The Singapore Family Physician

Back to issue Vol 44 No. 1 - The Extended Consultation

Problem Work, Pattern Work

Cheong Pak Yean, Ong Chooi Peng, Goh Lee Gan
The Singapore Family Physician Vol 44 No 1 - The Extended Consultation
15 - 18
2018
0377-5305
In this Unit we describe the first 2 types of intervention arising out of the extended consultation. In Problem work, the basic idea is to determine whether the patient’s behavior is a maladaptive response to antecedent stimuli, or the result of cognitive bias. We use counter-conditioning and contingency management to deal with maladaptive response. We use cognitive therapy to trace cognitive distortions that give rise to NATs and take steps to counter them. The problem approach is integrated as Cognitive Behavioral Therapy. The SMART solution to problems is deployed when there is no maladaptive behavior or cognitive bias at play. In pattern work, the salient life experiences of the patient which are selectively stored as narratives are examined. Such narratives may reflect a negative life pattern of thought and feeling. This is the problem-saturated story. Patients can be helped to change their pattern of thought and feeling and thus store their life experiences as preferred positive stories. The 4Rs – Re-membering, Re-framing, Re-authoring and Re-telling – help us to construct the new stories. When we do this consistently, the pattern work creates present and future stories of hope for the sufferer.