
antecedent.
Self-efficacy A person’s belief about what they can do has an
influence over what they actually achieve.
Stimulus The event, trigger, or antecedent to which we
respond.
Performance Criteria
(a) Explain the relationship between nature and nurture and their influence on
human development and behaviour.
Mandatory Content
(b) Explain the ways in which psychological insights can assist care workers to
understand human development and behaviour.
Psychologists are interested in how we all develop our individual personality. They
are particularly interested in trying to understand what parts of our identity comes
from nature – the genes we have inherited from our parents – and what parts
comes from nurture – the way in which we have been brought up.
One way of looking at this is to look at different people from the same family.
1) Describe 3 ways in which you are different from your parents or brothers and
sisters.
2) Describe 3 ways in which you are similar to your parents or brothers and
sisters.
3) Can you give reasons for these similarities: in your opinion, are these
similarities due to nature (your genes) or nurture (the way you were brought
up)?
4) What reasons can you use to explain the fact that there are differences
between you and the rest of your family?
So, there are clear links between genes and physical health, but even with these
clear links, it doesn’t mean to say that things will definitely turn out a certain way.
We can still influence nature with nurture: the way we look after ourselves, the
decisions we make and the life that we lead. This is called your phenotype: the
observable physical characteristics which are based on the interaction of your
genotype with environmental influences.
In the Sociology for Care unit, you will look in more detail at the influence that your
family, community and society have on your life chances. All kinds of social
factors might affect the development of your identity and the behaviour you
display: from the position you have in your family (oldest child, middle or
youngest), your gender, race, religion, whether you have a disability or not,
whether you live in an urban or rural community, whether you live in luxury or
poverty. This theme will be considered in more detail when we look at
psychological approaches and theories later in the unit.
Joe is a 53 year old who has spent most of his life in Pitfodels, a large psychiatric
hospital on the outskirts of town. When he was small he was a ‘difficult boy’ and
‘very slow to learn’. His elderly parents found it too difficult to cope with him and
as a teenager he was sent to Pitfodels. Today, he might have been diagnosed as
having learning disabilities. He grew up with the other residents and was relatively
content with life. Most things were done for him – his meals were made for him, he
could wander around where he wanted and he helped the staff look after the
garden. When the hospital closed 4 years ago as part of the move to care in the
community, Joe was one of the last to leave. He didn’t want to move to a strange
place away from all the people and routines he had known for years. Eventually,
he moved into Donnington Gardens supported accommodation where he shared a
flat with one other person. There were 4 flats in the same block all owned by the
same care organisation, so there was 24 hour a day support.
Joe stuck firmly to his routines to begin with. He always had to have one cigarette
when he got up and two more with his coffee at breakfast time. If he didn’t have
three cigarettes – no more, no less – he became agitated, but he found it difficult
to put his feelings into words. He would sit in his seat, not looking at anyone, and
make noises. When he had a meal, he ate his food really quickly and spilt a lot of
it. He didn’t notice he had made a mess on his clothes and so never attempted to
clean it up. His personal hygiene was poor and members of the public often
moved away when he went to the shops with a staff member to buy cigarettes. He
hated having a bath and when it came to having a shower, he just stood there with
the water running over him. The staff wondered whether someone else had
washed him when he was in Pitfodels: he just didn’t seem to know what to do.
A detailed support plan was established to work with Joe on a number of aspects
of his daily living. For instance, staff felt that he might be able to wash himself in
the shower if he was encouraged and so they took a three step approach: talk to
him about what he might do to wash himself, and the order he might do it in; show
him what to do when he was in the shower; and, if he still wasn’t keen to wash
himself, then they would assist him to wash himself, by holding his hand and
helping him move it. Since this was such an intimate task, they always ensured
that a male staff member was on duty to help Joe with his shower, as they were
aware of the need to respect his dignity and promote his independence. After
many months of support, Joe was able to take his shower unsupported by a
member of staff. His hygiene had improved as well and he was now able to eat his
food more slowly and talk during mealtimes.
Question
What role did nature and nurture take in Joe’s development? 4 KU 4 App
Although this topic comes up in Outcome 1, it is not a question that you can
answer in any depth until you have completed this unit. It will also help if you can
consider the information you have learned from other units you may have
completed in the Care Higher - ‘Sociology for Care’ and ‘Values and Principles for
Care’.
Discuss the answers to the questions in class, and write down your initial ideas.
Then, think about the questions as you go through the unit. They will be asked
again at the end and you should be able to give much fuller answers then, based
on the knowledge and understanding you have gained.
3) Why is a knowledge of psychology useful for care workers who want to engage
in continuing professional development?
Performance Criteria
(a) Describe theories from different psychological approaches which are used to
explain human development and behaviour.
Mandatory content
• empirical
• learning theory: stimulus, response and reinforcements
• social context important for humans: modelling, observing, self-efficacy
• cognitive processing.
• holistic
• phenomenological
• personal agency.
Mandatory content
Mandatory content
Psychodynamic Approach
Cognitive/Behavioural Approach
Humanistic Approach
This is the third major approach in psychology and emerged in response to the
limitations of the psychodynamic and cognitive/behavioural approaches. The
Humanistic approach considers that the other two approaches are too narrow and
do not account for the active part that people play in choosing how to behave.
The humanistic approach suggests that behaviour has to be understood from the
unique point of view of the person themselves looking at all aspects of their life,
not just their behaviour or past experiences. This approach considers that people
have free will and the capacity for change. Behaviour is the result of personal
experience and personal choice, based on the ideas a person has about
themselves and the world.
Psychodynamic Approach
Sigmund Freud (1856-1939) was the originator of the psychodynamic approach
and he believed that early childhood experiences provided an explanation for later
adult behaviour. He believed that people developed psychologically in stages up
until adolescence, by which time their personality was largely fixed.
The psychodynamic approach suggests that the mind has three levels.
These three personality structures usually work in harmony but conflict sometimes
occurs. The Ego has to work hard to keep the impulses from the Id under control.
When the competing needs of the Id and Superego are well-balanced and a state
of dynamic equilibrium is achieved then the person is said to be well-grounded.
When the Ego favours the Id then the person is said to be Egocentric or Self-
centred and acts impulsively. When the Ego favours the superego then the
person is rigid, conformist and demanding of self and others.
Psychologically healthy people develop a strong ego, and are able to cope with
the demands of the superego and id. Defence mechanisms help to regulate this
process through life. It is only when they are overused or become rigid that
emotional problems arise.
As a reminder:
Ego: weighs up whether an action is ok or not, given the circumstances
Id: doesn’t care about the consequence; throws caution to the wind; is reckless
Superego: very aware of right and wrong: wouldn’t want to be caught doing
anything bad
• Bought something on a credit card, knowing you didn’t have the money to pay
for it
• Being critical of someone who is very outgoing and flamboyant
• Taken another drink when you think it might put you ‘over the limit’
• Getting overly annoyed with yourself if you don’t get great marks in an
assessment
• Blamed someone else for something that you did
• You are never late and get very impatient with people who are
• Went into work even when you were feeling really lousy because you knew
you’d be letting people down
• Your house is always spotless and you don’t like it when the kids leave a mess
• Flirting with someone you know is in a relationship
• Found someone else’s purse in a changing room and handed it to a member of
staff
• Not handed in some college/school work when it was due and blamed the
dog/your children/an ill relative
• You never ask for help because you think you should be able to do everything
yourself
• Talk loudly to your friend in class when the tutor is talking even after the group
has agreed that it is disrespectful?
2) Can you give three other examples of behaviour from the Id and three
behaviours from the Superego? They don’t need to be from your experience!
Sublimination
Denial
EGO
Rationalisation Regression
.
Projection
Displacement
For example, the sentence ‘Richard Of York Gave Battle In Vain’ is a quick way of
remembering the correct order of the colours of the rainbow : Red, Orange,
Yellow, Green, Blue, Indigo Violet.
What do you think is described in this sentence? (Taking the first letter of each
word, think of the heavens.)
In both these cases, the order of the words is crucial, so they can’t be changed
and your sentence has to fit the words, but in a situation like memorising the 7
defence mechanisms, it doesn’t make any difference what order they come in, so
you can play around with the words a bit.
The point of having a mnemonic is so that when you sit an assessment, even
before you look at the questions, you can write down the key ideas quickly. This
means that if you look at a question, panic and your mind goes blank, you still
have something written down that will help you answer the question.
c) Share your ideas with the whole class. You can maybe decide on a class
definition, and the tutor could use this every time you revise this topic. This
repetition will help imprint the mnemonic in your mind.
A paper entitled ‘0-5: How Small Children Make a Big Difference’ has highlighted
some harsh realities about our approach to parenting and day care of young
children, and has made strong recommendations about the future. There is a
direct line between the experiences of early childhood and subsequent adulthood
– brain development is most rapid in the months before birth and up to age five. If
that is disrupted by drugs, alcohol, smoking, poor diet or stress then today’s baby
becomes tomorrow’s disadvantaged child. Once born, a child needs someone to
love them and to respond to their needs, and research shows that support and
education in parenting, plus well-delivered, enriched day care, pay dividends to
the family, the child and society. We insist on more formal education and training
to drive a car than to be a parent. But better parenting is not just for the
‘unfortunate’ or the ‘disadvantaged’. More affluent homes play with fire by
outsourcing care of their babies too early and for too long. Getting ‘early years’
right benefits the whole of society. Through economic research, psychology,
biology and neuroscience, the answers come out the same: treat what happens in
the first years as gold.
If you would like to find out more about mental health improvement work, visit
www.wellscotland.info
Excerpts taken from: Scottish Executive (2007) How Small Children make a Big
Difference in Well? Issue 10: Spring/Summer 2007
Questions
1) The report was written as a ‘provocation paper’ to get people thinking in a new
way about the issue of parenting and the impact it has on young children.
Discuss one thing you agree with in the article and one thing you disagree
with.
2) “We insist on more formal education and training to drive a car than to be a
parent.” Do you think that parenting skills are something that can be taught?
3) Why are the points in this article relevant from a psychodynamic point of view?
