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What does clients find most helpful about therapy?

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This is a reblog from Damon Ashworth Psychology! A brilliant post that I hope will be helpful and interesting.

Therapist-and-Patient

When clients first begin their therapy journey, they often ask to be taught specific skills that are going to help them achieve their specific goals.

They believe that if they can be taught these skills, they will be able to overcome their difficulties, or the problems that led to them entering therapy, and they will have no subsequent difficulties or need for additional therapy going forward.

Cognitive Behavioural Therapy (CBT) is a short-term treatment that clients can easily understand. It is based on the premise that all difficulties arise from unhelpful cognitions (beliefs, expectations, assumptions, rules and thoughts) and unhelpful behaviours. CBT aims to help clients see that their cognitions and behaviours are unhelpful, and tries to teach them skills that can help them to replace these unhelpful cognitions and behaviours with more helpful ones. If this is achieved, the assumption is that clients will change and therefore improve.

I do believe that if a client is able to have more helpful cognitions and behaviours then they will have significantly improved psychological health and overall well-being. I’m just not sure if I agree that the process that is required to get to this outcome is the same as what many CBT clinicians would believe. In fact, focus on distorted cognitions has actually been shown to have a negative correlation with overall outcomes in cognitive therapy for depression studies (Castonguay, Goldfield, Wiser, Raue, & Hayes, 1996).

What actually leads to improvements across treatment?

My previous article “What Leads to Optimal Outcomes in Therapy?” answers this question in detail and shows that the outcome is dependent upon (Hubble & Miller, 2004):

  • The life circumstances of the client, their personal resources and readiness to change (40% of overall outcome variance)
  • The therapeutic relationship (30% of overall outcome variance)
  • The expectations about the treatment and therapy (15% of overall outcome variance)
  • The specific model of treatment (15% of overall outcome variance)

For cognitive therapy for depression, both therapeutic alliance and the emotional involvement of the patient predicted the reductions in symptom severity across the treatment (Castonguay et al., 1996). Many therapists are now aware of these findings, but clients are generally not.

What do clients view to be the most valuable elements of therapy once they have improved?

By the end of treatment, especially if it is a successful outcome, clients tend to have a much different outlook on what they think are the most valuable aspects of therapy when compared to what they were looking for at the beginning of their treatment.

In Irvin Yalom’s excellent and informative book ‘The Theory and Practice of Group Psychotherapy’, he goes into detail about a study that he conducted with his colleagues that examined the most helpful therapeutic factors, as identified by 20 successful long-term group therapy clients. They gave each client 60 cards, which consisted of five items across each of the 12 categories of therapeutic factors, and asked them to sort them in terms of how helpful these items were across their treatment.

The 12 categories, from least helpful to most helpful were:

12. Identification: trying to be like others

11. Guidance: being given advice or suggestions about what to do

10. Family reenactment: developing a greater understanding of earlier family experiences

9. Altruism: seeing the benefits of helping others

8. Installation of hope: knowing that others with similar problems have improved

7. Universality: realising that others have similar experiences and problems

6. Existential factors: recognizing that pain, isolation, injustice and death are part of life

5. Interpersonal output: learning about how to relate to and get along with others

4. Self-understanding: learning more about thoughts, feelings, the self, and their origins

3. Cohesiveness: being understood, accepted and connected with a sense of belonging

2. Catharsis: expressing feelings and getting things out in the open

1. Interpersonal input: learning more about our impression and impact on others

The clients were unaware of the different categories, and simply rated each of the 60 individual items in relation to how helpful it had been to them.

What becomes apparent when looking at these categories is that giving advice or suggestions about what to do is often not found to be a very helpful element of the therapy process, even though this is exactly what most of the clients are initially looking for. What is far more important is the client developing a deeper knowledge of themselves, their internal world, and how they relate to and are perceived by others in interpersonal situations.

 

The top 10 items that the clients rated as most helpful were (Yalom & Leszcz, 2005):

10. Feeling more trustful of groups and of other people.

 

9. Seeing that others could reveal embarrassing things and take other risks and benefit from it helped me to do the same.

 

8. Learning how I come across to others.

 

7. Learning that I must take ultimate responsibility for the way I live my life no matter how much guidance and support I get from others.

