5 Ps
Presenting Problem
Sarah, a 28-year-old junior manager, struggles with feelings of inadequacy and low confidence, which affect her professional and personal life. She tends to avoid confrontation, accommodating others’ needs at the expense of her own, which is characteristic of a people pleaser (Clancy, 2018). Due to the challenges of asserting herself, she felt undervalued at work and overwhelmed with household responsibilities. Despite having a supportive partner, Robin, Sarah finds it difficult to articulate her preferences and feels uncertain about her own wants and needs.
Precipitating Factors
The recent transition into the managerial role, reinforced by Sarah’s accommodating nature and fear of confrontation, has precipitated her feelings of inadequacy and lack of confidence (Davidai et al., 2022). Importantly, being raised in a family environment where assertiveness was discouraged while peacekeeping was prioritized made the young woman have difficulty expressing herself in social situations (Aura, 2019). Being constantly overshadowed by more dominant older brothers meant that Sarah was shut down in her efforts to speak her mind.
Predisposing Factors
The client’s predisposing factors include her introverted personality, learned behaviors from her family environment, and a lack of assertiveness training or role modeling during her formative years. Sarah’s introverted personality may be a biological factor influencing her temperament and responses to social situations (Chen, 2018). These factors have influenced her beliefs about conflict and assertiveness, contributing to her current challenges in expressing herself effectively.
Perpetuating Factors
Such qualities as negative reinforcement, avoidance coping, learned hopelessness, and social comparisons have all played a perpetuating role. For instance, Sarah’s experiences of feeling undervalued and overlooked after failing to assert herself in professional settings serve as negative reinforcement, further solidifying her avoidance behavior (Edwards & Poling, 2020). Psychologically, Sarah may have internalized patterns of accommodation and avoidance as coping mechanisms, contributing to her current difficulties.
Protective Factors
Despite her struggles, Sarah exhibits resilience and has a supportive partner who encourages her to express herself and be confident. Her goals of improving her self-esteem and developing assertiveness also serve as protective factors, indicating her motivation for change and growth. It is essential that the client understands her issues and is willing to work on them, which represents a step in the right direction.
Intervention Plan
Cognitive Behavioral Therapy (CBT) is the chosen intervention for Sarah, given its efficacy in addressing cognitive distortions and behavior patterns associated with low self-esteem and lack of assertiveness. The approach will emphasize the importance of self-sufficiency, personal growth, independence from family, and directness in communication (Corey, 2019). In assertiveness training, Sarah will engage in role-playing exercises to practice assertive communication techniques. She will learn to identify cognitive distortions, such as selective abstraction or overgeneralization, and replace them with more realistic thoughts, thereby engaging in restructuring (Chan et al., 2023; Curtiss et al., 2021).
Moreover, through guided imagery exercises, Sarah will confront and desensitize herself to feared confrontational situations, gradually reducing her anxiety response (Roberts et al., 2019). Finally, the client will learn effective communication strategies, including active listening and assertive expression of thoughts and feelings, to improve her interpersonal interactions at work and home (Consiglio et al., 2023). Overall, CBT aims to address cognitive distortions and maladaptive behavioral patterns to help Sarah build the skills and confidence needed to assert herself effectively in both social and professional contexts.
References
Aura, J. (2019). Examining the influence of early childhood experiences on current expressions of verbal aggression and assertiveness. Electronic Theses and Dissertations, 250.
Chand, S. P., Kuckel, D. P., & Huecker, M. R. (2023). Cognitive behavior therapy. StatPearls.
Chen, X. (2018). Culture, temperament, and social and psychological adjustment. Developmental Review, 50(1).
Clancy, A. (2018). How to stop being a people pleaser.
Corey, G. (2019). Cognitive behavior therapy. Theory and practice of counseling and psychotherapy (10th ed.). Cengage Learning.
Curtiss, J. E., Levine, D. S., Ander, I., & Baker, A. W. (2021). Cognitive-behavioral treatments for anxiety and stress-related disorders. Focus, 19(2), 184–189.
Davidai, S., White, M. W., & Gregorich, G. (2022). The fear of conflict leads people to systematically avoid potentially valuable zero-sum situations. Scientific Reports, 12.
Di Consiglio, M., Burrai, J., Mari, E., Giannini, A. M., & Couyoumdjian, A. (2023). Imagine all the people: A guided internet-based imagery training to increase assertiveness among university students-study protocol for a randomized controlled trial. Healthcare, 11(13).
Edwards, T. L., & Poling, A. (2020). Motivating operations and negative reinforcement. Perspectives on Behavior Science, 43(4), 761–778.
Roberts, N. P., Kitchiner, N. J., Kenardy, J., Robertson, L., Lewis, C., & Bisson, J. I. (2019). Multiple session early psychological interventions for the prevention of post-traumatic stress disorder. The Cochrane Database of Systematic Reviews, 8(8).