All posts by Robert

Aug

2022

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Trauma and PTSD: When trauma leaves its mark

By Will Sutherland

A traumatic event involves fear-inducing circumstances, like actual or threatened death (war and natural disasters), serious injury and sexual violence¹. However, people can experience trauma by witnessing or repeatedly being exposed to details of a fear-inducing event (first responders seeing dead bodies and police officers hearing details of child abuse). It’s normal for these circumstances to cause people distress. However, for some, that distress continues long after the event, including: hypervigilance, panic attacks and intrusive memories of the event². Often, people will then avoid circumstances or stimuli to try and stop those symptoms from occurring. This prolonged experience of symptoms and avoidant behaviour are the main components of Posttraumatic Stress Disorder (PTSD).

75% of Australian adults have experienced a traumatic event at some point in their life². 12% will develop PTSD³ from those events. Genetics factors, level of support and comorbid conditions are correlated with higher levels of PTSD. Additionally, sexual assault is more likely to lead to PTSD than other traumatic events. Although relatively few people will develop PTSD from a traumatic incident, prolonged PTSD can have serious effects. This includes using illicit substances to attempt to avoid their symptoms⁵. Others may have difficulty with their work and relationships due to difficulty concentrating, self-destructive behaviour and aggression. 80% of those with prolonged PTSD will also experience comorbid disorders like anxiety and depression.

So, why does this happen? An evolutionary perspective suggests this was a survival advantage. Our brains likely developed a way of fortifying fear-inducing situations to memory to ensure we remember to avoid danger later7. In fact, the neurochemicals that help strengthen memories are mostly induced by stress and fear, like norepinephrine, and cortisol⁸. So, PTSD may be an unhelpful extension of what was an evolutionary advantage.

Fortunately, there are many effective treatments for PTSD, including cognitive behaviour therapy, Eye-movement desensitization reprogramming, exposure therapy and medication. These can help people to manage their symptoms and reduce their severity and frequency. Trauma Informed Care (TIC), is a recently developed framework that assists many different practitioners to provide effective PTSD treatment. TIC takes into consideration the specific needs of those with PTSD, like safe spaces and empowerment⁶. Others find support and recover through PTSD support groups. Eye Movement Desensitisation Reprogramming involves guiding the patient through remembering the traumatic event whilst engaging in bi-lateral eye movement (left-to-right)⁹. This is a relatively recent development but is very effective at desensitizing someone to the intense negative symptoms associated with the memory.

There are many promising treatment options for those with PTSD. However, it’s important to ensure the provider is trauma-informed and qualified. Unfortunately, improper treatment can re-traumatize people and make their symptoms worse⁶.

If you have any questions or would like to book in with our trauma-informed practitioners, please contact our Client Connect Team on 9809 1000.

References:

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
Post-traumatic stress disorder (PTSD). (2015, August 11). SANE. https://www.sane.org/information-and-resources/facts-and-guides/post-traumatic-stress-disorder#:~:text=How%20common%20is%20PTSD%3F
Australian Bureau of Statistics. (2018). National Health Survey: First results [Review of National Health Survey: First results]. Australian Government. https://www.abs.gov.au/statistics/health/health-conditions-and-risks/national-health-survey-first-results/latest-release
‌Australian Bureau of Statistics. (2008, October 23). National Survey of Mental Health and Wellbeing: Summary of Results, 2007 | Australian Bureau of Statistics. Www.abs.gov.au. https://www.abs.gov.au/statistics/health/mental-health/national-study-mental-health-and-wellbeing/latest-release
Health Direct. (2019, February 3). Anxiety – symptoms, treatment and causes. Healthdirect.gov.au; Healthdirect Australia. https://www.healthdirect.gov.au/anxiety
Trauma and young people: Moving toward trauma-informed services and systems. (2015). Orygen. https://www.orygen.org.au/trauma
Cantor C. (2009). Post-traumatic stress disorder: evolutionary perspectives. The Australian and New Zealand journal of psychiatry, 43(11), 1038–1048. https://doi.org/10.3109/00048670903270407
Sherin JE, Nemeroff CB. Post-traumatic stress disorder: the neurobiological impact of psychological trauma. Dialogues Clin Neurosci. 2011;13(3):263-78. doi: 10.31887/DCNS.2011.13.2/jsherin. PMID: 22034143; PMCID: PMC3182008.
American Psychological Association. (2017, May). Eye Movement Desensitization and Reprocessing (EMDR) Therapy. American Psychological Association. https://www.apa.org/ptsd-guideline/treatments/eye-movement-reprocessing

Aug

2022

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Personality Disorders

What are they?

Erratic behaviours, long-term dysfunction and tumultuous relationships. Personality disorders (PDs) are severe mental health conditions that cause distress and dysfunction. Personality can be defined as a pattern of thoughts, feelings and behaviours that are consistent across time and different situations. Our personalities are often viewed as the summation of different traits, like extraversion and agreeableness¹. Similarly, those with PDs experience dysfunction and distress, in consistent and long-term patterns. Including difficulty forming relationships, perceiving the world and sustaining employment.

How do they relate to Depression?

PDs are similar but different from mood disorders. Depression and Borderline personality disorder (BPD) share similar symptoms like low mood. However, PDs tend to produce more dysfunctional behaviours and thoughts². For example, BPD is more associated with suicidality and erratic behaviours in relationships. Whereas depression is more associated with mood and feeling. Another key difference between personality and mood disorders is the duration and frequency of symptoms. BPD and bipolar are both associated with mood swings. Those mood swings are typically more frequent and quicker to change with Borderline than Bipolar³.

PDs are often ego-syntonic whereas other psychological disorders are ego-dystonic. This refers to how someone feels about their dysfunctional thoughts, feelings and behaviours⁴. A good example is OCD and OCD Personality disorder. Those with OCD are ego-dystonic, meaning their OCD behaviours and thoughts do not align with their values. They are aware of how much it affects their life. If they perform a compulsion it’s due to the intensity of the obsession not because of a genuine desire to do it. However, those with OCD Personality disorder are ego-syntonic, meaning their OCD thoughts and behaviours do align with their values. They may even believe that their OCD is beneficial, with no downside. People with PDs often can’t see the negative effect of their condition. This can make treatment more difficult.

What are the different types?

There are ten different types of PDs, which are divided into three clusters⁵. The different types within a cluster share common symptoms.

Cluster A contains PDs involving odd and eccentric behaviours and thinking⁶. These include Paranoid, Schizoid and Schizotypal Personality Disorders. Cluster B containsPDs involving unstable emotions and impulsive behaviours. These include Antisocial, Histrionic, Borderline and Narcissistic personality disorders. Cluster C contains PDs involving anxious and fearful thoughts and behaviours. These include Avoidant, Obsessive-compulsive and Dependent personality disorders.

