What Do Therapists Do?

I have been really pleased recently lots of people are having conversations regarding mental health, I mean, we talk about health in general all the time. We talk about obesity, cancer, sports injuries, bird flu, food poisoning etc, so while we are at it why not have a conversation about ‘mental’ health? There seems to be an acceptance that it is good to talk, that we should address the stigma and in doing so more people will have useful conversations about mental health which can only be positive, right?

I think it is probably more useful than not, but I am an evidence-based practitioner so only time will tell whether more conversations about mental health will lead to actual better mental health. What I am really interested in is how conversations about mental health lead to action, I find this aspect of the new dynamic endlessly fascinating.

When I first started practising as a student CBT therapist I had to constantly explain to people what CBT is, and what therapists do. I find that I am having that conversation less and less, because more people seem to have their own ideas about CBT and/or how therapy works/what therapists do. I have to say; a lot of what people think regarding therapy seems pretty bizarre to me. More worryingly is that they seem to have these ideas because they have either a) had one or two sessions of therapy or b) know someone who has had therapy. This is a topic which could probably be better explored in another post, what I want to concentrate on today is what I do as a therapist and how I hope the things I do will help someone who is seeking therapy.

I read a post recently on the excellent Respite Room website in which the writer was explaining that despite the fact they have gained an awareness of their mental health, despite the fact they now have resources, have developed coping strategies, despite the fact they can acknowledge the action they are taking and the knowledge they have gained, there are days in which they are physically and mentally challenged.“ I am doing all the right things and it’s still not enough, not always.” This description is something I am frequently aware of with clients, and the frustration this brings can become debilitating, adding to the existing pressures and challenges they are already facing.

As a therapist one of my jobs is to look at the process when clients are affected n this way. Each client is a unique individual, and a unique set of circumstances has brought them to therapy. When we are working towards the recovery phase of treatment and looking at relapse prevention, or if we are finding the initial stages of therapy challenging because progress isn’t being made at the pace the client desires, I am mindful of the process the client is engaging with. I am looking at several details, but I definitely want to know, “what expectations does the client have in relation to their capabilities?”

I will illustrate this with an example. *I haven’t used any specific details from a client I have worked with in the past, but I have drawn inspiration from different people I have worked with to come up with a plausible, illustrative scenario.

Michael (no reference to any real person) has been attending therapy for weeks. Michael is a year-old male who is affected by depression, anxiety, anger management and appears to have PTSD due to a sexual assault he survived when he was years old. The main reason Michal is attending therapy is his use of street diazepam which he has used for years to self-medicate. Michael has experienced sustained periods of abstinence but is frequently relapsing and would like help to enter sustained recovery. He has now been abstinent for 10 weeks but almost used yesterday.

When Michael attends the session, he explains that he is feeling very low, he struggled to get out of bed for the past two days, he is avoiding answering his phone, even to text people and has struggled to find the motivation to attend mutual aid meetings which had been providing support, “I don’t think I am ever going to get better!”. He reports he only came to the session today because his sister popped by to check on him and insisted on driving him to his session.

Where to begin? Although Michael may seem like a fairly extreme example, let’s look in general at his history. Michael experienced a traumatic event during his childhood. Traumatic events take many forms and are subjective, it may be that Michael has PTSD which has not yet been diagnosed, he may not, but it’s safe to assume that what Michael experiences as a child has affected his beliefs about himself, other people, and the world in which he exists. Michael has used diazepam to cope with his day to day experience, this may also seem extreme to people, but in general we all find diverse ways to cope with our existence. Some people work lots, some people never work. Some people paint, some people have lots of cats, come people have lots of children. We all find ways to exist, sometimes these coping mechanisms are healthy or helpful, sometimes they are not. Michael has recently been thinking that he is not experiencing the change he desires and has doubts that therapy will help. Who among us doesn’t have doubts sometimes? Michael also is no longer engaging with the things that seemed to be helping, which some may find confusing, but ask yourself then next time you are feeling tired or anxious, what are the things you do which give you joy, are you doing them?

On the surface Michael appears like an extreme example, but dig a little deeper and we find a person who:

  1. Has experiences from his past which were difficult to live through and reminders of which cause distress
  2. Has developed coping mechanisms which may be problematic
  3. Has thought patterns which appear to be unhelpful and irrational
  4. Is behaving in ways that at times are counter intuitive and appear designed to perpetuate his problems rather than provide solutions

Does this describe anyone you know?

