Digging out a weed (unhealthy belief and behaviour) is important, but you also need to plant a flower (healthy belief and behaviour) in its place. For example, if you notice that an old belief like ‘I have to get my boss's approval, otherwise it proves that I'm unworthy' resurging, dispute the belief with arguments about the logic, helpfulness and truth of the belief. (Chapter 16 has more about disputing unhealthy beliefs.)
You also need to plant a healthy belief, such as ‘I want my boss's approval, but I don't have to get approval in order to be a worthwhile person'. You can strengthen the new belief by gathering arguments for the logic, helpfulness and truth of the alternative healthy belief.
To strengthen new beliefs and behaviours further, you can devise situations that you know are likely to trigger your old unhealthy beliefs, and work at endorsing and acting according to your new beliefs instead. For example, deliberately seek your boss's feedback on a piece of work that you know is not your best. Resist your old behaviours that arise from the unhealthy belief that ‘I must get my boss's approval', such as over-apologising or making excuses. Instead, accept yourself for producing a less than good piece of work and take note of constructive criticism (refer to Chapter 14 for more about self-acceptance, and head to Chapter 16 for more techniques to strengthen new beliefs).
You can dig out unhealthy behavioural weeds and plant behavioural flowers in their place. For example, you may note that you drink more alcohol in the evenings as your mood lowers with the shortening days. You know that the onset of winter gets you down because you spend more time in the house. You can make the choice to stop drinking more than one glass of wine in the evening and start going to a local dance class or some other activity instead. You can also make a list of activities to do indoors, which will keep you occupied during the winter evenings.
Plant flowers in place of weeds, and tend those flowers to keep them hardy. Your weeds will have greater difficulty growing again where healthy flowers are thriving.
A happy gardener's checklist
Here are some points to help you prevent and overcome relapse. Use this checklist to stop your marigolds getting choked by bindweed.
Stay calm. Remember that setbacks are normal. Everyone has ups and downs.
Make use of setbacks. Your setbacks can show you the things that make you feel worse as well as what you can do to improve your situation. Look for preventive measures that you may have used to get better, but that you may have let slide when your symptoms reduced.
Identify triggers. A setback can give you extra information about your vulnerable areas. Use this information to plan how to deal with predictable setbacks in the future.
Use what you have learned from CBT. Sometimes you think that a setback means that you're never going to get fully well, or that CBT hasn't worked for you. But if the stuff you did worked once, then chances are the same stuff can work again. Stick with it; you've nothing to lose by trying.
Put things into perspective. Unfortunately, the more you've improved your emotional health, the worse black patches will seem in contrast. Review your improvement and try to see this contrast in a positive way - as evidence of how far you've come.
Be compassionate with yourself. People often get down on themselves about setbacks. No one's to blame. You can help yourself get back on track by seeing a setback as a problem to overcome, rather than a stick with which to beat yourself.
Remember your gains. Nothing can take your gains away from you. Even if your gains seem to have vanished, they can come back. You can take action to make this happen more quickly.
Face your fears. Don't let yourself avoid whatever triggered your setback. You can devise further exposure exercises (refer to Chapters 13 and 17) to help you deal with the trigger more effectively next time it happens.
Set realistic goals. Occasionally, you may experience a setback because you bite off more than you can chew. Keep your exercises challenging but not overwhelming. Break bigger goals into smaller, mini-goals.
Hang on! Even if you aren't able to get over a setback immediately, don't give up hope. With time and effort, you can overcome the setback. Don't hesitate to get appropriate support from friends and professionals if you think you need to. Remind yourself of times in the past when you felt as despairing and hopeless as you do now. Remind yourself of how you got out of the slump - and use the same strategies now.
Happy gardening!
Being a compassionate gardener
What do you do if one of your precious plants isn't doing so well? If you notice that you've got blight on your prize rose, do you deprive it of food and water, or do you try to treat the disease? It's better not to abuse or neglect the plants in your garden for failing to thrive because - if you do, they may only wilt further. You probably don't blame the plant for ill-health, so why should you blame yourself when you relapse?
Yes, take responsibility for anything that you may be doing that's self-defeating. And yes, accept responsibility for taking charge of your thinking, and ultimately, for engineering your own recovery. But, also take a compassionate view of yourself and your problems. Some of your unhealthy tendencies may have taken root partly due to childhood and early adulthood experiences. Others may have some biological underpinnings. Some of your problems may have arisen from a trauma. You're not alone in having emotional problems. You're part of the human race, and there is no reason to expect more of yourself than you do of others with regard to staying emotionally healthy.
