Skill five: Thoughts and the self
Dec
16
2007
16
2007
Our perspectives on ourselves, the future, and the world and just how we think about events, and respond to our own thoughts as a constant flow of consciousness, has much to do with how we feel (our moods) and how we behave. The message here is that thoughts and feelings determine mood. Much of the time all of this runs on automatic such that you respond to thoughts and ways of viewing the world in a habitual manner, built up over time, and in which your moods are trapped. As a result, mood flucuations are often cyclical or repeat themselves and/or are easily triggered off. Intensity of moods is often determined by the stressors upon us or the responses that we are in turn making in the face of stressful events. The approach to these issues from the 1970's and 1980's emphasised specific goals to change a behaviour or a thought pattern (cognitive and behaviour therapy). The actual skills that you need to learn to deal with dysfunctional responses to thinking now go beyond this initial approach. So what skills do you need to learn? Firstly, build awareness of your thoughts through mindfulness-based breathing exercises and also learn to take a decentered perspective on your patterns of thinking (refer to the skills of mindfulness discussed earlier). You will always have negative thoughts and feelings but you do not have to latch on to them and have them consume your sense of self (and your well-being) in the process. This moment is also a good time to revisit the first skill you learned, namely values. This will help you to ask questions about your thinking such as 'What does this event or situation mean to me?' or 'What does it mean about me?' The latter question is important in that you may have habitual negative ways of reacting to others - changing yourself first, including the way that you are thinking, can lead to big changes in the way others in turn behave. Secondly, and in the case of thinking about the more concrete problems that you may have in the here-and-now, you may wish to generate some new perspective about the events around you. For example, your subjective responses to events and the way you think about them may be really at odds with reality. This is a common problem for many of my clients who make rapid assumptions about people and the world, rather than examining what is really going on. Too often everything gets personalized and then generalized in making broad assertions about people, events, and places. As a result an individual may poorly assess and cope badly even with everyday situations involving the behaviour of others. If you are receiving feedback from others that this is the case, and has been for a period of time, then this is a psychological skill area that you need to develop. In consultations with a Clinical Psychologist you will be able to determine if this problem area is a component of broader psychological health issues (as it often is).
The Dalai Lama '...I think that to a large extent, whether you suffer depends on how you respond to a given situation'. (in The Art of Happiness)
The Dalai Lama '...I think that to a large extent, whether you suffer depends on how you respond to a given situation'. (in The Art of Happiness)
Posted by Richard Taylor in Psychological skills. Comments
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What is OCD?
Dec
14
2007
14
2007
Obsessive-Compulsive Disorder (OCD) is an anxiety disorder. This is something often not understood or appreciated by the sufferer. It is often a very disabling disorder in that the sufferer finds it difficult to do routine things day-by-day. Obsessions and compulsions take up much of the available time, for example, excessive cleaning.
Obsessions are recurrent and persistent thoughts, impulses, or images that are experienced as intrusive, unwanted, inappropriate and mostly as irrational in the cold light of day. I say mostly because of the doubt element that many of my clients experience, for example, 'How though can I be sure that this thought is not the case?' and 'Isn't is possible that my sore arm could be caused by cancer?' The thoughts, impulses, and images of obsessive ideation as it is called cause marked anxiety and distress and are not simply excessive worries about real - life problems. The sufferer often attempts to ignore or to suppress the obsessions, or to neutralize them with some other thought or action (here control is the problem which is something we will return to later) . For example, in thinking something deemed unacceptable having to blink both eyes in a certain sequence in order to 'put matters right' (i.e. to relieve the felt anxiety and distress of the obsessional thoughts).
Obsessions are viewed by the sufferer as the product of his or her's own mind (they are not imposed from without as a thought insertion).
Compulsions in turn are what I call the 'putting matters right' component in response - the things the person feels compelled to perform in response to the obsessions, often according to rigid rules developed over time (for example, doing things in particular multiples). Compulsions include repetitive behaviours (e.g. hand washing, checking) and/or mental acts (counting, repeating words or actions). Many sufferers check things after the event by running what I call movies in their head about what exactly happened. A sufferer can have an obsessive thought that they may have offended someone in a conversation and then feel compelled to call the person to 'check out' in a round about way that they had not been responsible. Compulsive behaviours or mental acts are designed to reduce distress or prevent some dreaded event or situation.
In some cases compulsions can take on a mind of their own and are performed in what is called a functionally autonomous fashion (a bit like learning to take a headache pill before and in case that you do get a headache). There is mostly no realistic relationship between the compulsive part and the obsessional part that triggered it in the first place and the compulsive behaviour is clearly excessive, e.g. hand washing.
