by Steve Rose | Aug 30, 2020 | Suicide and Mental Health
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Self-care is crucial for maintaining mental health. Though we often neglect self-care, distracted by the responsibilities of daily life. Our minds tell us self-care is selfish and that we need to focus on helping others instead.
Working in mental health and addictions, I am a strong proponent of self-care. I need to help myself before I can help anyone else. Going into potentially stressful situations while hungry, tired, and frustrated is a recipe for burnout, making it difficult to be helpful at all.
If you value helping others, you need to be able to help yourself first. Self-care is not selfish. Instead, giving people the best version of yourself allows you to be even more helpful while preserving your mental health in the long-run.
Here are some self-care tips for mental health:
- Practice saying “no”
- Ask for support when needed
- Let go of toxic relationships
- Meaningfully connect with others
- Focus on the present
- Get clear on your values
- Take time for yourself
- Focus on what you are grateful for
- Incorporate some form of exercise
- Spend time outside
- Incorporate healthy dietary habits
- Get quality sleep
Let’s delve into these tips, dividing them into three broad categories: interpersonal self-care, mental self-care, and physical self-care.
Interpersonal Self-Care
This form of self-care considers the quality of your social relationships. As social beings, the quality of our close social relationships is one of the most significant predictors of well-being.
Practice Saying “No”
This is about personal boundaries and assertiveness. If you lack these two skills, it is easy for others to take advantage of your kindness and willingness to help.
Although there is nothing wrong with helping others, it can be problematic when it comes at the expense of your health. You can only give what you can give yourself first.
Ask for Support When Needed
To use a popular self-care metaphor, you cannot pour from an empty cup. To give yourself to others, you need to refill your cup. This may sometimes require asking for support.
Although you may not want to feel like a burden, consider the fact that you would likely do the same favor for the person you are asking. You are just as worthy of support. As much as our modern world instills the value of independence, this is an unrealistic standard since we all depend on one another somehow.
Let Go of Toxic Relationships
You become most like the people with whom you surround yourself. If you find you are becoming cynical and resentful, consider the influence of those around you. It is tempting to get pulled into gossip and negativity, but like junk food, the short-term benefits outweigh the long-term costs.
Letting go of toxic relationships does not necessarily mean avoiding or confronting people. Instead, it means refocusing your attention on those that matter most, letting others be.
Meaningfully Connect with Others
Meaningful social connection fulfills our social needs. Loneliness and social isolation are significant contributors to mental health and addiction issues.
This may mean unplugging from your devices and social media for a while, but it could also mean using social media in ways that help you better connect with others. I explore this dynamic further in my article, “Is Social Media Making Us Less Social?”.
Mental Self-Care
This form of self-care requires using effective psychological strategies to maintain mental resilience. This involves mindfulness, personal boundaries, and clarity regarding your values.
Focus on the Present
Worrying about the future or ruminating on the past takes you away from the present moment. Since the present moment is the only place you can effectively deal with issues that arise, worry and rumination threaten self-care, keeping you stuck in your head.
One helpful exercise consists of directing your attention to the sensations in your body. Notice the sensation of your body in the chair, notice your feet on the floor, and notice the rise and fall of your breath. See my article on How to Stop Living in Your Head for more exercises.
Get Clear on Your Values
Are you in the habit of asking yourself what you want? We can sometimes go through periods of focusing so much on others that we lose touch with our own values.
For example, if you value creativity, how can you bring this value into your daily life more often? If you value authenticity, how can you bring this quality to each interaction? Without clarifying your values, it is easy to lose touch with your own sense of self, finding yourself merely responding to the environment’s demands.
Take Time for Yourself
Carving out alone time is a crucial feature of any self-care plan. If you have a busy lifestyle with several responsibilities, it may be challenging to find the time. This is where the interpersonal self-care tips come in.
Are you overbooked because you have been unable to say “no”? Are you unwilling to accept support when necessary? If you cannot find time for yourself, resort back to the interpersonal self-care skills for personal boundaries.
Focus on What You Are Grateful For
Gratitude may feel like one of those self-care buzzwords. We know it’s good for us, but we don’t think about it too often. The reason why gratitude has acquired such a strong reputation as the greatest virtue is due to the strong research backing its effectiveness:
“…people who were asked to write a gratitude letter once a week for three weeks were significantly happier, less depressed, and more satisfied with their lives at the end of the intervention.”
Physical Self-Care
Physical self-care is an essential but often neglected way to improve one’s mental health. Since the mind and body are so intertwined, optimizing one’s diet, exercise, and sleep, vastly improve mental resilience.
Spend Time Outside
Spending time outdoors is an easy way to get natural vitamin D from moderate exposure to the sun. Roughly twenty minutes of mid-day exposure to the sun can have a significant impact on your well-being. Research demonstrates the power of vitamin D for mental health:
“…treatment of inadequate vitamin D levels in persons with depression and other mental disorders may be an easy and cost-effective therapy which could improve patients’ long-term health outcomes as well as their quality of life.”