If you take a responsible, compassionate view of setbacks, you will be more able to help yourself get well again.
You know that ‘they' say you should talk to your plants to make them grow? Well, it may sound a bit daft, but maybe there's something in it. Try imagining yourself as a little pot plant on your kitchen windowsill. Talk to yourself encouragingly and lovingly when you notice your leaves drooping. Give yourself the types of messages that nurture rather than deplete you.
How does your garden grow?
Research shows that CBT has a better relapse-prevention rate than medication on its own or other types of therapy. This difference may be because CBT encourages you to become your own therapist. Doing behavioural and written exercises does seem to help people to stay well, and for longer. Try to continue to be an active gardener throughout your life. Left to their own devises, most gardens become overrun with weeds. Think of maintaining the health of your psychological garden as an ongoing project.
Chapter 21: Working with the Professionals
In This Chapter
Deciding to work with a professional CBT therapist
Getting the most from your CBT therapist
Identifying the characteristics of a good CBT therapist
CBT has gained popularity in recent years, due in part to research showing that it's an effective treatment for many common psychological problems. CBT is increasingly becoming the treatment of choice for most mental health problems. Doctors and psychiatrists are referring more people for CBT therapy than ever before. In the UK, more government funding has been allocated to train CBT therapists in order to meet rising demand. These days, you can access CBT treatment in books, on the Internet, in groups and in one-to-one sessions (Appendix A lists websites and organisations that you may want to contact). This chapter helps you determine how to seek further help, how to select a CBT therapist and how to get the most out of your treatment.
Procuring Professional Help
The information in this book may be all you need to overcome your emotional problems. Or, you may consider checking out some of the other self-help books we recommend in Chapter 25, which can give more guidance on specific problems.
Instead of helping yourself, to help you tackle your difficulties you may decide that you want or need additional assistance from a qualified therapist. If you have problems that are severe or difficult to overcome, your doctor may also prescribe medication, or refer you to a psychiatrist for a more specialised assessment of your difficulties. Psychiatrists can
usually refer you to a psychotherapist who's qualified to treat your specific problems. Your GP may also be able to suggest a therapist, whether or not you've also been referred to a psychiatrist.
Self-help approaches, such as books like this one, have the advantage of costing little, being easily available - even in the middle of the night and during holidays - and providing enduring advice for years to come. Perhaps most importantly, when you use a self-help book, you know that the person who's making the changes in your life is you. A good self-help book can be invaluable, even if you're also seeking professional help. In fact, most CBT therapists recommend a book or two during treatment. Your therapist may collaborate with you, using a book of your choice - such as this one - as a resource. Alternatively, ask your therapist whether she has any suggestions for material you can read to help you get the most from your treatment.
Ask yourself the following questions to determine whether now is the right time for you to look for professional help:
How severe are your current problems? For example, if you have severe depression or if you feel like you can't go on any more, seeking expert help is strongly recommended, as you may be too ill to benefit fully from self-help techniques. By ‘severe' we mean that your problem is interfering significantly with your relationships, ability to work or carry on with normal daily activities. If you've experienced uninterrupted symptoms for more than two months, or if you notice that your symptoms are coming back more often, you must seek out professional help.
Have you tried self-help approaches in a consistent and systematic manner for at least two (and ideally six) weeks? If you feel you're making some progress on your problems, you may not need to work with a professional at this time. However, if you're not satisfied with your rate of progress and still feel bad much of the time, then structured therapy sessions may help you.
Check out how long you need to wait for National Health Service (NHS) treatment in the UK. Putting your name on a waiting list sooner, rather than later, is a good plan if resources are overstretched in your area.
Do your problems interfere with your ability to concentrate and utilise self-help material? If so, a therapist may well be able to help you digest information and techniques at a pace you can manage.
Do you see the sense in self-help principles but struggle to apply them to your own life? Most therapists are much more experienced than you in applying psychological principles to specific types of problems. They can suggest more ways to help you move forward and guide you on how best to use the therapeutic techniques described in self-help books.
Have you reached a plateau or obstacle in your self-help programme that you can't overcome on your own? By working with a trained and experienced therapist, you may develop the ability to overcome barriers and jump-start your treatment. A therapist can often suggest ideas that you may not have tried, which can serve as a motivator to get your treatment moving again.
Are you ready to share your problems with someone and team up with her on achieving shared goals for therapy? Therapy is a team effort. Therapists don't ‘fix' you. Your treatment still needs lots of input from you.
