by Steve Rose | May 31, 2023 | Addiction and Recovery, Identity, Purpose, and Belonging, Suicide and Mental Health
The Diagnostic and Statistical Manual of Mental Disorders, more commonly known as the DSM, has been the gold standard for the classification and diagnosis of mental disorders for over half a century. Published by the American Psychiatric Association, the DSM is widely adopted by mental health professionals globally as a guide for diagnosing and treating mental illnesses. Its categories of mental disorders and their criteria are used in a myriad of ways, from guiding therapy to informing insurance coverage.
However, despite its significance and widespread acceptance, the DSM has been subject to critique. In this article I will provide a critique based on the humanistic perspective of Carl Rogers. As one of the most influential psychologists of the 20th century, Rogers’ viewpoint emphasized the inherent worth and self-determination of individuals. His perspective challenges the dominant medical model underpinning the DSM, which leans heavily towards categorizing and pathologizing individuals’ behavior and experiences. This critique is especially relevant in today’s world, where mental health issues are on the rise, demanding a more inclusive, empathetic, and individualized approach to mental health care.
In light of this critique, I propose the concept of “contextual pathology” as a potential alternative. Contextual pathology shifts the focus from an individual-centric perspective to an interactional perspective, taking into account the interplay between an individual and their environment. It challenges the established notions of pathology, suggesting that weaknesses or traits considered pathological in one context may actually be adaptive or strengths in another.
This approach offers a novel lens through which we can reexamine and redefine our understanding of mental health. In the following sections, I will delve deeper into these ideas, illuminating the shortcomings of the DSM, the humanistic critique, and the transformative potential of contextual pathology.
The DSM and Its Limitations
The DSM, now in its fifth edition, traces its roots back to the early 20th century when mental health professionals sought a common language and standard criteria for classifying mental disorders. Over the years, it has undergone several revisions to reflect evolving understandings of mental illnesses. The main purpose of the DSM is to facilitate diagnostic accuracy and treatment consistency among professionals in the field. It provides a common language that allows practitioners to communicate effectively about their patients’ mental health.
Despite its widespread use and significance, the DSM has been subject to criticism, particularly for its emphasis on individual pathology. Critics argue that it encourages a reductionist view of mental health, distilling complex human experiences and behaviors into neat categories and labels. This perspective overlooks the complexity of human experiences and the influences of societal, cultural, and environmental factors. By focusing primarily on individual symptoms and disorders, the DSM inadvertently neglects the person behind the pathology and the unique context in which they exist.
Several studies have also pointed to the limitations of an individualized diagnostic approach. For example, the phenomenon of high comorbidity rates, where individuals are diagnosed with multiple disorders, raises questions about the validity of clear-cut categories in the DSM. Moreover, many have noted the DSM’s lack of attention to cultural variations in the expression of distress, with the risk of overdiagnosing or underdiagnosing certain groups. Furthermore, a narrow focus on pathology may lead to an over-reliance on pharmaceutical interventions, possibly at the expense of addressing other meaningful aspects of an individual’s life. These concerns collectively highlight the need for an approach to mental health that goes beyond mere categorization and embraces the complexity and diversity of human experiences.
Carl Rogers and the Humanistic Approach to Mental Health
Carl Rogers was a prominent figure in psychology, particularly known for his humanistic approach to psychotherapy. Rogers’ theories revolutionized the field by shifting the focus away from the therapist and diagnosis, towards the client’s experiences and perspectives. His ‘Client-Centered Therapy’ highlighted the value of empathy, genuineness, and unconditional positive regard, significantly influencing the practice of psychotherapy.
At the heart of Rogers’ humanistic approach is the belief in the inherent goodness and potential of individuals. He posited that people are essentially self-actualizing; they strive for growth, fulfillment, and the realization of their potential. This perspective also emphasized the importance of individual experiences and subjective perceptions, as opposed to diagnostic categories and norms. The humanistic approach acknowledges the complexities of human existence, placing significant value on personal experience, autonomy, and the innate striving towards self-improvement and personal growth.
Focus on the Intrinsic Worth and Potential of Individuals
Rogers’ humanistic approach starkly contrasts with the pathology-focused framework of the DSM. The DSM’s emphasis on identifying and classifying disorders may detract from the inherent worth and potential of the individual. Rogers, on the other hand, viewed individuals as more than a collection of symptoms, underscoring the importance of understanding and supporting the person’s subjective experiences and inherent potential.
