Counsellor - London, Stevenage | CBT Care

Counsellor - London, Stevenage | CBT Care

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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)

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* 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.

RE-CBT treatment for Shame

Unconditional Self-Acceptance, Shame and Shame- Attacking Exercises

By: Meir Stolear, BA (Hons.), MSc (London); 2012

Definition:

 Self: One’s complex (or over-simplistic, as it often is) view of oneself as a living human being.

Acceptance: An act of accepting reality, difference, roles, and more. Acceptance is also an act of mental approval of self, other people and the world as it is.

Shame: A painful unhealthy negative emotion caused by irrational beliefs, such as believing that one is a total failure or is a totally rejectable person when one’s behaviour reveals shortcomings or an action leads to failure. Shame can also be caused by other unhealthy negative emotions such as guilt, depression and ego-anxiety.

Shame-attacking exercises: These are RECBT therapeutic activities that aim to dispute one’s irrational beliefs about oneself, about others and about the world one lives in. The RECBT clinical view is that such activity can lead people to accept themselves as imperfect human beings, free themselves from unhealthy negative emotions about themselves and free themselves from self-defeating behaviour.

Unconditional Self-Acceptance (USA) and shame- attacking exercises:

Albert Ellis (the originator of RECBT) created the concept of USA in 1955. It is a modern adaptation of a number of conceptions in ancient philosophies.

USA aims to help us to see ourselves as imperfect, complex human beings and to avoid having an over-simplistic view of ourselves. The main idea is to be able to evaluate (in rational ways) our own strengths and weaknesses and our own positive and negative physical and mental components; also to see ourselves as unique individuals, biologically and psychologically;  also  to be able to accept what cannot be changed in ourselves, to accept what can be changed and improved, and to be wise enough to know the difference between these two.

Self-estimating (i.e. self-esteem), when it is done in a very simple way (e.g. judging oneself to be a good or bad person, successful or a failure, good-looking or bad-looking, etc.), tends to cause too many mood-swings, self-defeating behaviour, and/or other psychological problems. Moreover, it may even lead us to over- or underestimate ourselves, which may damage our future goals and prosperity.

USA on the other hand, is very much about celebrating our strengths, setting ourselves achievable life goals (based on our self-understanding), making us willing to test our own strengths and not shy away from failing and the shame attached to it. Without testing ourselves, for fear of failing and shaming ourselves, how else can we can find out our strengths? If we are not willing to take some more risks , how can we ever achieve enough in our lives? By learning to accept ourselves (with no conditions attached) we will learn that the shame that we feel when we fail or do wrong, is not about who we are altogether but about one small aspect of us and it is never disastrous in our lives.

Shame-attacking exercises are all about learning to accept ourselves unconditionally. It is about learning to separate shameful behaviour from the entire self. It is about attuning oneself to the common good, but without being a slave to it and denying our own wishes and aspirations. It is about tolerating our imperfections and accepting that doing some shameful things (as will often occur) will not kill us. Being ashamed of ourselves however, may depress us to the point where we wish to die.

A good range of shame-attacking exercises can be put together from a mixture of elements of behavioural modification and reinforcement of new rational thinking and believing.

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7 Habits of Highly Effective CBT Therapists:

By: Meir Stolear (2010)

Introduction:

 Stephen R. Covey (1989) Model for 7 Habits of Highly Effective People:

Definition: Habits are made from the interaction of three elements, which are: knowledge, skills and desires.

Knowledge (i.e. theoretical paradigm, model) - what is to be done and why.

Skills (i.e. practical abilities) - how to do it.

Desires (not to be confused with demands) - want to do it.

 * Effective habits are internalised core beliefs (personal principles) combined with patterns of behaviour.

* Effectiveness: An aim to maximise one's long-term benefit, personal empowerment, effective problem solving, maximising opportunities, learning, and the ability to integrate ideas and principles.

* The Maturity factor: Effective habits improve with lifetime experiences (i.e. maturity). In our lives we are progressively moving ourselves from dependency (need to be looked after) to independence (me, me, me; the importance of being me) and finally into interdependence (team work). 

