Case Study:
Portia is a 26-year-old medical student, who is currently completing her internship at
BaragwanethHospital. Since she started her long work hours, she has developed insomnia.
The lack of sleep has started impacting on her performance at work, and her supervisor
referred her to a psychologist to assist with possible stress, and the triggers for the
insomnia.
Tobias, the psychologist, suggested that she try listening to soothing music, take a hot bath
before going to bed, and limit screen time 1 hour before bed. After 2 weeks, Portia’s
insomnia did not get any better. Tobias then suggested that when she cannot sleep, instead
of trying to fall asleep, Portiashould get up and clean the house.
Question 1:
The suggestion from the psychologist to ‘listen to soothing music, take a hot bath before
going tobed, and limit screen time 1 hour before bed’ can best be described as:
Perturbation
First order change
Second order
change
Maintaining the status quo
The correct answer is alternative 2, first order change.
Explanation: The psychologist’s initial intervention was based on a logical solution to the
problem which did not challenge the rules of the system. First order change is consistent
with the rules of thesystem, and does not alter the underlying organisation of the system.
Therefore, the solution of listening to soothing music and taking a hot bath before bed, is
an attempt to address Portia’s symptoms instead of addressing the systemic organisation
that gives rise to her symptoms.
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