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David Solomon MA MBACP(SnrAccred) MPractNLP

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Tag Archives: Having Therapy

The Benefits of Practising Gratitude

David Solomon MA MBACP(SnrAccred) MPractNLP Posted on June 8, 2019 by DavidJune 12, 2019

Paul Mills, a professor from the University of California in San Diego, is the lead author of an article on the practice of Gratitude, and its effects on physical health and emotional wellbeing.
I have thought for some time that because – for obvious evolutionary reasons – the body is hardwired to prioritise danger and other bad stuff that happens or might happen to us, that we need to find a way to restore some balance by consciously remembering the good stuff, the stuff we can be grateful for.


It is particularly important for anyone who suffers from periodic episodes of depression, that when we feel “up” we make lists – the longer the better – of the good stuff, so that we have something to buoy us up when we feel “down.” The practice is also vital for those who are torn apart by their self-critical inner voices. I’ve prepared a leaflet detailing the practice for those clients,  but here some general information:

Now, when things are bad, we may think, quite naturally, that there is nothing to be grateful for, but AT THE VERY LEAST we can be grateful that things aren’t even worse. I may feel like an incompetent, unattractive idiot who doesn’t deserve to have any friends, but I can be grateful that not everyone agrees with me! And we can usually do a lot better than that minimal and rather grudging example of gratitude, with practice.

I’m not asking you to lie to yourself. I’m asking you to treat yourself as if you were a person you need to care about.

And as with everything, exercising makes Gratitude stronger.

The practice of gratitude is easy to explain: you get a small notebook and pencil, and place it by your bed. At really stressful times its a good idea to carry it around with you, actually. Every night when you get into bed and are ready to go to sleep, you open the book and, thinking back over the day, write down just three things that you are grateful for, as if you were your own loving friend. These items must be written as positive statements, so you phrase them without using not, never, don’t, etc. So, for example, instead of saying my leg didn’t ache so badly today, you would say that my leg felt better today. Instead of saying that I didn’t feel so depressed today, you say I felt a little lighter today. If it’s difficult for you to think of three things, then spend a few minutes reading back what you have written in your notebook already, and you will recall something suitable. If you have faith, you can think of it as the practice of counting your blessings from a loving God.

Don’t expect instant results. It takes time for your brain to respond to this new, and initially difficult, way of thinking.

Gratitude practice activates the mammalian care-giving system which releases feel-good chemicals in our bodies (oxytocin and intrinsic opiates) and allows you to be self-compassionate, to deprogram the ingrained thinking habits, to feel much better.

By offering support and kindness to ourselves, we find that the body responds by feeling better.

And it has been shown to achieve a lot more for the body than “just” allowing it to feel better. Research using brain scans shows that after three months practice the medial prefrontal cortex has become much more sensitive, which helps to explains the steadily increasing effects of Gratitude practice that you will notice.

But Mills’ article talks about the physical effects too: “better mood, better sleep, less fatigue and lower levels of inflammatory biomarkers related to cardiac health.” The study involved 186 men and women who had been diagnosed with asymptomatic (Stage B – structural damage but no symptoms) heart failure for at least three months.
“We found that those patients who kept gratitude journals for those eight weeks showed reductions in circulating levels of several important inflammatory biomarkers, as well as an increase in heart rate variability while they wrote. Improved heart rate variability is considered a measure of reduced cardiac risk,” said Mills. “It seems that a more grateful heart is indeed a more healthy heart, and that gratitude journaling is an easy way to support cardiac health.”
Wow!
The full study is published by the American Psychological Association here (link to pdf)

I originally published this article in January 2017, but have updated and renamed it as new research is reported.

Posted in The Art and Science of Therapy, Therapy Research | Tagged Having Therapy, life-skills | Leave a reply

How Do My Results Compare With IAPT / NHS Therapy?

David Solomon MA MBACP(SnrAccred) MPractNLP Posted on March 17, 2019 by DavidApril 30, 2019

(Spoiler alert – very well!)

This essay came about because of two things happening around the same time.

Firstly, I was questioned as to whether private therapy was good value compared to the NHS – “The NHS has got to be doing it cheaper, hasn’t it!” was what was said to me. And there certainly wasn’t a question mark at the end of her sentence.

I looked it up, as to be honest I thought it would be around my charge of £30 to £60 per hour session.

I was rather annoyed and disgusted to discover that it costed £95 a session for “low intensity work,” and around £175 for “high intensity.” I can deliver either.

But never mind the cost, what about the quality, was my next thought…..

 

The second thing that happened was that a blog I follow (which looks at the application of statistics to therapy, amongst other things)  published an article on the measured recoveries made by clients given therapy in the NHS. It’s here(link).

