Sunday, 20 September 2015

How to say hello/goodbye to your therapist?

Now and again, a client has come for an initial interview and the dialogue has been so profound that the memory of it has remained imprinted on my brain.  The following was one such occasion: A very bright and enthusiastic young woman began our conversation by sharing with me what she had been doing to prepare for our first session together.  Among other things, she commented that she had read a book that had proven to be very helpful.  With genuine curiosity, I asked, "What was the title of the book?" Her reply was: "How To Say Goodbye To Your Therapist".  I looked at her quizzically and remarked, "But we have just met!" She then proceeded to explain to me that according to the author/therapist of this book, how one says hello, has all and everything to do with the kind of goodbye the person anticipates.  While memories of former goodbyes may remain unconscious, nevertheless, they have impact.  For example, if former relationship endings with people of significance have been painful or difficult, chances are that the person will enter into new relationships with considerable caution or they may not even enter at all!  Traumatic endings, such as early experiences of rejection or abandonment, can wreak havoc with one's relationship life. New beginnings may be avoided or it may take a great deal of time before the person opens up.  After all, if you don't get in too deep, it's not likely to hurt so bad when the relationship ends.  

I was sharing this information the other day with a client of mine whom I have seen for some time. Her relationship with her mother was harshly ruptured in her late teens when her mother left the family abruptly and soon after moved to another city.  To this day, feelings towards her mother remain unresolved and this painful early life experience has proven to have enormous influence on her capacity for closeness with others.  Relationships with others generally have remained pretty distant and superficial.  Her own feelings are often blunted and she does not let people in too deep. In new social groups, she is slow to enter into conversation and it can take several encounters before she connects with people.  She never felt like she was enough for her mother and consequently remains terrified that if anyone really got to know her that they would head for the hills!  Some internal voice is relentless in trying to convince her that nobody would be interested in her and that if they were, she would not have much meaningful to say anyway.  In romantic relationships, she has chosen men who do not like to talk about feelings and they seldom ask questions about her which suits her just fine. Her choices allow her to keep her own feelings at bay and to feel secure in the walls that she has erected to ensure that people do not get in too close and personal.  Goodbyes can refer to so many things...the end of a trip, graduating from school, losing a pet, relocating cities, completing a team project, launching a child, etc.  Endings are inevitable in life and whether you are aware of it or not,  the ending you anticipate often colors the way you will enter these experiences.

One of the gifts that therapy has to offer is a chance to do things differently when earlier life experiences have been difficult.  When this happens, tremendous healing can take place.  A good therapist is reliable, attentive, and non judgmental.  A climate of safety is created so that an entirely different kind of joining and ending can be experienced.  Ending therapy is a whole new opportunity to address struggles in former goodbyes.  It can allow a client to have an experience of saying goodbye that is mutually agreed upon, conscious and feels right.  Such an experience can heal old wounds and make for more intimate and meaningful beginnings.

Sunday, 6 September 2015

What is CBT?

Nowadays, chances are that if you have been diagnosed with depression or anxiety by your G.P. and she encourages you to seek counselling that she will suggest you go to someone who does "CBT". What is CBT and why do many people see it as the treatment of choice for these kind of psychological problems?

CBT is an acronym for "Cognitive Behavior Therapy".  It refers to an orientation used by therapists from a variety of backgrounds that involves helping people to change how they feel by assisting them in changing their thought patterns.  The assumption of this way of working is that the way you feel is very much a product of the way you think so if people can be taught to change their thinking then this is one very powerful and effective way to feel better. Psychological research with tens of thousands of subjects has taught us that people who are depressed or anxious tend to think in ways that are distorted and that there are forms of "twisted thinking" that are identifiable and common to those who suffer from problems with mood. For instance, people who are anxious tend to catastrophize and magnify the negative in situations.  They also tend to make negative predictions by fast forwarding into the future and imagining worst case scenarios .  On the other hand, people who are depressed are good at discounting the positive and focusing in on the negative feedback that they receive; they also tend to be harshly self critical and personalize blame.  Outcome studies have provided scientific support for evidence that CBT is an effective treatment for anxiety and depression. The premise of the approach is that by teaching people what we have learned about the types of distorted thinking patterns that negatively affect mood, they can more easily notice when these are occurring and learn to modify the things they say to themselves so as to feel better. To achieve this, however, people first need to learn how to become good observers of their own thoughts.

