When helping someone change, it can feel like we are trying to convince them of a better path forward. They may be stuck in self-destructive forms of avoidance, rationalization, or rigid thoughts, keeping them from being present and living in alignment with their values.
It is tempting to argue our way through, but the more we try, the more resistance we encounter. If you are a professional working in mental health and addiction, or a frustrated family member or friend, the creative hopelessness technique may help you move forward more effectively to provide support.
The concept of creative hopelessness is a technique in Acceptance and Commitment Therapy (ACT) designed to help persons give up on ineffective ways of being, helping them open up to a new values-based path forward. It avoids argumentation by posing a set of questions that allows the other person to be convinced by their own lived experiences.
Drawing on the work of Steven Hayes and the lessons presented in his course, Act in Practice, the approach can be summarised in the following steps:
- Ask what they want.
- Ask what they have been doing to get what they want.
- Curiously ask how these things have been working.
- Actively listen, then summarize their desires and actions.
- Ask if they are willing to try a new approach.
Let’s delve into how it works and how you can use this powerful technique in your interactions.
How Creative Hopelessness Works
Creative hopelessness works by guiding a person toward convincing themselves to give up hope on ineffective approaches. The key is having them persuade themselves, based on their own experiences. Their lived experiences are the most powerful motivational tool at our disposal.
When we try to argue with someone, based on our own experiences, they can’t fully integrate the advice. They may say “you’re right,” showing signs they agree, generally followed by a, “yeah, but…” giving rationalizations on why it’s different for them.
As FBI hostage negotiator, Chris Voss shares, hearing “you’re right” is deceiving, since it feels good. We think we just won them over, not realizing it is a short-lived hollow victory. If you hear “you’re right,” it may be a red flag that you’re doing too much arguing and not enough listening and evoking.
Rather than hearing, “you’re right,” you want to hear, “that’s right.” This means you are demonstrating accurate empathy, and the person is actively engaged in a collaborative process, rather than being a passive recipient of well-intentioned advice.
Creative hopelessness requires guiding the person through the lessons of their own lived experiences. This is how one comes to terms with the ineffectiveness of one’s current approach. As Stephen Covey says:
“If we keep doing what we’re doing, we’re going to keep getting what we’re getting.”
Merely telling someone this has a very different effect compared to inquiring into what they have been doing and asking how it has been working.
When asking how their previous attempts have been working, it is also essential to maintain curiosity and neutrality rather than asking presumptively or sarcastically. Perhaps some aspects of their previous attempts are actually working.
The goal is to determine the aspects of their experience that have not worked, having them come to a state of hopelessness regarding those approaches, not a general state of hopeless.
From Hopelessness to Hope
This is where the creative aspect of creative hopelessness comes in. Guiding someone to a place of hopelessness regarding their current way of operating is only helpful if they are presented with a new sense of hope in moving toward a valued direction.
Asking if they are willing to try something different offers a way out of this state of hopelessness, so long as they are willing to take a courageous step into unfamiliar territory.
If they are still showing signs of hesitation, it may be useful to refocus on what they want and what they value. As stated by Victor Frankl:
“Those who have a ‘why’ to live, can bear with almost any ‘how’.”
Keeping the process focused on their ‘why’ increases motivation to move forward, despite the fear and uncertainty. It is vital to continually revisit this ‘why’ recalling what is important to them and what they value.
In Acceptance and Commitment Therapy (ACT), values are ways of being. This means you are generally able to turn it into an adverb. Here are a few examples: lovingly, creatively, genuinely, excellently. Values are qualities of being, not destinations in themselves; therefore, gaining clarity on one’s values allows for ongoing motivation. See the “Values” section in my comprehensive summary of ACT here.
Values-based goals can also be drawn on for motivational momentum. Goals involve a vision of a specific valued destination. When discussing goals, it is important to make sure the person describes what they want, rather than a description of what they don’t want.
For example, when asking what someone wants, they may say, “I want to stop feeling so anxious.” Although this may be true, it does not pave a valued path forward. Perhaps re-framing the question may be helpful. For example, “So let’s imagine your anxiety is gone… What would you do? (goals) What do you want your life to be about? (values).”
This is one way to gain a clearer answer to the first step of creative hopelessness, inquiring into what they want. Although it is the first question, it may be effective to continually come back to it, clarifying a values-based path forward. This ‘why’ provides a positive vision of the future, offering courage when letting go of old habits.