There are a range of services throughout Scotland which respond to the needs of
parents and children, based on the understanding that what happens in the early
years has an impact on the wellbeing of the individual throughout their life. Below
are details of two organisations. Look up some more in your local area.
Home-Start
www.home-start.org.uk/about
• Visiting families in their own homes to offer support, friendship and practical
assistance
• Reassuring parents that their childcare problems are not unusual or unique
• Encouraging parents' strengths and emotional well-being for the ultimate
benefit of their children
• Trying to get the fun back into family life
Parents ask for Home-Start's help for all sorts of reasons:
• They may feel isolated in their community, have no family nearby and be
struggling to make friends
• They may be finding it hard to cope because of their own or a child's physical
or mental illness
• They may have been hit hard by the death of a loved one
• They may be really struggling the with emotional and physical demands of
having twins or triplets - perhaps born into an already large family
Parenting Across Scotland (PAS) has been funded by the Scottish Executive to
provide a focus for issues affecting parents in Scotland. They believe that parents
should be valued more, and that family relationships in all kinds of ‘families’ are
crucial to everyone’s health, well-being and achievement.
It is a very good starting place for information and links to services for parents in
Scotland.
The psychodynamic approach suggests that people have drives and instincts that
we will express or repress, depending on circumstances. In some care settings, it
is possible to provide service users with creative ways of expressing these
feelings of anxiety, aggression, frustration, guilt, fear, loneliness, confusion,
sadness or anger, in a safe environment.
For many people, it is easier to express their feelings, especially ones that are in
their pre-conscious or unconscious, through drawing, writing, music, drama, sport
or some other form of communication, other than speaking. Talking forces people
to organise their thoughts, whereas what some people need to do is to find the
feeling behind the words, or to take time to let things come to the surface. Also,
many people in care settings are unable to use words to communicate their
feelings and it is up to care workers to find other ways of enabling service users to
understand and express their feelings. One example is music therapy.
Music Therapy
www.musictherapyscotland.co.uk/musictherapy.htm
• Provide an outlet for strong and difficult feelings by giving opportunities for
musical expression and creative communication
• Explore important personal themes and patterns of relating
• Develop social skills such as self-awareness and awareness of others,
listening skills, concentration skills, communication skills
• Develop self-confidence and raise self esteem
Question
"R always appears calmer, happier and more relaxed when he emerges from his
music therapy session". "It’s as if he has released some frustration from his
body." How can these quotes from support staff of service users who have
attended music therapy be explained in terms of the psychodynamic approach?
It is up to you what you put on it or in it; where the tree is; what is above, under or
around it; what season it is; what type of tree it is.
You will have 10 minutes to draw you tree and after that the tutor will ask you to
put it up on the wall. It is up to you whether you want to share your picture with the
rest of the group.
This is not an art competition, so don’t worry whether it looks ‘good’ or not: it just
needs to exist!
DRAW A TREE
Erikson believed that social factors have a lot of influence on the way we behave
and develop. For example, we are influenced at home by our parents, in our
community by our friends, and at school by our teachers. As we mix with others in
our social worlds, we gather information that will affect our behaviour.
In this unit, we will concentrate on the 4 later stages of development. The material
given on this page is for background information only, so you can see what
Erikson’s full theory looks like. You will not be assessed on these first 4 stages in
the NAB or external Higher exam in Care.
This is the time when children are most helpless and therefore dependent on
adults. It is the quality of the caregiver relationship that is the foundation for later
trust in others. If caregivers are inconsistent or rejecting a feeling of mistrust will
develop. If care is loving and consistent, infants will not be unduly anxious. The
crisis is over when the child develops more trust than mistrust. However, it could
be dangerous for a child to be too trusting: a little bit of mistrust is healthy. The
trusting child is willing to take risks and will not be overwhelmed by
disappointments. The virtue of hope develops.
The child becomes capable of more detailed motor activity, language skills
improve and there is the development of imagination. These skills allow the child
to initiate ideas and actions and to plan future events. They begin to explore what
kind of person they can become. They enjoy role-play and test limits to find what
is permissible and what is not. Initiative is the result of encouragement, and guilt
stems from being ridiculed and feeling inadequate. Developing a sense of initiative
allows the child to find purpose in life.
Children begin to learn the skills needed for economic survival. Social skills
enable them to co-operate with others and peers and teachers are important in
the development of self-worth. Children become familiar with tasks and the
satisfaction of task completion. This develops a sense of industry that prepares
children to take up a productive place in society. If this does not develop there is a
sense of inferiority and a loss of confidence in their own ability. If the sense of
industry is stronger than the sense of inferiority then the virtue of competence is
developed. If the sense of industry is too strong then there is a danger that work
becomes overvalued and too much importance is placed on work at the expense
of other attributes.
This stage represents the transition between childhood and adulthood. During this
stage there is a search for an identity. Children consider all the information they
have about themselves and their society and they commit themselves to a
strategy for life. When this is achieved they have gained an identity and become
adults. Gaining a sense of self or personal identity marks a satisfactory end to this
stage of development. Role confusion results from a lack of identity. There is an
inability to choose a role in life, perhaps making superficial commitments that are
soon abandoned. Some take on a negative identity from the undesirable or most
dangerous roles they have been presented with.
Freud once defined a healthy person as one who loves and works. Erikson agrees
and says that only those who have developed a secure identity can risk entering
into a love relationship with another. The young adult is ready to commit to
partnership and those with a strong identity look for intimate relationships with
others. Those who do not develop a capacity for work and intimacy withdraw into
themselves and develop a feeling of isolation.
The person who has encountered the right circumstances to develop a positive
identity, be productive and develop satisfying relationships will attempt to pass on
the circumstances that caused these things to the next generation. Interacting with
children, or producing or creating things to enhance the lives of others can do this.
They develop the virtue of care. Those who are unable to invest something of their
own selves in others are socially impoverished and stagnation results.
The person who can look back on a happy and fulfilling life does not fear death.
There is a discovery of order and meaning in life and an acceptance of what has
been. This stage brings a feeling of completion. Those who look back with
frustration experience despair, knowing that it is too late to start again. Wisdom is
the result of ego integrity.
Summary
We move through the stages as we grow older, but we may carry unresolved
issues from earlier stages. We may be able to work through these conflicts during
experiences later in life, but it is more difficult to do this. Equally, although we
have developed a strong sense of identity in Stage 5, circumstances later in life
may well challenge this. How we deal with problems/situations later in life will
depend on the ego strengths we have built up in our earlier stages. So, the
outcome of every stage has implications for the development of our identity and
personality.
Questions
1) Pick one of the characters in the case study and discuss:
a) What stage they are in and what conflict Erikson suggests they have to resolve.
• Interactions in a care setting may be brief and superficial and workers may not
be able to get to know the service user well enough to understand and work
with them in any detail
• the service user has to have a certain amount of self awareness to respond to
any interventions at this level – if something is still in their sub-conscious, they
will not be ready to ‘see it’ and act on it
• this approach favours clients who are able to express themselves verbally and
with a degree of insight.
• any change in behaviour is likely to take a while to manifest itself
• the approach is not scientific, in that it cannot be tested
• People in real life don’t fit easily into stage models. Workers can sometimes
get lost in trying to ‘fit’ people into the theory rather than try and use it as a
general guide
• Some if the ideas are dated. For instance, in Erikson’s model, the ages given
offer a guide to the timing of the stage of conflict, but things have changed
since Erikson wrote this in the 1950’s. There have been many changes in the
way people lead their lives – many people live with their parents longer, as it is
too expensive to rent or buy and many people postpone having a family till
their 30s or even 40’s. However, the general pattern, and the ego strengths
associated with each stage are still relevant.
• Some people feel that Erikson’s model, like many psychological theories, is
based on the needs and experiences of white, western men and therefore
doesn’t always explain the situations of women and people from non-Western
cultures.
3) Try and come to an agreement about any you disagree about or are not sure
of.
Childhood
experiences
Defence
Mechanisms
Ego
Id
Instincts and
Drives
Lifespan Theory
Pre-conscious
Psychodynamic
Approach
Rationalisation
Regression
Repression
Sublimation
Superego
Unconscious
Cognitive/Behavioural Approach
The Behavioural approach was being developed around the same time as the
psychodynamic approach in the 1910’s and was a reaction against it. The
cognitive approach was developed in the 1950’s when psychologists realised that
it was impossible to study behaviour in humans without also looking at the thinking
associated with the behaviour. Its main features are:
Empirical
Everything we are and everything we do has been learned from our interactions
with the world. People are born as ‘blank slates’. We are not born with any drives
as the psychodynamic approach believes: we pick up our thoughts, attitudes and
behaviour from those around us. We are not programmed from birth to do
anything or be anything. It all depends on the experiences we have in life.
We learn by making links (associations) between a stimulus (an event) and our
response to it. We learn through observing something, or someone, and repeating
what we see. Since all our behaviour has been learned, it means we can UNlearn
it and RElearn new behaviours. Behaviourists believe that we constantly learn
throughout our life: our basic patterns are not established as teenagers as the
psychodynamic approach believes.
This model shows that we make associations between events, linking our
response to the stimulus. Anyone who has ever trained a dog will recognise the
way this model works. If you tell it often enough to ‘Sit!’, and make the same hand
movement each time, then give it a biscuit and a cuddle for ‘being a good dog’
when it does sit, then the dog will obey the command in the future. It might even
learn to sit if you just raise your hand, without even saying ‘Sit!’ As you can see
from this, repetition is essential in order for a strong association to be made
between a stimulus and a response.
Of course, humans are more complex than dogs, but the process of learning and
reinforcing a behaviour is basically the same. This is clearly shown in the way
some phobias develop: if you get stung by a bee one day, the next time you see a
bee the associated thought is ‘This was painful last time’ and so you run away.
Once you have repeated this behaviour a few times and not got stung, then you
have reinforced the behaviour, because the consequence is positive – no sting.
