Compassion-Focused Therapy Podcast

I enjoy listening to Lynne Malcolm with Radio National Australia’s, “All in the mind” podcast series. I tend to listen to several podcasts over a weekend (especially when tramping) and then I have to wait a few months to repeat the process. I went back to their site tonight to find a few new mental health podcasts that I could enjoy for this weekend and I was especially pleased to find a podcast on compassion – and more specifically Compassion-Based Therapy – with the founder to this approach (Dr. Paul Gilbert) as a guest on the podcast.

I hope you enjoy this podcast as much as I did.

Counselling the Homeless

I was asked what I would do if I won the lottery. Without pausing, I said, “Counsel the homeless!”. She was very surprised by this and responded with, “The homeless don’t need counselling. They need food.” I asked if she was feeding them.

I considered this conversation in the days that followed. I wondered how many people would consider counselling as a low priority for the homeless because they thought the homeless had higher priorities and how many would think counselling the homeless was a waste of effort because they don’t think the homeless are worth helping. Regarding the first option, I would suggest that everyone needs good mental health and everyone needs someone with whom they can share their joys, pain and everything in between. Regarding the second option, I am reminded of Irvin Yalom and his efforts decades ago to offer group therapy to the terminally ill. Some questioned counselling the terminally ill as “a waste of time” as they would be dead soon, anyway.

Wow. As a therapist, this sounds heartless to me. I didn’t enter counselling to help keep the cogs of Capitalism moving by patching up workers and sending them back to the assembly line. I became a counsellor because I had experienced pain and I wanted to help others through similar difficulties. If you help to alleviate someone’s pain and they survive a week or fifty years, are your efforts any less valid? I would say, “no”.

Returning to the question of therapy for the homeless – no person’s pain and suffering is any less valid than any other’s. For those who think the homeless have higher priorities than mental health, I would disagree in the strongest terms. For those who think that there are more worthy people to focus on – shame on you.

I have this image of cashing in that lottery ticket (maybe I should play?), buying thermos to fill with hot coffee and purchasing raincoats to give away in windy and wet Wellington. Taking myself into the city and walking around with the coffee and raincoats, sitting with people and hearing their stories and giving them an ear and a shoulder. We are all struggling through this life. Don’t disregard people because they make you uncomfortable, or because their existence might seem terrifying.

One last thing – my son and I were going to the shopping centre several years ago (he was eight years old). We got out of the car and he called for me. He began running down the street. This was very strange for him. He kept calling me and running. We ran a couple of blocks and as I was catching up to him, he stopped at an older woman, who was soaked to the bones in the downpour. She was carrying a few bags. My son, Jack, said to her, “Hello, lady! Would you like a ride somewhere?” She turned quickly towards us, terrified. She then saw the dear face of a young boy and realised he was friendly and was offering to help. A beautiful smile came upon her face and she said, “No, dear. Thank you very much.” She turned away and continued smiling as she walked off. I wasn’t going to tell him I thought she was homeless. As we walked away, my son pushed out his chest, smiled and said, “We tried to help that lady!”

May our hearts be so pure and kind!

Counsellor Jerry

Family Scripts Considered

I have written about family scripts before, but as they are both fascinating and provide excellent insights for family work, I wanted to visit this topic again.

The theory is that we learn ways to relate in our earliest relationships and through this relating, we take on various “roles” – think of actors in a play, if that helps. Some people become the aggressors, some the victims. Others become dependent, while their co-actors become dominant. The place individuals take in these social interactions may be influenced by the personalities of the “players”, but there is also the coercion of others acting in the interpersonal performance.

For example, a man who grows up dominated by his father, may then try to take the role of the dominant person in his relationships with his own children. A child who is put in a dependent relationship with a parent, may then grow up and try to take a dependent relationship with a spouse. These roles are very rarely analysed or challenged by the actors, so when a person doesn’t want to “play along”, others in the group can exert a great deal of pressure to try to force the non-compliant member to play his or her part.

How does this relate to therapy? People enter into relationships with others who don’t share their scripts. Some are able to navigate their needs and create new meaning – new scripts – while others find themselves unable to understand the interpersonal problems that exist between themselves and their partners. Trying to understand the scripts that a person follows, nominating their needs and looking for new meaning can be extremely powerful within family therapy. There are roles we want in life and there are others we feel are thrust upon us. Being able to note the difference in these and working to create a life that is what you want is the therapeutic work of family scripts.

