Category: CBT

3 Reasons Why CBT & Brief Therapy Sometimes Does Not Work…

I expect some visitors to my site to be a little wary about CBT & therapy. Let’s be honest – you’ve visited this site because you want to make changes and you see real value from investing in yourself, and you feel really motivated to get on with it.

But… there is probably a nagging thought along the lines of what if it doesn’t work, and how that seeing a therapist could be an expensive mistake that will make you feel a bit silly.

I have many clients who come to see me who have seen a therapist before, with no success. I really empathise with people in that situation, and rather than deny that people sometimes don’t get a result, I will explain reasons why 90% of the time this happens, and how I address these issues.

This article is not to bad mouth individuals and other therapists, (there are some extremely good ones in Sussex) rather to explain what tends to go wrong and how I work to avoid this and what I think you need to be aware of, whoever you choose to see.

1. The Outcome Disregards Experience

This is the biggest stumbling block for my clients. I think the trend of “change everything overnight” thinking by therapists has come from the field of coaching and motivational speaking.

For example, let’s say I have a client who wants to become more confident and social around new people.

Now a traditional approach is to use therapy to let the client imagine feeling calm and confident around others and feel at ease – to remember and draw on calm and peaceful times and to remember themselves when they had previous experiences of being social and how they wish to be in future.

This might work for a few weeks, but there is something crucial missing from that – gaining experience. The outcome is based on a brief past experience and imagination, and no solid foundations. This isn’t really going to hold up if they go into a social situation and make a social blooper and feel bad about it afterwards. In this situation the change can unravel very fast after a big test.

A great deal of clients I work with who have social anxiety problems aren’t used to conversing and mixing around people outside of work, family and close friends.
Often they have felt uncomfortable and even avoided meeting new people so it will take experience to build up their social skills and work their way to greater social confidence and a larger social circle.

A more realistic approach could be to work on the fear that has been stopping them from taking the first steps and trying new things, and showing them how uncomfortable their present comfort zone really is.

This can pave the way to the client finding comfort when experiencing new social situations, expanding their comfort zone, building momentum and moving towards their bigger goals.

By working in smaller steps rather than taking a giant leap, then by it’s nature the work we do will be provable and self reinforcing. Remember – the first steps are important and they will get you to your goal. If you don’t learn to walk, you’ll never travel far.

2. Working Too Fast

Early in my training I noticed the “industry standard” of how therapy sessions should be run tended to be three sessions over three consecutive weeks before reaching a “guaranteed outcome”. We were told that CBT & brief therapy was supposed to be quick and this is what clients expected…

This then, and now seems absolutely nuts. Above all else clients expect a solution to their problem or steps taken towards resolving it and the underlying issues, not to fit conveniently to the therapists schedule. Could you imagine a surgeon or other health care professional behaving in such a manner?!

Working with a client effectively is not about dropping them into a new outcome, because as I mention above in point 1, that is going to deprive them of valuable experience they really need. You need a bit of time for your comfort zone to shift and for the changes to become your new, familiar reality.

This is why you may have heard people try therapy, say the changes worked well for two or three weeks and then it unravelled. They probably needed a session or two more over an extended period of time (i.e a month or two) in order to really cement the changes and ensure they stick.

Any therapy work should be about a therapist assisting their client and leading them into a new reality and new outcomes, and by doing this, giving the you the client something really valuable. It also means it might take a little time and I think most of you reading this would rather I work with you for as long as it takes, rather than abandon you and cut you loose too soon.

3. The Problem Not Being A CBT Or Brief Therapy Issue To Begin With

CBT can help deal with many personal problems, and when used effectively can produce profound changes. But for all it’s uses, sometimes it’s the wrong tool for the job.

In therapy there are two main ways of working with a client:
1. To offer help & support
2. To facilitate change

CBT practitioners & brief therapists fit in to point 2 – to facilitate clients and help them make changes. This is to change established behaviours, habits and thoughts which have been, and continue to be  obstructive and problematic. For example anxiety disorders, jealousy issues, addictions and guilt.

