Thursday, August 25, 2016

"Why do you say therapy includes risks?"

Change is not made without inconvenience, even from worse to better.
Hooker in Johnson's Dictionary of the English Language (1755)

If you’ve never worked with a therapist before, you might think it’s a totally positive process that’s all about feeling better. 

However, therapy isn’t all sunshine and roses. In fact, the very nature of it often includes challenging discussions. 

Surprisingly, that risk isn’t just when talking about serious traumatic events like rape; it can come from all kinds of issues - even study technique. Here’s why...

The benefits of therapy include feeling better about yourself, strengthening your coping skills, improving your relationships, solving problems, having a safe place to express emotions, and more.

Because therapy covers all kinds of issues, you start off with a discussion where you describe your needs and goals. I don’t charge for that because for me this is just a conversation to see if we can work together. 

However, if we decide we can, I will then tell you that therapy can involve risk.

Basically, the reason that therapy involves risk is because it’s a service that helps you make changes in your life. All change comes with risk; that’s the nature of the beast.

Sometimes the risks are obvious. For example, if you’re seeking assertiveness training, then you will understand that when you change, your relationships will change too. 

Hopefully this will be mostly positive, but you accept there may be some lesser effects that you don’t like as much - like arguments, resistance and more.

That seems reasonable, right? However, it’s surprising how even seemingly innocuous therapy goals can involve challenge.

Here’s an example:

John wants to improve his study technique. Together we look into his preferred learning style, at his energy levels through the day, at how he approaches small and big projects, at how he manages obstacles, at how he deals with team work, and other related matters.

Although it’s personal, it may not be sensitive. However, suppose John prefers to work alone? He may become anxious and stressed when discussing his approach to group work.

Also, sometimes you seek therapy for one issue, and then something completely different pops up.

Like in this example:

Jane is depressed because she was fired. Her goal is to manage her depression but while we’re examining what happened, Jane causally mentions that she’s been unpopular in every company she’s ever worked for. As we talk, Jane shares that she often screams at her subordinates.

And this is where the risk comes in!

If Jane was so stressed that she didn’t even realise that she’d behaved inappropriately, discovering this can be a bit of a shock. When we talk more, Jane might realise that she’s doing this in her personal relationships too.

While I advise people of the risks of therapy, I tend to perceive it as positive because I think it’s always useful to gain insight.

Also, you can decide what you do with that insight. If you discover something that you want to change, then therapy is the place to do it. You may also decide that you are happy with the status quo.

To go back to our examples, John might learn some skills that will help him with group work. He might also decide to avoid training for jobs where he’d have to work in teams and instead opt for a career where he can work independently.

Jane might learn to manage her stress better so that she can build a better career path for herself. She might also look into her personal relationships and decide that she needs to make changes there too.

Or maybe not! Jane might discover that her partner doesn’t mind the odd screaming match. Her partner may just happily yell back and see it as a bit of passionate foreplay.

So in a nutshell, it’s part of good ethics to warn people about the risks involved in therapy. You may have a completely positive experience, or you may learn something new about yourself that surprises or challenges you.

Whatever happens, you have the final decision in how you approach it. Just work through all the possible options, and pick the strategy that suits you.

Thursday, August 18, 2016

Boost Your Mood With Pleasant Activity Scheduling

Feeling low, and wondering what on earth you can do to get your groove back?  Check out Pleasant Activity Scheduling, a simple method that injects the fun back into your day.

One of the signs of being depressed is that you lose your sense of enjoyment.  If you love tennis and lunch, depression can make tennis seem a waste of time and lunch seem unappetising.

As a result, you stop playing tennis, stop going for lunch, and before you know it, you’re becoming less active and more isolated.

Whether you choose to take antidepressants,go for therapy or both, one simple activity you can do by yourself is Pleasant Activity Scheduling. As the name suggests, this involves you getting out your diary and adding fun To Dos into your schedule.

Spending time with Target, my cat pal, is always fun
For example:
·        On Monday I have lunch with a friend. 
·        On Tuesday night I play badminton. 
·        On Wednesday night I phone an old school friend. 
·        On Thursday night I eat ice-cream while watching a film.
·        On Friday I pack a lunch and read a novel.
·        On Saturday afternoon I cook lunch for friends.
·        On Sunday I go for a walk in the park.

If it’s part of therapy, I will help you figure out what kind of activities will work best for you and when to time them.  To make the most of this when you're depressed, there are a few variables that have to be considered in each case. 
This short post is not the place to describe them but the journal paper behavioral activation treatments of depression: A meta-analysis offers a nice simple overview.

You don’t have to be depressed or in therapy to take advantage of this technique. Just doing this as a stand-alone is a simple, effective practice for self-care.  It can’t harm you, either so it’s perfectly safe.

In fact, I recommend Pleasant Activity Scheduling routinely because so many of us find it hard to achieve a decent work-life balance. With the pressures of work and family, our own happiness often takes a back seat. 

So if you find that most of your schedule involves duties (going to the dentist, picking up dry-cleaning, paying bills) then it’s only sensible to balance those stresses with some self-care.

Finally, if you’re a parent, make it a family exercise. It’s especially useful for kids who are burning out due endless cycles of school, tuition and exams. 

Have a happy, busy weekend!

