How people change: normalising problems

One of the most frightening things about having a mental health problem is how crazy it can all seem. Panic attacks in which your body seizes up; depressed moods that make the world look like a place of devastation; obsessions that keep you doing the same damned thing hour after hour. Too often, the client ends up worrying about where it is all going to end. The anxiety that results creates a spiral of worry that compounds the original issue. The burning question many clients have is: what the hell is happening to me? Why this? Why now? Clients naturally seek answers, and failure to address this may block people from taking that first step towards resolution.

Related to these questions is another concern: will this psychotherapist be able to help me? Does he know what he is doing? Can I trust him? This concern is especially salient if the visitor has never been inside a consultation room before. It’s even more pressing if she has and been turned off by the vague, or disturbing, answers so far received from other professionals.

In framing the answer the therapist is not simply offering re-assurance. She is also providing a route map. One that takes in the reasons for the problem, and indicates what the solution might be. Along the way, she normalises the predicament the client is in.

Normalising is the art of reframing the problem from ‘weird’ and ‘alarming’ to ‘expectable’ and ‘soluble’. Expectable in terms of the cognitive and emotional characteristics of the client, the life problems that triggered the disorder, and the physical result (the anxious state). Soluble in terms of addressing, one by one, his thoughts and emotional judgments, his physical state, and his difficulties in life.

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How people change (New series)

I have been a student of personal change ever since I was a depressed teenager reading Dale Carnegie’s How to Stop Worrying and Start Living (although that book never worked for me, as I never could work out where to start living). Before and after I trained as a psychotherapist I studied the Upanishads, Gurdjieff, Zen Buddhism, Taoism, Stoicism, Psychoanalysis, Transactional Analysis, Hypnosis, Ericksonian therapy, Cognitive-Behaviour therapy, NLP, EST, Brief Solution-focused therapy, and Acceptance & Commitment therapy. All of which later on filtered through the lens of working with my clients over the past 32 years.

This series of articles summarises my conclusions of what works best in therapy, as well as what doesn’t. And I aim to share these insights with you over the coming months.

Here is the planned list of articles (the list may change as the series unfolds)

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Keeping Brief therapy brief

In a study by the psychologist, Moshe Talmon, in the 1980s it was revealed that the most common number of psychotherapy sessions (the modal number) was one. That’s right – a single session was the most common in the largest group of clients. It had been thought that the reason one was the most common number was that clients were ‘shopping’ or ‘dropping out’. But a follow up study on clients who elected for single session therapy revealed that this wasn’t the complete story. And that many such clients were perfectly happy with their visit, stating that they found some of the answers they were looking for.

A famous example of single session therapy took place in August 1910, when the composer Gustav Mahler visited Sigmund Freud. Freud, who was on holiday in the Netherlands, took Mahler for a walk around the town of Leiden as they discussed the reduction in Mahler’s sex drive. We don’t know precisely what was said, but we do know that Mahler was happy with the advice Freud gave him, and that his marriage improved as a result.

Practitioners in Brief Therapy like me work on the assumption that every session – including the first – could be the last. Therefore every session focuses on helping the client change. Either what they want to change (for example, their anxiety), or how they can change (for example, moving away from the thoughts that create anxiety). Sometimes we might have a conversation about why change is necessary (for example, because doing so will improve their relationships). ‘Why’ conversations can be helpful, insofar as they connect clients to their values in life, and push them towards further changes.

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Defusing from Anxiety

In my last article I wrote about defusing from Anxious thoughts. In this article I describe how to exit from unwanted states. For example, a panic attack.

To remind you: defusion is the art of extracting yourself from an unwanted thought, a feeling, a memory, or a hallucination about some future event. Not resisting, resenting or running away from any of them. For if you do any of those things you give power to the gremlins. Instead, you acknowledge their presence, accept the gremlins are at work in your head, then smilingly turn your attention to a something worthwhile.

Distorted thoughts trigger bad feelings. A worry triggers anxiety. A helpless thought triggers depression. A craven thought triggers an addictive urge. In our example, let us say that you have thoughts related to social anxiety. Your mind is telling you that the party you are about to join will be a disaster. That you will have nothing to say. That others will conclude you are pathetic. That you will break down and will have to leave. For some reason, you fail to defuse from these thoughts in time. A few seconds later you experience a panic attack.

At this point you will most likely have another bad thought: that the panic is so awful you cannot possibly enter the room. And that thought seems like the clincher: you really have no choice but to go home.

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Defusing from Thoughts

In my last post I referred to the flaw in our minds through which we become entangled in anxious, depressing, obsessional thoughts. In this post I explore ways we can disentangle from them.