PDs are commonly diagnosed by a psychiatrist or a psychologist. The first step is often consulting with your GP. PDs can be managed and treated with medication and psychotherapy. For example, Dialectical Behaviour Therapy is an extension of Cognitive Behaviour Therapy designed specifically for BPD⁷. Crisis management resources are also important when personality disorders lead to harmful behaviours.

If you have any questions or would like to book in with our psychologists or psychiatrists, please contact our Client Connect Team on 9809 1000.

By Will Sutherland

References

1. 12.1 Personality and Behaviour: Approaches and Measurement – Introduction to Psychology – 1st Canadian Edition. (2014, October 17). Opentextbc.ca. https://opentextbc.ca/introductiontopsychology/chapter/11-1-personality-and-behavior-approaches-and-measurement/

2. Health, P. B. (2022, April 12). What’s the Difference Between a Personality Disorder and a Mood Disorder? Promises Behavioral Health. https://www.promises.com/addiction-blog/difference-between-personality-disorder-and-mood-disorder/

3. Mental Health Conditions. (n.d.). NAMI Chicago. Retrieved July 2, 2022, from https://www.namichicago.org/mental-health-conditions

4. Syntonic and Dystonic. (n.d.). Richard B. Joelson, DSW. https://richardbjoelsondsw.com/articles/syntonic-dystonic/

5. Robitz, R. (2018, November). Psychiatry.org – What are Personality Disorders? Psychiatry.org. https://psychiatry.org/patients-families/personality-disorders/what-are-personality-disorders

6. Health direct. (2019, January 11). Personality disorders: an overview. Healthdirect.gov.au; Healthdirect Australia. https://www.healthdirect.gov.au/personality-disorders

7. Behavioral Tech. (2021). What is dialectical behavior therapy (DBT)? Behavioral Tech – Training, Continuing Education in Dialectical Behavior Therapy (DBT). https://behavioraltech.org/resources/faqs/dialectical-behavior-therapy-dbt/

8. Mayo Clinic. (2016). Personality disorders – Symptoms and causes. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/personality-disorders/symptoms-causes/syc-20354463

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Jul

2022

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the difference between psychologists and psychiatrists

Psychologists & Psychiatrists, What’s the Difference?

Navigating psychological disorders and life stressors can be a formidable task, and finding the right support is often perplexing. Two primary mental health professionals, psychologists and psychiatrists, play crucial roles in assisting individuals with similar challenges, yet their approaches differ. Psychiatrists, armed with a medical degree, specialize in mental health disorders and can prescribe medications, address medical issues, and employ psychotherapeutic techniques. On the other hand, psychologists delve into the science of human behavior and employ evidence-based therapies to tackle psychological disorders and life stressors. Both professionals often collaborate with general practitioners. For those grappling with severe disorders, engaging a variety of specialists, including psychologist Melbourne, can address diverse needs, although financial considerations may guide the choice.

Psychiatrists

What do they do?

Psychiatrists are qualified to prescribe medications, address medical issues, and utilize psychotherapeutic techniques, working in hospitals, community health services, or private practice.

When would you see one?

Seek a psychiatrist if experiencing severe symptoms from psychological disorders like PTSD, severe depression, or anxiety. When psychotherapy or other interventions prove insufficient, considering a psychiatrist is appropriate. They can provide an official diagnosis of psychological disorders.

Psychologists

What do Psychologists do?

Psychologists study human behavior and its relation to thoughts and feelings, employing evidence-based therapies for psychological disorders and life stressors. These may include anxiety, depression, trauma, grief, financial stress, relationships, parenting, crime victimhood, or aging. They work in hospitals, community health services, or private practice.

When should one consider seeking assistance from psychology Melbourne?

Engage a psychologist when experiencing significant distress that impairs crucial areas of life, especially when struggling to understand or function in various aspects. Psychologists, often the first line of intervention for mental health issues, can offer mental health assessments and, in some cases, an official diagnosis.

Key Differences

	Psychiatrists	Psychologists
Prescribe Medication	✅	❌
Officially Diagnose	✅	Certain psychologists like clinical psychologists can. It’s best to check with the psychologist first.
Psychotherapeutic interventions	Some might specialise in diagnosis and medication and less so in psychotherapies and counselling. It’s best to check with the psychiatrist first.	✅
General counselling	Some might specialise in diagnosis and medication and less so in psychotherapies and counselling. It’s best to check with the psychiatrist first.	✅

What next?

If you would like to see a psychiatrist or a Melbourne based psychologist, we suggest seeing your GP for assistance. They can give you specific advice and write you a referral. Most psychiatrists require a referral before you can see them, but you can see a Melbourne psychologist without one. A referral will entitle you to a significant rebate from Medicare.

This resource from Health Direct (https://www.healthdirect.gov.au/question-builder) can help you to articulate yourself when speaking to a mental health or medical professional.

If you have any questions or would like to book in with our Melbourne psychologists or psychiatrists please contact our Client Connect Team on 9809 1000.

Jul

2022

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Money and Psychology

The reciprocal relationship that affects our financial decisions and mistakes.

From winning the lottery to the global financial crisis; our psychology is intimately linked with our finances. Financial worries accounted for three of the four greatest concerns in 2021, only outranked by COVID-19¹. Specific professions like financial psychiatrists have been created to address these concerns. Money can influence our perception and choices. Conversely our personality can affect our finances. Here are some common ways this can happen.

The sunk cost fallacy is the human tendency to let our previous investments and losses (sunk costs) influence our future decisions². This typically refers to economics however it happens in politics, business and relationships. For example, the longer people spend in a relationship the more likely they are to stay because of the time they have invested. Similarly, if someone invests in a company, then the stock dives, they may double down on their investment in a desire to recoup the money they have lost. However, the previous loss does not necessarily predict the next outcome. When people make financial decisions, they’re often based on emotions not logic.

Another recent psychological phenomenon is Sudden Wealth Syndrome. The term was coined by psychologist Stephen Goldbart to describe the distress people experienced after suddenly making large amounts of money³. Typically, this happens to people who have made money through winning the lottery, inheritance, and even crypto currency. This sudden change in circumstances can affect their self-image, motivation, and relationships. It can be exacerbated if they put little to no effort into making that money, like buying a lottery ticket. Although it may be hard to empathise with the struggles of someone gaining incredible wealth, the symptoms can be severe. People often begin to disconnect from their friends and family as they start to distrust people’s motives. They also might fear losing their wealth, could become paralysed with new choices or worried about the impact on their children⁴. This doesn’t mean that having more money is a terrible thing, but it can be complicated.