Quite frankly I found the results shocking.

So will you, and I reproduce the bare bones of the NHS/IAPT results below .

For comparison,  I have worked out my own matching statistics, and show those in blue, together with some thoughts on the discrepancies.

It is recognised that the primary characteristic of a high-quality counsellor/psychotherapist is the ability to enable clients to maintain engagement, i.e. to help them to keep coming until they have what they need. This can be measured by:

A. The proportion of those entering therapy who have a managed/planned ending. In my service, it is 82%, compared with the NHS at 58%.

B. The proportion of clients who have had a managed ending that show demonstrable improvement (using recognised psychological tests). In my service it is 98%, compared with the NHS at 51%, and of course the NHS is starting from a lower percentage anyway (51% of 58%, rather than my 98% of 82%).

That’s the bottom line really, but if you want a further breakdown, I’ve put some of the calculations below.

Why is the difference so stark? – Well, here are a few guesses.

  • The NHS/IAPT controls what therapies are available there, and how they are practised – the process is carefully “manualised” and there is little flexibility in the approach.
  • The whole idea of “low intensity” and “high intensity” therapy seems to me to be missing both the point, and the research, actually.
  • With me, my approach is tailored differently for every client. A psychiatrist that one of my client’s sees occasionally said that he felt that I was delivering “A Bespoke Service.” Unsurprisingly, I liked that.
  • Although I do do some pro-bono work, client’s have to be able to pay for my services, and that does mean that I get a greater level of readiness and commitment, and ability to engage with the world.
  • The NHS is all about seeing as many patients as they can, regardless of staff readiness and morale (sorry, but it’s true, and it isn’t the fault of individual therapists). I try my best to put people off from coming if they are not ready, I really do NOT want to see someone who isn’t ready to work with me.
  • I run my life around the delivery of a high quality service, including lots of meditation, down-time, reading, learning, and no late nights, excess alcohol, etc etc. I didn’t become a therapist as a career move, I became a therapist because it was very clear to those in the volunteer service I was helping at, and clear to the therapists I attended in my own personal therapy, that I had a natural ability to do it well, and the commitment to do the required training.

==========================

More Detailed Statistics Follow (for the Strong-Willed Only):-

  1. The journey from referral – 30% of IAPT referrals don’t enter treatment [I’m afraid I have no way of capturing this data for my own clients, as I rarely hear from people who decide to go elsewhere,  or nowhere.]
  2. The journey from entering therapy – 45% of IAPT clients that enter therapy don’t complete. [17% of my clients do not complete a course of six sessions,  or where they have decided to have more than six sessions then cancel what turns out to be their last session.  In these cases, having no closing data from testing, I cannot say definitely whether the client has met the standards for significant improvement or recovery. In some cases, I think it likely that the client feels that the process is not helpful to them, but decide not to talk to me about it and thereby come to a managed ending.. But some also leave suddenly,  having made good progress,  because they find it difficult to do endings,  or because they intend to return at some point, but haven’t needed to so far.]
  3. The outcome at therapy ending for all clients – 53% of IAPT clients do NOT achieve  recovery [the lower the number the better for this one. I use the CORE-OM test, an internationally recognised test for assessing risk, health, improvement and recovery. My percentage of completing clients who do NOT achieve recovery is 18%.]
  4. The outcome at therapy ending for clients that were at case level at the start – 51% of those clients achieve recovery (reach a point on psychological tests which are below the scores of a clinical population) in IAPT therapy [for my clients,  83% achieve recovery, and 98% have measured significant improvement in their symptoms. For my clients the main limiting factor is the budget in these cases. Often their employer will only pay for six or eight sessions and the client is would have to pay for further sessions with me once this number has been reached. These clients may well go on to other agencies – I often recommend local or online resources to clients who have finished but who would benefit from further sessions .]
Posted in Questions from Clients, Standards, Therapy Research | Tagged Having Therapy, Therapy Costs | 1 Reply

Can I Have A Free Trial Session?

David Solomon MA MBACP(SnrAccred) MPractNLP Posted on April 4, 2017 by DavidMarch 25, 2017

Only if you don’t want to come for another session!

Many therapists, particularly when newly qualified, will offer a free first session so you can see how you can get along. My way is to insist on payment for the first session, usually in advance, with a guarantee of a refund of that payment if either of us doesn’t want to continue for any reason at all after having attended for the first session.

Yes, if you come to the first session, you are welcome to leave, having had a full session, and with a refund, if you decide for any reason that you do not want to continue.

