Higher Care - Unit 1 - Psychology For Care

National Qualifications: Psychology for Care Higher

Support Material August 2007

Acknowledgements SFEU is grateful to the subject specialists in Scotland’s Colleges and other agencies and industry bodies who have been involved in the writing of this and other support materials for the national qualifications in Care. SFEU is also grateful for the contribution of the Scottish Qualifications Authority in the compilation of these materials, specifically for its permission to reproduce extracts from Course and Unit Specifications. Thanks to Eileen MacLennan and Trish Gibb for ideas for some of the case studies. Material has been adapted from Higher Still Development Unit (1998) Care: Human Development and Behaviour Higher Teacher Resource Pack Material has been adapted from Morrison, C. (2003) Higher Human Development and Behaviour COLEG Aby Vuillamy at Music Therapy Scotland: http://www.musictherapyscotland.co.uk/musictherapy.htm COSCA Counselling & Psychotherapy in Scotland for information about Breathing Space: McLaren, T (2007) Open Up When You’re Feeling Down in Counselling in Scotland Spring/Summer 2007 COSCA 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 © Scottish Further Education Unit 2007

Care: Psychology for Care, Higher

Care: Psychology for Care, Higher 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. Enquiries relating to this Support Pack or issues relating to copyright should be addressed to: Marketing Officer - Communications The Scottish Further Education Unit Argyll Court Castle Business Park Stirling FK9 4TY Website: www.sfeu.ac.uk Further information regarding this Unit including Unit Specification, National Assessment Bank materials, Centre Approval and certification can be obtained from: The Scottish Qualifications Authority Optima Building 58 Robertson Street Glasgow G2 8DQ 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.

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Contents Reference Section

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What is the Care Course all about?

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The Course in Care (Higher)

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Unit Outcomes, PCs and Evidence Requirements

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Tutor Support Section

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How to Use This Pack

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Question Types in Higher Care Assessments

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Guidance on Specific Activities

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Activity: Memorising Information

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Guidance on Unit Delivery

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Resources

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Student Support Section

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Key to Activity Symbols

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Study Tips

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Glossary of Terms: Psychodynamic Approach

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Glossary of Terms: Cognitive Behavioural Approach

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Glossary of Terms: Humanistic Approach

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Outcome 1: Performance Criteria and Mandatory Content

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Activity: What is Psychology?

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The Influence of Nature and Nurture: Physical Health

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Application to Care: The Influence of Nature and Nurture

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Activity: The Relevance of Psychology for Care Workers

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Outcome 2: Performance Criteria and Mandatory Content

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Psychological Approaches: An Overview

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Psychodynamic Approach

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Anxiety and Defence Mechanisms

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Application to Your Own Life: Parts of the Personality

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Application to Your Own Life: Anxiety and Defence Mechanisms

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Study Tip: Mnemonics

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Application to Care: The Importance of the Early Years

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Application to Care: Support for Parents

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Application to Care: Music Therapy

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Activity: Drawing a Tree

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Erik Erikson and Lifespan Theory

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Lifespan Theory: Details of the first four stages (Optional)

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Lifespan Theory: Details of the last four stages

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Application to Care: Jasmine, Grace and Emma

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Evaluation of the Psychodynamic Approach

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Peer Assessment: Check your Knowledge of the Psychodynamic Approach

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Cognitive/Behavioural Approach

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Application to Your Own Life: Setting Goals

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Application to Your Own Life: Learning Strategies

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Application to Care: Setting Goals

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Application to Care: Breathing Space

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Albert Ellis and Rational Emotive Behaviour Theory

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Application to Your Own Life: the ABC (DE) model

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Application to Your Own Life: Irrational Beliefs

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Application to Your Own Life: The Stresses of Being a Student

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Evaluation of the Cognitive/Behavioural Approach

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Evaluation of the Cognitive/Behavioural Approach

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Peer Assessment: Check your Knowledge of the Cognitive/Behavioural Approach

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Humanistic Approach

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Application to Care: the CALM Project

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Study Tips: Marking an Assessment

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Carl Rogers and Person Centred Theory

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Application to Your Own Life: Self-image Speed Dating

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Application to Care: Frank

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Application to Care: Fatima

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Study Tip: Spider Diagrams

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Peer Assessment: Check your Knowledge of the Humanistic Approach

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Revision Activity: Analysis and Evaluation of the Three Psychological Approaches and Theories

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Peer Assessment: Psychological Approaches and Theories

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Application to Care: Drug Rehabilitation Services

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Outcome 3: Performance Criteria and Mandatory Content

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Life Change

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Activity: Types of Life Change

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Activity: The Effects of Life Change

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Transition: Adams, Hayes and Hopson

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Application to Care: Hearing Loss

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Application to Care: Barbara and Duncan

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Loss: Colin Murray Parkes

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Activity: Murray Parkes’ Model of Loss

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Application to Care: Steven

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Application to Your Own Life: Writing Your Own Obituary

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Application to Care: Sarah

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Evaluation of the Theories of Life Change

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Activity: the Relevance of Psychology to Care Workers

111

Study Tips: Preparing for an Assessment

112

Study Tips: What Do Command Words in Questions Mean?

113

Study Tips: Preparing for the External Exam – Care Higher

114

Formative Assessment: Donald

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Formative Assessment: Prince and Princess of Wales Hospice, Glasgow

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Possible Answers to Activities

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Possible Answers to Application to Your Own Life: Anxiety and Defence Mechanisms

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Possible Answers to Application to Your Own Life: Learning Strategies

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Possible Answers to Application to Care: Breathing Space

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Possible Answers to Application to Your Own Life: Irrational Beliefs

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Possible Answers to Application to Care: the CALM Project

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Possible Answers to Revision Activity: Analysis and Evaluation of the Three Psychological Approaches and Theories

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Possible Answers to Peer Marked Assessment: Psychological Approaches and Theories

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Possible Answers to Activity: The Effects of Life Change

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Possible Answers to Formative Assessment: Donald

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Possible Answers to Activity: the Relevance of Psychology to Care Workers

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Reference Section

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What is the Care Course all about? 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. Summary of Unit content Psychology for Care (Higher) The purpose of this Unit is to provide candidates with a framework to understand human development and behaviour. It will enable candidates to learn about some of the key psychological approaches that can provide insight into understanding human behaviour and development and to apply these approaches in a care context. Candidates will also be able to enhance their knowledge and understanding of different models of transition and loss as well as discussing and applying their relevance in a care context. In the Unit candidates study: • the role of psychology in a care context • the application of psychological approaches in a care context • theories of change, i.e. transition and loss 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 At Higher, the key elements of knowledge and understanding, analysis, application and evaluation are assessed in the following ways:

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• Knowledge and understanding Candidates should be able to demonstrate wide-ranging and detailed knowledge and understanding of aspects of care practice and the relevant concepts, theories and methods employed by care professionals in their roles. The range of knowledge should extend to an understanding of key theoretical and practical issues in sociology, psychology and values and principles for care and their application in care practice. • 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 interrelationship 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. The balance of assessment between knowledge and understanding and analysis application and evaluation in Course and Unit specifications will be approximately: • Course — 50% knowledge and understanding, 50% analysis, application and evaluation. • Units — 60% knowledge and understanding, 40% analysis, application and evaluation

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Unit assessment Satisfactory evidence of the achievement of all Outcomes and Performance Criteria for each Unit is in the form of written and/or oral recorded evidence, produced under closed-book, supervised conditions within a time limit of one hour for each Unit. 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 The Course assessment consists of 2 Question Papers. Each Question Paper lasts 1 hour 20 minutes. There is a break of 20 minutes between each paper. 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) Link between Unit and Course assessment/added value 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. In Units at Higher candidates are required to demonstrate knowledge and understanding and the ability to analyse and evaluate a range of related care theories and their practical application. The Course assessment will require candidates to use their knowledge and understanding of psychology, sociology and values and principles and to apply critical and analytical skills to answer questions drawn from the whole Course. Scottish Further Education Unit

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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.

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The Course in Care (Higher) 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. The knowledge acquired in the areas of the understanding of human behaviour through applying psychological and sociological approaches and theories to care situations is transferable to other academic or career pathways, particularly those which involve working with people, either individually or as part of a team. This Course can therefore have a number of significant advantages for the candidate. For example it: • helps candidates to understand the inter-relationship between psychology, sociology and care values and principles which form the basis for care practice • provides an insight into the wide range of factors which might impact upon an individual’s development and behaviour • enables candidates to inform and enhance their understanding of effective service provision • increases candidates’ awareness of the dangers of viewing human behaviour and development purely from their own ethnocentric perspective • raises candidates’ awareness of the psychological factors influencing their perceptions of normal development and behaviour • raises candidates’ awareness of the role of sociology in shaping social policy.

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Aims The Course provides opportunities for candidates to: • acquire specialist knowledge and understanding required to care for others • develop the ability to apply knowledge in a range of contexts • develop awareness of their personal value base • develop self-awareness and self-reflective practice • identify people’s needs and develop skills for care planning • develop an understanding of the values and principles that underpin professional care practice • develop awareness of the role of legislation and care planning in promoting positive outcomes for people requiring care • develop an understanding of the main sociological theories that provide insight into the influences that shape individuals’ lives • develop an understanding of the way in which psychological approaches help to understand aspects of human and behaviour.

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Unit Outcomes, PCs and Evidence Requirements Unit Specification: statement of standards SUMMARY This is a mandatory Unit in the Care (Higher) Course but it can also be taken as a free-standing Unit. This Unit is designed to provide candidates with a framework to understand human development and behaviour. It will enable candidates to learn about some of the key psychological approaches that can provide insight into understanding human behaviour and development and to apply these approaches in a care context. Candidates will be able to understand different models of transition and loss and discuss their relevance in a care context. 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 1. Explain the role of psychology in a care context. 2. Evaluate the application of psychological approaches in a care context. 3. Evaluate theories of life change in a care context. Acceptable performance in this Unit will be the satisfactory achievement of the standards set out in this part of the Unit Specification. All sections of the statement of standards are mandatory and cannot be altered without reference to the Scottish Qualifications Authority. OUTCOME 1 Explain the role of psychology in a care context. 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 Evaluate the application of psychological approaches in a care context 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.