Critique of the Pathology-Oriented Approach
The DSM’s pathology-oriented approach also contrasts with Rogers’ positive view of human nature. By focusing on diagnosing and treating disorders, the DSM potentially overlooks the individuals’ strengths and capacities for growth. Rogers’ perspective encourages therapists to see beyond the diagnosis to the person behind it, understanding their experiences, and supporting their self-actualizing journey.
Emphasis on the Subjectivity and Complexity of Human Experiences
Finally, Rogers’ emphasis on the subjectivity and complexity of human experiences contrasts with the DSM’s objective, categorization-based approach. While the DSM attempts to distill complex human experiences into defined categories, Rogers acknowledged the richness and diversity of these experiences. His approach encourages a more nuanced understanding of mental health, viewing it as a complex interplay of personal experiences and interpretations, rather than a list of symptoms to be ticked off a checklist.
Proposing the Concept of Contextual Pathology
In order to highlight the crucial interplay between the individual and society to avoid an over-emphasis on individual pathology, I propose the concept of contextual pathology. This is a novel approach to understanding mental health that emphasizes the interaction between an individual and their environment. This is not merely shifting the locus of pathology to the social context (social pathology). Rather, it considers the specific fit between the individual and their social context.
I postulate that what may be considered a pathology within one context may not necessarily be so in another. Instead of viewing mental health issues solely as individual failings or dysfunctions, this approach considers how various contexts can influence an individual’s mental health.
The conventional approach, represented by the DSM, emphasizes individual pathology, focusing on diagnosing and treating mental disorders based on symptoms manifested by the individual. In contrast, contextual pathology does not concentrate solely on the individual’s symptoms but also takes into account the external factors impacting the individual’s mental health. These factors can include social relationships, cultural norms, economic conditions, and other environmental influences.
The benefit of a contextual approach is that it provides a more holistic view of mental health. By considering the broader context, it offers a deeper understanding of the conditions contributing to an individual’s mental health issues. It helps to uncover systemic and environmental issues that may contribute to mental distress, paving the way for more comprehensive and potentially more effective interventions. Additionally, it can help to destigmatize mental health issues by acknowledging the role of external stressors and societal pressures.
Consider an individual exhibiting traits of hyperactivity and impulsivity, traits typically associated with Attention Deficit Hyperactivity Disorder (ADHD). In a traditional classroom setting, these traits might be disruptive and viewed negatively. However, in a different context, such as in an energetic startup environment or creative pursuit, these traits could be seen as advantageous, fostering innovation and quick decision-making. The contextual pathology perspective encourages us to consider these situational factors before rushing to pathologize behaviors or traits.
The following examples highlight the concept of contextual pathology. Although the names and details of each example are fictionalized, they highlight real and common problems.
A Tale of Contextual Pathology: The Story of Sofia
Sofia, a vivacious and creative young woman, always found herself at odds with traditional academic structures. From an early age, she displayed a deep sense of empathy and emotional intelligence, often understanding and interpreting the world through her feelings rather than through the dry facts and figures that school emphasized. The educational system’s focus on objective knowledge, logic, and standardized testing felt stifling to Sofia, making her feel out of place and unsuccessful.
Frustrated by her inability to conform to these academic expectations, Sofia began to see herself as incapable or deficient. Her teachers labeled her as ‘disruptive’ because she often asked unconventional questions or made remarks that strayed from the curriculum’s strict content. Her report cards frequently mentioned her ‘difficulty focusing’, and she was referred to a school psychologist for potential attention deficit hyperactivity disorder (ADHD).
When Sofia turned sixteen, she took a part-time job at a local nursing home, assisting with activities and day-to-day care for the residents. The nursing home environment was markedly different from school. Here, Sofia’s empathy, emotional intelligence, and creativity were not only valued but crucial. She quickly formed meaningful relationships with the residents, understanding their needs and feelings, often without them having to say a word.
In this environment, Sofia’s ‘disruptive’ nature became a strength as she proposed and implemented innovative activities that significantly improved the residents’ quality of life. Her ‘difficulty focusing’ on dry academic materials turned into an ability to multi-task efficiently, keeping track of multiple residents’ needs and the dynamic demands of her role.
Sofia thrived in this context. What was once pathologized as a ‘weakness’ in the educational system became her greatest strength in the nursing home. She was not ‘disordered’; rather, the traditional school setting was not a suitable environment for her unique capabilities and perspective. This shift in context perfectly illustrates the concept of ‘contextual pathology’—when the problem is not inherent within the individual but arises from a misalignment between individual traits and societal roles or contexts.
