Psychotherapy

What is the Healthy Adult mode in schema therapy?

One of the key ideas in schema therapy is that we all have different 'modes', or parts of our personality, which are more or less helpful for us in our lives. One of the most important of these modes is the Healthy Adult, which is the part of you that does all the important day-to-day stuff like going to work, being a caring parent and partner, paying the bills, going to the gym, not drinking too much, and so on. 

So the Healthy Adult does all the important, healthy stuff that you often take for granted, but without which life would quickly grind to a halt. This part is also very protective, again in terms of the outside world, being assertive when you need to stand up to an aggressive boss, say, or dealing with the teenage neighbour who loves blasting their favourite house music at 2am.

Silencing your inner critic

The Healthy Adult also protects you from yourself. In schema therapy, we also work with two 'maladaptive parent' modes, the Demanding Parent and Punitive Parent. The first drives you way too hard, often leading to stress or burnout – nothing is ever good enough. And the second is your inner critic, telling you that you are stupid, or fat, or useless. Both modes need to be disempowered, told to shut up and leave you alone. It's the Healthy Adult's job to do that. 

Finally, and perhaps most importantly, the Healthy Adult looks after the most vulnerable, wounded part of you, the Vulnerable Child. This part holds a lot of your most difficult schemas, so is the mode that is triggered when you feel anxious, upset, threatened or ashamed. All of our work in schema therapy is about healing this part of you, at first with my help but later through your Healthy Adult.

Working together, we will build this healthy, protective part of you like an inner muscle, until it is strong enough to calm you down when you're upset, or help you through a challenging job interview or parent's evening at school. You will feel yourself getting stronger and stronger; making increasingly healthy choices in your life; letting go of self-soothing strategies like excessive drinking or spending... And you will find yourself becoming more like the person you always wanted to be, but never knew how.

If you would like to find out more about how schema therapy can help you, call me on 07766 704210 or email dan@danroberts.com

Warm wishes,

Dan

 

Five common myths about cognitive therapy

In some ways, cognitive therapy is the victim of its own success. Since it was developed by Aaron Beck in the 60s, cognitive therapy (also known as cognitive behaviour therapy, or CBT) has become the dominant form of 'talking therapy' in numerous countries around the world, including the US and UK. This is mainly because it works so well – research consistently shows CBT to be the most effective form of therapy we currently have. But it's also about economics – the NHS has embraced it partly because it's cost-effective too. Many problems can be resolved in under 20 sessions, some (such as phobias) in five or six.

However, as I explain below, this is not how Beck intended cognitive therapy to be practised. His initial therapy model was a 20-session treatment for depression, which I think is about right for most people. I strongly disagree with the (financially-driven) short-term treatments many people receive on the NHS for anxiety, depression and other serious psychological problems. This is just one of the myths I try to bust with my clients, and when I am teaching cognitive therapy to students. Here are some more:

1. CBT is all about filling in forms

Not true. Although some CBT techniques do involve written work for clients (such as daily thought records), good cognitive therapy is based on the relationship between therapist and client. This should be warm, trusting and supportive, as with other approaches to counselling and psychotherapy. And many of the techniques I and other cognitive therapists use involve stories, metaphors, working with imagery, role-playing, mindfulness-based techniques, drawing, Gestalt-style 'empty-chair' work... none of which involve forms!

2. CBT is a short-term, quick-fix approach

Nope. In my own practice, I always tell people that there is no such thing as a quick fix for complex, highly sensitive problems; so our work will be slow and incremental. A few problems – especially 'specific phobias' – can be resolved quickly. Most others take time – somewhere between 10 and 20 sessions, in my experience; while deep-rooted, hard-to-shift problems might take a year or more.

3. Feelings are not important in cognitive therapy

Ironically, cognitive therapy is all about emotions. Despite the name (cognitions being all of the thoughts, values, beliefs, memories, etc that make up our minds) we only focus on changing unhelpful thinking because that has a powerful impact on feelings and moods. Nobody comes to therapy saying 'I want to think more rationally'! They come because they are hurting in some way; my job is to help them feel better on a consistent, long-lasting basis.

