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What is CBT?

What is CBT

CBT – Cognitive Behaviour Therapy – is a highly effective form of therapy that focuses on the link between what we think, what we do, and how we feel as shown in the diagram below:

Our thoughts influence our feelings, our feelings inform our behaviour, and our behaviour can reinforce our thoughts and beliefs. As such, we can find ourselves in “vicious cycles” of unhelpful thoughts, uncomfortable or distressing feelings, and unhelpful behaviours that keep us stuck in the cycle.

Note that I’m saying unhelpful thoughts and behaviours. In therapy, it’s important to step back from judgement as this creates a barrier to effective change. Rather than criticise ourselves as being wrong, silly, or stupid, we can simply notice that what we’re thinking and doing is unhelpful for the outcome we’re seeking. 

CBT aims to help the client develop self-awareness and tools to be more present in daily situations and to be able to identify and adjust unhelpful thoughts and behaviours in order to feel better.

CBT is evidence-based and recommended by NICE guidelines (National Institute of Clinical Excellence) which is the government standards and recommendations for the best practice of health and care treatments and technologies.

What to expect 

CBT sessions tend to last 50 minutes and take place on a weekly basis. 

The sessions are quite structured with an agenda set at the beginning of each session so that both client and therapist know what will be worked on. The therapist will typically lead on this in the beginning sessions as the client becomes familiar with therapy but there is always scope for the client to add items to the agenda, perhaps particular situations that have been on the client’s mind that week.

CBT is usually more time-limited than other forms of therapy – typically 6-20 sessions – to work on a specific problem. For example, if you have a problem with anxiety in social situations, the first few sessions are about understanding what happens for you in social settings in terms of your thoughts, feelings, and behaviours and considering where this problem has originated from. The next few sessions might work on adjusting your thoughts and testing new behaviours. The remaining sessions are used to create a plan to maintain your progress before moving towards an end. 

CBT involves out-of-session work which may involve things like reading over some information, reflecting on your experience, practicing CBT tools and models, or trying out new ways of doing things. The purpose of this is to build forward momentum for the change you’re working on and create new pathways in your brain to turn these new strategies into habits.

We’re only together for 50 minutes each week, do you think that alone is enough to change your life? Like with most things, you’ll get out what you put in! If you’re struggling to do the agreed work, let your therapist know so a solution can be found.  

CBT with me

I am calm, friendly, and organised and I make it my mission to help clients make meaningful, sustainable change. As my client, I want you to understand yourself more fully, to get to the root of the problem, and to feel empowered to make choices and decisions. 

I encourage you to turn up as yourself – no need to worry about getting things right or wrong, or oversharing, or swearing. The time and space we have together is safe for you to say what needs said and I’ll be here to guide you forward.

I’m big on holistic health so I’ll likely check in with your hydration, nutrition, exercise, sleep, and caffeine consumption as these factors all interlink with our mental health and wellbeing.

Language is also a key point of interest for me – language says a lot about the meaning we give to ourselves, other people, and the world. Don’t be surprised if I ask you what you mean by certain things or pick up on words, phrases, or images – I’m not quizzing you, I’m genuinely keen to hear more about your perspective!

My biggest aim is for you to feel better within yourself and about yourself, I’m here for you.

If you work with me through an insurance provider, we’ll have allocated session numbers to help you work on resolving a particular problem. I’ll draw out a research-based treatment plan and we’ll work methodically towards reaching your hopes within our timeframe.  

If you work privately with me, sessions can be a little more flexible if needed, and you may wish to continue seeing me over a longer period of time. This can be for various reasons – perhaps a life event occurs that you’d like some support navigating; perhaps you’d benefit from regular accountability, or perhaps you like knowing you have someone impartial to speak to. 

Ways to work with me

  • I provide online therapy sessions via Zoom on Mondays, Wednesdays, and Thursdays.
  • I provide face-face therapy sessions in Edinburgh on Tuesdays.

How to get started

Drop me an email with your name, your preference for remote or face-face sessions, and your availability and we can arrange an initial call to get started!

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book-review

“You mean I don’t have to be dumb?” How to develop a growth mindset

There are some things you can do and others you can’t, right? Maybe it’s not so black-and-white.

“Mindset – Changing the way you think to fulfil your potential” by Dr Carol S. Dweck seeks to educate the reader on “how a simple belief about yourself permeates every part of your life”.

Dweck calls this belief a “mindset” and categorises into “fixed mindset” and “growth mindset”.