I know this describes my experience, and certainly most of my clients or service users have tended to present along these lines. Therapy, in all it’s modalities, is designed to help tackle these very human traits. For example, if Michael was attending a psychodynamic therapist as opposed to a CBT practitioner, their goals for therapy would probably be designed to tackle this presentation, but they would probably be stated in different language. I would hope the goal of all therapy would be not only to help clients make whatever changes clients have identified, but to allow through the therapeutic process the client to come to the realisation that it’s okay for the client to be who they are. To be able to accept ourselves as human beings with frailties and nuances, to accept that some days we function better than others, and more importantly not only to have awareness that this happens, but to embrace this is part of our very human condition. In other words, to find what being ‘good enough’ is like. To embrace it, to accept what it means to be good enough, to differentiate between doing wonderful things for ourselves and others and true self care which lies in the development of a compassionate voice that tells me ‘you are good enough, even when you feel like utter shit!”

What do therapists do? I hope by using the various tools and techniques at our disposal we facilitate a process whereby clients achieve their goals for therapy, while at the same time learning to accept that it is okay to feel how we feel, even if that isn’t a very nice feeling, because it will pass, especially if we learn how to challenge and intervene while feeling comfort in our discomfort, peace in our conflict.

If you are interested in reading more about mental health, I highly recommend The Respite Room https://www.therespiteroom.com/blog/ where you will find diverse voices talking about mental health in a natural way, and they aren’t trying to sell you anything! They also organise a weekly walk in Glasgow and are starting an orchestra!

For the same reasons, I would recommend listening to the Mood Swings podcast http://moodswings365abz.libsyn.com/

And finally, if you want to geek out a  bit regarding mental health/psychology/psychiatry then you could do a lot worse than by listening to the BBC ‘All In The Mind’ radio show, or work through the archived episodes here https://www.bbc.co.uk/programmes/b006qxx9/episodes/player

Life Long Learning

Today our 1st year diploma students celebrated the last day of term by completing their final therapist practice session, and then discussing their experience of 1st year by delivering a learning statement to their peers. As a trainee tutor, I had to share my experience also, so it provided a good opportunity to explore my year and the impact teaching has had on me personally and professionally.

My 1st year as a student therapist was back in 2012, and although at times this seems like a lifetime away I have experienced many similar feelings at various points during my 1st year as a trainee tutor delivering the SCOTACS Diploma in Counselling and Groupwork: A Cognitive Behavioural Approach (there is a mouthful for you!). Watching the students evolve, change, and adapt to their learning over the past 10 months has been inspirational. The diploma course is designed to equip the students with the tools and techniques they require to deliver effective CBT to clients, but more importantly it also require the students to experience the same things their clients would experience by attending therapy. This requires the students to explore their own material by following the standard CBT protocols of assessment, formulation and treatment.

Now I am aware through having conversations with therapists at CPD events or through work that not all courses ask this of their students, however at the Centre of Therapy the course has always had a strong ethical element underpinned by the belief that at no point should therapists be asking clients to undergo treatment interventions they haven’t already experienced for themselves, or at the very least wouldn’t happily attempt on themselves. This may seem like a no brainer, but bizarrely I have come across many situations in which therapists or counsellors have discussed interventions they use without ever having experienced the impact of the intervention. For me, this opens an interesting area for discussion. On the one hand, therapists use very specific interventions for some presentations, so in this respect I can understand why a therapist who has never experienced any issues relating to compulsive behaviours or substance use would be required to experience interventions designed to help clients with these specific presentations. However, as a CBT practitioner, every client who attends therapy will be expected to undergo assessment, formulation and treatment. As such, at the very least it seems appropriate that every CBT practitioner has completed this work on themselves at some point before working with clients.

Our 1st year students have embraced this process, some more than others, but in general as the students delivered their learning statements today a theme emerged of a group of students who had similarly underestimated the amount of work it takes to become a CBT practitioner, but who had opened to the process of change and experienced how therapeutic practice can deliver results in surprising areas of our lives. Of how therapy can bring enlightenment about our processes and begin to answer fundamental questions about who we are as individuals, while at the same time beginning to answer why we behave as we do within wider groups. Our students have begun to experience the recognition of their beliefs about self, others and the world, about how these beliefs evolved, and the tantalising genesis of what mastery over the effect of these beliefs might look like. It also appears that many of the students believed they were generally ok, but now realise they are probably, and I am quoting here, a bit ‘fucked up’. The amazing thing is not the realisation that they might be fucked up, but rather the acceptance that this may well be true, and it is ok to feel like this.

