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.

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The ACT Counselling Services team are currently travelling around Scotland delivering a 1 day training event on John Bowlby’s Attachment Theory and Lifelong Relationships. We are also very fortunate to have an extremely talented Neuroscientist contributing to some of the inputs. Most of our knowledge in relation to Attachment Theory comes directly from John Bowlby’s Son – Richard Bowlby, who members of the ACT team were fortunate to be taught by. These events have been enormously well received and requests to deliver these events have been flooding in.

When writing and delivering the events, as well as in subsequent discussions we never cease to be amazed that the first 2-3 years of one’s life will shape how one thinks, feels and behaves in relationships with others throughout the life cycle. The very brief introduction to Attachment Theory offered below does not even begin to do the theory justice, so if it peaks your interest then, by all means get in touch and we will be happy to advise you of times and places where future deliveries of the 1-day event will take place.

What is Attachment Theory

Basically it is an evolutionary and instinctual necessity for Human Beings to endeavour to form Secure Attachment Styles with significant caregivers. This is a basic aid to human survival. The human brain in 2016 is exactly the same as it was in archaic times (over 50,000 years ago). Our brains (when we are infants) do not realise that it is 2016 and most people in the western world live in comfortable and safe environments. Our brains respond as if we still live in the wild, amongst the animals and if an infant is not close to a larger, older and protective caregiver then one might be eaten for want of a better word.

Forming a secure attachment

As such, infants engage in what is called ‘Attachment Behaviour’ in an attempt to keep the primary caregiver close by and to form a ‘Secure Attachment.’ Babies are born ready and know exactly what to do in order to form a secure attachment and as a result, feel safe. How the primary caregivers respond will actually determine whether a secure or insecure attachment style is formed.

What attachment behaviour involves

Attachment Behaviour involves the child crying when separated from the primary caregiver. This is the child’s insurance policy as it is a very difficult (almost impossible) cry to ignore. Attachment behaviour also involves remaining close to the primary caregiver and quickly returning to their clutch when feeling threatened. When the child is confident that it’s needs are being met then a secure base is established from which the child can begin to explore the world, safe in the knowledge that the consistent and loving primary caregivers will be present and available on return.

Do you want to know more?

If you want to find more about attachment theory, a lot more about yourself and more importantly how to improve the quality of life of yourself or others then simply get in touch using one of the various methods available on this site. You can call ACT counselling and CBT services in Glasgow on 0141 554 0838 or email us here.

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The ACT Counselling Services team have had 2 insightful weeks delivering inputs 6 and 7 of the ‘Practising Schema Focused Therapy’ course. The themes have all been about perpetuation and ‘Repetition Compulsion’ (Freud, S), or ‘Schema Chemistry’ (Young, J). We think it is absolutely incredible that we, as human beings continue, albeit unconsciously, continue to play out very specific childhood experiences over and over again. This perpetuation causes us significant problems and distress, but we keep on doing it. The hardest part to come to terms with is that is actually our attempts to cope that continue to cause the problems. This often leads people to approach ACT for relationship advice.

What went wrong…?

We pick our parents as partners. If you don’t believe this, then you are most likely in denial. No parents are perfect and we unconsciously choose partners who we hope will provide us with the opportunity of correcting what went wrong. As a result of parental deficiencies we, at some point, experienced anger, sadness or despair as a result of our unmet needs. Children, however, cannot tolerate these feelings and instead cling to hope. We perceive that the problem actually lies with ourselves and continue, throughout our lives to seek the corrective experience.

Want to find out more or get some relationship advice, get in touch to discuss signing up for the next course, beginning 04/05/16. See more information here in our Services section.

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So what is the value of Imagery Assessment and why is it used in Schema Therapy?

It is important within the Assessment and Education phase of Schema Focused Therapy that the client’s Schemas are accurately identified. The mistake that a lot of Practitioners make is that they provide the client with extensive information and psycho-education as regards schemas. They then administer one or more inventories to help identify the client’s schemas. At this point, if the client’s hypothesised schemas match with the high scoring schemas on the inventories then the Practitioner is satisfied that enough information has been gathered to state with surety that ‘this is one of your schemas.’

How are Schemas stored?

