Change – and a New Technology to Support You in Your Journey

Therapy is, essentially, about change. And change isn’t something that comes easy to most of us.

We often respond to situations influenced by thinking errors we are not aware of. We become accustomed to, and stuck in, a way of thinking or certain behaviours because to us they make sense, they make us feel safe, and, most importantly, they seem to work.  There’s therefore very little reason for us to change – why fix what ain’t broke?

Becoming aware of such patterns and learning how to change them therefore requires the motivation and confidence to do so – and practice.

A lot of that happens outside the therapy session and is frequently referred to as “homework”, something that is prone to raise resistance or anxiety in clients. Traditional tools like thought sheets are also often impractical – who will want to pull out a sheet of paper to jot down their thoughts and feelings in the midst of a social situation?

However, there is technology available that enables clients to do just that, and more, quickly and inconspicuously, without paperwork.

Crossroad Counselling & Psychotherapy is currently offering our clients the opportunity to enhance their therapy with the help of Siario’s technology (www.siario.com).

Clients can track their mood or anxiety, log and challenge their thoughts in particular situations and observe the associated emotions. They can identify and modify beliefs, and explore reasons for and against changing along with the ability to access helpful resources – all conveniently on their smartphone or tablet. At the click of a button they can submit exercises to their therapist before their next session. All resources and exercises can be tailored to the individual needs of the client.

Use the form on the right to contact us or give us a call if you are interested in trying it out!

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Thinking errors

People with psychological problems often make errors in their thinking. By understanding these distortions, we can learn to break the emotional link between a distressing event and our typical reaction to it. Therapy teaches us to evaluate the validity and usefulness of our thoughts, values and beliefs, and identify which thoughts and behaviours need to be changed to improve our moods.

For this, we first need to identify, or become aware, of specific automatic thoughts in specific situations. Everyone has automatic thoughts. These are thoughts that just seem to pop into our heads. Because we’re not deliberatly trying to think about them, we call them automatic. Because they enter our minds really quickly, we generally notice the associated feelings or emotions much more than the thought itself. Often, the thoughts are distorted in some way, yet we believe they are true and react to them as if they were.

Thought: “I always mess things up” — Feeling: “Sad”

Although some automatic thoughts can be true, many are either untrue or only partially true. Here are some examples:

All-or-nothing thinking (black-and-white thinking): You see a situation in only two categories, rather than on a continuum.

If I don’t get it done perfectly, I’ll fail.

Catastrophizing: You predict the future negatively and don’t consider other, more likely outcomes:

It’s going to be horrible.

Discounting the positives: You tell yourself that positive experiences or qualities do not count.

(after receiving a compliment) “He’s only saying that to be nice”

Mind reading: You believe you know what someone else is thinking about you.

I’m sure they all thought I was stupid.

“Shoulds” or “Musts”: You have a precise idea of how how they and others ‘should’ and ‘ought’ to be.

I should have got an A on my exam.

Once we have identified an automatic thought that distresses us, the next step is to evaluate it. We examine it, test its validity or utility, and develop a more adaptive response.

Questions we can ask ourselves are:

“What is the evidence (for and against) this thought?”
“Is there an alternative view/explanation?”
“What is the best/worst that could happen?”
“What is a realistic outcome?”
“What is the effect of my believing this thought?”
“If I thought differently, how would I feel?”
“What would I tell a friend in the same situation?”

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Ask your counsellor, are you allowed to drink

“My daughter said to ask you can I drink this weekend.” I was just about to digest this question and come up with an answer that put the question back on the client, when he said “I know you won’t give me an answer to that, but what I really want to know is am I an alcoholic”. I wasn’t going to get away that easily. When I asked why that “label” was so important, he explained that if he were an alcoholic this meant he could never drink again, because it was a disease, a disease that couldn’t be cured, and that he would just have to accept that this illness had control over him.

Traditionally, the most dominantly used model for explaining addiction is the Medical or Disease Model. This model posits that addiction only affects certain people, those with a biological dysfunction, often as a result of a genetic predisposition. Loss of control is considered a symptom of the disease, denial a factor that maintains it. Any social or psychological factors that might be contributing factors to a person’s addiction are considered irrelevant. Consequently, confrontation of denial is essential, so is the acceptance that one is powerless over the addiction, and the only acceptable treatment is lifelong abstinence. While this explanation has the advantage of being a straightforward definition that is easy to understand and takes the blame away from people by considering them “sick” rather than “bad”, it has the disadvantage that the notion of “lack of control” actually legitimises and reinforces the addictive behaviour, as addicts are convinced that they are not at fault for their behaviour. Describing addiction as a primary disease that can’t be cured turns addicts into victims rather than them being active agents, and robs them of all hopes of getting better. It also posits that these people are different from others which can lead to stigmatisation.

Harm reduction therapy, on the other hand, is a client-centred approach to working with people that aims at reducing the harmful consequences of addictive behaviours without requiring abstinence. Interventions are designed to meet clients where they are, rather than where the therapist would like them to be. The therapist accepts the client’s view of the problem as a legitimate starting point and small, incremental steps to reduced harm as legitimate goals. Aside from steps towards abstinence or moderation, this may include resolving the client’s ambivalence about using, using in a safer manner, clarifying personal goals with regards to alcohol or substance misuse, or working on interpersonal issues. The rationale is that clients’ confidence in their ability to change increases with each small step, and they learn that positive change is possible – contrary to the traditional 12 step belief that the person is powerless over their addiction.

