This article is a case study about a young client struggling with anxiety. It discusses how he and his therapist found a way to communicate with one another through the use of drawing therapy.

Jake and his overwhelming anxiety

Jake was too young to be one of my clients, unfortunately he was also too old to fit into the paediatric mental health team and the teenage support group for anxiety was overwhelmed.

 Jake had a bad experience and didn’t trust therapists

Jakes mother  described a boy who every morning thought he would get up and go to school and by 9:05 had failed.  He was then stressed all day about having to go to school the next day and couldn’t concentrate on his schoolwork at home, even if his granny sat and helped him

The start of CBT therapy

Jake`s mother and I agreed not to tell the services that I was working with him in case it stopped him from obtaining more appropriate input.  We also agreed she would sit in on the sessions as a silent observer.

Jake didn’t say much either apart from telling me how he’d been let down by other therapists who had promised a phased return to school with him in control – but this hadn`t happened. I told Jake that I didn’t really care whether he went to school or not, all I cared about was helping him get through the time period until he felt ready to do so.

I did the standard CBT things using Zoom at Jakes pace, he was very anxious before our sessions and quite often came into therapy feeling upset, and sometimes he cancelled, hiding in his bedroom.

How drawing therapy became part of his CBT

Once I discovered Jake could draw things changed.  Using the shared whiteboard he could depict his feelings and could use the subsequent image to explain what he meant.

Several of these drawings changed things greatly for both of us, the first picture showed how he felt about anxiety and the treatment of it.  He drew a very cross looking person with steam coming from his ears.  After we discussed it  I asked him whether he wanted to continue working with me.  There are no words to describe the rewarding feeling I had as I watched smiley faces prop up on my computer screen as he drew, miles away, in his own sitting room.

CBT Drawings to express and understand anxiety

Today Jake and I talked about anxiety, or rather I talked and he drew. I thought I knew what it felt like to be anxious, I’d been anxious before exams, been a bit stressed if I didn’t know the outcome of a dilemma, and I’m scared of the dark. Anxiety is huge, scary, unstable and destructive. Jake drew his “ monster” on the shared whiteboard.

The first thing I noticed was the Boris hairstyle – my interpretation, Jake just wanted to make it look stupid. It wasn’t very big either but had a foot in the door. The front door which was open because the anxiety had come with a reasonable-sounding request. Once Jake allowed the anxiety in it talked and talked to him and even when he tried to make it leave by another door it never stopped telling him something was wrong. In the end, Jake simply stopped opening the door.

He wasn’t frightened though, his anxiety was stupid, annoying and persistent, but never scary, destructive or unstable.

I guess anxiety is just a word, but a picture is a thousand words.

AUTHOR: Emily Cobb

Cognitive Behavioural Therapy

If you are looking for therapists who offer Cognitive Behavioural Therapy for a range of mental health issues you can read more about it on this page. We offer therapy at Act Counselling and CBT Services and are happy to speak with you today should you wish to find out more and book in with one of our therapists. Get in touch with us today via our online contact form or call us on 0141 554 0838.

The post Drawing Therapy appeared first on ACT Counselling and Training Services Ltd.

Frank didn’t do feelings. He was a man at all times. Anger doesn’t count as a feeling, Frank did anger. Frank knew why he did anger – it was necessary to protect himself and his family. He did sometimes regret what he did in anger. I’m not sure why Frank came to therapy, I know why he said he came to therapy – to deal with his need to check things all the time.

Not a talker

Frank didn’t do talking much either, at least not about feelings. He was a large man, pleasant and smiling, easily laughing, Successful in his occupation. After some time Frank did do the talking, even about feelings. He felt things that he had buried since childhood. He didn’t so much as “sit with the discomfort“ but seem to shrink into himself like a little boy.

Frank was fearless

Frank was fearless, he could stand up to anybody. He knew what was right, he knew what was wrong. He knew who had to be stopped and he knew who had to be protected and he knew it was his job to do that. He didn’t know why sometimes he went too far. Frank was not a bully, he was not a violent man so he began to avoid situations where he might need to defend somebody. Frank has a lovely family and didn’t need to go out socially. He was able to check whether he was likely to get himself into trouble before he went for a walk, he didn’t need to go for a walk very often anyway. His wife was pretty good at making sure he was never anywhere where there was conflict. He was a minefield made as safe as possible. There was always the possibility of something unpredictable so Frank had to be on high alert all the time.          

