Counselling for Stress Problems

Stephen Palmer, Windy Dryden

• Publisher: SAGE Publications Ltd
• Year: 1994
• Print ISBN: 9780803988637
• eBook ISBN: 9781446225325
• Edition: 1
• Topic: Psychology
• Subtopic: Psychotherapy
• Index: Psychology

Seminars by Professor Windy Dryden. See the man live and in action. To find out more and to book your place go to www.cityminds.com

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`A welcome addition to the series. The co-authors... have endeavoured to give a thorough and practical guide to this vast subject and they have managed to do this within the confines of an easy-to-read, cheap and relatively short paperback... a very useful practical volume for the general counsellor to have on their book shelf? - Counselling, The Journal of the British Association for Counselling and Psychotherapy

This comprehensive guide views stress counselling and management from a multimodal perspective. Clear guidelines show practitioners how they can give their clients the most effective help for their stress problems using a technically eclectic and systematic approach.

The authors discuss the symptoms and causes of stress and outline a framework in which stress problems can be understood. They emphasize the importance of assessment as a guide to the selection of multimodal interventions and of tailoring the counselling approach for each client. Chapters discuss the range of interventions that can be used - cognitive, imagery, behavioural, sensory, interpersonal and health/lifestyle - and the most useful techniques that can be employed within these models, such as disputing irrational beliefs, coping imagery, psychodrama, relaxation training and assertion training. Case examples illustrate commonly used techniques.

1

Stress: a Working Model

Before we explain our approach to stress counselling and stress management, it would be useful to share a working conceptual model of stress. A personal anecdote may illustrate some of the factors involved and help to highlight the complicated nature of stress.

Example of stress

It was an important day. I (S.P.) was about to start a series of lectures for a government agency which was due to close down. Even though, in the previous 12 months, the staff had received out-placement counselling and assistance to help them procure new jobs, this had been to no avail – a result of the recession, no doubt. Anyway, I got up promptly as I had a number of things to do before the lecture. Apart from putting my lecture notes in order and sorting out accompanying handouts, I also had to check my tax return and ensure it was posted that day to the Tax Office.

You may be thinking that I lack time management skills. Unfortunately, due to an unforeseen event, I had to leave work early the previous day without completing all my tasks. However, I knew that if I arrived at work early the next morning then I would have no difficulties in achieving my goals.

Little did I realize that the universe was conspiring against me! Being a creature of habit, I started the day as usual with a relaxing bath and then a slice of toast with my favourite mug of tea. Yes, things were going well. I managed to avoid any conflict with the teenagers. My partner had already left for work and it was my turn to go.

‘Where the hell are my keys?’ I exclaimed.

They were not in their usual place. I always put them on top of the bookcase in the hallway, by the front door. I knew if I did not leave promptly then I would be caught in all the traffic arriving at 8.45am bringing children to the school in my street.

‘Damn it! I’ll be late for work. Today of all days’, I cursed.

Everything had been going so well up to this point. Where were my keys? I had no idea. I always left them in the same place. Perhaps my partner had tidied up the shelf.

‘Damn her obsessive-compulsive disorder.’ I had to find someone else to blame and not take responsibility for the loss of the keys! However, my partner just liked a tidy house. She didn’t have a disorder. That was just ‘therapist-speak’. As I thought about this I became angry.

‘It’s those bloody kids. They’ve knocked the keys off the shelf and they’ve fallen behind the books.’

I started taking the books off the shelf in great haste. Books landed everywhere. The keys were nowhere to be seen. Time was ticking by. The clock chimed. It was 8.45am.

‘Damn it! I will be late now.’ My level of frustration tolerance was gradually lowering.

However, I didn’t want to come home to a row so I quickly tidied up the mess I had made all over the floor. Perhaps I had left my keys in my jacket. I furiously checked all the pockets. I couldn’t find them. I could hear my partner’s voice in my head telling me:

‘You’re incapable of looking properly for things. You couldn’t even find socks if they were on your feet!’ I had this clear image of my partner gesticulating at me too. By this time I noticed my stomach was feeling rather empty even though I had just eaten my breakfast. I decided to check slowly through my pockets again. Unfortunately, my luck had run out – no keys could be found.

I recalled having a spare set of keys somewhere. I had an image of them next to a box of pencils.

They must be in my stud/, I thought. I almost fell down the stairs running to my bolt hole (the study). I found them.

Thank God for that’, I blasphemed. I dashed back upstairs, picked up my bag, and left the house.

