Republic of Uganda

Enhancing Coping Strategies

Workshop 4: Monday 14th November

Elaine Hunter and Dave Baillie

Bridge from our last meeting

What were the key things discussed?

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 Homework review

Longitudinal formulation of Case example

‘Juliet’

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 Early adverse life
experiences

Formation of negative core beliefs

about self, others and the world

Critical Incidents

Assumptions triggered

Negative automatic
thoughts

Behaviour Affect
 Early adverse life experiences : Cold and critical relationship with mother, Rivalry with
siblings, Sent away to relatives, Mother returned to work (rejection), excluded at school, cruel
teacher, teased about appearance. Father only source of attention but stopped when teenager,
abusive boyfriends

Negative core beliefs . Self = ugly, unloveable, defective, worthless.

Others = critical, rejecting, abusive
world = cruel, plays tricks on you

Critical Incidents : new baby & hears message from husband boasting of affair

Assumptions triggered: If I’m not loved by a man then I’m worthless. If my

life is not perfect then it is my fault and I have failed

Negative automatic thoughts: My marriage is false. My husband doesn’t

love me. He is just the same as other men. I have failed. This is my fault

Behaviour: hypersomnia, increased alcohol Emotions: depression,

and cannabis, avoiding her husband, not anger, guilt
confiding in her family and friends
 Agenda for today’s training

What do you think would be important to cover

today in terms of enhancing client’s coping
strategies?

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 Our ideas for today’s training
30 mins
 Potential advantages of enhancing coping
strategies with clients
 Ways of analysing how to make the client’s
coping more effective with case illustrations

15 mins (if time....)

 Role play of your course client or another
client

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 Cognitive and behavioural efforts to control
or master the symptoms or to minimise the
distress caused by them

 Naturalistic studies have found that the

majority of clients use active coping but with
varying degrees of success
◦ (Breier & Strauss, 1983 ; Carr, 1988)
 Enhancing coping strategies can be useful :
◦ To managing symptoms
◦ To minimising distress
◦ To minimising disability
◦ To improve quality of life
◦ Early in therapy to help with engagement and for
those clients who want a ‘quick fix’
◦ To instil hope
◦ Provide short term relief / respite
◦ To increase the client’s sense of control
 Can appear to trivialise the client’s difficulties so
need to suggest usage carefully

 Let the client know that these are basic, simple,

strategies that you can try early on but that you
will have other things you can do later in therapy

 May not be that effective if you don’t know

enough about the client / haven’t yet got a good
formulation
1. Improve existing coping strategies by
analysing together why these may help and
increasing the use of these

2. Increase the range of coping strategies by

suggesting new things they can try

3. Practice strategies in the therapy session,

and as homework, to gain skills
 Ask about general ways of coping
◦ How do you cope with this?
◦ What do you do to make yourself feel better?
◦ Is there anything you can do to get rid of X?
 Check out behavioural and cognitive
strategies
 Find out the specifics of what they do:
◦ “relax”– how do they do this?
◦ “Don’t think about it” –how do they do this?
◦ “Keep busy” – what do they do?
 Assess the effectiveness of each strategy
◦ How much does this help?
◦ Use rating scales (0-10)
◦ The best strategies are consistently helpful
◦ Explore when they are most successful and where less
helpful

 Supplement your clinical interview with a

symptom severity diary for a few days  1 week,
if possible
◦ What they are doing and how severe symptom is on 0-
10 scale
◦ This will be more accurate
Situation Possible reason What I can do instead
why
Being inactive at Mind empty Go for a walk
home Read a magazine
Visit my neighbour
Make cards/dolls
Do a crossword puzzle
Drinking coffee Caffeine makes Drink a herbal tea instead
me anxious
Feeling low Voices can get Talk to someone
at me more Cuddle my cat
Look at my holiday photos
Make cakes
Going to the Noisy and Concentrate on shopping list
shops crowded Listen to music on walkman
Hum to myself
Situation Possible reason How can I do more of this....
why
In the morning Busy with things
Feeling
refreshed
Talking on the Talking
phone Interacting with
someone else
Vacuuming my Noisy
home Busy with things
 Ask client to practice any new strategy as
homework – agree frequency
 Create hierarchy of situations in which to

practice (easier  more difficult)

 Ask client to keep a record of success of the

strategy
◦ Diary / Checklist
◦ Rate the effectiveness of the strategy
 (e.g. Severity of problem before and after using
coping) (see handout of diary for this)
Review progress
 Find out if strategy was used
 If not implemented:
◦ Explore reasons why and problem solve
accordingly
◦ If memory problems, can make coping cards (see
Joan as example...)
 If strategy successful:
◦ give praise and booster practice
◦ Chose another strategy and repeat process
◦ If second strategy successful
 chose another problem and repeat process
 Things I can do to help my mood

Watch a Talk to
DVD uncle and Go
aunt & go for a
to their drive
allotment

Keep occupied by
Go to the knitting or writing a
Horniman Look letter
museum around
the
shops
Go to
the 999 Talk to Do some puzzles
club Pam
Spend time with Ryan
 My strategies for reducing self harming

Ice cubes Use my

stress Pop
ball some
bubble
wrap
Keep
Cuddle a soft occupied by
toy Draw on knitting
myself with a
red pen

Use red
food Have a hot Tear up paper into
colouring shower and small pieces
body scrub
 Things I can do to help with the voices

Listen to Read Listen to my

books on Aloud session CD Pray
tape aloud
Listen to music
Listen to the
radio/TV
Use my Keep occupied by
relaxation/ Be firm knitting or writing a
special place/ letter
with
mindfulness
tape the
voices

Talk to Hum to myself

someone Count under my
by phone breath
Chew gum
Put in ear plugs
Spend time with
others: Ryan, Pam, Use my self soothing strategies such as
my family camomile tea
 Please get into pairs
 One of you can play your course client or

another client you know well

 Other person plays therapist

◦ See if you can find out when the client’s problems

are worse....
◦ Ask the client what they think the reasons for this
might be
◦ See how they might do something differently
◦ Repeat this process with when the problem is better
and how they can do more of this....
 Homework setting
What would be useful for you to do between
now and the next time we meet?

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 Summary of today’s meeting
What were the key things discussed today?
What did you learn from our session today?

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 Feedback

How did you find the session today?

Is there anything you didn’t like that we need
to change?
What could we do differently?

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