For my part, I have been with the students every step of this journey and I have experienced similar moments of doubt, neurosis, panic and exhilaration. I have used the experience to re-engage with my own experience of therapy. The extra work has been extremely time consuming and at times it has felt exhausting to work full-time while also training to become a tutor, see private clients, and look after my mum. I have a very understanding wife! All in all, the last ten months has been unbelievably rewarding. I managed to complete my accreditation with BABCP, my work with ASC and Forth Valley Recovery Community has been successful. My supervisees have all continued to develop and improve, and I have taken immense pleasure out of learning a new skill. I hope I continue to learn and develop as a therapist, I intend to continue to stay as open as possible to new experiences and I thank my students and clients for teaching me the important stuff that helps me grow personally and professionally. I accepted how fucked up I am a long time ago, I wish I had accepted it sooner, but if youth is wasted on the young then so be it. We live and learn if we want to and I certainly want to learn more, roll on year 2!

 

8 years……

Earlier this month I celebrated 8 years clean and sober, and this week I celebrated receiving my accreditation as a psychotherapist from BABCP. Their is a nice symmetry to both events coming close together as it allows me to evaluate the choices I have made since making the significant changes in my life which have led me to this point in my journey. One of my colleagues, who is also in recovery, doesn’t celebrate his sober birthday but for me, I always enjoy marking the anniversary. It allows me to look back at the road I have travelled, while looking forward and planning my next steps. Of course the trick, as always, is to take one day at a time……

Developing and moving on

I was delighted to receive confirmation from the BABCP that I have been successful in my application for accreditation so I can now call myself a cognitive behavioural psychotherapist. This marks another stage in my own journey, and it has been a difficult stage to negotiate. When I completed my diploma in CBT at the end of 2014, I assumed it would take me another 12-18 months to gain my accreditation. As my old tutor used to say, life gets in the way, and it has been a far longer journey than I anticipated. My work for ASC takes up so much of my time and helping to design and facilitate the growth of a recovery community, combined with the work that goes in to research the effect of the community and evaluate our impact on the growth of recovery within the community has been rewarding, challenging, but more than anything else time consuming. Thankfully, it has also been enjoyable for the most part and I look forward to watching our community to continue to develop and grow.

The reason I wanted to post this blog was to say how valuable good supervision was to me in assisting me to gain my accreditation. Without the help, guidance, patience and wisdom of my supervisor Ann I might well have given up on the process at one point. I certainly would probably not have finished when I did. I also had the help of my friend and fellow therapist Kiera for the last few months of the process. We egged each other on, supported each other, provided information for each other, and also provided a shoulder to cry on when the frustration became to much. I guess going through this process highlighted one of the ways in which therapy can be so powerful, in that by sharing a journey with other people allows us to draw strength from each other, and find solace in the shared experience if necessary.

Therapy Everyday: Stress and Anxious Thoughts prt 2

Stress and Anxious Thoughts pt2

One of the main causes of stress and anxious thoughts I have experienced recently is the thought of playing live in front of an audience with my band for the first time in 10 years.  So far, the stress and anxious thoughts have been manageable so far, and in some ways really healthy in that I have been pushed out of my comfort zone and been forced to pick up my guitar again and play music for the first time in years. I miss playing, and more importantly I missed playing music with my friends, so the stress and anxiety accompany the joy and happiness of playing music again. This is something I can definitely handle, but the past is the past, it lurks in the background reminding me why it’s been ten years since I played with my friends, and it has at times proven more difficult to cope with than the thought of standing in front of people playing music again.

Ten years ago I was an emotional and physical mess. I was 31 years old, I was struggling with my identity, I was struggling with my addiction to alcohol and my use of illicit drugs, I was struggling with depression, and I was struggling with whether or not I wanted to continue being alive. I had not benefited from my ability to write a song. I had not benefited from my ability to hold a note. I had not benefited from being in a band with some amazing, talented people. My behaviour was often abhorrent to others, it was certainly abhorrent to me at times. I had been through a period of self harming, I had a criminal record, my family were slowly being disenfranchised by my continuing unreliability and emotional instability, and for me, it appeared my choices regarding my future were narrowing by the day. I couldn’t function, and I believed I certainly couldn’t function without the aid of chemicals. Life was dark and the future appeared unwelcoming.