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OUTCOME 3 Evaluate theories of life change in a care context. 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. EVIDENCE REQUIREMENTS FOR THIS UNIT The mandatory content for this Unit can be found in the appendix at the end of this Unit specification (www.sqa.org.uk). Written and/or oral evidence is required to demonstrate the achievement of all Outcomes and Performance Criteria for the Unit. The evidence must be produced under closed-book, supervised conditions within a time limit of one hour. 60% of the total marks available must be allocated for knowledge and understanding with the remaining 40% of the marks being allocated for analysis, application and evaluation. As candidates will increase their knowledge, understanding and skills throughout their study, assessment should take place towards the end of the Unit. The use of a cut-off score may be appropriate for this assessment. An appropriate instrument of assessment would be a case study or case studies accompanied by a series of structured questions. The questions should sample across the mandatory Unit content and allow candidates to generate evidence for all Outcomes and Performance Criteria in an integrated way. 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.

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If reassessment is required, it must sample a different range of mandatory content. The standard to be applied, the breadth of coverage and an appropriate cut-off score are illustrated in the National Assessment Bank (NAB) items available for this Unit. If a centre wishes to design its own assessments they should be of a comparable standard. 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.

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Tutor Support Section

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How to Use This Pack There are a number of ways to bring Psychology for Care to life and so there is a range of material which can be used with different class groups, depending on their ability. Not all the worksheets and activities are intended to be used with every class. For groups taking the external exam Care Higher, more time will need to be spent on helping students to memorise and understand key terms, so more time may be spent on self, peer and formative assessment. For classes who are doing this as a stand alone unit, then tutors may be able to make more use of the exercises which enable students to understand and apply the material to their own life and to care settings. 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. Students should be encouraged to provide stimulus material for class discussion. They can collect media examples that they would like to use in class to examine aspects of human development and behaviour. Students can also use their own experience as a basis for exploring the concepts used in this unit but it is important that they attempt to see issues from different developmental and cultural viewpoints as well. Using video material to offer insights into situations that the student is unfamiliar with can extend their understanding and experience. Visiting speakers may also provide case study material that is useful to an understanding of some of the concepts used in the unit. Many of the websites mentioned in the pack have sections with personal stories and these are excellent sources of ‘real life’ case studies. 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.

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Question Types in Higher Care Assessments Students are required to demonstrate Knowledge and Understanding (KU), Application (App), Analysis (A) and Evaluation (E) in the NABs and the external Exam. The external exam now has 25 marks allocated to a section where students are expected to integrate their knowledge from the three units, analysing and evaluating information in a holistic manner. It is important that students are prepared by their tutor to answer these types of question. 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.

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Guidance on Specific Activities Application to Your Own Life: Drawing a Tree Page 56 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. It is important to emphasise that it is not someone’s drawing skill that is being discussed, but what their drawing might say about them. It is not a psychoanalysis of someone: it is a general discussion on how very differently people have interpreted a broad remit ‘Draw a tree’, and whether their interpretation says anything about their ‘subconscious’. Why did they choose a certain colour, a certain season – they most likely won’t be able to put it into words, but the picture says all that needs to be said. A tree is a symbolic image which tends to represent both stability and growth, and so is an ideal metaphor for how a person feels about their own place in the world. Do students think the exercise does actually show anything about their subconscious? 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? Study Tips: Spider Diagrams (Page 90) Before reading over the handout with students, it might be useful to do the Activity: Memorising Information on page 23 This will hopefully show how useful it is to organise knowledge into groups and to make links between these groups of ideas, when it comes to memorising and recalling information. The point should always be made that memorising is only one step in preparing for an assessment. The other skills which need to be developed are Understanding, Application, Analysis and Evaluation. Study Tips: Mark An Assessment (Page 82) This is a very useful exercise for students. Tutors should build up a selection of answers to practice assessments over the years and adapt material from their own class groups, bearing in mind issues of confidentiality. Answers from a few different students work can be amalgamated into a template ‘good’ or a template ‘poor’ answers to illustrate different points to students.

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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.

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Activity: Memorising Information The student handouts for this exercise are reproduced on the next two pages. This exercise can be used at any point in the course, but would be especially relevant when introducing the Study Tip: Spider Diagrams on page 90 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? 5) This activity can be adapted in a number of ways. 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.

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Memorising Information: 1 Memorise the following information:

Auchinyell Kincorth Mastrick Mugiemoss Torry

Aberdeen Memorising Information

London

Barnes Brixton Chelsea Knightsbridge Walthamstow

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Baillieston Carntyne Shettleston Battlefield Penilee

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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

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Rationale for teaching/learning approaches There are a number of policy initiatives which have been considered when developing this pack. They are summarised below.

1) Assessment is for Learning Programme http://www.ltscotland.org.uk/assess/ This programme is based on the principle that ‘good feedback is essential to inform improvements at all levels in the education system’. In it, everyone – the tutor as well as the students – is regarded as a learner. There are 3 parts to the AifL approach: 1) Assessment for learning: day-to-day classroom interactions and feedback that are focused on the learner and sensitive to their individual needs; 2) Assessment as learning: pupil’s participation in assessment and reflecting on their learning helps them to become better learners; 3) Assessment of learning: concerned with enhancing teachers confidence in their own judgements so that assessment information is reliable, comparable and dependable. 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. Formative Assessment (process): • clarifying learning intentions at the planning stage • sharing these with pupils • involving them in self evaluation • focusing oral and written feedback around the learning intention of each lesson or task • appropriate questioning • organising individual target setting • raising children’s self esteem via the language of the classroom • (Gardening analogy: feeding and watering the plant).

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Summative Assessment (product): • baseline testing • end of topic tests • National Assessment Bank • (Gardening analogy: measuring the size of the plant). Formative Assessment Strategies Formative assessment improves learning. Assessment is used to allow learners to develop an awareness of how THEY can improve their learning. With written work, this can be done with: • ‘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.

2) Curriculum for Excellence (2004) 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.

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• All CYP can be successful learners, effective contributors, confident individuals and responsible citizens • Every CYP fulfils their potential; attainment will rise across the board • There is a renewed emphasis on equipping CYP with essential skills including literacy, numeracy and creative thinking skills and promoting good health and well being • Scotland’s education system continues to meet the challenges of the 21st Century. Teaching activities A number of the suggested teaching activities suggested in the Curriculum for Excellence framework are already used widely in care courses: • 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.

3) Citizenship in Scotland’s Colleges (2006) 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.

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4) Changing Lives - Report of the 21st Century Social Work review: Implementation Plan (2006) http://www.scotland.gov.uk/Publications/2006/02/02094408/0 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.

5) Learning Together (1999) http://www.scotland.gov.uk/learningtogether/ The Scottish Executive produced the publication ‘Learning Together’. This outlines a strategy for education, training and lifelong learning for people working in the National Health Service in Scotland. There is an emphasis on the value of education and lifelong learning in contributing to the delivery of quality services within the NHS. Candidates who study and achieve care units and courses can expect to improve their opportunities for employment within a care sector with this learning ethos. 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.

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Guidance on Unit Delivery 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 Introduction to unit: Definition of psychology; 1 Relevance of psychology to care; Discussion of importance of nature and nurture Overview of psychological approaches 2 Psychodynamic approach Psychodynamic Theorist: Erikson and Lifespan Theory 3 4 5

Psychodynamic approach: Evaluation of strengths and weaknesses for care Cognitive Behavioural approach

8

Cognitive Behavioural theorist: Ellis and Rational Emotive Behaviour Theory Cognitive Behavioural approach: Evaluation of strengths and weaknesses for care Humanistic approach

9

Humanistic theorist: Rogers and Person Centred Theory

10

Humanistic approach: Evaluation of strengths and weaknesses for care

11

Review of approaches and theories and their relevance for care

12

Transition: Adams, Hayes and Hopson

13

Loss: Murray Parkes and Worden

14

16

Review of Transition and Loss Formative assessment Review of unit content: Relevance of psychology to care Preparation for Assessment Assessment: closed book in class

17

Feedback on Assessment and Remediation

18

Unit evaluation

6 7

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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 Dryden, W et.al. ( 1999) Counsellig Individuals: A Rational Emotive Behavioural Handbook (3rd Edn) London: Whurr Magazines and Newspapers 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 www.disabilitynow.org.uk Magazine on disability issues with good info and links 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.

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Care Organisations on the internet This is a list of some organisations whose services will be based on the psychological approaches and theories discussed in this unit.. www.ageconcernscotland.org.uk/index.asp Age Concern site which covers issues relating to older adults. www.barnardos.org.uk Barnardos work with children and young people, families and communities to work towards their vision that the lives of all children and young people should be free from poverty, abuse and discrimination. www.carescotland.org.uk Care Scotland This website is produced jointly by the staff of local council social services departments and the Scottish Executive and has up to date information about care in Scotland – policies and practice www.nrcemh.nhsscotland.com/ The National Resource Centre for Ethnic Minority Health (NRCEMH) is a unit of NHS Scotland and supports NHS Boards to develop their cultural competence in delivering health services to black and minority ethnic groups, to reduce inequalities and to improve the health of these communities. www.quarriers.org.uk/ Quarriers They provide a range of services in Scotland through more than 100 projects for Adults and children with a disability; Children and families; Young people with housing support needs; People with epilepsy and Carers. www.shelter.org.uk Shelter. Homelessness campaign and information. www.show.scot.nhs.uk Scottish Executive Health Department site. Information on range of issues including homelessness and disability. www.turning-point.co.uk/ Turning Point provides services for a range of people, including those affected by drug and alcohol misuse, mental health problems and those with a learning disability.

Website About the Psychological Approaches and Theories 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.

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Student Support Section

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Key to Activity Symbols

Reading

Brainstrorming

Writing

Discussion

Case studies

ICT Research

Reflection

Revision

Group Investigation

Study Tips 1) Highlighting Key Words 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! Occasionally, it is useful to highlight a sentence, if it gives a definition of a key term but even then, it is better to try and highlight only the relevant parts of the sentence. It might also be useful to highlight the key term in one colour, and the definition in another colour, so again you are making the separate points stand out differently. Less is more when highlighting 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.