The well-trodden path

Frank didn’t do talking about emotions, he did do pictures and he did do analogies. Frank described his behavioural experiments as walking through a field that was overgrown. There was a path in it that was well-trodden but lead to thistles. He had to stop himself going down that way and tread out another path. This was quite difficult the first time, but Frank noticed that the more times he did it the easier it became until he had two well-trodden paths, then three and four.

Frank didn’t do feelings, but he did face the buried monster. He realised that he was burying it. He drew a picture. The picture had a man digging a hole and putting the soil in a pile in front of him to keep the monster away. Frank commented that “I’m so busy digging to pile up a wall in front of me that I don’t notice the great big hole I’ve dug out  behind me that I’m about to fall into”   

Making friends with the monster

Frank stopped building his wall, he tolerated with the feelings of fear and trepidation that engendered .Instead of running away from the monster he stayed and watched his approach. He saw that the big dog running towards him with his teeth showing wasn’t growling, just panting in the heat. He drew the dog and as he looked at it he laughed saying, “ that doesn’t look like a dog, that looks like a teddy bear!“         

Frank walks alongside his monster, it isn’t a very nice monster but it is nowhere near as bad as he had originally thought. Frank keeps an eye on the monster so that it doesn’t get out of hand again .

Frank is brave

I enjoyed working with Frank, he was brave and worked hard to understand what was happening underneath the layers of rules and walls.He was Open, honest and generous with his self reflection. The confusion, desolation and horror of the core belief was almost palpable. The courage he showed when he stopped building the wall to keep the monster away and waiting until it appeared to face it  was difficult to believe.

I have often used his analogy of the path in the field, The monster becoming a teddy bear and the concept of making a wall to keep the monster out but creating a big hole and falling into it as a result of this.

Frank’s ideas have helped other clients understand.  Frank’s ideas have helped me understand.

Frank doesn’t think he does feelings, Frank doesn’t think he can talk, especially not about feelings. I think Frank is wrong, in vulgar parlance I think Frank “nailed it”.  

The post Frank Feelings appeared first on ACT Counselling and Training Services Ltd.

There is so much noise.  It is deafening.  Communication is in overload.  We have a global catastrophe here and now.

I invite you to stop, pause for a moment and consider your life, your presence in humanity and your capabilities just now and as we go forward. You may not be unwell, you may not know somebody in hospital, you may not know someone who is ill.  You may feel this will not impact on you or you will get through it because you are young or you have a healthy lifestyle or you are not taking this seriously for a variety of other reasons.  You may be infected, you may fall ill, and you could die.  At the same time conversely, those in higher risk categories due to cancer treatments/therapeutic drugs or older age may come through it.  We do not know who will survive and who will not, and this is the reality which we each must face.

Come together, respect each other

I am invested in the outcome for me, my family, my relatives, my friends, my neighbours, for you, for your family, your relatives, your friends and the future of our human race.  This is so much bigger than just you and me.  This is about us coming together now, respecting each other and offering our strengths whatever they are for the greater good.  I believe that you  have  something to offer from a smile to a kind word shared,  to your time, skills, knowledge and personal resources with a willingness to learn,  giving freely for no other reason than the wish to contribute of yourself and help make a difference to the outcome today tomorrow and when it finally ends whatever that will look like.   I believe in your capacity to put aside your own fears and issues and focus on the strengths you have in going forward to enable healing and compassion, sharing and supporting each other.   Already, this is happening, it is alive and growing.   We are connecting, recognizing it is down to each of us and that each of us can make a difference.

Be kind to yourself

For those of you who are struggling for personal reasons or reasons out with your control, be kind to yourself and reach out for help enabling a friend or a professional to share your pain and help you accept yourself for who you are just now.   Today, may not be your time to shine, but your time will come and then it will be your turn to share your strength and acceptance for another.  I cannot within these words, reach out to everyone and I know there are those who feel the situation is out of their control and this may be.   Take what control you can back into your being and space no matter how small that is.   Do what you need to do without causing harm.  Consider your strengths and put them to good use.  Identify the tasks that you need to address and deal with them one by one.  Call out your unmet needs and share and they will be met.  Trust in humankind.

Reflect, reassess

From operating as an individual to operating as a community, and we can stop and reassess what we are doing.  What has got us to a place with too few ventilators, not enough PPE, too few drugs, people not self-isolating/social distancing, funerals with no one to attend them, frontline staff at risk of dying.  This is for analysis and but not just now.  In seeing the problems, we can identify solutions which are realistic and achievable.  We need big thinking and a joined-up approach locally, nationally and globally.  We need to sustain an effort for this acute phase and going forward into a more chronic ongoing stage.  