So, what’s the difference? In practice very, very few clients fail to show up for the first session if they have paid in advance. This is very much to their own benefit, as if they just vanish without attending or paying, they are not going to come back and give therapy a chance to make a difference in their lives. And it has been proven over and over that therapy can make a huge difference in their lives. So I don’t want to discourage them from having that opportunity to better themselves.

It’s true that most clients who come for the first session will continue for a course of sessions, be that six sessions – my suggested course – or longer. And the overwhelming majority of those clients will come to feel that the experience offers extraordinary value for money. But if they don’t want to return I am delighted to offer a refund. In a way it could be argued that I’m paying these clients not to return!  Why? – because I only want to work with clients who really, really want to work with me.

Of course,on occasion, I believe that I am not the right therapist for a client. Obviously they get a refund, and suggestions as to other therapists who may be more suitable. Sometimes, I want the client to think hard about their motivation and expectation of therapy before coming for a course of sessions. In those cases I will insist on giving a refund immediately. If the client then decides they want to return for a course (and it has to be said that most do), they will pay me for the first session too.

Posted in The Art and Science of Therapy | Tagged Having Therapy, Therapy Costs | Leave a reply

Bipolar Disorder – does counselling help?

David Solomon MA MBACP(SnrAccred) MPractNLP Posted on April 4, 2017 by DavidNovember 30, 2017

My sister is waiting to see if she has bipolar disorder, and it is affecting our whole family. Would a few therapy sessions with you help while we wait for an NHS appointment for her? (You did not leave me an email address so I am replying to your questions here, having changed some of the details).

A diagnosis of bipolar disorder is life-changing for the sufferer and for their families, so here we might actually have two questions:

1. Would counselling help me, as a family member, cope with the stresses of living with my sister – yes it would, but it is probably not practical on a long term basis because of the cost. Perhaps occasionally when things are getting on top of you. Do keep a look out for support groups, often run by e.g. Mind, as they can be an alternative to therapy for the families of patients.

2. This really is a question for your sister, not for me. If she feels it will be of help to her to have somewhere to vent her frustrations while she waits for the NHS to come up with some help, then yes, it will. If she doesn’t think so she is very unlikely to attend often enough for therapy to help.

Unfortunately many sufferers of bipolar disorder, particularly in the “up” phase, are very resistant to attending therapy sessions or taking medication, and the patient’s willing cooperation is crucial when it comes to having private counselling.

There is no reason that I know of where counselling of itself would be unwise. Counselling/psychotherapy, along with medication, is the recommended treatment for bipolar disorder. Waiting times are a big problem still for mental health services, although the suicidal ideation that frequently accompanies bipolar disorder will mean that the appointment will be quicker.

Posted in Questions from Clients, The Art and Science of Therapy | Tagged Having Therapy | Leave a reply

How Does Psychotherapy and Counselling Work?

David Solomon MA MBACP(SnrAccred) MPractNLP Posted on March 25, 2017 by DavidMarch 25, 2017

The important thing is that the research shows quite clearly that it does work.
Oh, I can give you half a dozen theories, that’s one advantage of having an MA, but I quite like the following explanation:
It’s a special kind of conversation where two people get to know one person (you) better. While we both get to know you better, many of the problems in living that caused you to attend seem to resolve, or fall away, and be seen in a different light.
Sometimes missing life-skills can be identified, and we can agree on coaching to rectify these gaps in skills, such as deep relaxation, or assertiveness.

Or we can just agree it’s magic, and let it go at that!

(if you still want a more scientific explanation, here’s one – link – that’s pretty close)

Posted in Therapy Research | Tagged Having Therapy | Leave a reply

Seven Ways to Sabotage Your Therapy

David Solomon MA MBACP(SnrAccred) MPractNLP Posted on December 10, 2016 by DavidMarch 25, 2017

I’m not a great fan of internet lists, although it’s difficult for me to resist titles like this one. It isn’t original, unfortunately, although I am very familiar with these seven, and several more too.

This list, and several others to do with therapy, was published by Ryan Howes, in Psychology Today (link), and includes the following ways of not helping yourself when working with a therapist:

  • Choose your therapist quickly
  • Don’t ask questions
  • Lie
  • Make hints and speak in riddles
  • Triangulate (spend the time talking about other people’s troubles, rather than your own)
  • Compartmentalise (pretend that one area of your life is completely disconnected from the rest of your life – the connection is you, of course)
  • Vanish

Ryan gives some explanation on each in the article.

In practice, it is very difficult to avoid what’s on the list. I would go as far to say that if you can avoid everything on this list you have probably had a lot of therapy already! So it is more something for us both to keep in mind during therapy, to watch for ourselves doing it, and ask why (if we can!)

Posted in In The Media | Tagged Having Therapy | Leave a reply

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