Taunton Somerset Counselling David Trott

Taunton Somerset Counselling David Trott

About the Author

To book a counselling session with David, or to request further information, please call in confidence 01823 443022. You may also contact David via email on: davidtrott747(at)btinternet.com Please replace (at) with @ in the email address.

David has a specific focus on integrative counselling, integrative counselling and psychotherapy, the integrative counselling model and the integrative counselling approach.

Keep up-to-speed with David's integrative counselling and psychotherapy articles that explores integrative counselling case studies.

Qualifications

David is a member of The British Association for Counselling and Psychotherapy (BACP) and works strictly within their ethical framework. As a fully qualified Integrative counsellor, he can adapt the therapy on offer, to best meet the individual needs of the client or group.

What is the BACP Register Counsellors & Psychotherapists?

The BACP Register of Counsellors & Psychotherapists is a list of BACP members who have met the standards for registration. In addition, the Register has gained an important quality mark of accreditation by the Professional Standards Authority for Health & Social Care, which is an independent body accountable to Parliament.

Website URL: https://somersetcounselling.org

The Rationale Behind Talking to a Counsellor Rather Than Friends or Family

Back in 2012 I wrote an article about how it’s far better for someone in distress to talk to a professional counsellor than a friend or family member. Now seven years later it feels right to update and expand that piece in line with current attitudes and ideas. Since my original post we have seen views about mental health and personal stories being expressed more openly, often by celebrities like actors, musicians, sports stars and even Royalty. These people have done much to bring the whole subject of mental health into the limelight and have helped to improve attitudes to where we now see psychological health moving towards being treated the same as physical health. However for some progress is gradual and by this I mean we still encounter occasional derision around mental health issues by some who wouldn’t dream of disrespecting a person with a physical illness and so we sometimes still find prejudice if we scratch below the surface.

Previously I talked of what can happen when someone confides in a family member or friend and the result of that being the listener possibly feeling some responsibility for the talker’s situation. When this happens it’s a springboard for upset and hurt and may trigger the talker to hold back and not talk freely about their concerns and issues because they are afraid of upsetting the listener. An example of this could be the son encouraged to follow in his father’s footsteps and join the family firm, even though the young man had other ideas about his future. Plucking up courage to speak to his parents about his unhappiness and the feeling that joining the firm was a big mistake, he gets into a heated argument and decides that he cannot raise the subject again. The parents feel hurt by their son’s apparent rejection of their help and his ungratefulness at the chance to carry on the family business and ruminate on `where they went wrong. `

Alternately, if the young man has sought the help of a professional counsellor, things might well have turned out differently. He would have been able to talk freely without any fear of upsetting anyone because counsellors and psychotherapists are not personally connected to their client’s story and are independent in their outlook and because of their long training are virtually unshockable. A proficient therapist will be genuinely interested in their client, empathic and non-judgmental and do their best to help their client but they won’t advise them or tell them what to do. It’s all about the therapist supporting the client while he or she explores their thoughts and feelings and if the client can come up with their own solutions there’s more value in that then being told what to do. The client will be encouraged to maybe see things differently and helped to explore ways of resolving their situation. All this is done in the confidential and private setting of the counsellors own comfortable therapy room.

Depending on the individual client a profession counsellor will work with them along a planned path, which will start with identifying what the client wants to achieve in counselling, what changes they want to make to their lives and what their goals are. Through active listening the counsellor will help the client identify unhelpful thinking and irrational thoughts that are creating unwanted feelings and explain how to replace those unhelpful thoughts with new positive ones.

The work might include the acquisition of an understanding of the origins and development of emotional difficulties and becoming more aware of thoughts and feelings which had been blocked off or denied. Hugely important is self-acceptance and the development of a positive attitude towards self and movement in the direction of fulfilling potential as well as being assisted to arrive at a higher state of spiritual awakening. The therapist will also help the client to find a solution to problems which the client had not been able to resolve alone. Right from the very first session, the aim of counselling is that at some stage the client will leave feeling better about whatever was troubling them and with new skills to keep themselves psychologically well. So we can now see now that it’s not just family and friends being too close to be helpful, it’s also the skills the counsellor has to move things forward that makes things different.

In conclusion: Imagine that you have taken yourself away to your favourite seaside resort to give yourself time to make sense of something disturbing and worrying in your life. You walk along the front, taking in the vastness of the sea, the seemingly endless beach and the gulls riding the wind overhead. You notice families enjoying a day out and couples holding hands with eyes only for each other, oblivious to people around them. You reach the end of the promenade to where the bandstand sits upon a grassy knoll and decide to sit for a while on a wooden bench where you get into conversation with a total stranger. The stranger seems understanding and genuinely interested in you and you find yourself trusting them. You pour your heart out to them and talk of things that you have never told your family or friends. This is similar to counselling because counsellors are not personally involved in the situation and are impartial. Therefore there is no conflict or bias and you won’t upset them because they are trained to listen. Hence, there is no hidden agenda, no ulterior motive, no past, regret or guilt: the counsellor is maybe the perfect stranger.

What To do Next

If you feel counselling is maybe what you are looking for, or if you require further information the next step is very simple. Visit the Contact page and drop David a message via email, or call. 

To book a counselling session with David, or to request further information, please call in confidence 01823 443022.

© David Trott 2019

 

 

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Farming: We Reveal the Dark Side

Travelling around Somerset and our neighbouring counties it’s easy to become accustomed to the lush pastures, rolling hills, woods, hedgerows and huge areas of arable land that make up our wonderful environment. To us it may just be the backdrop to our busy lives but to the operators of one of the biggest and important industries in the UK, it’s their workplace. We are talking of course about farming and the men and women who help feed the nation and add billions to the economy of the nation; the farmers.

According to 2014 Government figures the value of UK agricultural production (at market prices) was £25.8 billion, this included 970 million dozen eggs laid by 37.1 million birds and 14.6 billion litres of milk from 1.8 million cows. During this period 400,000 people were employed in farming and 71% of land in the UK was used for farming – impressive by anyone’s standards.

To the layman or casual observer, farming may seem an idyllic and pleasant way to earn a living. We see farmers out on their tractors or passing by in Land Rovers with their trusty black and white Collie in the back and we may think `That’s the life`. We might be impressed by the massive machinery they use or the nice looking farmhouse and buildings. We could notice the farmer’s children playing in the yard with the freedom that we wish our own children had. It’s possible that we really believe we see real farming life at the county shows where the gleaming white coats of exhibitors and their beautifully presented animals convince us that all is perfect and flawless down on the farm. We might then venture into the food tents and sample the delights within. It’s no accident that the red and white gingham tablecloths, cheese, pickles and crusty bread feed into our desire to view farming as a wholesome, healthy occupation enjoyed by wholesome, healthy ruddy faced people who love the countryside and the job they do. But there’s another side to this seemingly idyllic profession, a dark side that’s not spoken about very often, a side that even in our open society cries out to be heard and understood; mental health issues for farmers.