4. Cognitive therapy is all about positive thinking

A common myth, this one. In fact, cognitive therapy is all about rational, realistic, balanced thinking, which is not necessarily positive. If you are in a horrible job or relationship, thinking positively about it would be both impossible and unrealistic. Someone once said that cognitive therapy is all about seeing things as they really are. Life is full of pain, hardship, loss, struggle... as well as joy, wonder, love, delight. The key is to give both equal weight, rather than focusing purely on the negative (common to both anxiety and depression, in different ways).

5. CBT only offers superficial symptom-relief

A common criticism from my non-cognitive counselling/therapy peers. It's true that CBT can help people feel better much more quickly than other approaches. That's one of the reasons it's so popular and successful. But this is only the start. If you suffer from depression, say – which has a high chance of relapse – as well as helping you feel better in the short-term, my aim is to teach you new ways of thinking and behaving which protect you from depression in the long-term. Again, we have very good evidence to back this up, as well as my own experience of staying in touch with clients after therapy ends to see how they're doing.

So, hopefully you now have a clearer idea of what cognitive therapy is and is not. If you would like to book a session, email dan@danroberts.com

Warm wishes,

Dan

Why exercise is key for good mental health

Most psychological problems – such as chronic stress, anxiety or depression – will require some kind of psychological treatment, especially if they persist over time. But it's easy to underestimate the impact of direct physical interventions on psychological problems.

Partly, of course, this is because the whole separation of mind and body is an artificial one – your mind is the product of your brain; hormones play a key role in regulating your moods; psychological problems such as stress and anxiety have a whole range of physiological symptoms... In reality, your mind and body are inextricably linked, with an exquisitely complex feedback system between the two.

So it should come as no surprise that regular physical exercise is key to good mental health. Think of exercise in two main areas: cardiovascular and relaxing. Cardio exercise such as cycling, dancing, racquet sports, football, brisk walking or swimming, weight training or martial arts burns off hormones such as adrenaline and cortisol that are produced when we are anxious or stressed; just 20 minutes of moderate exercise gives you a shot of endorphins, which help you feel happy and calm; and regular cardio exercise is proven to be just as effective as antidepressants for mild to moderate depression (and with no nasty side effects).

Stress-relieving exercise

Relaxing exercise includes yoga, tai chi, gentle swimming or slow walking and is an excellent stress-reliever, especially if you do it in a green space, such as your local park. This kind of exercise activates the relaxation response, which balances out the stress response and helps you feel calmer and more relaxed. If you are suffering from depression, you may lack the energy to do more vigorous exercise, but it's really important to do something even if it's just a walk round the block.

So if you're stressed out, struggling with an anxiety problem or depressed, remember that exercise will really help – and if the problem is short-term, it may be all you need to regain your equilibrium and feel better, so why not give it a try?

And if you would like to book a session, call me on 07766 704210 or email dan@danroberts.com

Warm wishes,

Dan

Acceptance vs change in cognitive therapy

A common dilemma for people engaged in cognitive therapy is understanding when to try and change a thought, behaviour, feeling, situation, relationship, etc and when to accept it. One way I explain this apparent contradiction is to say that the first stage of cognitive therapy is all about change. We identify specific problems in the client's life and come up with goals embodying the ways that person's life would be different if we solved those problems – this is all about change.

We then identify the thoughts, beliefs and behaviours that are maintaining the person's problems and start to modify those – again, our agenda here is change.

But more advanced cognitive therapy places far more emphasis on acceptance than change. Increasingly, the new 'third wave' forms of cognitive therapy like compassion-focused therapy (CFT), dialectical behaviour therapy (DBT) or acceptance and commitment therapy (ACT) are a fusion of mindfulness, cognitive therapy and other approaches, such as experiential or psychodynamic therapies, to help treat more longstanding or hard-to-reach problems and conditions.

Mindful acceptance

Acceptance is at the core of mindfulness theory and practice, because the Buddhists who originally harnessed the power of mindfulness understood that in life there are many things we can neither change nor control. We all get older and eventually die, as do those we love and care for. We all suffer from problems with our health, especially as we get older. Many things appear entirely beyond our personal control, such as climate change, the fluctuating economy, wars, natural disasters and even the actions of our own Government. So it is fruitless for us to spend hours worrying or disturbing ourselves about the things we cannot change – the Buddha discovered 2,500 years ago that an accepting mindset will greatly reduce our distress and unhappiness.