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Glossary of Terms: Psychodynamic Approach Childhood experiences Defence Mechanisms

Ego

Id

Instincts and drives

Lifespan Theory

Pre-conscious

Psychodynamic Approach

Rationalisation

Regression Repression

Sublimation Superego

Unconscious

The psychodynamic approach believes our childhood experiences have an important influence on our adult behaviour. 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. This is part of the personality which is our ‘internal adult’. The ego is in touch with reality and negotiates between the impulsive id and the moral superego. It is the reality principle. The most primitive part of the personality. It contains basic biological urges and wants, and seeks instant gratification. The ‘internal child’, or pleasure principle. People are born with instincts which influence their behaviour. The Psychodynamic approach believes there is an in-born drive to satisfy two biological urges: towards life and towards aggression/death. Developed by Erikson. Personality development is seen as a life long process. A person’s ego develops in response to the way they deal with a conflict at each of the 8 stages of development. The resolution of the conflict is influenced by social experience. The level of our mind where we store memories and knowledge. People can access this information, with a bit of thought or prompting. Humans are influenced by drives and instincts, many of which are buried in their unconscious mind. Our experiences in childhood influence our behaviour as adults. Justifying our actions to reduce anxious feelings. e.g. saying the other person ‘deserved it’ when you’ve just shouted at them. Blaming the other person. A defence mechanism: displaying behaviours from your childhood when you feel stressed or anxious A defence mechanism: pushing thoughts to ‘the back of your mind’ because they make you feel anxious. This can happen consciously or unconsciously. Unacceptable desires are redirected into a substitute activity. The part of the personality that represents values and morals. It is said to be an ‘internal parent’ or morality principle. The level of our mind which the psychodynamic approach believes holds our repressed and forgotten memories. It is not easy to get access to these thoughts and memories, but they still influence our behaviour.

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Glossary of Terms: Cognitive Behavioural Approach Antecedents Behaviour Blank slate Cognitive/ Behavioural approach Cognitive processes Consequences

Empirical Extrinsic Reward Imitation Intrinsic Reward Irrational belief Learning

Modelling Reinforcements

Response Self-efficacy Stimulus

An event that leads a person to respond: a stimulus, a trigger. The response to a stimulus or antecedent. The way we act in response to an event. Behaviourists believe we are born with no drives or instincts. All our behaviour is learned. Human behaviour is learned by observing, copying and modelling other people. The way we perceive an event will influence our response to it. A behaviour is more likely to be repeated if it is reinforced. These refer to mental processes. The ability to think, feel, reason and problem solve are included. The result of our behaviour. Depending on the consequence, we are more, or less, likely to repeat the behaviour. Based on observation or experiment A reward which comes from outside the person: money, praise, a medal. Copying the behaviour of someone else. A reward which comes from inside the person e.g. a feeling of pride or satisfaction A belief that doesn’t help us achieve our goals in life. A self-defeating belief. Behaviourists believe we learn by making associations between an event, our response and the consequences. (ABC model) Copying the behaviour of someone else, generally someone we admire and look up to. Something that is more likely to make a person repeat a behaviour. It could be an intrinsic or extrinsic reward. The way we act in relation to a stimulus, or antecedent. A person’s belief about what they can do has an influence over what they actually achieve. The event, trigger, or antecedent to which we respond.

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Glossary of Terms: Humanistic Approach Conditions of Worth

Congruence Core Conditions

Empathy External Locus of Evaluation Full potential Holistic

Humanistic approach

Ideal-Self Internal Locus of Evaluation Locus of Evaluation Personal Agency Phenomenological Self-Actualisation Self-Concept

Self-Esteem Self-Image Unconditional Positive Regard

Uniqueness of the individual

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People around us only show us love and respect when we say and do what they want, and fit in with their expectations and demands. We are only worth their love if we meet their conditions. Genuineness, being natural, being sincere. The three personal qualities that Rogers believes are essential for a good helping relationship: Unconditional Positive Regard, Congruence, and Empathy. Understanding the world from another person’s point of view: ‘standing in their shoes’ When your opinions and decisions are influenced by the beliefs, values and goals of other people. The Humanistic Approach believes that all humans are motivated to fulfil their potential. People are more than just their childhood experiences or their thoughts and observable behaviours. You have to look at all aspects of a person’s life in order to understand them fully. Humans are born with the potential for growth and, given the right circumstances, will develop their full potential. The picture a person has of what they would like to be. Being able to make a decision based on your own values, beliefs and goals. The place where you form your opinions and make decisions: it can be internal or external. People have free will and the capacity to make decisions and choices. Relating to how a person experiences and feels things; from the unique viewpoint of an individual. Being the best you can be at something, fulfilling your potential. The information and beliefs that we have about ourselves is called our self-concept. Our selfconcept is made up of different parts. How a person feels about themselves. How a person views themselves – personal qualities, body image and roles Being non-judgemental and accepting. This doesn’t mean agreeing with everything the person says or does, but it does mean that you accept that there is a reason why they are this way at the moment. Everyone is different; the person is the ‘expert’ in their own life.

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Outcome 1: Performance Criteria and Mandatory Content Explain the role of psychology in a care context.

Performance Criteria (a) Explain the relationship between nature and nurture and their influence on human development and behaviour. Mandatory Content • a minimum of three ways in which psychology can assist care workers to understand human development and behaviour in a care context. • a minimum of two reasons for the importance of nature in influencing human development and behaviour • hereditary factors and genes: genotype and phenotype • a minimum of two reasons for the importance of nurture in influencing human development and behaviour • environment and social influences • The importance of interaction of nature and nurture on the individual (b) Explain the ways in which psychological insights can assist care workers to understand human development and behaviour.

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Activity: What is Psychology? Psychology is the study of the individual. Psychology is interested in how someone develops their sense of self – their picture of who they are. It looks at the way in which each human being develops their own special identity throughout their life. This identity is shown through the way we behave and the attitudes and opinions we develop. It is shown by the emotions we have and the ways in which we express those emotions. It is shown in the choices and decisions we make throughout our life. Psychology is interested in identifying patterns of behaviour, for example, the way we respond to change and loss in our life. This is particularly important for people working in care, as you are so often working with someone who has experienced a transition in their life. People tend to go through phases in the way they respond to loss, such as a death of a loved one. They may first of all feel disbelief, then anger and depression. But in most cases, people will eventually come to terms with the loss and adjust their life to cope with the new circumstances. We will look at life changes in more detail later on in this unit. 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?

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The Influence of Nature and Nurture: Physical Health There is no question that we inherit certain physical characteristics from our parents: the first thing most people say when they look at a new born baby is ‘He’s got his mother’s eyes’ or ‘She’s got her father’s smile’. As we grow older the physical similarities become even clearer, but there are also other signs that we share similar genes to our parents or siblings (brothers and sisters). Our eye colour and hair colour and type are genetic: if your maternal grandfather is bald, you are more likely to go bald too. This is called your genotype. It is the genetic ‘map’ or blueprint that you are born with. Some conditions, such as Huntington’s Disease and Haemophilia are passed on genetically, and people can get tests from an early age to see if they are likely to develop the illness. Other illnesses have a genetic link: if a close member of your family has had certain types of cancer, a heart attack, a stroke or dementia, then you are more likely than average to also get that illness. However, although we might have a higher possibility of getting these illnesses, there are things we can do to affect the outcome. We can improve our diet and lifestyle to make sure that we give ourselves the best possible chance of leading a healthy life or we could take medication to deal with some of the signs and symptoms: we can influence the path that our genes might have laid down for us. 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.

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The Influence of Nature and Nurture: Identity and Behaviour When we talk about our identity and our sense of self, we tend to talk about our personality just as much as what our physical characteristics are. So, are some of our emotional and behavioural characteristics genetic as well as some of our physical characteristics? Is it the result of genes that a lot of people in a family seem to experience depression, or that there may be one person in each generation of a family who has a drink problem? Or are these things more likely to be a result of socialisation: we have been brought up by someone who was depressed or had a drink problem, and so that is the type of behaviour we have been used to. It is what we see as ‘normal’ and expected behaviour in our family and community. Psychology is interested in understanding patterns of behaviour (why do the different generations of a family have a drink problem) but they are also interested in individual difference (why do other people in the same family NOT have a drink problem). There is no definite answer to whether nature or nurture is most important in these circumstances. It appears that, as with physical characteristics, some personality and behavioural tendencies may be laid down in our genes – our genotype - but the way we are brought up has a major effect on whether we will develop that particular behaviour. 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.

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Application to Care: The Influence of Nature and Nurture 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?

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Activity: The Relevance of Psychology for Care Workers 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. 1) In what way is a knowledge of psychology useful for a care worker when assessing the needs of a service user?

2) In what way is a knowledge of psychology useful for a care worker when working with a service user?

3) Why is a knowledge of psychology useful for care workers who want to engage in continuing professional development?

4) What are the limitations of psychology for a care worker?

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Outcome 2: Performance Criteria and Mandatory Content Evaluate the application of psychological approaches in a care context. Performance Criteria (a) Describe theories from different psychological approaches which are used to explain human development and behaviour. Mandatory content Psychodynamic Approach: Overview • stage model: influence of psychological development in early years • levels of consciousness: conscious, pre-conscious and sub-conscious • dynamic: parts of the personality — Id, Ego, Superego • defence mechanisms (denial, repression, regression, sublimation, displacement, projection, rationalisation). Psychodynamic theorist: Erikson and the Lifespan Theory • lifelong psychological development in eight stages (only 4 stages need to be taught: adolescence, young adulthood, adulthood, maturity) • conflict at each stage which, if resolved, will lead to the development of an ego strength • importance of social environment. Cognitive/Behavioural approach: Overview • empirical • learning theory: stimulus, response and reinforcements • social context important for humans: modelling, observing, self-efficacy • cognitive processing. Cognitive/Behavioural theorist: Ellis and Rational Emotive Behaviour Therapy • links between thinking, feeling and behaviour • ABC (DE) framework (Activating event, Belief, Consequence, Disputing the belief, Effect) • irrational beliefs: a minimum of four.

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Humanistic approach: overview • holistic • phenomenological • personal agency. Humanistic Theorist: Rogers and Person Centred Theory. • self-concept: the link between self-image , ideal-self and self-esteem • conditions of worth; locus of evaluation (internal and external) • core conditions: Unconditional Positive Regard (Acceptance), Congruence (Genuineness), Empathy (Understanding). (b) Apply different psychological approaches to behaviour in a care context. Mandatory content A minimum of: two applications of the three named psychological approaches in a care context. (c) Evaluate the relevance of these approaches in a care context. Mandatory content A minimum of: two strengths and two weaknesses of each psychological approach when applied to a care context.

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Psychological Approaches: An Overview Psychology provides a number of different approaches to understanding human behaviour. No single approach has all the answers to any problem. As a care worker, you can use knowledge and understanding from all three approaches to help you work most effectively. People train for many years to become an expert in each approach, and it is likely that the service users you work with will have some contact with these experienced counsellors, psychologists or psychiatrists at some point in your career. However, a general understanding of the key ideas of each approach can help explain and understand a person’s behaviour and can help care workers to assess need and develop the most effective care plan with a service user. The three approaches we will consider in this unit are: Psychodynamic Approach According to this approach, human behaviour is determined by past experiences and inner thoughts and feelings, both conscious and subconscious. The development of personality takes place in stages. Our early childhood experience has an important influence on how we behave as an adult. People are thought to be always struggling (sometimes unconsciously) with impulses and desires. Difficulties at any stage of development are thought to have important consequences for future behaviour. Cognitive/Behavioural Approach The cognitive/behavioural approach believes that we learn our behaviour and so can unlearn and relearn it. Learning is seen as a series of actions, each triggered by a particular event or stimulus in the environment and influenced by the consequences of the action. Behaviour might begin in a variety of ways, including modelling, or copying the behaviour of another person, but it is the rewards that reinforce a behaviour, i.e. make the behaviour more likely to be repeated. Cognitive/behaviourists believe that the way a person perceives an event will affect the way they respond to it. Humans don’t just react to a stimulus, they respond, based on their understanding of what they have seen. 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.