Countryfile Magazine drew attention to the prevalence of mental illness among farmers recently with the shocking statistic that on average one farmer will take his own life each week in the UK. In France the situation is worse where a farmer dies on average every two days. So why are farmers at such high risk of suffering mental health issues?

Farming can be a very isolated occupation and it’s common for farmers to do entire days without seeing anyone, a far cry from bygone days when many farm workers were employed on the average farm. As opposed to many other professions farming is a 24/7 occupation with very long hours, far less days off and holidays and with the added element of `living above the shop` where the farmer cannot leave the worries and stress of his work behind at the factory gate.

We have seen many factors over the years that have tipped many over the edge – these include Foot and Mouth, Bird flu, TB, difficult market pressures, flooding, and loans and mortgage repayment issues, any one of which have the potential to decimate livelihoods. As well as this there is the sometimes negative perception of some farming methods by the general public

The social isolation of farming can lead to a lack of support or a lack of other people noticing mental illness symptoms. Most farmers are male, and it’s widely accepted that men are less likely to discuss personal problems than women. This could be linked to strongly held beliefs that men should be able to sort themselves out or that seeking help is somehow a sign of vulnerability or weakness. It’s also known that men are far more likely than women to take their own lives.

The most common mental health problem is depression, one in five of us will suffer from this at some point during our lives, and farmers are no different. There are major differences between feeling low and being clinically depressed. When the latter develops, the person can be affected most of the time, frequently for a number of weeks or months. Symptoms can include tiredness, restlessness, low mood, falling energy levels, poor concentration, a lack of interest in things that would normally give pleasure, an increase in alcohol or tobacco use, loss of sex drive and suicidal thoughts. Physical symptoms such as aches or pains may also occur.

So where can farmers turn for help? As a professional counsellor working in a village on the outskirts of Taunton, I have had clients from all walks of life. These include mechanics, architects, accountants, cleaners, musicians, garage owners, web site designers, welders, members of the armed forces, dentists and farmers. Although hugely diverse in their occupations, they all had something in common; there was something in their lives that prevented them from leading a happy and contented life, a black cloud that followed them around and weighed heavily on their shoulders.

Talking to a professional counsellor or Psychotherapist can help immensely. One reason for this is that counsellors and psychotherapists are not personally connected to their client’s story. A good therapist will be genuinely interested in their client, empathic and non-judgmental and do their best to help their client, while at the same time not advising or telling them what to do. It’s all a question of support for the client – support to help the client explore their thoughts and feelings and support to maybe see things differently and to hopefully move forward towards resolving their situation. All this happens at the client’s own pace in a confidential and private setting.

As well as counselling there are other avenues open to farmers seeking help with stress, depression and other mental health issues, these include -

Whichever path the farmer decides to go down for help, it’s important that one is taken. With deep seated habits of just managing or trying to cope on one’s own it sometimes feels right or normal just to carry on in the same old way but there is an alternative and that is to seek help before things get worse.

About the Author

David grew up on a small farm in Somerset, where as a young boy he helped with milking, the pigs, chickens , sheep and beef bullocks and in the summer, the hay making. He often attended livestock markets with his father at Glastonbury, Highbridge, Yeovil, Langport, Bridgwater and Taunton and helped with the family wholesale butchery business. Although almost a lifetime ago and set in a bygone age he feels it gives him an insight into the stresses of farming life and an empathic view of the valuable and essential work of the farming community.

What To do Next

If you feel counselling is maybe what you are looking for, or if you require further information the next step is very simple. Visit the Contact page and drop David a message via email, or call. 

To book a counselling session with David, or to request further information, please call in confidence 01823 443022.

© David Trott 2019





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Understanding And Managing Emotional Baggage

All of us, as we travel through life, acquire emotional and psychological baggage; unwanted stuff from painful events and times in our lives that we have not been able to get rid of. We drag this burden around month after month, year after year, often unaware that these negative feelings are shaping and influencing who we think we are and the choices that we make. Some of this baggage is overt and plain to see, while other baggage is concealed and lurks down in one’s subconscious.

What might be an example of emotional baggage? A fictional but an entirely plausible scenario might be the woman abused at an early age by a trusted relative. Through clever and devious means the young girl is led to believe by the perpetrator that she is somehow to blame for the attack.  She then carries this belief into adult life which then affects the view of herself, her life and relationships. She might therefore retreat from the limelight, keeping herself in the shadows where she won’t attract attention.  She might dress plainly and not make the most of herself for the same reason.  She might consider herself not worthy of the good things in life and by doing so punish herself for what `she did wrong. `

So why do we put up with it? It’s been said by some that this baggage can almost become comfortable to carry, we certainly get used to it’s weight and sometimes can’t imagine what it would feel like to be without it. However we have a choice; to carry on taking this stuff around with us, allowing it to disturb our lives, relationships and future or to make a conscious decision to ditch it.

In the counselling room I see baggage, either overt or subconscious rearing it’s burdensome head most days. As a symbol of this I often describe a scene from the brilliant 1986 film The Mission set in 18th century South America in which Captain Rodrigo Mendoza played by Robert De Niro drags around a large net of armour, shields and swords as penance for previous behaviour.  The scene is harrowing and follows Mendoza as he struggles through jungle and rivers and up steep hills with his huge load. At times he loses his footing and tumbles backwards but regains his stability and forges forward again, never able to put his burden down until he has punished himself suitably. It’s a fine performance by De Niro but one that is played out every day by ordinary people with ordinary lives  

So we see that emotional and psychological baggage can affect who we think we are (Ego) and influence our choices in life. But how do we put down that baggage once and for all? The answer is likely to be counselling, where long held beliefs and assumptions can be explored together by the person and the therapist and maybe a different view of the client’s situation offered.

The fictional client discussed above, when in therapy could well come to see that the abuse she suffered was not her fault. She might then feel able to come out from the shadows and allow herself to shine. She might put herself forward more, have more confidence, dress better but most of all put down that heavy sack of armour.      

© 2017 David Trott 

 

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The Psychology of Hoarding

In counselling and psychotherapy as in many other walks of life, one can never be sure what problem or issue our next new client will bring through the door.  In this hectic paced life with it’s stress and pressure, anxiety is often the fundamental subject of concern for clients, although this may be cloaked or concealed, masquerading as something else.  So before us we have the overt and obvious and then we have the concealed and stealthy, each intertwined with each other like garden ivy.  Attempting to unravel this, we may ask which happened first, which in itself is reminiscent of the chicken and egg dilemma.

