Uncover Strengths & Build Resilience with CBT: A 4-Step Model - by Wendy Robinson, Principal Consultant
July 31st, 2007
I attended a Cognitive Behavioural Therapy (CBT) Conference on Resilience in May, which I’ve been persuaded by Laura to now write up. Actually, having a nudge to reflect deliberately on a conference is just what I need …I love learning, and I love reflecting, when I have the time to do it, and when I discipline myself to do it. Then I remember what I did really learn, and how I might be able to apply it with clients.
I’m an occupational psychologist, so it was interesting to spend two days with an audience of mostly clinical psychologists (in a lecture theatre holding 800 delegates). I know bits’n’pieces about CBT, but must admit, am not overly attracted to it. However, I do know it’s the only therapeutic approach which carries enough research on it, to be able to ‘prove’ its efficacy in working with clients. Hence, I believe, it’s the only therapeutic approach which is officially endorsed by the NHS.
Anyway, I was interested to know where the world of clinical psychology and CBT was, in relation to ‘strengths’ and ‘resilience’, and whether Taylor Clarke could learn anything from this, either in working as coaches with clients, or in supporting managers to support their people.
Dr Christine Padesky was described in the conference bumpf as ‘one of the leading cognitive therapy presenters in the world, appreciated for her depth of knowledge, compassion, and good humoured warmth’. She has presented workshops with Aaron T. Beck, and was named ‘most influential international CBT therapist’ by the BABCP (British Association for Behavioural and Cognitive Psychotherapies).
“We all know perfectly well what resilience means until we listen to someone else try to define it.” (George Vaillant (1993) The Wisdom of the Ego) Dr Padesky took several suggestions from the audience as to our definitions of ‘resilience’ …’bounce back-ability’ was a common theme, ‘the power to come back again to a prior position’, ‘the ability to respond and get through adverse situations’. On the second day she quoted:
“To fall 7 times,
To rise 8 times,
Life starts from now”
(Daruma Doll, 6th Century)
“Be dedicated
Be persistent
Rise up no matter how
many times we stumble
Never give up”
Founder of Buddhism
I like quotes. They have the power to describe something like ‘resilience’ in a more earthy, or ‘real’ way, than lots of scientific psychological language can.
Anyway, back to the main theme of the conference which was all about ‘uncovering strengths and building resilience’. Dr Padesky presented a four-step model which she has developed with her colleague Dr Kathleen Mooney.
1. Search for the individual’s strengths;
2. Construct the individual’s Personal Model of Resilience (PMR™)
3. Apply PMR™
4. Practice PMR™
Step 1, searching for strengths, fits in very well with the Positive Psychology (PP) approach. I was interested in her take on ‘uncovering strengths’; through demonstrations with volunteers from the audience, she illustrated the conversational nature of this step, and also, the power and simplicity. Being familiar with Martin Seligman and Chris Peterson’s VIA Strengths Survey, and to a lesser extent, the Gallup StrengthsFinder, I was quite taken with this more personalised way of uncovering strengths. I think the advantage of Padesky’s technique, is it’s simplicity, and importantly, the fact that because the words (strengths) have come from the client’s own story and examples and memories, the client fully knows what they ‘mean’. I think it’s possible to have more of a felt sense of your strengths, if these have been worked back from your stories, rather than concluded from taking a 240 item questionnaire. The key thing, in helping people tell their stories, is to find an example of something they enjoy doing. This can be absolutely anything in their lives. For a clinical population, this might include everyday activities, which despite the problems and obstacles faced in life, the individual is still able to carry out and persist with. Hobbies, talents, people we love to spend time with, sports teams we love to follow, little things in our lives which we derive pleasure from, huge things in our lives which we derive pleasure from ….shine the torchlight on whatever area of the person’s life can yield their strengths.
Padesky has adapted Nancy Davis’s (1999) ‘characteristics of resilient individuals’ and uses this as a mental checklist, whilst uncovering strengths in conversation with a client:
1. Physical (e.g. good health …therefore, ‘pick your parents well’!)
2. Spiritual (e.g. having faith that one’s own life matters; sense of connection with humanity)
3. Moral (e.g. helping others whilst under pressure yourself)
4. Emotional (e.g. emotional regulation)
5. Social Relational (e.g. basic trust; ability to make and keep good friends)
6. Cognitive (e.g. capacity to exercise foresight; problem solving abilities; internal locus of control; self-understanding)
Try rating yourself against these six characteristics; say on a 10 point scale, where 1 = ‘I don’t possess much of this at all’ through to 10 = ‘I am strongly resourced here’. Also, rate other people you know – say, pick someone you know who you would generally consider to be ‘resilient’, and one person you know, who you would generally say is not very resilient. (If you’re a coach, do for coaching clients, if you’re a line manager, do for people you line manage, or used to line manage.)
What do you discover? What reflections do you have on this?