A personality trait that can affect the financial decisions we make is Extroversion. In her seminal book Quiet: The power of Introverts, Susan Cain suggests listening to Introverts could have reduced the severity of the Global Financial Crisis of 2007. In fact Cain provides multiple examples where Financial Institutions ignored and even demoted introverted employees, when they raised concerns. Many companies chose to promote and listen to extroverts preferring their positivity, high energy and confidence. Unfortunately, extroverts are also more likely to discount the potential risks when deciding. They are also more likely to have a sensitivity to rewards, which can drive them to make unreasonable decisions. Warren Buffet even suggests that people who are highly reward sensitive and unable to endure the natural highs and lows, shouldn’t be in the stock-market.

The relationship between psychology and money can affect global, local and personal decisions. With the cost of living rising in many countries around the world, you might be more likely to make an emotional financial decision. It might be time to look at your financial plans from a different angle. You could run your plans by a friend or a financial advisor. If you think your emotions might be getting the better of you, you can speak to a psychologist or counsellor for more support.

National Debt Helpline 1800 007 007. (9:30am to 4:30pm Monday to Friday)

By Will Sutherland

1. Gebrekal, T. (2021). What Worries the World? August 2021 [Review of What Worries the World? August 2021]. Innovation & Knowledge : Society. https://www.ipsos.com/sites/default/files/ct/publication/documents/2021-08/What%20Worries%20the%20World-August_2021.pdf

2. Thaler, R. (1980). Toward a positive theory of consumer choice. Journal of Economic Behavior & Organization, 1(1), 39-60. https://doi.org/10.1016/0167-2681(80)90051-7

3. Blog | MMC Institute. (2010). Retrieved June 27, 2022, from http://www.mmcinstitute.com/about-2/sudden-wealth-syndrome/

4. Wealth Psychologist. (2019). Investopedia. https://www.investopedia.com/terms/w/wealthpsychologist.asp

5. Cain, S. (2013). Quiet : the power of introverts in a world that can’t stop talking. Penguin Books.

Jun

2022

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Dialectical Behaviour Therapy

What is DBT and Why it Saves Lives.

By Will Sutherland

We all struggle from time to time with our mental health and relationships. However, some people experience these struggles so severely and frequently, that it fundamentally affects their wellbeing and safety. Dialectical Behaviour Therapy (DBT) was developed to assist those experiencing extreme difficulty in relationships, decision-making and emotion regulation. Although DBT is best known for assisting those with borderline personality disorder, it has also been consistently effective for those with Generalized Anxiety Disorder, Clinical Depression and those engaging in self-harm and suicidality¹. DBT is a broad system of therapeutic treatments that significantly reduce the rates of suicidality and hospital admissions². One of the most important components of the treatments is the group skills training³. The Three Seas Group is now conducting a 12-week DBT Group Skills Training Program for adolescents and adults. The program will cover the four key components of DBT: mindfulness, emotional regulation, distress tolerance and interpersonal effectiveness.

Firstly the program begins with mindfulness techniques. This involves a process called Wisemind⁴, where participants learn to integrate their emotional self, logical self and intuition. This allows them to act more efficiently and to be more present in their experiences. Participants also learn to engage more fully in their lives by being mindful of what they are doing and how effective their choices are at reaching desired outcomes.

Secondly, participants learn to tolerate distress. First participants learn to acknowledge that pain is a part of life and second, to chose tolerant behaviours instead of impulsive behaviours. These techniques are for daily life and crisis situations. One notable technique is TIP⁴, which works to address physiological symptoms. The technique suggests plunging your face into icy water (Temperature), engaging in Intense exercise or slowing down your breathing (Paced)(see below), to reduce autonomic arousal that leads to distress.

The third component is emotional regulation. Participants will learn how important emotions are to our actions and our relationships. Then they learn to identify their emotions and helpful techniques to manage more challenging emotions. Our emotions motivate us to act, however sometimes those emotions lead to unhelpful habitual reactions. The Opposite Action Technique⁴ teaches participants to identify an alternate behaviour to the one their emotion encourages. If a participant is angry and they feel like acting destructively, they can instead consider choosing a kind or constructive response.

The fourth component is interpersonal effectiveness. This involves strengthening existing relationships, ending toxic relationships and creating new healthy ones. Interpersonal Effectiveness teaches participants techniques to develop relationships where their needs are met. These involve improving interpersonal communication, negotiation and mindfulness during conflict. One of these strategies is the DEARMAN technique⁴ (see below).

The Three Seas Group DBT program is run in a classroom format, where practical and effective skills are taught through psycho-education. If you have any questions or would like to find out about our next in-take please call our Client Connect Team on 9809 1000.

TIP

Temperature – using cold or ice water.

Intense Exercise

Paced breathing – slowing the inhale and exhale.

See here for further information on TIP: https://dbt.tools/distress_tolerance/tip.php

DEARMAN

Describe the situation

Express yourself

Assert yourself

Reinforce (reward) the other person

Remain Mindful of triggers and emotions

Appear confident and open

Negotiate

See here for further information on DEARMAN: https://dbt.tools/interpersonal_effectiveness/dear-man.php

McCauley E, Berk MS, Asarnow JR, et al. Efficacy of Dialectical Behavior Therapy for Adolescents at High Risk for Suicide: A Randomized Clinical Trial. JAMA Psychiatry. 2018;75(8):777–785. doi:10.1001/jamapsychiatry.2018.1109
Behavioral Tech. (2021). What is dialectical behavior therapy (DBT)? Behavioral Tech – Training, Continuing Education in Dialectical Behavior Therapy (DBT). https://behavioraltech.org/resources/faqs/dialectical-behavior-therapy-dbt/
Mehlum, L. (2021, 2021/02/01/). Mechanisms of change in dialectical behaviour therapy for people with borderline personality disorder. Current Opinion in Psychology, 37, 89-93. https://doi.org/https://doi.org/10.1016/j.copsyc.2020.08.017

Linehan, M. (n.d.). Home. Dialectical Behavior Therapy (DBT) Tools. https://dbt.tools/index.php

May

2022

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Gender and Mental Health

A call to oust out-dated gender generalisations within mental health.

By Will Sutherland

http://capmh.biomedcentral.com/articles/10.1186/s13034-015-0088-x

There’s an old story about Arthur Miller from the opening night of his play, Death of a Salesman. He watched from the back of the theatre as his play was brought to life publicly for the first time. Typically, it would be difficult to gauge the audience reaction to a drama during the play, but this one was different. Throughout the production Miller noticed a strange metronomic response to his play. The shoulders of the suited men in the audience started bobbing up and down, as they tried to subdue their tears. These men had seen themselves, their ambitions and their paternal relationships reflected to them, perhaps for the first time.