Help and support issues, point 1, are dealt with by counsellors and psychotherapists. These are issues which are at crisis point and developing in the here and now. For example a recent bereavement, the days after a accident or recent personal trauma.

Before working as a CBT practitioner I trained and worked as a psychotherapist, helping and supporting young people and to this day I still see clients who I work with from a help and support perspective, and if required, move to change work when the client is ready.

Sometimes people do visit CBT practitioners and brief therapists when they need help and support, not change. I can’t comment on why they aren’t referred on, but sometimes the therapist continues when it’s not appropriate.

This is damaging for the client as they go through the ordeal of seeking help (and I know it takes huge courage for some to pick up the phone or send the e-mail and get in touch) and then make no progress, feel no better and often end up very embarrassed.

Even worse, they often feel that they are beyond help and stuck with their problem which makes seeking further help harder, if not impossible.

A good therapist will be able to tell within minutes of the first session beginning whether they are in the right place.
My personal way of dealing with this situation is to tell the client ASAP if I notice this is not an issue that CBT can help, and that I’m willing to work with them from a help and support perspective, or refer them to other people who can also help. I would never consider charging for my time if this were to happen and they wished to go elsewhere.

And it does work both ways – many people have gone to see a counsellor or psychotherapist and not gotten a result because their problem actually requires change, not help and support.

You don’t tend to hear about it as much as fewer people talk about going to see a counsellor or psychotherapist than seeing a CBT practitioner, but it does happen. Examples of this mix up can include anxiety problems, eating disorders and low self-esteem / issues around self-confidence and OCD.

So as 2017 draws to a close, is there an aspect of your life you wish to change?

Do you feel stuck and tired of trying to cope on your own?

It’s never too late to get started. I understand that when you are struggling more than anything you want to feel better. I can help you.

Why not contact me today and find out how I can help you? I offer Skype sessions for those based outside of the UK.

Worried about cost? I offer both pay as you go and fixed fee Ongoing Support payment options which is more affordable that you may think.

Why not browse my site, find out a little more about me, read my client testimonials and get in touch today.

Regards,
Stephen

FULL POST & COMMENT

A Brief Explanation of CBT

Many people contact me to ask how Cognitive Behavioural Therapy is different from other therapies they may have tried before, and how it can be relevant in providing useful change when other approaches such as mainstream counselling or psychotherapy have failed.

The first point I would like to make is that CBT is unique amongst talking therapies because it doesn’t fixate on what label term is given to a problem, nor does it rely on using a pre-determined set techniques to overcome problems. CBTs strength is it’s flexibility and ability to improvise.

The mindset from traditional talking therapies generally goes along the lines of what problem does the person have, and how does it make them feel. The CBT mindset is different – It’s focus is not what problem the person has, it’s what they are experiencing and what is the process behind the problem, and how do you experience the problem?

Let’s take anxiety as an example. According to the CBT philosophy of change, anxiety is a process – a “produced” problem so it is something that you “do” and “experience” rather than you “have”.

Approaches using traditional medicine work by using medication to moderate and suppress your states of mind, which in turn would normally produce a slight reduction in the anxiety and short term relief. These medicines are not designed for long term use, but to give enough of a respite so a psychological therapy can be used to help overcome the problem.

Because anxiety is not a stand alone emotion, rather than one which is produced, there is a driving factor which is creating it in the first place. Only by identifying the likely root cause, and changing our perceptions of it, can the process be stopped anxiety truly be overcome.

The way I work with anxiety using CBT is to address three main areas:

  • Your beliefs & perceptions – what is the problem? what is the worst case scenario? what is the best case scenario? How would you know if you were OK?
  • Your state of mind – finding out how you go into the state of anxiety, and what state would be more resourceful? What is the opposite state of mind to anxiety?
  • Your behaviours – finding what specific behaviours are created by anxiety, and what would you rather do instead

The three areas are listed above are in the order of importance / leverage. Your beliefs & perceptions around a given situation or context will in turn produce a given state of mind, which in turn produces a given range of behaviours.

