by Steve Rose | Apr 20, 2021 | Suicide and Mental Health
On the go? Listen to the audio version of the article here:
Over the last couple of months, I have been busy sharpening the tools in my counselling toolkit. Due to the pandemic, there has been a high demand for mental health services, leading me to take a new role doing virtual counselling for clients across Canada.
Although I had to take a step back from regular writing, I’ve been getting the opportunity to help many people, gaining valuable lessons along the way.
Thus far, throughout my career in addiction and mental health, I’ve enjoyed collecting and sharpening new counselling tools, learning that having multiple tools at one’s disposal is critical. As they say, when your only tool is a hammer, every problem looks like a nail.
In my experience, effective counseling requires using the right tool, at the right time, in the right way. This does not mean you need to have every single tool in existence. It’s more effective to be a master of a few different tools than to have a rudimentary understanding of many.
My counselling toolkit can be divided into three different sections:
- Building a foundation (person-centered approach)
- Holding space for emotions (humanistic approach)
- Reframing thoughts (cognitive-behavioral approach)
Sticking with the construction metaphor, a person’s thoughts, emotions, and actions are the wood, support beams, and concrete. They are the primary raw materials in counselling.
But before you start building, you need a foundation.
Start with a Foundation
You may be hired to renovate a room, construct an addition, or perhaps just knock down a kitchen wall. Either way, you can’t make assumptions unless you ask your client. This is the foundation of a person-centered approach.
Making assumptions without first asking the client what they want is like a friend asking your opinion on a paint colour, and you tell them how to remodel their home.
You won’t be very helpful if you start making assumptions.
“But what if my friend’s home is falling apart?” you may ask.
If you think someone requires more than they are asking for, there is a time and place to introduce the subject. Perhaps deep down, they realize they need a lot more help but are not ready to address these other areas right now. If they need to paint a room to brighten their day before taking on the rest of their renovations, simply help them choose the paint colour.
Meeting a person where they are at is the foundation of an effective counselling relationship. Like the foundation of a home, the concrete needs to set before you can start building on it.
The Open-ended Question
Laying the foundation to a strong counselling relationship by meeting someone where they are at does not require fancy tools, but it can be easily overlooked.
When someone presents a set of problems, it might be tempting to try to address what we perceive to be the most important issue first.
Rather than starting with an assumed priority, I like to get a sense of what is going on, then directly ask an open-ended question like the following: “what would you like to get out of our work together?”
This is the core of solution-focused counselling and single-session counselling. There is often a misunderstanding that counselling has to be a long and drawn-out process that explores every aspect of someone’s past. This might be helpful in certain situations, but it is not necessarily what everyone needs during a session.
Another open-ended question might include the following: “By the end of this session, what would tell you this has been a helpful conversation?” or “If you get what you want out of this conversation, what would it allow you to do tonight or tomorrow?”
By starting with the end in mind, I can quickly determine what kind of conversation this is going to be. In my experience, counselling conversations generally fall somewhere on a spectrum between two broad categories: 1) conversations for support and 2) conversations for advice.
Conversations for support generally involve persons simply looking for someone who will listen with compassion, facilitate a sense of connection, and offer validation that they are doing the best they can. Clients often express this as “just wanting to know I’m not crazy” or “I just need to vent.”
Let’s take a closer look at the best tools for these types of conversations.
When determining the primary goal is to support a client who simply needs a compassionate ear, I immediately switch to my set of connection tools for holding space. These tools are the essence of a humanistic counselling approach.
Many clients, especially those in crisis, just want to feel heard. They have often felt dismissed or not understood by friends, family, colleagues, or other professionals. This leads to a sense of isolation or perhaps even shame.
The best way to hold space is to simply listen.
I originally learned about holding space from Heather Plett in this article:
It means that we are willing to walk alongside another person in whatever journey they’re on without judging them, making them feel inadequate, trying to fix them, or trying to impact the outcome. When we hold space for other people, we open our hearts, offer unconditional support, and let go of judgement and control.
To continue with the construction metaphor, it’s like adding strong supportive beams in a building. They are non-imposing and usually invisible, but their strength allows a structure to hold space, keeping the occupants inside safe.
In counselling terms, this means compassionately being with another person with complete acceptance, allowing them to feel held by your presence, and safe to express whatever they need to.
Let’s consider a few other tools that can help hold space more effectively.
Reflective listening means showing the other person you understand rather than simply saying, “I understand.”
How do you do this?
Although we can never really understand exactly what another person is going through, we can do our best to show we get it, on some level. We may not have been through the same experiences, but we all feel the same emotions from time to time and can connect with another person’s experiences through this shared humanity.
Even if your understanding is imperfect, just showing you are trying to understand can be enough. This is the core of empathy.
Reflecting back what you understand the other person is saying demonstrates this empathy.
It can be as simple as saying, “wow… you’ve been through a lot recently.” or it could be a brief summary of everything they’ve shared. The key is that it comes from a place of genuine compassion.
Here is an example of a more complicated form of reflective listening whereby you prompt the person to continue by saying the statements you believe they may say next:
Person: “I’m here because I find it difficult to control my drinking.”
You: “…and you’re looking to gain back some control.”
Person: “yeah… I miss the way things were with my family before I started drinking.”
You: “… spending quality time with the ones that matter.”
Person: “That’s right…”
Reflective listening is the primary tool I use to hold space. It allows the other person to feel safe and understood.
Although reflective listening is a tool, holding space goes beyond one’s words. It is an attitude and way of being with the other person. There is no need to change anything or fix anything in these moments. Just simply being with the other person during these difficult moments is often all they need.
If a client is ready to start developing new coping skills, I take out a different set of tools to work with their underlying unhelpful thoughts. This is the foundation of a cognitive-behavioural approach.
At the core of self-destructive actions, there are often unhelpful thoughts. For example, a person struggling with an addiction is not simply chemically hooked to a substance. Although there may be physical dependence, it often goes much deeper.
Past traumas or chronically unmet needs can result in distorted perceptions of oneself and the world. For example, this is common for people who grew up with emotionally unattuned parents struggling with mental health or addiction issues. Growing up in this environment can lead to distorted beliefs and habits that were adaptive in this early environment but become maladaptive in adulthood.