An Example of Creative Hopelessness
Here is a rough example of creative hopelessness, following the steps indicated in the introduction. I open the conversation with an ineffective approach, then transition into a collaborative creative hopelessness process.
Person: “I’ve been struggling for years, feeling like I am stuck in my head. I’m always analyzing everything, thinking about what might go wrong.”
You: “You need to get out of your head and focus on the present… have you tried meditation?”
Person: “Yeah… it hasn’t really worked… I feel like if I stop worrying, everything will fall apart.”
You: “That’s not a realistic thought… things will likely be fine.”
Person: “You’re right… but I’ve been through a lot, and this is helping me survive.”
You: “What do you want your life to be about?”
Person: “I want to be able to protect my kids and show them love.”
You: “And what have you been doing to protect your kids and show them love?”
Person: “I’ve been constantly thinking about what might go wrong and how I can give them the best life possible.”
You: *curiously inquires* “How has this been working for you?”
Person: “I guess I’ve kept them safe, but I don’t feel like I am able to be present and show them love, since I’m stuck in my head.”
You: “What else have you tried?”
*Continue inquiring into the effectiveness of past approaches.*
You: “So it looks like you value your family and want to be able to give them a great life, while being present and engaged.”
Person: “That’s right.”
You: “And this pattern of retreating into your had has kept you from lovingly connecting with them as often as you would like.”
Person: “That’s right… I want to be there for them.”
You: “And retreating into your head seems to be taking you away.”
Person: “Yeah… it is.”
You: “And when you keep doing what you’re doing, you keep getting what you’re getting… so I’m wondering if you would be willing to let go of this approach and be open to trying something different…”
Person: “Let’s do it.”
The end of the creative hopelessness technique is the beginning of the change process. It simply brings the person to a state of willingness to move forward. The process of change can be uncertain and uncomfortable, so fostering this sense of initial motivation and commitment can help an individual take the initial steps forward.
The initial steps depend on the person. In the example above, work may start by developing present moment awareness. If the person’s primary concern is related to emotional avoidance, work may begin by focusing on acceptance and emotional openness. If the person is unclear on their values, work can start with exercises focused on clarifying values.
For a comprehensive overview of Acceptance and Commitment Therapy (ACT), check out my article How to Improve Psychological Flexibility. In that article, I break down each of the six ACT processes, offering metaphors and practical exercises.
Although this article is focused on ACT, I also drew on my background in Motivational Interviewing (MI). The creative hopelessness technique can significantly benefit from integrating MI since it is focused on working with resistance and increasing motivation for change. For a comprehensive overview of MI with examples of how it works, check out my article, How to Do Motivational Interviewing.
Since this article is focused on techniques used in mental health and addiction treatment, many aspects may not be relevant if you are using this outside of a clinical setting.
If you are helping a child or family member, some aspects of this approach may be helpful, but it is important to maintain personal boundaries since over-involvement can be counterproductive. For more on this topic, see my article on the difference between helping and enabling. If you are helping a child or family member, my article here may be helpful.
Motivational interviewing is a powerful counseling style, focused on helping someone gain motivation toward a valued direction in their life. The technique was first developed in the addiction field and is now being used broadly within healthcare settings.
As an addiction counselor, I have attended several workshops on motivational interviewing and noticed a wide range in the quality of instruction. I’ve witnessed persons leaving these workshops with a shallow understanding of the approach, feeling confused, or deciding to give up on the approach altogether.
Since I am passionate about motivational interviewing and love sharing complex ideas in accessible language, I was inspired to create a practical in-depth summary of this powerful approach.
These are the four processes of Motivational Interviewing (MI), a scientifically validated approach to helping someone change:
- Engage them through reflective listening
- Focus on the main issue they are facing
- Evoke their reasons for change
- Collaborate on a plan for change
In this article, I delve into each of these four motivational interviewing processes, translating the most practical elements into simple language. Whether you work in mental health, addictions, other areas of healthcare, or are just trying to help a friend or family member, I hope this powerful approach can help.
What is motivational interviewing?
According to Dr. William Miller, the founder of Motivational interviewing:
“Motivational interviewing is a collaborative conversation style for strengthening a person’s own motivation and commitment to change.”