 

6. Expressing negative and/or positive feelings toward another member.

 

5. The group’s teaching me about the type of impression I make on others.

 

4. Learning how to express my feelings.

 

3. Other members honestly telling me what they think of me.

 

2. Being able to say what is bothering me instead of holding it in.

 

1. Discovering and accepting previously unknown or unacceptable parts of myself.

Each of the 20 clients that made up these survey results had been in therapy for an average of 16 months, and were either about to finish their treatment or had recently done so. Obviously these items were in relation to group therapy, so the most important factors for change across treatment in individual therapy may be different. However, even with individual therapy, Yalom believes that in the end, it is the relationship that heals.

For more information, feel free to check out Chapter 4 in ‘The Theory and Practice of Group Psychotherapy’ by Irvin Yalom and Molyn Leszcz (2005), or any of the other studies out there that look into the outcomes or therapeutic factors involved in change across psychological treatment.

If you have ever wanted to discover and learn more about yourself, accept yourself more, express yourself better, take greater responsibility for your life, challenge yourself and develop more trust in others, a longer-term psychological therapy may be just what you need!

 

Dr Damon Ashworth

Clinical Psychologist

Anger management 

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Next week I will start working with a client searching treatment for anger issues. I wondered if anyone in here has tips on how to manage anger?

Red brick road

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My boyfriend is snoring, so instead of trying to sleep I embrace the opportunity to write. My mind was occupied anyway with memories and random thoughts, so why not write it down instead?

Last weekend me and my boyfriend went to Poland. It was a great trip, where we had four whole days to do whatever we wanted. We managed to do some sightseeing, try an escape room for the first time, and take a day-trip to Berlin. The city we travelled to in Poland is called Szczecin, just a 2,5 hour bus drive to Germany`s capital city. Since it was cold, we did not see everything that was there, but we took the “red walk”, seeing some of the main attractions.

The so called “red walk” connects nearly all the attractions within the centre. This is by far the best way to discover the centre on foot, as all attractions are marked by a number (there are about 40) on the pavement, so you won’t miss one. At each of them there is a sign explaining some details about the sights.

Wikitravel

szczecin-philharmonic-poland-harmony0416
One of the attractions in Szczecin

Like Dorothy in the wizard of oz, we were safely taken to our targets by following the red lines. My shoes were sadly not red and pretty (and not very warm), but it was still a nice walk.

Szczecin is a pretty city, regardless of its unpronounceable name.

The creativity (and humor) of the hard-working Polish people also manifested itself on the bus to Berlin. There was a little menu describing what we could buy if we got hungry or thirsty, and on it there was a small addition: You could get a friendly neighbor for free!

 

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Need a friendly neighbor? 

Every city has something special, but the people you travel with makes the exploration of it even more memorable and exciting . I am glad I came to this part of Poland that I knew nothing about, happy to have seen the world through Polish eyes. Although I`ve read that the country has its problems, like a high unemployment rate, Poland still manages to show itself from its best side. Maybe a hard life makes people focus on what is good in life? We all know that people who look at the bright side and build on their strength when life gets difficult, can achieve great things. Painting the road with red lines might not seem like something groundbreaking, but it is clever.

I could have written a lot more about the trip, but will leave it for now. I can`t wait to go and explore more of the world. For now, I will just remember the weekend and soak up creativity whenever I encounter it.

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Talk to me

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When I was 15, I took the bus from Stavanger to Bergen after saying goodbye to my boyfriend. The last thing I wanted, was to talk with anyone. I struggled to keep my tears back and wanted to have time to think about everything we did and he said (like a typical teenager). But to my horror, an old woman sat next to me and I knew immediately that she was a talker. Little did I know that this would be one of the very conversations I remember from that year. We talked about everything, and soon started on a philosophical journey together. I told her about my boyfriend, and how hard it was to live so far apart from him (over 10 hours with a car or bus). She responded by saying how healthy it is to meet people who live in a different place than where you grew up. Because they probably see the world a little bit different than you, and that means you might end up learning something new.
This woman was so wise, and I learnt something new too: By opening up to all kinds off people, even strangers, you might change the way you think and see the world. I was reminded of this event when I listened to “an organized mind” by Daniel Levitin in my car. He described a study where the researchers asked people if they thought they would prefer sitting alone or talk with a stranger on the bus. They were quite sure about what they would like the most, but it seems like we don`t always know how much we crave connections with others. The study is described below, and I hope you enjoy it as much as me. Maybe the next time you`r filled with dread, hoping that somebody won`t disturb you on a bus, plane or train, you might look at the commute as an opportunity instead of fear.

