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Case study on low self esteem in work

She has being in the same company for the past 15 years and was recently promoted to a managerial position, following the completion of her first degree. Since assuming her new position, she has become very anxious about her ability to function in her new capacity. She has been feeling lethargic and struggles to get up in the morning to go to work. The position requires her using computers more than she was previously accustomed and despite the fact that she has undergone training, she feels incompetent especially in the preparation of reports. She feels unsure about what she wants to do with her life and feels that she is not good at anything. She fears losing her job because she feels, she will not be able to get another job and so would not be able to take care of the family.

Robin has low self-esteem resulting from her abuse as a child. She has always felt that she was never smart and has not achieved much in her life. She does not feel that she is particularly good at anything and this has resulted in her having only moderate success in life.

Information to be gathered in the initial meeting

I have decided to use the Rational Emotive Behaviour Therapeutic (REBT) approach. REBT uses an A-B-C-D-E model Ellis as cited in Gladding, (2009) states:

A- signifies the activating event/experience

B- represents how the person thinks (rational or irrational) about A

C behavioural and emotional reaction to B

D- disrupting (challenging) the irrational belief and replacing them

E- effective thoughts and hopefully a new philosophy that will help the client achieve great life satisfactions

Based on the information Robin needs a therapeutic process that is short 5-15 session and one that will give quick, but lasting results.

I would enquire about the nature of her concerns that caused her to seek counselling help (Dryden 2004 p. 30). This would result in her telling her story (a summary of which is provided above).

Ascertain the client’s feeling about therapy, and based on her response we would explore her feelings further to clear up any misconceptions through psycho education (Curwen, 2005, p. 61)

Discuss what she would expect to achieve from therapy (Dryden, 2004 p. 30). after which I would have her identify what she considers to be the main problems and select the one that she would like to work on first. Based on her response a discussion may ensue, if my assessment identifies a presenting problem that takes priority over the one Robin has selected.

Gather information on the Robin’s demographic, physical and mental history

Robin would also be provided with an informed consent form, which would outline ethical aspect of conducting the psychotherapy process and provide information on the length and cost of sessions. Clarification would be provided for any queries raised.

Propose treatment approach

Based on the information gathered, I would assess Robin as suffering from work anxiety. I would decide that she has no meta-emotional problems that would negatively affect the problems selected. Dryden (2004) meta-emotional problems are emotional problems about emotional problems such as being ashamed of feeling anxious. As a result we would decide to work on the problems identified by Robin in the first session namely anxiety and fear.

Steps to be taken include:

Developing a therapeutic alliance

Agreeing to work on the problems identified individually. We would agree to work on her anxiety first. In our second meeting, Robin would be asked to explain/recount situations at work that could be linked to her feelings of anxiety. Ascertain what about the situation is anxiety provoking for her. Based on her recount it would be highlighted that she had submitted two reports late due to challenges with completing the report in Excel. She fears this could occur again and show that she is incompetent. Robin admitted that her fear of using Excel results in her putting off working on the report until it is necessary. She is also angry with herself because she feels she is slow as she still finds its challenging to use Excel after receiving training, she feels stupid and worthless.

Teaching the B–C connection and assessing irrational beliefs. I would show Robin that she has depreciating thoughts/beliefs about herself such as being incompetent and slow (B) and that her feelings of anger/anxiety is the emotional response (C) to her beliefs. Also point out that B and C are connected to her critical A which is her subjective account of the upsetting aspect of the situation (i.e. failure to complete her reports on time)

We would spend some time examining irrational and rational beliefs. That involves defining them and identifying her irrational beliefs. Robin’s irrational thought identified are:

If she loses her job she will not be able to get another one

Her challenges with excel means that she is incompetent and stupid

If she submits another report late she will lose her job

The aim of the process is to show Robin that her irrational thoughts are self-defeating and goal blocking. Once Robin indicates that she understands the connection between her thoughts/beliefs and her emotional response and resulting behaviour we would move unto the process of disputing her irrational beliefs. I would utilize Socratic questioning to challenge her irrational beliefs.

Based on the problems Robin is experiencing two immediate goals are

improving her proficiency in Excel

reduce her irrational thoughts.

Robin would be taught problem solving skills and techniques that would help her to overcome the practical adversities is experiencing at work. Robin needs to succeed at work and while she may not lose her job over the difficulties being experienced in using Excel, she needs to feel better about herself, reduce her work anxiety and her anger. After deciding, that she needs to work on improving her proficiency in Excel we would explore alternate strategies that would be used, identifying the resources and support she would need to achieve her goals (Nelson-Jones, 2006, p. 324). Therefore, to meet this goal Robin would; on a daily basis practice for 1 hour using Excel, (she currently has a template, which she inherited). Specifically she is to work on reconstructing the template bit by bit to improve her understanding and proficiency. She also would identify a resource person who would be available to assist her whenever she has difficulties. It would also be decided that she would work on her monthly report weekly to reduce the likelihood of a late submission and reduce the pressures that Robin is having in preparing the report within a short time frame. In addition, she would be instructed to use rational coping statements such as “I can accomplish this task” and visualizing herself successfully performing her task to encourage her (Nelson-Jones, 2006, p. 324).