As addictions exist on a continuum (non-use, moderate use, persistent addiction) and people’s personal goals regarding their addiction, their motivation, and their readiness to change, their strengths and vulnerabilities and psychological and socioeconomic factors can differ greatly, an abstinence-only, one-size-fits-all approach is unlikely to be successful for the majority of users. Harm reduction therapy offers a more flexible approach addressing the multifaceted needs of this client group and each individual client. It also recognises the importance of addressing the clients’ ambivalence about changing and other motivational issues before it is possible to pursue behavioural change.

For many clients, their addiction has an important personal meaning or function, like dealing with negative emotions or a sense of identity. Giving up their addiction, unless a viable alternative solution can be identified, can cause fear and anxiety and a reluctance to change. It is therefore often necessary for users to explore the meanings and functions their additive behaviour has for them and to come up with healthier solutions before they can consider changing their alcohol or substance abuse pattern.

The therapeutic alliance, the collaborative relationship between the therapist and the client, is of utmost importance. Motivation is considered the result of the interaction between client and therapist. Confrontation is to be avoided, the focus is on the mutual development of needs, goals and strategies. This empowers the client to be active and involved in treatment, and may as a consequence lead to a reduction in attrition and dropout.

References

Miller, W. R., & Rollnick, S. (2002). Motivational Interviewing. Preparing People for Change. New York: The Guilford Press.
Tatarsky, A. (2002). Harm reduction psychotherapy: A new treatment for drug and alcohol problems. Northvale, NJ: Jason Aronson, Inc.
Tatarsky, A. (2003). Addiction as a Disease: Birth of a Concept. Journal of Substance Abuse Treatment, 25, 249-256.
Thombs, D. L. (2006). Introduction to Addictive Behaviors (3 ed.). New York, USA: The Guilford Press.
White, W. (2000). Addiction as a Disease: Birth of a Concept. Counselor, 1(1), 46-51.

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Stigma and Eating Disorders

An abundance of studies has highlighted the degree to which mental illness is still subjected to stigmatisation. Eating disorders are classified in the DSM as psychiatric disorders, which, like other mental illnesses, makes them prone to be stigmatised within society.

Research examining public opinions on eating disorders suggests that eating disorders are often believed to be the choice of the individual affected by them. Characteristics attributed to people with eating disorders include “vain, self-centred, fragile, unreliable, attention-seeking, or even annoying”. Studies carried out on the general public highlight that there is a belief that people with eating disorders can “pull themselves together”, “have only themselves to blame” or are “likely to be acting this way to get attention”. In light of the widely held belief that maintaining a healthy body weight is desirable, these results may be an indication for the perception that having an eating disorder is simply an extreme effort in this context of maintaining one’s body shape, therefore reflecting the belief that having an eating disorder is a life-choice. Eating disorders are consequently frequently considered less serious than other mental health issues and trivialised.

People with eating disorders have a reputation of being difficult to treat. Studies have shown that treatment professionals working with eating disorder clients hold negative attitudes and beliefs about this service user group. There is also evidence that there is a reluctance to treat people with eating disorders, often attributed to the associated medical and psychological consequences of eating disorders, to the ambivalence of people with eating disorders with regards to treatment and change, or to the stigmatisation of these conditions. Several studies have indicated that many treatment professionals, too, believe that eating disorders are a lifestyle choice.

The tendency to hold people with eating disorders responsible for their condition can result in significant negative consequences. Generally, individuals that are blamed for their condition are more likely to generate anger (as opposed to empathy or compassion) and less likely to bring out helping behaviour in others than those with conditions that are considered outside their personal control. The negative attitudes of treatment professionals can negatively impact on the relationship between therapist and client, and consequently on treatment outcome, as well as the quality and the availability of eating disorder services. Additionally, mental health literature has indicated that one of the consequences of being stigmatised is a reluctance to seek and engage in treatment. This has been found to be true in the context of eating disorders also, where studies have indicated that both stigma and shame and a fear of negative attitudes on behalf of treatment professionals can act as a barrier to seeking treatment.

There is therefore a need for community-wide interventions that address the stigmatisation of eating disorders as well as the misconceptions about eating disorder treatment. This includes raising awareness about the distress and dangers that accompany all types of eating disorders, their seriousness compared to the perception that they are trivial, but also of conveying the message that recovery is possible.

For treatment professionals, the NICE Guidelines and the Vision for Change Report stress that stigma can be reduced by providing a service user-centred environment with a strong therapeutic relationship. Both argue that there is a need for more training programmes to increase the skills of clinicians in the eating disorder area and subsequently their confidence in working with this client population.

In light of the self-stigma experienced by people with eating disorders there is a need to also target the empowerment of people affected by these conditions. This will encourage them to believe that they can recover and achieve their life-goals and enable a more recovery-oriented relationship between treatment providers and service users.

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