A recent research study summarised here in Science Daily has found mindfulness based cognitive behavioural therapy to be more effective than ongoing use of antidepressants to reduce the risk of people relapsing into depression. This is a significant finding, because four fifths of people who suffer from an episode of depression will relapse into another episode at some point in their life.
To be fair, the differences between mindfulness based therapy and medications was not statistically significant. However, even if the two treatments are equally effective, as might well be the case, this will still be significant for many people. Many people do not like to take psychiatric medication, either due to side-effects of the medication, or due to a wish to be pro-active rather than relaying on a pill. The alternative, that of doing eight 2.25 hour long group sessions, with the option of four sessions of follow up over the two years, is not onerous. Furthermore, some participants reported feeling empowered by learning mindfulness skills - something I've never heard in relation to taking medication.
Whilst both options can be effective, it's nice to hear alternatives to medication validated, as well as the transformative power of mindfulness.
Finding motivation and staying motivated for change can be hard. Whether you're trying to lose weight, improve your work performance, or become more focused in your sports training, these tips can help. How do we know this? These principles are drawn from a form of psychotherapy or counselling called motivational interviewing. The evidence shows that it can help with the hardest of changes, like getting an alcoholic to stop drinking, a heroin addict to stop shooting up, or even with stopping smoking cigarettes (which is more addictive than alcohol or heroin!) If this approach can work with these issues, then do you think that maybe it can help get you to the gym? You might want to try these tips in the order presented.
Tip 1: Explore the Ambivalence
Be honest, you want this change that you're thinking of, but you also don't want it. Change would be nice. If you get fit you might feel healthier, more sexy, your mood might improve from the endorphins, you might attract a partner, and lots of other benefits. Make a list of all of the benefits of making the change you want.
BUT! Making this change also won't be nice. Exercise is hard. At times you won't feel like it. You might feel awkward at first, or might be afraid of failure. Make a list of all of the reasons not to make this change. Be honest, there's a reason you haven't done it yet.
Now sit back and weigh up the pros and cons of change. It's not a guarantee that you'll pick change, but it will probably help you to move out of stuck ambivalence, which is tiring and frustrating.
Tip 2: Feel the Discrepancy Between How Things are and How You'd Like Them to Be
Our motivation comes from this discrepancy - things aren't how we'd like them to be... otherwise, we'd have no motivation to change. Spend some time reflecting on, or telling a friend about how things are and how you'd like them to be. You might start with the facts of the situation, but what really motivates us is feelings. When you can feel your dissatisfaction, rather than ignoring it, you're much closer to being ready to change. This might be a bit painful or scary or frustrating, but if you're focusing on something that's good for you, it may be worth it.
Tip 3: Focus on What's Possible
You might have done the above two steps and feel really fired up about making your change, but not do the necessary actions to make that change real. Why? If you don't think it's possible for you to succeed, you probably won't try. Make a small, realistic goal, or problem solve the challenges until you feel confident enough to actually try.
Good luck for making your changes!
Like many of us, over Easter I got away from Christchurch to take a break, and to get a bit of the nature cure. As it does for lots of us, it worked for me, but I also feel that I got some more insight into how we relate to our environment, particularly those of us who have more environmentalist tendencies.
I was looking out over a lake at the view, and began to notice the wind pick up very quickly. This disturbed my reverie. I began to watch the people on the beach below me take cover. Boats out on the water adjusted their course. The trees began to sigh and whistle in the wind. It was then that I got it: rather than my normal environmental thinking that the earth is fragile, and that frankly there are more than enough of us humans to go around, I shifted my thinking.
Maybe it was the vastness of the high country landscape, or the fierceness of the wind, or the human response to take cover. The earth and it's ecosystems are robust, and will survive (albeit changed) us humans, however much environmental havoc we may create. We humans are vulnerable, with precariously teetering economies, ultra specific needs for lifestyles and health, and a sense of cultural harmony and good will that is fragile at the best of times.
Perhaps that is why psychotherapy and counselling are useful for addressing environmental issues - or at least another reason for it's value. Psychotherapy, the art and science of working with human vulnerability, is exquisitely attuned to working with the ways we deny or guard our vulnerabilities - and the consequences of this.
So, if you find yourself as an environmentalist assuming your own robustness, and projecting your vulnerability onto the earth, then try turning it on it's head. See if you feel more refreshed and human, and maybe even feel a bit warmer towards not only yourself, but the rest of the human race!
