Therapy with Kirsty

It can be common to think that you’ve not achieved anything or that some achievements don’t count or aren’t a big deal. Or as soon as you’ve achieved a goal quickly think ‘what’s next’ or ‘now what’.

The first way of thinking is common for people with low mood or depression, the latter is common for anxious people. Both can feature for people who are affected by low self-esteem.

These mentalities mean that you don’t get a chance to give yourself some validation or celebration for the achievement which, over time, can prevent your self-esteem from growing or can actually decrease your self-esteem.

It can become exhausting when it seems as though you’re on a constant hamster wheel or that your goalposts keep changing; every time you think you’re going to achieve something you never feel fulfilled or satisfied. This can lead to thoughts such as ‘I am not good enough’, a thought which sounds pretty rigid, unhelpful, and goal blocking.

The changing goalposts have probably served a purpose at some point in the past – that’s why they feature now – perhaps they’ve helped you succeed academically or at work or have helped you find a sense of forward momentum. However, they also have some downsides which is what you’re experiencing now – unfulfillment, burnout, stress, low mood, fatigue.

We need to redress the balance. It’s ok to strive for excellent results but it’s important to pause and recognise them along the way. Positive data logging can be a helpful start – write down your achievements no matter how big or small, this demonstrates to yourself that you’re doing more than you think you are. Reflect on how your achievements make you feel and what the positive results are from your achievements – this helps you to appreciate your achievements instead of moving onto the next. Think about your weekly diary, do you have enough time for work, rest, and play? Having me-time is a great way to feel restored and to not feel resentful of the work we put in during the rest of our week.

And of course, therapy is an ideal space for you to look at all this in more detail, to consider your own thinking styles and belief systems that are perpetuating this pattern.

I read these words in the excellent book Therapy by Stephen Grosz (picture below).

The reason the words resonate with me is that they seem to reflect the human condition; we would like things to be different but effort and consistency are needed to bring about this change and we need to be willing to step out of our comfort zone to make it happen. And that is challenging and can be pretty scary.

These words cause me to reflect on change; there are always gains and losses as a result of change, even when the change is of our own doing or we view it as positive.

If I’m to make this change, what will the gains and losses be? Will the gains be worth it? Am I worth it? How might my life be different? How will I react? These are all common thoughts that can go through the mind ahead of any change, ahead of stepping into therapy.

Change can be exciting and it can be daunting, it can be sprung upon us or we can decide to change of our own accord, it can be done slowly or quickly, it can be done in one step or many smaller steps. It’s new and it’s uncertain.

Therapy can help assess your priorities, way up the costs and benefits, and take steps to bring about change.

Beginning, middle, and end. That’s how we’re taught to tell stories.

Therapy is the story of two people coming together to relate, to learn, and to affect change.

So, like other stories, therapy follows a beginning, a middle, and an end.

In the beginning, we relate. I listen to your story. I find out what it is to be you, how you think, what you do, what you feel, how you relate to yourself, other people, and the world, what beliefs you hold about yourself, and how you became you.

In the middle, we learn. I give you information and tools, and you learn how to implement them in your life. The information (aka ‘psycho-education’) provides you with knowledge of how we work as humans, how the belief systems form, the common unhelpful thinking habits we are prone to, and how our emotions appear in the body. The tools are more practical, they involve worksheets as guidance and behavioural changes to test out. We go over them in session and then you can test them out in your life.

In the end, we affect change. We reflect on what’s been achieved, we consider possible future setbacks, and we think about how you’d respond. At this stage, you’ll have the information and knowledge, as well as the confidence, to use in your life.

And finally we say goodbye, safe in the knowledge that we can return to this story at any time in the future. 

Therapy is an opportunity to grow as a person, to work on things in your life, to find ease and a more peaceful way of living. Research shows that therapy can be very helpful for many people, and that most clients leave feeling much better than when they started. Research also shows that the more clients know about therapy before they start, and the more they put into it, the likelier they are to get more out of it. So this blog post outlines the therapy I offer and what you can do to make the most of it.

What would you like to focus on?

The time is yours to use how you see fit, here are some of the issues that clients often choose to focus on are:

• Making sense of how you’ve become the person you are and put things in perspective
• Making sense of a specific problematic event that sticks in your mind
• Problem-solving, planning, and decision-making
• Changing behaviour
• Negotiating a life transition
• Dealing with difficult feelings and emotions
• Finding, analysing, and acting on information
• Undoing self-criticism and enhancing self-care
• Dealing with difficult or painful relationships

What is CBT and is it flexible?

