What is PTSD?

By: Meir Stolear (2016)

After many years of working with many clients who suffered from or diagnosed with Post Traumatic Stress Disorder (PTSD), I came to conclude that this is a condition caused by human being ability to re-traumatize themselves about their past trauma that they have experienced.

Over the years I have learned from my clients, that person can suffer like all another animal, but unlike other animals, human is capable of creating a suffering about the past and present pain suffering they have experienced (e.g. being angry about being anxious). In the REBT/CBT therapeutic model, we are assuming (and we have some scientific validation for it) that human suffering (i.e. emotional, psychological and behavioural disturbances) comes by and large from the way we think about the circumstances of our life and the beliefs that we are having about our thoughts. We can be assured that most of us, if not all of us, will endure undesirable, unfortunate, and potentially traumatic experiences during our life time. However, not all of us will respond to such experiences in the same ways. I am assuming that some people may have learned to respond in over amplified stress responses to a particular stimulus, where as other people may react to such events in much more flexible and healthy ways.

When people experience the distress of fear, anxiety, depression, or anger, often they will have experiences of a secondary problems or distress about their genuine pain (e.g. anxiety about anxiety, depression about long-term experiences of anxiety, etc.). As clinicians, we need to address such secondary disturbances on the onset of the therapy, as it may overshadow the primary problem and interfere with our aim to resolve the original problem.

What is a safe therapeutic intervention?

There are many treatments models for PTSD problems, but the modality I prefer to use with my clients is the REBT/CBT one, which is the original cognitive behavioural therapy (CBT) as we know it. It was Albert Ellis who started to develop the Rational Emotive Behaviour Therapy (REBT) model in 1955, but the original model has been modified and changed over time based in face of new scientific and clinical evidence, although the core practice has not changed much.

Basically, REBT maintains that it is not the external world that is causing our disturbances, but the way we think and believe about the adverse events that we have experienced in our life time. We try to make sense of our experiences, but often may end up disturbing ourselves more, should we employ the so call irrational thought and beliefs in our analysis of our memories.  The REBT/CBT practitioners aims is to address all that and to help the clients to think rationally about the experienced bad situations of their lives and positively moving forward towards achieving their lives long-term goals. We work as a team (i.e. client and therapist) to identify those irrational thoughts, emotions, and behaviours, which interfere with their recovery and which tend to lead into a self-defeating behaviour. Together we work on ways to respond in more efficient ways to the past traumatic event, as memorized, but without shame or blame. In doing so, we help our clients not only to feel better about themselves and their lives, but more so it helps them to get better and being better as human being.

Finally, according to REBT/CBT therapeutic model, the way we think about our experiences will determines our emotional and behavioural response to those experiences. If we think and believe in an irrational fashion (e.g. being demanding, rigid, etc.) about our life experiences, we than tend to develop a self-defeating cognition and behaviour, which are maintained and reinforced by our unhealthy negative emotions, such as anxiety, depression, shame, anger, guilt and jealousy. On the other hand, if we stay rational (e.g. accepting responses, being flexible, etc.) about our negative life experiences, we may still experience strong negative emotions, such as worries, sadness, remorse and health anger, but these are an healthy negative emotion. Such health negative emotions will help us to keep ourselves focused on our life goal and will keep us functioning effectively in the face of any past or unfortunate future events, as memorised.

Emotional cycles - by Meir Stolear

Your thoughts and beliefs are automatically activated by the external conditions that you are. Your thoughts and beliefs are enabling your feelings, which guide your actions. When your thoughts and beliefs are not synchronised well with your environment, it may trigger a great stressful experience inside you. Not undoing your stresses is most likely to trigger emotional problems for you, which in turns will activate a self-defeating behaviour. If this cycle has not stopped, you may find that you are developing emotional problems, such as depression, anxiety, anger, shame and more. 

You may consider the idea of provision of emotional problems, by attending few CBT/REBT sessions, as from my long clinical experiences, prevention are a better strategy in life than cure. For more information visit www.cbtcare.com

Human range of emotional - behavioural conditions and REBT/CBT practice.

Human range of emotional - behavioural conditions and REBT/CBT practice. 

Over 23 years of providing psychological services to a large range of emotional and behavioural problems, it has never failed me to see how so many of my clients believe that their problems are medical problems. As many argue this point before me, I don't tend to agree that much of so call emotional disorders are results of some form of medical problems and in need of medical intervention. For example, it is historically documented that human kind can get oneself into unhealthy negative emotions such as depression anxiety, anger and more. Such feelings will lead any person to act in a self-defeating ways and that what I mean by human range ability. However,  does it means that the when a person reached his or her out most negative range, the causes are biological one and. Therefore, he or she need to be treated with medications?

I argue that human ability to think and understand oneself, other people and the world around him/her is a complex one. So complex that many things can go wrong when a flow of information gets into a messy cognitive processing.  Many philosophers, psychologists, sociologists and other human scientists do their utmost to understand where cognitively things may go wrong and why they are going wrong, but there is no clear one answer to all of that. Maybe because no one mind entirely processes information in the same way as the other. Nor do I believe that all thoughts create emotions and behaviour in total uninformed ways.