I've noticed that the recent tipping of the beautiful Christchurch weather into rain, wind, and grey skies has had an effect on my mood. I find myself feeling slightly more serious, a bit more withdrawn, and a little bit somber. (You don't have to worry about me though - I'm not getting depressed, and as a therapist, I'd know!)
We all know weather affects our mood, but interestingly, I rarely meet people who are angry at the weather. We don't tend to look up at the sky and shake our fists in anger at it, even when the weather really has ruined our day or our plans. I think we don't get angry at the weather because we don't personalise it. There's just no point getting angry and geared up to fight the weather, because it really is hard to convince ourselves that the rain is coming down out of a sense of spite and malice or intent to personally hurt us. It's just laughable. This makes bad weather generally a nuisance, but nothing more than that, because we don't add an extra layer of suffering through getting angry and getting into conflict with the weather.
What if we could similarly avoid unnecessary suffering in our relationships? Actually, it is possible. By talking through in therapy our rationale for our anger, we can familiarize ourselves with it, and then often let it go. For instance, if I get angry at my partner, and realise that a belief that reinforces that is that my partner takes me for granted and exploits me, then in therapy I can really examine that. Are there other possible explanations for his or her behaviour, explanations that may move us towards compassion rather than anger? Or, on the other hand, maybe my explanation that my partner exploits me is actually correct, but, will I be better served by examining my own complicit patterns of naivete?
Through therapy we can develop the capacity for emotional balance, in which we may be affected by the storms of our life, but do not become pulled into fighting ourselves and others unnecessarily.
Having recently been practicing counselling and psychotherapy in Australia, I've noticed that here in New Zealand we are lagging behind in awareness and use of online therapy. I have no evidence to back this up, but I presume that Australians are taking to online therapy because of the difficulties accessing a therapist due to the immense distances and spread out population, once you get outside of the major cities.
Therapists use various video platforms to work with clients, including popular ones such as skype. My experience has been that after a self conscious first five minutes, and bar the occasional irritating lag or need to repeat a sentence, both therapists and clients quickly forget that they are not in the same room together, and that online therapy really functions very similarly to meeting in person.
But, you may ask (I certainly did)... does it work as well as meeting in person? Actually, what research I've seen actually says that it works better. This article summarises the findings briefly. Intuitively, I'm not so sure about this, and want to inject a note of caution. The type of therapy studied, cognitive behaviour therapy, is fairly brief therapy that tackles the symptoms but not the causes of the issues. I'm not so sure that deeper therapeutic work would translate so well to working online.
Still, I think that online therapy is a great addition for people who live in remote areas, those who want to access a specialist therapist who may practice far away, or those who are impeded by shyness or disability from doing therapy in person. At Lucid Psychotherapy we do offer online counselling, so contact us if you're interested.
What would it be like to have an uninvited guest come to stay... indefinitely. This guest isn't just with you at home, they come with you for walks, to work, when socialising with friends, in fact, everywhere you go, this guest tags along. Not only does the guest come and observe, creating a certain amount of awkwardness in you and self-consciousness, but the guest keeps speaking up with opinions and judgements. In fact, the guest keeps up a running monologue during your entire day, only to be drowned out occasionally by television or other stimulation that is loud enough to drown out that incessant voice.
Sounds like a nightmare, doesn't it? Well, welcome to your life, or your own mind, to be more precise. Those who have practiced a little bit of mindfulness will probably recognise the above description, because it is such a common experience to begin some sort of mindfulness practice and feel quite shocked at just how much our internal monologues just won't shut up.
Whilst mindfulness practice at first highlights our inner commentary, persisting with practice will help bring relief. We cannot permanently evict our uninvited guest, as much as we might like to, but we can slow down the commentary, learn not to buy into everything it says, and generally have a more spacious and compassionate experience in how we talk to ourselves.
Integrating mindfulness into the therapy and counselling process can be very empowering for clients and therapists, particularly because sometimes what is required isn't analysing, understanding, or changing something in our lives. Sometimes it's just being aware or our lives and ourselves, and accepting what we see. Mindfulness is a tool for doing just that.