Something we noticed was that even ‘low resilience’ people have some areas of resilience – which is good news …it provides hope, and sometimes a place to start work on (assuming you were coaching them). Also, it became evident to us, that there are many pathways to start to work on – many options for building resilience.
To the extent that people have had many obstacles to overcome in life (or at work), they will have shown lots of resilience. Rockwell (1998) refers to the strength, intelligence, insight, creativity and tenacity – of those who have overcome difficulties. This is a reframe. That is, rather than focus on what’s not right, what’s been difficult, what the individual doesn’t now do well, etc. focus on the strengths the individual has had to show, in order to survive and get through this stuff.
Step 2 – construct the PMR™, was again interesting to see in action, ‘on stage’ (and well done to those brave souls, who volunteered to go on stage and talk through a personal problem, or role play a client of theirs!). In essence the building of the PMR™ consists of writing down, for the client and with the client, their - behaviours, coping strategies, emotions, automatic thoughts, underlying beliefs, their stories, heroes, and any symbols or metaphors which occur to them – as they talk about how they overcome difficulties, in the story they have been talking about. The content of the story doesn’t matter so much, it’s the things people say to themselves, it’s the things they do, it’s how they feel, as they face up to obstacles and persist their way through them. E.g. ‘I’ll be damned if this is going to get the better of me’; ‘no matter what, I’ll hold my head high’ etc. The list of potential thoughts, beliefs, feelings, coping strategies is endless. Key things are written down on the PMR™ - using the client’s words, and checking that these are ‘right’, that they fit for the person.
Step 3 – Apply PMR™ - is about applying this set of thoughts, beliefs etc. to the problem faced, and clearly stating the goal (‘to be more resilient in ….(problem area)’). The ‘problem area’ we are most interested in at Taylor Clarke is how people cope with change in their working lives, and how organisations can increase the capacity for change. Many people feel ‘changed out’. How can we all cope better with the amount and type of change? Surely we must call on our own personal resilience to help us with organisational change? And surely we can help others call on their personal resilience to help them cope with change?
Step 4 – Practice PMR™ - is all about constructing some ‘Behavioural Experiments’ in collaboration with the client, to help them go away and use the ideas generated, to help them overcome the obstacles as they face them in reality. So, for example, ‘no matter what, I’ll hold my head high’ …taking the power of that along with it’s associated emotions and memories for me, back into the work environment, in which I’m feeling ‘changed out’. Of course, the power of the technique is in the skill of the therapist (coach) in facilitating the client to identify manageable situations, to start to experiment with more resilient tactics, and over time, to build up to more challenging situations, once the PMR™ has been continuously refined and improved.
A key thing here is to continue to use constructive language, and to endorse the client’s strengths; e.g. if the client struggles, to put her strengths into use back at work, because she finds the back-at-work environment so difficult, this is another example of how she’s persisting, despite the obstacles.
Finally, a few concepts/ideas/quotes I liked from the two days:
- “a genuine smile melts the distance between people” (i.e. it’s good to be human, when we’re working with people, as coaches or as therapists)
- Two ways to quieten the amygdala (e.g. if client is panicky and worried): (i) a human smile (ii) novelty
- You can apply the resilience model to teams as well as individuals
- Resilience is often best captured through stories and sayings
- Saying ‘it’ll be fine’ to those using the coping strategy of ‘defensive pessimism’ won’t work! That is, if I believe something isn’t going to go too well, and I anticipate all the things which might go wrong, and mentally rehearse what I would do …I’m using defensive pessimism. Now, if someone says to me ‘ah, it’ll be fine’ …it’s really not going to help me! What I need is someone to help me rehearse and to understand my anxiety. Defensive pessimism is in many ways a healthy coping strategy, and we probably all do it at some time.
- The importance of Acceptance, for growth and change. I may not like what happened, but if I’m to move on, I need to accept it
- Epstein’s notion of the ‘two minds’; one is rational, and for example, responds well to the language of logic. The other is experiential; intuitive; what we feel in the gut. This part of us responds to image, story, narrative, icons, metaphors. Padesky’s PMR™ aims to embed the experiential – because it’s the client’s words, images, story, which makes it up
- ‘the goal’ when we’re talking about resilience, is not to solve or eliminate the problem, but to be resilient in the face of the problem; the latter can facilitate acceptance of the problem
- We’re all more resilient than we think
- We cast off our resilience e.g. ‘oh, I just got on with it!’ ‘oh, it was nothing!’ …therefore, it’s important to talk about the little things we have done, to fully account for our resilience
- To listen to others’ stories of resilience is great! It’s so much less depressing than listening to the story of what went wrong
- The source of resilience doesn’t have to come from great wisdom, great one-off experiments, etc. it’s in the everyday. (The strengths which got us through past, big, crises, may be better for future, big, crises! Our day-to-day strengths ….are reinforced every day.)
- Resilience is a process; it’s the way in which we experience the journey
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