Last year, at a party, I met a family member’s partner for the first time. He asked me what I did. I told him I’m studying to be a psychologist and with the quick draw of a Wild West sharpshooter, he responded with- ‘Psychologists are the most messed up out of everyone’. This guy, who I’d met maybe 15 minutes earlier, was suggesting that all Psychologists were more mentally unstable than the normal population. At that point I realised, this guy could not find out I used to be a part of the other group in society, considered equally as ‘messed up’: comedians. Now, telling someone they’re most-likely ‘messed-up’ is obviously a great conversation starter, but in other contexts generalising predictors of mental health is drastically neglectful.

The first aim of this article is to oust out-dated gender generalisations within mental health. Secondly, to suggest we be a little more curious about the nuanced variables that moderate predictors of mental health. Otherwise stated, everyone is messed up’ but in their own way. I have especially noticed many reductive presumptions involving men’s mental health, that don’t align with my observations nor the research^{1, 2}. The first presumption I notice is that men’s emotional distress could be eliminated or reduced if they simply talked more about their feelings. Perhaps this is extrapolated from how effective discussing emotional distress within social groups can be for women^{6, 7}. The second presumption is that men experience mental health issues at greater rates than women. This may be a mis-attribution from the statistics indicating higher rates of substance abuse and suicide for men^{3, 8}. Either way it’s important for us to continually assess our presumptions and reasoning. This will hopefully yield even more accurate and appropriate mental health assistance for those in need.

In 2018 it was reported that 1 in 5 Australians suffered from a mental or behavioural condition¹. Women have higher rates of psychological disorders at almost every age group and with almost all disorder types. This disparity is as large as 25% in the 18-24 age group¹. Although, these statistics should encourage a proportionate response to these rates, there are additional variables that complicate things. Firstly, although women are more likely to have a mental health disorder, they are also 30% more likely to seek treatment, when in need³. Secondly, men are over-all three times more likely to die by suicide ⁸. Finally, how men and women typically process emotional distress is shown to be literally backwards from one another⁵.

One study in particular supported this difference, showing that gender can moderate the benefits of social support in adolescents with depression⁵. The study found that a feeling of self-control mediated the relationship between social support and reduced depressive symptoms. However, both genders had a different order to this process. Boys benefited most from the ‘don’t talk about it approach’. This involves first engaging in unrelated physical and social activities without mentioning the distress. This can increase their feelings of self-control and autonomy over their circumstances, which gives them the confidence to discuss their distress. However, girls benefited most when they began by making their social group aware of their distress. Increasing the social group awareness led to restoring their feeling of self-confidence and agency over their life circumstances.

The study is a small example of how differently we can experience and process mental health issues. Since it was published, research has been extended to explore other gender identities including non-binary and transgender populations. Culture has also been explored as a moderating factor within the relationship between gender and distress. The risks of neglected mental health issues can be terrifying and generalisations can ease this with a feeling of certainty. Yet, it is vitally important that we continue to challenge our assumptions and consider the individual nuances in a person’s mental health.

By Will Sutherland

If you or someone you know needs support please consider contacting one of these helpful support lines:

Lifeline: 13 11 14

Beyond Blue: 1300 22 4636

1. Australian Bureau of Statistics (December: 2018) Mental Health[https://www.abs.gov.au/statistics/health/mental-health/mental-health/2017-18], ABS Website, 24th May 2022.

2. Australian Bureau of Statistics (December: 2021) First Insights from the National Study of Mental Health Wellbeing, 2020-21 [https://www.abs.gov.au/articles/first-insights-national-study-mental-health-and-wellbeing-2020-21] ABS Website, 24th May 2022.

3. Australian Bureau of Statistics (October: 2008) National Survey of Mental Health and Wellbeing: Summary of Results. [https://www.abs.gov.au/statistics/health/mental-health/national-survey-mental-health-and-wellbeing-summary-results/latest-release] ABS Website, 24th May 2022.

4. Sundberg, L., Agahi, N., Fritzell, J., & Fors, S. (2018). Why is the gender gap in life expectancy decreasing? The impact of age- and cause-specific mortality in Sweden 1997-2014. International journal of public health, 63(6), 673–681. https://doi.org/10.1007/s00038-018-1097-3

5. Martínez-Hernáez, A., Carceller-Maicas, N., DiGiacomo, S.M. et al. Social support and gender differences in coping with depression among emerging adults: a mixed-methods study. Child Adolesc Psychiatry Ment Health 10, 2 (2016). https://doi.org/10.1186/s13034-015-0088-x

6. Andrews, B., Brewin, C.R. & Rose, S. Gender, Social Support, and PTSD in Victims of Violent Crime. J Trauma Stress 16, 421–427 (2003). https://doi.org/10.1023/A:1024478305142

7. María P. Aranda, PhD, LCSW, Irma Castaneda, PhD, LCSW, Pey-Jiuan Lee, MS, Eugene Sobel, PhD, Stress, social support, and coping as predictors of depressive symptoms: Gender differences among Mexican Americans, Social Work Research, Volume 25, Issue 1, March 2001, Pages 37–48, https://doi.org/10.1093/swr/25.1.37

8. Australian Bureau of Statistics (September: 2021) Causes of Death, Australia [https://www.abs.gov.au/statistics/health/mental-health/mental-health/2017-18] ABS Website, 24th May 2022.

May

2022

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Self Compassion Part 2

Part 2.

Research-based suggestions for increasing your self-compassion.

By Will Sutherland

In the previous article on Self Compassion, I wrote about the mounting scientific support for self-compassion as a catalyst in psychotherapy and recovery. I also outlined the various evolutionary and attachment based theories that underpin this effect. I’ll be honest, it wasn’t until I finished the last article that I finally conceded: ‘Fine! I’ll start being self-compassionate!’. I naturally skew towards the tough love camp. Evidently, self-compassion was not the most appealing practice for me. However, I have reluctantly introduced some self-compassion practices. And to my delight, these practices and concepts have become a wonderful addition to my existing mental health practices. That’s the good part; compassion is a skill that can be learned⁴. There is a growing body of research identifying the functional components of self-compassion. In a pioneering study on self-compassion, Kristin D. Neff presents three components that make up self-compassion: self-kindness, connection and mindful self-regulation¹³.

Self-kindness is reacting to your own failures with the same grace and gentleness that you would to a friend⁵. Additionally, it involves challenging self-critical thoughts. Those with eating disorders are typically low on self-kindness and experience very high levels of shame and self-criticism¹². A twelve-week Compassion Focused group program for those with eating disorders, significantly reduced reports of shame, self-criticism and pathological-eating⁹. The study also significantly reduced another barrier to self-compassion; fear of compassion¹². Fear of compassion is described as both: the belief that you’re not worthy of compassion and the fear that self-compassion will negatively affect how you are perceived by others⁹. The maladaptive view that self-criticism is necessary and helpful, is not reserved for those with eating disorders. Many athletes believe that too much self-compassion may encourage mediocre performance⁶. However, self-compassion not self-criticism increases your ability to through navigate the natural failures and successes in sport. Self-compassion is also likely to increase behavioral reactions in sport and reduce maladaptive reactions to failure⁷.