Filling one’s house, garden and garage with things, known as `Hoarding` seems to me to fit exactly into this possibly over simplistic picture of anxiety leading to hoarding or hoarding leading to anxiety.  Our understanding of this distressing situation has been greatly helped in recent years by excellent TV programmes such Channel 4’s `The Hoarder Next Door` where we see renowned psychotherapist Stelios Kiosses working with people who have surrounded themselves with possessions and who cannot bring themselves to part with them.   In almost every case, as the therapy unfolds, the client is found to have suffered some form of trauma or loss in their life and the therapist can often attribute the start of their hoarding behavior to this unhappy time in their lives.  So we see the client feeling a need to surround themselves with possessions which gives them comfort and a sense of security in their vulnerable state.  The problem of course is that the amount of possessions gets out of hand and affects the functionality of their house.  However, despite the difficulties that their hoarding creates, the client finds it extremely hard to let go of their things because doing so would cause more trauma through the loss and separation.

In severe cases we see people with so many possessions that they are unable to use rooms in their house for the purposes that they were intended.  For example people that are unable to reach their bed and so they sleep in a chair amongst their hoard or they cannot use their kitchen or bathroom because of the clutter.   It’s not unusual for the person’s hoard to have little or no monetary value but none the less the person will have an ultra strong attachment to it and will become extremely upset if someone tries to clear it.  Therefore it’s easy to see why treating Hoarding Disorders can be quite difficult.  This is partly because very often Hoarders don’t view their habit as an issue and have little appreciation of the effect it’s having on their lives.  Those who do realise they have a problem may not ask for assistance because they feel ashamed or embarrassed.

Is there a difference between hoarding and collecting?

The simple answer is yes and the difference is how they are organised.  Lots of people collect items such as coins, matchboxes, beer mats or thimbles but these are usually easily accessible and well organised.  There might be albums, shelving or those shallow plastic organisers with partitions and compartments involved and may have a value.  However a hoarder may collect random stuff like old newspapers, magazines, plastic containers, leaflets or cardboard boxes in a non structured way i.e. piled on top of kitchen work tops, on settees and chairs, in the bathroom and in the stairs, impairing the use of these places.

The thinking and logic of a hoarder will almost certainly hinder their ability to get rid of things and this will show itself in excuses and reasons why they need to keep their hoard.  Broken electrical items will someday be repaired, out of date food is still ok, old newspapers might contain something interesting, eighty-seven ice cream containers are useful for putting stuff in, the supermarket trolley in the garden could be converted to a go-cart for the grandchildren, the bank statements from 1957 might be required by HMRC and those leaflets about pizza and curry houses might be needed one day.  

Treatment is often in the form of Cognitive Behavioural Therapy (CBT).  Here the therapist helps the person to understand why they find it so difficult to throw things away and why the clutter has amassed. This will be in conjunction with hands-on tasks and strategies to work with.

The following case studies are real but have been generalised and disguised to protect the identity of the clients, who have all given their permission for their story to be anonymously outlined here.

A symbol of another age

Attachment features strongly with hoarding issues but also filters down into the need or compulsion of keeping of items which maybe do not suit the style or period of one’s house or are simply disliked, solely because they came from an emotionally significant person.  One such circumstance comes to mind when a middle aged man had to clear the house of his late mother.  Much of the ladies possessions were worn out or broken but she did have a rather beautiful oriental teapot which the son placed in pride of place on his own welsh dresser. 

The man’s wife agreed it was a fine example of a teapot but felt it didn’t fit into the style of their house and suggested that it should be put into a sale of fine art and china.  The man resisted, pointing out that it belonged to his mother and what a lovely thing it was.  To call it an argument is too strong but whatever it was, it went on for some months until the very last time the man repeated his plea  `But it was my mother’s`.   At that point the wife having had her fill of his reasoning exploded with `But your Mother wasn’t a ******* teapot.

Later in therapy we found out that there was of course more to it than the ******* teapot.  The piece came from a gentler time when tea was expensive and tea making was a sophisticated ritual.  The item itself had originally belonged to the man’s Grandmother and had been brought back from Hong Kong by another of her daughters, who was married to a shipping executive based there.  It was the days of Ocean going steamers, deck chairs on the sundeck, white linen suits and cigarettes in stylish holders, in fact a vignette of pre-war refinement.

It became likely as our work together progressed, that our man unconsciously sought to hang on to those genteel, sophisticated days that his family had once been a part of and really had little to do with the teapot itself.

Unable to lose anymore

An example of someone surrounding themselves with possessions in the aftermath of trauma again comes from my own client work.  My client’s son went abroad to live and left his father with his car to look after.  The car had a certain smell to it – tobacco and that single guy sort of aroma of aftershave and body spray.  When it became apparent that the son had made a new life for himself and he would not be returning, pressure mounted on the father to sell his son’s car.  He dragged his feet over this, annoying his wife greatly because they had little room for it on the driveway.  The father would start it every week and sit in it – feeling that he was looking after it for the son.  He felt it was a link to the boy and he enjoyed thinking about the places he had been taken in it. However, the longer it stayed there, the more the car developed into a constant reminder of the loss the father felt.  He was unable to move on and accept the new situation, instead he insisted on protecting the vehicle from those who threatened it and his associated memories.

Recapturing childhood

A man approaching retirement booked a counselling session and explained that he had become almost addicted to attending Toy and Train Fairs, where he spent copious amounts of money on older Dinky die-cast toys and Hornby locomotives and rolling stock.   Such was his obsession that when he got home, he would leave the items in his car over the following week and smuggle them past his wife in dribs and drabs.

In this case we cannot call the man a hoarder because his collection was organised and tidy, however there was something more to it.  In therapy it emerged that the man got a warm fuzzy feeling when he bought something he liked and it was more about this feeling than the actual toy or model itself.  It’s very likely that this warm fuzzy feeling he talked about was caused by the release of Dopamine in the brain and this pleasurable feeling is very addictive.  In further sessions it came out that he had had a rather impoverished childhood and he was never able to have the things that many other children had.  As an adult he had become successful and quite wealthy and decided that he would have everything that he had missed out on as a child and so he surrounded himself with lovely things.

As therapy continued he felt strong enough to tell his wife of his past actions and to also miss the odd toy fair or show.  He stopped smuggling items into the house and eventually bought less and less.  In the end it was enough to know that he could have more if he wanted it but really his collection was now complete.