Providing you with more resourceful beliefs & perceptions around the root cause driving anxiety will ultimately help control and eliminate it.
Because of the underlying mind set of CBT, there is no endless analysing of how you feel about a problem, and no need for intrusive digging for hidden meanings and insight that may lie in the past. Whilst awareness and insight can be useful, they seldom offer enough leverage to produce lasting change.

CBT also differs because it focuses very much on pushing you away from the problem, and pulling you towards the solution. So not only will I be working with changing your thinking patterns to change the problem, I will also dedicate a good deal of time working with your expectations and perceptions of what the solution is. So in the case of anxiety, how will you focus on calmness and relaxation and positive states of mind.

As with all therapies, CBT is a formal and taught model and philosophy of what actions can be beneficial to a clients well being. However it’s important to realise that despite being a popular theoretical approach, it is not complete by any means – I do use other methodologies to cover some of the blind spots that CBT has.

To summarise, CBT is a well structured model of therapy which uses a very different approach to other talking therapies, by focusing principally on the here and now actions and how the problem “works”, rather than focusing mainly how you feel and how you “have” the problem and what it meant in the past.

Please contact me if you have any questions, or to book your appointment today.

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Emotional Eating & Problematic Behaviours Around Food

For many of us, controlling how much we eat presents numerous challenges which are difficult to overcome. So why is it a challenge for many of us to lose weight, and what caused us to become overweight in the first place?

The answer often lies with emotional eating – using food comfort. Eating for comfort is common and many of us are not even aware of it happening, let alone why we are doing it.
The foundations for problems around food start very subtly during early childhood. Have you ever noticed how children are often rewarded with food for doing something good, or even just for behaving? It’s not uncommon for some parents to use food as a form of bribery.

Or how about the fast food chains children’s meals?  Junk food put in a funky looking box with a toy from the latest blockbuster kids movie. Is it any wonder kids are hooked on fast food from an early age? I must hand it to their marketing department – it’s genius marketing!

Many people over eat because they are feeling down, depressed and generally dissatisfied, and they address these negative feelings by eating food.

Of course we know logically if you’re eating based on emotional hunger, then your body will never be satisfied by real food, which is why depressive eating continues with such momentum.

The cycle works like this. The person starts off feeling “hungry”, and then has something to eat. Soon after they feel bad about eating and start to feel guilty about it.
This guilt leads to them having a “treat” in order to feel better, which sends them back at the beginning of the cycle.

This is why as a therapist when I’m working with a weight loss client I’m most interested in what my client perceives will be different once they have lost weight and hit their target weight. How will things be different, and what will they be doing differently.

Most importantly, what will they be able to do once they lose weight that they feel cannot do now? These things are usually the drivers of the emotional eating and will need to be dealt with immediately because they are obstacles to any lasting progress.

To overcome emotional eating, the person needs to begin to bridge the gap between something that they cannot do now, and what they expect to do once the weight is gone in future.

Let’s take loneliness as an example. Many clients I work with are very lonely and would rather be out and around other people.

For whatever reason, be it social anxiety, breaking up with a partner, an argument around family or friends, moving into a new and unfamiliar area or stress at work – they have entered a cycle where their initial comfort comes from food, and their weight increases.
Over time their self-image and social appetite plummets and they no longer feel motivated to go out.

In this example, my intervention would be based not only around behaviours around food, nutrition and recognising hunger, but also to directly address the issue of loneliness.

Why does this person feel they cannot go out now, but will be able to when they are thinner?
This is key to shifting the weight. By expanding their comfort zone and working with them so they are able to get out there and socialise as they are at their present weight, no matter what they look like, then a large part of their hunger will diminish.

This is challenging but it has some great secondary gains. If the overweight person gets to grip with the loneliness and starts to go out instead of staying in and eating food, then they will be physically more active and they will lose weight quicker than if they waited and carried around this emotional luggage, waiting for the final result.

Their weight loss journey will be much more enjoyable and fulfilling – remember weight loss can take a long time, often around 6 months to a year.

Interestingly, eating disorders follow a very similar pattern of thinking. In cases anorexia and bulimia, both are dealing with a multitude of emotions, predominantly guilt.