The second component of self-compassion is connection to your common humanity¹³. This links back to the Buddhist notion that suffering is a universal part of human experience, and not an individual’s fault¹. Also linked to attachment theory, connection to a common humanity is modeled after a caregivers unconditional acceptance⁴. This connection helps us to identify that all humans will experience suffering and help us to meet that suffering with compassion not shame. It also produces feelings of social connectedness and the related hormones that our brains, like oxytocin³. This may explain why a compassion focused intervention for those with Psychosis significantly reduced feelings of social marginilization⁸. Similarly, Compassion Focused Therapy resulted in significant reductions in depressive symptoms in many different groups¹¹. One theory is that self-compassion may negate the Depressive Attributional Style¹⁴. Which involves attributing personal success to external factors and failures to your own fault. Thus viewing themselves as a disconnected and solely responsible failure; or, as the common recovery expression puts it, feeling like ‘a piece of shit in the centre of the Universe¹⁵. The opposite of connection to common humanity.

The third component of self-compassion is mindfulness and self-regulation¹³. In this context, a practice of mindfulness helps us to self-regulate emotional and cognitive distress. This distress is theorised to be, in part, due to the evolutionary development of the human brain³. The ability to experience momentary distress whilst diffusing/detaching ourselves from them, is an invaluable tool in life and managing psychological disorders^{6, 8, 9}. A helpful reminder used in recovery and CBT is thoughts and feelings aren’t facts. Emotional self-regulation and mindfulness work by engaging our para-sympathetic nervous system, which calms our autonomic responses like heart rate and cortisol release⁴. Especially those with substance abuse issues, emotional-regulation techniques are incredibly effective in recovery². In fact mindfulness and emotional regulation are key components taught in both Narcotics Anonymous and Alcoholics Anonymous². Another common reminder used in Alcoholics Anonymous is the acronym HALT¹⁶. Before making a decision or launching into an action, addicts are encouraged to ask, ‘am I Hungry, Angry, Lonely or Tired?’. Considering these basic human needs and recognising their influence over our perceptions can help to avoid jeopardising recovery².

Several recent meta-analyses^{3, 4, 5} have provided clinical support for Buddhism’s long-held belief in the importance of self-compassion compassion¹. These studies highlight the efficacy and ease of implementing self-compassion for different populations and disorders^{8, 9, 10, 11}. Self-compassion has theoretical support in evolutionary and attachment theory, linking its significance to our biological and social human needs^{3, 13}. Although compassion is commonly modeled to us by our caregivers it is a learnable skill³. Through practicing self-kindness, connection and mindful self-regulation, self-compassion can help us navigate the natural highs and lows of life¹³. Engaging in mental health treatment can be a challenging and complicated endeavor, especially with the addition of self-criticism and shame. Self-compassion is an invaluable partner in any mental health or recovery journey, for all of us Unicycle-riding-bears.

Below are some extra resources for increasing self-compassion as well as some useful phone lines for especially difficult times.

Loving Kindness and Compassion meditation: https://www.youtube.com/watch?v=sz7cpV7ERsM

4 ways to boost self-compassion, Harvard Medical School: https://www.health.harvard.edu/mental-health/4-ways-to-boost-your-self-compassion

HALT (Hungry, Angry, Lonely or Tired?): https://americanaddictioncenters.org/blog/common-stressors-recovery

13 11 14 – Lifeline Crisis Support Line

1300 22 4636 – Beyond Blue

References

1. Hofmann SG, Grossman P, Hinton DE. Loving-kindness and compassion meditation: potential for psychological interventions. Clin Psychol Rev. 2011 Nov;31(7):1126-32. doi: 10.1016/j.cpr.2011.07.003. Epub 2011 Jul 26. PMID: 21840289; PMCID: PMC3176989.

2. Chen, Gila. (2019). The Role of Self-Compassion in Recovery from Substance Use Disorders. OBM Integrative and Complementary Medicine. 4. 10.21926/obm.icm.1902026.

3. Gilbert, P. (2014), The origins and nature of compassion focused therapy. Br J Clin Psychol, 53:641. https://doi.org/10.1111/bjc.12043

4. Ferrari, M., Hunt, C., Harrysunker, A. et al. Self-Compassion Interventions and Psychosocial Outcomes: a Meta-Analysis of RCTs. Mindfulness 10, 1455–1473 (2019). https://doi.org/10.1007/s12671-019-01134-6

5. Inwood E, Ferrari M. Mechanisms of Change in the Relationship between Self-Compassion, Emotion Regulation, and Mental Health: A Systematic Review. Appl Psychol Health Well Being. 2018 Jul;10(2):215-235. doi: 10.1111/aphw.12127. Epub 2018 Apr 19. PMID: 29673093.

6. Lindsay M. Sutherland, Kent C. Kowalski, Leah J. Ferguson, Catherine M. Sabiston, Whitney A. Sedgwick & Peter R.E. Crocker (2014) Narratives of young women athletes’ experiences of emotional pain and self-compassion, Qualitative Research in Sport, Exercise and Health, 6:4, 499-516, DOI: 10.1080/2159676X.2014.888587

7. Nathan A. Reis, Kent C. Kowalski, Amber D. Mosewich & Leah J. Ferguson (2022) ‘That’s how I am dealing with it – that is dealing with it’: exploring men athletes’ self-compassion through the lens of masculinity, Qualitative Research in Sport, Exercise and Health, 14:2, 245-267, DOI: 10.1080/2159676X.2021.1920455

8. Braehler C, Gumley A, Harper J, Wallace S, Norrie J, Gilbert P. Exploring change processes in compassion focused therapy in psychosis: results of a feasibility randomized controlled trial. Br J Clin Psychol. 2013 Jun;52(2):199-214. doi: 10.1111/bjc.12009. Epub 2012 Oct 24. PMID: 24215148.

9. Kelly AC, Wisniewski L, Martin-Wagar C, Hoffman E. Group-Based Compassion-Focused Therapy as an Adjunct to Outpatient Treatment for Eating Disorders: A Pilot Randomized Controlled Trial. Clin Psychol Psychother. 2017 Mar;24(2):475-487. doi: 10.1002/cpp.2018. Epub 2016 May 30. PMID: 27237928.10.

10. Lucre KM, Corten N. An exploration of group compassion-focused therapy for personality disorder. Psychol Psychother. 2013 Dec;86(4):387-400. doi: 10.1111/j.2044-8341.2012.02068.x. Epub 2012 May 17. PMID: 24217864.

11. Cuppage J, Baird K, Gibson J, Booth R, Hevey D. Compassion focused therapy: Exploring the effectiveness with a transdiagnostic group and potential processes of change. Br J Clin Psychol. 2018 Jun;57(2):240-254. doi: 10.1111/bjc.12162. Epub 2017 Oct 17. PMID: 29044607.