That was ten years ago. These days, I have been clean and sober for almost 8 years, and the opportunity to play music with my friends again was just too good an opportunity to miss out on. Our old promoter and manager offered us a gig last years, we agreed to do it, although I never really thought it would actually happen. We are now 4 weeks away from playing our first gig together in well over a decade. If truth be told, I am shitting myself, but in a good way. The last few months have been a struggle as I try to learn to play again, but it has been incredibly rewarding. Just being in a room together with my friends has been an incredible experience. And at times, we have sounded like a proper band. Hopefully by the time the gig comes round we will sound like a band most of the time, but I honestly don’t care. At this point, the whole experience has been life affirming. The boys are just a joy to be around, and I have felt incredibly alive. Roll on the 4th of March.

 

 

Therapy Everyday : Anxiety and Stress

Stress and Anxious Thoughts

It’s been a ridiculously long time since I posted anything, and I pay for this website, so I figure I should probably use it now and again. Of course I am being disingenuous. I decided towards the end of September that I should probably spend more time finishing my accreditation to become a psychotherapist and less time wittering online. I gave myself 6 weeks to complete and hand in, that was in September.

I have still not handed in my application….

To be fair, I have actually completed the application and I am now just packaging. I will post my application with my friend at the end of the month and then wait the 5 months to find out if I can call myself a psychotherapist, or remain a therapist. In the meantime, I guess this is a good time to look at my goals from a couple of months back. Clearly I have not achieved my goals, but what have I been doing instead of using therapeutic tools regularly and then writing about it for my blog?

 

As it turns out, I have been living, eating, teaching, working, playing, stressing, worrying, laughing and pretty much doing all the things I have been doing regularly until this point in my life. My mother continues to get worse, such is the way of degenerative conditions. My stress and anxiety has been manageable at times, and less so at others. Although I have felt stressed and under pressure, I realise that this is related to what is happening in my life at present. This means I have been able to draw links between external factors, internal factors, and coping mechanisms. I would be more concerned, or maybe even require specific interventions if my ability to cope or the effect of factors on my ability to cope, had begun to appear out of sync. For example, although I haven’t felt great at times recently, this is linked to my mother’s on-going illness, as well as how much time I have been able to spend attending to myself in order to help me cope with what is going on. I have felt supported by my family and friends, and I have been able to utilise supervision to aid my work and ensure I am able to offer my clients the therapeutic interventions they require. However, none of this means I can’t feel better more of the time, none of this means if I don’t make changes I won’t be able to cope better and adapt to my situation in a healthier way. This is a developing situation and I intend to mindful of my feelings, and mindful of the situation I find myself in.

One of the things I have noticed is that the way I exercise has changed; in the past I have ran daily, something I rarely do these days. Also, I have not made time to relax/meditate recently; it has been months since I practised any yoga. My intervention for the next week is to run more and complete some yoga. My hypothesis is that if I do this, I will feel better and cope with my stress in a healthier way. Simple. There are lots of thought exercises I could do to tackle any anxiety I am feeling at this time, but I am choosing to use behavioural interventions as the source of stress appear to be rational and  external which I have little control of at present. If I cannot change the external factors, I will attempt to change how I am feeling.

I am hoping to do more of this in 2017
I am hoping to do more of this in 2017

Therapy Everyday – Reflective Practice

I first became interested in becoming a therapist during the summer of 2011 when I was referred to the employee assistance programme set up by the company I worked for. I engaged with therapy for six sessions and my therapist was a kind, intelligent, forthright and caring woman who allowed me the space I needed to make radical changes in my life. She listened to me; she offered me choices regarding what I might want to do with the type of relationships I allow in my life, including the relationship I had with myself. My therapist never offered advice, never made suggestions and never told me her opinion. She was kind but challenged me; she listened to what I said without judgement, but called out discrepancies, irregularities and inconsistencies, but not in a way to make me feel bad, patronised or worthless. She questioned what I was saying in a way that felt like she wanted to know more about me, and to allow me to find out more about myself.

Until I began studying counselling and then therapy, I had no idea about the process a therapist undertakes in order to evaluate their relationship with their clients, or to be able to learn more about a person based on what they are saying, and also what they are not saying. What I learned was there are a huge variety of tools, techniques and strategies which can be adopted by a therapist to help build relationships with clients, as well as ways to use verbal and non-verbal communication to engage with others in a way that provides for a deeper level of understanding between people, and then to use what we learn about each other within therapy to form the basis of work we can undertake together to make changes in our lives.

