Tag Archives: cognitive behavioural therapy

Why do people become therapists?

There are academic research studies published about the various reasons why people choose to become therapists. Have a Google, it is rather interesting. If you would like to know why I became a therapist read on…….

whyAged 19 I had a very promising career in opera and classical music ahead of me. The pleasure I got from singing gradually reduced over time as the pressure increased. I became more and more disillusioned with the classical singing world and eventually decided that despite my talent, this it was not what I wanted for my career anymore. I was then at a loss. Even if I had wanted to pursue a musical career it had started to become apparent that it was too physically demanding for me (I now know this  is due to Ehlers-Danlos Syndrome although I was undiagnosed at the time) My life had revolved around music from the age of six. What on earth was I going to do now?

I remember getting out a piece of paper and a pen. I thought that if I made a list of all the things I enjoyed, that it might be helpful. The first two things I wrote down were;

  1. People
  2. Animals

I briefly entertained the idea of becoming a veterinary receptionist, but did not know where my career would go after that. I then realised I was more of a dog person than an animal person.

I was then left with just people. I love people. I really do. I have always been fascinated by why people behave or think in certain ways. Just for my own pleasure I would watch anything to do with psychology on television and read anything I could get my hands on. I don’t remember but apparently when I was in infant school, before I started studying music, I would tell people I wanted to be a psychiatrist. People very close to me had experienced psychosis and depression, so I was also aware that mental health problems were very real.  One of the main issues I had with my career as a classical singer, is that I did not find it meaningful. Although I greatly appreciate the benefits of entertainment for others, I was so wrapped up in my own performance nerves that I could not appreciate it. I had this urge, and still do – to help people. I did not feel I was helping people with my singing voice.

The next natural step was to find a way to combine psychology with my love of people. I did some career research and decided that I would like to go into psychological therapy. I did not feel that a counselling course would provide me with enough depth or breadth to enable me to make informed decisions about which type of therapy I’d like to study (that is not to say I do not think counselling can be helpful for others. I sometimes refer people on to counselling if I feel it may more appropriate for them than CBT, and during my career in mental health I have met many people who have found counselling beneficial). It was very important for me to become and member of the British Psychological Society and so I enrolled to start BSc Psychology. Ironically before beginning my degree I became very depressed. This was before IAPTs existed and I saw a psychologist within the NHS and had what I now realise was CBT based therapy. I then went on to have cognitive-behavioural therapy to try and help manage chronic fatigue. I kind of fell in love with it (CBT not the fatigue!). People close to me had also had CBT. Whilst it is not a miraculous cure, it really had a meaningful effect on my life and my nearest and dearest. I wanted to offer the same support to others, with a therapy grounded in a solid evidence base. I still kept an open mind and studied many different perspectives during my degree.  I graduated and worked in different roles in mental health. I got to witness the impact of CBT on lots of different people. My love and respect for CBT only deepened, so I took the plunge and trained did my post graduate diploma in cognitive behavioural therapy –  and the rest as they say is history!

Why the concepts of mental strength and weakness make me feel uncomfortable.

We are not mentally strong or mentally weak. We are mentally human.

dumbell

How many times have you heard someone say ‘S/he must be so strong to cope with what she does’? Or how about ‘some people are just weaker than others’ – how many times have you heard a statement like this or something similar?

These statements suggest that the way in which each of us reacts to different situations in life is dependent on how ‘strong ‘ we are. If we believe this then by association we must also buy into the idea that those who become extremely distressed by certain events, to the point of clinical depression, anxiety or psychosis are ‘weak’. I don’t know about you, but that sounds wrong to me.

We are all here, not of our own choosing, we just happened to be born. We did not choose our individual genetic makeup, the parents we would be born to, or the socio-economic situation we would be in. Some psychologists believe that we are born with a certain set of personality traits, some more dominant than others. For example I am an extrovert, there is no getting away from it, but I did not choose to be that way.

Rather than thinking about the way people respond to distress as being a sign of strength or weakness, I think it is much kinder to think of the way people react as being  somewhere on a continuum of resilience. For example the chemicals, neurotransmitters, hormones and structure of my brain perhaps do not predispose me to schizophrenia or psychosis. Does this mean I am ‘stronger’ than someone with schizophrenia? I don’t think so. I think I am lucky, that my particular anatomy means that I do not develop psychosis.