Many individual scientists, theorists and clinicians accept that by and large people may fall into the so call unhealthy negative emotions such depression, anxiety, etc. due to irrational and very hard ways of processing information (i.e. cognitive processing). Why is that occurring? We have no one answer, and we may never have one answer to such complex questions.

Is not that I don't recommend that people will ask to see a medical doctor when they are acting in a self-defeating style and in danger of hurting themselves or other people. In fact, I do recommends that they should see a specialist first, as medication and hospitalization as a more efficient form of crisis intervention than talking therapies.  However, as a long-term solution I do believe that learning to resume emotional and behavioural responsibility is the way forward, and that can be achieved by attending some form of talking therapies. I personally recommend REBT/CBT therapy, as it is much more cost efficient and it is teaching good self-help management skills.

Wisdom

Fairness is not an attitude. It's a professional skill that must be developed and exercised. -Brit Hume

“In case of dissension, never dare to judge till you've heard the other side.” ― Euripides, The Children of Herakles

Do not be wise in words - be wise in deeds.  -Jewish Proverb

“Even injustice has it's good points. It gives me the challenge of being as happy as I can in an unfair world.” ― Albert Ellis


We must interpret a bad temper as a sign of inferiority. - Alfred Adler

“Everything that is done in this world is done by hope.” ― Martin Luther

Counsellor - London, Stevenage | CBT Care

Counsellor - London, Stevenage | CBT Care

Looking for Cognitive Behaviour Expert Psychotherapist/s? Visit: http://cbtcare-london.co.uk

Is it really important what kind of therapy modality you take?

Is it really important what kind of therapy modality one should take?

(By Meir Stolear, 27/07/13)

Dr. Bruce Levine (24/05/13), don’t think so. In his article “Why a Great Therapist Probably Beats a Great Antidepressant” (http://www.takepart.com/article/2013/05/24/best-therapy-for-depression-counseling-or-antidepressant), he used the following evidence.

Bruce Wampold (2010) examined hundreds of studies and found that outcome effectiveness doesn’t depend on the specific techniques of psychotherapy, but instead on the alliance between a therapist and their client, as well as the client’s confidence in the therapy (e.g., CBT) and in the therapist. In other words, what matters is finding a great therapist you like and trust.

Michael Lambert estimates that the factors responsible for “client improvement in psychotherapy are as follow:

40% of improvement can be explained by independent positive changes in the client life.

30% can be explained by therapist individualities (e.g., empathy, acceptance, warmth, and encouragement).

15% can be explained by “expectancy” or the placebo effect (i.e., patient believes that their therapist is extremely credible and trusts them).

15% can be explained by the techniques used in talk therapy; specifically, if the therapist and client believe in a technique, like CBT, that might be more important than the technique itself.

However, in my 20 years of clinical experience, I have learnt that CBT (specifically REBT) are by far more efficient way to help people to get better. What could be completed in 6 to 12 months, using a traditional counselling or psychotherapy, can be accomplished in 8 to 20 weeks of CBT/REBT treatment (preferably done by an experience therapist). However, I do agree that it is the constructive therapeutic alliances, which will determine a successful therapy outcome.  

Effective Clinical Supervision

EFFECTIVE SUPERVISION

By Meir Stolear (2008)

www.cbtcare.com

http://cbtcare-london.co.uk/

* Effective supervision can best be offered in a context in which supervisors are aware of professional bodies' and institutions' requirements.

* Supervisors and supervisees work together towards a good outcome that will improve the service to the client and improve the supervisees' professional development.

* Supervisors and supervisees frequently give each other constructive criticism and feedback in an open and respectful manner.

* Supervision is best structured, where regular timetables for meetings are agreed. The content of supervision meetings to be agreed and learning objectives determined at the beginning of the supervisory relationship. Supervision contracts can be useful tools, in which detail regarding frequency, duration and content of supervision; appraisal and assessment; learning objectives and any specific requirements, is included.

* Good supervision best covers the following: clinical management; teaching and research; management and administration; pastoral care; interpersonal skills; personal development and reflection.

* The quality of the supervisory relationship will strongly affect the effectiveness of the supervision process (i.e. there is more to gain from a supervision session where the supervisor and the supervisee have developed a good professional alliance).

* Good training for supervisors needs to include some of the following: understanding teaching learning processes; assessment skills; counselling skills; appraisal skills; unbiased feedback; careers advice skills and interpersonal skills.

Summary: supervisors and supervisees can work well together if they understand and agree on the following:

* Helpful supervisory behaviour includes giving direct guidance on clinical work, linking theory to practice, engaging in joint problem-solving tasks, offering feedback and reassurance, and providing role models.

* Ineffective supervisory behaviour will include the following: rigidity; low empathy; failure to offer support; failure to deal with supervisees' concerns; not teaching LFT; being indirect, intolerant and emphasising the negative aspects of the practice being evaluated.

(3) In addition to supervisory skills, effective supervisors need to have good interpersonal skills, good teaching skills and be clinically competent.