There is now a strong and automatic association between ‘Bee’ and ‘run away’. In
fact, even hearing a bee might be enough to set you running inside: you don’t
even need to actually see it to trigger the response. Learning is generally a
gradual process where behavioural responses are shaped by repeated
reinforcements.
We learn from our individual experience as we have just seen, but we also learn
many of our behaviours from observing others and copying their behaviour. I
might never have been stung by a bee, but if my dad runs into the house every
time he hears a bee, I might pick up his behaviour. This is called copying or
imitation. I won’t always do this consciously, but if I have lived with people who
behave in certain ways, I pick up their habits and it becomes ‘normal’ for me too.
This is one explanation for why certain traits run in families – from the way speak,
to how aggressive we are and what our relationship to alcohol is.
This isn’t a straightforward process. Many adults try and teach children ‘good
behaviour’ and employ all kinds of rewards and punishments to promote the
behaviour, but the child never adopts the desired behaviour. They still hit their
younger sister, they still refuse to eat certain kinds of food, they still bang the door
when they are in a mood. So, it’s not as simple as just being exposed to certain
types of behaviour: not everyone in the same family picks up the same habits.
One influence on our perception is how much we admire the person who is
modelling the behaviour, and therefore how much we want to be like them. If we
look up to them and admire them, then we are more likely to mimic their
behaviour. This is why so many health promotion campaigns and commercial
advertisements use sports and film stars to get their message across. It’s also
why you don’t always do what your parents want you to – your brother or friend is
a much more desirable model. Another influence on how we respond to a stimulus
is our sense of self-efficacy. Self-efficacy is our opinion about how good we are at
something. If we have the opinion that we are clever, then, although we may find a
new subject daunting, we will probably think ‘I’ll pick this up once I’ve read things
over a few times.’ If we have a sense of ourselves as slow or not very capable, we
might be put off starting the subject at all.
When setting goals, it is important to be clear both about what you want to
achieve and how you intend to achieve it. One way of doing this is to make sure
that the goals you set are ‘SMART’. This means your goals should be:
• Specific – i.e. not vague or general. It might even be the first step of a larger
plan you have for your future.
• Measurable – you will be able to determine when you’ve done it
• Achievable – it is within your remit and resources
• Realistic – it can be done
• Time-bound – you have set a concrete date to have it completed
Example: I want to lose 1 stone (measurable) in weight by my holiday in the first
week of July (time bound). I don’t have time to go to a weight watching class, don’t
really like dieting and hate the thought of paying money to lose weight (looking at
what isn’t realistic or achievable). I have given myself 3 months to lose the weight
(time-bound and realistic), so feel that by increasing my exercise and cutting down
on sweets I should be able to gradually lose the weight (too vague). I will walk for
at least 30 minutes 3 times a week and go jogging twice a week for 20 minutes
(specific, achievable, realistic and measurable). I will have fruit instead of biscuits
or scones with my tea and coffee and I won’t have anything to eat after my
evening meal (specific, achievable, realistic and measurable).
Use this model to help you set 2 personal goals. Get your neighbour to check if
they are ‘SMART’.
Think about HOW you learned to do it and discuss your answers with the class.
• Was it just random trial and error? Did you just plug away at it and eventually
arrive at the right way of doing it?
• Did someone show you what to do, step by step? Did you have to be shown
more than once?
• Did your sense of self-efficacy help or hinder you?
• Did you just pick it up from being around people who knew what to do?
• Did you have a lot of support when you were struggling, or did you manage to
get over the difficult bits by yourself?
• Did anything about the way you learned put you off or make you change the
way you were learning?
• Were you praised for learning, or given into trouble if you didn’t do well
enough? Did either of these responses act as a motivation or did it put you off?
2) Bearing in mind your answers to the questions above, make a list of 5 things
you can do to make learning the material in this unit, and preparing for the
exam, easier.
1)
2)
3)
4)
5)
The ABC model of learning is used in many situations in care settings, when
service users want to change aspects of their behaviour. With the help of care
workers, they might develop strategies with rewards built in which will reinforce
the new associations and lead to the desired behaviour. For example, if a service
user with learning disabilities has stated that he wants to lose 1 stone, then the
care worker will assist them to establish different patterns of eating and exercise
to help him achieve this goal. The rewards have to be meaningful to the service
user, or it won’t be much of an incentive to stick with the new regime, so they
might plan a special trip to the pictures, or to hear their favourite band.
Taking a cognitive/behavioural approach the service user and care worker might
then want to consider whether the goal they are aiming for is still the correct one.
If it is, then what else can be done to make a stronger association with the new
behaviours?
Our emotions and behaviour are influenced by our thoughts, not the other way
around, therefore the best way to change our emotions and behaviour is to
change our faulty way of thinking: our beliefs about ourselves and the world.
REBT believes that people are fallible: nobody is perfect, we all make mistakes,
indeed, ‘We’re only human’, but that people often cannot forgive themselves or
others - for this being the case. Ellis believed that early conditioning had a role in
influencing how we acted, but he felt that our own negative and self-destructive
reinforcement of early negative experiences also played a large part in our
present situation.
For various reasons, people hold on to outdated feelings of anger, guilt, hostility or
depression which are no longer applicable to the present circumstances. We are
responsible for choosing to continue repeating messages we may have been
given in our childhood. Our parents may set the basis for the ideas, but we
ourselves perpetuate the self-limiting beliefs and self-defeating behaviour,
unquestioningly. We cling to outdated beliefs because they are ours, and so we’ll
keep them. These beliefs have been passed down from generation to generation
in a family or society, and have become the accustomed way of thinking, and
therefore acting.
REBT believes that blame is at the core of most emotional disturbances. We have
been brought up being told we ‘must do this’, or ‘should do that’ and now we make
these demands (on ourselves and others) and blame someone (ourselves or
others) when these unrealistic and unobtainable expectations are not met. The
goal of REBT is to change our self destructive ‘I should…’ and ‘You must…’ into ‘I
prefer...’ or ‘It would be good if … but I can live with…’
Everyone acts on the basis of certain values they hold about themselves and the
world, and the goals towards which they strive. Ellis felt the main goals for all
humans are to stay alive, be relatively happy, self-accepting, creative and
productive, and able to build meaningful relationships.
Ellis said that it is rational if the things we think and do help us work towards these
goals, and that it is irrational if they do not lead towards these goals. Are our
beliefs and behaviours effective in achieving our goals or ineffective. Are they self-
enhancing or self-limiting?
Irrational beliefs are unrealistic and illogical. We set ourselves and others
demands that are absolute and inflexible, and impossible to achieve. It is this
rigidity of expectation of ourselves and others - something must happen, or
someone should always do something – that lies at the base of most human
disturbance. These beliefs lead irrational behaviours such as procrastination and
lack of self-discipline. Ellis believes that the three basic irrational beliefs which lie
at the root of most people’s problems are:
1) I must do well and must win approval for all my performances, or else I rate as
a rotten person.
2) You must act kindly and considerately and justly towards me or else you
amount to a louse.
3) The conditions under which I live must remain good and easy, so that I get
practically everything I want without too much effort and discomfort, or else the
world turns damnable, and life hardly seems worth living.
Ellis believed that people contribute to their own psychological problems by the
way they interpret events and situations in their life. A person who has rational
beliefs can accept the fact that life is complex and that things will not always turn
out the way they want – but they can live with it. They are flexible and accepting of
the variety of outcomes that might happen in a situation. Importantly, they can see
that they might need to endure short-term discomfort in order to attain long term
goals. They don’t give up easily because they meet an obstacle which makes
them feel anxious or upset. They realise that this is something they need to cope
with, in order to achieve their longer term aim (to be happy, creative, productive
and build meaningful relationships). So, a student who fails an assessment might
think ‘This proves I’m no good. The tutor didn’t really help us prepare for it
anyway. There’s no sense me going back to college’. Another student who fails
the same assessment might think ‘I’m really disappointed at that, but I suppose I
could have worked harder. If I’m going to move to HNC I’d better study more for
the next assessment. I’ll go and see the tutor and see if they can tell me what I
can do to improve next time’.
In order to change irrational beliefs, there are three things a person can do:
To replace the irrational beliefs with more realistic ones we need to use language
which is less commanding, catastrophic and extreme. Humour can often be used
to show how ludicrous or amusing an irrational belief can be, but this should be
used carefully, as humour can often be used in a hostile or judgemental manner.
B Belief: the thoughts and opinions you have about the event
In a care setting, one way of using this theory to help service users would be to
imagine themselves in a situation and role play how they might see it (the
Activating Event) and their Belief about it differently. This will help them confront
the resistance or anxiety they have about a situation and develop new ways of
thinking and acting. It is a technique often used with young offenders or people
with addictions.
However, it is important to remember that because people create and direct their
own lives, there is no particular set of values or goals that have to be strived for. It
is the particular values and goals of the individual which need to be appreciated in
order to understand why they think and act in the way that they do.
B: Belief B: Belief
It’s terrible when people
don’t do what I expect
C: Consequence C: Consequence
I’m upset and angry
D: Dispute D: Dispute
Maybe her internet
connection is down;
maybe she didn’t
realise I expected her to
answer
E: Effect E: Effect
I’ll phone her and check
how she is
Irrational Beliefs
1) The idea that you must – yes must – have sincere love and approval almost
all the time from the people you find most significant.
2) The idea that you must prove yourself thoroughly competent, adequate and
achieving; or that you must at least have real competence or talent at
something important.
3) The idea that life proves awful, terrible, horrible or catastrophic when things
do not go the way you would like them to.
4) The idea that emotional misery comes from external pressures and that you
have little ability to control your feelings or rid yourself of depression or
hostility.
5) The idea that if something is dangerous or fearsome, you must become
terribly preoccupied with and upset about it.
6) The idea that you will find it easier to avoid facing many of life’s difficulties
and self-responsibilities than to undertake some rewarding forms of self-
discipline.
7) The idea that your past remains all important and that because something
once strongly influenced your life it has to keep determining your feelings and
behaviour today.
8) The idea that people and things should turn out better than they do and that
you have to view it as awful and horrible if you do not quickly find good
solutions to life’s hassles.