  • The anorexic will always feel intense guilt around food, so much so that they find it hard to eat even small amount because of how bad it makes them feel both during and after eating.
  • The bulimic will feel bad about eating, but for brief respite they will eat some food. However, soon after a meal or snack they will either exercise or make them self sick to eject the food and the thus feeling of guilt that comes with having eaten it.

So to recap. If the food is acting as a coping mechanism, then the only long-term way to change and lose weight is to deal with the trigger that activates the coping mechanism in the first place. Utilising CBT to change self perceptions and create new choices will do this.

As always I welcome questions and feedback.  Feel free to contact me to make an enquiry or book an appointment.

FULL POST & COMMENT

The Myth Of Boosting Self-Confidence

Confidence is great. It makes us feel relaxed and in the zone. We can feel unstoppable, things seem easy and we feel a great sense of control.

Many people want more and I don’t blame them. However, confidence can be a bit hit and miss. It varies from person to person, place to place and situation to situation.

A lack of confidence and an abundance of frustration can lead one to feel quite down and deflated. So, how do we change this. How can CBT help improve self-confidence and put you back in control?
I would define confidence as one of many states of mind we can experience, the same as happiness, sadness, excitement, confusion and curiosity.

Many celebrities and life coaches quite forcefully point out that confidence issues are easy to fix, and it can be built from imagination exercises and motivational affirmations. The lady on BBC Breakfast last week was a typical example – simply focus on feeling better and doing things that motivate you and it will all come together eventually.

I can see where they are coming from but it seems too simplistic and misses the point somewhat. I’m sure it sells their CDs, books and DVDs but I do wonder how often they work with real people with real problems.

From working with people from all walks of life who wish to improve their levels of confidence and self-esteem, improving confidence can’t be solved by imagination and motivation alone.

Those who have difficulties raising and maintaining their levels of self-confidence are experiencing another problem. Confidence has an evil twin which needs to be dealt with – fear.

Fear is one of those necessary emotions which really can be a nuisance. It’s a very primal and hard-wired state of mind, which is there to protect us at all costs and keep us safe and out of trouble.

Fear can be useful – for many people who are regular public speakers a small amount of fear is essential. Many performers and comedians would not be as good as they are without it.
Fear is what gives them the buzz and adrenaline rush to get on stage or in front of the camera and spur them on to perform.

And what would be the point of an extreme sport or even a roller coaster without a slight element of fear – it’s the whole point!

Usually we have healthy respect for our fears, and they keep us safe and out of danger. But sometimes fear doesn’t work for us, rather than helping us, it hinders. Nothing can paralyse us and hold us back like fear.

So, I would ask you to consider that confidence is a fluid state of mind, specifically where there is a near complete lack of fear and anxiety within a given context or situation.

To build up confidence, we need to not only work on building motivation and the positive aspects of feeling good, but also work to conquer the fears and anxieties and what makes us feel bad.

CBT has several proven ways of dealing with our fears. Not only to get a rational insight and understanding of why we fear a given situation, but the methods of changing those fears so they evolve into understanding and more useful states of mind.

Fear is a very intense and powerful state of mind, if you can take that intensity and channel it to a more useful state of mind such as curiosity or even excitement, then feeling confident is easily achievable.

As always I welcome questions and feedback. Feel free to contact me to make an enquiry or book an appointment.

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Dating & Meeting New People

Valentines day has just passed and recently I’ve been working with a number of clients who wish to feel more confident and improve their future chances of dating success.

CBT is a great way to overcome fears associated with meeting new people and being comfortable in large groups and new environments. It is also useful for those who struggle with over thinking and over analysing, which can cause them to seem a bit distant and not engage fully with the people they are with in the “here and now”.

I’m going to share my thoughts on a three areas that are often overlooked and present problems for those struggling to establish and maintain relationships.

1. Identity

Here is the biggest mistake I see with those struggling with dating  – trying to be appealing to everyone. By doing this, you generally become noticed by no one and end up frustrated.