The above, of course, is not enough. How can it be? All of the above is related to logic, words and numbers. This is the fundamental flaw as schemas are stored deep in the reptilian part of our brains, in the amygdala. Schemas are stored in early childhood with images and a high-level of emotion attached to them. Thus, they are not stored with any logic, words, numbers or explanations attached to them. As a result, schemas must be triggered and felt by the client on an emotional level before the client and therapist can be sure that this is a schema belonging to the client.

Imagery Assessment is the main assessment methodology that is used to identify schemas accurately. To find out more about this technique, see how it is used, and practise using it, please refer to our ‘Practising Schema Focused Therapy’ short course information section of this website, where course information and booking instructions can be found.

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The ACT Team are fresh from delivering another 1-day ‘Introduction to the Theory and Practice of Cognitive Behavioural Therapy’ course. As we have come to expect, the participants were a pleasure to work with and the time passed by so quickly.

The course requires participants to examine their own childhood experiences and the resulting self-defeating behavioural patterns. The participants were quick to identify these and also quick to realise that it is not necessarily about completely changing the rules that drive the self-defeating behaviours but just altering, adjusting or updating the rule.

Rules for Living

So what do we mean by ‘rules.’ What we mean is ‘Rules for Living.’ A rule for living is the behavioural adjustment that a child makes in order to cope with negative messages that they have internalised about themselves as a result of experiences in the family, classroom or playground. Some examples are outlined below:

Examples of rules:

• If I put other people’s needs before my own then they won’t reject me
• If I worry and expect the worst then I’ll be prepared when it happens
• If I am perfect then I’ll be considered good enough.
• If I keep in control then I’ll cope
• If I keep my emotions to myself then I’ll be seen as strong
• If I hit out then it keeps the aggressors at bay.
• If I keep my opinions to myself then I won’t be humiliated
• If I don’t try then I won’t fail
• If I don’t expect too much of myself then neither will others
• If I avoid intimate relationships then I won’t get hurt
   

So why not change them?

These are only some examples as there are probably hundreds or thousands of different rules and variations unique to each individual.
So if they are self-defeating then why not change them. Well, the thing with rules is that they can also make us good at what we do. Furthermore, they also shape the contact that we have with other people as we arrange ourselves in certain ways in order to fit together. So really it is about keeping the parts that work and changing the parts that don’t.

So the person who puts others needs before their own still cares for and helps others but also looks after themself. The perfectionist still has high standards but maybe reduces them by 20% and reduces the time and attention that goes into maintaining them.

Why are they self-defeating?

Why are they self-defeating we hear some of you ask. Well, the perfectionist will never be perfect, the person who self-sacrifices too much will be treated like a doormat by some others and essentially rejected, the worrier will never prepare for all unexpected outcomes and therefore never trusts themself. Again, these are just some examples. The old rules are familiar, habitual, comfortable and hard-wired in the brain. Even though they cause problems, they lie in the unconscious and they are ingrained. In order to alter rules, a person must be able to tolerate a certain degree of discomfort. Rules are like predictions and therefore new predictions must be generated, tested and evaluated. 

To anticipate and predict

Human beings have an enormous amount of information to process on a daily basis through the senses and belief systems. If every experience was treated as a brand new experience or situation then life would be unbearable. We, therefore, learn to anticipate and predict. These anticipations and predictions are carried in the unconscious mind and enable us to live the majority of our lives on autopilot. Examples of unconscious daily predictions are:

• If I stand on the floor then it will take my weight
• If I push the handle then the door will open
• If I smile at someone then they will smile back
• If I turn the key in the ignition then the car will start

What would or do we do if the predictions outlined above do not work? We have to think in order to generate new ones:

• If I stand only on the beams then I’ll be supported
• If I kick the door down then it will open
• If I smile at most people then they will smile back
• If I phone the AA then they will help me

Therapy and rules

Anything familiar about the structure of the above? Yes indeed, the same structure and exact same concept as ‘Rules for Living.’ We are of the opinion that the vast majority of people referring themselves for therapy, it is because their rules/predictions are either not working, causing too many problems, too exhausting or they have collapsed altogether. So therapy is that time of constructive revision, where the therapist and client collaboratively work together to generate new ones.

The points we want to make

All Posts

The first point that we want to make is that if the client could have done this for themself then they would not be in therapy. The next point is the importance of a prediction, either positive or negative lying behind any behavioural experimentation. We are probably leaning mostly towards the CBT approach here; it is a scientific approach that sets experiments. An experiment must be testing something, this leads to lasting, enduring and elegant change.

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.