9) The idea that you can achieve happiness by inertia and inaction or by
passively and uncommittedly ‘enjoying yourself’.
10) The idea that you must have a higher degree of order and certainty to feel
comfortable; or that you need some supernatural power on which to rely.
11) The idea that you can give yourself a global rating as a human and that your
general worth and self acceptance depend on the goodness of your
performance and the degree that people approve of you.
12) The idea that people who harm you or commit misdeeds rate as generally
bad, wicked or villainous individuals and that you should severely blame,
damn and punish them for their sins.
Questions
2) Read through the list and pick out four of the beliefs that you might apply to
your own way of thinking, or the thinking of someone you know. 8 App
4) Pick three of the beliefs and try to summarise them and put them in your own
words. See Dryden (1999) Counselling Individuals: A Rational Emotive
Behavioural Handbook p124-126 for a briefer version of some of these beliefs.
Note: Albert Ellis died in July 2007 and right up until his death, he was still actively
involved in developing and changing his theory. This means that you might read a
slightly different version of his theory when you look up information about him in a
book or on the internet. Don’t let this confuse you: it just shows that psychological
ideas are not ‘set in stone’ but respond to feedback from the people who put it into
practice.
As a student, you are likely to experience some stress. If you are at college, you
will have had to adjust to a new environment and if you are still at school, you may
be worrying about what happens next.
• Student A has to choose one of the stresses that they personally face.
• Students B and C have to ‘dispute’ this with the student, see if they can help
student A understand what irrational beliefs lie behind it (see page 73 for the
list) and try to work with the person to come up with a way of rephrasing their
stress, into a form that they can do something about.
Look at the dialogue on the next page as an example of how this might work.
• behaviour can be observed easily, so clear goals can be set and progress can
be measured
• it is solution-focused: specific problems or behaviours can be identified and
worked on
• the goal setting process allows for small steps to be set and success to be
more easily achieved, giving a sense of intrinsic satisfaction
• meaningful extrinsic rewards can be built in to the goal setting and care
planning process
• it can be a quick approach – results can be seen in a short time
• it provides a lot of techniques and tools to be used with service users
(modelling, role play, assertiveness training, relaxation and stress
management techniques, dealing with challenging behaviour)
• it is very effective with certain issues e.g. phobias, anxiety, certain kinds of
depression.
• this approach doesn’t tackle the causes of behaviour, so when rewards don’t
work, the behaviour may return
• the service user may become dependent on the worker/situation to maintain a
behaviour
• behaviour in one area of life may be changed without an effect on other
behaviours
• this way of working can become very instrumental, focussing only on the
observable aspects of a person.
Antecedents
Behaviour
Blank slate
Cognitive/Behavioural
Approach
Cognitive processes
Consequences
Extrinsic Reward
Imitation
Intrinsic Reward
Irrational Belief
Learning
Modelling
Reinforcements
Response
Self-efficacy
Stimulus
Humanistic Approach
This approach, developed in the 1950’s in America, was a reaction to both the
psychodynamic and behavioural approaches. It was developed by Carl Rogers
(1902-1987) who had initially trained as a psychodynamic therapist, but felt that
there were significant limitations to the approach. He felt that both the previous
approaches looked only at limited aspects of a person’s experience, whereas
Rogers believed you had to look at all aspects in order to help them understand
themselves fully. Past behaviour and experiences were important, but the
person’s current actions, thoughts and feelings were the most important things to
explore. If the person could clearly understand, accept and express them openly,
then they would have the possibility of developing psychological health.
Holistic
The Humanistic approach sees the person as a whole, not just focussing on
childhood experiences (psychodynamic) or behaviour and thinking processes
(cognitive/behavioural). Existence is not just about being alive. Cats and trees are
alive but they do not have a conscious awareness of what it means to exist. As
humans we are aware of the passage of time and that we are part of this process.
We are aware of existing inside ourselves and of being separate from other
people. We have a spiritual dimension and an awareness of ourselves in relation
to other people - these things are uniquely human. To understand a human, you
need to look at all aspects of their life.
You will not be assessed on the details of Maslow’s model at Higher level, as it is
dealt with at Intermediate 2 level. However, it gives useful background information
on the range of needs that the humanistic approach believes is important to
consider when looking at an individual ‘holistically’.
The humanistic approach believes that the actualising tendency – the process of
becoming all we can be - is the basic human drive. Humans have a in-built
tendency to be the best we can, if circumstances allow. Rogers uses a gardening
analogy to explain what he meant. He used the example of a potato: if you place a
potato in a box in the attic, it will still grow shoots and search for any available
light, but the shoots it makes will be long, spindly and weak. However, it is the
nature of the potato to grow shoots, and so that is what it will do, however hostile
the conditions are.
Similarly with humans, it is in our nature to fulfil our potential, but if the conditions
aren’t correct, then we will not grow into the psychologically strong and healthy
people we might have been under other, more favourable, circumstances. Clearly
this idea is relevant in care settings where many of the people we work with have
encountered discrimination, poverty, abuse and other barriers to achieving their
full potential. A good care service may be one of the places where the person can
discover more about what they are capable of, because they receive the support
and conditions that enable them to discover their interests and abilities.
Phenomenological
Rogers believes that the person is the expert in their own life (not any family
members, friends, professionals or workers who happen to be in contact with
them) and it is up to helpers to understand the world from the person’s point of
view if they are going to be able to help them to help themselves.
The role of a care worker is to help the person understand their own thoughts and
feelings, so that they can gain the strength to make the decisions and take the
actions that would enable them to lead a more fulfilling life. It isn’t up to the care
worker to diagnose or assess the client: it is the role of the care worker to
encourage the person to understand themselves and follow their instinctive desire
to grow.
Personal agency
According to humanistic theories we, ourselves, are largely responsible for what
happens to us. People have free will and the capacity to make decisions and
choices. We are able to change and adjust to circumstances, given the right
conditions. We are not, as the psychodynamic approach might suggest, always
struggling to control impulses and desires. Nor do we simply respond to
environmental stimuli as the behaviourist approach suggests. The humanistic
approach suggests that we continually strive for growth, dignity and self-
determination. The humanistic approach understands that we are often limited,
constrained and oppressed by the conditions we have to live under, but that we
always have a choice about how we can act and respond to a situation.
Sometimes, if conditions are harsh, the choice is very limited, but our instinctive
drive to make the best of our situation is still there, motivating us.
1) Your task here is to mark a fellow student’s work to the previous activity:
Application to Care: the CALM project.
This should help you develop a clearer understanding of what a good answer
looks like, or maybe what a poor answer looks like and WHY that is the case:
2) The tutor will hand out the ‘Possible Answers’ sheet and you should compare
the answer with the information on the sheet. A student may have something
different from the possible answers suggested, but still be correct: check this
out with your tutor.
3) Discuss your allocation of marks with the other student and check if you agree.
Remember – they will have marked your work as well, so this is a negotiation.
This exercise also shows that you can both have different answers, but both
be correct.
4) Your tutor might get you to mark other pieces of work as the class progresses.
At first it is often easier to assess whether someone else has written a good
answer than it is to assess your own work.
Self-concept
The information and beliefs that we have about ourselves is called our self-
concept. Our self-concept is made up of different parts: self-image, self-esteem
and ideal-self.
Figure 1 Self-Concept
Self-
Concept
actually our goals, because of the conditions of worth we have received. They are
instead the goals and dreams of our parents, friends, or partner. Another way to
increase our self-esteem therefore would be to re-assess our ideal-self. Why do
we have goals which are unrealistic and keep us in a constant state of depression
or discontentment because we will never be able to achieve them? Are they really
what we want to do, or are we just fitting in with other people’s expectations and
someone else’s dream?
Many of us lose touch, sometimes from an early age, with what we actually think
and feel, because of the pressure we get to fit in with what our family and friends
expect of us. This is what becoming a member of our family, community and
society is all about: we are socialised into a particular culture. This is an essential
part of learning how to fit in with others and get on in life. However, in many
cases, it moves us away from what makes us a unique individual. We are
expected to conform to what a girl/boy, Christian/Muslim, Scottish/Irish person
should do. In a lot of cases, we want to do this, as it gives us our sense of identity.
But in some cases, the identity you are taking on isn’t yours: it’s the one of your
‘tribe’. It is why teenage can be such a difficult time: adolescents are struggling
with finding their identity - who they are and where they fit in – in amongst all the
messages they get from school, the media, family, friends and their hormones!
You get conditions of worth from people around you: you are only acceptable to
them if you fit in with their picture of you, not if you act as an individual. We all
have to work through this process of learning to fit in with others, but also letting
our own personality and spirit shine through.
When those around us only show us love and respect when we say and do what
they want, then they are attaching conditions of worth to our relationship. Their
acceptance of us is conditional on us getting into their scheme of things. This is
known as conditional love and we feel that we must always struggle to be
accepted. This doesn’t just happen in adolescence, it happens throughout our life.
We get messages from family, friends, the media, our religion etc about what we
should do, wear or aspire to. We spend a lot of our life fitting in with other people’s
expectations, by being a ‘good son’ or a ‘good wife’, but there are times when we
need to decide for ourselves what it is we really want.
Rogers calls this having an internal locus of evaluation. He suggests that when we
are too influenced by people and things outside us, we have an external locus of
evaluation. This means that we don’t feel comfortable making decisions for
ourselves, and we might not even know what we want in a situation, because we
have given other people power for too long, or just ‘gone along with the crowd’.
You can see how this could easily happen to people in care settings where there
is the possibility that decisions are made about people rather than with people, if
their needs are not understood and people don’t make an effort to actively involve
service users in the care process.
Good care services will ensure that service users – and staff – have an internal
locus of evaluation, where they are encouraged to know their own mind, and voice
their opinions. When we have an internal locus of evaluation we feel good about
ourselves and in control of our own lives and we tend to be more sensitive to the
needs of others as well. We are not concerned with changing our behaviour to
gain social approval, because we have a clear sense of our own values and
feelings.