I ask you to Identify your strengths and play to them. 

• Those who can coordinate, coordinate
• Those who can innovate, innovate
• Those who can dream, dream
• Those who can labour, labour but do it now.

Start today, this is not an unscheduled holiday for some and a crisis for the few who are fearfully fulfilling their professional role whilst inwardly fearing for their lives and the lives of their families.  What can you do for you, your loved ones, your neighbours, for your country men and women, for humanity?  This is not a dress rehearsal. 

What you can do

Consider your mortality.  Look at death in the eye and hold onto life.  Let us thrive in a new way, living together compassionately and kindly.  

Our shared vision and positive coordinated action can make a positive difference for humankind. It is not too late.

Now is the time.   Look after your neighbour and friends as you would like your own family members to be looked after.  Who are our neighbours and friends?  They are all of humankind.

I am a mother of 5 young people, a wife, a daughter, a sister, an aunt, a cousin, a friend, a neighbour, a citizen of the world.  I am also a nurse and a trainee counsellor.

By Siobhan Campbell – year 1 diploma student

The post Inviting You to Share Good News appeared first on ACT Counselling and Training Services Ltd.

As Therapists or other professionals move further along their journey of personal development, self-awareness and ultimately work towards self-actualisation it might be fair to say that we become less vulnerable. In relation to the vulnerability/stress model this leaves us more predisposed to taking on higher levels of stress, none more so in the stories we hear from our clients. Of course, some client’s stories touch us more than others and what of the ones about abandonment, neglect, abuse, trauma, emotional deprivation? It is our job but also in our nature to empathise with our client’s. With regards to empathy, the paradoxical theory often stands up in that our greatest strength is also our greatest weakness.

Dealing with Vicarious Trauma as a therapist

We empathise with the hard end of human suffering on a consistent basis. For some Therapists/Professionals, this might be daily. This often comes at a price. At ACT Counselling Services we often hear stories from colleagues of ‘taking the client home with me,’ which of course means thinking about the client in one’s own time. We also hear stories of colleagues having nightmares, rescue fantasies etc. A lot of professionals will take issues of vicarious trauma to Clinical Supervision and whilst this might well be helpful there is so much more that can be done.

Can we learn from Buddhism?

Traditional Buddhism has been a long advocate of the ‘suffering’ involved in being a human being, yet Buddhist Monks appear to remain compassionate and optimistic. What is their secret? Furthermore, can we as Therapists/Professionals learn from Buddhist Monks in order to offset Vicarious Trauma? Also, are there more practical steps that can be taken by Therapists/Professionals and their organisations to create a culture that protects us from the impact of Vicarious Trauma?

Do you want to learn more about Vicarious Trauma?

To find out more about the above and answers to the questions posed, visit our CPD Events page on this website and register for the ‘Vicarious Trauma’ CPD event scheduled to be delivered in Dunblane on Friday the 25th of August 2017. You can call us here at ACT Counselling and CBT Services in Glasgowon 0141 554 0838 or contact us online here.

Cognitive Behavioural Therapy

If you are looking for therapists who offer Cognitive Behavioural Therapy for a range of mental health issues you can read more about it on this page. We offer therapy at Act Counselling and CBT Services and are happy to speak with you today should you wish to find out more and book in with one of our therapists. Get in touch with us today via our online contact form or call us on 0141 554 0838.

The post Vicarious Trauma appeared first on ACT Counselling and Training Services Ltd.

With CBT group therapy, where clients are given the opportunity to work with their counsellor on a 1:1 basis regarding the substance and attend a group to address, arguably two of the most common underlying mental health issues associated with substance misuse, anxiety and depression.

Respective anxiety and depression manuals were compiled and given to each group member for them to use on a weekly basis and indeed keep for future reference after the group ended. In true CBT tradition, an inventory was completed on a weekly basis and cross-referenced with the previous week. Examples of other items covered throughout each group are:

-Cognitive distortions

-Automatic thoughts

-Thought records

-Identifying emotions

– Controlling breathing exercises

-Progressive muscle relaxation

-Graded exposure

-Daily achievement journal

-Behavioural activation

-Safe place imagery

-Activity schedule

-Rumination

-Strengths and qualities

Group work and its benefits…

There was always time for group discussion which led to another vital part of any group, that being mutual aid. As a facilitator, it is a privilege to witness catharsis, universality and the installation of hope within each group I have been part of. Indeed bringing each group to an end, listening to the changes that have been made and plans to do more of what has helped is inspiring and motivational to me. There is no better feeling than playing a small part in another human beings recovery.