Common distorted self-perceptions include thoughts such as the following:
- I am not enough
- I will be a burden if I ask for help
- I’m bad/ broken/ hopeless
- I’m undeserving
- I’m unlovable
- I’m worthless
Continuing with the construction metaphor, these thoughts are equivalent to a distorted wall, throwing off the alignment of a room. This would require reframing some of the walls, but the walls need to be deconstructed before reframing can be done.
In conunselling terms, this means getting to the root of unhelpful core beliefs.
Identifying Core Beliefs
Deconstructing one’s thought processes to identify core beliefs should be done carefully. Like knocking down a wall, getting too reckless with the hammer could indirectly affect other areas of the house.
I generally ask what thoughts are going through their head during a challenging moment. For example, if someone is anxious every time they walk into work, I may ask them to imagine they are in that situation and share what might be going through their head at that moment.
If they are struggling to think of something or they begin to notice discomfort in their body, I will ask them to describe this discomfort in detail. Where is it located in the body? What does it feel like? I then ask if this discomfort had a voice, what would it say?
Responses might often include, “You’re going to mess up.” I would then go further, asking if this were true, what it would mean about you as a person. A response might include, “I’m going to lose my job.” Since this does not directly answer the question, I might ask what this would mean about them as a person. A common response might include, “I am not enough.”
Unhelpful core beliefs are distorted ideas about oneself, often extending into many areas of one’s life. For example, the core belief of not being enough often extends beyond isolated events such as worries about one’s work performance. It can affect one’s level of self-worth in all relationships, leading to frequent feelings of fear and unhelpful behaviors such as avoidance or overcompensation.
Unlike reframing a room in a house, reframing core beliefs does not merely require knocking down the old one and constructing a new one. Since core beliefs have often been around so long, they tend to pop back up frequently.
There is no process of unlearning in psychology. There is only new learning. You can’t just knock down the wall and burn the lumber. You have to use the same lumber to reconstruct the new wall.
In counselling terms, reframing these beliefs often requires putting them into a new context. For example, rather than unconsciously going through life with “I’m not enough,” we can identify where it may have come from and how to let go of it when it returns.
In this particular example, a person may share a highly invalidating upbringing with parents who frequently criticized them for not being good enough. Bringing this core belief to light and tracing its origin gives it a new context. It can then be held as an unhelpful thought that has been learned from one’s past experiences.
Gaining this perspective allows a person to step back from these unhelpful thoughts and reframe their meaning.
This is a fancy-sounding concept in Acceptance and Commitment Therapy (ACT), referring to one’s ability to step back from one’s thoughts.
When we are fused with unhelpful thoughts, they become heavy and weigh us down. We identify with the self-critical thought rather than noticing it’s just a thought and letting it go.
A popular metaphor in ACT includes the leaves on a stream visualization. It consists of imagining you are sitting beside a stream with leaves floating down it. Bringing your attention to your physical sensations, you step out of overthinking and into the present moment. If a thought comes in, place it on a leaf and watch it float by. If you would like to try this exercise, you can find a guided version of it on YouTube here.
The goal of this exercise is not to merely float into a dreamlike bliss where you stop identifying with every thought, going through life in a state of idyllic apathy. The goal is to practice stepping back from unhelpful thoughts, allowing you to focus on things you value.
For example, when “I’m not good enough” shows up, it can be used as a reminder that you care about a particular situation, such as doing quality work. You can then thank your mind for the reminder that you value your job and that you will not get hooked by this unhelpful thought right now.
Although you are working with the same lumber, you now have the blueprint. Having a broader perspective on the situation allows you to respond in ways that are more self-compassionate, increasing the chances you will act effectively.
This is another major tool I tend to use in reframing.
If people talked to their friends how they often talk to themselves, they wouldn’t have many friends for long.
People often beat themselves up with phrases such as, “I’m bad, I’m stupid, I’m crazy….” This lack of self-kindness cuts a person off from common humanity, making them feel uniquely defective and isolated. It then reinforces unhelpful worries and behaviours, decreasing the odds of effectively handling difficult situations.
After identifying and reframing core beliefs, I find it helpful to bring up the concept of self-compassion.
I often introduce self-compassion by asking how a person would talk to someone they care about going through the same situation. I then have them confirm this is the most helpful way to engage with someone and that harshly criticizing this person would be counterproductive.
I would then draw attention to the interpersonal process we’ve been engaged in over the session. If I were to constantly criticize them through the session, would this improve their chances of changing? They often immediately resonate with how unhelpful this would be.
After getting their full agreement on these examples, I suggest the same applies to how they talk to themselves. I then inquire into their thoughts after noticing this tendency and ask if it would be possible to pretend they are talking to a friend, next time they notice a lack of self-compassion.
When designing a room, the space can look very different, depending on your perspective. Perhaps we’ve become more familiar with this idea, given the increased use of videoconferencing from home. From the frame of a carefully placed webcam, a space can look clean and organized, but it can look very different from another perspective.
For me, perspective-taking has been a powerful reframing tool. I find it to be most beneficial among persons who are caught up in their view of a situation, unable to empathize, or have rigid beliefs about someone else’s intentions.
For example, if someone rigidly projects specific intentions onto their partner’s actions, perspective-taking can help determine a more accurate interpretation of events. This is particularly helpful if these unhelpful interpretations include concerns about one’s adequacy. In this way, perspective-taking can be a multi-purpose reframing tool that can also initiate cognitive diffusion.
This kind of reframing should be done carefully since you can unintentionally break the foundation. For example, asking how the other person views the situation can be interpreted as invalidating and appear as if you are supporting the other person’s behaviour.
When using perspective-taking, it is helpful to have a solid foundation of trust and approach it carefully, inviting the person to see the situation from behind the other person’s eyes. If approached with a spirit of curiosity and openness, it can lead to significant insights.
My goal in this article has been to reflect on my counselling toolkit. Hopefully, this has also been beneficial for you.
If you are a fellow practitioner, perhaps it has offered some ideas for your toolkit. If you are someone who is looking for support, perhaps it has debunked some myths about counselling and provided a few insights.
When sharing my role with others, people often ask, “what do you tell people?” As you can see in this article, the answer is always, “it depends.”