Cognitive Behaviour Therapy (CBT) is an evidence-based approach that focuses on the connection between thoughts, feelings, and behaviours, as well as inner beliefs about self, others, and the world, and how this plays out in everyday interactions and interrupts our own values. Usually our thinking styles, behaviour patterns, and beliefs have formed from early life experiences and relationships or from specific, memorable moments.

The therapy offered is based on the belief that we are experts on our own lives (even if at times we don’t feel like we are), with lots of potentially good ideas about how to deal with problems.

Flexibility applies to the number of therapy sessions that you receive. Typically CBT is short in nature, around 6-16 weeks, but everyone is different and I’ll work with you in a way that is comfortable for you. Some people come for a few sessions and find that it’s enough to put them on the ‘right track’. Other people attend therapy for slightly longer. What is important is to do what’s best for you personally. If you have some sessions and then want to stop, you can always come back at any time in the future.

Flexibility can also involve the choice of therapist. Some people may only feel comfortable talking to someone of the same gender, or someone from the same ethnic group, etc. If you start with me, and then feel – for whatever reason – that I’m not the right person for you, please let me know. I’ll do my best to find you another therapist who would be better for you.

Thinking about what you want from therapy

It’s important for me to know what you want to achieve in therapy – what your goals are. Your goals are a kind of agreement between us which specifies what you want to achieve and they’ll steer our work together.

At the start of therapy, it can be hard to be clear about exactly what it is that you want to achieve. Maybe you only have a sense of what you hope to get from therapy. This is perfectly normal – I’ll encourage you to talk about your goals, and gradually they’ll become clearer. You can have a few goals or just one and your goals might change over time.

One of the ways to get the most out of therapy is to spend some time thinking about your goals before the first session and between sessions. Writing your goals down can be helpful so you don’t forget them. Writing them down also means that you can visually see your goal which helps increase motivation and makes your goals more concrete which impacts how behaviour in relation to goals!

The plan

CBT won’t seek to diagnose you – a psychiatrist or clinical psychologist could help you with this if that’s what you’re pursuing. We’ll work together to understand your concerns e.g., self-esteem, anxiety, low mood, loss, and to create a plan to help you move towards a sense of ease and comfort. We’ll use some questionnaires along the way to gauge progress or to highlight sticking points that we can work through together.

Being active between therapy sessions (I’m not talking about the gym!)

Between therapy sessions, I review our work and think about what could be done in the next session to take things forward. It’s valuable for you to do the same. At the end of each session, we can agree ‘homework’, ‘experiments’, or ‘projects’ – something you’d like to work on between sessions.

It’s useful for you to think about what has come up for you in therapy, whether you’re getting what you need, how the therapy can be improved, etc. It can be hard to remember these thoughts and one option to consider is keeping a therapy diary where you write about what therapy has meant to you.

Giving feedback

Effectively tailoring the therapy to your specific needs is only possible if you’re willing to give honest feedback to your therapist. I’ll ask you for feedback during the therapy session and I may invite you to take some time to review overall progress after approximately six sessions.

When giving feedback, it’s important that you’re as honest and detailed as you can be. It may be uncomfortable for me to learn that you think that I ask too many questions (or not enough questions), or I’m not meeting your needs in some way. But ultimately, I want to help you and don’t want to pretend everything is OK if it isn’t.

Feedback is a gift – you’re giving me an opportunity to learn how to better relate to you.

Any questions or worries – please ask

You might have some more questions that I haven’t covered here, please head over to my FAQ page or get in touch to check it out with me.

This is a simple grounding exercise to bring you back to the here-and-now if you are stressed, overwhelmed, or are stuck in your thoughts.

5… 4… 3… 2… 1

5 things you can see 👀

4 things you can hear 👂

3 things you can touch 🖐️

2 things you can smell 👃

1 deep breath 🧘‍♂️

Test it out. What do you notice?

Self-care is the process of taking care of ourselves. Might seem obvious but how do we do it?

Basic daily choices are a form of self-care:

🚿 Hygiene and dental care
🏃🏻 How much we move our bodies
😴 How much sleep we get
🍲 What we choose to eat
💦 Whether we drink enough water

But there are also other ways we can take care of ourselves:

📖 Read a book
🧘‍♂️ Yoga or meditation
📱 Unplug from social media
☕ Have a coffee with a friend
💅 Give yourself a manicure
🙏 Practice gratitude
🎉 Celebrate a win (big or small!)
💃 Start a new hobby
💋 Talk to someone about how we feel

Asking yourself “what does my mind or body need” is a helpful way to decide what to do to take care of yourself.