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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. Levels of the mind The psychodynamic approach suggests that the mind has three levels. Conscious Pre-conscious Unconscious

Where we actively think and perceive things around us. It is what we are currently aware of, or can easily recall. Where we store memories and information. People can access this information, with a bit of thought or prompting. Where desires and fears that we are not consciously aware of are hidden, e.g. immoral urges, experiences from the past.

Parts of the personality Id

Ego

Super ego

Most primitive part of the mind: what a baby is born with. Holds basic biological drives e.g. libido or life force, and death instincts which push an individual towards aggression and destruction. It is selfish and unrealistic and doesn’t pay attention to other people’s needs. It is the ‘child’ part of our personality. Looks for instant gratification: the pleasure principle. The other two personality structures (Ego and Superego) develop from this base. Develops gradually as a person realises that not all needs can be met immediately. It helps balance the demands of the Id and Superego. This is the ‘socialised’ part of our personality, where we become aware of ourselves in relation to other people around us. We don’t act on impulse: we learn to stop, think and consider situations. It is the adult part of our personality. It is in touch with the real world: the reality principle. Develops as the child becomes aware of rules and regulations and of right and wrong. It is the ‘parent’ part of our personality. It represents values and conscience: the morality principle.

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 Selfcentred and acts impulsively. When the Ego favours the superego then the person is rigid, conformist and demanding of self and others.

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Anxiety and Defence Mechanisms Sometimes when the moral Superego is too overwhelming, or the impulsive Id is too insistent, we find that we experience anxiety. This is an unpleasant feeling and the Ego can employ techniques called defence mechanisms to keep these impulses and feelings out of consciousness and under control. In the short term, this is good as it helps us to get through a difficult situation where we are maybe angry, frustrated, sad or hurt. For instance, bereaved people are often very busy in the period following a death, organising the funeral etc, but this can also be a type of displacement - putting off the inevitable pain they will feel when things settle down. If we continue to ignore the anxiety and the causes of it, then we are likely to experience more stress and even mental health problems when our feelings do eventually surface. Denial

Displacement

Projection

Rationalisation

Regression

Repression

Sublimation

Refusing to accept reality, e.g. Not going to see a doctor about a lump in your breast, or a mole which has grown bigger Shifting a feeling from a threatening target towards a substitute object or person, e.g. banging the phone down instead of shouting at the boss. Transfer of your own unacceptable feelings or desires on to someone else e.g. Being quite harsh with someone else for being late, when you’re often late yourself Justifying our actions to reduce anxious feelings e.g. when we’re not invited to a party to say that we didn’t want to go anyway. Going back to a form of behaviour typical of a younger person e.g. an adult stamping his feet when he doesn’t get his own way. Pushing painful memories out of the conscious mind and into the unconscious e.g. abused children who continue to insist that their parents love them. Unacceptable desires are redirected into a substitute activity e.g. doing a work out at the gym instead of having an affair with their best friend’s partner.

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.

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Application to Your Own Life: Parts of the Personality 1) Here are some examples of behaviour. Can you say which behaviours are ruled by the Id, which by the Superego and which by the Ego? 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!

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Application to Your Own Life: Anxiety and Defence Mechanisms Can you fill the boxes with examples from your own experience of how you (subconsciously) use these defence mechanisms to try and deal with the demands from your Id and Superego, or from the life circumstances that might make you feel anxious, angry or sad. Possible answer on page 118. Id (Stay in bed, don’t go to work)

Repression

Superego (You’ll let everyone down if you don’t go in)

Sublimination Denial

EGO

Rationalisation

Regression .

Projection

Displacement

Got drunk again last night and made a fool of myself Argument in class with another student

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Study Tip: Mnemonics Making a mnemonic (pronounced – nem-on-ic) is one way of remembering all the key words associated with a topic. All it involves is making up a phrase or word which reminds you of the first letter of each of the key words. 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.) My Very Early Morning Jam Sandwiches Usually Need Peanuts 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. 1) Make a mnemonic that will help you remember the 7 defence mechanisms. a) Work individually first, as everyone’s mind thinks in different ways: be an independent learner! b) Compare your answer to other people sitting beside you. 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. 2) What do you think the weakness of using a mnemonic is? One of the weaknesses would be that although it demonstrates knowledge, in that you have memorised the key words (K), it doesn’t mean that you actually understand what the terms mean (U), and therefore you won’t be very good at applying the ideas to a case study (App), or using the information to analyse or evaluate a situation (AE). Using a mnemonic is just one step in preparing for an assessment. Scottish Further Education Unit

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Application to Care: The Importance of the Early Years Read the following article about the impact that a child’s experience during the first few years of their life has on their future development and answer the questions that follow. 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. The paper makes two major recommendations: 1) Improve parenting across the UK to establish a new parenting norm, a new culture of parenting 2) The greatest return on investment in education comes in the first five years of life – the very area where we spend the least amount of public funds. We need to address this issue. 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?

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Application to Care: Support for Parents 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 Home-Start is a voluntary organisation which provides support to parents with young families. The volunteers have to be parents themselves, as it is felt that someone with children of their own will understand the issues that the service users face with more empathy. Volunteers help in a number of ways, helping to increase the confidence and independence of families by: • 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 http://parentingacrossscotland.org 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. Scottish Further Education Unit

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Application to Care: Music Therapy 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 Music therapy provides an alternative mode of communication, which is often more accessible than words for some people. Through exploring the instruments and expressing themselves creatively, clients can develop their communication skills, explore important personal themes and gain insight into their patterns of behaving. Client-groups who have benefited from Music Therapy include children and adults with learning disabilities, autism, communication disorders, and challenging behaviour, elderly people with dementia or neurological conditions, people who have suffered trauma and abuse, and people with depression and mental health problems. The Aims and Objectives of Music Therapy can include: • 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

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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?

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Activity: Drawing a Tree Your tutor will supply you with a piece of flipchart paper and lots of large pens. Your task is to draw a tree. 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! There are no limits or requirements in this task, apart from:

DRAW A TREE

Tutor Instructions are on page 21

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Erik Erikson and Lifespan Theory Erik Erikson (1902-1979) was one of the writers who developed the psychodynamic approach. He actually received psychoanalytic training from Freud’s daughter Anna. Unlike Freud who believed that psychological development was fixed by the end of adolescence, Erikson suggests that development is a lifelong process. We encounter new situations at each stage of our life and we have to work out how to respond to them in order to achieve psychological balance and health. 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. Erikson’s theory is known as the eight ages of development as he defines eight major life crises which he says are significant in terms of individual growth and development. During each stage, Erikson believes there is a life crisis which we need to work through. There are two outcomes, one positive and one negative, which will have implications for the development of our identity. We will develop a mixture of both outcomes from each stage, but if the positive outweighs the negative, then an ego strength will emerge. This means we will have a stronger sense of who we are. The eight ego strengths, as shown in the table below, are hope, will, purpose, competence, identity, love, care and wisdom. Whether we are able to resolve the crisis successfully depends partly on the people around us at the time, and partly on our own personality. STAGE

AGE

Infancy

Birth 1year Toddlerhood 1 – 3

CONFLICT Trust versus Mistrust

EMERGING STRENGTHS HOPE

Autonomy versus Shame and Doubt

WILL

Pre-school Age School Age

4–5

Initiative versus Guilt

PURPOSE

6 – 11

Industry versus Inferiority

COMPETENCE

Adolescenc e Young Adulthood Adulthood

12 – 20

Identity versus Role Confusion

IDENTITY

20 – 24

Intimacy versus Isolation

LOVE

25 –64

Generativity versus Stagnation

CARE

Maturity

65 – death

Ego Integrity versus Despair

WISDOM

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Lifespan Theory: Details of the first four stages (Optional) 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. 1) Trust v Mistrust (Infancy) 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. 2) Autonomy v Shame and doubt (Toddlerhood) As a toddler control of behaviour is gained. Skills include walking, talking, climbing, and becoming ‘toilet trained’. The caregiver has to guide the child’s behaviour into socially acceptable directions without damaging the child’s sense of autonomy. Over protection or strict control will produce shame and self doubt. The development of a sense of autonomy will allow the virtue of will to develop. This refers to the ability to exercise free choice as well as self-restraint. 3) Initiative v Guilt (Pre-school age) 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. 4) Industry v Inferiority (School age) 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.

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Lifespan Theory: Details of the last four stages 5) Identity v Role Confusion (Adolescence) 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. 6) Intimacy v Isolation (Young Adulthood) 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. 7) Generativity v Stagnation (Adulthood) 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. 8) Ego-Integrity v Despair (Maturity) 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.

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Application to Care: Jasmine, Grace and Emma Jasmine took early retirement, aged 53, from her job as an assistant head teacher in a secondary school to look after her mother Grace, who had been diagnosed with Dementia. Jasmine didn’t want her mother to go into a care home but there was no-one else to look after Grace, as her husband had died many years ago. Grace came to live with Jasmine and her husband, Al, who works in the merchant navy and so is away for long periods of time. Both Jasmine and Grace thought that they would have many years together as the dementia was still in its early stages when she moved in. They enjoyed each other’s company: Jasmine enjoyed having someone to talk to in the evenings, and Grace felt safe when she was having ‘one of her turns’. Jasmine drove her mother to a local day centre on Tuesday and Thursday mornings and got friendly with some of the other people who attended. She ended up going in to help out on Thursdays when they had a music session - she’d been part of a choir for many years and loved any chance to sing in public. A year after she moved in, Grace had a bad fall while out in the garden and broke her hip. There were complications when she went into surgery and she never recovered. Al was in Indonesia at the time and couldn’t get back for the funeral. Grace’s daughters, Emma and Sam, helped her with the funeral arrangements. Jasmine was quite lost after the funeral - it had all happened so suddenly, and she hadn’t been prepared for it at all. She found comfort in sticking to her old routines and still went along to the day centre on Thursdays, as she enjoyed the company. The manager asked if she wanted to do some sessional work in some of the other centres, and she jumped at the chance. It would mean working in different places each day, but that didn’t bother Jasmine – she was doing something she really enjoyed and certainly didn’t want to go back to the stress of working in a secondary school. A few weeks into this new arrangement, Emma (24) announced she was pregnant. Emma and her husband Mark had been trying for a baby for ages so they were thrilled. However, she had just been promoted at work and didn’t feel it was the right time to take a long maternity leave. She wanted her mum to be the main childminder while the baby was young. Although Jasmine was delighted for Emma and Mark, she knew that she didn’t want to give up her new job and look after a baby full time. She felt she’d had her stint at doing that with her own two daughters and was ready for new challenges in her life. 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. b) How far they have succeeded in resolving that conflict? Scottish Further Education Unit

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Evaluation of the Psychodynamic Approach Strengths in a Care Context • helps workers to understand the way in which past experience might be influencing a person’s current behaviour • helps explain why people don’t always do what they consciously ‘know’ is good for them • defence mechanisms help explain why and how people don’t face up to things, in order to avoid feelings of anxiety • Erikson’s model suggests that there is the possibility to develop ego strengths at later life stages, if the conditions are right – this provides an optimistic view of the possibility of change • Erikson’s model views life as a series of challenges which have to be responded to, which ties in with the care values of promoting independence and acceptable risk. Weaknesses in a Care Context • 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.