Incorporate Some Form of Exercise
The American Psychological Association released an article stating psychologists have often neglected the power of exercise in their practice. They summarize a study on the effect of exercise on Major Depressive Disorder (MDD), concluding:
“The efficacy of exercise in patients generally seems comparable with patients receiving antidepressant medication, and both tend to be better than the placebo in patients with MDD.”
Incorporate Healthy Dietary Habits
Limiting sugar intake may be the single best way to immediately improve one’s mental health. High levels of sugar consumption are associated with anxiety, depression, dementia, and several other illnesses. A study on sugar intake and mental health found:
“…men in the highest tertile of sugar intake from sweet food/beverages had a 23% increased odds of incident [common mental disorder] CMD after 5 years.”
Get Quality Sleep
We’ve all heard the familiar rule that we should be getting at least 8 hours of sleep each night. This is generally a rough guideline, and each individual requires a different amount of sleep.
Beyond the amount of sleep, quality of sleep is just as important. This means sleeping in a dark room without disruptions and maintaining a regular sleep schedule. A report by Harvard Health states:
“…sleep disruption — which affects levels of neurotransmitters and stress hormones, among other things — wreaks havoc in the brain, impairing thinking and emotional regulation. In this way, insomnia may amplify the effects of psychiatric disorders and vice versa.”
Conclusion
Engaging in interpersonal, mental, and physical self-care has numerous mental health benefits. Beyond the mental health benefits, self-care allows you to be the best version of yourself so that you can more effectively be of service to others. If you value helping others, the best way to do so is by helping yourself first.
This is the same reason why persons on an airplane are directed to put their own oxygen mask on first. You can’t be of use to anyone else if you can’t breathe.
Hopefully, these tips have helped and inspire you to take action on a path toward improved self-care. If you’re interested in checking out my other articles on mental health, you can find those articles here.
by Steve Rose | Aug 29, 2020 | Addiction and Recovery
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When considering the root causes of addiction, it is important to look at various underlying contributors. The media is full of oversimplified depictions of addiction, making it seem like substances themselves cause addiction. Working in the field, in addition to looking at the research, I realized this is a myth.
Upon beginning treatment, I often share the iceberg model with my clients. The addiction is the visible tip of the iceberg, whereas the underlying causes are generally invisible but comprise the vast majority of the issue. To effectively deal with the addiction, we must first consider what is causing it. So what are some of these root causes?
Underlying root causes of addiction include trauma, pain, and unmet needs such as purpose, belonging, and self-esteem, which may be amplified by family and genetic factors.
Let’s dig into the research and unpack each of these underlying causes to dispel some popular myths about addiction.
Also, if you or someone you know is struggling with mental health or addiction issues, you can check out my resource page for suggestions on how to find help.
Drugs Don’t Cause Addiction
Growing up, I recall the anti-drug campaigns spreading the myth that drugs cause addiction. The logic was simple: Drugs are so powerful and so pleasurable that once you try them, you’ll be hooked; therefore, “just say no.”
Perhaps this was effective for someone like me. With my cautious temperament, the fear of such powerful substances kept me away from them.
In general, research does not support the effectiveness of fear-based anti-drug campaigns. Also, it leads to further harm by perpetuating a superficial understanding of how addiction works.
Bruce K. Alexander is a popular advocate against the myth of drug-induced addiction. In his address to the Canadian Senate, he cites a longitudinal study on substance use rates among secondary school students, stating:
“In this group, 41% reported having used cocaine at some time in their life… and less than 0.1 % reported using it at least 20 days in the month of the interview. Thus, less than one student in 400 who reported having used cocaine could be considered a current addict.”
He goes on to share a similar finding regarding crack usage:
“…5.1% had used crack at least once in their life… and less than 0.05% had used 20 or more days in the month of the interview. Thus, the ‘most addictive drug on earth’ caused persisting addiction in no more than 1 experimental user in 100.”
These findings dispel the myth that substances necessarily cause addiction. Although substances are involved in addiction, there needs to be a better explanation of why some people become addicted, and others do not.
Bruce Alexander further dispels this myth in his famous Rat Park Study. He demonstrated that if you put rats in a bare cage alone with addictive substances, they will overdose. But if you put them in a cage with other rats and engaging novelties, they no longer overdose.
This study points to social isolation as one of the underlying causes, explaining why some people develop an addiction. The pain of isolation led rats to cope through ingesting the drug, whereas the rats not subject to this form of pain were more resilient.
This leads us to the insightful words of Gabor Maté:
“The question is not why the addiction, but why the pain.”
Early Trauma Can Cause Addiction
Traumatic adverse experiences during one’s childhood is one of the biggest underlying causes of addiction. Adverse childhood experiences may include physical abuse, emotional abuse, neglect, parental discord, and sexual abuse.
