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.
It’s been a while hasn’t it folks! As some of you may know I live with quite a few chronic illnesses. Unfortunately I have had a flare up of some of them, whilst other symptoms are still being investigated. I am currently not well enough to practice CBT and have not been for the majority of this year. I wanted to blog about this not only to give an update, but to remind everybody how important it is when you work in a caring profession to be aware of your fitness to practice. Put as concisely as I possibly can, I am not fit to practice as my symptoms currently affect my ability to be able to travel, and my ability to be able to concentrate for various different reasons. Mental health work and CBT is my absolute passion (something I have dedicated many hours to in training and work) and it hurts deeply not to be able to practice. However, I have reached a certain level of acceptance meaning I finally felt able to write this blog post. I am not going to expand on my feelings about this here as it is very personal and it would be inappropriate in a public setting. I am looking to the future to hopefully finding answers to some of my symptoms and finding effective treatment, and for those conditions already diagnosed, adjusting treatment to get them back under control. For any other people with chronic illnesses
(or Spoonies as we are affectionately known see Spoon Theory as to why) you may relate that a flare up of one condition often sets off another! The road to being able to be fit to practice again is probably going to be a long journey. I sincerely hope that going through all of this will make me a better therapist one day, and if nothing else I am certainly getting a great opportunity to practice what I preach. CBT may not ‘cure’ long term health conditions, but for me personally, it helps me to cope with the impact of them somewhat. In the meantime, if anyone has any spare spoons…. please send them my way!!!
“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!
How can I expect my client to trust me, if I am unprepared to ever appear vulnerable? How can I expect my client to comfortably explain a missed session or extended absence from therapy, if I am unprepared to do the same?
In a clinical context self-disclosure refers to the act of revealing personal details about yourself to your client. I think self-disclosure in a therapeutic sense can be broken down into two different types;
- self-disclosure in order to aid the process of therapy
- self-disclosure when my personal life impacts on my work as a CBT therapist
For me, both types of self-disclosure are equally important as part of effective cognitive-behavioural therapy and are wonderful tools to build trust within the therapeutic relationship. In my experience many therapists are frightened of self-disclosure as in our training the importance of ‘boundaries’ is consistently drummed into us, from lecturers, clinical supervisors and academic literature.
However, I believe that whilst cognitive behavioural therapy is evidence based, (which I strongly believe in, and support) there are some aspects of any type of psychological therapy and many medical interventions that make it an art. It is well-known that it is very difficult to measure empathy and the strength of a therapeutic relationship. Measures of such things are highly subjective, and necessarily so, we do not have a better way of measuring (apart from extremely expensive neuro-imaging equipment) such intricacies other than self-report. Nevertheless, just because we cannot accurately measure something it does not mean it is not essential or unimportant. For example, try to describe and measure love…… very difficult.
As a scientist-practitioner and a social scientist the art of the therapeutic relationship is built upon trust. How can I expect my client to trust me, if I am unprepared to ever appear vulnerable? How can I expect my client to comfortably explain a missed session or extended absence from therapy, if I am unprepared to do the same? It’s all very well saying to a client “I’m ill” and not expanding on it, but I find clients then often ask questions. Turning round and saying ‘I cannot tell you what’s wrong with me because it may affect our therapeutic relationship and would break boundaries’ sounds reasonable enough. However, clients are then likely to feel rejected (after all they haven’t studied the science and research behind boundaries) and moreover, worried. They may think, ” does she have a life threatening illness?”, “has she got an illness that gives her pain so it means she can’t concentrate during out sessions?” etc… In instances such a these I find truth is very powerful. By telling my client about my illness, I am given the opportunity to reassure them that my competence is not affected (otherwise I would not practice) and it also says to them, “I am a vulnerable human being just like you and that’s ok.”. Clients are so grateful for my honesty and it invariably builds mutual understanding and trust.
The other type of self-disclosure works slightly differently. This is useful for therapeutic gain by demonstrating to your client that in some situations you can personally relate. This communicates that as a therapist you are also vulnerable and imperfect but also shows that you practice what you preach. For example I am happy to tell my clients that struggle with insomnia that I have struggled with this in the past and still do from time to time. Certain CBT techniques work better for me than others and I appreciate than sleep hygiene is not an overnight cure (pardon the pun) and that it can be tough and sometimes take perseverance before benefits are to be had.
I will not bore you with what are and are not appropriate self-disclosures, as this is very much down to personal discretion and a matter I have (and all therapists should) discussed in clinical supervision. I guess my message is this: Self-disclosure is a beautiful thing, therapists need not fear it as long as your intentions for self-disclosure are always in the best interests of your client and are not damaging to your own mental or physical health and well-being.