12. Kelly AC, Carter JC, Zuroff DC, Borairi S. Self-compassion and fear of self-compassion interact to predict response to eating disorders treatment: a preliminary investigation. Psychother Res. 2013;23(3):252-64. doi: 10.1080/10503307.2012.717310. Epub 2012 Aug 24. PMID: 22917037.

13. Kristin D. Neff (2003) The Development and Validation of a Scale to Measure Self-Compassion, Self and Identity, 2:3, 223-250, DOI: 10.1080/15298860309027

14. Abramson, L. Y., Seligman, M. E., & Teasdale, J. D. (1978). Learned helplessness in humans: Critique and reformulation. Journal of Abnormal Psychology, 87(1), 49–74. https://doi.org/10.1037/0021-843X.87.1.49

15. David, A. (2014, April 23). Recovery Expressions That Blew My Mind. HuffPost. https://www.huffpost.com/entry/addiction-recovery_b_5194789

16. Alcoholics Anonymous : the story of how many thousands of men and women have recovered from alcoholism. (2001). Alcoholics Anonymous World Services.

May

2022

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Self Compassion Part 1

Mounting scientific support for self-compassion as a powerful catalyst in recovery.

By Will Sutherland

This is the first in a two-part series on the complementary benefits of compassion in recovery and psychotherapy.

I love a good metaphor and I relish a broadly applicable simile. I take to figures of speech like a duck to cold water (a duck that enjoys Wim Hof cold-water exposure). This is one of the many reasons I love Improv Comedy, the art of improvising comedic scenes on stage. Which, due to its transient and ritualistic essence, is infused with beautiful and broadly applicable metaphors.

I once took an improv class where the teacher asked us to consider ourselves ‘Bears riding Unicycles’. Meaning, creating novel and hopefully comedic scenes from nothing, is already complicated and impressive enough. Instead of trying to impress the audience with overly complicated choices, we were encouraged to keep it simple. We were also encouraged to take stock of the challenging endeavor we were undertaking. Just like with every other metaphor I come across, I started to try and fit this one to every aspect of my life. At times it was like fitting a square usb-b cord into a round usb-c port. Eventually, I realized that an improviser imagining themselves as a unicycle-riding-bear, greatly parallels the effect of self-compassion in psychotherapy and recovery.

Simply engaging in mental health treatment is impressive and challenging enough. Any additional pressure to improve faster or greater, is unhelpful and counter-productive⁶. Berating and criticizing yourself to increase improvements, may appeal to you and even provide short term assurance. However, previous research strongly supports the positive and complimentary effect of a self-compassionate approach to mental health recovery⁵. Psychotherapy can be an incredibly challenging endeavor. So, anything that increases or decreases that challenge, is noteworthy. Especially something that is consistently beneficial for many different life challenges and psychological disorders^{8, 9, 10, 11}.

Compassion has long been a core tenet of many religions and cultures, most notably Buddhism¹. Over the last few decades scientific research has supported Buddhism’s belief in the importance of compassion. Self-compassion refers to how a person treats themselves in response to failure or significant challenges⁴. It has been consistently shown to reduce depressive symptoms¹¹, to increase the ability to self-regulate⁵ and to increase relationship quality⁴. Self-compassion is typically learned through modelling from our primary caregivers. Nurturing received in early childhood can be a template for how we can, as adults, emotionally self-regulate and deal with adversity^{3, 4}. However, not everyone receives the nurturing and compassion necessary to replicate it in adulthood⁴. Alarmingly, low self-compassion can have a significant impact on later life. Recent studies have found strong associations between low self-compassion substance abuse², PTSD⁴, eating disorders⁵, personality disorders and physical health issues⁴.

This strong relationship between self-compassion and severe negative health outcomes, has compelled researchers to explore the reasons why it is so significant. One key theory suggests the association is due to the specific evolutionary development of human brains³. As far as we’re aware there was no brainstorming (pun intended) during the big bang about how human brain’s should be structured. Instead The human brain developed because of Darwinian Selection to Function³: Over millions of years higher-order parts of our brain developed over lower-order parts, in response to societal and environmental demands. Our modern-day challenge is to navigate the different, ad-hoc layering of our brain parts and their sometimes-conflicting motives. This can be quite the challenge, not unlike a bear riding a unicycle. One of the greatest factors influencing the evolution of our brains was social connections³. Strong motivations to make and maintain social connections would have increased our chances at survival³. So we are likely the descendants of those who were the most sensitive to social stimuli like connection and relational validation. In fact our brain chemistry is now significantly driven by social factors such as kindness, connection and mindfulness⁴. If these fundamental factors are modeled to us in childhood, they will then transfer to our tool belt of adaptive skills as an adult. However, without these skills both ordinary life stressors and psychological disorders are immensely harder to endure and recover from.

The good part is that self-compassion is a skill that can also be learned in adulthood⁴. There is a growing body of research working to identify the functional components of self-compassion¹³. In the next article I will outline these components and corresponding techniques that can improve self-compassion.

By Will Sutherland

Below are some phone numbers that are great for especially difficult times.

13 11 14 – Lifeline Crisis Support Line

1300 22 4636 – Beyond Blue

References

2. Chen, Gila. (2019). The Role of Self-Compassion in Recovery from Substance Use Disorders. OBM Integrative and Complementary Medicine. 4. 10.21926/obm.icm.1902026.

3. Gilbert, P. (2014), The origins and nature of compassion focused therapy. Br J Clin Psychol, 53: 6-41. https://doi.org/10.1111/bjc.12043

13. Kristin D. Neff (2003) The Development and Validation of a Scale to Measure Self-Compassion, Self and Identity, 2:3, 223-250, DOI: 10.1080/15298860309027

Apr

2022

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R U not OK being not OK? Because that’s OK!

Why it’s important to be compassionate towards our hesitations and resistance to mental health treatment.

So, you’re thinking about going to therapy. Congratulations! And for some people that will be that. Their next phone call will be to a psychology clinic or to their cousin’s best friend, whose sister saw that person one time for that thing.

Stigma of Seeing a Psychologist

But for others, going from thinking about seeing a mental health professional to taking the next step can feel impossible. It can seem like an acceptable thing for others but not for you. It can feel so contrary to your personality that it seems ridiculous. And in the current period of increased awareness and publicly stated acceptance of mental health treatment, that can be a problem. It can all too easily feel like all Australians, except you, are totally at ease with therapy. However, stigma and barriers towards mental health treatment are complex and different for all of us.

A myriad of factors are at play; from culture to country and gender to generation¹. It is possible that it will always be that way. I wonder if attempting complete elimination of mental health stigma is feasible or even helpful. Perhaps initiatives like RUOK day will only ever ease these challenges. I think the final word on Mental Health treatment should be; do what you have to do to get yourself in the door.