Thinking about the right therapy for you
Doctors and psychologists often recommend CBT because research evidence supports its effectiveness (refer to Chapter 1). Specifically:
CBT is an active problem-solving approach that helps you develop skills and enables you ultimately to become your own therapist.
CBT focuses on the present, whereas many other therapies focus on personal history. In CBT, you use your childhood experiences to help you and your therapist understand how you may have developed specific beliefs and ways of behaving. However, the focus is on your current problems and the ways in which your thinking and acting perpetuate your problems.
CBT emphasises a collaborative relationship in therapy. CBT therapists can help you build skills and they're likely to expect you to carry out assignments in between sessions.
Several newer branches of CBT treatment are now developing that stick to the core principles outlined previously but also incorporate some novel ideas. Some of these include:
Schema-focused therapy: This is often used to help people dealing with enduring personality difficulties that interrupt their ability to form healthy relationships.
Mindfulness-based CBT (MBCBT): This therapy combines core CBT principles with ideas rooted in Zen Buddhism. It's been proved useful for the treatment of depression and anxiety problems.
Acceptance and commitment therapy (ACT): This treatment has proved useful for depression. It emphasises self-acceptance and compassion as you strive to get well. (For more on ACT, see Chapter 12.)
CBT hypnotherapy: This therapy enhances CBT with hypnosis. Self-hypnosis can be learnt and may be particularly helpful for those suffering from trauma, phobias or general anxiety disorders.
As with any form of therapy, be sure to research the treatment before you commit to it. Also make sure you find a fully accredited and qualified practitioner.
In addition to CBT, you may come across dozens more therapeutic approaches when you investigate your treatment options. Some of the more common psychotherapies practised today include:
Transactional analysis: Focuses on the internal relationship between the parent, adult and childlike aspects of human personalities.
Person-centred therapy: Emphasises the therapist displaying warmth, empathy and genuineness towards the client, but without directing the client.
Psychodynamic therapy: Focuses on the client expressing feelings derived from early experiences, as these feelings arise during the ongoing relationship between client and therapist.
Systemic therapy: Commonly used with families and couples, this emphasises the idea that emotional problems are the product of a dysfunctional system, for example a family or relationship.
Interpersonal therapy (IPT): Focuses on changes in life roles, grief and disputes with significant others. IPT is another proven treatment for depression and some eating disorders.
Meeting the experts
Lots of mental health professionals are able to provide general counselling and support. If you specifically want CBT, don't hesitate to say so. Many psychiatrists, psychologists and nurses have had some training in CBT, but check out the extent of their training and experience. Ideally, choose someone who's had specialist training in CBT. Specialist training means that the therapist has obtained a degree, diploma or Master's qualification in CBT from a university or recognised training institute.
Ask your therapist if she's accredited with either the UKCP (United Kingdom Council for Psychotherapy) or BABCP (British Association for Behavioural and Cognitive Psychotherapies), if you live in the UK (contact details for these organisations are listed in Appendix A). You can also ask your therapist to tell you where and when she studied, and if you're sceptical, you can check this information out with the relevant educational bodies. Some therapists have their certificates, which outline their qualifications, on display. If you're referred to a therapist by a psychiatrist, the psychiatrist may be able to give you more details about your therapist's credentials, or to verify the information that a therapist gives you.
In the UK, anyone can call themselves a counsellor or psychotherapist, regardless of whether they have any professional training. A therapist with a recognised professional qualification will not be offended if you ask about their relevant training. You have every right to satisfy your desire to know about your therapist's background and training, because this is your treatment. If you know that you want CBT as part of your treatment, you must ask about the CBT specifics of your therapist's training and experience.
In case you're a bit flummoxed by the range of different professionals offering help, here's a little breakdown of them:
Psychiatrists are medical doctors who specialise in psychological problems. They can prescribe medication and typically are more knowledgeable than family doctors about the drugs used to treat psychiatric illness. Not
all psychiatrists are trained in CBT, although many can refer you to a CBT therapist who they're familiar with.
Clinical psychologists have usually studied a broad range of therapies and have basic training in how to apply therapeutic principles to specific problems. Many can offer CBT but may not have specialist training.
Counselling psychologists have been trained in basic counselling and different types of psychotherapy. Like clinical psychologists, most counselling psychologists have no specialist training in CBT, but they may offer it as part of the techniques they use.
Nurse therapists are originally trained in psychiatric nursing. They have a more in-depth understanding of psychological processes and disorders than general nurses. Psychiatric nurses in the UK may have undergone further training to specialise in CBT.
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