Additionally to reduce her irrational thoughts Robin would have to complete homework assignments such as:

Preparing Reminder cards – using study cards to record rational statements and repeat them several times daily between sessions (Nelson-Jones, 2006, p. 323)

Using Disputing Irrational Beliefs (DIBS) self help forms - The forms consist of six questions:

the beliefs that needs to be disputed

whether the belief can be rationally supported

existing evidence for the belief

existing evidence against the belief

the worst that could happen to the individual if they ever achieved what they wanted to in respect of that belief

good things that might happen if they never achieved what they wanted to achieve (Dryden & Ellis cited in Nelson –Jones, 2006, p. 323)

Robin would be required to provide feedback on the homework assigned at the start of each session. The feedback would include submitting copies of the completed self-help forms for discussion, reporting on the frequency of use of the remainder cards, reporting on the progress of the Excel practice sessions and the weekly updates of her monthly report. The purpose of this would be to focus on what she has learned or failed to learn between sessions so that blocks to the learning process can be addressed (Nelson-Jones, 2006, p. 323). This would help her internalize a new and effective method of thinking, which, should lead to new emotional effects.

Gladding (2009) highlighted the following strengths of the REB therapeutic approach:

The approach is clear, easily learned and effective.

The approach can be easily combined with other behavioural techniques to help clients more fully experience what they are learning

The approach is relatively short term and client may continue to use the approach on a self- help basis.

These strengths can be seen in the application of REBT to Robin’s case where Robin easily understood the B-C connection and the use of disputing. Desensitization (behavioural technique) will be used to help Robin confront her fears about using Excel. The use of homework between sessions will help to develop Robin’s self-help techniques to support her efforts to change independent of the therapy sessions.

The therapeutic approach, however, places little emphasis on exploring the past despite accepting that it does affect current behaviour. This evidenced in the failure to explore Robin’s childhood abuse. Exploration of these events can help Robin to gain a better understanding of her thoughts and action and deal with the trauma experienced.

The Consulting Psychologist is expected to be competent in addressing issues at the organizational, group and individual level. Lowman (2002) summarized the expected competencies of the consulting psychologist in the individual domain as “skilled in performing assessments and interventions centered on persons as separate entities in organisational work contexts. The consulting psychologist is expected to have the knowledge, skills, and abilities to assess and intervene with individuals in non clinical work and career related contexts and to be able to differentiate situations requiring assessment or intervention with abnormal psychological conditions and those with the more normal range of behaviour”.

In conducting work at the individual level, the psychologist can perform the function of an executive coach. Lowman (2002) defines executive coaching as a “formal, ongoing relationship between an individual or team having managerial authority and responsibility in an organization and a consultant who possess knowledge of behaviour change and organizational functioning. The relationship has the goal of creating measurable behavior change in the individual or collection of individuals that result in increased individual or organizational performance”. There is no specific requirement for the use of counseling theories in the executive coaching process, but the theories can be applied to effect the desired changes. The application of behavioural counseling theories in executive coaching is illustrated using the case of Dan.

The behaviorism approach seeks to change specific thinking patterns and particular thoughts. The focus is on the conscious thinking rather than the unconscious process based on the idea that changing habitual ways of thinking has a powerful effect on both feelings and behaviour (Peltier cited in Brunning, 2007, p.18).

Scenario

Dan is a 32-year-old newly promoted audit manager in the internal audit department. He has worked hard over the years as an auditor but is not comfortable with his new leadership responsibilities. The Audit Partner complains that he does not have a strong presence in audit meetings and is not assertive. The Audit Partner is confident of Dan’s technical knowledge, but is worried about his potential for further advancement in the firm if he does not change; he believes coaching could help Dan.

The executive coach uses a 360-degree evaluation to obtain information from Dan’s boss of what contributed to his perception of Dan (Peltier, 2001, p.59). The evaluation highlights that the seats chosen, the way he sits, his tone of voice, lack of eye contact and lack of contribution to meetings, are what has created this perception. The results of the evaluation will show that Dan’s behaviour needs to be changed. This will be done by focusing on his actions and the resulting feelings. Dan indicates that he feels intimidated by the partners and is uncomfortable due to his age, when compared to his peers and superiors. He was afraid of making mistakes, which would suggest that he was not prepared for this level of responsibility and his present actions (i.e. when he sits, not contributing to meetings) are aimed at making him inconspicuous. A tape of will be made of a partner/managers meeting and this along with the results of the 360 degree evaluation will be discussed with Dan and goals agreed. A change plan and a plan of action will be implemented, which will include practice tapes of Dan speaking up and making points, in mock meetings, making note of his tone, how he sits and makes eye contact (Peltier, 2001, p.60). Additionally through discussions, progress will be made in changing Dan negative/irrational thoughts about himself and his work situation that is negatively affecting his behaviour. The feedback that will be provided will help Dan to see the areas that needs correction. The practice sessions will allow him to feel more confident and comfortable with the changes. One of the first tests will be getting Dan to change where he sits and this will be done over the course of the first 5 sessions. By the end of the 20 sessions, Dan should improve his speech, posture, eye contact and contribution to meetings. His confidence should grow generally because of the support from the coach and the positive feedback he should receive from his peers and superiors.