Another Tale of Contextual Pathology: The Journey of Alex
Alex, a man in his mid-twenties, found himself adrift in a sea of uncertainty. Having graduated from a prestigious university with a degree in finance, he secured a lucrative job at a top consulting firm, fulfilling what he had been told was a path to success. Yet, despite his achievements, Alex felt a gnawing emptiness, a lack of purpose and fulfillment that he couldn’t quite articulate.
In his corporate job, Alex felt like a square peg in a round hole. His work environment valued analytical thinking, competitiveness, and long work hours. Despite his best efforts, Alex struggled to keep up with the demands of his job. He was often criticized for being ‘too sensitive’ or ‘too slow’, as he preferred to think deeply about the tasks at hand and was greatly affected by the high-pressure, cutthroat corporate environment.
He often questioned his capabilities and self-worth, and as his mental health declined, he was diagnosed with depression and anxiety. Society seemed to suggest that his struggles were a result of personal weaknesses or flaws – his inability to cope with the ‘real world’.
However, things took a turn when Alex’s friend introduced him to a local non-profit organization seeking volunteers for a community project. Deciding to take a break from his corporate job, Alex joined the non-profit and quickly discovered a context in which his perceived ‘weaknesses’ were actually strengths.
In the non-profit environment, Alex’s sensitivity was a valuable asset, allowing him to connect with the community members on a deeper level and understand their needs and concerns. His preference for deep thinking was appreciated as he brought thoughtful insights into the planning and execution of the projects. The slower pace and collaborative, meaningful work brought him a sense of purpose that had been missing in his corporate job.
In this new context, Alex was no longer ‘too sensitive’ or ‘too slow’ – he was empathetic and contemplative. His depression and anxiety started to ease, not because he had ‘fixed’ himself, but because he had found an environment that nurtured his natural traits instead of stifling them.
Alex’s story further illustrates the concept of ‘contextual pathology’. His mental health struggles were not inherent flaws but rather a reaction to a context that did not align with his natural abilities and needs. When he found a suitable environment, he was not only able to function but truly thrive, underscoring that the problem often lies not in the person, but in the context.
A Third Tale of Contextual Pathology: The Story of Anne
Anne, a sprightly and spirited woman in her seventies, found herself struggling to adjust to the constraints of her retirement home. Having led an active life as a school teacher, she cherished her independence and often found joy in small, spontaneous adventures like exploring new walking trails or trying out new recipes.
However, the retirement home she moved into had a rigid daily schedule and minimal activities that she found engaging. The staff often mistook her desire for independence and spontaneity as ‘rebelliousness’ or ‘difficulty adjusting’. Despite being physically healthy, Anne began to feel depressed and stifled, her vibrant spirit gradually dulled by the mundane routine and lack of autonomy.
Concerns about her mental health led to a series of assessments, and she was soon diagnosed with late-onset depression. The narrative quickly turned to her ‘inability to adjust to aging’ or ‘refusal to accept her new lifestyle’. Anne began to question herself, wondering if she was indeed flawed or ‘difficult’.
But a change came when her granddaughter introduced her to a community gardening project in her neighborhood. Eager to break free from the monotony of her retirement home, Anne joined the project. She found joy in the dirt under her nails, the nurturing of plants from seedlings to full bloom, and the satisfaction of creating something with her own hands.
The garden offered flexibility and the opportunity for spontaneous discovery that she craved. Her natural teaching abilities resurfaced as she guided young volunteers in the garden. The ‘rebelliousness’ that the retirement home staff frowned upon turned out to be her unique zest for life, now sparking joy and learning in the community garden.
In this context, Anne was no longer a ‘difficult’ elderly woman but a valuable mentor and vibrant community member. Her depression eased as she regained her sense of purpose and autonomy.
Anne’s journey highlights ‘contextual pathology’, demonstrating that her struggles were not personal failings but rather the result of an unsuitable environment. By finding a setting that embraced her spirit and strengths, she was able to reclaim her mental well-being and truly thrive. This reinforces the notion that we must consider the broader societal and environmental contexts when addressing mental health.
A Fourth Tale of Contextual Pathology: The Case of Lucas
Lucas, a man in his thirties, had always been deeply analytical. From a young age, he was fascinated by patterns, systems, and abstract concepts. He had a knack for dissecting complex ideas and problems, often losing himself in hours of thought and analysis. However, he struggled to express his thoughts verbally and found social interactions demanding and exhausting.