Asking me what I tell people is equivalent to asking a home builder what tool they use. It depends on what needs to be done at that moment.
But unlike construction, counselling can often be most productive when doing less. I heard a great quote recently by Judson Brewer in his new book, Unwinding Anxiety. He says, “don’t just do something… sit there.”
People who value compassion often feel compelled to rush in with their shiny well-stocked toolbox and try to fix things. I have to remember this every time I begin a conversation.
Although I used a repair-oriented metaphor throughout, the metaphor has its limits. Counselling is not about “fixing” people.
Taking a “fixing” orientation assumes people are broken and puts them into a passive role within the dynamic. This disempowers them in two ways. Implying they are broken can reinforce unhelpful self-critical thoughts. Also, placing someone in a passive role takes away a core ingredient of motivation; it takes away their sense of autonomy, self-efficacy, and sense of incremental mastery.
I’ve written about this collaborative approach to counselling in my article on how to do motivational interviewing here.
While exploring my counselling toolkit, I also realized there are way too many tools to fit within one article. If you are interested in taking a more detailed look inside my ACT toolkit, check out my article on how to improve psychological flexibility, here.
by Steve Rose | Oct 17, 2020 | Identity, Purpose, and Belonging, Suicide and Mental Health
On the go? Listen to the audio version of the article here:
As an addiction counselor, I’ve learned the importance of considering a person’s underlying needs. Addictions, as well as other mental health issues, are often the result of unmet needs. There are various theories of fundamental human needs, including Maslow’s hierarchy of needs and the basic psychological needs theory. The approach I present here is based on the core yearnings in Acceptance and Commitment Therapy (ACT).
This approach is supported by over 330 clinical trials, providing a comprehensive understanding of our human needs that encompasses those provided in the previously mentioned theoretical models.
Our underlying needs consist of the following:
- Belonging and connection
- Meaning and self-direction
- Coherence and understanding
- Feeling and experience
Let’s delve into each of these six areas, exploring what each of them means and how we can meet these needs in more effective ways.
We need belonging and connection
Human beings are fundamentally social creatures. The need for belonging and connection is crucial for our mental wellness. Being one of the main themes in my articles, I’ve often discussed the power of social connection.
According to a Harvard study that followed a group of individuals for 80 years, the quality of one’s relationships is the best predictor of overall health and happiness:
“…people’s level of satisfaction with their relationships at age 50 was a better predictor of physical health than their cholesterol levels were.”
When this need is not met, we often attempt to fill the relational void through ego identification. Inflating our sense of self through stories about our own “specialness,” continually comparing ourselves to others. As described in my article, Is Social Media Making us Less Social:
“Social Media is making us less social when used to compare oneself to others, contributing to higher levels of loneliness and lower levels of well-being among frequent users. It can be social when used to connect with others.”
Our attempts to compensate for the connection through comparison drives us further apart. “I am” statements require social comparison, making us feel even more cut off from others. Clinging to the idea of our specialness gives us a seductive illusion of connection at the expense of genuinely meeting this need in the long term.
According to ACT, the yearning for belonging and connection underlies the process of “self as content” vs “self as context.” Rather than trying to fill ourselves with more identity content, we can more effectively meet our need for connection by letting go of the rigid ego identification. This requires recognizing we are not the contents of our thoughts, but rather, we are the space where the thoughts occur.
A useful metaphor consists of seeing ourselves as the sky rather than the weather. The sky is not the weather. Rather, it is the ever-present blue space that contains the weather. The sky does not attempt to control clouds as they come and go, nor does it identify with the clouds.
Sometimes our thoughts are like storm clouds, while other times they are like fluffy stuffed animals. We can more effectively meet our need for connection by simply noticing when you are having these difficult thoughts based on social comparison and letting them go. As Eckhart Tolle asks, “Can I be the space for this?“.
We need meaning and self-direction
Without a sense of meaning and self-direction, we feel apathetic, lacking motivation. As described in my articles on Veterans in Transition, This is a common theme among persons leaving the military where they gained a deep sense of meaning in their roles compared to the relative sense of meaninglessness in civilian life.
Others may experience a lack of meaning and self-direction in soul-destroying jobs where you feel like a robot, just going through the motions for a paycheque. Working in these deserts of meaning, we may feel tired all the time, only gaining the strength to complete the most basic tasks out of fear of punishment.
Meaning and self-direction are the most fundamental ingredients of motivation. As an addiction counselor, motivation is one of the most important variables I focus on. As described in my article on, How Motivation Works, we feel motivated when we have a sense of being in control of our actions.
When someone takes away your sense of control by telling you what to do, it provokes a reaction to do the opposite. This is why the collaborative technique of motivational interviewing is used in addiction counseling. Rather than telling someone what to do, we can help someone meet their need for a sense of self-directed meaning by evoking their values and collaborating with them to create an effective plan.
In ACT, the yearning for meaning and self-direction underlies the process of having a values orientation. This means gaining a clear understanding of what you value. Although many people tend to immediately focus on goals, they are distinct from values. Values are a “way of being” without a particular end-point. For example, if you value being “compassionate,” there is no end-point. You can always turn to your values to fill the motivational fuel-tank. As stated by Viktor E. Frankl:
“Those who have a ‘why’ to live can bear with almost any ‘how’.”
Finding your “why” provides motivational momentum in difficult times. Gaining clarity on one’s core values allows for ongoing motivation, independent of one’s specific goals.
We need a sense of competence
A sense of competence, mastery, or feeling that we are progressing is another key underlying feature of motivation. Feeling stagnate in our lives deprives us of the natural rewards we receive when seeing progress.
Fundamentally rooted in the dopaminergic reward-centres of our brains, we experience pleasure when correctly solving a problem. This explains why we experience satisfaction after completing a check-list, solving a puzzle, or winning a game.
These tasks are engaging so long as they are challenging, but not so challenging that it begins to evoke feelings of incompetence. We naturally enjoy what we are good at, which is the core of developing a passion. As stated by Cal Newport in my article on What it Means to Follow Your Passion:
“Passion comes after you put in the hard work to become excellent at something valuable, not before. In other words, what you do for a living is much less important than how you do it.”