In this review of Mindset by Carol Dweck, I’ll cover:

  • An intro to the author
  • What is a fixed mindset
  • What is a growth mindset
  • My key takeaways 
  • How this book relates to the work done in therapy
  • And whether you should grab yourself a copy

Let’s get into it.

The Author

Carol Dweck is a professor at Stanford University and is one of the world’s leading researchers in personality, social psychology, and developmental psychology.

She uses her own research, anecdotes from her own life experience, and her work with her students, to illustrate how our mindset can have a big say in how we behave and interact with the world across various settings – arts and science, sport, business, education, and relationships. 

You can expect to find out how mindsets change:

  • What people strive for and what they see as success.
  • The definition, significance, and impact of failure.
  • The deepest meaning of effort.

So what are these mindsets? 

In essence, the mindsets are what we believe about ourselves in terms of our intelligence, competence, and talent. 

The fixed mindset is rigid and black-and-white. In this mindset we might think we can either do something or we can’t. 

Whereas the growth mindset is more flexible. In this mindset we’d be more inclined to believe that we can learn and improve.

The fixed and the growth mindsets interact with key life components including how we view challenges, obstacles, effort, criticism, and the success of others, as shown in Carol Dweck’s diagram below:

Mindset by Carol Dweck, Two Mindsets

Dweck explores these topics in the eight chapters and each chapter ends with “Grow Your Mindset,” which includes tips on how to apply the lessons from that chapter. The final chapter is dedicated to helping the reader cultivate a growth mindset.  

My Key Takeaways

The fixed mindset is a barrier to change, development, and progress. The growth mindset is a starting point for change, but the work doesn’t stop here – “skills and achievement come through commitment and effort”.

In the chapter on Parents, teachers, and coaches, Dweck describes growth teachers who convey the message that there are no shortcuts, no magic, and no miracle workers. 

These two takeaways really chime with my approach to therapy – while I understand why clients would like to magically feel better, it will take time, effort, and commitment to gain traction and momentum. 

According to the research, “normal young children misbehave every three minutes”. Although this might bring a big sigh of relief to parents out there, there’s another message that comes with this: children pick up messages very early on about whether their behaviour and mistakes are “worthy of judgement and punishment or an occasion for suggestions and teaching”. It might be worth considering which message you’re conveying and how this could be tailored to, not just your children, but anyone you have a relationship with. 

Although children love receiving praise about intelligence and talent, Dweck cautions that, “Praising children’s intelligence harms their motivation, and it harms their performance”. This is because if success equals intelligence, then failure equals stupidity, and this is the fixed mindset. Instead, praising the effort, process, and learning leads to longer-term confidence and a growth mindset. 

On the other side of the coin is criticism. Children require honest, constructive criticism to learn and grow. Dweck tells us that even though we often just want to protect our children from criticism, not providing effective constructive criticism can lead to a lack of confidence, which can have far-reaching repercussions into their future. Constructive criticism should not be conflated with judgement. Constructive criticism involves helping people to become better. 

“Change can be tough, but I’ve never heard anyone say it wasn’t worth it.”
Mindset, Carol Dweck

The biggest takeaway for me was stated in the first chapter, “The message is: you can change your mindset” which resonated fully with me in the four-step process in the final chapter which Dweck calls “the journey to a growth mindset”. The four steps involve acceptance, trigger-awareness, persona creation, and testing, with a fifth step being maintenance. Dweck expertly navigates any resistance in the reader by explaining that we all have a fixed mindset in some areas of our lives and that it’s just part of being human.  

How Mindset by Carol Dweck relates to the work done in therapy

The aim of the book aligns with the principles of Cognitive Behavioural Therapy because the premise of CBT is that we hold beliefs about ourselves, other people, and the world which shape our thoughts and actions. 

Having negative beliefs leads to unhelpful thoughts and behaviours, meaning that we can find ourselves stuck in vicious cycles that take us away from our desired outcome and can even inadvertently confirm our negative beliefs. 

Below is one of Dweck’s descriptions of the growth and fixed mindsets responding to an academic failure, which I have transferred into a CBT model:

We can see that although the feeling of disappointment is present in both mindsets, the growth mindset leads to helpful thoughts and more effort, whereas the fixed mindset leads to unhelpful thoughts and avoidant behaviour. 

Our interpretations inform our behaviour. If we can get our mindset in check, more productive and effective behaviours will follow.

In therapy we explore what the beliefs are, where they came from, as well as how to create new beliefs, thoughts, and actions that serve us better.

Should you read it?

I would absolutely recommend you read Mindset by Carol Dweck for yourself and use the four-step process in the final chapter to work on your own mindset. 