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I recently attended a conference on children’s services within Glasgow where 2 of the keynote speakers highlighted the need to shift away from “labelling” or diagnosing mental health problems in children and move towards “case formulations”. They proposed that we should be thinking from the outset, in partnership with the child and their family about what the difficulties are that need to change and what goals we would like to achieve (ie what changes do we want to see in the child’s mood, behaviour, presentation etc). We would then move on to think about how we are most likely to achieve these goals.

A major shift in practice in child mental health diagnosis

As a social work manager, this shift in approach is already being used within multi-agency meetings I attend within education. It has meant a major shift in practice away from long conversations about the child and their difficulties, to looking at strengths, goals and actions. This has allowed us to be more efficient in terms of use of time and more productive in terms of outcomes from the meetings. Within social work, this approach is also being used both at team meetings with staff as well as meetings with children and their families.

Focus on solutions, not the problem

This struck me as being very similar to the CBT approach. Talking through the presenting issue/problems with the person and identify what changes they would like to achieve so that they are able to live happier, more fulfilling lives. I think one of the benefits of this approach is that it doesn’t focus too much on the problem or the causes of the problem, but rather on what solutions or changes that can be made to achieve one’s goals, with clearly agreed actions being taken forward for the next week to put in place and review.

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.

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In the 10+ years that I have known my wife she has always been involved in helping people in some way, both in her professional life as well as her personal one. Throughout this time she has always had a fascination with what “makes people tick” and a real skill for developing relationships with people and getting them to see things from a different point of view. My wife has now been a qualified CBT therapist for several years and currently delivers the CBT diploma course with ACT counselling. I think this course really allowed her to develop those skills as well as giving her more of the theoretical understanding of what she was already thinking and doing with people.

How it affected me

The course had a big impact on me as well. My wife would come in from the course buzzing with excitement, telling me about what they had been doing that day and discussing whatever topic had been delivered by Andy and the team. She would talk about things like “core beliefs”, which are the messages we get from those around us growing up (generally our parents) and how this can influence our thoughts and behaviour throughout life. This made me consider my own experiences as a child as well as those of the children I work with as a social worker.

CBT in social work

Another way the course impacted on me was with the idea that as a therapist you are not giving them answers so much as guiding them to find their own solutions. As a social worker, this can be more of a challenge with some of the families I work with as we often have to be very directive and clear with people what we expect to happen. However, we will often use CBT principles to ensure families are motivated to work towards these shared goals. It has also been very useful in considering how I support my team of staff in supervision, both formally and informally in finding their own solutions to issues both within and outwith the workplace.

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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.

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The ACT Team have an up and coming CPD event on 20/02/16 titled ‘Gestalt — a way of living’ looking at Gestalt Psychotherapy. Whilst preparing the course materials we cannot help but remember the insight and power connected with this approach and its ability to help us as human beings make sense of our lives. With this in mind, let’s reflect on the connection between a family’s attitude to vomiting and the syntonic (in harmony) and dystonic (impaired) personality.

How did your family deal with vomit?

How did your family deal with the vomit? When you were young (before the age of 7) and you felt a bit unwell and were taken by surprise by a surge of vomit, what did your family members do? As you vomited all over the front room carpet, what did they do? Was your vomiting a family affair, did your siblings/cousins etc get to watch and make comment? Did Mum, Dad or significant caregivers tell you not to mind the mess, just get all that nasty stuff up? Did they hold and comfort you?

Were you reassured?

Perhaps your vomiting was dealt with differently. Did the significant caregivers reassure you, guide you to the toilet, spend a little bit of time with you and then leave. They might have come back to check on you at regular intervals. The last option the family or significant caregivers might have had was to quickly grab you when the vomit began, rush you to the toilet, sit you in front of the loo and quickly close the door. The last words you might have heard were to make your way to your bedroom once all vomiting had ceased at which point a bucket would be delivered to you and food parcels thereafter until all the messy stuff was gone.

How this links to life’s problems

However, the vomit was dealt with is probably how you now deal with life’s problems (the messy stuff). If the vomiting was shared, then you will share life’s problems with those close to you. If you were, supported and reassured to an extent then you probably share problems or the messy stuff in life to a certain extent but not the whole story. If your vomiting was a solitary affair conducted in isolation, then this is probably how you deal with life’s problems. The messages we hear and the rules we learn in childhood shape who we are today.

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