Wednesday, August 10, 2016

Hi, I'm Ellen and I'm An Atheist

When I set up my web site, I asked friends to give me feedback.  I was quite surprised that they approved of my spelling and a bit taken aback by their take on my statement,
I am an atheist. Normally that doesn't come up in conversation but if you're looking to talk through questions of infidelity, sexuality, gender, divorce, abortion and other life issues without a religious perspective, you may find that information useful.
"Don't say you're an atheist," several friends chorused.  "You'll put people off!"

That was surprising because I was hoping that particular bit of disclosure would encourage trust. While atheism is unusual in South East Asia, where I come from, Holland and Scotland, it's pretty normal.
Proportion of atheists and agnostics around the world
Proportion of atheists and agnostics around the world

It's fairly common for mental health practitioners to describe how they work, so that clients can choose between different therapeutic approaches. For me, describing personal values is just as important.

Therapists are human and they can have strong beliefs about marriage, sexuality, abortion and other issues. 

As a result we've got two extremes with practitioners who try to divorce their practice from their own ideals on one end, and faith-based counselling on the other.  

If you're depressed because you've had an abortion, because your same sex relationship is in difficulties, or because your husband's third wife is a horror, you might think twice about reaching out to someone whose personal values would clash with yours.

So I say I'm an atheist because I want potential clients to understand where I'm coming from.

As far as I'm concerned, being an atheist isn't that important. Although I don't have a faith, I've lived in five countries, I've met a lot of people, and I work with Christians, Muslims, Buddhists, Sikhs and Hindus.

You see, when it comes to therapy, it's not my beliefs that count. If you come to me and tell me your marriage is in trouble, but your religion forbids divorce, that's just another parameter we work with.  My opinion about marriage or divorce doesn't come into the picture at all. All that matters are your beliefs. 

I'm not saying I can work with anyone. When the gap is too wide, and it becomes too difficult to understand each other, then the prospect for healthy change is too narrow.

And because I worry about that, I offer a free fifteen minute chat to all new clients, just to see if we click.  If we don't, we're just out of a little time and you can look for a better match.

However, given that atheists are targeted in some countries, should I hide what I am?

Tell me what you think.  Should I say I'm atheist in my profile or not?

Credit: graphic is from Wikipedia

Friday, August 5, 2016

Is Psychology A Science?

I often tell the people I work with not to put too much trust in numbers. Usually it's because we're using a test or study and I'm explaining the background and limitations.  
Actually, this is part of larger discussion, and for what it's worth, here are some quick thoughts on the debate. They're meant for a general audience so feel free to wade in with comments and criticism. 

In a college or university, you’ll probably find the chemistry, biology and physics departments are part of the School Of Science whereas the psychology department is part of the School Of Art And Social Science.   
So, does that mean psychology is not a real science? 

Note: if you love flame wars, you’re going to enjoy this discussion!

If you've not picked up a paper or textbook since school, you might remember how you did an experiment in physics or chemistry and then replicated it again and again and again.

This is why for many people science involves: clearly defined terminology, having a hypothesis that explains the phenomenon you’re examining, and if you love Popper (and who doesn’t?) being able to falsify that theory too, then setting up a tightly controlled experiment that will test your theory, being able to observe, quantify and record results accurately, and finally, being able to reproduce the results.
Karl Popper
Karl Popper, serious brain.

Psychology isn’t like that.  There are no universally agreed on definitions for depression, happiness, and stress.  Even observing them can be tricky.

This is why people often refer to chemistry, biology and physics as “hard science” and psychology as “soft science”.   
In such discussions, there’s often a bit of sneering, with the idea that soft science is somehow a bit grubby, a kind of parlour trick. 

However, hard science is in poor supply.  If you keep an eye on the news, you’ll see that biologists argue over what kinds of cells qualify as stem cells, chemists argue over how to classify crystals (and over hyphenated terms!)  and physicists tend to work with concepts so out there, that they’re still been arguing over the quantum mechanics theory, 90 years after it was first published, and discussing whether it really is necessary to provide empirical evidence for their ideas at all.   
And let’s not talk about how scientific medicine is, or we’d be here all day!

For me, when I'm not cautioning clients over numbers, the issue isn’t who has the hardest science.  What I’m interested in are investigations into human nature that tell us something about ourselves. 

Psychological research deals with challenging topics that affect us all.  Like, why do we rush to help if it’s just us and them, but we’ll maybe stand back if there are fifty of us?  And why does a great piece of good fortune coming our way not make us permanently happy?

We have some ideas about why these things happen, but they are controversial - meaning that some studies are hard to replicate. 
While psychological research isn’t perfect, we’re doing some good work at understanding ourselves.   

Ideally everything we do should be revealing in some universal way.  But given the difficulties involved in this field, I think that any kind of insight is useful.  
 If someone can provide information that only applies to a particular group, like Scottish nuns aged 25 to 40, that’s okay.  As long as it helps someone, and we're all clear about limitations and caveats, I’m all for it.
I am not okay with pushing theories and practices that have been disproven. I understand why people hate to give up on old ideas even if they are proven to be pseudoscience and nonsense, but I don't approve.

I believe that what really matters is critical thinking.  When it comes to therapy, you need to have a good grasp of the field, and to be clear, rational, open-minded, and informed by evidence when it comes to practice.  And above all else, there’s the fundamental ancient principle, do no harm.