According to a report by the Substance Abuse and Mental Health Services Administration:
“When children are exposed to chronic stressful events, their neurodevelopment can be disrupted. As a result, the child’s cognitive functioning and/or ability to cope with negative or disruptive emotions may be impaired. Over time, and often during adolescence, the child may adopt unhealthy coping mechanisms…”
A 2008 study confirms that substances are a key aspect of this unhealthy coping, early on in life:
“…children with particular adverse childhood experiences may initiate drinking earlier than their peers and that they may be more likely to drink to cope with problems (rather than for pleasure or to be social).”
The anti-drug campaigns focused on inducing fear of substances neglects the fact that the most at-risk youth are not primarily using it for pleasure. Rather, they are using substances to escape from pain.
Another study on childhood abuse, neglect, and household dysfunction found that those who had more than five adverse childhood experiences were seven to ten times more likely to report substance use problems. The authors state:
“Because adverse childhood experiences seem to account for one half to two-thirds of serious problems with drug use, progress in meeting the national goals for reducing drug use will necessitate serious attention to these types of common, stressful, and disturbing childhood experiences.”
These findings reinforce the need to redirect public funds away from anti-drug campaigns, focusing on the root of the problem: adverse childhood experiences.
A recent 2019 study summarizing two decades of research on adverse childhood experiences argues:
“Adverse childhood experiences and rearing may generate a public health burden that could rival or exceed all other root causes.”
These early experiences affect the brain differently from experiences in adulthood, resulting in long-lasting neurological changes. Beyond the brain, these changes impact parental attachment, resulting in changes in one’s ability to gain secure attachment in one’s relationships later on in life.
Beyond using substances to cope with these early experiences, a recent 2020 study found that adverse childhood experiences also contribute to mobile phone addiction. Other common behavioral addictions among youth might include internet use, gaming, and various forms of gambling within online games.
The recent recognition of behavioral addiction in the DSM-V further emphasizes that substances are not necessary for an addiction to develop. Although substances are often involved in addiction, they are are not the primary cause.
Various Forms of Pain Cause Addiction
Adverse childhood experiences and other forms of pain may not necessarily come in the form of trauma. The field of psychology defines trauma as typically involving actual or threatened death, or other extreme events involving hopelessness or horror.
A person may never have pivotal experiences that fit the typical definition of trauma but may suffer long-term due to their perception of certain early events.
For example, a person may recall being insulted or embarrassed by a parent. This situation may not necessarily have stood out to an onlooker as “traumatic,” but one’s perception of the event can have lasting effects.
For example, a child may internalize an off-handed comment regarding their weight, and they may carry these words with them throughout their life. These internalized words distort their perception of themselves, resulting in a spiral of further distorted perceptions as they interact with others, filtering others’ responses through this self-stigmatizing identity.
This form of emotional pain can result in core psychological needs not being met. For example, if avoiding social situations becomes one’s primary coping method, one’s need for connection may be unmet. Turning to substances or behaviors is one way someone may cope with the pain of these unmet needs.
The spiral of short-term coping leads to long-term consequences, taking the person further away from actually dealing with the problematic core beliefs.
Another common underlying cause of addiction may be a lack of purpose. When feeling bored, stuck, or tired of the monotony of daily life, substances or addictive behaviors may be used to escape. This is another example of a situation that wouldn’t typically qualify as traumatic but can significantly impact someone’s mental health.
Family and Genetics Increase Risk of Addiction
When looking at the root causes of addiction, many people are quick to point out genetic factors. I thought it would be necessary to consider here since genetics does not necessarily cause addiction. Instead, genetics increases the risk someone will develop an addiction if the above factors are present.
This means your genes do not cause you to develop an addiction. Rather, they may be a risk-factor or protective-factor, offering a particular level of resilience against early traumas and other forms of pain or unmet needs.
In a study looking at pairs of twins, the researchers found
“…genetic factors played a major role in the development of alcoholism…”
Although this is the case, there is no particular “addiction gene.” More recent research argues several genetic interactions are involved. Therefore, it is essential to consider the interaction between genetics and other psychological factors such as trauma. The authors state:
“…it has become apparent that variants in stress-related genes such as CRHR1, may only confer risk in individuals exposed to trauma, particularly in early life.”
Genes may affect one’s baseline resilience, but as stated previously, early traumas, emotional pain, and unmet needs are the root causes.
Also, genes are not the only way a person inherits traits. Effective and ineffective forms of coping may be inherited through social learning within the family.
Conclusion
Addictive substances and behaviors are the tip of the iceberg. The root causes of addiction include adverse experiences in childhood and emotional pain resulting in unmet needs.
Substances or behaviors are used to cope with this underlying pain, offering short-term benefits and long-term costs, making it harder to actually meet one’s underlying needs.