Rogers believed that in the ideal helping relationship, the helper would be able to
display unconditional positive regard (acceptance) as well as congruence
(genuineness) and empathy (understanding). These three conditions were seen to
be central to a positive helping relationship. If the worker doesn’t put on a
‘professional mask’, but is natural and sincere, then the service user is likely to
feel that they are genuine and trustworthy. If the worker attempts to see the world
from the point of view of the service user by using empathy, then the service user
will feel understood, and that they matter. Someone has taken the time to get to
know and appreciate them as a unique individual.
But it’s not only to other people that we can show the core conditions. Rogers
believed that a person with a positive self-concept would be demonstrating these
conditions to themselves. They would be:
3) Speed Date to find your equal and your opposite in the class.
The tutor will set up the timing for this. You will be allowed I minute/1 ½
minutes/ 2 minutes to talk to another person in the class and find out in what
ways your self-image is similar and in what ways you are different. The tutor
will ring a bell/blow a whistle/shout: this means you must move on to the next
person and start again. The tutor will have arranged how long you will spend
doing this activity, and it is unlikely that you will be able to talk to everyone in
the class.
a) Everyone sands up and mingles, so people can choose who to talk to.
b) Half the class sit around the outside of the room with a chair opposite them,
and the other half move round each person in order.
You may already have an idea of who your equal and opposite is if you know
the people in your class well, but remember: people don’t always see
themselves in the way that you see them. Some apparently confident people
see themselves as quite insecure, and some apparently quiet people are
actually very confident: they just don’t make a song and dance about it.
4) At the end of the exercise discuss as a group: did you find out anything
different about someone else in the class? Did you find out anything about the
way that they see you?
5) Extension of this activity: Your class has to organise itself into a human
chain from ‘The most… (organised, outgoing)’ to ‘The least…’ . Can you come
to an agreement? Does your self-image conflict with how others see you?
Which opinion do you fall in with? (external or internal locus of evaluation)?
Frank, aged 73, started having soreness in his joints over 10 years ago, when he
was still working as a joiner for a large building company. He had always been a
physically capable and active person, playing football in his youth and playing a
round of golf most weekends. When he retired he joined the bowling club because
he got bored sitting around the house all day: there were only so many home
improvements he could make to the house, and he’d done them all!
The pain in his joints got worse from time to time and although he never
complained, his wife, Rose, could see that he was struggling to do certain things.
She told him he had to go and see a doctor about things and ask if he could get
any help. He said ‘OK’ just to stop her going on at him, but they both knew he
wouldn’t make the appointment. He hadn’t been to the doctor for over 20 years
and was proud of the fact that he wasn’t the kind of person who got ill. However,
things got worse. He had to stop playing golf earlier in the year and even began to
find the bowls a bit of a struggle. He was clearly in pain after some games but
wouldn’t ever admit it to Rose.
Things came to a head one night when he was trying to mow the lawn and he just
couldn’t handle the mower properly. Rose got exasperated at him for not giving up
because she was frightened that he’d hurt himself. They had a big argument in
front of the neighbours. Frank went into the house and just sat staring into space
all night, not reading the papers or watching TV. He just glared at Rose when she
tried to ask him if he was OK.
He did go to the doctor and was diagnosed with arthritis and the doctor gave him
some medication. Frank didn’t take the pills because he’s ‘Not an old man yet’ and
he ‘Doesn’t believe they’ll do any good anyway’. A physiotherapist is coming to
the house tomorrow to check his mobility and give him some exercises to do.
Questions
1) Describe Carl Roger’s theory of the self-concept and explain how it could help
understand Frank’s behaviour. 8 marks (4 KU 4 App)
Now, compare this case study to the one about Fatima, on the next page.
Fatima, aged 33, has had arthritis since childhood. No-one can pin point exactly
when she got it or why, but it is a condition she has lived with most of her life. She
was the middle of 3 children, so she was always just treated as ‘one of the family’
and did the same things as the other children, although her mobility has always
been poor. Her parents decided they weren’t going to treat Fatima differently, and
made sure that no-one in the family ever complained about things being different
because they had to go slower, or because there were things they couldn’t do.
Fatima’s older sister, Yasmeen, was worried that people might make fun of her in
secondary school because she had a strange walk, or that she might get knocked
about in the corridor because the pupils were so rowdy, but there was never any
problem. Fatima made friends easily as she was a good laugh and had a really
strong, positive character. She was very popular and became a prefect in 5th year.
Her favourite subjects were computing and music: she was particularly interested
in composition and the technical side of music production.
In the next few years she married and had a child. She was delighted that despite
the mobility problems which she experienced throughout the pregnancy (she
could hardly get out of the house in the last 3 months), the birth went ok and she
was able to breast feed her son during his first year. She has taken a career break
to enjoy spending time with her son and is now an active member of a support
group for women with disabilities who are going through pregnancy and dealing
with young children. She travels to groups to give talks and supports other women
individually on the phone and by email. Her career break has also meant she has
time to start composing music again on the computer, and she loves the fact that
technology is now so much more advanced than it was when she was at school.
Question
1) Using Rogers Person Centred theory, explain how the core conditions that
Fatima has received throughout her life has influenced her self-concept.
12 marks (6 KU 6 App)
• All care workers can develop and demonstrate the core conditions without a lot
of training
• the approach looks at all aspects of a person including the spiritual
• the focus is on the uniqueness of the person which ties in with the care value
of individualisation
• the approach aims to help the person become accepting of themselves and
develop an internal locus of evaluation, so it corresponds to the care value of
promoting independence
• the benefits of an accepting, genuine contact can be experienced immediately
by a service user
• the focus on the service user as the centre of the care relationship is the basic
principle of person-centred planning
When sitting an assessment, you need to be sure that you have memorised the
correct knowledge, and can recall it on the day. Most people develop techniques
to help them do this. One technique is to make and memorise a spider diagram.
These are also called mind maps and mental maps.
The main point is to make a diagram with just the key words. It is different from a
list because the information is organised into groups and this helps you remember
the links and associations between the pieces of information.
• less is more: get each point down to a word or small phrase: UPR is used
instead of Unconditional Positive Regard. By the time you sit an exam, you
should know what UPR stands for!
• add another level, rather than have too much information at one level:
internal and external are a separate level from locus of evaluation
• use colour and space to make the levels and clusters clear: Each key aspect
of Rogers theory is in a separate branch of the diagram; main words are
larger; groups of ideas are put in a box
Ideal-self Internal
Self Esteem
Locus of Evaluation
Person
Centred
Approach
Core Conditions
UPR (Acceptance)
Congruence (Genuineness)
Empathy (Understanding)
3) Try and come to an agreement about any you disagree about or are not sure
of.
Conditions of Worth
Congruence
Core Conditions
Empathy
Full potential
Holistic
Humanistic approach
Ideal-self
Self Actualisation
Self-concept
Self-esteem
Self-image
There are some similarities between the three different approaches and the
theorists, as well as clear differences. This activity will help you work out whether
you have understood the information, and can analyse it.
2) Describe one similarity and two differences between the Psychodynamic and
Humanistic approach. 6 KU
2) Check your answers with the person next to you. Try and come to an
agreement about any you disagree about or are not sure of.
3) Discuss with them whether you think they have given the correct amount and
type of information as indicated by the KU and AE marks.
a) I wonder if it was Vickram’s early childhood experiences that have made him
unable to form relationships with others. Do you think he may still be
unconsciously grieving for the mother that he never knew? 1KU
b) I think that Vickram is disruptive when he comes into hospital because the
other boys tease him and he has learned that he needs to stick up for himself
or they’ll keep on doing it. 1KU
c) Vickram is a sensitive boy. He does not have high self-esteem because his
family have always attached conditions of worth to his behaviour: they want
him to do well at school and join his dad in the Doctor’s surgery, but he is more
interested in sport and travelling the world while he has no ties. 1KU
7. Why is a knowledge of the Carl Roger’s ‘Core Conditions’ useful for a care
worker? 6 marks (4 KU 2 AE)
Performance Criteria
(a) Describe theories of life change which are used to explain human
development and behaviour.
Mandatory content
Transition
Adams, Hayes and Hopson
Loss
Colin Murray Parkes
William Worden
Four Tasks:
Life Change
We all experience many different changes throughout our lives. Some of the
changes are welcome, some are not. Some cause us to grieve and some are
causes for celebration. Some of the changes are expected and some are sudden.
The one thing for certain is that we have all experienced change and that we have
all developed ways of dealing with change. Some of us welcome it and some of us
try and avoid it.
In care, we work with people who are going through a process of change. Coming
to a new care service is a change and we need to be aware of how we can
understand the difficulties people might experience when joining a new service.
Equally, when people leave, we need to think about how to make the end of their
time with the organisation as positive as possible, whatever the reasons for their
leaving.
In between these two extremes, we work with people to assess their needs and
identify a care plan that they will be working towards. All of this involves change,
some of which might be quite difficult to achieve, and both the service user and
care worker may face many obstacles when implementing the care plan.
In general life, although people experience many changes which are expected,
they can still sometimes be difficult to deal with. Examples of this might include
starting primary or secondary school, going through adolescence, having our first
sexual relationship, ending a relationship, starting and finishing college or work
and becoming a grandparent or the death of a parent. Some of these events are
transitions (a change from one situation to another, such as adolescence, or
becoming a grandparent), whilst others are losses (ending a relationship, the
death of a parent). Many people cope with these situations well, but others find
that they don’t deal with them well and sometimes have life long problems related
to the event.
Then there are the unexpected changes in our life: accidents, sudden death,
being the victim of a crime. Although we know these happen to people, we hope
they won’t happen to us or the people we love, and so we tend to have a different
kind of reaction when our lives are turned upside down, sometimes overnight, by
these events.
Before we look at theories of life change which describe how people respond to
these transitions and losses, we will look in ore detail at what some of these
changes might be.
5 years old
12 years old
18 years old
30 years old
70 years old
Before we look at each model in detail, it is useful to think about the effects of life
change in general terms, relating it to situations from your own life, because you
can then assess how well each model explains your experience.