Reasons for Attending Therapy

It may take more effort, patience and self-compassion than you would like to give. It may take longer for someone you love to get into therapy than it did for you. That’s okay. Some people need many, many reasons to get in the door and others need time. Some may wait for a huge life event to occur, some may feel a slow, subtle build over many years. You might need to open more than one door before you find the right room for you. Of course, some will need to read the article Ten Reasons Why Ricky Martin Went to Therapy, before they reflect on their own La Vida Loca (Crazy Life). Personally, for me, it took a 70+ year old New York acting teacher screaming ‘If you’re in this class you need to be in therapy’. A cliché I know, but one I’m grateful for.

Resistance to Therapy

If you do need any of these things and more, you are not alone. A 2020 Study showed that 3 in 5 Australians had been affected by mental health stigma². Subsequently they either avoided initiating mental health treatment or did not reveal the true severity of their distress. In Australia we have seen how difficult it is to predict national mental health needs.

Beyond Blue was proposed as a five-year program to help those with depression. In 2022 it has well and truly exceeded its expiry date by 17 years. In 2020 they received 273,845 phone calls, 69% higher than 2015³. The extension of this widely accessed service is fantastic. However, even though more people are accessing mental health services, 60% of Australians still find it difficult to candidly begin treatment³. Clearly there is an ongoing need for sensitive public messaging that addresses real challenges.

Any resistance or hesitation towards initiating treatment is ok. Do what you have to do to get yourself in the door. Good luck.

Sean Stickney, Daniel Yanosky, David R. Black & Natalie L. Stickney (2012) Socio-demographic variables and perceptual moderators related to mental health stigma, Journal of Mental Health, 21:3, 244-256, DOI: 10.3109/09638237.2012.670878
Groot, C, Rehm, I, Andrews, C, Hobern, B, Morgan, R, Green, H, Sweeney, L, and Blanchard, M (2020). Report on Findings from the Our Turn to Speak Survey: Understanding the impact of stigma and discrimination on people living with complex mental health issues. Anne Deveson Research Centre, SANE Australia. Melbourne.
Beyond Blue, 2020. Annual Highlights 19/20. Annual Reports. [online] Available at: <https://www.beyondblue.org.au/docs/default-source/about-beyond-blue/annual-reports/beyond-blue-annual-highlights-2019-20-web-with-fins.pdf?sfvrsn=b62e4ceb_4>

Apr

2022

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Nick Bonner on Schema Therapy

Interview with Nick Bonner on all things Schema Therapy & more

By Will Sutherland

Key Points:

The importance of promoting client-autonomy
Utilising imagery and experiential techniques through Schema Therapy
The solitary nature of being a psychologist

Nick is a general psychologist at The Three Seas Psychology in Richmond and Northcote. He works primarily with Schema Therapy and CBT and is working towards integrating EMDR into his practice. Nick also enjoys playing basketball and supports the Utah Jazz in the NBA.

Will Sutherland (Interviewer)
Thanks again for agreeing to do this. We haven’t pre-prepared for this interview, I think that’s good.

Nick Bonner (Psychologist)
Yeah, going in cold and not so staged.

WS
Okay, so the first question is, what are the sort of values that are important to you in your practice of psychology?

I think probably the real core value is trying to promote client autonomy. So, allowing clients to have the flexibility to redirect things if things aren’t working for them. Also, trying to be very attuned to their own unique needs when it comes to therapy. I try to roll with it even if there’s a part of me that might not agree with something. If that’s somewhere they want to go, I’ll try to just indulge that and let them guide the journey a little bit.

So, I’d say promoting client autonomy is probably key. Then I think the other would be trying to be as authentic as possible about your experience with them. So, if you feel moved by something they’re saying, let them know. Try to cultivate a relationship with some level of self-disclosure.

Do you think that ties into motivational interviewing and trying to discover their reasons for being there, too?

Yeah, I think it does tie in with the kind of motivational interviewing approach, although I don’t tend to use it that frequently these days. Sometimes if you feel stuck as a therapist, I think it’s good just to sit back and drop all your therapy modes. Instead try to closely attend to what the client thinks is happening for them. And share your own experience of what you think’s happening with them.

Could you talk about the development of different techniques over time in your practice?

Yeah. So, I think the first love was always schema therapy. At uni, I remember the point when we started to come to schema therapy. That just felt like a real lightbulb, eye opening moment. I always felt a bit uncomfortable about purely working with thought alone. I always thought that that was a bit reductionist and overly sort of simplistic. And I think the schema therapy model made a hell of a lot more sense to me. It was a lot more holistic. It acknowledges the role that early life experience plays in clients later presenting issues. It’s just more of an integrative kind of therapy.

The techniques that really appeal to me are probably more of the experiential techniques within schema therapy. I find they’re the ones that are often quite powerful for clients at driving change. So, I might use the Empty Chair Technique that schema has borrowed from Gestalt therapy, or imagery rescripting, which deals with these adverse early life experiences. They’re probably the techniques that have always been fascinating.

And that probably also comes across to the client as well, that this is a technique that you’re passionate about. That probably brings that energy into the room as well.

Yeah, definitely. I think clients can grasp it. They’ll say ‘I know these thoughts I’m having aren’t true. I don’t believe them but, I can’t help but feel that they’re true.’ Schema helps them understand that it’s these early life experiences and these memories that are still part of the problem for them. And they need to have a different experience from what they once had. I think they grasp that quite well. Often, they find the imagery and rescripting techniques quite helpful and powerful. When purely cognitive based therapy hasn’t been enough.

Obviously, most jobs in the world, you’ve got co-workers working with you in the same room. Do you find that challenging being the only one in the working position, when practicing?

100%. Yeah. I think that’s one of the big challenges for any kind of health related, private practice. How do you attain support when needed? I think that’s particularly challenging after a difficult session. Luckily, I’m quite an introverted person. So, I probably can cope with that quite well. But I imagine if I was even 30% more extroverted, I’d probably really struggle with it. And there are still times where I might struggle with that a little bit. But I think that’s where the importance of supervision comes in. Even just little chats with people out in the hallway can help. Those little things matter. But it’s definitely a challenge.

I heard this story about Bono from U2, that after they had been on tour for months, the first week or two after Bono’s wife has to keep telling him to get down off the dinner table, metaphorically. Because he’s still acting like he’s in front of thousands of people. Is there an equivalent for yourself in that? Are there times when you have to shift out of, I guess, the Psychologist Mindset when you’re talking with friends or even with your family?