Meeting one’s need for a sense of connection, self-esteem, and purpose requires delving into the underlying forces driving one’s addiction and developing the skills to more effectively deal with the difficult thoughts and emotions driving one’s behaviors.
If you are interested in reading more, check out my Addiction and Recovery section.
by Steve Rose | Aug 26, 2020 | Addiction and Recovery, Suicide and Mental Health
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Persons with mental health or addiction issues often deal with stigma. In turn, stigma negatively affects mental health. This downward spiral makes it harder to seek treatment, leaving people feeling even more socially isolated.
Stigma consists of a label used to exclude an individual, causing them to internalize this label as part of their identity. They generally consist of labels based on negative stereotypes about a specific demographic. For example, the word “junkey” can be stigmatizing for persons with an addiction. So how does this affect someone’s mental health?
Stigma affects mental health by inflicting further harm on already vulnerable populations. A person may internalize a stigmatizing label, causing further isolation, distrust, and low self-esteem, resulting in increased anxiety or depression.
Anxiety is the fight or flight response to stigma, whereas depression is the purposelessness and hopelessness resulting from this downward spiral.
In this article, I share the experience of Stephanie, a fellow recovery advocate who experienced a great deal of stigma during active use and recovery.
How Stigma Triggers Anxiety
Persons already suffering from mental health or addiction issues often experience anxiety. A stigmatizing social environment amplifies this anxiety. As Stephanie states:
“When I got off the drugs my anxiety went right through the roof. It told me I was a mess and no good and that it would be years before I ever was trusted or treated “normal”. When people stigmatized me, it confirmed those anxious thoughts for me. A lot of my recovery work has been on my anxiety. It was bad before I used, but after it was worse.”
While in a vulnerable state of recovery, she had to navigate family, friends, and professionals who treated her differently due to her addiction. She states:
“It’s not so much what they said as how they treated me. They were cold and avoided conversations with me. There were a lot of snide comments about how I should make better choices… everybody wanted to make sure I understood how much I hurt the people around me… they didn’t seem to think I knew.”
This sense of being different from everyone else leaves a person feeling isolated. Without a sense of social support, persons who are already vulnerable experience increased anxiety, particularly in social situations. As Stephanie states:
Social situations could mean answering a lot of questions based on stigmatic things people heard and believed about addiction. It could mean people talking horribly about me because of the life I previously led. It could mean running into people from my past that could tell others around me that didn’t know… because of the stigma and negative perceptions, I had horrible anxiety when having to go into social situations. Until I was strong enough to use an education “shield” to deflect the anger towards the stigma and educate the person using the stigma, I would avoid all social settings at all costs.
As the isolation and anxiety spiral further, it makes it increasingly difficult for a person to pull themselves out of this difficult place.
How Stigma Affects Identity
As stigma takes over one’s identity, a person begins to internalize stigmatizing labels. This process can also be called “self-stigma”. The labels become anxious thoughts, replaying like a broken record. Stephanie’s mind raced with self-stigmatizing thoughts:
“You are a fuck up… You cant do this… You are not good enough… No one likes you… You can’t work… You’re stupid… You won’t get better… You will never stop… No one will take you seriously… Everyone is better off without you…”
This self-stigma is further reinforced when interacting with others who make off-handed remarks regarding any of these anxious thoughts. Stephanie felt like she was living in a constant state of judgment:
“It made it worse and harder to navigate the world. I was afraid that everyone would hate me. I was always second-guessing everything I did and how people perceived me.”
This prevented her from being able to reach out for help. Living in this state of anxiety led her to believe there was no way out:
“I was hopeless and believed that I would not be able to get help. In my own head, I was a lost cause.”
What Stigma and Anxiety Have in Common
Stigma and anxiety are both based on fear. We fear the unknown, and a person using stigmatizing language often does not know or understand the experiences of those they stigmatize.
Beyond the realm of mental health and addiction, we can find a great deal of stigma in the politics of immigration. Before the pandemic captured all of the headlines, immigration was one of the biggest global issues. This included issues like Brexit, Trump’s statements regarding Mexicans and other minority groups, and the surge in nationalism.
Stigma does not often come from true hatred. Even when hatred does exist, the issue goes much deeper. Beyond hate, anger, and frustration, you can often find fear. Immigrants and other minority groups can provoke fear among those who lack familiarity with such groups.
When we feel threatened by economic uncertainty, fear often gets projected outward as anger. Immigrants and other minority groups often become scapegoats for this fear.
Now, more than ever, we need to keep our fear in check. As we navigate a world full of heightened fear of contagion, we need to consider the humanity of others, rather than resorting to broad stigmatizing labels.
Conclusion
Stigma affects the mental health of persons who are already vulnerable by further instilling a sense of social isolation. This social isolation increases social anxiety, potentially leading to internalized self-stigma. Self-stigma makes recovery increasingly challenging as it becomes reinforced by others, leading to further marginalization and a sense of hopelessness.