As with any therapeutic/psychoeducational setting, without the core conditions of genuineness, acceptance and empathy, neither groups nor 1:1 settings would have very little chance of building rapport, therapeutic alliance, working alliance, call it what you will, between the presenter/facilitator and attendees. Effective psychotherapy in any setting requires an effective therapeutic alliance between client(s) and therapist/facilitator.

Diploma Course…

The ACT Counselling Services PG Dip Level Diploma in CBT and Groupwork is the ideal course on which to learn and develop the knowledge, skills and attitude to become an effective group facilitator.

To find out more get in touch on 0141 554 0838 or contact us here.

By Mark Vance (PG Dip CBT)

Cognitive Behavioural Therapy

If you are looking for therapists who offer Cognitive Behavioural Therapy for a range of mental health issues you can read more about it on this page. We offer therapy at Act Counselling and CBT Services and are happy to speak with you today should you wish to find out more and book in with one of our therapists. Get in touch with us today via our online contact form or call us on 0141 554 0838.

The post Triggers for Substance Misuse appeared first on ACT Counselling and Training Services Ltd.

Whilst thinking about the shaping of the personality during childhood in our last blog, it occurred to me that it would be a disservice not to reflect on the connection between force-feeding infants and the internalisation of beliefs, rules and values and how this affects our children and mental health. Many of these will, of course, be crucial in developing the child as a family member and a social human being. They will fit well with the child’s temperament and personality and will serve them well throughout their life. What about the ones that don’t fit and cause the developing person endless psychological distress (varying levels).

Choo choo…

So let’s think for a moment of the infant in the high chair who is confronted by the caregiver with mush on a plastic spoon that they do not like the taste of. They have tried it before and they do not like it. The usual physical defence mechanisms will kick in such as batting any attempts to put it in their mouth away, keeping the mouth shut until the mush ends up all over their face, bib, clothes, the floor etc. Then the caregiver decides to become creative and attempts to trick the child into believing that the plastic spoon with mush on it is actually a plane or a train etc, as if… The little one, however, ain’t for having it and any mush that does enter its mouth is immediately ejaculated by spitting.

You will eat it…

The caregiver, however, is resolute. There is only going to be one outcome here ‘because I am the adult, I know what is good for you, and if you don’t do what I say then you won’t survive.’ The child’s last line of defence is to swallow the mush whole as it is not the texture or consistency of the mush that they dislike but the taste. This, of course, will inevitably cause indigestion.

These are the rules…

However, it is not just food that we are force-fed when we sit around the table. Infants are also forced to swallow whole, without question or trial, the family beliefs, rules and value systems for the very same reasons as food is force-fed. ‘We are the adults, we have been out in that world longer than you, we know what is best and if you want to be part of this group……these are the rules (some examples):’

In this family…………..

• ‘We put others needs before our own, we don’t confront others’
• ‘We never say no’
• ‘We worry about things and always expect the worst’
• ‘We don’t settle for second best’
• ‘We don’t try too hard and don’t get ideas above our station’
• ‘We don’t display or talk about emotions’

Etc, etc, etc

Anxiety is born

If these internalised rules do not fit with the infants developing personality then they will go onto cause self-defeating life patterns and the tension will cause psychological heartburn in the form of anxiety. Just like the food, the infant did not have the choice to reject them and could not chew them over to decide if they liked the taste.

Rules, beliefs and therapy

It is these internalised rules and beliefs that bring people into therapy. Therapy is a process of dissemination where the rules, beliefs and values that fit with the client are celebrated and kept. The ones that do not fit are examined and altered. Not necessarily vomited up completely.

Cognitive Behavioural Therapy

If you are looking for therapists who offer Cognitive Behavioural Therapy for a range of mental health issues you can read more about it on this page. We offer therapy at Act Counselling and CBT Services and are happy to speak with you today should you wish to find out more and book in with one of our therapists. Get in touch with us today via our online contact form or call us on 0141 554 0838.

The post Anxiety and Internalised Rules appeared first on ACT Counselling and Training Services Ltd.