In his job as a sales manager, Lucas often felt out of place. His role demanded high levels of social interaction, quick decision-making, and a focus on interpersonal relationships. Lucas’ analytical mind and introverted nature were seen as drawbacks in this context. His difficulty with small talk and tendency to over-analyze were often mistaken for aloofness or indecisiveness.
Consequently, Lucas’ mental health started to deteriorate. He felt anxious, overwhelmed, and inadequate. The job he was supposed to be good at felt like a daily struggle. He was diagnosed with social anxiety disorder and recommended cognitive behavioral therapy to ‘improve’ his social skills.
Things began to change when Lucas joined a local chess club as a leisure activity. In this new environment, his analytical mind was not only welcomed but greatly valued. Chess offered Lucas the opportunity to apply his pattern recognition skills and strategic thinking without the pressure of social expectations that had plagued him in his job.
Furthermore, Lucas later found employment as a data analyst. In this role, his ability to discern patterns and analyze complex data was highly appreciated. His perceived ‘weaknesses’ in the sales job turned out to be his greatest strengths in a context that valued his analytical skills. He found his work fulfilling and was able to excel without the constant dread of social interactions. His ‘social anxiety disorder’ was significantly alleviated, not because he had become more sociable, but because he was no longer in an environment that stressed his weaknesses.
Lucas’ story is another example of ‘contextual pathology’. His struggles were not due to inherent flaws or a disorder, but rather a misfit between his individual traits and his job. When Lucas found an environment that appreciated his strengths, he was able to thrive, further illustrating the importance of considering context in understanding and addressing mental health.
The Shortcomings of Individualized Pathology
While individualized approaches to mental health, such as Cognitive Behavioral Therapy (CBT) or medication, play a critical role in managing mental health issues, they can inadvertently overlook the broader social and environmental context that significantly impacts an individual’s mental well-being. This section highlights how these approaches may neglect unhealthy social environments, challenging workplaces, economic realities, and the lack of fit between the individual and their role.
Unhealthy Social Environments
Unhealthy social environments, characterized by things like lack of social support, prejudice, discrimination, or toxic relationships, can profoundly affect an individual’s mental health. While CBT or medication can help manage symptoms and improve coping strategies, they may not fully address these external factors. Without addressing these toxic environments, the individual may continue to experience distress, and the impact of the therapy may be compromised.
Challenging Workplaces
Workplace stressors, such as high job demands, low job control, and lack of workplace support, can lead to anxiety, depression, and burnout. While individual-focused approaches can help employees manage their stress responses, they do not necessarily change the challenging work conditions. Efforts should also be made to promote healthier work environments that foster well-being and resilience.
Economic Realities
Economic factors, such as poverty, unemployment, and financial instability, are well-known to be associated with a wide range of mental health problems. However, individualized treatments like CBT or medication do not directly address these economic realities. While these treatments can help individuals cope better, they may not be enough to alleviate the psychological distress caused by economic hardship.
Lack of Fit Between the Individual and Their Role
The lack of fit between an individual and their societal role or expectations can lead to significant distress. For instance, a person with a highly creative personality might feel stifled and unhappy in a rigid, monotonous job. While individual-focused approaches can help the person cope with their feelings of dissatisfaction, they do not address the underlying issue: the mismatch between the person and their environment.
The recognition of these limitations does not diminish the value of individualized approaches, but rather underscores the need for a more holistic approach that acknowledges and addresses the broader societal and environmental context impacting mental health. It highlights the importance of integrating individual-focused treatments with efforts to improve social environments, workplaces, economic conditions, and the alignment between individuals and their roles.
Contextual Pathology and Its Challenge to the Current Economic System
Contextual pathology as a concept has implications that extend beyond the realm of mental health and into our broader economic structures. This perspective presents a challenge to the current economic system, which often prioritizes productivity, efficiency, and uniformity over individual well-being and the complex interaction between an individual and their environment.
The Pressure to Conform
Our current economic system often creates an environment that places high demands on individuals, requiring them to conform to specific roles, behaviors, and expectations. These expectations may not align with an individual’s unique abilities, interests, or values, potentially leading to stress, burnout, and mental health issues. The concept of contextual pathology argues that these symptoms are not just personal failings but may also be indicative of an unhealthy or unsuitable context.
Neglect of Environmental Factors
The current economic system can also neglect environmental factors that contribute to mental health issues. This can include poor working conditions, economic inequality, and lack of access to basic needs like healthcare, nutrition, and housing. By pathologizing individuals without acknowledging these contextual factors, the system can shift the blame onto individuals and overlook systemic issues that need to be addressed.