Recovering from stigma requires separating yourself from the negatively spiraling self-reinforcing thought loops. Rather than identifying with a self-stigmatizing thought, greet it like an old friend, welcome it in, and tell it you have more important things to focus on right now. Then focus on those more important things, letting it be.
Recognize persons who perpetuate stigma are often doing so based on fear or ignorance. Their reactions to you say more about them than about you.
Lastly, stigma makes it difficult to trust others enough to reach out for support. This is a large part of what kept Stephanie stuck in her addiction. When she gained the courage to reach out for help, she broke the power of stigma, finding a supportive treatment facility. Through the support of staff at Aegis Health Group in Windsor, Ontario, she was able to rebuild trust, coping skills, and the confidence to succeed in her recovery.
Unfortunately, many people do not encounter supportive professionals the first time they reach out. Like so many others, Stephanie had to reach out to various sources before finding the right fit for her. If you have been unable to find the right support, persistence will likely pay off when you find the right fit. I discuss this topic further in my article here.
If you would like to learn more about Stephanie’s story of recovery from addiction, you can find it in my article here. If you want to reach out to her, you can contact her on her personal Facebook page here.
by Steve Rose | Aug 9, 2020 | Suicide and Mental Health
On the go? Listen to the audio version of the article here:
If you recently met with a therapist and felt let down by the experience, you are not alone. Working in the field, I have seen far too many clients finally reach out for help, only to be met with an ineffective, unprofessional, or inexperienced therapist. These experiences destroy trust and reinforce a sense of hopelessness, making the problem worse.
There are many good therapists, but they are often hard to find. The field of counseling and psychotherapy is filled with many different types of professionals, specializing in many different areas, with a wide range of quality and skill. So why is it so hard to find a good therapist?
It can be challenging to find a person who specializes in a specific area of concern. Also, there are many ineffective therapists, so persons seeking therapy need to be critical of the support they are receiving.
This article dives into this important issue, helping you understand why it’s often challenging to find the right therapist, in addition to offering practical suggestions on how to find a good therapist.
If you or someone you know is struggling with mental health or addiction issues, you can check out my resource page for suggestions on how to find help.
Not all Therapists are Specialists
One of the primary reasons many people have difficulty finding the right therapist is due to a lack of specialization. Many practitioners focus primarily on anxiety and depression.
According to a survey by the American Psychological Association, just over 40% of practitioners say they “very frequently” treat anxiety, compared to around 5% for addictions, and under 5% for Obsessive-Compulsive Disorder.
Finding someone who specializes in your specific area allows for better-targeted treatments, easier rapport regarding the specifics of your experience, and potential referrals to more relevant resources such as peer-support groups.
Although generalists can be helpful when using evidence-based treatment approaches, a specialist has developed a keen eye for spotting specific useful details. For example, someone who specializes in addiction may have a better sense of the particular types of denial and have more practice in the art of effective communication when dealing with resistance or fluctuating motivation.
I recommend finding a specialist who has a strong track-record helping people with your specific type of issue. In the past, it could be difficult to find a specialist in your local community, but in a world of ever-expanding online options, specialists are becoming increasingly more accessible.
Online counseling is an effective way to access specialized treatment. The scientific literature also confirms it is as effective as face-to-face counseling, as I shared in my article on online counseling. If you are looking for online support, I have provided a list of resources here.
Choosing the Right Specialist
Not understanding the different forms of specialization is another reason why it can be so challenging to find the right support. This is usually a result of lacking familiarity with the field of psychology and the other helping professions.
I’ve often heard people say they tried seeing a therapist but was simply only handed a bunch of pills and didn’t feel genuinely listened to. When I hear prescriptions are involved, my first question is usually, “did you see a psychologist or a psychiatrist?” Although they sound similar, they are very different types of specialists.
Here is a quick and simple breakdown of the various types of specialists. Since regulations vary by country and jurisdiction, I will provide a broad overview of the field:
Psychologists: These are persons with a doctoral degree in psychology who are licensed to diagnose mental disorders and treat them with psychotherapy. They are generally specialized in a specific form of therapy, focused on specific types of issues, and they do not prescribe medications.
Psychiatrists: These are medical doctors who focus on diagnosing and treating mental disorders with medications. Distinct from psychologists, their interactions with patients are far more evaluative and focused on selecting the proper medication to fit the disorder. Although the majority do not, some may offer therapeutic support.
Both psychologists and psychiatrists can use “Dr.” in their prefix, but psychologists hold a PhD (Doctor of Philosophy) or a PsyD (Doctor of Psychology), whereas psychiatrists hold an MD (Medical Doctor).
Mental Health Counsellors: These are persons with at least a Master’s Degree in psychology who are licensed to practice psychotherapy and treat issues similar to a psychologist. Mental health counselors offer therapeutic treatments similar to psychologists and may also specialize in a particular area.