We are often told to find our passion through soul searching, but this can often have the opposite effect. Rather than finding our bliss, we end up living in our heads, continually planning or strategizing without taking action. Without taking action, we cannot know what we genuinely enjoy since this enjoyment is dependent on developing skill in a particular area.
My personal experience with this occurred as I developed more skill in writing. I used to be terrified of a blank page, never knowing what to write. Throughout school, I would only write the bare minimum word-count for the assignment and always relied on several quotes to add more fluff.
Throughout the last decade of blogging, in addition to writing a doctoral dissertation, I’ve gained quite a bit of practice writing. This practice has led to quite a bit more competence, leading to an increased sense of reward and enjoyment.
In ACT, the yearning for competence underlies the process of committed action. This means building patterns of committed action, integrating them into your life over time. The most common barrier to committed action is procrastination, based on perfectionistic ideas.
Procrastination is perhaps more rooted in fear than laziness. Rather than beating ourselves up for not taking action, it could be more helpful to consider the underlying fears preventing action toward your valued goals.
We need a sense of coherence
A sense of coherence and understanding allows us to make sense of ourselves and the world. When this need is not met, we feel uncertainty and fear. A common way to cope with a lack of coherence is to impose false order, retreating into your head, and treating life like a problem to be solved. Common defense mechanisms include rationalization and intellectualization.
When the problem-solving mind takes over, we become fused to our thoughts, making it difficult to take a step back from them. For example, if a driver cuts you off, it is easy to immediately rationalize that this person is selfish and careless. Imposing false order onto the character of the other person allows the world to make sense again, amidst the driving chaos, neatly dividing the everyone into judgmental categories of “good” vs “evil”.
Although this form of black and white thinking provides an immediate sense of coherence, it causes us to react in anger, perhaps putting ourselves in further danger. Flexibly looking at the situation without clinging to our initial judgments allows us to be open to the uncertainty inherent in the situation.
For example, the seemingly “bad” driver may have recently received news that a loved one is passing away, and they are rushing to the hospital. Although this does not excuse dangerous driving, being open to these potential alternatives allows us to gain enough distance from our judgmental mind to be able to choose the most effective path forward, rather than merely reacting.
The purpose of stepping back from your thoughts about a situation does not have to do with the accuracy of those thoughts. Maybe you are right that the driver is doing something dangerous. Maybe you are right that what the driver did was illegal. Maybe you are right that they need to be taught a lesson. But at what cost?
Rightness does not equal effectiveness. If you’ve ever tried to change someone’s behavior by telling them that they are wrong, you will quickly see how your rightness does not translate into effectiveness. As described in my article on Motivational Interviewing, we can’t make people change by being more right. This same logic applies to our own minds. We may be right, but at what cost.
In ACT, the yearning for a sense of coherence and understanding underlies the process of cognitive defusion. When we are fused to our thoughts, we are entangled with them, unable to make space for potential alternatives. We create rigid versions of reality, supported by unconscious rules about the way things ought to be. Rather than genuinely meeting our need for coherence, we become further frustrated by a reality that refuses to conform to our expectations.
Stepping back from our thoughts requires opening up to a space of uncertainty in a way that allows for more practical ways to choose one’s path forward. My article on How to Stop Living in Your Head delves more into common thought patterns, in addition to offering some helpful exercises.
We need a sense of orientation
The need for orientation gives us a sense of place in the world. When suffering from a chaotic past, it is common to lose this sense of orientation, taking us out of the present moment. Constant thoughts of the past or worries about the future occupy our attention as we try to gain a sense of security in the present.
The more we live in the past or the future, the further we get away from the present, amplifying a sense of disorientation and disconnection. We may dwell on why something happed in the past, what we could do better in the future, and how it’s not safe to focus on the present moment because getting out of our head might result in some kind of danger.
In ACT, this yearning for orientation is based on the process of present-moment awareness. Mindful attention to the present moment allows us to meet our need for orientation because we can more effectively attend to actual events in the here and now rather than getting caught up in rumination.
The GPS metaphor is helpful to make sense of this underlying need. Imagine you are driving with a GPS and it tells you that you will need to turn right up ahead. Rather than looking at your current location on the road, you fixate on the GPS screen, missing all of the events happing around you in real-time. When you look up, you fixate on the rear-view mirror, analyzing all of the things you nearly hit while you were distracted. Realizing that turn is coming up, you turn your eyes back to the GPS screen, focused on the exact distance left before the turn.
Although it is useful to plan for the future, like using a GPS, and consider the past, like using a rear-view mirror, it can take away from genuine orientation by taking us away from the present moment, making us less effective as we navigate our path in life. My article on The Benefits of Meditation for Addiction delves into the power of mindfulness practice.
We need a sense of feeling
Our final underlying desire is the need to feel and experience life. Sometimes we feel pleasant emotions while other times we feel unpleasant ones. When the desire to avoid unpleasant ones takes over, we avoid situations that could potentially evoke discomfort. This means also avoiding pleasant situations.
For example, a person may avoid the joy of close relationships due to avoiding the potential pain that might result if the relationship fails. A person who values social connection may avoid the pleasure of connecting with others due to the risk rejection and the resulting disappointment.
In ACT, this yearning for feeling underlies the Acceptance process. A helpful metaphor includes having a tug-of-war with your unhelpful emotions. You may tell yourself, “Don’t feel anxious… Don’t feel anxious… Don’t feel anxious….” As you engage in this fruitless struggle, you become more anxious. Rather than choosing to do a particular meaningful task, you decide to avoid it, fearing these feelings will get out of control.
Avoiding situations reinforces the potential danger to your mind, strengthening its association with a fear response. Your mind says, “If you’re avoiding this situation, it must be dangerous.” Like an addiction, avoidance offers the temptation of a short-term gain at a long-term cost. Genuinely meeting one’s need to feel joy requires a sense of openness to feel painful emotions.
An openness and willingness to experience discomfort does not mean resignation or masochism. Instead, it means dropping the rope in the metaphorical tug-of-war, letting the uncomfortable entity stay where it is, and deciding to pivot toward a valued direction. Discomfort may come and go, but your ability to choose your way forward remains unchanging.
When considering the underlying factors driving addiction and other mental health issues, it is crucial to keep these needs in mind. Without considering a person’s unmet needs, we only see the symptoms of these unmet needs. Trying to treat the symptoms rather than the underlying needs does not get to the root cause of the problem.