1) Pick two of the changes you identified in the previous exercise: one should be
a wanted or expected change and one should be an unwanted or unexpected
change. They might include things such as: losing your sight and needing to
wear glasses, starting college, losing your possessions because of a house
fire, moving house to a new area, the death of a pet, ending a relationship,
joining a new sports team, being promoted in a job or being involved in a car
crash.
2 Make a list of at least 6 feelings at the time of these changes, e.g. shocked,
surprised, relieved etc.
3) Make list of at least 6 ways your thinking was affected, e.g. couldn’t
concentrate, went over things again and again my mind.
4) Make a list of at least 6 behaviours at the time of these changes, e.g. cried a
lot, couldn’t sit still, had lots more energy to do things – decorated the house.
1. Immobilisation – Initially, the person is in a state of shock. This may last for
minutes or much longer. There is disbelief: ‘This can’t have happened’, ‘This
can’t be happening to me’. They might feel quite dazed and need to sit down.
Their self-esteem will drop as they realise that there is a threat to the life they
have lived.
2. Minimisation – There may be a temporary increase in self-esteem as they
‘play down’ what has happened. ‘It might not be as bad as it looks’
3. Depression – When the reality of what has happened sinks in, the person
starts to feel pain and realises how difficult things might be, and how their life
might change. They might be quite angry about how things have turned out,
blame other people, or feel that they won’t be able to cope and withdraw from
others.
4. Acceptance of reality/letting go – This is when a person’s self-esteem is at
it’s lowest: they accept that things won’t go back to the way they were before.
They have to face up to the fact that their life has changed, and start thinking
about moving on with their new life.
5. Testing – This is where the person tests out new ideas and behaviours. They
start to see that there may be new ways of leading their life in their changed
circumstances. The person’s self-esteem starts to rise as they develop a more
positive self-concept: they are beginning to develop a different self-image.
6. Search for meaning – trying to ‘make sense of the situation’ and understand
the need for change. Their previous self-concept has been affected by the
transition and they are now developing new ideas of what is important for them
in this new stage of their life: developing both a new self-image and imagining
a new ideal-self.
7. Internalisation – By this stage, the person has adapted to their changed
circumstances and has developed a higher self-esteem, accepting the mew
situation and having developed a positive self-concept. The transition has
become an accepted part of the person’s life.
In summary, Adams Hayes and Hopson suggest that people experience a range
of feelings as they go through transition and that these feelings are ‘normal’ and,
for most people, will pass .The ups and downs in self-esteem represent a cycle of
change, which suggests this is not a smooth process. People can become stuck
at some of the earlier stages – e.g. depression, and may need support to work
their way through their feelings. Many people will return to earlier stages as they
cope with the transition: it is common for people to have ‘bad days’ or go through
a difficult period long after the initial situation. For example, you may have moved
on from being bullied at school until you experience bullying again as an adult in
the workplace. Then, all the feelings of powerlessness and inadequacy may come
flooding back to you. You may have been relieved to leave an abusive marriage,
but can still become depressed when you hear that your ex-partner has had a
child with someone else. You may have thought that you had got over the death of
your mother, but find yourself very tearful when it would have been her 70th
birthday, even though she has been dead for years.
There are 4 million people in the UK who could benefit from hearing aids but don’t
wear them. Research suggests that this is because of embarrassment and what
people think others will think of them.
• Two in three people in the UK who could benefit from wearing a hearing aid
are not doing so.
• This translates to 4 million people who are not getting the help they need -
280,000 people in Scotland alone.
• If someone has deteriorating sight, they wait on average four years before they
decide to get their eyes tested.
• This compares to a wait of 15 years on average before going for a hearing test.
The RNID ‘Breaking the Sound Barrier’ campaign aims to reduce the
embarrassment of wearing a hearing aid by raising awareness of hearing loss.
They have developed a hearing telephone check, which takes less than five
minutes to complete, to get people to think seriously about their hearing. The
telephone check received over 240,000 calls in the first six months, making it the
most successful launch for a health campaign in the UK.
You can take the sound check by phoning 0845 600 5555.
The ‘Breaking the Sound Barrier’ site also has a Quiz and information about
hearing loss.
Source:
http://www.breakingthesoundbarrier.org.uk/home/
http://www.rnid.org.uk/about/in_your_area/scotlandWhat's happening in Scotland
Question
1) Losing your hearing is a transition that many people will experience. Using
Adams,Hayes and Hopson’s model of transition, explain why people might be
resistant to admitting that they have a hearing problem.
7 Marks (4 KU 3 App)
Duncan however has become unwell and has to attend a hospital 60 miles away
for tests. He has developed a heart condition and his doctor says he can no
longer drive. Barbara does not drive so they have to rely on the daily bus, which
leaves at 7.30am and returns at 6pm. They find it is a long day as it involves
getting up early and much waiting around. Duncan is often exhausted by the trip.
The shopping is also bulky and sometimes difficult to manage on the bus.
Neighbours have been helpful but they feel they cannot keep asking for help: they
have nothing to offer in return.
Duncan enjoys going to the local hotel for a few drinks most nights with the other
men, even though the doctors at the hospital say he should cut back on his
drinking. He enjoys telling stories about his experiences in South Africa and he
likes the short walk home. He tells Barbara that he “might as well enjoy the life he
has, as he might not have long to go now”. Barbara feels Duncan is acting very
irresponsibly, but whenever she tries to discuss it he shouts at her. She is
unhappy and feels isolated, as she has no close friends in the area that she can
just pop in and chat to. She has a couple of friends in South Africa that she writes
to and phones occasionally, but she doesn’t want to complain to them too much.
She doesn’t know what she should do to make things better, and she is worried
about what she will do if Duncan dies.
Question
1) Using Adams, Hayes and Hopson’s model of transition, describe the behaviour
of: 4 KU
a) Duncan 3 App
b) Barbara 3 App
10 marks
Murray Parkes has carried out a lot of research in Britain into the experience of
people who have been bereaved, and is concerned that grief is being
‘medicalised’, rather than being seen as the natural expression of feelings of loss.
We spend our life building attachments to people and things, and when this
attachment is broken, then the downside is that we feel emotional pain. He
believes that it is too easy these days to go to a doctor and get medication to help
with the pain and distress people feel, rather than to experience the normal
process of grieving.
He believes that models of loss can act as a reminder to people that a lot of
behaviour in response to loss is natural and actually beneficial. The person is not
‘going mad’ or behaving irrationally – they are upset, angry or depressed and this
is a natural response to a difficult change in their circumstances. He suggests that
most people will pass through four phases when coming to terms with their loss,
but is concerned that an apparently simple model should not to oversimplify a
complex issue. Phases are not a fixed sequence through which each person must
pass in order to recover from bereavement. He talks about phases rather than
stages, because he doesn’t feel that people progress through them in a linear
manner: it may be that people are experiencing aspects of two or three of the
phases at the same time.
1) Numbness:
• Feelings of detachment and numbness
• They form a psychological barrier to block the pain of loss
• Allows a person to apparently carry on with normal living.
2) Searching and Pining:
• Concentration levels fall
• The individual adopts searching behaviours to try and locate that which has
been lost
• Pines for the lost person and develops ‘pangs of grief’.
3) Depression:
• Realisation that the lost person/object will not return
• Searching becomes pointless
• Anger abates to be replaced by feelings of apathy and despair.
4) Recovery:
• Former attachments are put behind the individual
• The individual releases themselves from the lost attachment
• The person can now adopt new thinking, relationships and attachments and
normal living.
Determinants of Grief
Murray Parkes was particularly interested in why some people are more
vulnerable to grief and why they find it more difficult to reach the phase of
recovery. He believed that there were a number of factors – determinants of grief
– which might affect the extent and depth to which an individual would experience
the grieving process. This is influenced not only by the actual situation of the loss
but by the types of attachment they have had with other people in the past, as well
as the type of attachment they had with the person that is now lost. You can see
from this that is work is based in the psychodynamic approach.
Some of the factors which will affect the process of grieving are:
• the way in which the person died: was it an accident, a suicide, a murder,
• part of a public disaster such as a train crash?
• the suddenness of the death: was it expected or unexpected?
• the nature of the death: was it painful or prolonged?
• the relationship to the individual: was it an unborn baby, a gay partner that
• no-one else knew about, a new relationship that you felt had a long future,
• a life-long relationship, a grandchild?
• the age of the people involved
• how their relationship was prior to the death: had they had an argument, was it
ambivalent or troubled
• previous experiences of when a death has occurred
• personality factors: is the person prone to anxiety or depression, do they
• have a history of mental health problems, do they tend to depend on other
people to do things for them
• other stressful events around the time of the bereavement
• social factors: does the person have a strong social network or are they
isolated?
1) Pick one of the changes or losses you have experienced that you think fits
Murray Parkes’ model and explain why the model is useful in describing and
understanding what you went through.
2) Consider the following situations and discuss why you think a knowledge of
Murray Parkes model would help care workers understand how best to work
with service users.
a) A care home for the elderly is having to shut down and the 14 residents are
having to be moved into 4 different care homes, 2 of which are in a separate
town.
b) A very popular worker in a day centre for people with mental health problems
is taking early retirement.
c) A friend of one of the teenage girls in a children’s home teenage girl in school
was killed in a hit and run accident.
d) Maisie, the resident cat in supported accommodation for people with learning
disabilities, had to be put down after a long illness.
Steven went to live with his only relative after his mum died, his Aunt Jean. She
has been very kind but Steven has become very anxious since moving in with her
and is not eating much at meal times and would rather stay in his room and listen
to the radio than watch TV with her in the evening. He has a picture of his mum
beside his bed and he is often sitting looking at it when Jean goes in to check if
he’s needing anything. He used to get himself up in enough time to have a shower
every day, but now Jean has to knock on his door 4 or 5 times before she hears
him moving about.
He has twice missed the train he needs to get to college on time and his tutors
have phoned her to check if he is OK. Because it is winter, he tends to go out in
the evening less anyway, but he has made excuses not to go to help out at the
junior youth club in the local community centre. He used to love doing sports and
arts activities with the children and they loved him. They had sent him a card
when his mum died and the other 3 leaders had come along to her funeral.