Marriage and Family Therapists: These are professionals who generally hold at least a Master’s Degree, specializing in psychotherapy for couples and families. They focus on relational issues and look at family systems.
Social Workers: These are professionals who generally hold an Undergraduate Degree or Master’s Degree in social work and may receive licensure or registration by a governing body. There are a wide variety of social workers.
Those with an Undergraduate Degree who are licensed or registered can deliver counseling services but often work for public agencies as case managers delivering social services including assistance with employment, housing, and protecting vulnerable populations.
Those with a Master’s in social work who become licensed or registered generally specialize in an area and can offer psychotherapeutic treatment, similar to a Psychologist.
Addiction Counselors: These are professionals who generally have a college certificate in chemical dependency, in addition to having several years of experience working in the field, focusing specifically on treating addictions.
This is a broad overview of the main types of therapists and counselors. Although each type of professional focuses on slightly different areas, it is possible to benefit from using many at the same time.
For example, you may see a psychologist to treat trauma, while seeing a psychiatrist to address chemical imbalances in your brain. You might also see a social worker who specializes in housing while seeing an addiction counselor to help cope with an addiction.
Knowing the difference between each type of professional helps manage your expectations, in addition to knowing which form of support best fits your needs.
In terms of my own background, I fit into the addiction counselor category. I received a PhD in sociology, which does not allow me to practice as a Psychologist. My career path is relatively unique since most Sociologists stay in research rather than working with people directly. To read more about my own unique path into the field, I tell my story here.
There are many Ineffective Therapists
Sadly, this is one of the biggest reasons why people find it so hard to find a good therapist. I’ve heard of too many cases where people had terrible experiences with therapists, leaving them feeling hopeless and destroying their trust.
Each time I hear these stories, I feel deeply sad for the individual who perhaps took their first step toward recovery, trusting another person with the most private details of their lives, only to be confronted by accusations, a lack of empathy, or the use of ineffective practices that do not suit their specific issue.
There are effective and ineffective practitioners at all levels. Someone’s role, specialization, education, and experience does necessarily make them an effective therapist. There is actually a study in the Journal of Counseling Psychology showing that a practitioner’s amount of experience does not predict positive client outcomes.
The most ineffective therapists can do active harm to clients. As Cris Reed shares on Quora:
I have seen A LOT of psychiatrists/psychologists/therapists/what-have-yous. Sadly, the vast majority of them just didn’t give a shit. I had a therapist that started checking her watch two minutes into an hour long therapy session, before we’d even talked about anything.
She continues, sharing the following regarding her medication:
…the psychiatrist who took me off meds that were working, put me on ones that didn’t work, refused to listen to me, or my husband, or my THERAPIST that the pills were making me suicidal, just kept increasing the dose… I know someone else who saw him for some very serious issues and he told her she just needed to pray.
Although these may sound like isolated incidents, they are not. Situations like this are far too common. I’ve heard of many instances where mental health professionals have been actively destructive to their clients.
Fortunately, I have seen more examples of effective therapists than ineffective ones. It may be difficult to find the right type of practitioner with the right level of skill and compassion, but it is possible with a bit of effort and insight into what to look for in a good therapist.
How to Find a Good Therapist
Ask someone you trust. If you know someone who has sought support for mental health or addiction issues, it could be helpful to inquire about their experiences with therapists. If they had a positive experience with a particular person, this does not guarantee you will also connect the same way, but it increases the odds of finding the right fit.
See if you can schedule a free consultation. Many therapists offer free 10-15 minute phone consultations. This allows you to get a good sense of their interpersonal style and whether or not this is someone you will feel comfortable with.
Ask questions about their approach. Although merely feeling comfortable with this person is a significant factor in therapeutic success, you also want to know if they use evidence-based practices. Some of these may include Cognitive-behavioural Therapy, Acceptance and Commitment Therapy, Dialectical-behavioural Therapy, and various mindfulness-based techniques.
Trust your instincts. If you feel like something is not right, take a step back and follow your gut feeling. A therapeutic relationship should feel very comfortable, despite the difficult subject matter. The therapeutic process will feel like a challenge, but the relationship needs to be based on comfort, mutual respect, and trust. If there is any question of whether or not you can fully trust this person, it is time to reassess your therapist.
Notice red flags. If you’re not familiar with therapy, these may be easy to overlook. Some red flags include the following:
- They form a description of your issue that does not feel accurate
- Blaming, shaming, or judging you
- They share too many personal details, rather than focusing on you
- They seem inexperienced in your area of concern
- You feel pressured to accept their version of reality
- They are not open to feedback
- They seem distracted during the session
- They give too much praise and reassurance
Although this last point about positive feedback may seem counter-intuitive, praise and reassurance can sometimes serve as a way of making the client dependent on the therapist for external validation, rather than dealing with deeper issues regarding self-esteem.
