Weber, Linda

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Clinical Sociology ReviewVolume 12 | Issue 1 Article 211-1-1994On the Development of Reflexive ThinkingLinda WeberState Unviersity of New yorkFollow this and additional works at: http://digitalcommons.wayne.edu/csrThis Practice Notes is brought to you for free and open access by DigitalCommons@WayneState. It has been accepted for inclusion in ClinicalSociology Review by an authorized administrator of DigitalCommons@WayneState.Recommended CitationWeber, Linda (1994) "On the Development of Reflexive Thinking," Clinical Sociology Review: Vol. 12: Iss. 1, Article 21.Available at: http://digitalcommons.wayne.edu/csr/vol12/iss1/21On the Development of ReflexiveThinking: A Practice NoteLinda Weber, Ph.D.State University of New YorkInstitute of TechnologyIntroductionIn this practice note, a case study is presented which focuses upon thispractitioner's attempt to integrate theoretical insights of George Herbert Meadinto a therapy session with an "agoraphobic" female. It is hoped that thispresentation will provide some insight into the utility of theory in clinicalpractice.Annie, a 35-year-old, white, never-married woman from a working-classbackground, presented as a self-labeled agoraphobic. In response to the questionof why she wanted assistance, Annie replied that she wanted to be cured fromagoraphobia, a condition that she knew she had ever since seeing a Phil Donahueshow on this topic. During the initial consultation, Annie's various nervous ticks(e.g., pushing her glasses up her nose, twitching her eyes, and shaking her hands)accentuated the anxiety she was under.BackgroundAnnie had been previously seen in the family practice center at the medicalcenter where the counseling took place. She had been referred to the familytherapist in the Behavioral Medicine Department and subsequently referred to medue to my growing specialization in the treatment of stress and due to my276ON THE DEVELOPMENT OF REFLEXIVE THINKING 277willingness to take cases that others did not want. The referral was initiated byAnnie's physician on request. The physician felt that Annie's extreme anxietysurrounding the medical establishment would be problematic in the future ifimpending emergency treatment or elective treatment were performed.Annie's only other experience with counseling was through the voluntaryservices provided by a lay hypnotherapist who was a friend of the family. Herimmediate family was comprised of a still living father, mother, and older sister.The following factors were identified by Annie as contributing to her presentstate of fear/anxiety about everyday living:1. constant fighting between her parents during her childhood2. seeing a neighborhood boy being hit by a car at age 6,3. her father threatening her mother with a gun at age 8,4. constant harassment about being a special needs student,5. a sexual assault (i.e., rape) on her first date at age 18,6. a constant non-supportive environment by her parents, especiallyher mother, during the above events.Although not revealed in the initial interview but in a subsequent session, it shouldbe noted Annie was sexually abused by her father from the age of seven years tothe age of 12 years.All of Annie's tensions and anxieties surfaced in two previous suicideattempts and frequent bouts with depression. Until Annie had seen the Donahueshow, she has been living primarily in seclusion, too fearful to go outside herapartment. When she did venture out, she would frequently be overcome byanxiety attacks.InterventionAs a symbolic interactionist imbued with the ideas of conflict theory, Igenerally focus on issues of the self and power relations. Annie appeared to haveno power in any of her interpersonal relationships. With the idea of empowermentin mind, I asked Annie to design her own therapy. Since viewing the Donahueshow, Annie had read a few lay, self-help books on agoraphobia. In some sense,she had more knowledge than I did on this particular ailment. Annie's firstreaction was, "That's your job to cure me." I responded that my job, as I definedit, was to assist her in achieving her goals for personal growth. Annie respondedback, "Well, then I'll go to a psychiatrist." I asserted that I would help her finda psychiatrist; however, if she decided to use my services, she could meet with me278 CLINICAL SOCIOLOGY REVIEW/1994the next week with a list of fears, a list of things that would help her get better, anda list of things that would tell her that she was getting better. Annie left miffed.Needless to say, Annie returned and together we worked on her lists. On herlist of things that frightened her, she had included things related to sickness/illness(e.g., emergency rooms, sirens, ambulances), to storms (e.g., tornadoes, thunder,lightening), to relationships (e.g., meeting people, talking with people), and toeveryday occurrences (e.g, crossing the street). On her list of things to get better,she included walking around the hospital, possibly volunteering, learning moreabout the hospital and storms, and possibly joining a group. She felt that the mainissue/criteria for improvement was her ability to participate in any of these thingsand not have an anxiety attack. For the purpose of these counseling sessions, wedecided to focus on overcoming her medical fears and the fears of people sincewe could work on these objectives in the medical center setting.Although Annie was placed in charge of the specifics of her program, I didnot believe that her problem could be solved solely by addressing specificbehaviors. If this were the case, we would be in counseling together, forever.Instead, a more generalized approach was needed.According to Turner (1987) in his presentation of an interactionist model ofmotivation, the capacity for reflexive thought formulates the basis for thedevelopment of a substantive self-concept which subsequently determines be-haviors by influencing the definition of the situation. Reflexive thinking ischaracterized by the ability to view oneself as an object (Mead 1934). This object,the self-concept, is comprised of both identity and self-esteem. Self-esteem is theevaluative component of the self whereas identify is the content of the self-concept (Gecas 1982). One's self-concept acts as a filter through which selectiveperception and recall occur. Hence, one's beliefs, encompassed by the phrase "thedefinition