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Peer Assessment: Check your Knowledge of the Psychodynamic Approach 1) Give a brief definition of each of the terms below. 2) Check your answers with the person next to you. 3) Try and come to an agreement about any you disagree about or are not sure of. 4) Check your answers with the Glossary on page 35. Childhood experiences Defence Mechanisms Ego Id Instincts and Drives Lifespan Theory Pre-conscious Psychodynamic Approach Rationalisation Regression Repression Sublimation Superego Unconscious

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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 Behaviourists criticised the psychodynamic approach for being untestable: no-one could prove if the unconscious mind exists or not. Instead, behaviourists were interested in carrying out research to prove how behaviour developed. A number of scientists and psychologists in America, Europe and Russia carried out tests on animals under laboratory conditions and developed theories about how behaviour is learned. Learning Theory: Stimulus, Response and Reinforcements 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. What happens as a consequence of our response is also important in determining whether the behaviour is repeated or not. Depending on the result, we are more likely – or less likely – to repeat the behaviour. If we feel we have been rewarded for our behaviour, we are likely to repeat it: the behaviour has been ‘reinforced’. 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

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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. Social context: modelling, observing 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. Cognitive Processing: self-efficacy Psychologists realised that looking at behaviour, even in a social context, wasn’t enough to explain and understand human development. They realised that they needed to look at the ways in which people think about things. A person’s perception of a situation (how they processed it cognitively) had to be considered. 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.

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Application to Your Own Life: Setting Goals 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’. Goal 1: I want to…………………………………………………………………….. In what way is it: Specific : Measurable : Achievable : Realistic : Time bound : Goal 2: I plan to……………………………………………………………………... In what way is it: Specific : Measurable : Achievable : Realistic : Time bound :

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Application to Your Own Life: Learning Strategies 1) Think about an activity you have learned to do: how to swim, skateboard, drive, use a computer, play the piano, cook a meal, put up wallpaper, set up a profile on a blog. 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)

Possible answers on page 119

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Application to Care: Setting Goals 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. Can you see why a knowledge of the cognitive/behavioural approach would be useful in care settings, where plans are made with service users which set goals and targets that will get reviewed every 6 – 12 months? Stating the desired changes and goals in behavioural terms will make it easy to see whether progress has been made. Has the person lost weight? Are they able to travel without support from their house to the Day Centre? Have they been drug free for 3 months? Have they stuck at their college course this time, and dealt with the problems of late attendance and missed classes that meant they dropped out last time? These are all ‘visible’ goals. The service user and care workers can see whether these things have been achieved, or not. Each goal will have been split into a series of smaller steps, and a reward will have been factored in once they have achieved each mini-step. It might take a while to achieve each step, and there will certainly be times when the service user seems to take a backwards step, or gets stuck and doesn’t feel they can move on. 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?

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Application to Care: Breathing Space Breathing Space is a free and confidential phone line mainly, but not exclusively, for young men experiencing low mood or depression, or who are worried and in need of someone to talk to. Men traditionally find it more difficult to be transparent about their difficulties and are often loathe to speak openly about how they address their problems. A service like Breathing Space offers male clients an opportunity to begin the process of speaking about their problems before they become overwhelming. John, 42, phoned this evening. He said he’d phoned six times before but had been unable to speak. He was living alone after having separated from his wife and children. He wanted to talk about his deep sense of shame and guilt over things he had done many years ago. He didn’t want to go into detail just yet, but wanted to know that it would be ok to speak another time to one of the advisers as he was finding the burden too much to bear. Just to pick up the phone had been hard enough. But he had made the first step. In 2004 there were 835 suicides and undetermined deaths in Scotland, 73 percent of them were men. In 2005 there were 763 suicides and undetermined deaths and 70 percent of them were men. In 2006 the figure was 765. A young man working in a hotel in the Western Isles has been cutting and burning himself as acts of self-harm. He feels he must continue to work as he has large debts to the bank and to an ex-girlfriend. He continually feels low and miserable. He would like to go home and stay with his family but they have no time for him, given the problems that the other family members have at this time. At times he wishes he was dead. Excerpts taken from: McLaren, T (2007) Open Up When You’re Feeling Down in Counselling in Scotland Spring/Summer 2007 COSCA pp14-16 Questions 1) “Men traditionally find it more difficult to be transparent about their difficulties and are often loathe to speak openly about how they address their problems.” Give 3 reasons why you think it is more difficult for men to talk about their problems compared to women. 2) One of the sections on the Breathing Space website is about Cognitive Behavioural Therapy. Go on the website - www.breathingspacescotlandco.uk and read the information about CBT, and compare it to the other items in the toolkit. a) According to this site, what are the advantages of CBT? b) When is CBT NOT useful for people? Possible answers on page 120

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Albert Ellis and Rational Emotive Behaviour Theory Albert Ellis originally trained as a therapist in the psychodynamic approach, but felt it was inadequate because, no matter how much insight people gained into their past and why they acted in a particular way, they wouldn’t achieve change unless they acted on this new information and insight. He believed it was necessary for a person to re-condition their response in order to free themselves from their emotional problems. Links between thinking, feeling and behaviour 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…’

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Rational and Irrational beliefs 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 selfenhancing 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. The full list of 12 irrational beliefs is on page 73. 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’.

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ABC (DE) model In order to change irrational beliefs, there are three things a person can do: • Become aware of them (insight) • Challenge them (dispute) • Act to change them (action) 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. Ellis demonstrated this process by using the ABC (DE) process. A Activating Event: the trigger B Belief: the thoughts and opinions you have about the event C Consequence: emotional or behavioural. You feel or behave in a certain way. D Disputing: debating with yourself, detecting your irrational beliefs (‘Where is the evidence for that belief?’) and discriminating which of your thoughts are rational (towards your goals) or irrational (against your goals). E

Effect: there will be a new effect or consequence as a result of the debate with yourself and the new actions you take as a result. Your thoughts will be more effective and rational, and your feelings and behaviour will change accordingly.

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.

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Application to Your Own Life: the ABC (DE) model An example

Your Example

A: Activating Event My friend didn’t reply to my email

A: Activating Event

B: Belief It’s terrible when people don’t do what I expect

B: Belief

C: Consequence I’m upset and angry

C: Consequence

D: Dispute Maybe her internet connection is down; maybe she didn’t realise I expected her to answer

D: Dispute

E: Effect I’ll phone her and check how she is

E: Effect

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Application to Your Own Life: Irrational Beliefs Ellis believes that there are 3 main irrational beliefs as noted on page70 but that these can be further expanded into 12 items. 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 selfdiscipline.

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. Source: National Extension College (1996) An Introduction to Counselling Theory p97 Scottish Further Education Unit

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Questions 1) Define Irrational belief.

3 KU

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

3) Discuss three examples of irrational beliefs that can be compared to ideas in the psychodynamic approach. 6 AE

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. For example, number 2 might be ‘I must do very well, or I’m worthless’.

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. Possible answers on page 121

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Application to Your Own Life: The Stresses of Being a Student 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. Some of the more familiar stresses are: • Keeping motivated in a class that you find difficult • Keeping interested in a class you find boring • Keeping awake in class because you were working late last night/the kids were ill in the middle of the night/you were out socialising • Balancing study/work/family/social life and finding time for revision • Not getting on with people in the class • Not believing you are good enough – even if the tutor has told you many times that you are a capable student • Feeling that you haven’t learned anything in class today – in fact, you are more confused than when you came in • Feeling that you are too slow and that everyone else picks things up quicker than you 1) As a group, add as many more stresses to the list as you can. 2) Split into groups of 3. • 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.

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I find Numeracy boring.

Why? What happens when you get bored?

I’m finished the work within half an hour and then just have to wait there chatting while the tutor gets on with the others. Once they catch up, we move onto the next topic.

Do you think you might have an unrealistic expectation that ‘things should turn out better than they do and that you view it as awful and horrible if you do not quickly find good solutions to life’s hassles’? (IB8)

Maybe. But it’s her job to make it interesting and give me something to do. (IB 12: blame)

What could you do to make it more interesting? (Disputing the belief)

I don’t know. The tutor’s already said I could take in other work to do. I suppose I could study for the First Aid exam, or go over my Psychology notes.

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Evaluation of the Cognitive/Behavioural Approach Strengths in a care context • 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. Weaknesses in a care context • 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.

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Peer Assessment: Check your Knowledge of the Cognitive/Behavioural Approach 1) Give a brief definition of each of the terms below. 2) Check your answers with the person next to you. 3) Try and come to an agreement about any you disagree about or are not sure of. 4) Check your answers with the Glossary on page 36.

Antecedents Behaviour Blank slate

Cognitive/Behavioural Approach Cognitive processes Consequences Extrinsic Reward Imitation Intrinsic Reward Irrational Belief Learning Modelling Reinforcements Response Self-efficacy Stimulus

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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. One of the other writers in this approach, Abraham Maslow (1908-1970) suggested that humans have 7 needs that motivate us. These needs, in order, are: Physical: the need to quench our thirst and have enough rest Safety: physical and psychological safety Social: the need for social contact and a sense of belongingness Esteem: the need to feel good about ourselves Cognitive: the need for mental stimulation Aesthetic: the need to appreciate beauty in our life Self-Actualisation: the need to fulfil our potential and to be all we can be. 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.