No one tool or paradigm does everything, but the concept of family scripts can be very powerful in making clear your motivations and responses within your family unit.

If you want to work through your family scripts with a counsellor, feel free to contact us.

If you are interested in reading more, I would recommend this text:

Rewriting Family Scripts : Improvisation And Systems Change

Mindfulness-Based Cognitive Therapy – A Conceptualisation

Therapeutic approaches like Cognitive Therapy, Narrative Therapy, Mindfulness-Based Cognitive Therapy and others (there are hundreds) are ways to conceptualise working with those in need of therapeutic assistance. Therapists are attracted to specific approaches for a number of reasons and once these therapists decide on the approaches they will use (some are quite eclectic and will borrow from multiple modalities), the therapist uses the approach to “make sense” of your issues. What does this mean? Therapists will hear your story and begin to fit your issues into an approach to help you. For me, these approaches are Narrative Therapy and Mindfulness-Based Cognitive Therapy (and Cognitive Therapy more generally).

When using Mindfulness-Based Cognitive Therapy (MBCT), I tend to think of the therapy model as comprised of three levels. These three levels help me to decide a treatment plan for clients and also help with setting expectations of therapy.

Level One – I call this “symptom relief” and many people think this is all Cognitive Therapy is (we will get to the “mindfulness” later). This perception is aided by the “quick help” – “Brief Therapy” for which (if a client is lucky) insurance companies will pay. Find the symptoms and give some immediate relief. Within Cognitive Therapy, this is looking for dysfunctional thinking, such as “automatic thoughts” and “cognitive distortions”. Once the almost automatic thoughts a client tells him or herself are identified, the therapist can help the client come up with ways to notice and change these thoughts. Similarly, if a client is in the habit of filtering life through cognitive distortions (e.g. black and white thinking or catastrophic thinking), the therapist helps the client review these thoughts, challenge them and then come up with alternate possibilities. While level one can provide some immediate relief, it is only the beginning in therapy. Many will stop therapy after this immediate relief, either from financial considerations or because they assume they are “cured”.

Level Two – This is where the client and therapist look at the combinations of thoughts into “schemas” and “modes”. Schemas are ways to organising information and relationships among this information. Moving beyond the surface dysfunctional thoughts of level one, the client and therapist dive into the schemas into which these thoughts are organised. Modes are a more recent addition to Cognitive Therapy and are an attempt to look at “the ‘synchronous interactions’ among the cognitive, affective, physiological, motivational, and behavioral systems of personality.” (see Level two requires looking at how client beliefs are combined to form larger views of the world and responses to it.

Level Three – This is where mindfulness comes into play. Yes, basic mindfulness techniques can be used almost immediately, but mindfulness is a practice, not simply theory, and takes time to master. I have also listed this as level three because it is a different approach to thoughts, which I have found most applicable after learning the thought management techniques of levels one and two. In levels one and two, the client learns to examine, question and reconsider thoughts. In mindfulness, the goal is to calm the mind through focusing on the breath or an object. As this happens, the practitioner learns to watch thoughts come and go (arising in consciousness and falling away once not focused upon). In my experience as both a meditator and a therapist, this is a different relationship to thoughts than levels one and two. Adding mindfulness to Cognitive Therapy gives the client another way to approach their thoughts, realising that they are more than just the thoughts that arise and fall away in their minds.

This conceptualisation helps me both with working through my own thoughts and when helping others. As noted in reference to mindfulness (level three) these levels are not rigid – clients can be taught mindfulness techniques from the beginning and note can be made of schemas in level one – but these levels allow the client and therapist to work through MBCT in a progressive way. That is, starting with dysfunctional thoughts, moving to how the client brings these thoughts together into larger frameworks (schemas) and then helping the client to learn to step outside of the whirlwind of thoughts (sometimes referred to as “decentering”) through meditative practice.

If you are seeing a new therapist, ask him or her how they conceptualise their work with clients. If they cannot tell you, it might be worth considering another therapist.

Cognitive Therapy Techniques: A Practitioner’s Guide

I have focused on Mindfulness for awhile, so I thought it was time to swing back to Cognitive Therapy study. I do that – study one thing until I want to step away for awhile and then jump to something else. This keeps me continuously upgrading my skills, without burning out on one topic. I love therapy, both for how I am able to help others, and for the insights that I get for my own mental health.

Never stop learning! Even though I have studied CT (CBT) for years, I am always interested in finding something new that might help me help others.