Losing a loved one

Another situation where attachment shows itself is in the period following a bereavement.  The transition stages from the shock and numbness of the initial loss to the acceptance of the new situation is well documented and is indicative of the progress the bereaved is making.  However, some people get stuck and this can show itself in the refusal to dispose of the decease`s belongings, partially clothes.  From the outside, one can see that there is no logic to this practice as the person has died and will not be returning; however for some the need to keep the clothes is overwhelming. 

Despite much preparation, the task of disposing of a loved one’s clothes is probably never going to be easy and for some people it may rank as one of the most stressful experiences of their life.  For many, it may take months to feel strong enough to start the task but for Hoarders, it may never happen without professional help.  Somewhere in the distressed state of mind of the bereaved is probably guilt at what needs to happen and maybe a sense of responsibility as custodian of the deceased person’s things.  These possessions are obviously a link and may well still carry their scent.

So, it’s clear that Hoarding is often a symptom of an underlying issue such as loss, attachment or trauma.  In such cases the root cause must be addressed before working on the resulting problem.  Here at somersetcounselling.org we use the analogy of the flat tyre – we look, find and repair the puncture before we attempt to inflate it again.

 

 

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Royal Speaks Out On Mental Health Issues

Like a breath of fresh air Prince Harry this week has spoken out about his own mental health issues in the years following the death of his mother Diana, Princess of Wales when he was 12 and the positive results he received from counselling. 

In the past we have heard honest and in depth accounts of mental health problems from celebrities such as Stephen Fry and Ruby Wax who have done much to bring to the fore these issues but Prince Harry is the highest profile person in this country to speak in such personal terms. I believe that this will do much to help remove the stigma that still remains around mental health issues.

In my own work as a professional counsellor I see many clients who are surprised by the fact that the brain is just another organ of the body, like the stomach, heart or lungs and can go wrong.  If a person consulted their GP about chest pains, there probably would be little of the embarrassment or apprehension likely from a consultation about depression, anxiety, phobias or suicidal thoughts.  In fact it’s likely the person with chest pains would wear the scar of any future surgery with pride, unbuttoning their shirt and showing friends and family.  Generally this is not the case in the UK with mental health where such concerns are spoken about in hushed tones or not at all.   I see this manifested in my own practice where some clients have travelled many miles from home to be somewhere they are not known and so are less likely to bump into friends.

Prince Harry in his honest interview with The Telegraph’s Bryony Gordon speaks of blocking out his mother’s death by sticking his head in the sand as a way of coping with it.  The result he says was a shutting down of his emotions for the last 20 years, which in turn had a serious effect on his working and private life.

With the interview, Prince Harry is following in the footsteps of his mother who in 1995 spoke in a groundbreaking interview with Martin Bashir on BBC’s Panorama about her post-natal depression, self harming and bulimia.  Now 22 years later Prince Harry once again breaks with tradition and talks openly about issues that affect one in four of us, where rank or circumstance affords no immunity.

Prince Harry has discovered what many have known for innumerable years, that talking helps.  Since the early mists of time, people have sought out someone to confide in and these days we are lucky to have an abundance of highly trained professionals to listen.

If you feel you are affected by any of the issues mentioned by Prince Harry or have any other concerns that are troubling you, then I urge you to seek help in the form of a professional counsellor because as Harry found `it’s good to talk`.

© David Trott April 2017

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Cognitive Behavioural Therapy and Types of Unhelpful or Irrational Thinking

In the modern world of counselling and psychotherapy, a leading tool used by therapists is Cognitive Behavioural Therapy (CBT).  This works by the client being shown by the therapist the link between events that happens in our life, our beliefs associated with those events and our resulting emotions and behaviour.

A key aspect of CBT is the Types of Unhelpful or Irrational Thinking that we might employ when we try to process what is happening.  These engrained faulty patterns of thought often prevent us from seeing things as they really are and can make a situation worse.

In no particular order, let’s start with `All or Nothing or Black and White` thinking – this is perfectionism.  All or nothing thinking is extreme thinking that can lead to extreme emotions.  People either love you or hate you.  Something is either perfect or a disaster.  Imagine you are trying to eat healthily in order to lose weight or to get fit but you give in and eat a doughnut.  All or nothing thinking may lead you to conclude that your plan is in ruins and you might as well eat the other eleven doughnuts in the pack.  Another example might be the shiny new car on our driveway, which is our pride and joy.  In a supermarket car park someone opens their car door heavily and puts a ding in the side of our prized possession.  With All or Nothing thinking, our car is ruined and might as well be scrapped. Our world is not black and white.

Next we have Overgeneralising - sweeping statements.  This is the error of drawing global conclusions from one or more events.  We tend to assume irrationally, that if one thing goes wrong everything else will.  For example, you get into your car to go to work, it doesn’t start.  You think to yourself `Things like this are always happening to me.  Nothing ever goes right`.   Other examples might be `It’s not safe to step outside your door these days` or `They’re building everywhere, there’s no green fields left.  If you find yourself with thoughts that involve the words always, never, everybody, nobody, the world is…, all, none, people are…you may be overgeneralising.  Be specific about the situation.

Another unhelpful way of thinking is Mental filtering – focusing on the negative.  Glass half empty.  Mental filtering is a bias in the way you process information in which you acknowledge only information that fits with a belief you hold.  For example – you believe that you are unlikeable and really notice each time your friend is late to call you back or seems too busy to see you.  You tend to disregard the ways in which your friend acts warmly towards you on other occasions. 

Our next unhelpful way of thinking is Mind reading – and that is assuming you know what others are thinking.  With mind reading the tendency is often to assume that others are thinking negative thoughts about you.  For example – you are chatting with someone in the street and they look over your shoulder as you are speaking, breaking eye contact and yawn.  You conclude that the other person thinks your conversation is dull and he’d rather be talking to someone else.  In CBT the theory is that there is always another way of viewing things, so the person you are talking to may be yawning because they slept badly and looking over your shoulder because they are expecting their bus to arrive.  There are countless possibilities and probably don’t involve you. 

Fortune telling – This is very much like our previous example.  You think you know what is going to happen.  You probably don’t possess the powers of a superhero that allows you to see into the future but still think you can do it.  For example you have invited your boss and her husband for dinner.  You are worried by this and decide that it is going to be a total disaster.  They won’t like the food, your house and you won’t know what to talk about.  Fortune telling can stop you taking action and can work like a self fulfilling prophecy.  

An interesting but maybe a harder one to identify is Personalization and blame -removing yourself from the centre of the Universe- you see yourself as the cause of some negative external event.   Taking excessive responsibility for bad things.  Significant negative events are very rarely down to just one person.  For example you feel guilty because a friend lives in chaos and turmoil and you can’t sort him out.  You think `If I was really a good friend, I’d be able to help him`.

