It’s been a long time since I’ve blogged. I’ve really been missing it. I am thinking of doing a series of regular blog posts sharing how I am using CBT in my own life each day. I’m hoping this will serve as a reminder to those who have already received some form of CBT or introduce new people to the benefits of cognitive behavioural therapy. Being a Mummy to a 10 month old baby means that committing to blogging every day probably isn’t realistic, as much as I’d like to. I might manage a daily insightful tweet but even that can be a chore with a baby. Instead I was thinking of doing a weekly blog post sharing in which ways CBT has enhanced my wellbeing for each preceding week. I’d be really grateful for any feedback or suggestions anybody has about this idea. I’m really looking forward to connecting with my followers and a wider audience again.
Those three little words. Depending on who says them or in which context, those words can provoke different responses in us. Sometimes we don’t want to hear those words, sometimes we expect something different. I think those three little words are so important. I am referring to “I don’t know”. I think this simple sentence can say so many things about a person. It’s often not the words we want to hear from our therapist. We go therapy most often seeking answers, wanting to be ‘cured’, to have our problems solved.
However, I think “I don’t know” is one of the most powerful sentences one can hear or say. For me it represents above all one of the most important qualities in a therapist: integrity. I think it speaks volumes about a person who is comfortable enough to admit they do not know something, has the integrity not to lie, to be truthful and honest. To be content enough with their own level of knowledge to admit when they do not know something shows confidence in their current abilities, it says to me that they are enough. I would much rather have somebody tell me they do not know something than try to pull the wool over my eyes or grab at straws trying to come up with an answer that makes them sound competent. Nobody has all the answers and that is ok. The realisation that we do not know something can be the catalyst to discovery of new knowledge or even prompt us to ask new questions, it can put us on new pathways. Nothing new would ever be discovered if nobody admitted they did not know something. I think saying “I don’t know” as well as being honest, can be liberating, it stops us having to try and “fake it” to pretend we know, when we don’t. The response “I don’t know” frees us of that certain type of stressor, the one we often put on ourselves – to always look like we know what we are doing. Human beings are fallible, we make mistakes, we are imperfect and flawed, and so is our knowledge and that’s ok. So next time you find yourself in a situation where you don’t know something but want to give an answer other than “I don’t know” perhaps wonder whether in fact I don’t know is possibly the best answer of all.
You may or may not be familiar with the concept of problem solving. It is an approach that can be applied to many problems in life, both practical and interpersonal (relationships with other people) ones.
There are 5 basic steps to problem solving and I beleive that from my experience it is the 5th step – evaluation, that most people forget to implement.
Here are the 5 steps:
1. Define your problem.
2. Brainstorm solutions.
3. Review and choose the most appropriate solution.
4.Put into action chosen solution.
5.Evaluate your progress.
I cannot tell you how many times I have encountered people who are ploughing away, often very diligently for weeks or months and never evaluate their progress. A good analogy is a diet for weight-loss. You wouldn’t stay on a diet on which you aren’t loosing weight. However, if you don’t weigh yourself you won’t know if you are losing, maintaining or gaining wait. Whatever your solution make sure you measure your progress. If after you have evaluated, things are not going to plan then you are in a position of awareness and can either make some adjustments or perhaps try a different solution on your list. It’s the same as this age old saying………….
So next time you are working on a solution, remember to evaluate your progress so that you aren’t using up your energy on something that is not actually helping you.