of the situation" are influenced by one's self-concept which subse-quently influences behavior.In Annie's case, I felt that part of her "fear" may have arisen from an inabilityto view herself in the context of her social situation. Hence, she would be unableto see herself as a participant; thus, she would be unable to make effectivejudgments concerning her behavior.The extent and nature of an individual's identity is commonly assessed usingKuhn and McPartland's Twenty Statements Test (TST) (1954). The TST is anunstructured questionnaire in which respondents answer the question "Who amI?" with up to twenty statements.In an attempt to assess the extent and nature of Annie's identity, a number ofmethods were employed. First, the TST was utilized during one session. Annieresponded that she didn't know what I wanted her to do. Upon clarification, sheON THE DEVELOPMENT OF REFLEXIVE THINKING 279still did not know how to describe herself. Second, I then asked Annie to close hereyes, to picture herself, and to describe her image. She said she did not seeanything and did not know how to describe herself. Finally, I asked her to drawa picture of herself. She responded by drawing a stick figure with curly hair.The above testing procedure appeared to indicate that she had a very vagueto nonexisting concept of her self. Although people may say that I really testedher verbal, writing, and artistic abilities, it is important to keep in mind that thebasis of self formation, from a symbolic interactionist viewpoint, is language.However, I was not planning on giving her English lessons; instead, I wasplanning on developing her ability to see herself as an object.The intervention developed into the following routine for approximatelyeight weeks. During the first half of the hour session, Annie and I would walkaround the first floor of the hospital. I would allow her to direct the tours. Wefrequently ended up at the doors of the emergency room. She did not want to andwould not enter this area. Upon coming across patients, and especially traumavictims, we would slow down so Annie could catch her breath. I noticed herimmediate tendency was to stare directly at these patients as she entered her panicattack. We avoided all panic attacks by retreating from the area, by her learningto not focus on these victims, and by her learning to breathe deeply during theseencounters. Slowly, the number of times she had to stop on these rounds werereduced. The emergency room, however, was still a barrier.The second half of the intervention dealt with building her self-concept. Westarted with some basic methods. First, she would stare in mirrors and describeherself. Second, she would close her eyes and try to conjure up these images.During these sessions, two minimal occurrences, but nontheless "break-throughs" were noted. In one instance, Annie came in with a tape of scary sounds.She was real proud she could listen to these sounds and not get scared. Myimmediate response, in a teasing manner, was to say "You, the person who isscared of everything, bought a tape of scary sounds?" Now, we've all had thosecrucial moments which are usually filled with dead silence, where we could kickourselves for saying something not thought out. Well, this was one of mine.Realizing the intensely serious way Annie viewed herself and the world, thisattempt at humor could have easily backfired. She finally burst out laughing,commenting, "That's funny, isn't it?" This was the first time she had laughedabout herself or her actions during counseling.In another instance, Annie and I were talking about a thunderstorm that hadoccurred that week. I asked her to imagine that she was floating by the ceiling andlooking down. I then asked her to describe herself and her behaviors. She vividlyrecalled her activities, which included hiding under tables, and covering herself280 CLINICAL SOCIOLOGY REVIEW/1994with her mattress in her tub while waiting out the storm. As she was describingherself, she smiled and commented that she guessed she had gotten a little carriedaway.After this eight-week session, I asked Annie to join the group therapy sessionI was leading, in part because she had gained some confidence about herself, and,in part, because I felt that the group could confirm, and disconfirm some of herbeliefs about reality. Annie was able to manage her group member role quite well.During this time period, Annie "discovered"/remembered that she had beenabused sexually by her father from age 7 to age 12. A referral was given to her forthe rape crisis center which was currently treating adults molested as children.The symbolic culmination of my work with Annie was a visit to theemergency room. At the end of approximately four weeks of group therapy, Anniefelt that she would be able to go into the emergency room. I arranged with a nurseto give us a tour and we purposely chose mid-week afternoon to avoid potentialchaos. The visit was successful, with two ambulances arriving with sirens blaring,dropping off patients, and leaving without Annie having a panic attack. Inaddition, she was not even visibly upset by the activities in the emergency room.By this time period, both Annie and I had received some comments about herimprovement from her physician, other therapists at the medical center, and herfamily. Although not a solid measure of improvement, these comments are at leastan indicator of such.ConclusionThe symbolic interactionist perspective has a great deal to offer the field ofcounseling clinical sociology. Reflexive thinking, as the basis for self-conceptformation, and subsequent behaviors, provides an ideal entry point for interven-tion. For those individuals found lacking in social skills, training in the area ofreflexive thinking should enhance the ability of these individuals to participate inmore successful social relationships.REFERENCESGecas, Viktor. 1982. "The Self-concept." Pp. 1-33 in Jonathan H. Turner and J. F. Short (eds.),Annual Review of Sociology 8. Palo Alto, CA: Annual Reviews.Kuhn, Manford H. and Thomas McPartland. 1954. "An Empirical Investigation of Self-Attitudes."American Sociological Review 19:68-76.Mead, George Herbert. 1934. Mind, Self, and Society. Chicago: The University of Chicago Press.Turner, Jonathan H. 1987. "Toward A Sociological Theory of Motivation." American SociologicalReview 52:15-27.

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