He has moved some of his belongings into Jeans house, but has refused to go
back to his old house to finish sorting things out. They will have to give the keys
back next week, and Jean is worried that there might be some important things
that he still needs to take away. Anything that is left will be put to a charity shop or
taken away by the council.
Question
Using Murray Parkes model of loss, explain the process Steven is going through.
8 marks (4 KU 4 App)
The first of Worden’s tasks is to ‘Accept the Reality of the Loss’ and one of the
reasons that this is difficult is because people don’t even like to think about their
own death, and what may or may not happen before that event.
It might start:
Jinty McGinty, who died peacefully in her bed last week/as she attempted to be
the first granny to land on Mars, will be best remembered for the way she …
At work, she …
etc.
Sarah is a 28 year-old woman who lives with Alan, her husband of 5 years, in the
suburbs. Alan works from home and Sarah looks after the house and does the
books for Alan’s business. Sarah’s mother died when she was 15, and her father
left soon afterwards, leaving Sarah’s aunt to look after her and her younger sister,
Jenny. Her aunt died 3 years ago.
Sarah has been trying for a baby since she got married and has miscarried twice.
She has recently been told she may never conceive and the chances of IVF being
successful are small.
A year ago, Jenny became pregnant and had a termination without telling Sarah.
When Sarah found out she was so angry and upset that she told Jenny she never
wanted to see her again. Sarah said to her husband that they could have looked
after the baby and that everyone would have been happy.
Sarah has since become quite depressed, and gets argumentative, and at times
abusive, towards her husband. Alan now finds it impossible to work from home
and has found temporary office premises in town.
Sarah has started to eat for comfort when she gets depressed, but is worried she
may get fat, so has started to make herself sick after a binge. When Sarah’s
husband offers to help in any way, she shouts at him and goes to bed. She has
started to sleep a lot during the day and won’t go out any more. Jenny has tried to
make contact, but Sarah refuses to see her and says she will never forgive her.
As a result of Sarah’s behaviour, Alan has threatened to leave if she does not do
something to address her situation. He took her to see their doctor who gave her
medication and suggested she go to a support group for people with mental health
problems, which is based in the local health centre. Sarah’s attitude at the
moment is that she doesn’t care what happens any more, she just wants to be
alone so no-one else can hurt her. Alan is considering phoning a private
counsellor that a friend told him about to see if that can help lift Sarah out of her
depression.
Question
• Helps anticipate the variety of ways someone might respond to transition and
loss
• introduces the notion that there is a process and many people will move
through a phase, no matter how painful and difficult it is at the time
• helps people understand that there are ups and downs in the process of
coming to terms with a loss. People can remain at one stage for varying
lengths of time: there is no ‘minimum’ or ‘maximum’ time that people should
stay in any stage. It only becomes a problem for the person if they feel stuck at
a stage and need help to move forward, or if they are not able to carry out their
daily activities
• care workers can use different skills when they recognise that people are in a
new phase: empathy may be most suitable when the person is upset or angry,
whilst encouraging and motivating is useful when the person is ready to move
on
• these models can help people understand how they might react, before the
loss actually occurs and this might help them have insight to their behaviour
when they are going through the process.
• People’s reaction is not linear, and people will move through the
stages/phases/tasks at different paces and in different ways. People are
individuals and their behaviour cannot be predicted
• the models show general patterns and individuals may vary widely in how they
respond
• some people may get ‘stuck’ in a particular phase and feel that they are letting
themselves (or others) down because they are not ‘getting better’ and moving
onto the next stage. Care workers need to make sure that people don’t feel
pressurised to ‘get on with things’ before they are ready.
You were asked at the beginning of the course to consider these questions as you
went through the course. Now you have completed the course, you should be able
to answer these questions fully, using examples from the approaches, theories
and models you have covered.
3) Why is a knowledge of psychology useful for care workers who want to engage
in continuing professional development?
• Memorise key ideas so that you can describe or explain them. This
demonstrates that you have knowledge and understand how to use that
knowledge (KU)
• Be able to apply them to a case study (App)
• Pull the ideas together in way that you can analyse or evaluate a situation (AE)
Students can take a few simple steps to ensure that they are well prepared for any
assessment they sit. Here are a few suggestions.
Assessment questions are asked in ways that give you very clear instructions
about what to do. There should be no mystery about how to write a good answer,
and there are no trick questions. It all comes down to being prepared and knowing
what you are being asked to do in any question.
Questions in Higher Care Assessments are likely to ask you to do the following
things:
You are also given clear guidelines in the marks allocated to each question about
what kind of information is required in the answer.
• See comments on page 112 about Preparing for an Assessment. They all
apply to the external exam as well.
• When doing past papers in college, give yourself 10 minutes reading time,
when you do not write anything. This will get you used to reading through the
whole paper before jumping in to answer questions without knowing what is
coming next.
• Practice answering individual questions in a given length of time. When doing
practice questions at home, set an alarm.
• Read through the paper and allocate time before writing. There are 50 marks
available in each paper, and both last for 1 hour 20 minutes. This means that,
giving yourself 5-10 minutes to read over the case study and look over the
questions, you will have 1½ minutes for each mark. This is the same as the
ratio in the internal assessments, so you should aim to spend no more than 7
or 8 minutes on a 5 mark question, or 15 minutes on a 10 mark question.
• Use the marks to determine length of time to be spent: don’t get ‘bogged down’
in a question. If you get stuck, leave space on the page for you to come back
and finish it, or start the answer to the next question on a new page.
• You don’t have to answer the questions in the order they appear in the exam
paper – just make sure you number their answers clearly!
• Develop a strategy of ‘familiar topics first’ to leave more time for challenging
questions. Always try and write something down for each question: information
sometimes come flooding back when you start writing.
• Sometimes it is better to write down your spider diagrams and mnemonics
BFORE you look at the questions, just in case you panic if your ‘favourite’
topics don’t come up and your mind goes blank.
Donald is 18 and is due to be discharged from hospital after having a below knee
amputation following a road traffic accident near his village in the Borders. His
three friends who were in the car at the time escaped with minor injuries. His
wound is healing well and he has had several fittings for his below knee
prosthesis. This ‘artificial leg’ is not yet available, but should be available before
he leaves hospital. At the moment, he has to use a wheelchair to move about the
ward.
Donald has voiced concerns about how he is going to cope at home, as his
bedroom is upstairs. The nurses on the ward are concerned about his mental
state as he has not discussed anything about the accident or the loss of his lower
leg with either family or the staff. He has informed the staff that the only people he
wants to visit him in hospital are his parents. He doesn’t want any of his friends or
his girlfriend to visit and see him “in this state”. His colleagues in the restaurant
where he worked have texted him, but he hasn’t answered.
Donald’s mother keeps “fussing” over him like a child and is doing everything for
him; she even cut up his diner for him in hospital the other evening. He is dreading
going home with her. He feels as if he is 5 years old again. His father, a
policeman, has remained very quiet while visiting but Donald knows that he is very
angry that the car cannot be repaired and that Donald behaved so recklessly. He
also feels he has let his father down as there has been lots of advice against
dangerous driving given by the police force to young drivers in rural areas.
Questions
3) Using ‘the determinants of grief’ in Murray Parkes model of loss, explain why
his parents might take time to come to terms with their son’s new situation.
A Hospice is a place that people with a terminal illness, such as cancer, attend.
The Hospice has a number of services, including an in-patient ward which offers
short term admission to help support patients and carers in the final stage of their
life, and a day centre for people who are coping well at home, but may need
support for specific needs or issues.
At the heart of the Hospice ethos is the commitment to treat the person, not the
disease, and to consider the family or carers as well as the person who is ill. The
hospice recognises the emotional and spiritual needs of the service user, as well
as their physical and medical requirements. Although a terminal illness can’t be
cured, a hospice can help a person to cope with the symptoms (by offering pain
and symptom control) and the emotional distress, and achieve the best possible
quality of life for their remaining time.
Source: http://www.ppwh.org.uk/index.cfm/page/127/
Questions
These ‘Possible Answer’ sheets are provided to give some guidance to learners
and tutors, but should not be seen as definitive answers. They could be used to
prompt discussion of the variety of answers which would be appropriate to each
question.
Repression
Remembering as you fall off to
sleep at night that you still haven’t
Id phoned a friend you’d intended
too, but forgetting about it the next
day, until you fall off to sleep Superego
again.
Sublimination
Denial
Being physically sick Not believing it
and having to stay off when a friend tells
work, rather than talk you that your
to your boss about partner has lied to
their bullying you, and getting
behaviour. EGO angry with the
friend instead.
Rationalisation Regression
Going over an Staying in bed,
argument in your because you’re ‘not
mind time and time feeling that well’
again, justifying why rather than going into
it was ok for you to college when you
say what you did. know you haven’t
completed a project
that is due in that day.
Projection
Taking an instant
dislike to someone
because they are Displacement
too bossy, even Pouring yourself an
though people find alcoholic drink or reaching
you a bit controlling for the cigarettes when you
at times. are feeling under pressure.
Got drunk again
last night and made a
Argument in class fool of myself
with another student
2) Make a list of 5 things you can do to make learning the material in this
unit, and preparing for assessments, easier.
- Place: set up a study area in the house: ‘When I sit down here, I know I’m going
to work. I won’t answer the phone or feel like I have to wash the dishes’
- Time: set up a regular time you study. It might be lunchtimes in the library, or on
the morning of your study day, or between 9 and 10 each night when the kids are
in bed. Whenever it is, try and get in the habit of ‘This is study time’. Switch the
mobile off, don’t make any other arrangements. Just sit and study.
- your tutor will be ‘modelling’ relevant information all the time, when they explain
each new idea in class. Unless you have a brilliant memory – take notes!
- listen to the students who seem to have grasped the subject better than you. The
way that they put the ideas into their own words will add to how the tutor has
explained things.
