Boundaries of the Soul

Cognitive behavioural therapy, or CBT as it’s usually called, is a talking therapy. It involves a series of sessions that last for between 30 minutes to an hour where you talk to a trained therapist. It is a way of learning about how you think about yourself, the world and the people around you and how your thoughts and feelings are affected by what you do. Once you understand this, you can learn to make changes in the ways you think about situations and how you respond to them. The ‘Cognitive’ part of the therapy is about how you think about things, and the ‘Behavioural’ part of the therapy is about what you do. So CBT is about changing the ways you think and how you act.  After a while, these changes add up to make you feel better. CBT isn’t a therapy that delves into your past trying to find causes for your emotional distress and symptoms. It concentrates on how you feel now, and the difficulties and problems you face now, and the changes you can make that will help you to feel better now.

What conditions does CBT help?

CBT has been found to help people with mild to moderate depression. It is also used in a number of other conditions including anxiety, bulimia, obsessive compulsive disorder, panic, some phobias, and post traumatic stress disorder.

How does CBT work?

When you have a condition like depression, it is very common to have a negative way of seeing the world around you and responding to anything that happens in a negative way. The world seems over-demanding and even minor problems can seem overwhelming. CBT helps by teaching you how to break down these seemingly insurmountable problems into smaller parts. You can then see how these smaller parts are connected and how they affect you.

The smaller parts are:

• A Situation – a problem, or something that happens that you find difficult or distressing

The situation causes you to have:

• Thoughts - what you think about the situation. Is it overwhelmingly difficult or are you able to deal with it?
• Emotions – how you feel about the situation. Does it make you feel good or does it make you feel bad?
• Physical feelings – sometimes a difficult situation or emotional turmoil can cause physical feelings like dizziness, nausea, headache, shortness of breath, sweating, palpitations and so on. Does this situation make you have feelings like this?
• Actions – what you do in response to the situation. Do you do something positive about it or do you just ignore it?

Each part can affect the others. How you think about a problem can affect how you feel physically and emotionally and what you do about it. Changing one or more of the parts can also change the others. So, if you change the way you think about a situation, or what you do about it, this can change your emotional and response as well.

In depression, there is a vicious circle that connects your thoughts, emotions, physical feelings and actions. If a situation arises that you think about in a negative way, this is likely to make you feel even more depressed, perhaps give you a physical symptom like a headache, which makes you feel worse still, and your response is to do nothing about it because your negative thoughts tell you there is nothing you can do about it. Interpreting the situation in such a negative way almost always leads you to jump to unrealistic and unhelpful conclusions.

This can lead to a downward spiral that creates new situations out of nothing that have the effect of making you feel even worse. You start to have unpleasant (and false) thoughts about yourself.

CBT helps you to break this vicious circle of negative thinking, feelings and behaviour. When you see these parts separately, you can learn to change them – and so change the way you feel.

The series of CBT sessions is intended to help you to learn how to change your thinking and behaviour so that you can do it on your own, and work out your own ways of tackling your problems.

What does CBT involve?

CBT can be done on a one-to-one basis, or with a group of people. It can also be done using a self-help book or even a computer programme

One-to-one therapy usually involves between 5 and 20 sessions, weekly, or fortnightly, with a therapist. A course of treatment could last anywhere from 5 to 40 weeks, depending on the circumstances. For the first few sessions, the therapist will check that CBT is suitable for you, and you will decide what problems you want to address in the short, medium and long-term. Sessions usually start by agreeing on what to discuss that day. Although CBT concentrates on how you feel now, at times you may need to talk about the past to understand how it has affected you, so the therapist may also ask you questions about things that have happened previously in your life.

Once you’ve identified the problems you want to work on, with help from the therapist, each problem is broken down into its separate parts, as in the example above. It helps if you keep a diary so you can learn to recognise your own ways of thinking and how this affects your emotions, how you feel physically and how you respond.

The therapist will help you to work through your thoughts, feelings and behaviour to see whether they’re negative, and how they affect each other, and you. They will then help you find ways to change unhelpful thoughts and behaviours. For example, you will probably learn how to challenge a negative or upsetting thought and replace it with a positive one. Your therapist will help you to develop a range of positive thoughts that you can use.

This is much more difficult than it sounds, so to help you get into the swing of it, your therapist will suggest ‘homework’ which involves exercises where you practise these changes in your everyday life.

If I’m depressed, why should I consider having CBT?

Depression can have a devastating effect on your quality of life, your relationships with other people and your ability to work. CBT can help you to take control of the depression. CBT isn’t suitable for everyone, and it doesn’t work for everyone.