This may seem a bit harsh, but let me explain. Firstly I have a bit of bad news.

Who ever you are, you will not be every ones cup of tea, I can guarantee this. You can’t make everyone happy, no matter hard you try. Some people can’t keep you happy either.

People tend to have “types” of person they are attracted to and able to build connections with. The good news is you are someones type right now, and someone is hoping to find someone like you. You may well be overlooking them..

Studies have found that in the UK around 15% of those also seeking a partner are likely to be compatible with you and best able build connections and relationships with.

This means not only do you need to think hard and learn about who you are looking for, but also get feedback from friends and family about who is likely to be looking for you.
Those who have the greatest dating success and settle down are the ones who really know how to appeal to and find the 15% they are compatible with. This comes down to hobbies, interests, style, personality types and social environments.

Sit down, have a think as clearly as possible who you would like to meet, and also consider what would you like to be doing with them. What would be a great weekday evening out for you, and how would you like to spend a Sunday with them?

But it doesn’t stop there. The 85% who would not be right for you can also help – these people are potential allies too. Potential friends which can not only offer great friendship, but also offer networking opportunities and introduce you to even more people who are in that 15% that are looking for someone like you.

So to repeat, if you are a single person, although 85% of people who are available will probably not be compatible, they are potential allies and the remaining 15% will be the type who could really be into you. Learn who these people are.

2. Body Language

Learning about your body language and it’s influence around others will really help you. Within 15 seconds of meeting someone new, the way you move and behave in your environment will have a profound influence on how they will treat you.

This is a very primal function which is hard-wired into us all from a young age, and the purpose is to help us identify if others are a friend or foe.
During the first 15 seconds of meeting someone new our mind is busy, scrambling around looking for visual cues such as placement of our hands, feet, signs of physical tension, speed of movement, posture and facial expressions, looking for a potential threat.
This is also when you determine if you find another personal physically attractive or not.

First impressions tend to work retrospectively, especially on the dating scene. If someone makes a good first impression, such as being relaxed and friendly, then as time goes on the other person will automatically look out for signs to re-enforce this initial judgement and prove it was right.

If on the other hand your come across as a bit nervous, creepy and make fast and sudden movements… then good luck trying to turn that first impression around…

For men this is extra important. Slow, smooth motions and a thoughtful tone of voice will put you in good stead. Keep your feet wide apart pointing towards the person you are talking to and keep your back straight, no slouching. No putting your hands in your pockets or fingers through your belt loops!

If you want to learn more, there are lots of videos on YouTube, and I can recommend the following two books which cover the basics:

  • Body Language For Dummies – Elizabeth Kuhnke. ISBN 978-0-470-51291-3
  • What Every Body is Saying – Joe Navarro. ISBN 978-0-06-143829-5

3. Looks & Presentation

Our self presentation is important, no doubt about it. You do not need to be perfect, but as I wrote above the first 15 seconds are vital for first impressions.

Many people have problems with their looks, and wish what they see in the mirror was a little bit better here or there. This is not what I mean by attraction or being attractive – when it comes to our skin and bones, what we have got is what we have got, and there is little we can do about it.

Attraction is something that is created and a great deal of it comes from how well we present what we have. Presentation is something that is deeply personal, and with a bit of thought and creativity you can make an impact and make others aware that you take pride in yourself. It also implies we will take pride in our partner too.

This comes down to your clothing, aftershave / perfume, haircut, grooming and general cleanliness. Looking out of my office window now, it’s very obvious who takes pride in themselves and gets signals of interest from others.
It’s also obvious who blends in and won’t make much of an impact. Aim to make an impact, find a style that suits you and your personality.

As much as you can make your appearance work for you, you cannot ride on your looks and over rely on them. They will generate interest, present opportunities and give you foundations to build on, but they are not going to do more than give you a chance to initiate a conversation move to the next level of interaction.

I know plenty of male and female models, impeccably dressed, who have had difficulties getting beyond small talk, and have been have been in lots of short relationships which went nowhere, or have been single for a very long time. This is usually caused by problems with identity which I covered in section 1.