The time-honoured approach is that of Cognitive-Behavioural Therapy, in which we identify the thought, write it down and hammer it with facts, logic and counter-evidence. Exposing it for the nonsense that it is. A simpler, but similar approach is The Work, developed by Byron Katie in which you go beyond the thought by addressing four questions to it:

Is that thought true?

Can you absolutely know that it is true?

What happens to you when you hold that thought?

Who will you be without that thought?

Both these approaches work well for the majority of people, as I can testify from years of using both.

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The Flaw in our Minds

The more I work with depression, anxiety and obsessional disorders, the more they display a mystery about the human mind. How is it we are so easily hijacked by depressing thoughts, anxious thoughts, obsessional thoughts? On average, each human being has at least 50,000 thoughts per day. Some are trivial, some constructive, some are funny. 6,000 of them are repetitive thought chains, focusing on the same issue. Yet the anxious person will keep coming back to the same twenty or thirty negative thoughts. Every hour, every day. That tiny group of worries, self-judgments and catastrophic predictions creates her mental health problem.

What is it about the human mind that makes it so easy for us to be taken in by thoughts?

The answer lies in how consciousness works.

From a few weeks after birth to the moment of death, consciousness runs on like a continuous cinema reel, recording every event, every sensory experience, every thought, and every emotion. To which we add our ever-changing story. 

In consciousness, we also connect to the outer world: people (and the things they say), rooms, food, drink, atmospheres and (if outside) woods, trees, lakes and skies. Also, recording the inner world of thoughts, emotions, sensations, and reactions.

And here lies the flaw: that consciousness gives the same reality to thoughts as it does to experience, and on (factual) written or spoken words. We come to believe that what thoughts tell us are as real as the instructions in a manual. When in fact many thoughts have no referent.

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9 Habits of Resilient People (No. 9)

This is the concluding piece in a series of articles on resilience.

The ninth habit is: Resilient people are (mostly) spiritual people.

This is one of the few habits which has been studied scientifically. Numerous surveys show that people with spiritual beliefs live longer (on average) and manage stress better. They also cope with potentially terminal illnesses more effectively.

By ‘spiritual’ I mean those beliefs through which we live by a higher purpose in (or beyond) this life. A purpose which gives meaning and direction to existence. This could be based on formal religious belief but for many it does not. While some people have a deep sense of the divine at work in themselves and in others, some find this hard to understand. For many people it is enough for them to appreciate the beauty and intelligence in nature and its species; or in the revelations of art, science, mathematics and philosophy. For others still it is enough to know that they are giving service: for the family, for the community, or for future generations.

One reason spiritual beliefs and values aid resilience is that they provide us with a refuge in times of crisis: in tragedy, illness and death. They enable us to keep going even when we feel like giving up. They give us the strength to support others who are in despair. And despair is the enemy of resilience.

A deeper reason relates to personal fulfilment. To know that you are part of something bigger than you are, and that the service you give to others is important, provides you with an inner strength and a will to live that is inspiring to others and fulfilling to you. And, generally speaking, a fulfilled life is not only a happier life but a healthier one too.

9 Habits of Resilient People (No. 8)

This is the eighth in a series of articles on resilience.

The eighth habit is: Resilient people take ownership.

What this means is that resilient people take total responsibility for what happens to them. Another way of putting this is that resilient people do not become victims or succumb to self-pity.

This does not mean that ownership for what happens means that you are always the cause of what happened. It may be (partly) your fault if you lost your job, or your relationship, or got into debt. But you aren’t the reason for an airplane crash, a terroristic attack, or the cancer that killed your mother. But in either case you can decide how you are going to respond.

Let us also make a distinction between a reaction and a response. A reaction is usually automatic and predictable and woeful. A response is something that is planned, thoughtful and focused. Reactions may take any of the following courses:

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9 Habits of Resilient People (No. 7)

This is the seventh in a series of articles on resilience.

The seventh habit is: Resilient people spend time with resilient people

In article No. 4 in this series I mentioned that resilient people actively ask for help when they need it. The people they ask will most likely be people who are as resilient as themselves. For who better to ask than someone who knows how to deal with a crisis? For that reason resilient people will notice resilience in other people and will recruit them to their network of friends and supporters.

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9 Habits of Resilient People (No. 6)

This is the sixth in a series of articles on resilience.

The sixth habit is:

Resilient people practice self-renewal.

By self-renewal I mean that resilient people are never satisfied with the status quo; they are always looking for new horizons. Another way of putting this is that resilient people are continually re-inventing themselves.

Many of you reading this article may recall someone you know who mysteriously gave up their lucrative job in banking, or law, or in industry and went on a trip round the world (or went on a retreat in India, or built a house, or started a charity, or retrained as a teacher, etc.). I can guarantee you that that person is well-equipped to handle life’s disasters. For one thing they have shown already is that they are able to give up their attachments and start over again.

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