Let us consider depression. If I were to lose my job, feel down about it for a while and then feel optimistic about finding a new one, does that mean the person who is made-redundant and becomes extremely depressed, with feelings of hopelessness about their future is weak. I do not think so either. Perhaps that person does not have a close support network of friends and family around them, or perhaps they know that if they cannot pay their rent they will end up homeless. Even if were to take two people who have exactly the same life experiences and encounter a difficult life situation, and one becomes extremely anxious whilst the other remains calm, does it mean they are ‘weak’. I don’t think so, perhaps their particular set of hormones, chemicals and all the other physical parts of their humanness mean that are more biologically geared to respond with anxiety. So for whatever reason, I think that in different situations we all have different levels of resilience when we are faced with a potentially distressing situation. Our levels of resilience are often influenced by elements that our out of our control; biologically, socially and economically. I hope this makes you think more kindly about others and yourself. We are not mentally strong or mentally weak. We are mentally human.

How I feel about perception polarisation and parity of esteem

image

This photograph demonstrates nicely the vast difference between the way physical and mental illnesses are viewed and interpreted by ourselves and others. The depth of shame some of my clients feel about having a mental health issue saddens me greatly. As one of my heros, the wonderful Paul Gilbert says, ‘none of us choose to suffer’. To find out more about the work of Paul Gilbert please visit http://www.compassionatemind.co.uk/. In the same way that we do not choose to have agonising tooth ache, we also do not choose to feel frozen with anxiety, hopeless with depression or terrified by hallucinations. A fantastic article by psychiatrist Alex Langford, in The Guardian today, conveys how pervasive the polarisation between services for emergency physical and psychiatric care is.  To read Alex’s article Why mental health bed cuts make me ashamed to work for the NHS click here. To read Alex’s blog The Psychiatry SHO* click here.

Daily I encounter another demonstration of perception polarisation. Most people think nothing of telling their friend/colleague/relative that they have physiotherapy every week, but how many of us would feel comfortable telling those same people that we see a psychological therapist every week. Makes you think doesn’t it. We all need to strive for parity of esteem – making sure the same provisions are in place for all types of illness, physical and mental. However, more than that we need parity of esteem in the way we judge mental and physical illness in relation to ourselves and others, because until we shift our own perceptions, how can we expect others to change theirs?

I describe my excitement at meeting a new client, how I am rubbish at imagining what people look like, my belief that people should always be treated as humans – not statistics and how I wish I had a magic wand.

I always feel very excited before I meet a new client. I get butterflies in my tummy. I am aware of the anticipation in the air from both myself and the new person I am meeting. The overriding thought in my head is always ‘Will I be able to help them?’. I imagine clients often think ‘Will she be able to help me?’ (Although when they actually see me they probably think ‘Wow – she is really short!’). I think my excitement comes from several things

  1. I just really love people
  2. I really love my job – the prospect of being able to use my skills to support someone.
  3. I genuinely get excited during an initial assessment, if from what a client is telling me, I think CBT will be helpful for them in someway. If I don’t think CBT will benefit them I feel a bit sad, though I’ll always sign post them to somewhere/someone who I hope will be able to help them in a different way.

When I first physically see a client, I am always fascinated between the difference between the real person and the image I have built up in my mind of what they look like. I am invariably wrong!

I feel incredibly privileged during our first session. This person is trusting me, who is a complete stranger to them with some of their innermost thoughts and fears. Yes, I have formal qualifications, but I hope that right from the start I emit compassion and reassurance. I have met some people with so many qualifications in therapy and mental health that they are almost coming out of their ears, but they give off an air of what I can only describe as ‘clinical coldness’. Sometimes arrogance accompanies this too. Whilst I want to inspire confidence in people, I would be so upset if I ever seemed cold or disinterested. This is a human being, not a subject, participant, product, statistic or unit.

I aim to create a space of safety and trust and hope I to convey this very quickly to a new person.

I feel such a surge of empathy when my client first tells me their story. I wish that I had a magic wand and could take their pain away. I totally believe in cognitive-behavioural therapy, but there is no getting away from it; therapy is hard work. I sometimes feel angry when I hear stories of injustice, abuse or violence. In spite of these feelings, ideas of possible helpful techniques start flowing through my mind. I mostly leave first sessions with people the same way I felt before – excited! I’m excited about the work we are going to do together to help them (even if I do still wish I had a magic wand).