- Don’t be afraid to ask the tutor or another student to repeat things if you feel they
have really made sense; it will be positive feedback for them and it will help
imprint the information in your mind.
- bearing in mind the last point: take responsibility for your own learning. If you are
finding someone or something difficult to understand, find another way of looking
at the material. Quite often, new ideas don’t sink in or make sense first time round
– you need to give yourself time, come back to the ideas (repetition) and look at
them again. Don’t expect someone else to do your learning for you!
Goal Setting
- Don’t expect to become an expert overnight. Set yourself small goals (I’ll look
over my psychology notes for half an hour tonight and highlight the main points. I’ll
check any words I don’t know in the glossary) and reward yourself once you have
achieved them. Repeat this process until you have grasped all the main ideas.
- When you have an assessment to prepare for, make sure you spend at least
2/3/4 nights looking over the material: do not leave it all till the night before the
assessment. Ever!
• CBT is not suitable for severely depressed people as they are too
depressed to learn new thinking skills
• However, once they have begun to recover with medical treatment CBT
may be helpful.
Source:
http://www.breathingspacescotland.co.uk/bspace/displaycontentpage.jsp?pConte
ntID=198&p_applic=CCC&pElementID=98&pMenuID=93&p_service=Content.sho
w&
4) The idea that emotional misery comes from external pressures and that you
have little ability to control your feelings or rid yourself of depression or
hostility.
This is similar to the psychodynamic idea that we are controlled by drives and
our unconscious, over which we have little or no control.
6) The idea that you will find it easier to avoid facing many of life’s difficulties
and self-responsibilities than to undertake some rewarding forms of self-
discipline.
This is similar to the psychodynamic idea of ‘parts of the personality’. Your Id
wants to avoid things that might not have a spontaneous result, so the ego
might employ a defence mechanism to keep you from anxious about not facing
up to things. The superego might demand that you stick in at something and
work at it.
7) The idea that your past remains all important and that because something
once strongly influenced your life it has to keep determining your feelings and
behaviour today.
The psychodynamic approach believes that experiences in early childhood
influence us for the rest of our life.
9) The idea that you can achieve happiness by inertia and inaction or by
passively and uncommittedly ‘enjoying yourself’.
This describes the Id part of the personality, which wants pleasure now and
doesn’t want to work for it, or worry about any long term consequences.
10) The idea that you must have a higher degree of order and certainty to feel
comfortable; or that you need some supernatural power on which to rely.
This is like the Superego, which is the adult part of the personality. It is based
on morals and wants everything to be correct.
Remember: although Ellis disagreed with a lot of Freud’s ideas (e.g. 7), in some
of these examples, they agree about the source of people’s problems (e.g. 9 & 10:
if the ‘Id’ or ‘Superego ‘is dominant, you will experience emotional distress).
In what way do you think this project demonstrates the key features of the
humanistic approach?
a) Holistic
The project offered a number of services to meet the different needs of people in
the area.
They are looking at all aspects of the young people from their feelings ‘There is
increased fear for personal safety amongst more than half of all young people in
the neighbourhood’ to their behaviour ‘The trauma of living in the proximity of
violence may even be the reason for a higher than usual suicide rate’.
b) Phenomenological
They wanted to find out how the young people themselves felt about the situation,
so they asked them in a questionnaire.
They were aware in their research that they needed to consider how ‘young
people cope with an environment that is, or is perceived as, increasingly more
violent’. The project realised that how a person sees their world is what they base
their behaviour on.
They realised that, from the point of view of a young man, there might be stigma
associated with talking about mental health, and so they paid particular attention
to this in their research.
They ‘offered support groups to young people in single sex groups’ because, they
realised that – especially during adolescence - it is sometimes easier to talk about
personal issues within a same sex group.
c) Personal Agency
The project got young people involved at all stages, from the initial research to the
delivery of services encouraging them to take control over their lives and have a
say in what was happening to them.
The whole basis of the project is to say to young people in the area, ‘We know you
face difficult circumstances, but there are still things you can do about it. You don’t
need to feel powerless.’
One of the irrational beliefs that Ellis speaks about is ‘The idea that you can
give yourself a global rating as a human and that your general worth and self
acceptance depend on the goodness of your performance and the
degree that people approve of you (IB11)’
2) Describe one similarity and two differences between the Psychodynamic and
Humanistic approach.
Similarity
They both believe that humans are born with an in-built drive.
Differences
They disagree about the nature of the inborn drive. The Psychodynamic Approach
believes there is both a drive for life and for death/destruction, but the Humanistic
Approach believes there is only one drive, which is towards self-actualisation, or
fulfilling your potential.
3. Id is the most primitive part of the unconscious and is driven by desires. Ego is
the part of the mind and personality that is in touch with reality and negotiates
between the impulsive id and the moral superego. Superego is the part of the
personality that represents values and morals. It is said to be the internal
parent or our conscience.
4. The Psychodynamic Approach suggests that the Ego can employ techniques
called defence mechanisms to keep unpleasant feelings of guilt or anxiety
under control and out of consciousness. Examples would be: denial,
displacement, projection, rationalisation, regression, repression, sublimation.
(Student should give a brief definition of their chosen DM to achieve the mark).
7. The core conditions are the 3 qualities that Rogers believes are essential to
the helping relationship: Unconditional Positive Regard (Acceptance),
Congruence (Genuineness) and Empathy (Understanding). (NB students need
to briefly describe these, not just list them, to gain the full mark). If a care
worker can demonstrate these qualities with a service user they are likely to
establish an open and trusting relationship where the person feels respected
and empowered.
8. The self-actualised person is sensitive to the needs and rights of others. This
person can also be spontaneous and strives to experience life to the full. They
are not concerned to have social approval but have a clear sense of their own
values and feelings. They know and accept themselves and are equally
accepting of other people and their right to be different.
3) Make list of at least 6 ways your thinking was affected, e.g. couldn’t
concentrate, went over things again and again my mind
forgetful, fretted,
obsessive, couldn’t get things out of my mind,
kept on thinking it hadn’t happened and that it had all been a bad dream,
kept on thinking could see him in a crowds, although I knew he was dead
Couldn’t sleep, woke up in the middle of the night, had nightmares, woke up early
and couldn’t get back to sleep again.
Didn’t feel like eating, ate too much, didn’t feel like making meals, so just ate
rubbish, felt sick all the time.
Started smoking again, started drinking more, hated going back home to an empty
house so stayed on late at work/out at the pub.
Shouted at people, smacked my kids more and hated myself for it, got impatient
and irritated with people in shops so stopped going unless I really had to.
Couldn’t face people being sympathetic as it just made me cry, so didn’t go into
work; took the phone out and turned my mobile off, didn’t want people to pity me
or tell me that things would get better, so just avoided them, just wanted to talk all
the time, whether people wanted to listen or not, tended to rant a bit.
Note:
The theories and models of life change that we consider in this unit show that for
many people, the types of feelings and behaviours described above follow a
pattern and it is likely that people will go through a series of phases before they
come to terms with the change - even if it is a positive and expected change.
The Person Centred Approach suggests that people’s sense of self is made up of
three parts: self-image, ideal-self and self-esteem. Self-image is the way you see
yourself, ideal-self is how you would like to be and self-esteem is how you feel
about yourself. A person’s self esteem is likely to be higher if their self-image and
ideal-self are close together.
Since the accident, Donald’s self esteem will be low. His plans for the future will
now be uncertain. He doesn’t want contact with his friends, girlfriend or work, as
his self-image is now one of an invalid, and he doesn’t want people to see him in
that state. It is far from his ideal-self as someone who is lively and probably quite
active. He is cutting himself off from a lot of the things that gave him identity, and it
will be difficult for him to build up a strong self-image again unless he interacts
with his friends and colleagues. Staff have to understand that his whole self-
concept has been affected, and that it will take time for him to develop a new self-
image. This will involve things like getting his artificial leg and learning how to walk
with it, and seeing what he is capable of, before he can establish a new self-
concept.
b) Describe two ways in which a knowledge of Ellis’s theory would help hospital
staff work with Donald.
Staff would know that they have to understand Donald’s beliefs about his situation
in order to understand his response to the situation. He feels that he has let his
father down and he dislikes his mother fussing over him and both these beliefs will
be affecting the way he behaves, not wanting to talk about the accident, or how he
is going to face up to his new life at home. Staff might encourage Donald to
express some of these feelings, rather than bottling them up, and help him find
someone he can open to. In Ellis’s terms, they might ‘dispute’, or discuss with him
about whether ignoring his situation is a good way to deal with it. This does not
mean that they will argue with him, or force him to talk, but rather that they might
suggest to him that there are alternative ways for him to deal with his situation.
However, knowing that he will act on his perception of the situation, they need to
make sure that they understand what his point of view is.
3) Using ‘the determinants of grief’ in Murray Parkes model of loss, explain why
his parents might take time to come to terms with their son’s new situation.
Murray Parkes suggests that certain factors make it more difficult for people to
come to terms with a loss. In this case, the suddenness of the accident will be a
factor. One minute, their son was an active 18 year old with a job, friends and a
girlfriend, the next minute he is in hospital and has had his lower leg amputated.
Also the fact he is so young will be a factor. He had all his life in front of him, and
now they won’t know what to expect: will he still have a job, and a girlfriend? Will
he end up staying at home? Will he be able to drive a car again? All the things
they had expected for his future are now uncertain.
Another factor would be his relationship with his father. Because his dad is a
police officer, who has warned about the dangers of young men driving recklessly
in rural areas, he will be especially angry that is own son is one of the casualties
of this type of accident. He may also wonder if there was more he could have
done to protect is son, or warn him of the dangers.
3) Why is a knowledge of psychology useful for care workers who want to engage
in continuing professional development?
• It will provide them with information about different areas in which they might
want to specialise e.g. counselling skills, music therapy etc.
• It is sometimes criticised for being gender blind and not paying attention to the
different psychological experience of women
• It is also criticised for having a cultural bias towards a white, western viewpoint
Tel: 01786 892000 Fax: 01786 892001 E-mail: [email protected] Web: www.sfeu.ac.uk