While a sufferer may clearly see that the obsessions and compulsions are excessive and/or unreasonable, they may resist giving them up because they are viewed as offering some control over the situation, no matter how time consuming. Having to deal with the sheer terror of living with the uncertainty of obsessive ideas can be an overwhelming prospect, particularly if the neutralizing compulsive behaviour has been around for a long time.
At work, compulsions may have to be hidden to avoid detection. This can become another sourse of anxiety in itself. For example, while undertaking a business assignment a young accountant was found to be repetitively re-working and checking the accounts of clients but could not legitimately bill for this time. The partners of her small accounting firm were at a loss to comprehend and to understand just what was going on. OCD was the last thing that came to their minds. The sufferer's day-by-day attempt to control and live with the disorder may be largely invisible to the casual observer or family friend (despite the presence of much repetitive behaviour).
The sufferers of OCD often experience the following: poor self-esteem; mood flucuations which are particularly evident to close family members; guilt all the time; anger problems, and difficulties in relationships.
Also, many sufferers seek to avoid the sources of their problems through avoidance. For example, avoiding places that trigger off obsessions about being contaminated. Avoiding people who create problems. Avoiding certain rooms in the house so as not to feel contaminated.
The sufferer can also feel OK if someone else can take the responsibility for checking something. Research has demonstrated that obsessive ideas and compulsive behaviours are all commonly experienced, for example, who hasn't been convinced that they had their airline tickets but then felt compelled to check just one more time on the way to the airport (you could see this as caused by the stress of travelling). Who has not had the thought that the gas might have been left on and then felt the need to quickily returm just to check it out for a final time. I used to have a neighbour that after going on holidays would always send a postcard asking me to check if his front door had been left open. Both in terms of these everyday examples, and in the case of OCD, stressful life events puts more pressure on and then your vulnerability to anxiety gets activated.
In the next postings I am going to deal with how to get help, what to ask and to look for, and I will discuss what psychological treatment will generally involve.
Obsessions are recurrent and persistent thoughts, impulses, or images that are experienced as intrusive, unwanted, inappropriate and mostly as irrational in the cold light of day. I say mostly because of the doubt element that many of my clients experience, for example, 'How though can I be sure that this thought is not the case?' and 'Isn't is possible that my sore arm could be caused by cancer?' The thoughts, impulses, and images of obsessive ideation as it is called cause marked anxiety and distress and are not simply excessive worries about real - life problems. The sufferer often attempts to ignore or to suppress the obsessions, or to neutralize them with some other thought or action (here control is the problem which is something we will return to later) . For example, in thinking something deemed unacceptable having to blink both eyes in a certain sequence in order to 'put matters right' (i.e. to relieve the felt anxiety and distress of the obsessional thoughts).
Obsessions are viewed by the sufferer as the product of his or her's own mind (they are not imposed from without as a thought insertion).
Compulsions in turn are what I call the 'putting matters right' component in response - the things the person feels compelled to perform in response to the obsessions, often according to rigid rules developed over time (for example, doing things in particular multiples). Compulsions include repetitive behaviours (e.g. hand washing, checking) and/or mental acts (counting, repeating words or actions). Many sufferers check things after the event by running what I call movies in their head about what exactly happened. A sufferer can have an obsessive thought that they may have offended someone in a conversation and then feel compelled to call the person to 'check out' in a round about way that they had not been responsible. Compulsive behaviours or mental acts are designed to reduce distress or prevent some dreaded event or situation.
In some cases compulsions can take on a mind of their own and are performed in what is called a functionally autonomous fashion (a bit like learning to take a headache pill before and in case that you do get a headache). There is mostly no realistic relationship between the compulsive part and the obsessional part that triggered it in the first place and the compulsive behaviour is clearly excessive, e.g. hand washing.
While a sufferer may clearly see that the obsessions and compulsions are excessive and/or unreasonable, they may resist giving them up because they are viewed as offering some control over the situation, no matter how time consuming. Having to deal with the sheer terror of living with the uncertainty of obsessive ideas can be an overwhelming prospect, particularly if the neutralizing compulsive behaviour has been around for a long time.
At work, compulsions may have to be hidden to avoid detection. This can become another sourse of anxiety in itself. For example, while undertaking a business assignment a young accountant was found to be repetitively re-working and checking the accounts of clients but could not legitimately bill for this time. The partners of her small accounting firm were at a loss to comprehend and to understand just what was going on. OCD was the last thing that came to their minds. The sufferer's day-by-day attempt to control and live with the disorder may be largely invisible to the casual observer or family friend (despite the presence of much repetitive behaviour).
The sufferers of OCD often experience the following: poor self-esteem; mood flucuations which are particularly evident to close family members; guilt all the time; anger problems, and difficulties in relationships.