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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 Behaviour is explained from the unique viewpoint of the individual, not by an outsider ‘looking in’. It is important to be aware of how an individual experiences their own world, and what their point of view of it is, because this is what their behaviour is based on. Every individual is unique and you can only understand their actions by looking at a phenomenon (situation) from their point of view. 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 selfdetermination. 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.

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Application to Care: the CALM Project The Calm Project, run by the YMCA and based in Greater Pollok in Glasgow, provides a range of services for young people aged 12-21 years old who have been affected by violence, violent crime, bereavement and/or loss. The project was established in April 2002 after a series of youth murders in Pollok. The murders affected the mental well being of the young people in these areas. There is increased fear for personal safety amongst more than half of all young people in the neighbourhood. The trauma of living in the proximity of violence may even be the reason for a higher than usual suicide rate. Therefore, the project works to improve their mental wellbeing, confidence and self-esteem. The Calm Project aims to promote mental health, reduce anxiety about violence and relieve inner pain and suffering amongst young people in Greater Pollok. The project developed in two stages with the first stage incorporating a six-month research period to establish which issues affect young people most. The research was carried out by young people trained in conducting focus groups, interviews and other appraisal techniques. It focussed on how young people cope with an environment that is, or is perceived as, increasingly more violent. The CALM project was aware of the stigma attached to mental health problems and the difficulty for individuals, particularly young men, in admitting the need for support, so part of the initial research was devoted to finding ways to offer services while avoiding stigmatisation. The responses from the young people highlighted that there was a need for the project to offer support to young people affected by violence through support groups, befriending and counselling. During the second stage, the project offered a range of support services such as befriending to young people on a one to one basis, working with the young person on a weekly or fortnightly basis, helping them to cope better with their issues. The project also offered support groups to young people in single sex groups as well as running various other group work programmes to improve the young people’s confidence and esteem levels. y features of the project were to involve local young people and adults, and to develop a sense of community, partly by trying to improve communication between age groups and partly by working in partnership with local agencies and community groups. Source: www.ymcaglasgow.org/service_detail.asp?serviceid=6 Questions (Possible answers on page 122) 1) In what way do you think this project demonstrates the key features of the humanistic approach? a) Holistic 4 marks (2 KU 2 App) b) Phenomenological 4 marks (2 KU 2 App) c) Personal agency 4 marks (2 KU 2 App)

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Study Tips: Marking an Assessment Throughout this unit you have been given Peer Marked Assessments: activities where you were asked to discuss your answer and ‘mark’ someone else’s work – that is discuss with them whether you thought their answer was correct or not. These have concentrated on knowledge-based activities, looking at whether fellow students have memorised the correct terms. 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: • Is there not enough information in the answer? • Have they misunderstood the question? • Have the used the correct terms but not seemed to really understand what they were writing? • Did they just not know the information in the first place? • Did they just list when they were asked to describe or explain? • Did they go off at a tangent or give irrelevant information? 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.

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Carl Rogers and Person Centred Theory Carl Rogers called people who enjoy life to the full ‘fully functioning people’. They are seen to be psychologically healthy people. In order to achieve psychological health, people need to have a positive self-concept, which is based on not having too many conditions of worth imposed on them, and receiving the core conditions from people they interact with. Self-concept The information and beliefs that we have about ourselves is called our selfconcept. Our self-concept is made up of different parts: self-image, self-esteem and ideal-self. Figure 1 Self-Concept SelfConcept

SelfImage

The way a person sees him/herself

SelfEsteem

The value a person puts upon him/herself

Ideal-Self

The way a person would like to be

Our self-image is the picture we have of ourselves: it is made up of our qualities (funny, serious, trustworthy, impatient) our body image (fat, thin, attractive) and our roles (sister, friend, husband). It is OUR picture of what we think we are like – other people may disagree, but it is our internal picture, and so it is the point of view we act from. Our ideal-self is the picture of who we would like to be: perhaps sportier, or more organised, or more courageous, or more able to speak out in class. A lot of psychological discontent is caused because our picture of who we are (self-image) doesn’t match up to our picture of who we would like to be (idealself). How we feel about ourselves (our self-esteem) is likely to be low if our selfimage and ideal-self are too far apart. Equally, we are likely to feel good about ourselves and have high self-esteem if our self-image is close to our ideal-self. So how can we achieve higher self-esteem? Sometimes, having a gap between who we are and who we want to be can act as a motivation for change. We all have different dreams, hopes and goals: perhaps to go to college, visit the gym more regularly or travel the world a bit. These are useful when they are our own goals, and when they are achievable. However, for many of us they are not Scottish Further Education Unit

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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? Conditions of Worth and Locus of Evaluation 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 Scottish Further Education Unit

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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. Core Conditions: Acceptance, Genuineness and Empathy So how do we get to this position where we have an internal locus of evaluation? Rogers suggested that an important influence in healthy personality development is ‘unconditional positive regard’. This can be thought of as a kind of acceptance from others. If parents and people who are important to us (significant others) communicate by words and actions that we are respected and loved, regardless of what we say or do, then we have their unconditional positive regard. This allows us to develop high self-esteem and self-acceptance. They might not approve of what we do, but they can see that it is what we need to do at that time. 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: • accepting of themselves (not making unrealistic demands of themselves or others and not having an unachievable ideal-self) • genuine (open and sincere with themselves and others) • empathic (clear about their own point of view, but not needing to impose it on others. Able to see that other people might have their own point of view which is different, but equally valid: ‘live and let live’)

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Application to Your Own Life: Self-image Speed Dating 1) As a group, make a list of at least 30 qualities or characteristics a person might have and write them up on the board. Some suggestions might be: happy, outgoing, patient, serious, organised, … 2) Make a personal list of your self-image, by writing down as many of the characteristics as you think you have. Feel free to add any more you think of at this time. 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. The exercise can be organised in two ways 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. Listen to what the other person is saying. 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)?

Scottish Further Education Unit

86

Care: Psychology for Care, Higher

Application to Care: Frank 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) 2) Explain how an understanding of Roger’s Core Conditions would help the physiotherapist work effectively with Frank. 8 marks (4 KU 4 App)

Now, compare this case study to the one about Fatima, on the next page.

Scottish Further Education Unit

87

Care: Psychology for Care, Higher

Application to Care: Fatima 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. She went to college to get qualifications in computing and moved to Edinburgh to join a trainee IT scheme with a large bank. Meeting new people, living in a new flat and starting a new job: nothing was familiar, she encountered lots of obstacles and for the first time she became aware that she was ‘disabled’. People found it strange when she said this, but she had just never seen herself as disabled before – she’d just always done what she had wanted to do, and got on with life. Nobody had ever made a big deal about it. She did what she always does in these situations: worked out how to make the best of things and decided that although she enjoyed her new job, she didn’t enjoy living in a new town where she didn’t really know anyone, so she managed to get a transfer back home with the bank. 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)

Scottish Further Education Unit

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Care: Psychology for Care, Higher

Evaluation of the Humanistic Approach Strengths in a care context • 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 Weaknesses in a care context • Roger’s theory was developed as a model of counselling and it is more difficult for people in day-to-day settings to demonstrate the core conditions fully • any attempt to change behaviour using this approach may take a long time and therefore be dispiriting for the service user • sometimes people require a more direct response to a particular problem

Scottish Further Education Unit

89

Care: Psychology for Care, Higher

Study Tip: Spider Diagrams (Tutors: see page 23 for preliminary exercise on Memorising Information) 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. The important points to remember are: • 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 Figure 2 Person Centred Approach Spider Diagram Ideal-self

Internal

Self Image

External

Self Esteem

Locus of Evaluation Self-concept

Conditions of worth Person Centred Approach

Core Conditions UPR (Acceptance) Congruence (Genuineness) Empathy (Understanding)

Scottish Further Education Unit

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Care: Psychology for Care, Higher

Peer Assessment: Check your Knowledge of the Humanistic Approach 1) Give a brief definition of each of the terms below. 2) Check your answers with the person next to you. 3) Try and come to an agreement about any you disagree about or are not sure of. 4) Check your answers with the Glossary on page 37. Conditions of Worth Congruence Core Conditions Empathy External Locus of Evaluation Full potential Holistic Humanistic approach Ideal-self Internal Locus of Evaluation Self Actualisation Self-concept Self-esteem Self-image Unconditional Positive Regard Uniqueness of the individual

Scottish Further Education Unit

91

Care: Psychology for Care, Higher

Revision Activity: Analysis and Evaluation of the Three Psychological Approaches and Theories 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. 1) In what way is Ellis’s Rational Emotive Behaviour theory similar to Roger’s Person Centred theory? 8 marks (4 KU 4 AE)

2) Describe one similarity and two differences between the Psychodynamic and Humanistic approach. 6 KU

3) Which Psychological Approach (Psychodynamic, Cognitive/Behavioural or Humanistic) do you think would be most useful for a care worker to know about? Give 3 reasons for your answer. 9 Marks (3KU 6AE)

4) Which Psychological Theory (Erikson’s Lifespan Theory, Ellis’s Rational Emotive Behaviour Theory or Rogers Person Centred Theory) do you think would be most useful for a care worker to know about? Give 3 reasons for your answer. 9 marks (3 KU 6 AE)

Possible answers on page 123 Scottish Further Education Unit

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Care: Psychology for Care, Higher

Peer Assessment: Psychological Approaches and Theories 1) Answer each of the questions below. 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.