Another application of counseling theories by the consulting psychologist is in group or team development. Team development addresses achieving cohesiveness and encouraging members to act as integrated whole in order to become more productive (Boyce, 2004, p. 3). Koortzen and Cilliers cited in Lowman (2002) expressed the view that consulting psychologists need to have knowledge of cognitive-behavioral, humanistic and psychoanalytic psychological approaches in order to apply them to group and team development. The approach applied would be dependent on the types of problems being experienced by the group. Based on the problems, the theory models, assumptions, methodology and techniques of the particular approach would be applied to achieve the desire results.

The cognitive-behavioral approach may be more suitable for situations in which the group dysfunctional behaviour results form self-defeating behaviors and an inability to make the requisite behavioral changes. The humanistic approach would be used to facilitate the development of interpersonal skills or to teach relationship-building skills where a lack of interpersonal sensitivity, realness or empathy exists. The psychoanalytic approach would be used if the team presents conscious and unconscious conflicts, problematic relationships exist with leaders or authority figures and there is difficulty in understanding self and collective anxiety. Koortzen and Cilliers cited in Lowman (2002) further stated that consultants not trained in psychodynamic approaches to groups and organizations often felt ineffective and uninformed in dynamic organizational situations such as meetings and team developments.

The psychoanalytic approach to team development intervention uses several models. The use of the psychoanalytic approach is examined in the following scenario.

Scenario

ABC Ltd is a small consulting firm owned and founded by Bob. He is experiencing problems with his management team. He feels that although he has hired some of the brightest persons, they are not providing enough support and though he has empowered them to make decisions, they seem incapable of doing so. As a result, he still has to make all the decision. This has resulted in Bob feeling anxious about the future of the business.

As part of the consulting process, the consultant will collect data and analyze assessment data in order to diagnose the problem facing the group (Wheelan, 2005, p. 436). The consultant would then use Bion theory to diagnose the problem. Bion argues that in every group, two groups are actually present: the work group, and the basic assumption group. The work group is that aspect of group functioning which has to do with the primary task of the group - what the group has formed to accomplish. The basic assumption group describes the tacit underlying assumptions on which the behaviour of the group is based. Bion specifically identified three basic assumptions: dependency, fight-flight, and pairing. When a group adopts any one of these basic assumptions, it interferes with the task the group is attempting to accomplish (Wikipedia, par.20). Based on Bion theory Bob’s management team seems to have adopted the dependency assumption. Dependency groups are characterized by members, which want to be protected by one individual, usually the leader. The group’s behavior implies that the leader is all knowing and all-powerful, and that group members are ignorant, inadequate and immature. The intelligence and power of the leader are never questioned or tested by the group (Minahan & Hutton, 2004). Interventions in the form of team development workshop can used to give members an opportunity to study their behaviour.

Based on the above discussions it is seen that counseling theories are applicable to the work of the consulting psychologist in his role as an executive coach working with individuals and with teams/groups.

In addition to applying counseling theories to individuals and groups, the consulting psychologist engages in counseling in relation to work-based issues such as performance, work relationship, career development and grief counseling. In performing these counseling functions, the consulting psychologist needs to use his knowledge to determine if clients need other forms of treatment. Brunnings (2007) states “if the client personality seems to be the crucial factor in the way he/she performs their current organisational role or was the main reason behind persistent conflicts in the workplace then psychotherapy may be needed. If a recurrent theme e.g. loss has been identified and is considered to be essential for the client to address then, perhaps counseling may be appropriate”. In both instances cited, the Consulting Psychologist would refer the individuals for treatment but would not actually counsel the persons or conduct psychotherapy.

Further Lowman (2002) stated “consulting psychologist individual level assessment skills do not normally include assessment of abnormal personality or mental dysfunction except to the extent that the consulting psychologist is expected to be able to differentiate the needs of persons whose characteristics may require a different type of intervention (e.g. referral for a formal mental health evaluation or intervention)”. Additionally he stated that “although consulting psychologists should be familiar with and able to apply an array of counseling theories and methods, they are not necessarily expected to be prepared to conduct mental health treatment with clients. Rather, consulting psychologist refer such clients to appropriately prepared colleagues when they believe such care is necessary”.

The ensuing discussions have highlighted the fact that the counseling theories are relevant to the practice of the consulting psychologist. The use of counseling theories in executive coaching is considered a gray area, which could present an overlap between consulting and counseling psychologist. Kampa and White cited in Lowman (2002) argued that the intended outcomes of both psychotherapy and executive coaching are behavioral change. The fact that the behaviour change sought in executive coaching focuses on change as it relates to effective performance within the organizational or work context is probably not especially important, because changes in one sphere of a person’s life will most probably have an impact in other spheres. Despite these concerns the relevance of counseling theories to the consulting practice cannot be denied, however the consulting psychologist must be guided by the guided by the ethical competency guidelines of the profession.

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