(1) Meta-goals: higher self-esteem, responsbility, choice makers, congruence — four basic therapeutic beliefs

(2) Final goals

(3) Sessional goals

(4) Iceberg goals

(5) Incremental goals

The personal iceberg metaphor of the Stair Model

Behaviour (action, story line)
Coping (stances)
Feelings and feelings about feelings (job, excitment, anger, hurt)
Perceptions (beliefs, assumptions, mind-set, subjective reality)
Expectattions (of self, of others, from others)
Yearnings (universal) (loved, accepted, validated, freedom)
Self: I AM (life force, spirit, core, essence)

Reference: Banmen J. Using the Satir Model – working effectively with suicidal clients (Training Manual). Centre for Suicide Researach and Prevention The University of Hong Kong. 2004;90-102

Human beings have the drive to survive, grow, develop and realize one’s potential.

“Yearnings” – basic needs that require atttention and some level of satisfaction.
if these yearnings are fullfilled –> human being can achieve the goals of
- becoming a postiive choice amker
- being more responsible for one’s internal and external world
- being more whole or congruent and experiencing highger self-esteem

Four common dysfunctional stress coping — survival stances
> Placating
> Blaming
> Computing
> Distracting

> Placating
- try to please everybody at the cost of denying their own needs and importance
- say yes when they want to say no
- complete surrender to the wishes or demands of others
- extreme: martyrdom
- lack self-worth and self-confidence, feel hurt, sad, anxious, resentful and harbour suppressed anger inside
- keep away from feeling
- SELF is not important, CONTEXT and OTHER important
- depress –> find no way out –> commit suicide

> Blaming
- judge, yell, find fault, critcize, use anger to express feelings and expectations
- behaviour often drives people away
- rejection and loneliness –> trigger helplessness and suicidal idea /act
- expect others to rescue them
- SELF, CONTEXT important, OTHER not important

> Computing (Super-reasonable)
- emotionally cold, withdrawan, rational, logical, out of touch with their inside
- avoid feelings, fear being overwhelmed by feeling
- separate from emotions and life-energy –> lose meaning and purpose –> finally give up and might plan self-destruction
- suicidal attempts –> big suprise to others
- SELF and OTHER denined, CONTEXT relevant

> Irrelevant
- hyperactive, restless, behave inappropriately, seeking attention
- distract themselves and others, difficult to focus

Reference: Banmen J. Using the Satir Model – working effectively with suicidal clients (Training Manual). Centre for Suicide Researach and Prevention The University of Hong Kong. 2004; 77-81

Peripehral Examnation
- clubbing for bronchiectasis or CA Lung
- central cynaosis
- nicotine staining for previous smoking history
- muscle wasting

Central Examination
- flattening of the chest wall
- thoaractomy scar over which side
- trachea deviated to the side
- apex beat deviated to the side
- chest expansion is reduced in the side
- percussion is dull
- breath sound is diminshed +/- bronchial breathing in upper zone