A person can be supported in stopping an addictive substance or behavior, but they may still act in ways that a destructive to themselves and their relationships. When underlying needs are not attended to, a person attempts to fulfil these needs in ways that are ineffective, leading these needs to be even further unmet.
Here is a summary of the information conveyed in this article, describing the ineffective and effective ways one may attempt to meet each underlying need:
The need for belonging and connection
Ineffective approach: Constructing ego identities to demonstrate your superiority and receive external validation.
Effective approach: Noticing you are having self-critical thoughts rather than identifying with these thoughts.
Meaning and self-direction
Ineffective approach: Following what you think you “should” be doing, according to social standards.
Effective approach: Asking yourself what you value and what you want your life to be about.
Ineffective approach: Procrastination to avoid failure, protecting a perfectionistic ideal of your envisioned future self.
Effective approach: Building habits of committed action, developing skills over time, despite short-term setbacks.
Coherence and understanding
Ineffective approach: Engaging in rigid debates, focused on being right.
Effective approach: Stepping back from your thoughts/ judgments, flexibly attending to the present moment.
Ineffective approach: Analyzing past situations and worrying about the future.
Effective approach: Mindfully bringing your attention to the present moment.
Feeling and experience
Ineffective approach: Avoiding painful feelings and the situations that may evoke them.
Effective approach: Being willing to experience painful feelings and the situations that may evoke them.
For an in-depth exploration of these underlying needs in the context of the six processes of Acceptance and Commitment Therapy (ACT), you can check out my article How to Improve Psychological Flexibility. In that article, I share more metaphors and exercises designed to help you meet your underlying needs more effectively.
If you are interested in taking a deep dive into ACT, I highly recommend the online ACT Immersion course by Dr. Steven Heyes, the founder of ACT. This course has been an invaluable resource for me personally and has informed many of the explanations provided in this article. If you are serious about learning ACT, this is the course for you. Check it out here for more information.
The Big Book of ACT Metaphors is another great resource I would recommend. It is a highly practical book full of explanations, metaphors, exercises, and ACT worksheets, ready to use in your everyday practice.
ACT Made Simple by Dr. Russ Harris is another excellent resource, offering an easy-to-read summary of ACT. This book has recently been updated to include an ACT understanding of self-compassion and trauma, translating complex ideas into simple language.
If you would like to connect with a specialized ACT therapist, view the directory on the official ACBS website here.
by Steve Rose | Sep 30, 2020 | Suicide and Mental Health
On the go? Listen to the audio version of the article here:
Many people find it difficult to be flexible in life. When unexpected situations arise, it is easy to feel frustrated, making you want to lash out. These rigid ways of being prevent you from getting what you want in the long term, increasing frustrations as you dwell on how things are not working the way you want.
Increasing your mental flexibility helps you stay calm in challenging situations, allowing you to cope with difficulties more effectively, and better navigate stressful situations to achieve desired outcomes. So how can you be more flexible in life?
- Accept what you can’t change
- Step back from your thoughts
- Focus on the present
- See the bigger picture
- Live by your values
- Take some risks
Let’s take a closer look at each of these areas of mental flexibility.
Accept what you can’t change
The first step to being more mentally flexible is to accept the things that are outside your control. When living rigidly, you are stuck in your head, trying to control everything. Holding onto this sense of control is a false sense of security, causing more frustration.
Getting clear on the things that are outside our control requires a sense of acceptance. As written in the Serenity Prayer:
“God, grant me the serenity to accept the things I cannot change, courage to change the things I can, and wisdom to know the difference.”
When we can accept our limited ability to change an event, we can then let go of the anxieties and frustrations, fueling our need to cling to a false sense of control.
The practice of letting go takes courage and willingness to step into a sense of uncertainty. There is a vulnerability in uncertainty, but there is also serenity and freedom from unproductive thoughts.
Step back from your thoughts
Stepping back from your thoughts allows for more flexibility in life by giving you mental space. Rather than merely reacting to your mental chatter, creating space between your thoughts and actions will enable you to choose more effective ways to adapt to a situation.
For example, suppose a car cuts you off in traffic while speeding. Your initial thought might be that the person is selfish and immoral; therefore, they should be punished. This can lead to putting yourself in unnecessary danger.
Rather than merely reacting, taking a step back from your thoughts allows you to think of alternative scenarios. Perhaps the driver just got the news that a loved one is dying, and they are racing to the hospital. There are infinite possibilities, and we cannot know the “truth” at that exact moment.
We cannot control the other driver, so stepping back from our initial judgments creates the space necessary to move forward effectively.
Focus on the present
Focusing on the past and future takes you away from your life in the present. Being more flexible in life requires developing a sense of present-moment awareness.
One way to do this is to bring your attention to the breath. You might also notice the sensation of your feet on the floor. You can then bring your attention to the sounds around you, curiously listening to the many layers.
Bringing your attention to physical sensations takes you out of your head and into the present since these sensations are occurring in the present moment. You are not thinking about your past breath or anticipating your future breath. It is an ever-present bodily rhythm you can tune into at any moment.
Focusing on the present builds behavioral flexibility since you can more appropriately respond to situational demands. For example, if a car cuts you off while you are lost in thought, you would be less able to respond and adapt to the situation safely.
Focusing on what is going on in the here and now allows you to notice relevant details, especially when things don’t go as expected.
See the bigger picture
It is easy to get caught up in thinking about how we are being perceived, having thoughts like, “How does my hair look? Did I wear the right clothes? Do I fit in?”. This leads to constant social comparison, leading to rigid ways of defining oneself: “I’m a failure, I’m a mess, I’m not enough.”
Rigid self-definitions cut us off from others, leading to rigid ways of being, for self-protection. Thinking you don’t belong causes you to retreat into avoidance patterns, preventing you from meeting your social needs and getting what you want in life.
Seeing the bigger picture gets you out of your head by bringing your attention to what others might be experiencing at that moment. For example, if you’re at a meeting at work, you can see the situation from two different perspectives: your own perspective, or the perspective of others; although the latter takes some imagination.