An over-reliance on positive affirmations may also be a red flag since research demonstrates they are not generally effective. For more on this topic, see my article: Do Positive Affirmations Work? A Look at the Science.
Use clear and assertive communication. It is okay to say you disagree with your therapist. If they interpret your situation in a way that doesn’t feel right, it is okay to correct them or share that you feel misunderstood. You are in control and can decline to discuss specific topics until you are ready. Also, if something is not working, you can request trying a new approach. If your therapist is not receptive to appropriate feedback, it might be time to reassess the working relationship.
Switch therapists, if you’re not feeling supported. It is perfectly normal if you do not find the right therapist the first time you reach out for support. I have seen several instances were people have sought help from three or more therapists before finding one suitable for them. Like dating, you may not find the right fit early on in your search, but if you are persistent, finding the right person makes all the difference.
Where to Find a Therapist
Ask Local Service Providers. If you are not familiar with the services available locally, try reaching out to a local agency to inquire about the type of services they offer, in addition to other services available locally.
Persons who work in the field will generally have a strong understanding of quality services that might fit your needs. Another benefit of local agencies is that many are government-funded and therefore offer support for free or at a reduced cost. One drawback to receiving government-funded support may be long wait times.
You can find local mental health agencies by doing a quick google search, or you can check out MentalHealth.gov if you are in the US.
Use the Psychology Today Directory. This is a listing of therapists and counselors who offer private support, meaning their services are generally not publicly funded. If you have health insurance, a portion of their services may be covered.
The main benefit of using this directory is the ability to search for a local specialist, in addition to filtering results by type of insurance coverage. Another advantage is the lack of wait times and the ability to immediately reach out to several different professionals who may provide a free phone consultation.
If you are interested in checking out the Psychology Today Directory, you can find it here.
Try online counseling services. Online counseling services such as BetterHelp.com offers online support via text, audio, and video calls. They are not publicly funded, nor do they generally accept insurance coverage.
The main benefit of online counseling services is their accessibility, ease of access, lower cost, and the ability to switch counselors any time with a simple click of a button. Like any service provider, the range of counselor quality varies widely, so it is essential to look for red flags and change counselors until you find the right support.
Conclusion
No amount of education, training, or certification can weed out every ineffective therapist. I cringe every time I hear horror stories, hoping these experiences don’t cause people to give up hope.
With enough persistence and a bit of luck, you will likely find the right support. Ask someone you trust, reach out to a local organization, or use online directories to search for specialist support.
If you have any questions, feel free to contact me or leave a question below this article, and I will personally do my best to assist.
by Steve Rose | Jul 22, 2020 | Suicide and Mental Health
On the go? Listen to the audio version of the article here:
The other day I decided to take a look at the scientific evidence on counselling. As a counsellor myself, I’ve seen it work, but I was curious about what others are saying. I searched the phrase, “does counselling work?” and was surprised by the top result. An article in the Independent stated that although counselling works in the short-term, it has no long-term benefits.
Shocked by the conclusion, I dug deeper, looking into the studies they cited, in addition to doing my own review of the literature. I discovered that the studies on the short-term benefits of couselling did not provide an accurate picture of the evidence and did not consider the various forms of counselling.
After digging deep into the scientific literature on whether or not counselling works, I came to the following conclusion:
Counselling works in the short-term and long-term, so long as it is practiced by a skilled counsellor using evidence-based techniques, in addition to having strong empathic interpersonal abilities to facilitate a supportive therapeutic relationship.
As a counsellor, I’ve personally seen many long-term transformations, but as a researcher, I know I cannot rely on anecdotal evidence. This article is a summary of my review of the literature.
The titles of each study cited below are hyperlinked if you would like to read more.
Counselling Works in the Short-term
The scientific evidence unequivocally supports the effectiveness of counselling in the short term. Several high-quality studies point to these benefits.
The following Cochrane Review concludes that counselling works in the short-term but not in the long-term:
Counselling for mental health and psychosocial problems in primary care
Counselling is associated with significantly greater clinical effectiveness in short-term mental health outcomes compared to usual care, but provides no additional advantages in the long-term.
Why might there be no evidence for long-term effectiveness?
The above review focuses on a narrow definition of counselling, distinguishing it from cognative-behavioural therapy. This is problematic since many counsellors practice cognitive-behavioural approaches and other evidence-based techniques.
The following study also finds short-term benefits but fails to demonstrate long-term benefits by relying on a similarily narrow definition of counselling:
Acupuncture and Counselling for Depression in Primary Care: A Randomised Controlled Trial
In this randomised controlled trial of acupuncture and counselling for patients presenting with depression, after having consulted their general practitioner in primary care, both interventions were associated with significantly reduced depression at 3 months when compared to usual care alone.