The Paradigm Shift
Adopting a contextual pathology perspective challenges the economic system to shift its paradigm. It encourages a move away from a one-size-fits-all approach to a more flexible system that acknowledges and accommodates the diversity of human experiences and capabilities. This shift could involve rethinking work environments, workloads, and expectations to promote mental health and well-being.
The Role of Policymakers and Stakeholders
For this shift to occur, policymakers, employers, educators, and other stakeholders would need to acknowledge the role of environmental factors in mental health and make the necessary changes. This could include implementing policies to improve working conditions, reduce income inequality, and ensure access to basic needs. It could also involve promoting mental health education and providing support services for individuals experiencing mental health issues.
Towards a More Inclusive Economic System
Ultimately, the concept of contextual pathology envisions a more inclusive economic system that values individual well-being and mental health as much as productivity and efficiency. This system would not only help individuals flourish but could also lead to healthier, happier societies and more sustainable economic growth.
Vision for a More Inclusive Approach to Mental Health
Our vision for a future mental health approach goes beyond individualized diagnostics and embraces a more holistic perspective. This approach would not solely rely on categorization of symptoms but would seek to understand individuals in their specific contexts, acknowledging the complexities of their lived experiences and the unique interactions between their traits and their environment. It would prioritize empathy, unconditional positive regard, and the belief in individuals’ potential for growth, reflecting Rogers’ humanistic principles.
The adoption of contextual pathology could significantly impact mental health practice and research. For mental health professionals, it could shift the focus of interventions from solely reducing symptoms to enhancing adaptability and resilience in various contexts. It could encourage professionals to consider environmental changes and societal interventions alongside individual treatments.
In research, it could shift the lens from searching for universal psychiatric truths to exploring the richness and diversity of human experiences across different contexts. It might also facilitate more interdisciplinary collaboration, with researchers from areas like sociology, anthropology, and environmental science contributing to a deeper understanding of mental health.
The integration of the humanistic approach and contextual pathology could transform mental health into a more individual-centered, compassionate, and context-sensitive field. This approach would value personal experiences and the pursuit of self-actualization, while also acknowledging the influence of context on mental health. It could lead to more personalized and effective therapeutic interventions that respect and respond to individuals’ unique experiences, environments, and pathways to growth.
Ultimately, this integration could foster a more nuanced, empathetic, and inclusive understanding of mental health, one that celebrates the complexity and diversity of human experiences, rather than reducing them to diagnostic labels.
Conclusion
The current framework for diagnosing and treating mental health disorders, represented by the DSM, has played a significant role in standardizing mental health practice and facilitating communication among professionals. However, this approach has limitations, especially when viewed from the perspective of Carl Rogers’ humanistic psychology and the emerging concept of contextual pathology.
An overemphasis on individual pathology often obscures the influence of environmental factors and reduces the complex, nuanced experiences of individuals to mere diagnostic labels. This reductionist view can inadvertently contribute to stigma and neglect the systemic and societal factors that can significantly impact an individual’s mental health.
Rogers’ humanistic approach, with its focus on the inherent potential of individuals and the subjectivity of human experiences, offers a valuable counterpoint to this pathology-oriented perspective. Meanwhile, the concept of contextual pathology brings attention to the influence of the environment and context on mental health, challenging us to consider how traits that are pathologized in one context may be strengths in another.
Adopting a mental health approach that integrates these perspectives can have profound implications not only for mental health practice and research but also for our broader societal and economic structures. It calls for a shift away from a one-size-fits-all approach towards a more inclusive, flexible system that values individual well-being and mental health as much as productivity and efficiency.
In closing, it’s important to remember that mental health is not merely the absence of mental disorders. It is a complex interplay of individual traits, experiences, and the context in which they exist. Embracing this complexity, rather than reducing it to labels, can pave the way for a more nuanced, empathetic, and inclusive approach to mental health.
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.
Tool Required:
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.
Hold Space
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.
Tool required:
Reflective Listening
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.
Reframe Thoughts
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.
Tools Required:
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.
Cognitive Defusion
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.
Self-Compassion
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.
Perspective-Taking
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.
Conclusion
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
- Competence
- Coherence and understanding
- Orientation
- 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.
Summary
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.
Competence
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.
Orientation
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.
Resources
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.
Conclusion
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.
Improved Mood
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.
Conclusion
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.