However,

• It is one of the most effective treatments for anxiety or mild to moderate depression.
• In moderate and severe depression it is the most effective psychological treatment – but it usually needs to be given in combination with antidepressants. If your mood is very low you it can be very difficult to change the way you think until antidepressant treatment has started to improve the depression.
• In mild to moderate depression it is as effective as antidepressants.
• The strength of CBT is that you can continue to practise and develop your skills even after the sessions have finished. This makes it less likely that your symptoms or problems will return. If they do, the skills you have learnt in CBT should make it easier for you to control them.

What about Online Therapy?

Online therapy is a new way to meet with your therapist. While it is not suitable for serious mental health issues, it is especially suited to CBT.

Online therapy, also known as e-therapy, e-counseling, tele-therapy or  cyber-counseling, is a relatively new development in mental health in which a  therapist or counselor provides psychological advice and support over the  Internet. This can occur through e-mail, video conferencing, online chat, or  Internet phone. Online therapy can occur in real-time, such as in phone  conversations and online chatrooms, or in a time-delayed format, such as through  e-mail messages.

Is there anyone who should consider not using it?

• You must be at least 18 years old to engage in online  counseling.
• You must not be suicidal  or a threat to others
• You have serious  thoughts of hurting yourself or others.
• You have a chronic  mental illness requiring intense treatment.
• You prefer face-to-face  therapy and it is available to you.
• You are uncomfortable  with computers and keyboards

Who is it for then?

Online therapy is the new smart way to deal with issues. It is increasingly  becoming the medium of choice for :

• Busy professionals who travel a lot.
• People in remote locations where finding a professional is difficult.
• People who are housebound for whatever reason.
• People in small towns where confidentiality is a problem

What about privacy?

I know you are entrusting me with some of your most personal and valuable information, including your personal health information.  Your trust is built, in part, on my commitment to respect the privacy and confidentiality of your health information.  I am committed to safeguarding and protecting your personal information, including health information about you.

There are limits to your confidentiality and privacy. Law requires that I report to the local Department of Social Services  any evidence I have of a child being abused or neglected. In other words, if you tell me that you are physically abusing or severely neglecting your child, or identify someone who  is, I am required by law to make a report to DSS.

Similarly, if you tell me that you are going to kill yourself or someone else, I am required by law to inform the police and the other person, and do anything else necessary to stop the suicide or murder.

And finally, in the rare event I would be subpoenaed by a court of law to produce your confidential records and a judge ordered me to comply, then I would. (Note: The same would be true in face-to-face therapy)

To protect your privacy, be prudent in how you store treatment-related emails and chat room transcripts. Make sure they are protected from unauthorized access by using and guarding your passwords. Consider deleting any emails (sent or received) or chat room transcripts that you do not want others to see, followed by emptying your trash or recycle bins. If you make hard copies of emails or chat transcripts, store them securely. Be aware that emails sent from a workplace computer are the property of the employer.

How does it work?

TO GET STARTED

1.         Contact me for a  convenient appointment giving your full email address.

2.        I will contact you to discuss the best method for the first  session.

3.        You are free to decide if further sessions are for you.

What can I expect ?

I am a specialist in CBT and I am convinced by its effectiveness.The basic assumption behind Cognitive Behavioral Therapy (CBT) is that one’s thoughts influence one’s emotions and behaviors, and that if negative thoughts are altered, negative  emotions  and  behaviors can be altered as  well. We are what we think, so to say. By  using a series of practical and easy to use methods, CBT looks at changing the “here and now” which means that less time is spent on delving into a clients’ past. This has a direct effect on a client’ s daily life and his ability to handle dysfunctional thought patterns that tend to affect mood  and  happiness.  In a therapeutic  alliance, the  therapist  and  client explore  and  try  to  change  these  thought  patterns.  CBT  has  a  strong  educational element to it in  the sense that the relationship built up in therapy serves as a model for other relationships. The  therapist  helps  the  client  to  formulate  problems  in  cognitive  terms,  and  is constantly inviting feedback from the client to ensure that he/she feels understood and can learn to contribute jointly with the therapist to the treatment. It is very much a problem – solving approach. Central to this approach is the use of Ellis’s ABC model which charts the relationship between a triggering event, the resulting behavior and how  dysfunctional  thought  patterns complicate  the  issue. The use of  homework assignments is used to consolidate what takes place in the session.  Goals are set in behavioral terms and potential solutions are tested out in practice: clients  are  encouraged to explore options for change  and evaluate  outcomes by comparing progress with previous experience and hence are encouraged to take an objective, scientific, view of their problems. In this way, clients are taught, in theory, to  become  their  own  therapists and  are thus  prepared  to  deal with  relapse and problems if and when they arise in the future.