1. Name the three main approaches used in psychology to explain human development and behaviour. 1KU 2. Identify which of the main perspectives is used in the following brief explanations of human behaviour. 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 3. Describe the three parts of the personality as outlined in the Psychodynamic Approach and how they interact. 4 KU 4. What is meant by the term ‘defence mechanism’? Briefly describe one example of a defence mechanism in your answer. 3 KU 5. What is meant by ‘identity versus role’ confusion in Erikson’s Lifespan Theory. 4 KU 6. Explain the importance of reinforcement and rewards in terms of cognitive /behavioural theory. 6 KU 7. Why is a knowledge of the Carl Roger’s ‘Core Conditions’ useful for a care worker? 6 marks (4 KU 2 AE) 8. Describe the behaviour of a self-actualised person. Scottish Further Education Unit

6KU 93

Care: Psychology for Care, Higher

Application to Care: Drug Rehabilitation Services There are 352 beds available for drug treatment in Scotland, situated across 22 services. 1929 clients were actually admitted to residential services in 2005-6. This is above the estimated capacity, suggesting that clients were attending for less than the maximum time allotted for treatment - i.e. they were leaving early. From services which collected the information 22% were reported as repeat presentations. From services who collected the information, 63% of admissions resulted in a 'successful completion' i.e. clients remained in treatment for planned duration of programme. Aftercare is crucial to long term positive outcomes. There is a considerable body of evidence to suggest that detoxification on its own is unlikely to help clients achieve lasting recovery. Detoxification and rehabilitation should therefore really be considered jointly. Detoxification (humane withdrawal from a drug of dependence) is a short – medium term strategy , varying between a few days and a few weeks and involves: • Clinically-supervised detoxification • Brief psychosocial intervention, usually counselling for relapse prevention • Crisis support or practical help with housing, benefits. Rehabilitation (long-term abstinence and re-integration into society) is a medium – long term strategy varying between 2 or 3 months and 1 year and involves: • Clinically-supervised detoxification (in some cases) • Intensive psychological support to address issues such as reason for drug use, parenting skills, low self-esteem, physical or sexual abuse • Therapeutic interventions may include one-to-one counselling, group therapy, cognitive behaviour therapy • Employability interventions (in many cases), including training in basic skills, social and personal skills, employment preparation. Questions 1) Using the 3 psychological approaches (Psychodynamic, Cognitive/Behavioural and Humanistic), describe the needs of drug users. 10 marks (6 KU 4 App) 2) Using the 3 psychological theories (Erikson, Ellis, Rogers), explain why a range of interventions are needed in detoxification and rehabilitation. 10 marks (6 KU 4 App)

Scottish Further Education Unit

94

Care: Psychology for Care, Higher

Outcome 3: Performance Criteria and Mandatory Content Evaluate theories of life change in a care context. Performance Criteria (a) Describe theories of life change which are used to explain human development and behaviour. Mandatory content Theories of life change to be covered are: • transistion: Adams, Hayes and Hopson • loss: Colin Murray Parkes and William Worden. Transition Adams, Hayes and Hopson • the theory of transition and how it affects self-esteem • seven stages: Immobilisation, Minimisation, Depression, Acceptance of Reality, Testing, Searching for meaning, Internalisation. Loss Colin Murray Parkes • four phases: Numbness, Searching and Pining, Depression, Recovery • a minimum of four determinants of grief. William Worden Four Tasks: • accept the reality of the loss • work through the pain of grief • adjust to an environment in which the deceased is missing • emotionally relocate the deceased and move on with life •

a minimum of two strengths and two weaknesses of using the stated theories of transition and loss within a care context.

(b) Evaluate the relevance of these theories in a care context.

Scottish Further Education Unit

95

Care: Psychology for Care, Higher

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.

Scottish Further Education Unit

96

Care: Psychology for Care, Higher

Activity: Types of Life Change Life changes can be welcome or not, cause us to grieve or a causes for celebration, expected or sudden. Can you think back over your life, and those of your family and friends, and think about the kinds of changes a person might have experienced by the following ages? 5 years old

12 years old

18 years old

30 years old

70 years old

Scottish Further Education Unit

97

Care: Psychology for Care, Higher

Activity: The Effects of Life Change Many writers have tried to outline the process that people go through when experiencing life change The theories and models have some similarities, but they each have a different emphasis. We will consider three theories of life change: • Adams Hayes and Hopson: Model of Transition • Colin Murray Parkes: Model of Loss • William Worden: The Four Tasks of Mourning When learning about these models, don’t forget about the Psychological approaches and theories we have just covered. A lot of the knowledge you have gained will be useful when discussing life changes and the ways in which people respond. 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. Possible answers on page 125

Scottish Further Education Unit

98

Care: Psychology for Care, Higher

Transition: Adams, Hayes and Hopson This seven stage model describes how our self-esteem is affected as we go through a transition, or change, in our life. As with all the models we consider in this unit, the writers don’t say that people have to go through all these stages. Rather they say that, looking at general patterns of behaviour, these are the likely stages, and the likely order that people will respond to a transition. They place particular emphasis on the way that a person’s self-esteem will be affected as they deal with the transition. We have already considered self-esteem in this unit when we looked at the work of Carl Rogers, and it might be useful to go back and look over your notes to remind yourself about his ideas. The seven stages are: 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.

Scottish Further Education Unit

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Care: Psychology for Care, Higher

Figure 3 Adams, Hayes and Hopson’s model of transition and self-esteem

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.

Scottish Further Education Unit

100

Care: Psychology for Care, Higher

Application to Care: Hearing Loss 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)

Scottish Further Education Unit

101

Care: Psychology for Care, Higher

Application to Care: Barbara and Duncan Barbara and Duncan have recently returned to the far north of Scotland to retire, following many years of living in South Africa where Duncan was employed in the oil industry. Their cottage has beautiful views and met all their expectations over the summer, when they had lots of friends to visit. 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

Scottish Further Education Unit

102

Care: Psychology for Care, Higher

Loss: Colin Murray Parkes 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. The four phases are: 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.

Scottish Further Education Unit

103

Care: Psychology for Care, Higher

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?

Scottish Further Education Unit

104

Care: Psychology for Care, Higher

Activity: Murray Parkes’ Model of Loss Murray Parkes wrote his model specifically about death, and the ways in which people respond to it. However, in a care setting, it is a useful model to use when looking at other kinds of change, loss and separation. The phases that people go through when coming to terms with other changes follow the same pattern, and can be just as intense and disruptive to their daily lives. 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.

Scottish Further Education Unit

105

Care: Psychology for Care, Higher

Application to Care: Steven Steven, aged 36, has Downs Syndrome and has lived with his mother Karen all his life. His dad left when he was 18 months old, and he hasn’t had any contact with him since. Karen died suddenly and unexpectedly at the age of 55 from a massive heart attack. Steven, his mum and his carers had never really spoken about the possibility of what he would do if Karen died, because it hadn’t seemed a pressing problem, so everyone was greatly shocked and upset. They had spoken occasionally about Steven going to live in supported accommodation with Key Housing or Richmond Fellowship, but Steven always decided that he enjoyed living at home and led an independent and happy enough life with his mum, and didn’t want things to change. 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)

Scottish Further Education Unit

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William Worden: Four Tasks of Mourning Worden looked not at what happens to you when you experience a loss, but more at what a person has to do in order to cope with the loss. Therefore it is an active model of responding to loss, which is useful in care work as it suggests things the person, or those around them, might do in order to enable them to work through the process of grief. Worden talks about tasks rather then phases. Task 1: To accept the reality of the loss There is often an initial sense of unreality at the time of loss. The first task of mourning is therefore to accept the loss as a reality. Some people refuse to believe that the loss is real and get stuck in grieving at this first task. It is normal after a death to hope for a reunion or to assume that the deceased is not gone. However, for most people, this illusion is short lived and it allows them to move on to task 2. Sometimes they will engage in ‘mummification’, where they retain the possessions of the deceased person, or keep their bedroom exactly as it was when they died. This is not unusual in the short term but becomes denial if it goes on for a longer time. Task 2: To work through the pain of grief This is accomplished by allowing the expression of feelings. This can include tears, sadness, anger and depression. Society can play an important role in this respect. Some societies allow very overt displays of grief, whilst in other societies giving way to grief may be considered unhealthy or seen as feeling sorry for oneself. Suppressing pain may prolong the process of grieving. This task of grieving can be impeded by the denial of feelings, the misuse of alcohol, or by creating an idealised memory of the dead person. People can deny that they feel pain, by having ‘thought stopping’ procedures or keeping very busy so there is no time to think. Some people may need support to complete this task. Task 3: To adjust to an environment in which the deceased is missing This involves recognising and perhaps taking on roles which the dead person once performed. Where the bereaved person’s identity was intertwined with the dead person there is a need to find a new sense of self. For example someone in a small village who has introduced herself and thought of herself as the doctor’s wife will need to develop a new sense of who she is. Task 3I can be hampered by not adapting to the loss. This might include a focus on personal helplessness, or withdrawal from the world. The task is resolved by the development of the skills needed to cope with their new life. Task 4: To emotionally relocate the deceased and move on with life This task involves using energy previously invested in mourning for the dead person and using this energy to live effectively. This is difficult for some people because they see it as somehow dishonouring the memory of the deceased. In some cases, they might also be frightened by the prospect of reinvesting their emotions in another relationship in case it also ends with loss. Other family members might also disapprove if they start a new relationship. This task is not completed if the bereaved person feels an inability to love or form new attachments due to clinging on to the past.

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Application to Your Own Life: Writing Your Own Obituary This is not as morbid as it sounds! When someone dies, a summary of their life is sometimes written, which lists their interests, achievements etc. It is not easy to think about death for many reasons, but one thing that thinking about death does, is to remind us about life and what ‘we are here for’. When someone close to you dies, you think about their life and what they have achieved, whether they have enjoyed it or had a hard time. 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. Writing your own imaginary obituary is an interesting exercise, because it acts as an indicator of the things you might want to achieve in life or be remembered for. Be as creative and ambitious as you like. Let your imagination go and see what life you would like to create for yourself. In earlier sections of this unit we have looked at ideal-self, self-actualisation and fulfilling your potential. If you were to have fulfilled your potential by the time you died, what would you have done?

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 … She was a loving mother to … She loved to spend her time … At work, she … She was most happy when… The highlight of her later years was … etc.

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Application to Care: Sarah 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 1) Use Worden’s Four Tasks of Mourning to explain Sarah’s behaviour. 8 marks (4 KU 4 App)

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Evaluation of the Theories of Life Change Strengths in a care context • 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. Weaknesses in a care context • 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.

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Activity: the Relevance of Psychology to Care Workers 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. 1) In what way is a knowledge of psychology useful for a care worker when assessing the needs of a service user?

2) In what way is a knowledge of psychology useful for a care worker when working with a service user?

3) Why is a knowledge of psychology useful for care workers who want to engage in continuing professional development?

4) What are the limitations of psychology for a care worker?

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Study Tips: Preparing for an Assessment For any exam in the Care Higher course, you have to do three different things: • 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. Before the Assessment 1) Check that you have all the relevant notes. Read over everything highlighting the main points as you go along, if you haven’t already done this. 2) Make a list of the key terms, or draw a spider diagram (see page90). Use the mnemonics (see page 51) that you have developed to make your notes as brief as possible. It doesn’t matter what format you use, as we all learn in different ways. Some people think better in lists, others in pictures. The important point is to WRITE the key words down again and again (repetition: remember the behavioural approach?) to check that you remember them and that you can give the relevant definition, without referring to your notes. 3) Some people stick their mind maps/lists beside the phone or on the fridge, so they are being reminded of them on a regular basis, without even paying particular attention to them (vicarious learning). During the Assessment 1) Read the question carefully. Answer the question that is asked, not the one you wish you had been asked. 2) Check whether you are asked to Describe, Explain, Apply or Evaluate and do what is asked. 3) Check how many marks are awarded to the question. This gives a very clear indication of how much you should write. In a Unit Assessment there are 40 marks to be achieved in an hour. This means, on average that each mark should be given 1½ minutes. So, in order to get through all the questions, you should spend 7 or 8 minutes on a 5 mark question. It doesn’t work out exactly like that in reality, as you need to spend time reading and thinking, but it is a general guide. If you spend too long on the first couple of questions by writing everything you know, rather than by just answering the question, you will miss out on the chance of getting good marks for the later questions.