As well as the tools we use within therapy to try to either understand each other in a more detailed way, there are also techniques we can use as therapists out with therapy which allows us to take the information we are gathering in sessions and evaluate it more fully and usefully.  As therapist’s we also reflect deeply on how we are within sessions with our clients. These reflections allow us to make changes to our behaviour which may benefit the process. They also allow us to think about what our client is saying during sessions, and also how we are processing what our clients are saying, as well as how we are using this information and responding to our clients. The reflections allow us to evaluate the impact therapy is having on us; reflecting also allows us to explore more deeply what kind of feelings and thoughts we are left with after sessions. What are we left with that remains unsaid, and what reasons might there be for not saying these things? And what can we then use to feedback to our clients which may be of use to the therapeutic process, and ultimately make us better therapists.

One of the things our new students on the diploma course are asked to do is begin reflecting on everything that is going on as they begin their journey to becoming therapists. They are asked to reflect on the therapeutic groups they take part in, on their work with other students in therapeutic practice sessions, on their work with clients as student therapists, and on their overall journey through the course. When I began studying the COSCA Counselling Skills Certificate reflective practice was new to me, something I had never heard of. I learned there are numerous reflective practice models which people can use to help guide their reflections and ensure they are useful and the first model we were introduced to was the Rolfe model pictured below.

rolfe-reflective-framework

Over the past few weeks, either in my day job at ASC, in my private practice, or as a tutor with the Centre of Therapy, there have been countless situations or contacts with people which have provided opportunities for me to reflect on how I have conducted myself and on the impact my relationships/contacts have had. In order to illustrate how this process works, I can look at the impact of my participation as a tutor last weekend which I described in the previous blog. I can use the Rolfe reflective tool to evaluate my experience and learn from it.

What – Describe the experience in terms of the achievements, consequences, responses, feelings and difficulties?

Taking part in my first classes as a tutor on the Scotacs Diploma in Cognitive Therapy and Group Work was an invigorating experience. I was able to be present, be myself, and use my own knowledge and experience to interact with the students. I was able to manage my thoughts and feelings in order to ensure I remained focused, while at the same time allowing myself to be open to enjoying the experience of meeting new people and learning to try my hand at something new. I felt comfortable and excited by the journey, with the only difficulties I experienced in trying to remember to attach the correct names to the new faces I was encountering.

So what – go further and discuss what has been learnt (about self, relationships, actions, thoughts, attitudes, cultures, understanding, strengths, weaknesses, and improvements).

What I learned is that the process of teaching and the actuality of engaging with a subject I love and people who are willing and open to learning is invigorating and exciting to me. I received further evidence in the form of feedback from others that I am good at building relationships, and if I look at why I believe this is the case then I think it is because I have a genuine interest in people and what they are interested in. I care about how other people’s experiences have shaped them and in turn what this teaches me about myself. I learned that other people respond well if they are approached from an open, honest and genuine place, and I learned that if I am as genuine as possible with people I receive validation in the form of people appearing to meet me in a genuine manner. As always I believe improvements I can make in terms of how proficient I am as a teacher lie in gaining more experience in our subject matter, in meeting with students at a level which they respond well to, in recalling the minutiae of therapeutic practice as well as the broader points, and in gathering more feedback where possible.

Now what – identify what needs to be done in order to develop learning, improve future outcomes and enhance practice.

I believe gaining more experience, or practicing doing what I am doing already, will aid my development in the areas I have highlighted above as areas in which I can improve. I also believe in continuous development through learning theory, and as such I will continue to study relevant material in my own time. For my next session I will be delivering as part of the course an input on Albert Ellis and REBT. Although this is a topic I know well and the techniques involved in REBT are techniques I use regularly, I will prepare by recapping what I already know and practicing some more ABC’s before the next teaching weekend.

 

The above example of reflective practice is something which can be used in any area of our life. Reflecting is not the sole property of therapeutic practice. Any time we struggle with communication, in any relationships we have were there appears to be blockages or barriers, where we find issues related to being stuck or not getting to the place we hope to be, using useful reflection’s enable us to look at the constituent parts of our processes and highlight areas where we can do things differently and by doing so we can achieve the movement we seek. Or at the very least we can identify the real issue or series of issues which are affecting us.