Regulating our breathing helps us to feel calm.

When we feel calm, we’re in control of our behaviour.

This is because the logical brain is in control of the emotional brain.

There are many different breathing exercises out there.

My favourite is a simple breathe in for 3 and out for 4.

Exhaling longer than inhaling helps our body to relax and our brain to move from emotional to logical.

Keep repeating in for 3, out for 4 until the anxiety decreases and the calm increases.

The brain is an organ.

This organ houses our thoughts, impulses, and emotions in the prefrontal cortex and amygdala.

Mental health problems are a biological illness in this organ. They are the result of genetic and environmental interactions, much like heart disease.

We can struggle to think of our mental health in this way as it is so intertwined with how we feel and the thoughts that go through our mind which makes it seem like there is a flaw in our character or personality. This is not the case.

Understanding our mental health can take some of the pressure off and help us be more objective.

We can begin to notice the thoughts that are unhelpful or unhealthy, the behavioural impulses or habits that have formed, and how this is impacting the way we feel.

CBT (Cognitive Behaviour Therapy) can help you with this process of becoming more objective and making changes and healthier choices to move towards a sense of ease and wellbeing.

Boundaries are crucial for living a healthy, balanced life. They are imaginary lines that separate me from you and are personal limits for what is acceptable.

They can be categorised in three ways: physical (who can touch us), mental (freedom of thought and opinion), and emotional (manage our own emotions and distance ourselves from emotions of others) and can also include practical elements such as time and finances.

Boundaries are a form of self-care and offer self-protection, but they also come in handy for creating realistic expectations by letting people know how to interact with us in a consistent way.

A lack of boundaries is particularly evident in people pleasers who typically struggle to say no, take on more than what’s reasonable, and put other people’s needs ahead of their own.

Set boundaries by:

1. Define your desired boundary
2. Communicate your boundary
3. Keep your communication simple
4. Say why this boundary is important

Cognitive Behaviour Therapy (CBT) was developed by Aaron Beck in the 1960s. CBT is a form of psychotherapy which focuses on the here-and-now and is characterised by its structured sessions and short-term nature, typically limited to six to fourteen sessions. The purpose is to achieve symptom relief, resolve disturbing issues, and learn skills to prevent relapse and deal with future problems. CBT sessions explore the meaning of client experiences, identify recurring themes, and connect present and past experiences. The behavioural element of CBT involves aspects such as goal setting, homework assignment and behavioural experiments, with the therapist having an active role in sessions.

Originally developed to treat depression, many therapists and clinicians have since adapted this approach for many psychological issues. CBT has also been adapted for clients of different ages, cultures, and levels of education, as well as in different formats including one-to-one, couple, family, and group settings. The cognitive model forms the basis of this approach, what this means is when a situation triggers a psychological disturbance, the associated inaccurate and/or unhelpful thoughts about the situation will influence emotional, behavioural, and physiological responses. It is the way in which a person interprets a situation that causes distress rather than the situation itself, with allowances made for some situations being universally accepted as being distressing. Through CBT, the therapist will provide education on aspects of the cognitive model as well as the cognitive triad: how the presenting issue distorts the view of themselves, others, and the world. CBT teaches people to evaluate and respond to their unhelpful thoughts and beliefs, to problem solve, and to modify their behaviour to reach a more balanced perspective and undergo lasting change.

CBT is goal-oriented and solution-focused and follows a beginning, middle and end structure. At the level of individual sessions, beginnings involve a mood check, agenda setting, obtaining an overview, and reviewing previous homework. Middles focus on working on a specific issue through psychoeducation and intervention use. Endings consist of session summary, homework setting, and eliciting feedback.

In the beginning of therapy, questions are asked to understand the client’s presenting issue(s), how they have arrived at therapy, and expectations. Agenda setting is introduced in the beginning of therapy to provide a structure for the session and set expectations for future sessions. An assessment is completed so that the therapist can obtain a measurable interpretation of the client’s presenting issue(s). The client is also asked to identify SMART (specific, measurable, achievable, realistic and time limited) goals which will form the focus of the therapy. Beginnings have a strong focus on psychoeducation and bringing awareness to the client. The middle sessions of therapy focus on the treatment of presenting problem(s). The purpose of endings is to work on relapse prevention which involves solidifying learning, identifying possible areas of concern, and client becoming their own therapist.