If the idea of CBT was to help people by teaching them to ‘think positive’ then cognitive behavioural therapy would not exist. CBT definitely is not about positive thinking. I promise you. This is a huge misconception. Actually in my opinion the cognitive (thought) element CBT is about teaching people to think factually, realistically, logically and reasonably, whilst taking into account feelings and behaviours. A few months ago I needed CBT therapy after going through a difficult time. I said to my therapist. ‘Things in my life at the moment are shit’. She agreed, there was no refuting the fact that in the current circumstances, things were ‘shit’ this was not a thinking error, or distortion. The amount of trauma I had and was continuing to experience and having just been diagnosed with several medical conditions and not long having been in hospital culminated in a state of what most people would agree was shittiness (does that have one or two t’s?). However, if I had just broken a nail but everything else in my life was relatively ok and then said ‘things in my life at the moment are shit’ this would be an example of a cognitive distortion, namely overgeneralisation and catastrophising. You can read more about cognitive distortions in this article from Harley Therapy. Nonethleses, in both of these situations, being told to ‘think positive’ would have absolutely no effect whatsoever. It’s as much use as telling somebody to fall in love with a washing machine, it just isn’t going to happen. CBT is about whether you believe or ‘buy into your thoughts’. We are all in the habit of believing our own thoughts, unfortunately we cannot always be relied upon to think logically or factually. We often engage in emotional reasoning ‘I feel bad therefore things must be bad’ or ‘I feel fantastic therefore everything is fantastic’. Yes we do get it right sometimes, but as in the case of depression, or OCD we cannot always trust the validity of our thoughts. So if we can’t just ‘think positive’ what do we do? We QUESTION our thoughts, we challenge them, we change our behaviour. Overtime this process can actually lead to a change in the type or frequency of the thoughts we have, hopefully they will be more realistic, and as a bonus more positive. This is what CBT is really about. It’s not about thinking positive. However, sometimes when things are shitty we need to learn to accept that, and that is a whole other blog post in itself, so I shall sign off now.
In this video I talk about some of the reasons I think people have a bad experience with, or don’t like CBT. It touches on various things such as the way CBT is delivered, people’s expectations and cognitive behavioural therapy for chronic pain and chronic illness. I’d be really interested to get people feedback on it, and wonder if anyone who has had CBT can relate to any of the issues that I address.
“Thank you, I’m glad you told me the truth, I would have worried you were terminally ill otherwise”. This statement is indicative of why I will continue to self-disclose despite being bullied on twitter.
The other night I was taking part in a really great scheduled mental health chat on twitter about CBT. Obviously I was really excited, I participate in this group chat most weeks and I was so pleased that this week’s topic was one so dear to my heart. I was talking about how I find self-disclosure to be an effective therapeutic tool. After the chat two other mental health professional people started saying; it was a fact that self-disclosure was never appropriate, that my behaviour was unethical, unacceptable and that I must be youngish, inexperienced and ‘done a course in CBT (inferring I was not properly trained)’ and were worried. These people know absolutely nothing about my clinical practice, and have no right to make assumptions about me as a person or my professional conduct. I am not sure which professional body they belong to, but raising concerns on twitter and making defamatory statements about another clinician is breech of the British Psychological Society’s social media policy. Of course it is ok to have differences of opinion, I frequently have differing views to those of other professionals on twitter. However, differences in opinion should always be expressed in a respectful way and never become personalised or accusatory, especially in a public forum.
I usually regard myself as a confident and assertive person, but to be harassed in this way and have my professional integrity attacked was extremely upsetting. If someone as usually resilient as me can feel so hurt, then it begs the question as to how severely affected those that are at a particularly vulnerable time in their life could be when on the receiving end of such nastiness?
The other side of the situation is this. So many mental health services users, psychologists, therapists and other mental health workers publicly and privately gave their support to me, and nobody condoned their behaviour. I am so touched by all the support I have received, I sincerely thank each and every one of you.
These tweeters took issue with the fact that I tweet about my medical problems and posted a photo of myself in a hospital gown. I feel very strongly that having long term health conditions are nothing to be ashamed of, and I never hide them from my clients. In fact the frequency of which I sometimes need to apply eye drops means it is impossible to hide from clients, and why would I need to anyway? I simply explain to clients in the first session why I need them. I believe telling people the truth, especially vulnerable clients, is much preferable to what people may imagine. For example, one client said to me “Thank you, I’m glad you told me the truth, I would have worried you were terminally ill otherwise”. How can I expect my client to learn to manage their long term or permanent health condition if I am actively trying to hide mine? I believe being open sends out a positive message, I have several chronic health conditions but I have learnt to manage them well, so I believe others can too. My health problems shape who I am. There is no doubt they influence my therapeutic practice, but I believe for the better. For those who are lucky enough to be healthy they cannot possibly understand how it feels to have a permanent disability or illness, how it feels to have an unpredictable illness, or live with chronic pain. That is not to say that therapists need to have personal experience to deliver effective CBT, but the added lived experience and personal insight I can offer is sometimes very powerful for clients, an added bonus of having me as therapist if you like.