* Factors that are needed for mature effective habits are: awareness of ecological, social, biological and other factors, that interact and govern life on earth (knowledge). Learnt new skills (time) and rational drive to what can be achieved (not to be confused with what must be achieved; irrational).

Effective habits framework:

Habit 1: proactive self-awareness, imagination, conscience and independent will;

Habit 2: goal setting;

Habit 3: organisation and prioritising.

These habits aim to move the person from dependency to independence, from self-mastery to character growth.

Habit 4: win-win;

Habit 5: understand and be understood;

Habit 6: synergy, habits integration.

These habits aim to help the person to move out of the independent state into creating the foundation for interdependence (i.e. team work).

Habit 7: Sharpen the Saw, Renewal.

This habit is about preserving and renewing your assets in four dimensions, which are: physical state, social and emotional state, spiritual state and mental state

7 Habits of Highly Effective CBT/REBT Therapists;

Putting Covey model into practice.

Effective Habit 1): Become self-aware. REBT theory teaches us that we are complex human beings. We are not our moods, our behaviour, our professions, etc., but are what we believe we are. Our self-beliefs will guide our moods and actions accordingly. We have the freedom to choose what kind of therapist we wish to become (better later than never). We aim to be emotionally and behaviourally responsible about our roles as CBT therapists. We do not blame our clients for the failures of our work with them, nor assume that the success of our work was only thanks to us. We learn to act as independent effective CBT therapists by understanding our strengths and weaknesses.

Effective Habit 2): Goal setting. Create rational goals to achieve, as effective CBT therapists. Have your goals in the forefront of your mind and ask no one to do it for you (help is welcome). Consider the entirety of factors that could help you to achieve your goals and work out what could block your goals. Start acting as soon as you are clear about what you are aiming for.

Effective Habit 3): Organisation and action. Set an independent and rational timetable for training, work experiences and supervision. Work with one CBT model long enough for you to become an expert before aiming to learn other modalities.

Effective Habit 4): Win-Win. Create an organisation and priority in the way you manage your career. Your clinical, administration and learning (including supervision) hours need to be well balanced to avoid unhealthy stress or other unhealthy negative emotions that can block your professional goals.

Effective Habit 5): Understand other people and be understood by other people. Formulating your client’s problems is an effective therapeutic tool, aiming to help you and your client to find solutions to the client's problems. However, if you have failed to understand the client correctly and not modified your formulation accordingly, your work with your client may have no real therapeutic effect. Doing formulation is team work and is to be done over the duration of the therapy, not only in the first few sessions. Moreover, to be an effective therapist the client needs to understand you. Therefore, it is better to avoid technical language and be in tune with your client's language and intellect.

Effective Habit 6): Synergy, habits integration. Here you are aiming at working together with your client as a team, for the common therapeutic goals. Here you are using all your first five habits together, as needed. As and when you are meeting a new client, you are most likely to experience a low level of trust in yourself and in your client. Your aims are to gain your client's  trust and to learn to trust him/her (good use of supervision can help with this). The success level of your work with your clients is heavily dependent on two factors, and these are: trust and co-operation. Your teamwork success with your clients can be carefully monitored (again by using your supervision well). In order to do this you need to identify three stages in your therapeutic alliances, which are: stage 1) defensive (learning to know one another); 2) respectful (learning to compromise); and 3) synergistic (achieving the therapeutic goals together).

Effective Habit 7): Sharpen the Saw - Renewal. This habit is all about self-preservation and self-renewing. REBT theory teaches us that if you are not compassionate and caring towards yourself you are less likely to be effective in your caring of other people. Albert Ellis, in his many books, advocated as an ideal putting oneself first and looking after loved ones a close second. That is to say, effective therapists need to be able to look after themselves, in order to be able to help their clients. Covey identified four dimensions for self-caring (compassion), which are: 1) your physical state (looking after the health of your body); your social and emotional states (leaving time to enjoy yourself socially and emotionally); your spiritual state (looking after your own values, life commitments, etc.)  and your mental state (staying rational and fulfilling your own mental needs, such as learning, writing, doing art, etc.). Combining the seven habits with the other six habits will help you to be an effective CBT therapist.