I turned back because I couldn’t remember if I had locked the front door. I put the keys into the lock and proceeded to unlock the lock. I had locked it when I left after all. I must have been on automatic pilot. I was wasting good time. I cursed myself.

I ran to where my car was parked. I noticed heavy traffic and that the weather was foggy and damp. I tried to open the car door. It wouldn’t open.

‘I don’t believe this’, I thought. The spare key doesn’t fit properly. Why, oh why, hadn’t I checked this out before? I collected myself and thought laterally. I was able to get entry through the passenger’s door. I put the key in the ignition and turned it.

The car engine made a ‘whirring’ sound and then it died. Somehow, the damp atmosphere had flattened the car battery. The morning was ebbing away, I was still stuck outside my house, I had the tax return to complete, my lecture notes and handouts to put into order, and then attempt to travel into London by British Rail and London Underground to give a lecture on ‘How to manage pressure and cope with redundancy’. It hadn’t been a good start to the day. I wasn’t feeling particularly calm either.

We can use this real example to demonstrate the complicated nature of stress. Initially, it appears that I became stressed because I could not find my car keys. They were not in the usual place as they ‘should’ have been. But there was no assailant about to attack me in my hallway. A knife was not at my throat. There was no need for my stress response to become activated. All that was happening was that I could not find my keys. I started blaming others, such as my partner or my teenagers, for allegedly moving the keys even though there was little evidence for this. As they had obviously moved the keys, as they ‘shouldn’t’ have done, I became angry about the situation. In fact, I was also angry with myself as I anticipated that I would be arriving late for the important lecture.

The empty feeling in my stomach was part of the stress response or, more accurately, a physical component of becoming anxious about arriving late, which blatantly I felt that I ‘must’ not do. These internal dogmatic and absolutist beliefs such as my ‘musts’ and ‘shoulds’ (commonly known as ‘musturbatory’ beliefs) put more pressure on me and added to my emotional state. The feeling in my stomach could also have been triggered by the voice and image I had of my partner in my head chastising me as she has often done before when I have been unable to find my socks in the airing cupboard. My thoughts and exclamation, such as ‘Damn it’, did not help to lower my stress either as these phrases tend to be like a catalyst to the stress response and the anger they evoke stimulates the release of adrenaline and noradrenaline from the adrenal glands.

It is important to realize that a whole series of events occurred externally and internally in a very brief period of time. It involved my behaviour, affect (emotions), sensations, imagery, cognitions, interpersonal relationships and my biological/physiological response.

There was an interaction between internal and external demands, real or perceived, and the apparent stressor of mislaid keys only contributed to the scenario. My strong internal belief that I had to pay the tax demand and arrive at the lecture on time exacerbated my response to the situation. Although I may have been influenced by sociocultural rules to do things on time, I do have a choice in the matter. I was my own worst enemy. As I became more distressed, I then blamed others as the major cause of my problem rather than taking a calm rational approach to the situation. Pragmatically, if I had stayed calm I would probably have saved more time in the long run and actually achieved my goals of the day.

Multimodal transactional model of stress

The working model of stress we use in our approach to stress counselling is known as ‘transactional’. This model provides a simple but realistic explanation of the complicated nature of stress as it addresses the inter-relationship between the internal and external world of individuals. We have modified the transactional models of stress proposed by Cox (1978) and Cox and Mackay (1981) to incorporate Lazarus’ seven modalities. Figure 1.1 illustrates the new multimodal transactional model.

In the model, the psychological processes are of fundamental importance. How a person reacts to an event is more due to his or her perceptions of it and his or her perceived abilities to deal with it than the event or situation itself. Therefore the event can be considered as a potential ‘trigger’ to activate the stress response but not necessarily the main cause of its activation. Once the event has passed, the person may remain disturbed about it due to the action or interaction of the different modalities. For example, clients suffering from a chronic form of stress known as post-traumatic stress diso...

Table of contents

• Cover Page
• Title
• Copyright
• Contents
• Foreword
• Preface
• 1 Stress: a Working Model
• 2 Assessment and Therapeutic Approach
• 3 Cognitive Interventions
• 4 Imagery Interventions
• 5 Behavioural Interventions
• 6 Sensory Interventions
• 7 Interpersonal Interventions
• 8 Health and Lifestyle Interventions
• 9 Case Studies
• 10 The Compleat Stress Counsellor
• Postscript
• Appendix: Handouts and Information
• References
• Index