In addition to our Wednesday morning clinic at Doctors of Cashel (7 Cashel St), Lucid Psychotherapy is happy to announce that our therapists have started another clinic, all day Monday at 296 Barbadoes St (Urban Eden Psychotherapy Practice.) We even have some evening appointments available at this location on Mondays. We're happy to be able to keep growing, and keep offering innovative, effective psychotherapy to the people of Christchurch.
This is the last in a series of posts on the relational approach to psychotherapy and counselling for common mental health issues. This post covers anxiety issues.
Like other mental health issues, there are different approaches to dealing with anxiety. The medical approach has it's advantages, but as anyone who has become hooked on sedating or anxiety reducing medication can tell you, it is not without its risks. Another approach, that of mindfulness based treatment for anxiety issues, can be very effective. By learning to control our attention through mindfulness, we can empower ourselves to regulate our physiological anxiety responses, and to deal more effectively with anxious thoughts. Neither of these approaches, however, deals with the relational context of our anxiety.
Our experience of panic, generalised, or specific anxieties is often triggered by relationship with others. In particular, we may be anxious of conflict with others, being vulnerable with others, around displaying certain emotions, or around intimacy in general. With the guidance of a psychotherapist or counsellor, we may be able to approach whatever our personal forbidden territory is, that anxiety keeps us away from. Usually when we approach this territory, we discover that it is not what we thought it is, and we can begin to get more familiar and comfortable with the anxiety provoking situation in our relationships.
In particular, as a therapist, I would watch for moments when a client re-enacts an anxiety driven pattern with me, their therapist. For instance, a person who goes to an old pattern of care-taking in relationships, when feeling anxious, will probably do that with me, their therapist, sooner or later. Working with these moments when the issue is "live" between therapist and client can be some of the most potent opportunities for healing and transformation.
Please let me know what you think about this, and stay tuned for further posts on other topics.
The relational approach is hot in the therapy world at the moment, but what does it actually mean, and why would those who are not mental health professionals want to know about it? This series of posts will discuss how we do or don’t think relationally about some common mental health issues, and what the implications of this might be.
First we’ll look at one of the most common mental health issues, depression. This is a significant issue in New Zealand, as probably most of us know due to series of education campaigns and some very useful efforts to reduce stigma. Often, however, campaigns to de-stigmatize mental health issues cast those issues in a medical light, presumably because we tend to feel little shame over other medical issues such as a broken leg or a heart condition. When taken to the extreme, this can lead to thinking that equates depression with chemical imbalances in the brain that are really only the responsibility of our doctor to deal with. Just like I wouldn’t advise a neurosurgeon on how to operate on me, coming from this perspective, I might sit back and wait for the medication prescribed by the expert to do its work on my depression.
I’m not advising anyone against anti-depressants, but I am suggesting that there’s more to the picture of depression than this. Two subtypes of depression involve relationships of abandonment/grief, and of intense self-criticism.
If I am suffering the first subtype, that of abandonment, I may be experienced in relationship as very difficult to reach and connect with, and my (sometimes unconscious) expectation of others is that they will readily abandon me. Others, whether recently or in my childhood may actually have abandoned me. Furthermore, I may now act in ways that sustain this pattern, by for instance, retreating from others into a depressive isolation. From this relational perspective, my depression isn’t only a chemical imbalance in the brain, it is a state of sustained and often unacknowledged grief, loss, and appropriately to this, sadness. If I'm depressed and doing therapy from this perspective, therapy isn’t just about kickstarting my brain's chemistry, but about helping me to grieve, and bringing me back into relationship – often starting with a relationship with a warm, reliable, and empathic therapist.
If I am suffering from the second subtype, that of self criticism, it may be extremely painful for others to witness just how much I disappoint myself. Though others may accept me, and I may even long to accept myself in the same way, it is as if an invisible wall exists to stop any of this acceptance easing my pain. A criticising relationship with myself has been internalised. In order for me to break with my loyalty to this self-criticism, in therapy I may need to explore with my therapist where it came from. What were the earlier relationships in my life in which I was criticised or invalidated, and was this criticism valid? Were the standards or the purposes of this earlier criticism compassionate and guiding, or punishing and unrealistic?
In a nutshell, that’s my brief introduction to a different, more relational, and hopefully more human way of viewing depression. Please let me know in e-mail or comments what you think about this. Check in again soon for the next post in this series: a relational approach to borderline personality disorder.
Post by Michael Apathy at Lucid Psychotherapy and Counselling.