The following systematic review and meta-analysis reinforces the evidence on the short-term effectiveness of counselling, but again distinguishes it from evidence-based mental health interventions such as cognative-behavioural therapy:
The clinical effectiveness of counselling in primary care: a systematic
review and meta-analysis
Counselling is associated with modest improvement in short-term outcome compared with usual general practitioner care, and thus may be a useful addition to mental health services in primary care.
The following study focuses on the effectiveness of counselling for quitting smoking, finding compelling benefits after six months:
Does individually-delivered counselling help people to stop smoking?
Combining the results of the studies showed that having individual counselling could increase the chance of quitting by between 40% and 80%, compared to minimal support.
The above evidence demonstrates the effectiveness of counselling at the three to six-month mark. Let’s now consider studies on the benefits of counseling in the long-term.
Counseling Works in the Long-term
This longitudinal study followed up twenty-one months after counselling ended, finding the positive effects were maintained:
A naturalistic longitudinal evaluation of counselling in primary care
Patients who received counselling made highly significant improvements compared with those on the waiting list. These improvements were maintained throughout the long-term follow-up. This would indicate that generic counselling has positive effects that can be maintained for a long period of time after counselling has been completed.
The following study delves into the specific processes responsible for the long-term effects of counselling:
The long-term effects of counselling: The process and mechanisms that contribute to ongoing change from a user perspective
Mechanisms integral to sustained impact were: the active engagement of people during and between sessions to work toward their own solutions; and acquisition through the change process of skills which could be further built on after the counselling ended.
This means counselling works in the long-term when client autonomy is supported. This means having clients practice skills between sessions, which can be applied independently after counselling is complete.
Evidence for Various Types of Counselling
The studies supporting the short-term benefits of counselling generally defined it as a client-centered emotionally supportive role, neglecting the fact that many counsellors are qualified practitioners of various evidence-based techniques.
The following study demonstrates the long-term benefits of cognitive-behavioral approaches:
CBT as an adjunct to usual care that includes antidepressants is clinically effective and cost effective over the long-term for individuals whose depression has not responded to pharmacotherapy. In view of this robust evidence of long-term effectiveness and the fact that the intervention represented good value-for-money, clinicians should discuss referral for CBT with all those for whom antidepressants are not effective.
The above study demonstrated positive effects over forty-six months. The long-term effectiveness of this approach may be attributed to its emphasis on facilitating independent coping skills. Once practiced, clients can continue to use these skills when counselling has ended.
Internalizing effective coping skills may be the key to long-term effectiveness. This is reinforced by studies on the effectiveness of self-help methods. According to thirty-three studies in A meta-analytic study of self-help interventions for anxiety problems, using self-help methods without having engaged in counselling can also be effective long-term.
Beyond a cognative-behavioral counselling approach, several other forms of counselling also have strong evidence for their effectiveness.
According to a meta-analysis of eighty-six studies on the effectiveness of humanistic therapies, this approach shows substantial stable gains over time:
In randomized clinical trials with comparative treatment control clients, clients in humanistic therapies generally show amounts of change equivalent to clients in nonhumanistic therapies, including cognitive behavioral therapy.
Motivational Interviewing is the most recent counselling approach based on a humanistic foundation and is particularly effective for addiction. For the evidence on the effectiveness of its approach see the following list summarizing the research: Systematic and Meta-Analyses of Research on Motivational Interviewing
Lastly, the most recent form of behavioral therapies are also strongly supported by research. Acceptance and Commitment Therapy is considered a third-wave behavioral approach, focusing on process rather than the content of cognitions. For a list of the 330 randomized controlled trials conducted on this approach, click here.
Does Online Counselling Work?
Since the world has recently turned to online platforms, this question is more relevant than ever. I reviewed the evidence for online counselling in my article Does Online Counselling work? and came to the following conclusion:
According to recent evidence, online counselling is effective for treating mental health and addictions. Multiple studies show it is generally as effective as face-to-face counselling and has the benefit of expanding access to mental health and addiction treatment.
For a more detailed review of the evidence on online counselling, check out the full article here where I summarize several high-quality studies on online counselling for mental health and addiction.
Conclusion
There is a large amount of strong evidence pointing to the fact that counselling works in the short-term. Although the evidence is mixed on the long-term effectiveness of counselling, this can be primarily attributed to a narrow definition of counselling that does not include many of the evidence-based techniques cited above.
If you are interested in taking a deeper look at the research on this topic, you can find several studies summarized in this systematic review of the evidence.
Beyond the scientific evidence, I have personally seen the transformative effect of counselling in my work in various roles within the addiction field. Throughout counselling, clients find a safe outlet for expressing difficult thoughts and emotions, in addition to learning how to more effectively cope when these difficulties are present.
Counselling works by helping clients overcome mental barriers to living the life they want. A collaborative counselling relationship fosters a deep sense of trust and mutual respect, helping someone become the best version of themselves.