After reading this book, I felt motivated and inspired to view challenges as learning opportunities, it’s already made a big difference in some key areas of my own life.

For anyone interested in continuing their learning, Dweck has provided a list of recommended books at the end which I reckon I’ll be working my way through because after reading her work, I truly trust her judgement.  

Have a read and let me know how you get on!

Mindset, Carol Dweck
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Get inside the mind of a therapist.

How do you review something so layered, so insightful, so expertly created? 

These are the questions I’m asking myself as I sit down to write this review of “Maybe you should talk to someone” by American psychotherapist Lori Gottlieb.

In this instant New York Times bestseller, Gottlieb tells her story of being a therapist, whilst also attending therapy as a client herself, the very same position I was in when my good friend gifted me this book. 

Gottlieb begins by posing the question, “how do we change?” and through the pages of her book she responds, “in relation to others”. The therapeutic process is brought to life by Gottlieb sharing her clients’ stories, her own perspective of sessions and clients, and how she finds relating to her own therapist, Wendell. The latter of which she captures brilliantly in her line, “I both loved and hated Wendell for saying that”. 

The strength and depth of the therapeutic relationship is the basis for effective work. But just like any other relationship, it can be complicated. It’s the process of turning up, sitting in discomfort, and doing the work from both client and therapist that creates safety for exploring and creating change. 

This book is an expertly crafted interweaving of stories that exemplify the therapeutic arc taking us from what’s bringing clients to therapy now, laying it all out, editing the narrative, moving towards meaningful change, and coming to an end.

Gottlieb introduces us to four of her clients:

  • A twenty-something who is into bad guys and booze
  • A thirty-year-old newlywed with a terminal illness
  • A forty’s TV producer who calls everyone else an idiot
  • A 69-year-old contemplating suicide if things don’t get better

Through these tales we sit in ambivalence with the twenty’s client, face death with the thirty’s, learn about defence mechanisms with the forty’s, and seek forgiveness with the almost-septuagenarian. The craftsmanship of the writing absorbs you in each client making it easy to follow each client’s journey. 

Just like therapy, as the stories unfold and we delve into the depths of learning with Gottlieb and her clients, there’s a somewhat sudden, yet also subtle, shift as the pace picks up as they all move through their change process, pictured below:

Stages of Change, James Prochaska, 1980s

Gottlieb describes this change process as happening “gradually and then all at once”. 

This book is one to be highlighted and scribbled on as Gottlieb brings an abundance of knowledge to every page. 

You’ll find out about:

  • Erikson’s psychosocial changes
  • Four ultimate concerns
  • Misery-seduction dynamic
  • Privacy vs. secrecy
  • Projection and projective identification
  • Reacting vs. responding
  • Ultracrepidarianism
  • Unconditional positive regard
  • And much, much more!

It’s not just the psychological context but also Gottlieb’s graceful articulation of tender moments of therapy that you’ll want to underline. A standout line for me was: “I watch her hear what she already knows” which for me called to mind so many of my wonderful clients, particular moments where we’ve sat in the reality of it all, where I’ve seen emotions appear before my eyes, where I’ve felt a physiological shift in my body and observed the shift in them as we arrive at and embody realisations. 

Therapists are somewhat mysterious as our work is bound with confidentiality, meaning that people often struggle to grasp the nature of our day-to-day as we can’t elaborate or exemplify what we do. By bringing the four clients plus herself as a fifth client, Gottlieb provides a real insight into how clients present and how therapists work in session, and how therapists are in Gottlieb’s words, “a card-carrying member of the human race” which is not a flaw, it’s our biggest credential.

Gottlieb captures the sense of mystery when she addresses the question that we therapists often get asked “what kind of people do you see in your practice”, to which she responds, “just like any of us, which is to say, just like whoever is asking”. 

You don’t need to be in crisis, you don’t need to have a diagnosis, therapy is for any of us.  

Throughout writing this review, I caught myself being tempted to refer to the author as “Lori”. This speaks to the familiarity she creates through her writing. It feels deeply personal and vulnerable whilst also feeling very considered and expertly crafted. I also struggled to write this review because I didn’t want to say too much that would spoil the story unfolding for you!

I highly recommend this book – whether you’re interested in going to therapy, have already been, are a therapist yourself, you want to learn more about humans, or you just want a damn good read.

Expertly written, this book is an absolute gem that I’m sure I’ll be rereading for years to come. 

* Bonus recommendation: If you read the book and enjoy it, I’d also recommend watching Couples Therapy on BBC iPlayer which is a similar behind-the-scenes look at therapy, facilitated by Dr. Orna Guralnik.