Now we get to  Awfulising or Catastrophising - exaggerating the importance of something.   Thinking that a situation is worse than it is.  Awfulising is taking a relatively minor negative event and imagining all sorts of disasters resulting from that one small event.  Some people seem to have a tendency to look on the black side.  You are waiting for your teenage daughter to return home at night.  She is a little late, by which time you have imagined she has been kidnapped by the local mad axeman, involved in a serious accident or has run away with her boyfriend to a hotel in Cornwall.  CBT is evidence based and so it’s likely that you haven’t any to support these fears.

A unhelpful way of thinking which is quite subtle and crafty in it’s action is - Emotional reasoning - assuming your negative emotions are how things really are.    This is confusing feelings with external reality.  An example of this could be - your partner has been staying on late at the office with a colleague for the last month.  You feel jealous, suspicious and mistrustful.  Based on these feelings alone you conclude that your partner is having an affair with their colleague.  One might feel that Birmingham is the capital of England but feeling that, however strongly, doesn’t make it so.  Stay with the facts and evidence.

A common thinking error is Labelling and mislabelling – This is using imprecise and emotive language to describe an event or person.  If you label other people as ` worthless ` or ` a waste of time ` you are likely to become angry with them.  Or perhaps you label the world as ` dangerous ` or `totally corrupt`.  The mistake here is to label something that is too broad and complex for a definitive label.  You read a distressing article in the newspaper about a rise in crime in your town.  The article activates your belief that you live in an unsafe place, which contributes to you not going out and about.

Our final unhelpful way of thinking is all about Making Demands  - Thinking Inflexibly.  Take a few moments and ponder on how often you use   `Got to` ` need to` ` have to` ` should` `must` ` oughtto` statements.  These can result in guilt about yourself.  “I should have looked after my parents better”  “I ought to make more of myself”  `I Have to go and visit my Gran in the nursing home`.  These statements are extreme and rigid and bring with them problems.  The inflexibility of the demands you place on yourself, the world around you and other people often means that you don’t adapt to reality as well as you could.  For example – You believe that you should never ever let anyone down; therefore you don’t put your own welfare first and end up stressed and depressed.

So there we are – a brief rundown on some of the unhelpful or irrational ways of thinking.  The idea is to be aware of them and try to reduce their use, as each day most of us will employ three or four of them without consciously knowing.  Eradicating them entirely from our life may be a tall order but awareness is everything.

 

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Getting Older - Cause for Counselling?

If one is lucky enough to be blessed with reasonably good health and also survive what life throws at us in our younger years, we will enter into a bizarre experience called `Getting Older'. This is unavoidable by the very fact that if we are still breathing, we are still alive and so getting older will happen. Often with youth comes the certainty that one is invincible and this heady intoxication of indestructible self assurance tells us that we will go on forever in this unbreakable vehicle called our body.   I know from my own experience that a belief exists that old age is something that happens to other people and older folks were always that way, having been born like that and so were never young.

So however intensely the young might believe this aging process will not happen to them and that they will somehow be spared old age, as long as they do not succumb to illness, accident, suicide, war or foul play they will gradually and inescapably drift towards the autumn of their years.  Yalom writes in The Gift of Therapy that `death denial` is a belief in our personal `specialness` and how we   believe that we will not be dealt with in the same harsh way that life deals with everyone else.  Therefore we will be spared that final journey, that unfathomable ending, that cut off point.

In our younger years, small changes happen without much drama or commotion until one day we catch sight of ourselves in a shop window and wonder who that elderly grey haired, slightly overweight person is.

It seems no coincidence that at the age of sixty, one becomes eligible for free prescriptions in England. This is because for many people, things appear to change at that age and the likelihood of some health issue increases.

As well as this, getting older means for most of us a certain loss of our good looks.  Our faces lose of their definition, gravity pulls them downward and our skin might become paler and lose some of it’s elasticity.  Our hair may become thinner and change colour and we could gain some weight.  I remember one lady who told me that she hated the way that she looked now and that was the same as all the other elderly ladies at the club she belonged to.  She spoke of her white permed hair, her glasses, paleness of her aging skin and the need to have flat comfortable shoes instead of the high heeled fashion shoes she once enjoyed.  For myself I could see that her image was not helped by the addition of an awful quilted anorak that her husband thought was quite `trendy`.

So psychologically how does this shift in the way we are affect us?  Invisibility is said to be common as one becomes older, invisibility in shops, bars and on the pavements, even the street charity reps, often look past the elderly to the next viable punter, which can add to the feeling of unimportance.  

Paradoxically, there has never been more respect and admiration then we are seeing now for the warriors of our armed forces.  Whichever war or campaign is being remembered, the nation’s hearts and souls back the men and women who have in the past protected us.  Sadly for many of these ex-service men and women, they remain traumatised by what they witnessed and still carry this mental scar.  For them, there’s no doubt in the positive value of counselling but unfortunately many from older generations will see such help as a sort of weakness and favour a spirit of `just getting on with it`, which I feel is a pity as there are many therapists out there with the right skills to help.

So we have the feeling of invisibility and one of unimportance but what of the father and mother whose flock have flown the nest?  They may have spent twenty years or so looking after their young and now they find themselves redundant as parents, rattling around in a house that once vibrated with noise and life.  Do they embrace their new freedom or quietly contemplate the emptiness not only in their home but also their consciousness.

It’s been noted that for some men, middle age and beyond appears to encourage thoughts of reliving their younger years by buying a sports car.   For many, owning what they had all those years ago is not possible, for example the Triumph Spitfires, MGB’s and Midgets are now rare and require lots of TLC.  The alternative is a shiny new fun carriage like a Mazda or a Toyota and one can witness many grey haired gentlemen once again enjoying the rush of open top touring.  However psychologically there is a lot more to it than that and our old friend Sigmund Freud would understand what these people are going through and what they may be trying to replace.  He called the human sex drive the libido and this is often affected to some extent by age.  According to the NHS Choices website –

`Many people lose some interest in sex as they get older, mainly as a result of falling levels of sex hormones, age-related health problems, or the side effects of medication. Older men especially can develop low testosterone levels, which can cause fatigue, depression and a reduced sex drive.  Speak to your GP if you're concerned about this. They may carry out a blood test to check your testosterone level and can tell you about treatments if your level is low. As women start to approach the menopause, levels of the female hormone oestrogen begin to fall, which can affect libido. Women can also suffer from low testosterone levels, especially after a hysterectomy. Testosterone is another hormone that can affect sex drive.  Speak to your GP if you're concerned the menopause may be having an effect on your libido. They may be able to offer you a trial of hormone replacement therapy (HRT) if it's suitable for you.`