From your perspective, you may start to wonder what everyone thinks of you, making you try to constantly manage their impression. Instead, try seeing the bigger picture and consider what each person might be experiencing at that moment. What might they be thinking or feeling? What do they want? How do they see one another?
You will likely realize other people are more focused on themselves than you. Seeing this bigger picture allows you to get out of the mental cage of rigid self-definition, leading to constant impression management.
This will allow you to genuinely connect with others, rather than being too preoccupied with yourself.
Live by your values
Getting clear on your values allows you to gain flexibility in life by giving you a sense of direction. Unlike goals, values provide an eternal sense of direction, despite obstacles.
For example, goals are like using a GPS to travel to a specific location. Values are like a compass pointing East. You never completely get to “East.” If an obstacle gets in your way, you can take a temporary detour, but you can adapt, reorienting yourself East when you get past the obstacle.
Values consist of ways of being, consisting of adverbs such as, lovingly, creatively, genuinely, excellently, and charitably. Having a clear understanding of your values allows you to reorient yourself toward what matters whenever you find yourself in a challenging situation, faced with difficult thoughts or painful emotions.
Take some risks
Taking reasonable risks allows you to act on your values, overcoming rigid mental barriers preventing you from moving forward toward a life of meaning and purpose.
Although this requires the courage to step out of old ineffective habits, it also requires creating new habits. Habits, routines, and common behavior patterns are not necessarily rigid unless you continue them after they are no longer useful. The ability to adapt to more effective habits allows you to move forward more efficiently.
Taking risks does not necessarily mean being reckless. Instead, it means gaining the necessary courage to continually step outside your comfort zone, in service of your values, so you can live the life you want.
These tips on being more flexible are based on the evidence-based psychotherapeutic practice of Acceptance and Commitment Therapy (ACT).
The six points shared above are based on the six processes of ACT. If you are a mental health practitioner or just interested in taking a deeper dive into these six areas, see my article, How to Improve Psychological Flexibility.
In that comprehensive article, I delve into each process, sharing metaphors and practical exercises, in addition to sharing the psychological reasons why they work. If you are looking for even more tips and tricks, you can check out my article, How to Stop Living in Your Head.
If you are suffering from prolonged anxious thoughts or depressed moods, it may be helpful to go beyond self-help methods and seek professional support.
Counseling can help by exploring your unique mental barriers, allowing you to develop coping skills to navigate your life flexibly. To learn more, see my article, The Benefits of Counseling.
by Steve Rose | Sep 27, 2020 | Suicide and Mental Health
On the go? Listen to the audio version of the article here:
When considering whether or not counseling is right for you, it’s important to understand the benefits clearly. As described in my article on What Counseling is Not, there are often many myths about counseling, preventing people from reaching out for support.
Counseling is a lot more than merely getting advice. It involves collaboratively working with someone, delving into the underlying issues that drive unproductive behaviors. Being a counselor myself, I’ve seen it’s benefits first hand, as clients build healthy coping skills, getting more of what they want out of life.
Here are the benefits of counseling:
- Fewer anxious thoughts
- Improved mood
- Insight into self-destructive patterns
- Increased self-esteem and confidence
- A Clearer sense of purpose
- Better focus on the present moment
- Greater interpersonal skills
- More effective coping skills
Let’s take a closer look at each of these benefits.
Fewer Anxious Thoughts
Many people seek counseling to help with anxious thoughts. Although counseling cannot erase these thoughts, it can help a person change their relationship to these thoughts.
For example, if you suffer from anxiety, you may benefit from counseling in several ways. First, counseling can highlight the particular patterns of thought interfering in your life, considering the common triggers and patters one uses to cope with these thoughts.
Once you gain insight into your anxious thinking patterns, counseling can help diminish the power of these thoughts over your life through various techniques. To learn more about this, see my article on How to Stop Living in Your Head.
Another significant benefit of counseling is its ability to improve your mood over time. Research demonstrates the effectiveness of psychotherapy to reduce depressive symptoms.
For example, if you suffer from depressed moods, finding it challenging to gain motivation, counseling can help by incrementally building patterns of committed action. Through collaborative conversations, counseling helps build motivation by focusing on building a sense of one’s values.
By focusing on one’s values, counseling works to build a deep internal sense of motivation rather than merely focusing on short-term external motivations. This is the difference between doing something because you feel fulfilled and doing something because you are being paid.
To learn more about motivation, see my article, How Does Motivation Work?
Insight Into Self-destructive Patterns
Counseling can help you become aware of self-destructive patterns in your life. As an outsider, a counselor can provide an external perspective on your situation, inquiring into how specific patterns continue to play out.
For example, you may be having repeated arguments with a significant other regarding the same events. You may realize there are common themes in your arguments, but through counseling, these patterns can be discussed with a neutral person who can help explore the patterns in more depth, looking for potential ways out of these self-destructive situations.
Increased Self-esteem and Confidence
Counseling can also benefit one’s sense of self-esteem and build genuine confidence by getting to the root of the issue and working on specific activities to address it.
For example, if you always feel like you are not enough, counseling looks at how you can change your relationship to that particular thought. Rather than trying to erase the thought through positive affirmations, counseling helps you pivot toward what matters, rather than staying stuck in the same unproductive thought-loops.
For more on positive affirmations, see my article, “Do Positive Affirmations Work?”
Clearer Sense of Purpose
Counseling can also benefit one’s sense of purpose. Suppose you feel lost, unable to gain a sense of direction, or are unmotivated to engage in everyday activities. In that case, counseling helps by first gaining clarity on your values, then collaboratively working with you to build a realistic plan.
For example, we are continually bombarded with media messages about the need to “find your passion.” Still, many people feel like they are spinning their tires, constantly feeling like they are drowning in a sea of options. Social media bombards us with social comparisons, tempting us to model our lives on the most recent trends.
Counseling helps you build a sense of purpose so you can focus on building a values-based path forward. For more on the concept of passion, see my article, “What Does it Mean to Follow Your Passion?“
Better Focus on the Present-moment
When struggling with anxious thoughts or depressed mood, you may feel stuck in your head, worrying about the future or ruminating on past events. Counseling can help you regain awareness of the present moment, especially if the practitioner is trained in mindfulness approaches.
