, Case Study (Questions 1-3):
Portia is a 26-year-old medical student, who is currently completing her internship at
Baragwaneth Hospital. 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, Portia should get up and clean the house.
Question 1
The suggestion from the psychologist to ‘listen soothing music, take a hot bath before going
to bed, and limit screen time 1 hour before bed’ can best be described as:
1. Perturbation
2. First order change
3. Second order change
4. Maintaining the status quo
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 the system, 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.
Question 2
The suggestion from the psychologist to ‘instead of trying to fall asleep, Portia should get up
and clean the house’ can best be described as:
1. First order change
2. Second order change
3. Reductionistic
4. Modernist
Explanation:
The psychologist’s suggestion to get up and clean the house is counterintuitive and
illogical, as it requires her to do more work when she is unable to sleep, instead of trying to
sleep. By doing this, Portia no longer tries to fall asleep, but instead does more work, which
is presumably the real systemic problem. When this is done knowingly, i.e., Portia
intentionally tries to stay awake to do more work, it shifts the control that the symptom has
over Portia into her own hands. The symptom is no longer something that controls Portia,
but Portia controls the symptom by purposefully trying to stay awake through doing more
Portia is a 26-year-old medical student, who is currently completing her internship at
Baragwaneth Hospital. 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, Portia should get up and clean the house.
Question 1
The suggestion from the psychologist to ‘listen soothing music, take a hot bath before going
to bed, and limit screen time 1 hour before bed’ can best be described as:
1. Perturbation
2. First order change
3. Second order change
4. Maintaining the status quo
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 the system, 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.
Question 2
The suggestion from the psychologist to ‘instead of trying to fall asleep, Portia should get up
and clean the house’ can best be described as:
1. First order change
2. Second order change
3. Reductionistic
4. Modernist
Explanation:
The psychologist’s suggestion to get up and clean the house is counterintuitive and
illogical, as it requires her to do more work when she is unable to sleep, instead of trying to
sleep. By doing this, Portia no longer tries to fall asleep, but instead does more work, which
is presumably the real systemic problem. When this is done knowingly, i.e., Portia
intentionally tries to stay awake to do more work, it shifts the control that the symptom has
over Portia into her own hands. The symptom is no longer something that controls Portia,
but Portia controls the symptom by purposefully trying to stay awake through doing more