A distressing worry for many men as they get older is Erectile Dysfunction (ED) also known as Impotence and this is the inability to get and maintain an erection.  According to the NHS Choices website -

`Erectile dysfunction is a very common condition, particularly in older men. It is estimated that half of all men between the ages of 40 and 70 will have it to some degree.  See your GP if you have erectile dysfunction for more than a few weeks. They will assess your general state of health because the condition can be the first sign of more serious health conditions, such as heart disease (when the heart’s blood supply is blocked or interrupted).`

`Erectile dysfunction is primarily treated by tackling the cause of the problem, whether this is physical or psychological. The narrowing of the arteries (called atherosclerosis) is one of the most common causes of ED. In these cases your GP may suggest lifestyle changes, such as losing weight, to try to reduce your risk of cardiovascular disease. This may help to relieve your symptoms as well as improving your general health. You may also be given medication to treat atherosclerosis, such as cholesterol-lowering statins and drugs to reduce your blood pressure.`   (Source NHS Choices)

Similarly to the way we attempt to turn the clock back with sports cars, we see the growth in toy fairs across the country where we see people urgently looking for that one thing that will bring back happy memories of childhood.  This might be that Dinky or Corgi toy, a teddy bear, doll, tin plate toy or train set.  I met a man once who had just bought a second-hand Tri-ang train from the 1960’s.  He told me that his family were poor when he was young and so they couldn’t afford these things but now he wasn’t poor and so he was going to have all that he wanted.  So we see people like this man attempting to repair a deprived childhood by collecting long desired items here in the present.

This touches a little into the TV programmes that are popular at the moment about `hoarders`.  People who live in cluttered houses, sometimes unable to function because of the amount of possessions that they have.  Often a lot of it we see as rubbish but the people involved are still unable to get rid of it.  Many of these programmes feature Stelios Kiosses who is highly regarded in the psychotherapy world.  Stelios studied psychodynamic counselling at the University of Oxford and is a member of the BACP.

We often see a theme or trend with the work of Stelios where he uncovers a traumatic experience in the lives of the hoarders.  This experience is often linked to loss and the collecting often turns out to be a way of compensating for this loss.  So the feeling for these people may be that of not being able to lose anything more, or perhaps more correctly anyone else from their lives.

For some as time goes on, there can be loss of independence and the need to have to rely on others.  This can be very hard and re-enforces the fact that one is older and just not the same as before.  Having others do one’s shopping if mobility is an issue, may be hard for some as it’s not just food but will include personal items that one might like to buy oneself.

Independence also includes money and getting older will eventually see people retire and this will almost always have some effect on their income.  Poverty in old age is a massive issue and too big to discuss here in detail but for many people the changes that they go through in later years will include some caused by their financial position. Often the phrase is heard that one has to be `really rich or very poor` because if one is caught in the middle, there’s little help to be had.

Loneliness, isolation and lack of communication may be big issues for people when they get older.  Maybe the person has had a busy working life interacting with customers and colleagues and suddenly they are cut free from this and now may feel confused about their role and place in life.  What do they do with their days?  Who do they speak to? 

So we see that loss can be a major element in getting older for some.  Loss of significance, health, visibility, communication and interaction, libido, independence – both financial and physical and perhaps the loss of a loved one.  This is where counselling might come into the picture.  It won’t turn the clock back but it may help resolve psychological issues brought about by the aging process and help the person to see a different view of their life.  This will in turn, enable that person to make the most of what they have and embrace the changes that they are going through.

© David Trott 2015

 

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Employee Assistance Programmes

Here in the UK, we are currently seeing many areas of growth and development as many companies publish encouraging figures for 2014. This feeling of optimism and positivity carries with it the knowledge that these high performing firms have often nurtured a special employer/staff relationship, where we see the employee valued by the company and vice versa.

Enlightened management have long understood the importance of a happy and healthy workforce and many will have put in place a benefits package for their employees. These packages may include a pension scheme, profit sharing, private use of company vehicle and health benefits, which will now often include an Employee Assistance Programme.

Employee Assistance Programmes (EAPs) provide the employee with an independent counsellor and completes the wholeness of the health package. Here we see counselling helping with employee’s emotional issues, an aspect of healthcare sometimes overlooked in the past. These days the link between a person’s psychological and physiological health is more widely understood and we now see the man in the street being aware that they may be feeling unwell because of some emotional issue. I know of a college tutor who when he feels poorly instead of rushing to see his GP will firstly ask himself `what am I worried about?`

The link between the psychological and the physiological can be easily and simply demonstrated by holding out one arm at right angles to the body. Imagine the arm being a branch of a tree gently waving in a soft Mediterranean breeze on a warm summer’s evening. Feel it rising and falling as it waves gently in the balmy night air, moving back and forward in time with the sea as it laps softly against the beach. Now imagine your arm is Brunel’s massive Clifton Suspension Bridge with it’s giant stone towers and vast iron chains holding up the huge deck made of steel girders. Think of the ends of this 1,500 ton colossus united to the solid rock of the cliff face, impervious and unyielding to movement.

So what’s the difference here between your arm being a soft waving tree and a mighty solid bridge? The answer is simple – just a thought. Thoughts affect our bodies and wellbeing and this is why we might feel better on a bright sunny day opposed to a dull and dismal one.

The dynamics of a client/counsellor relationship within a EAP setting will include the likelihood that counselling will be in the form of a short term, time limited model of approximately six sessions and counsellors must decide if this fits with their style of working. Moreover if the counsellor feels they would like to work long-term with a client then they should realise that this may not be possible within the EAP setting and that the providing company may not agree to extra sessions. The reason for this is because EAPs were brought about to provide short term support and problem solving and not for long-term client work. Also companies work with contracts and boundaries and need to make a profit and so will expect the counsellor to have a clear idea of what will be required to help their employee. However from my own experience I know of several household names who have gone that extra mile for the wellbeing of their workers.

Of course this is not a one way street in respect of the company’s good will towards their workforce. A happy worker will undoubtedly perform better than a disgruntled one and will return what is called the employer’s `duty of care` many times over with commitment and loyalty. But what exactly is `duty of care`?

`Duty of care` means that employers should take all reasonable steps to ensure the health, safety and wellbeing of their employees, which includes the physical and mental health of their workers. This legal duty serves the company well because there is also solid business sense here since `duty of care` is said to be a key factor in building trust and commitment in the employer/employee relationship. Additionally it helps to ensure that the skills brought to the firm or gained within the firm stays there and is not acquired by their competitors, which in turn can boost productivity and ultimately profits.