One example of a quick mindfulness check-in might be to bring your attention to your breath or other sensations in the body. This practice helps bring focus to the present moment, making you more effective in your daily life.
Here is a metaphor highlighting the benefit of present-moment awareness, from my article on How to Improve Psychological Flexibility:
“Imagine your thoughts about the future are like a GPS voice, telling you what is coming up next. You then become too fixated on the GPS, fiddling with the controls, adding stops, checking your arrival time, and adjusting the volume.
Becoming so focused on the GPS, you lose focus of the road, missing an exit, nearly rear-ending a car, and perhaps even making a wrong turn into a lake. Although a GPS can be helpful, we need to listen to its feedback from the present moment, engaged in the task at hand, and mindful of our surroundings.”
Greater Interpersonal Skills
Navigating social situations is a crucial skill. As I share in my article on Self-Care Tips for Mental Health, interpersonal self-care means having healthy personal boundaries.
For example, counseling can help you develop the ability to say “no” when appropriate, ask for help when needed, and help you let go of toxic relationships. While in unhealthy social situations, you may not be aware of the severity of the issue until getting an outside observer’s feedback.
Counseling can help you gain insight into unhealthy relationships and foster interpersonal skills to navigate these relationships and maintain personal boundaries.
More Effective Coping Skills
Counseling can help you develop skills to cope more effectively with stressful situations. Rather than merely reacting to stressful situations, counseling can help you gain the skills to move forward productively.
For example, counseling can help you gain insight into your patterns of behavior regarding stressful situations, in addition to helping you develop healthy coping skills such as mindfulness and interpersonal skills. Rather than immediately responding to the stress, these skills give you the ability to take a step back and reevaluate how you want to respond.
Although counseling has several benefits, the primary purpose is to help you get more of what you want in life and less of what you don’t want. Doing more of the same will get you more of the same results. Counseling allows you to gain insight into ineffective behavior patterns, unhelpful thoughts, and unproductive ways of coping with painful emotions.
If you or someone you know is struggling with mental health, addictions, or just wanting to optimize your mental toolkit, counseling can help.
by Steve Rose | Sep 22, 2020 | Suicide and Mental Health
On the go? Listen to the audio version of the article here:
There are many different myths about counseling. I’ve encountered many people who think counseling is not for them, due to these myths. Instead of trying to convince them otherwise, I’ve found it helpful to first ask about their understanding of counseling to see if it is accurate.
In many cases, a person’s resistance to counseling is rooted in these misunderstandings. Without first addressing these misunderstandings, a person may remain stuck in contemplating change without the motivation to seek additional support. By highlighting these myths, I hope to clarify what counseling is and what it is not.
- Counseling is not just advice
- Counseling is not cheerleading
- Counseling is not necessarily easy
- Counseling is not a quick fix
- Counseling is not all the same
Let’s look at each of these areas to further dispel some myths about counseling.
Counseling is not just advice
Many people believe counseling simply consists of receiving advice. Since people generally get enough advice from friends and family members, the last thing they want to do is pay someone to tell them something they’ve already heard.
Counseling is far more than advice. In fact, it’s generally a small part of counseling since giving someone advice often does not work. Many people hear advice from their doctor that they need to eat better and exercise, but how often does this change anything? Does a dentist’s advice to floss immediately transform someone’s oral hygiene?
Many people know what they need to do, deep down, but are using their current behaviors to cope with underlying issues. Advice only addresses the tip of the iceberg. Working through the underlying processes collaboratively allows someone to develop healthy ways of moving forward.
Counseling is not cheerleading
Many people believe counselors are supposed to be like cheerleaders, giving constant positive validation and encouragement. We are bombarded by popular messages to “think positive” and “be happy.” A popular song perpetuates this myth in the following lyrics:
“Everything’s gonna be alright
Everything’s gonna be okay
It’s gonna be a good, good life
That’s what my therapists say”
Positive affirmation may feel good in the moment, but it does not generally work in counseling. I did a review of the literature on positive affirmations in my article, “Do Positive Affirmations Work?” finding:
“Positive affirmations do not work for persons trying to boost self-esteem, change negative thoughts, or escape from painful emotions. The evidence suggests positive affirmations only work in individuals who are already positive or high performing.”
Imagine you are going through a difficult time and after sharing the details, a person responds, “It looks like you’re going through a lot, but don’t worry about it, everything will be fine!” This response will likely cause you to think of all the reasons why things will not but fine.
Effective counseling is often counter-intuitive, working in ways contrary to common sense—more about this in the next section.
Counseling is not necessarily easy
Like going to the gym, counseling is not meant to be easy. But if you put in the effort and stick with it, the can be significant changes over time. Like physical training, counseling requires intentionally putting yourself into stressful situations you can safely handle.
For example, if a person tends to avoid specific thoughts or emotions, a counselor may ask if it is okay to inquire further in that area. Collaboratively exploring painful areas allows a person to gain a sense of openness to positive situations as well.
Contrary to the common sense understanding that one should try to eliminate negative thoughts, counseling turns toward them, instead. As shared in my article on How to Stop Living in Your Head, struggling against negativity is like fighting quicksand:
“…imagine you find yourself on quicksand. Your natural reaction might be to run or struggle. The more you do this, the faster you will sink. A more effective approach is to lay down and make as much contact with the quicksand as possible. This increases your surface area, preventing you from sinking.”
Counseling provides a safe, supportive environment to gain contact with negativity and deal with issues preventing you from moving forward more effectively.
Counseling is not a quick fix
Counseling does not solve your problems in a single session. Many people go into counseling, hoping to be “cured,” not realizing it is more like hiring a personal trainer than a plastic surgeon. A counselor can support the process of change, but cannot make the changes for you.
The first session generally begins as more of an assessment where a counselor gathers relevant background information regarding your situation. Throughout the first few sessions, you may also start to question whether or not it helps, since it requires delving into difficult areas and stepping outside of your comfort zone.
Like going to the gym for the first time, you will likely experience discomfort, perhaps wondering if it’s even going to help. Just like fitness, counseling takes time and ongoing committed effort.
Although counseling takes time, if you feel unsupported, it may be a sign you are not seeing the right type of professional or the counselor is not an ideal fit for you. For more on the red flags to look out for, see my article, Why it’s so Hard to Find a Good Therapist.