CBT/REBT for Bipolar Disorder

Bipolar disorder – warning signs and treatments.

By Meir Stolear, BA (Hons.), MSc (London) - 2012

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Bipolar disorder is a condition in which people’s moods swing between short periods of high sprits or restlessness and an extremely low mood or depression. The disorder affects men and women equally and is usually first diagnosed at ages 15 – 25. The exact cause of the disorder is unknown but it is assumed to be either genetically transmitted or learned behaviour, or possibly a combination of both.

There are three different known types of bipolar disorder, which are:

1    People who have had at least one hyper episode and prolonged periods of severe depression.

2     People who are experiencing periods of high energy levels and impulsiveness and are engaged in risky or unusual behaviour. These high-energy periods alternate with periods of deep depression.

3     People who are experiencing less extreme mood swings and are often, wrongly, diagnosed with depression disorder rather than bipolar disorder.

 For most people with bipolar there does not seem to be a clear or known trigger that brings on manic or depressive episodes. However, the following events seem to act as a trigger of a manic episode for some or many bipolar sufferers:

•    Life changes such as childbirth, getting promotion at work, winning some money, etc.

•    Medications such as antidepressants or steroids.

•    Periods of sleepless nights.

•    Moderate to heavy use of illegal drugs.

Some of the symptoms to look for when one get too high:

•         Poor ability to concentrate.

•         Inability to sleep.

•         Making poor decisions, reckless behaviour, having sex with many partners.

•         Impulsive behaviour and quick loss of temper.

•         Hyperactivity, high energy and racing thoughts.

•         Talking a lot and false beliefs about oneself or one’s abilities.

•         Easily getting upset agitated or irritated.

Some of the symptoms to look for when getting depressed:

•    Loss of concentration, memory and ability to make decisions.

•    Loss of appetite and weight loss or binging on food and weight gain.

•    Fatigue and very low energy.

•    Thinking of oneself as worthless, hopeless, or a loser.

•    No pleasure in normally enjoyable activities.

•    Recurrent thoughts about death and/or suicide

•    Social isolation and self-imposed loneliness.

Treatments and treatment goals:

Medical treatments:

Medical doctors such as psychiatrists commonly prescribe mood stabilizer drugs, such as Carbamazepine, Lamotrigine, Litmus and Valproate. Some doctors may also use anti-anxiety and/or antidepressant drugs.

Electroconvulsive therapy (ECT) may also be used if the patient does not respond to medication. Transcranial magnetic stimulation (TMS) is often used after ECT treatment.

Patients who are in the middle of manic or depressive episodes and cannot deal with their lives independently may need to stay in a hospital until their mood is stable and their behaviour is under their own control.

CBT/REBT treatment:

Most treatments for bipolar disorder involve either medical or psychological interventions. However, evidence has shown that a combination of the two has achieved superior results. Evidence has also shown that treatment for bipolar based on medical intervention and Cognitive Behaviour Therapies (CBT) intervention is the most effective and efficient form of treatment known at present (http://www.babcp.com/Default.aspx). Whereas the medication (discussed above) starts stabilizing the patient’s moods and behaviour, CBT on the other hand teaches patients a long-term strategy for managing their disorders effectively and efficiently. CBT and Rational Emotive Behavior Therapy (REBT is a primary CBT model of treatment) specifically teach patients how to shift their attention from their irrational belief system to a rational one. Also, CBT and REBT (http://www.arebt.org/) motivate patients to adopt healthy behaviour, identify and achieve personal goals, create new meanings in their lives and teach them unconditional self-acceptance and unconditional emotional and behavioural responsibility. Moreover, these treatments help to develop new life strategies and bipolar management skills, so as to prevent lapses and relapses. The main aim of such intervention is to help the patient develop a healthy balance between self-reliance and compliance with the medical intervention, which the patients may have to stay on for much of their lives.

Websites links to visit:

Association for Rational Emotive Behaviour Therapy (AREBT): http://www.arebt.org/

British Association for Behavioural Cognitive Psychotherapies (BABCP): http://www.babcp.com/Default.aspx

International Bipolar Foundation: http://www.internationalbipolarfoundation.org/