Being that `duty of care` includes both the psychological and the physiological we can see why it’s dynamics are so wide ranging and inclusive. Areas that must be observed to stay within the legislation include: ensuring a safe working environment, defining jobs and risk assessments, provision of proper training, acceptable working hours and the use of rest and relaxation areas. Further to this staff have to be protected from discrimination, harassment and bullying and have proper channels for raising issues which are a concern for them. In this psychological area we can see how the provision of an independent counsellor fits well into the wholeness of the company’s commitment to care.

So in conclusion, Employee Assistance Programmes arrived in the UK some years ago as a positive export from the USA. Their usefulness as a means of employee support has been proven over time to a point now where it’s not only the enlightened and forward thinking companies that provide them.

EAPs are seen as a valuable and important feature of the employer/worker relationship and is reaching a stage now where it’s provision is an accepted norm rather than an unexpected bonus.

Counsellors who fulfil the exacting standards of accreditation and experience that are expected in EAP work can look forward to a busy working life as we see the whole concept of EAPs being available in the workplace going from strength to strength. David Trott © 2014

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Stress at the Top and the Benefits of Employee Assistance Programmes

It’s likely that in this affluent and flourishing country of ours that many of us will know someone who has risen to dizzy heights in the business world or professions, we might even be one of those high achievers our selves. If however we observe this elite world from the outside we may feel it’s straightforward to spot the outward trappings and signs of the archetypical successful person as we view the expensive car, nice house and exotic holidays of that person.

However this is the external view that is presented to the world and can deceive us into believing that this high flying world is one that is without problems and is to be envied or desired. We watch but maybe we don’t really see.

What is the reality of success and what does it bring? Well foremost is the fact that hardly any-one is safe in their job these days. This is in stark contrast to bygone years when one might expect to be settled in a position until the day of the clock presentation and the company pension. In recent times we have witnessed long established and well respected companies and financial institutions crumble and fall, throwing employees on to the unemployment rubble pile.

Although not confined to high achievers, there are many aspects of employment that when added to possible personal issues can bring anxiety and stress to the employee.

These can include:

  • Colleague tensions and uncertainties
  • Communication difficulties
  • Technical frustrations
  • The daily commute and travel
  • Sales target expectations
  • Increased sales areas
  • Restructuring and relocating

To help their employees cope with the worries and concerns that may be impacting on and affecting their ability to do their jobs, organisations are increasingly providing `Employee Assistance Programmes` (EAP) which centres around the employee being provided with personal counselling support.

In the United States, Employee Assistance Programmes have been used for some time where the value of looking after the employee as a whole has been recognized and appreciated in the workplace. Now the concept has crossed the Atlantic and is gaining popularity here in the UK where we see employers offering EAPs in addition to the usual benefits package.

Research has shown that a surprisingly large number of employees in the UK now have support from these schemes and it’s easy to see the benefits of an EAP scheme within a company for employees and employers alike with staff having support from an independent counsellor over issues such as stress, bereavements, relationship upsets and addictions. However, it’s important to keep in mind that EAP counsellors have in effect two clients – the employee themselves and the employer and have an equal duty to both.

In the world of psychotherapy we see some counsellors specialising in this type of work while others integrate it into their practice alongside their general client work. Here at my practice, I have experience of Employee Assistance Programmes and often get approached by companies wishing to acquire support for an employee.

These arrangements run very smoothly with the company stepping back from the proceedings and the client engaging in the process, knowing that the financial side of things is taken care of for them. Of course the resources of any company are not endless and it’s important to liaise regularly to keep the employer informed about the number of sessions that may be required.

Here a delicate balancing act takes place of care for the client and the maintenance of confidentiality while fulfilling one’s obligations to the company.

In conclusion, Employee Assistance Programmes appear to be a positive and helpful tool in company/staff relationships and generally works well for the interests of both. I would encourage any firms that have not yet put in place such a scheme to do so and likewise any employee who is suffering anxiety which impacts on their working life to seek support wherever it is available.

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The Origins and Contemporary Significance of CBT

Cognitive Behavioural Therapy (CBT)

To understand Cognitive Behavioural Therapy (CBT) better, we must be aware of it’s origins and how it has evolved over the years from different schools of thought. It’s foundations can be found back in the early part of the 20th century with the work of Pavlov and other Russian researchers and later with Joseph Wolpe who developed Behavioral Therapy (BT). This was seen as a challenge to Freud’s Psychodynamic Approach and Wolpe found how BT could be measured as opposed to Freud’s approach which could not provide empirical evidence.

Cognitive Therapy (CT) was developed by Aaron Beck, an American psychiatrist and psychotherapist at the University of Pennsylvania in the early 1960’s. His initial work focused on research into depression and how it could be treated. Beck’s work included the theory that faulty or dysfunctional assumptions are laid down as cognitive schemata in childhood and later are activated by critical happenings in adult life. This joining of events and dysfunctional assumptions bring about what Beck was the first to describe as `negative automatic thoughts` (NATs) which he believed was at the root of depression. Negative automatic thoughts are a key concept of CBT, which are negatively tinged appraisals or interpretations – meanings we take from what happens around us or within us. This breakthrough came when Beck observed a link between his patient’s `self talk` and their feelings. He also used the term `hot thoughts` interchangeably with `automatic thoughts` to describe thoughts heavy with negative emotions. As we know Beck’s method became known as cognitive therapy, referring to the key role played by thoughts and beliefs in producing feelings.

REBT – pronounced R.E.B.T.

As previously mentioned previously Cognitive Behavioural Theory evolved from different schools of thought and encompasses also the work of Dr Albert Ellis a New York clinical psychologist who developed Rational Emotive Behaviour Therapy (REBT) in 1955. Originally working as a psychoanalyst he later became dissatisfied with this kind of therapy and labelled it `inefficient` because it did not produce very effective results.

Ellis spoke of `thought-feeling fusion` which meant that our cognitive and emotional responses are sometimes two aspects of the same thing. Ellis is famous for quoting a the first-century philosopher Epictetus who said `Men are disturbed not by things but by the views which they take of them` Later Shakespeare makes Hamlet say `There is nothing either good or bad, but thinking makes it so, to me it is a prison. During the mid 60’s and 70’s the influence of REBT continued to spread with the writings and presentations of Ellis for both professional and lay audiences and the general area of cognitive behavioural therapy gained prominence and respectability.

Within REBT is the premise that humans are happiest when they have set themselves important life goals and work towards achieving them. Linked directly to this is the REBT definitions of `rational` as `that which helps people to achieve their basic goals and purposes` and `irrational` as `that which prevents them from achieving these goals and purposes`. Here we see strong connections to Humanistic Psychology and the work of Maslow and his `Hierarchy of Needs` where humans work towards `self actualisation` - a reaching of one’s full potential.