And we often find that, counterintuitively, mindfully accepting aversive or unpleasant feelings such as anxiety or anger and 'breathing into' them, rather than struggling, fighting or resisting them, helps those feelings naturally decrease and even dissolve. Acceptance can be both a powerful and empowering approach to solving some of our most painful problems.

In summary, change what you can and accept what you can't – not easy, by any means, but a very helpful way to live if you can manage it.

If you would like to arrange a session, email dan@danroberts.com

Warm wishes,

Dan

Is someone close to you narcissistic?

Psychologists talk about 'personality types' when they are describing ways of thinking and behaving that are common to us all, such as being a bit selfish/self-focused, obsessive about tidiness, or consistently avoiding things we feel uncomfortable with. We are all on a spectrum with these traits, but for some of us they are much more pronounced than others.

You may also have heard the term 'personality disorder', which is when someone strongly exhibits characteristics of one or more of these types, to such an extent that it affects their whole personality (not just their mood, as in a 'mood disorder' like depression) and typically makes life very difficult for themselves and the people around them.

Another term commonly used (and often misused) in the media is 'narcissistic'. Correctly used, narcissism describes someone who tends to be extremely self-focused, viewing the world and the people they encounter as being there to serve their needs. They will probably have an Entitlement schema and so feel entitled to special treatment, attention and recognition of their unique skills, knowledge or personal qualities. Narcissistic people also have a black-and-white view of the world and how things should be, with a strong belief that they are always right and that bad things in their life are other people's fault, not theirs.

Not every narcissist is willing to change , but some will – with enough leverage, incentive and assistance.
— Wendy Behary

Again, it's important to remember that we all have some of these traits and beliefs – it's how strongly those beliefs are held that's key. When these beliefs are deeply and rigidly held, then someone might be diagnosed with narcissistic personality disorder (NPD). Because people with NPD tend to be extremely single-minded about getting what they want, we see these individuals at the top of a number of professions, such as banking, politics, law, professional sports, music and acting.

It's tough to be in a relationship with a narcissistic person, because they tend to be very perfectionistic and critical. Because empathy is not their strong suit, they just don't get why or how they have hurt someone, and will tend to fly into a rage when challenged or criticised (behaving like the angry little person above). If any of this sounds like someone close to you, they may need help in learning to relate to others in a more compassionate, less self-serving way.

Schema therapy can help with that, if they can be persuaded to come along, which is often challenging. People with these characteristics usually end up in therapy because people – an angry boss or partner on the verge of leaving – have pressurised them to do so.

The most important thing is to understand why they are acting in baffling and sometimes hurtful ways – and remember that it's definitely not your fault. Knowledge is power, so read up on narcissism (I strongly recommend Disarming the Narcissist: Surviving and Thriving with the Self-absorbed, by Wendy Behary, a leading schema therapist specialising in narcissism) and develop strategies for protecting yourself and maintaining healthy boundaries.

If you or someone close to you is narcissistic, and you would like help with that, email dan@danroberts.com

Warm wishes,

Dan

How to set goals in cognitive therapy

One of the most important elements of the first session with my clients is setting some clear goals for their therapy. This is a key strategy in cognitive therapy, for a few reasons. First, although I see some clients for years, most people come for between 10 and 20 sessions, some less, some more, but that’s the number I always have in mind for straightforward problems like a fear of public speaking or single episode of depression. So we need to be clear about what we are trying to achieve, which of the client’s many problems we are hoping to tackle and, crucially, how we will both know when we have managed that.

When I ask about people’s goals, they often say something quite vague, like ‘I want to be less depressed’ or ‘I don’t want to worry so much about my health’. Now of course I want to help them achieve both of these end results, but it’s important that we get really specific about what exactly would be different if they were not depressed or health-anxious. Here’s how to set yourself specific goals: 

Start with a ‘problem list’. 
You, like me and every other person on the planet, probably have all sorts of problems in your life. You may be dissatisfied with your job, or unhappy in your marriage. Your kids might be hard to manage, or having difficulties at school. You might drink a bit too much or have money worries. Clearly, a relatively brief course of therapy is not going to help you solve all those problems! So be succinct and specific.