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Study Tips: What Do Command Words in Questions Mean? 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: Command Word Define Describe Discuss Explain Apply Analyse Compare Contrast Assess Evaluate

K&U X X X X

A&E

App

X X X X X X X

You are also given clear guidelines in the marks allocated to each question about what kind of information is required in the answer. Always look at the marks allocated to a question, as well as the command words in the question, before you begin to write your answer. They both give a very clear message about what kind of answer, and length of answer, is required. A question that asks for 2 KU may require 1 or 2 points of information, but a question which asks for 6 KU will require much more detail to gain maximum marks. A question worth 8 marks that asks for 4 KU and 4 AE requires you to give some information about the approach/theory/model asked for AND to analyse or evaluate this information in some way.

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Study Tips: Preparing for the External Exam – Care Higher Psychology for Care is one of three units that you will be assessed on in the External Exam Care Higher in June. The other two Units are Sociology for Care and Values and Principles for Care. Preparing for the Exam • 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. During the Exam • 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.

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Formative Assessment: Donald Read the following case study and answer the questions which follow: 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 1 How would a knowledge of the Person Centred Approach help staff understand Donald’s behaviour? 8 marks (4 KU 4 App) 2 a) Describe the main features of Albert Ellis’s Rational Emotive Behaviour Theory. 6 KU b) Describe two ways in which a knowledge of Ellis’s theory would help hospital staff work with Donald. 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.

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Formative Assessment: Prince and Princess of Wales Hospice, Glasgow 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. Among the services offered in the day care centre are: • Complimentary therapies, delivered by a team of volunteers within a calm, peaceful space. This can help with relaxation and anxiety management • The art project, designed to encourage and facilitate expression and provide a focus of activity • Creative writing is very useful if you "know what you want to say, but do not know how to say it". It offers a great opportunity to express yourself! • Social interaction is obviously good if you live alone, but people may also enjoy an outing to the Day Centre if they feel they've become isolated from day-to-day activities by their illnesses • Special appointments can be made to see the physiotherapist, chaplain, medical team or social work team. Source: http://www.ppwh.org.uk/index.cfm/page/127/ Questions 1) Describe the main features of the psychodynamic approach.

4 KU

2) Use one aspect of the psychodynamic approach to explain the relevance of one of the services the hospice offers. 3 App 3) Describe the main features of Carl Roger’s Person Centred Theory.

6 KU

4) Using 2 examples, explain how knowledge of the Person Centred Theory could help people who attend the hospice. 6 App

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Possible Answers to Activities In many of the worksheets and activities in this unit, there is not just one single correct answer to a question. 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.

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Possible Answers to Application to Your Own Life: Anxiety and Defence Mechanisms Repression Remembering as you fall off to sleep at night that you still haven’t phoned a friend you’d intended too, but forgetting about it the next day, until you fall off to sleep again.

Id

Superego

Sublimination Being physically sick and having to stay off work, rather than talk to your boss about their bullying behaviour.

EGO

Rationalisation Going over an argument in your mind time and time again, justifying why it was ok for you to say what you did. Projection Taking an instant dislike to someone because they are too bossy, even though people find you a bit controlling at times.

Argument in class with another student

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Denial Not believing it when a friend tells you that your partner has lied to you, and getting angry with the friend instead. Regression Staying in bed, because you’re ‘not feeling that well’ rather than going into college when you know you haven’t completed a project that is due in that day.

Displacement Pouring yourself an alcoholic drink or reaching for the cigarettes when you are feeling under pressure. Got drunk again last night and made a fool of myself

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Possible Answers to Application to Your Own Life: Learning Strategies 2) Make a list of 5 things you can do to make learning the material in this unit, and preparing for assessments, easier. Establish strong and positive associations - 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. Observe and Model - 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. - Give feedback to people who are explaining things to you. If it is positive feedback, it will reinforce their ability to explain things well in the future: if you don’t find their explanations clear, they can think about how else to re-word them. - 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!

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Possible Answers to Application to Care: Breathing Space Questions 1) “Men traditionally find it more difficult to be transparent about their difficulties and are often loathe to speak openly about how they address their problems.” There is a range of possible answers to a) and b) 2) One of the sections on the Breathing Space website is about Cognitive Behavioural Therapy. Go on the website - www.breathingspacescotlandco.uk and read the information about CBT, and compare it to the other items in the toolkit. a) According to this site, what are the advantages of CBT? •

CBT is a form of counselling in which the Therapist assists the client in developing skills to recognise and challenge distorted thinking that can lead to depression. • Cognitive Behavioural Therapists may use techniques e.g. getting the depressed person to do more things that give them pleasure, helping them to solve problems in their life and learning better social skills. How does it work? • People who are depressed have distorted thinking patterns. They see themselves and their situations more negatively than others see it. These thinking patterns make their depressed mood worse • In CBT, distorted thinking is challenged by the therapist who teaches the person to overcome their negative thinking patterns in everyday life. How effective is it? • There are studies showing that people with mild or moderate depression recover more quickly if they are treated with CBT • CBT is as effective as antidepressant drugs • Unlike antidepressant drugs, CBT works as well for adolescents as adults • An advantage of CBT is that it helps people learn skills that may prevent them from becoming depressed in the future b) When is CBT NOT useful for people? • •

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&

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Possible Answers to Application to Your Own Life: Irrational Beliefs 1) Define Irrational belief An irrational belief is one that is illogical and unrealistic. It tends to be absolute – something MUST or SHOULD happen ALL the time, or life will be unbearable. An irrational belief is therefore one that is impossible to achieve. Rational beliefs accept that the world is complex and that things won’t always go our way, but that we can cope with that – it’s not the end of the world. 3) Discuss three examples of irrational beliefs that can be compared to ideas in the psychodynamic approach. 6 AE Possible choices include: 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 selfdiscipline. 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). Scottish Further Education Unit

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Possible Answers to Application to Care: the CALM Project 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.’

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Possible Answers to Revision Activity: Analysis and Evaluation of the Three Psychological Approaches and Theories 1) In what way is Ellis’s Rational Emotive Behaviour theory similar to Roger’s Person Centred theory? 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)’ This is similar to Carl Roger’s idea of ‘conditions of worth’, where he believes that people will only value you if you do what they expect of you, and his idea of ‘external locus of evaluation’ where you are influenced in your opinions and actions by what other people think. 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. The Psychodynamic approach believes that we are greatly influenced by our childhood experiences. The Humanistic Approach believes that what the person does and thinks in the present is the most important, although it is clearly influenced by conditions of worth they have received throughout their life. 3) and 4) Students can be awarded marks for any valid answer.

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Possible Answers to Peer Marked Assessment: Psychological Approaches and Theories The following gives an indication of some of the expected answers to the test yourself questions. 1. Psychodynamic, Cognitive/behavioural and Humanistic perspectives. 2. a) Psychodynamic b) Cognitive/Behaviourial c) Humanistic 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). 5. Identity v Role Confusion occurs in adolescence. 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. Role confusion results from an inability to choose a role in life, perhaps making superficial commitments that are soon abandoned. Some take on a negative identity or the undesirable or most dangerous roles they have been presented with. Peer groups are often more important than family at this stage. 6. Behavioural development proceeds through reinforcement. An activity is more likely to be repeated if there is a reward (pleasurable consequence) to it. Rewards might be extrinsic (getting praise from someone, getting money or medals or getting status in the eyes of your peers), or intrinsic (a feeling of satisfaction and pride). 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.

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Possible Answers to Activity: The Effects of Life Change 2 Make a list of at least 6 feelings at the time of these changes e.g. shocked, angry, relieved etc sad, devastated, depressed, happy, content, overjoyed, ecstatic, surprised, delighted, frightened, worried, anxious, pathetic, hopeless, ashamed, guilty, felt it was all my fault, mortified, humiliated, annoyed, furious, violent, aggressive, cold, withdrawn, protective, impatient, irritable, critical, scathing, short tempered. 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

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. 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.

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Possible Answers to Formative Assessment: Donald 1 How would a knowledge of the Person Centred Approach help staff understand Donald’s behaviour? 8 marks (4 KU 4 App) 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 selfconcept has been affected, and that it will take time for him to develop a new selfimage. 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 selfconcept. 2 a) Describe the main features of Albert Ellis’s Rational Emotive Behaviour Theory. 6 KU Ellis’s model can be summarised as ABCDE. An event happens (Antecedent) and depending on the Belief a person holds about it, there will be certain emotional , behavioural Consequences. Ellis believes that people have irrational beliefs about a situation which can cause them psychological distress and discomfort. If a person has irrational beliefs about the situation (Antecedent), then they – or someone else - might Dispute this belief, by asking what evidence there is for it. If this debating of the belief leads to a different belief then there will be a new Effect – the behaviour or emotions associated with the Event might change. An irrational belief is a belief that does not help us reach our goals in life, the main ones being to stay alive and to be happy. 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

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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.

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Possible Answers to Activity: the Relevance of Psychology to Care Workers 1) In what way is a knowledge of psychology useful for a care worker when assessing the needs of a service user? • It provides underpinning knowledge e.g. Psychodynamic Approach • behaviour viewed as part of a pattern e.g. Murray Parkes • It describes behaviour at successive stages throughout life e.g. Erikson • explain possible reasons for behaviour and for changes in behaviour e.g. Humanistic Approach; Adams, Hayes and Hopson. 2) In what way is a knowledge of psychology useful for a care worker when working with a service user? • use knowledge to inform interventions and approaches to care-giving e.g. Rogers Core Conditions; Cognitive/Behavioural Goal Setting • range of tools and strategies e.g. Ellis’s ABCDE model • based on research evidence e.g. Worden’s four tasks. 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. 4) What are the limitations of psychology for a care worker? •

It is sometimes criticised for being gender blind and not paying attention to the different psychological experience of women

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It is also criticised for having a cultural bias towards a white, western viewpoint

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Psychology takes an individual perspective, which doesn’t always explain the full situation the person finds themselves in. Sociology on the other hand, views the person in terms of the wider context of society and looks at the role that discrimination, poverty and other factors has on the person’s experience.

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