Why You Should Put Down Your Smartphone and Talk to Strangers

Credit: pio3 / Shutterstock.com

Talking to the stranger in seat 4B on a cross-country flight is often considered one of the torments of air travel, to be avoided at all costs. But new research suggests people are deeply wrong about the misery of striking up conversations on public transit.

Contrary to expectations, people are happier after a conversation with a stranger, the study revealed.

“At least in some cases, people don’t seem to be social enough for their own well-being,” said study researcher Nicholas Epley, a professor of behavioral science at the University of Chicago Booth School of Business. “They think that sitting in solitude will be more pleasant than engaging in conversation, when, in fact, the opposite is true.” [7 Thoughts That Are Bad For You]

Talking to strangers

Epley, author of the book “Mindwise: How We Understand What Others Think, Feel, Believe and Want” (Knopf, 2014), studies social connection. Humans are social animals, he said, to the extent that having more and stronger friends and family connections is linked with a healthier life.

But in waiting rooms, trains, planes and other public spots, people fail to show their social stripes, Epley told Live Science. During his own commute in Chicago, he sees “highly social animals getting on the train every morning and being remarkably anti-social … They might as well be sitting next to a rock.”

Perhaps people know that interacting with a stranger is likely to be less pleasant than sitting in silence, so they choose the latter, Epley said.

Or maybe, just maybe, everybody is wrong about talking to strangers. Maybe it’s actually fun.

Only connect

To find out which is true, Epley and his colleagues recruited real-life commuters at Chicago train stations. They also conducted a series of experiments with bus riders. In some of these experiments, they simply asked people to imagine striking up a conversation on the bus or train. Would it be pleasant? Would they feel happy afterward?

By and large, people said “no,” it wouldn’t be pleasant, and that such an interaction wouldn’t result in a happiness boost. In addition, people guessed, on average, that fewer than half of strangers would be interested in chatting. They expected to be rebuffed.

In other experiments, the researchers actually asked the commuters to go through with the conversations. At random, some participants were assigned to start a conversation. Others were asked to sit silently, and a third group was told to go about their normal commute routine (which involved silence for some and speaking to a friend for others). The participants were given sealed surveys to complete and mail in after their commute.

The results? People had a more pleasant time when they talked to a stranger versus when they stayed silent. Incredibly, the findings held even when the researchers controlled for personality traits, like extraversion and introversion.

 Does the finding that talking to strangers makes people happier make you more likely to strike up conversations in public more often?
  • No way. You couldn’t pay me enough.
  • Maybe. I can see the upsides.
  • Definitely. I’d like to meet new people.
  • No – but only because I already chat with strangers.

“Everyone seems happier and has a more pleasant interaction when they connect versus sit in isolation,” Epley said.

Perhaps even more surprising, their conversation partners seemed to welcome the connection, too.

“Nobody was rejected in any of our studies, as far as I can tell,” Epley said. “Everybody who tried to talk to somebody was able to.”

In another study, the researchers set up participants in a waiting room, so they could test the happiness of both the conversation starter and their target. Again, everyone was happier after chatting — even the person who hadn’t started the conversation. Pairs of strangers deep in conversation also reported that the wait seemed shorter.

Epley’s research isn’t the first to find that interactions with strangers influence mood. Findings reported in 2012 showed that even smiling and nodding at strangers makes people feel more connected. [5 Wacky Things That Are Good for Your Health]

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My last day at work

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Today is my last day at work. I can’t believe that it’s already been a year. In ten days I’m starting working with adults like I did before and I really look forward to it. All though I never found my calling working in the school system, I have still learnt a lot. And I have also been very happy with the people I’ve met here. They have always been nice and comfortable to be around. 

We had lunch together for the last time today. I brought two cakes I struggled with yesterday. To my surprise, my leader had made a cake also, and I almost started to cry. She held a speech where she said so many nice things about me, so I really feel like they are satisfied with the work I’ve done here. The rest of the day has been full of hugs and nice conversions, and this evening some of us will go out and have a drink to say properly goodbye. 

The richest and most beautiful county in the world 

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I promised one of my readers that I would include pictures from my country. I will  publish a post later with pictures of Bergen where I live now, but I want to give a taste of my wonderful county now with this tasty appetizer. Are you wondering where you should travel next? Well, maybe you will consider Norway. And if you need a guide, I would be happy to show you the best places to go. 

If you are interested you can also visit my Pinterest site for more inspiration 

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