The ABC model

A major aspect to Ellis’s REBT model is the idea that our reaction to having our goals blocked or the thought of having them blocked is determined by our beliefs. To show this, Ellis developed what we know as his ABC model which helps people to see how their beliefs cause their emotional and behavioural responses

The ABC model

A. Something happens. (Activating event)

B. You have a belief about the situation. (Belief)

C. You have an emotional reaction to the belief (Consequence – emotional and behavioural)

An example of this might be:

A. An acquaintance sits on a different table from me in the local coffee shop

B. I believe I’m not liked by this person and she doesn’t want to sit with me.

C. I feel hurt and angry

The ABC model shows that A does not cause C. It is B that causes C i.e. If my belief (B) was different e.g. she didn’t see me, or she wants some quiet time, then my emotional response (C) would be different.

According to Ellis there are `Three Basic Musts` these are:

  • I must do well and win the approval of others or else I’m no good.
  • Other people must treat me considerately, fairly and kindly and exactly the way I want to be treated. If they don’t, they are no good and they deserve to be condemned/punished.
  • I must get what I want, when I want it, and I must not get what I don’t want. It’s terrible if I don’t get what I want and I can’t stand it.

These rigid and absolute beliefs can lead to psychological problems which include:

  • Depression, shame and guilt for the first
  • Rage, passive aggression and acts of violence for the second
  • Self pity and procrastination for the third
  • Ellis in his REBT work defined some of the characteristics of irrational thinking such as:
  • Repetition – recurring irrational belief.
  • Misattribution – blaming of ourselves/others/events, leading to distress.
  • Anti-Proof – un-provable beliefs.
  • Over Generalising – sweeping statements.
  • Demanding – `musts, shoulds and oughts are typical of demands.
  • Self rating – unrealistic self evaluating.
  • Awfulising or Catastrophising - imagining all sorts of disasters resulting from that one small event.

Merging of Schools

Gradually through time the two schools of CT and REBT merged and CBT became an approach in it’s own right. Since then CBT has been applied to a number of problems such as anxiety, phobias, substance abuse, schizophrenia, OCD, post traumatic stress disorder, bipolar disorder and couples work. Today we see many other branches of CBT such as Schema-focused therapy, Mindfulness-based CBT (MBCBT) Acceptance and Commitment therapy (ACT) and CBT Hypnotherapy.

A key difference between REBT and CBT is `secondary disturbance` and this is where somebody has a negative emotional response to their emotional response. For example in CBT we might have the belief of `I’m a failure` whereas in REBT the belief would have another layer to it, as in `I’m a failure and I can’t stand it`.

To help us analyses the therapeutic process of CB theory it’s useful to highlight that it’s fundamentally a collaborative project between the practitioner and client and both participate actively. The therapist knows about effective ways to help with problems and the client is an expert in his own concerns and issues. Keeping in mind that the client may be new to therapy or the collaborative emphasis is not what the client expected, clarification of the client’s expectations and why they are there is helpful. As CBT is structured and problem focused, the therapist works with the client to set an agenda and attempt to abide by it. CBT is educative and this may involve the therapist talking more than in some other therapies and will call for the client engaging in between session tasks called `homework`. From my own experience those clients who connect with CBT do so because of the empowerment they feel from being able to help themselves by acquiring a skill that they can use between sessions in times of distress or to stay psychologically stable.

CBT is said to help the client to think less negatively, so that instead of feeling hopeless and depressed, they can cope better with and even start to enjoy the situations they face. CBT includes goals the client might like to set and tasks between sessions, called `homework`. Also CBT deals with current situations more than events in the clients past or childhood and research shows that it works for a variety of mental health problems. However this doesn't mean that it's better than other therapies, but simply that others may not have been studied as much.

In particular CBT can help with:

  • Depression
  • Anxiety
  • Panic Attacks
  • Phobias
  • Obsessive Compulsive Disorder (OCD)
  • Post Traumatic Stress Disorder
  • Some eating disorders

The following case study relates to a past client of mine. It is anonymous and certain facts have been changed or omitted to maintain confidentiality.

If we consider the contribution of the CB theory model to therapeutic practice, I find it useful to relate it to my own Integrative work and the way CB Theory plays it’s part in treating the client as a whole. An example of this is a health professional that came to me because of stress problems at her busy workplace. Using CBT methods we (because it is collaborative) established that it was not the activating event of being a busy health worker that was causing distress but her beliefs that she was not good enough at her work and that the college she had attended was full of `upper-class types`. Once we discovered her beliefs and looked at the emotions that were caused, we worked on ascertaining if there was actually any evidence that she was not good enough. The belief about college was harder to explore but revolved around her working class childhood and her original unskilled work on leaving school. CBT methods brought to the surface not only many of her insecurities and feelings of being out of her depth but also a desperate need to `make good`.

As with any Psychological approach, CBT has strengths and limitations. We know it is affective for a wide range of problems and this is supported by well documented research. CBT is offered widely by the NHS here in the UK generally within Primary Care where 6-15 sessions might be obtainable. CBT is sometimes labelled as a `quick fix` or a `sticking plaster` and is regarded as time limited therapy, where a suspicion of CBT `wearing off` still exists and with it a belief that it may need `topping up` or refreshing at a later date.

As with all therapies CBT needs the client’s co-operation to some degree. In my own practice I remember one client where the process was impeded by their attitude and aggression, which led me to believe CBT was not for everyone. Their presenting issue was anger and they would arrive straight from work in a dirty and unkempt fashion with muddy wellington boots and sit with arms folded glaring at me and ordered that I `cure` them. Although obviously intelligent and resourceful, they were resistant to therapy and their aggression made interaction difficult.

Being a collaborative approach the client may well benefit from the knowledge that they are helping them self and this will fit in well with the idea of responsibility to one’s self and the notion that for every action there is a consequence. However in our multi-cultural society we might see some elements of it in which one’s own responsibility, choices or options are withheld or denied. This might be because of culture, gender or politics and here we might find CBT and it’s premise that there is always another way of looking at things difficult to work with.

In conclusion I believe that we can see clearly how Cognitive Behavioural Therapy as an approach has evolved over the years and continues to do so. From it’s foundations by Pavlov and Wolpe, through the years of Beck and Ellis to where it is now as one of the most extensively researched methods available, we see the forming of structure and progress. Today we see not only CBT being widely offered as a pure approach but also being integrated into therapist’s work to help with a huge raft of issues. I lean towards the notion that in another ten years or so, therapists will be writing of a number of new applications for this popular method.

David Trott © 2014 All Rights Reserved.

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