Turn the problems into goals 
Your goals should be the positive opposite of your problems. So if your biggest problem is being unable to stop worrying, your goal should be Worrying less. Ask yourself a series of questions to make this concrete:

Imagine you finish therapy and it helps you feel less worried – if I were talking to the less-worried you, how would I know? How would you be thinking, feeling and behaving differently?

What would you have space to think about if the worry didn’t take up so much of your mental energy? Enjoyable things to do with your partner, kids, or friends, maybe. Domestic tasks you have put off for ages that would give you a real sense of achievement to get done. Aspects of your life you would like to improve, but haven’t had the energy or mental space to attend to.

What positive feelings might you have more of that you don’t have right now? If you want to be less anxious, perhaps that would help you feel more calm, secure, strong, confident, peaceful or rested.

How would you behave differently if you were less worried? You may be less likely to fret about things you cannot control, for example. Or allow your teenage daughter to go to a party without it ruining your evening, as you sit at home worrying about every little bad thing that might happen to her. You might feel more able to attend social events, or just to switch off and relax – taking a long, hot bath, or listening to some beautiful music – without always being keyed up and full of restless energy.

Remember to use moderated language like ‘feeling less anxious’, or ‘being more confident at work’, ‘thinking more positively and compassionately about myself’. Your goals should be achievable, otherwise you will get disappointed and discouraged when you don’t reach them, so watch out for goals like ‘Having no anxiety at all’ or ‘Being the best public speaker in my company’, as these might be a tad hard to achieve.

Now write your goals – three or four of a paragraph each – and remember to keep referring back to them as you go through therapy.

If you would like some help with setting goals and want to arrange a session, email dan@danroberts.com

Warm wishes,

Dan

Is schema therapy for you?

Schema therapy is a form of cognitive therapy that was developed by psychologist Dr Jeffrey Young in the 1990s. Unlike cognitive behaviour therapy (CBT), schema therapy is a longer-term, more intensive treatment designed for people with longstanding, hard-to-treat problems such as recurrent patterns of depression, long-term OCD or other anxiety disorders, problems with intimate relationships and difficulties linked to painful experiences in childhood or adolescence. 

Schema therapy is a warm, compassionate form of therapy that emphasises the relationship between therapist and client as an important part of the healing process. Clients are encouraged to stay in touch between sessions, especially if they are struggling, which can be very helpful when times are tough. In therapy we first identify which schemas a person has and how they developed in childhood (for example, someone may have an Abandonment schema, because one of their parents left the family or was emotionally unavailable for them).

We also identify your modes – distinct sides of you that become active at different times. For example, you may have a Punitive Parent mode, which is the part of you that criticises and attacks for you for perceived failings or mistakes. Clearly, this is both unhelpful and distressing, so we work together on pushing back against this mode, getting it to be quiet and give you some much-needed peace, calmness and compassion for yourself. And your Vulnerable Child mode is the part that feels vulnerable, lonely, anxious or threatened – this part needs nurturing, healing and protecting, which is a central part of the work in schema therapy.

CBT or schema therapy?

I would say that for most psychological problems, such as chronic stress, anger management, phobias, health anxiety, one-off episodes of depression, social anxiety, and so on, CBT is the most effective therapy for you. Having been a CBT therapist for many years, I am passionate about this practical, problem-solving, highly effective approach. It works really well for most problems, most of the time.

But I decided to train in schema therapy to help the people for whom CBT did not seem to be enough. Some of my clients just did not respond to CBT at all; others responded well for a while, then we seemed to hit a wall. Especially for problems related to childhood trauma, abuse or neglect, 'treatment-resistant' depression or anxiety disorders, or across-the-board problems affecting every area of someone's life, CBT techniques just did not work as well as I or my clients hoped.

Dr Young created schema therapy for people with exactly these kinds of problems. Because schema therapy involves working at a much deeper, more emotionally-focused level than with CBT, we can heal those past hurts that are causing you problems today. Using experiential techniques like imagery and chair work, we can help you release and process stuck or painful emotions, while shifting unhelpful ways of thinking and behaving that make day-to-day life a struggle.

Schema therapy is a highly effective, potentially transformative approach – and may well help even if you have tried CBT or other therapies before, with little success.

If you are interested in finding out more, email dan@danroberts.com

Warm wishes,

Dan