So I will continue to tweet photos of me looking fabulous in my hospital gown, and raise awareness about eye health and adverse reactions to medication by sharing my own publically! If people do not like it, they do not have to have me as a therapist. There are plenty of therapists out there that will reveal absolutely nothing about themselves, and that is fine – I see no reason for me to criticise them, we simply have a different approach. I refuse to shy away from public media for fear of criticism. I have blocked those two individuals on twitter, I no longer respect or have any interest in what they have to say. My wonky spine and I (shhhhh I have scoliosis don’t tell anyone!) will be tweeting for a long time to come. I am chronically ill, but I am also chronically fabulous!
What do you wear when you are working as a therapist? Read on to find out how I choose my clothes, and why I wear the things I do. Fashion and CBT not the most likely of topics, but a subject that I find quite intriguing.
When I first started my CBT training, I asked my clinical supervisor ‘what should I wear when I start to see clients?’ He looked at me puzzled and replied ‘Clothes, Alieshia!’. ‘Very funny’, I said but seriously, I said, ‘how do I know what to wear?’. He looked at me again and could see I genuinely wanted advice. He said ‘as a woman you don’t want to wear anything that is too revealing, simply because it is too distracting for clients’. I said ‘yes, I had already thought that, I have never worn anything that shows my cleavage or is too short whenever I have worked in the caring profession. I agree. But apart from that how do I know what to wear?’ He looked at me again, surprised that I still was not satisfied with his answer. He looked down at himself and said, ‘I just wear this’. He was wearing a pair of jeans and a polo shirt. I looked at him and said ‘Yes, that is fine, but you have many years of experience and look your age, I don’t’.
My issue is that I look very young. Only the other week my new cardiologist started asking my Mum about my usual energy levels at home. My Mum had to turn round and say, sorry Dr S****** but Alieshia lives with her husband, she is actually 29. He turned round and apologised to me, he had thought I was still a teenager, living at home.
I feel that if I turned up to meet clients in a polo shirt and jeans that I would look so young that they may doubt my clinical capability and lose confidence in the therapeutic process, which would be counter-productive. For me personally it’s important for me to dress in a way that looks professional and choose an outfit that makes me look at least 20, I mean this sincerely, I do not jest. I have discussed clothing with some other therapists. My colleagues do not have the age issue to contend with but are honest with me, and can understand why it is important for me to dress in way which enhances my age.
So aside from the age issue, what other factors are there to consider when I dress for work?
For me I think it’s great that my first clinical supervisor wore casual clothes. On one level, I believe what you wear should not matter, CBT is a collaboration and not a platform for power dressing. By wearing jeans, it could convey the message that ‘I am relaxed, it’s ok for you to be too’. I can particularly appreciate how this might be great when working with children and young people. Business attire can sometimes be intimidating. However for me personally I believe that dressing smartly (not a three piece suit or anything, but smart trousers, top and shoes) conveys to my client ‘I respect you and have made an effort to dress this way. I am a professional and I want you to have confidence in that from everything, from the way I speak, the content of what I say, the way I conduct myself and what I wear’.
Some therapeutic approaches discourage from any personal expression and therapists will wear exactly the same outfit, or extremely similar clothing to each session. CBT is not like that, I have never come across any literature that discusses proper work attire! I still feel able to express my personality through my clothing and make-up without being distracting to my clients, whilst still being professional. What do you think about what your therapist wears? Are you a mental health professional, have you ever considered your work attire? Let me know in the comments below, or send me a tweet.
On a final note I shall leave you with this memory…… I wore a yellow top one day with matching yellow nail polish. In the morning my client said to me ‘Alieshia, you look like a ray of sunshine’. The next day my supervisor said to me (I had a different top on, but the same nail polish) ‘Alieshia, that is the most disgusting colour nail polish I have ever seen. It’s horrible’. Make of that what you will!