Counseling is not all the same
One person’s journey in counseling may look very different compared to someone else’s. There is no “one size fit’s all” approach. As a counselor, I meet each client where they are at, tailoring the process to meet their specific needs.
Some people may think counseling is not for them because they know someone who went to counseling and did not have a good experience. Or they know someone who they consider to have “far worse issues,” feeling like their problems are insignificant in comparison.
There is also a stigma around counseling. Some people may think counseling is only for certain types of people, but not for them. To use the fitness metaphor again, personal trainers are used by both beginners and athletes.
Many counselors have counselors, so no matter where you are on your journey, counseling can help if you are looking to optimize your psychological health.
by Steve Rose | Sep 20, 2020 | Suicide and Mental Health
On the go? Listen to the audio version of the article here:
Like addiction, suicide is a form of escape. Given my suicide research background and my current focus on addiction, I thought it would be appropriate to share my perspective on their similarities.
Suicidal thoughts can lead to addiction, and addiction can increase the risk of suicidal thoughts. Beyond their co-occurrence in this downward spiral, both operate similarly as a form of escape.
Suicide is an escape from deep emotional pain, in addition to an escape from the self and the world. It often occurs when one feels hopelessly socially isolated or feels like a burden on others.
Let’s unpack what this means and how suicide and addiction operate in similar ways.
What Causes Suicide?
Before considering escapism and addiction, let’s summarize the major theories of suicide, in simple terms, from the individual to the social level.
Starting with the most individual level, Edwin Shneidman states suicide is the result of “Psychache.” He defines this as extreme emotional pain.
Roy Baumeister adds to this theory, stating that the emotional pain is produced by constant painful thoughts regarding one’s self. In his article, Suicide as Escape From Self, he shares how these thoughts often involve the sense of oneself as a failure, an impostor, or not living up to an imagined standard.
Thomas Joiner builds on both of these theories in his Interpersonal Theory of Suicide. He states that the pain and thoughts result from the lack of belonging, combined with feeling like a burden and hopelessness regarding the prospects of this ever changing.
These theories can be mapped onto the societal level, considering Émile Durkheim’s sociological theory of suicide. At this level, suicide is often the result of an unregulated, individualistic society where people lose a sense of purpose and no longer feel a sense of community.
The risk of suicide is produced on various levels. Each case’s details will vary, but these theories highlight a general way of thinking about suicide, beyond some of the myth about it.
Let’s now consider how suicide and addiction are a form of escape.
Escaping Emotional Pain
As I share in my article on the root causes of addiction, trauma, and the pain of unmet needs, often fuels addiction. Substances or addictive behaviors serve as a way to cope with these challenges in the short-term, leading to increased difficulties in the long-term.
Addictions and suicide are both ways to escape from emotional pain. They are both short-term solutions with long-term consequences, affecting many others beyond the individual.
Like Baumeister’s description in Suicide as Escape From Self, people often use substances or addictive behaviors to cope with aversive thoughts such as, “I am not enough, I don’t deserve any better, and I am a failure.”
Like Joiner’s Interpersonal Theory of Suicide, persons with an addiction often feel isolated, as described in my article on the impact of isolation on addiction. They also begin to feel increasingly burdensome, beginning to believe others may be better off without them.
These similarities can also be observed on a societal level, as highlighted by the sociological theory of suicide. Community degradation can lead to economic despair, family disintegration, and increased rates of addiction.
Although addiction and suicide frequently occur together, they both independently function through similar processes.
A War In Your Head
In the case of both addiction and suicide, the individual experiences an intense mental struggle. They want a better way forward while also wanting to escape the pain. This battle is characterized in my article highlighting Stephanie’s experience, here:
“It was the biggest mind war I ever went through. You know what you’re doing is hurting you but can’t stop. It’s like watching a bad movie you are the star of.”
Suicide works the same way. A person often stays in a state of uncertainty of whether they will follow through with it, right until it’s too late to turn back. Fortunately, Kevin Hines lived to share his experience. After surviving a jump from the Golden Gate Bridge, he shares:
“I thought it was too late, I said to myself, ‘What have I done, I don’t want to die ‘”
Although he got a second chance, many others likely had the same thoughts while suspended mid-air, who did not survive.
This tragic reality highlights how suicide, like addiction, is not the person’s preferred path. No one wakes up one day and decides they want to become addicted to heroin. It is a gradual process, fraught with internal battles and mixed desires.
As highlighted by Kevin, a person thinking about suicide does not want to die. They want to escape the pain. Addictions are ways to escape the problem temporarily, but result in more pain in the long-term.
The link between addiction and suicide can be best highlighted in opioid addiction, particularly among Fentanyl users. In my experience working in a residential withdrawal context, persons using Fentanyl are generally well aware of the overdose risk, likely knowing several others who have overdosed. Speaking to these individuals, I often gathered there was a constant state of suicidal contemplation. Although they didn’t want to die, part of them hoped for it so that the pain would go away.
Playing Russian roulette with Fentanyl seemed to be a way to dull the pain while remaining open to the potential for a fatal outcome. This tragic situation has been recently highlighted by professional commentary in the New England Journal of Medicine:
“…data suggest that the true proportion of suicides among opioid-overdose deaths is somewhere between 20% and 30%, but it could be even higher.”
With the absence of a note, opioid overdose suicides are challenging to study, since the motive cannot be known. Also, as highlighted by the Golden Gate Bridge example, a person’s motives are often highly ambiguous, changing moment to moment as the war in their head continues.
Both suicide and addiction function through similar processes. They are attempts to escape from emotional pain caused by underlying troubling thoughts, unmet needs, or a sense of being hopelessly isolated and a burden on others. This process operates on an emotional level, a cognitive level, an interpersonal level, and a societal level.
If you want to learn more about the subjective experiences of individuals thinking about suicide, I’ve written an in-depth article here: Inside the Mind of a Suicidal Person
To learn more about my sociological perspective on suicide, see my article here: How is Suicide a Social Problem?
If you or someone you know is struggling with thoughts of suicide, please reach out to someone you trust or seek help from a qualified professional.
If you are in crisis, you can call the National Suicide Prevention Lifeline (in the US) or seek out your local Crisis Centre and speak to someone who can help.