When I think about the psychological and emotional issues a client may have and how these might affect their health and their actions I like to return to the humanistic model of psychology and I keep in mind when working with a client the wellness model such as the one developed by developed by Myers, Sweeny and Witmer. This model includes five life tasks – essence or spirituality, work and leisure, friendship, love and self-direction-and twelve sub tasks-sense of worth, sense of control, realistic beliefs, emotional awareness and coping, problem solving and creativity, sense of humor, nutrition, exercise, self care, stress management, gender identity, and cultural identity-are identified as characteristics of healthy functioning and a major component of wellness. The components provide a means of responding to the circumstances of life in a manner that promotes healthy functioning.iso claimsearch
When we talk of mental health, we are trying to describe either a level of cognitive or emotional well-being or an absence of a mental disorder. Without this balance a client’s ability to enjoy life and have a balance between their activities and efforts to a balanced and fulfilling life is challenged. An in balance of the five tasks can lead to an inability to function effectively. This in balance can prevent a client being able to communicate their current situation and their understanding of their current situation to us. Emotional and psychological difficulties will form filters in the client’s perception of the world and their own situation within it. Where a client’s belief systems and emotional and psychological health are perhaps not balanced these things can lead to both accidental and deliberate self harm in terms of self sabotage and other destructive behaviors’. If the clients reality, their ‘map of the world’ is not connected to the reality of the external world then this may mean that whilst they intend to change to less or non harming behaviors they may believe they have or they may substitute different but equally negative behaviors or they may be unable to understand that their reality is out of sync with the perception of those around them. In addition when we talk about the ‘benefits model’ we need to take into account that an inability to emotionally engage with the world about us may also be a benefit that the client is reluctant to lose.
A client might not be able to explain the issues that are affecting them, in terms we are able to understand, where they may have physical, emotional or psychological issues. Their ability to interact with us may be compromised by medication or a previous experience they have had with a health care provider or with health care. If a client is reluctant to discuss their health current or previous I would note this and then watch and note any other issues they may have or have a reluctance to discuss. I would observe speech and speech patterns, body language and look for anything that would give me an understanding of what the issues are for the client. I would allow a client who is reluctant to discuss health and issues around health the time they need to build rapport and trust; which is more likely to lead to the client revealing issues around their health which might affect their therapy. I always remind myself when meeting a client that we all apply filters in our exchanges with each other and may wish to present ourselves in a way that differs from reality. By observing the client during therapy I try to develop a therapy plan with the client that will address their issues and be tailored to their needs. I accept that because of the collaborative nature of therapy I can in the end only work with what I am told and what I can observe. If I feel that a client’s refusal or inability to disclose issues about their health are compromising my ability to deliver a therapeutic relationship I would have to end the therapeutic relationship.