Also, many sufferers seek to avoid the sources of their problems through avoidance. For example, avoiding places that trigger off obsessions about being contaminated. Avoiding people who create problems. Avoiding certain rooms in the house so as not to feel contaminated.
The sufferer can also feel OK if someone else can take the responsibility for checking something. Research has demonstrated that obsessive ideas and compulsive behaviours are all commonly experienced, for example, who hasn't been convinced that they had their airline tickets but then felt compelled to check just one more time on the way to the airport (you could see this as caused by the stress of travelling). Who has not had the thought that the gas might have been left on and then felt the need to quickily returm just to check it out for a final time. I used to have a neighbour that after going on holidays would always send a postcard asking me to check if his front door had been left open. Both in terms of these everyday examples, and in the case of OCD, stressful life events puts more pressure on and then your vulnerability to anxiety gets activated.
In the next postings I am going to deal with how to get help, what to ask and to look for, and I will discuss what psychological treatment will generally involve.
Session five: Acceptance
Dec
05
2007
05
2007
It may be that Western-trained clinical psychologists have for too long over emphasized the importance of changing or modifying unpleasant symptoms without recognizing the importance of acceptance. One reseacher has noted that acceptance involves 'experiencing events fully and without defense, as they are'. Escape and avoidance behaviour as a mechanism of control is often a strategy used by many people in coping with stress and anxiety. Control agendas in these terms are mostly destructive and only serve to entrench anxiety-related problems. The alternative is acceptance and willingness which refers to how open you are to experiencing your own experience when you experience it - without trying to manipulate it, avoid it, escape it, change it, and so on. In the sessions that follow I am going to review the acceptance of pain, thoughts, feelings, urges, or other bodily, cognitive (thinking), and emotional phenomena, without trying to change, escape or avoid them.
David Brazier in 'Zen Therapy' sums this up quite nicely. 'While we long for clear weather, the clouds are an obstacle to our happiness. When we learn to appreciate the whole sky, the clouds are seen simply as its adornment'.
David Brazier in 'Zen Therapy' sums this up quite nicely. 'While we long for clear weather, the clouds are an obstacle to our happiness. When we learn to appreciate the whole sky, the clouds are seen simply as its adornment'.
Posted by Richard Taylor in Mindfulness. Comments
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Access to private clinical psychology services
Dec
04
2007
04
2007
Brief guide:
1. By seeing a Clinical Psychologist you will receive the highest level of Medicare benefit for psychological treatment in new arrangements introduced from 1 November, 2006 by the Australian Government.
2. You must have a referral to a Clinical Psychologist by a GP (under a GP Mental Health Care Plan billed under item number 2710). The Clinical Psychologist must also have a Medicare Provider Number.
3. You can request a referral to a specific Clinical Psychologist or your doctor may refer you to someone that he/she recommends.
4. You can receive up to 12 individual sessions in a calender year. Your referring doctor is required to assess your progress after the first six sessions (billed as item number 2712). Provision exists for people to receive an additional six sessions in certain circumstances.
5. The rebate from Medicare will cover a substantial part of the costs. Out-of-pocket expenses (the gap) will then vary and you must check this out with the Clinical Psychologist before commencing your consultations. In some circumstances bulk billing may be available and this is the case in my own practice.
6. Out-of-pocket costs, up to the Schedule Fee, will count towards the Medicare Safety Net.
1. By seeing a Clinical Psychologist you will receive the highest level of Medicare benefit for psychological treatment in new arrangements introduced from 1 November, 2006 by the Australian Government.
2. You must have a referral to a Clinical Psychologist by a GP (under a GP Mental Health Care Plan billed under item number 2710). The Clinical Psychologist must also have a Medicare Provider Number.
3. You can request a referral to a specific Clinical Psychologist or your doctor may refer you to someone that he/she recommends.
4. You can receive up to 12 individual sessions in a calender year. Your referring doctor is required to assess your progress after the first six sessions (billed as item number 2712). Provision exists for people to receive an additional six sessions in certain circumstances.
5. The rebate from Medicare will cover a substantial part of the costs. Out-of-pocket expenses (the gap) will then vary and you must check this out with the Clinical Psychologist before commencing your consultations. In some circumstances bulk billing may be available and this is the case in my own practice.
6. Out-of-pocket costs, up to the Schedule Fee, will count towards the Medicare Safety Net.
Posted by Richard Taylor in Medicare Q & A. Comments
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Self confidence
Dec
04
2007
04
2007
'I think that, generally, being honest with oneself and others about what you are or are not capable of doing can counteract that feeling of lack of self-confidence.'
The Dalai Lama in 'The Art of Happiness'
The Dalai Lama in 'The Art of Happiness'
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