I hope you have found this information useful – I’d be happy to hear any feedback you may have. Please feel free to contact me if you have any questions about this topic, or to find out more about how I help you with dating and general self-improvement.

FULL POST & COMMENT

Working With Time Based Outcomes

A common approach in the field of psychology and therapeutic change work is to encourage a client to draw on past references and experiences to help them make changes and achieve future goals.

This can be a useful way of becoming motivated to change and initially take action. Whilst in theory it should work, in the long term it can be counter productive. Here are two examples of how these problems arise, and how they can be avoided.

Example 1

I work with a weight loss client, who is in their late thirties and struggling with extreme obesity. This client wants to lose weight and be at a similar weight and level of fitness as when they were in their early thirties, when they were fit and healthy.

To most people this would seem reasonable and achievable goal. However, consider the outcome again.

By adopting the mindset of wanting to be how they were in their early thirties, then they would essentially be going back to being the person who later went on to put on weight. It’s a subtle, but important point.

Example 2

I work with a client who has post traumatic stress disorder after a vehicle accident. The client has had difficulties getting over the shock of what happened and has been in emotional turmoil since then. The client wants things to go back to normal, and have life as it was before the accident.

Supposing that was in any way possible, if they were to have things like they were before, then they would still be the person who was later  involved in the accident.

In both examples, the new outcome they want will always be before a negative experience. The mind is very smart, and will put two and two together. It knows what happened next to a remarkable degree of accuracy.

So what can be done about this? Let’s look briefly at example 1.

Instead of targeting how their weight was at an earlier date, a cleaner way of working would be to set their target as not only losing weight and controlling their eating when they are 40, but all the way into their 50s instead.

To summarise –  although referring to the past can be useful for motivation purposes, it’s crucial not to have your personal targets set so you are repeating what happened in the past. Future based targets which present you with new choices will be the ones which are most effective and stand the test of time.

That’s all for now – I’ll be back with more next month.

FULL POST & COMMENT

Thoughts On BBC Radio 4 Broadcast

I listened to a BBC Radio 4 program on NLP this morning whilst on a break at my clinic. You can listen to the programme by clicking here – I thought I’d share a few thoughts of what I made of it.

One of the grey areas that struck me from the outset is what exactly they thought NLP is! Many believe it to be a therapy in it’s own right, many find it a process to “model excellence”. Here is my take on it..

My interpretation of NLP is that it’s a tool for modelling people who achieve great success in their fields, and the “template” used to establish it and to present the findings of the co-creators, Dr Richard Bandler & Dr John Grinder, was in the realm of therapy and psychotherapy – so that is how it’s most commonly taught.

Along with CBT I also run a private clinic, counselling worthing residents. I recall during my training that Bandler & Grinder reviewed recordings of counselling sessions by prominent counsellors, hypnotherapists and gestalt therapists to find the structure of how these people worked with their clients to achieve such great results.

Another example of NLP is the work of Paul McKenna. McKenna has modelled the eating habits and behaviours of naturally thin people and written self help books for people wishing to loose weight. From personal experience and his book reviews on Amazon, he is doing very well.

So if we take NLP to be a process of modelling, and the therapeutic applications we know of it as a “product” of this modelling, NLP could be applied to almost anything.

You could model how a successful racing driver achieves great results, and pass the learning’s down to new drivers by  dissecting the driving styles of  say..Lewis Hamilton or Alain Prost and call them the “Hamilton Model” or the “Prost Model”.

Like Dr Bandler and Grinders work, it would take hundreds or even thousands of hours or interviewing the drivers, their engineers, reviewing telemetry, video footage etc to get a complete overview of how the driver does “what they do” in such detail that it can be taught consistently and to a high standard.

I’m informed by a prominent NLP trainer that the fastest growing field of NLP modelling and applications at the moment is found not in the field of medicine, sport, education or even business training. I was shocked to learn that the #1 field for NLP modelling revolves around dating and relationships!

This did make me chuckle – I do wonder if this is what Dr’s Bandler & Grinder originally had in mind?

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