There are many who do not realize that there is constant mind chatter going on in their heads. The only time they might become aware of these internal voices is on long distance car rides or right before falling asleep when it is so silent that these internal thoughts become starkly apparent.  Those who grew up in cultures where meditation has been a part of daily life know that the mind is always filled with chatter and that what these internal voices say should not necessarily be accepted as truth. These ideas, however, have only recently been introduced into the mainstream of Western thinking through the contemporary surge of interest in Buddhism, yoga and meditation.  Up until recently, Westerners have been so identified with their minds that most people do not question what they think and in fact have believed that if the mind thinks it, it must be true.  Only recently have we come to realize that the mind has all kinds of masterful ways of distorting reality and that as one young blogger so bluntly put it, when you are depressed, the mind lies to you!  I worked with one older man in his 70's who had suffered social anxiety all of his life.  This is a condition where the person often fears that others are watching them and scrutinizing them with a critical eye.  At the end of therapy he said to me, "I cannot believe that in all these years up until coming to see you, nobody ever explained to me that just because I have a thought, does not mean it is true!"

You do not have to be depressed or have an anxiety disorder to benefit from learning to correct negative thinking and to shift to a more balanced, rational, positive view.  We all have internal voices that can take over and make our lives miserable.  Some examples of these negative voices are: "the critic", "the worrier", "the victim" and "the perfectionist".  Imagine these parts as characters sitting at a boardroom table in your psyche.  When the critic takes over, all you hear about is how you screwed up and what you should be doing differently.  If the critic was able to give constructive advice then it could be useful. Unfortunately, these parts that lead to distress are uni-dimensional and have a single focus.  The critic only knows one thing and that is how to criticize.  If the critic has you in its clutches, there can only be one result and that is, you feel terrible.  Thank goodness for all of us, the psyche is also balanced with positive parts such as"the supporter", "the nurturer", "the cheerleader" and "the optimist".  Even "the objective observer" is a welcomed voice when "the critic" has been ruling the roost!

It would be impossible for anyone to be constantly tracking their thoughts.  Fortunately, there is an internal guidance system or signal that lets us know when negative thought patterns have taken over. It's simple really.  All you have to do is be tuned in to your feelings.  When you feel bad, this is your cue to begin to examine your thinking.  A good question to ask anytime you find yourself feeling negative emotions such as depression, anger, anxiety or hopelessness is: "What am I saying to myself?"  This is what people who do CBT teach their clients.  Psychologists teach people how to stop and try to identify what's going on in their thought system whenever they are feeling bad and to modify these internal thoughts with more balanced, rational thinking.  CBT is not learned over night. When you think about it, there are hundreds of thousands of hours of tape time in your head filled with negative ways of thinking.  These thoughts now happen automatically and have created well- traveled deep ruts in your brain.  To turn around thinking takes conscientious work.  Often clients are taught to use thought records when they are feeling bad which are written recordings of the thoughts that have triggered them into distress.   They are then asked to formulate and write down alternative thoughts that are more realistic and balanced.  It seems that the most significant change takes place when people do these written exercises and write their thoughts down.  It keeps the thoughts from remaining hidden and under the radar. Writing makes the thoughts conscious so that they are easier to spot, separate from and modify. While doing thought records takes work and commitment, the rewards can be far reaching. It is amazing to witness how within 4 to 6 months of diligent effort, people can change the way they have been thinking for 20, 30, 40 and sometimes 50 years.  It is well worth the effort and never too late to change the way you think and ultimately the way you feel!