I’ve never really had a problem with that. I’ve always felt like none of your friends want you to be their psychologist and I don’t want to be theirs. So I feel like I’m pretty good with that boundary. There might be times when you’re, you know, something’s happening with a friend where you might sort of start indulging in some formulation. I actually find at the end of a workday I tend to want to listen to something that’s just completely unrelated to psychology. You know, so just podcasts on the way home.

What led to your interest in working with childhood trauma and treating children and adolescents?

Well, I don’t regularly treat kids and adolescents anymore. So, I’m probably much more interested in working with adults these days. But having said that, I think early childhood experiences are just so profoundly impactful. If you can understand that then you get a much better grasp of the client that’s in front of you. And it helps reduce any kind of judgement that you might have about the client. I think that’s one of the good things about psychology in general, is it helps make you a far less judgmental person. Because you have a much greater sense of empathy about how our clients had to learn to cope and adapt with the challenges in their daily life experience in their family or in their schooling life or whatnot. So yeah, I just think that more and more I’ve been attracted to therapy approaches that put childhood experience at the absolute core of the focus. I’m not sure if that answers the question. I just feel like, if you don’t understand that early childhood experience, I just don’t think you’re as well equipped to help a client with their presenting issues in the present. So it’s extremely important.

What’s the strangest metaphor or example you’ve given to a client that you probably would never find in a psychology textbook, but has been effective?

Yeah, that’s a good question. I’m probably not particularly novel about creating metaphors. I love it when a client develops their own metaphor and describes their experience. And I tend to just roll with that. And I find that that’s often really useful. Not only is it useful for helping understand their experience, but also as part of the change process. So, if you’re working with a metaphor that’s quite visual then it’s easier to get them to reimagine that. If you were in a more positive place, how might the actual metaphor change? How differently would it look? Yeah, I love it when clients come up with their own metaphors, but I’m probably not particularly creative at coming up with my own. But it’s a good question. For some reason, I always tend to just default to the ocean because I feel like it represents how varied life can be. How you might think that you’re on smooth seas and all of a sudden it changes or there’s something really horrible like a tsunami.

Yeah. It’s a pretty universal image as well.

Yeah, I think you can often adapt, like the conditions in the ocean to something that they utilise. I don’t I have anything particularly creative ones. I wish I was more creative.

It sounds like a lot of the techniques that you use take people away from the purely thinking about something and potentially overthinking about it. Do you think that’d be a fair statement?

Absolutely. Yeah, I think the core focus is what childhood needs weren’t sufficiently met for you. And how do we go about getting them met now. So that that can also mean reimagining their experience in their youth in a direction that’s far healthier for them. It also means looking at their relationships today, looking at the patterns of their behaviour and thinking is this helping you get that need met. Or is it counterproductive? I think that experience, from a behavioural focus, is particularly powerful. It not only means that clients can think in healthy ways, but they might actually believe it as well. So you might know that you’re not alone in the world but you might feel immensely lonely. These techniques help you actually feel like you’re connected and you’re bonded and not alone. That’s why they’re so damn integral as a successful change variable.

What is your greatest achievement in basketball?

I’m known in my team for being scared to take a shot. Perhaps that has something to do with my own schemas. And I’m a pretty cautious person temperamentally. So, for me, just to take the final shot in a game is, personally, a big achievement. I’d rather be trying to create a better shot for someone rather than to take it myself. And I’m not a particularly strong shooter, anyway. The other standout memory was being 15 and hitting a baseline fadeaway to win the game. Then probably the other one would be just as a kid when you throw up those full court shots. A bit of a tick tock moment, though we didn’t have that back then.

Do you think there’s any room for basketball metaphors in schema or in psychology in general?

The only time I’ve used anything to do with basketball and therapy would be more as a way of trying to bond with the client. So, we know that the therapeutic alliance is just integral to the change that you get in therapy. I think it’s sometimes underappreciated that the bonding part is actually really, really important. So when a client first walks in the door I want to think about ‘how close do I feel with this client?’ and ‘what could be some way of getting closer?’ So, if there’s any overlapping interests, maybe at the very end of the session I might have a very brief sort of touch point with the client about their interest just to basically say ‘hey, I’m interested in getting closer to you.’ That sense of bond is really important to allow them to feel vulnerable. Having said that, you have to be mindful about how much of your own personal life you share with the client. So, if you find yourself talking too much about yourself in the session, that’s a huge red flag and you should definitely be pulling back from that. I think with the right intentions and when you follow through it’s okay to share a little bit of yourself with the client.

And as you mentioned before, it might be something to do at the end of the session. Do you think especially if it’s been a challenging session or you’ve had to challenge them a lot during the session, it’s kind of a nice way to come back to the connection before leaving?

Yeah. 100%. I think that’s a pretty valid point. Letting go of some of the difficult stuff and being back in the present with them, with something that connects.

I think we’ve also revealed the fact that what I want more than anything else is a basketball metaphor for psychotherapy.

Maybe by the end of this discussion we can come up with something.

I was thinking maybe Cross-Court Violation. Like going back on old habits is a violation, or something.

Yeah, I’m think people often use sporting metaphors in the business world more than anywhere else. It’s hard to know how you could apply it. Actually, one that’s just come to me that I do use is when I’m talking about a client’s internal critical voice. I might say, look, it’s like you’ve got a bad coach, stuck in your head, you know? Then I might use the example of a good coach. I might actually draw upon personal experiences of less optimum coaches, and really helpful coaches. I’ll try and show the difference and how a good coach can still drive you. But they do so in a way that really gets the best out of you and still allows you to feel safe and accept who you are. So that’s probably the closest.

I feel like that’s such an easily accessible image, that you wouldn’t have to think too hard to invoke. So, again, coming back to that notion of finding an alternative to purely cognitive and a cognitive spiral towards imagery.

Totally. It’s the tone of the coach’s voice and it’s how the coach makes you feel. It’s not just the content, it’s the whole experience of this coach. If you can be aware of when the bad coach is there in their mind and separate from that, or try to cultivate this other good coach, it will get you where you need to go a lot better. Being stressed and afraid from the bad coach will never help you perform as well. So, that’s pretty easy to understand.

Do you think as well, with that metaphor, a good coach could still be quite direct and direct tough love without being critical. So, I guess the question is, is it also that it allows for not such black and white thinking of this as a good thought or a bad thought?

Absolutely. That there’s room to use less punitive, less demanding language. Instead using a more compassionate kind of tone when talking about those things. And certainly breaking it down from any black and white kind of rigidity, into a much more nuanced, grey, balanced place, which is always healthier.

WS
And the final question is, how does it feel to be on the receiving end of questions in this room for a change.

Yeah, I think it’s going well. I mean, I’m not particularly used to talking about myself. Maybe that’s why we become therapists. Even in my intimate friendships, I’m not generally the one to start talking about my own experiences. So, if I’m honest, there’s a slight discomfort about that. But in another way, it’s quite refreshing.