Rather than merely a set of techniques, it is fundamentally a way of being with people. It is tempting to simply try to give people the psychological tools as if simply explaining it to them clear enough will make them change. This is an antiquated learning model, based on the idea that persons are empty receptacles, needing to be filled with knowledge.
As a university course instructor, I quickly learned that merely lecturing people is a highly ineffective way to facilitate meaningful learning. This lesson was reinforced in my work doing problem gambling prevention. Although some people are naturally curious and want to learn more, most people shut down as soon as they feel like someone is giving them advice.
As Peter M. Senge says:
“People don’t resist change. They resist being changed.”
Resistance to change is not personal. Persons are coping with underlying pain, the best way they currently know how. Attempts to change someone are met with resistance since they take away someone’s need for control.
Deep down, people who seem to have no motivation do want to change. Getting to that kernel of desire is the goal of motivational interviewing, and this starts with considering our way of being with them. This entails actually being there with them.
How to be with a person
This is also referred to as the “spirit of motivational interviewing”. It is a way of being that entails partnership, acceptance, compassion, and evocation, forming the acronym, PACE. Keeping PACE with others means meeting them where they are at.
Let’s start by delving into acceptance since it has several aspects.
Accepting another person as they are, while also supporting their growth, is foundational. Although acceptance sounds like a simple word, there are four aspects of acceptance: absolute worth, empathy, autonomy, and affirmation.
This means maintaining a nonjudgmental attitude toward people who are presenting difficulties.
When we hear anger or frustration, it is useful to consider what pain might be causing the person to react the way they do. Slow down and see their humanity, despite the challenges on the surface.
This aspect of acceptance from Carl Rogers’ concept of “unconditional positive regard.” It requires setting aside one’s judgments about another individual, empathizing with them, and genuinely wanting the best of them.
When someone irritates us, it can be challenging to have unconditional positive regard, but when we start with empathy, we can understand the context of their behaviors, not taking it personally, and not blaming them for being ‘bad’, ‘lazy’, or ‘stupid’. We can see them as an imperfect individual, like ourselves, striving to live a ‘good’ life. When we have unconditional positive regard, we empower individuals to see the best in themselves, inspiring them to act accordingly.
This means actively attempting to understand the other person’s point of view.
We can start by becoming curious about the other person’s inner world. This curiosity allows us to take a step back from our own biases and assumptions, facilitating mutual understanding and respect.
This entails facilitating the other person’s sense of control and independence.
We can’t make people change. We can only help spark their own desire to change. Supporting their autonomy means knowing when to slow down and simply hold space.
This means acknowledging the other person’s strengths and efforts.
We are often quick to latch on to the negative traits a person displays, overlooking their unique strengths, abilities, or efforts. Recognizing someone’s strengths helps us maintain respect for them as an individual.
Compassion requires us to actively promote a person’s welfare based on their own needs.
We often feel compelled to judge what will be best for another person. This causes us to direct the focus, assuming we know what they need to prioritize. As we take the reins, we disempower the other person, putting them into a passive role in the process.
This aspect of motivational interviewing was added when the founders, Rollnick and Miller, noticed that their method was being advertised by an “influence coach” selling his book on “How to Get Anyone to Do Anything — Fast!”.
Getting “anyone to do anything” does not require compassion since it does not consider their best interests first. Rollnick and Miller wanted to be clear that their technique is intended to be used with and for the other person, not simply for the interviewer’s personal benefit.
Evocation requires us to actively elicit the person’s own reasons for change.
We often feel compelled to make arguments for why someone needs to change. Usually, the arguments for and against change already reside within the other person. It is our job to evoke their own arguments for change, thereby increasing their intrinsic motivation.
This is the opposite of those all too common “should” statements. Has anyone ever said you should do something? How do you feel after someone tells you this? Evocation elicits the person’s own arguments for change, bypassing this resistance.
Partnership requires us to collaborate with the other person to form a plan.
We may feel compelled to dictate what we may consider a strong action-plan, pacifying the other person, leaving them feeling like they have “homework” rather than having a collaboratively constructed plan of action. Partnering with the other person inspires intrinsic motivation to change becuse they feel in control of the process.
This is the foundation of motivational interviewing. Without being with people in this open, accepting, compassionate way, the technical skill will generally be ineffective.
Now that the foundation has been laid, let’s consider the four processes listed in the intro:
These may occur in the order listed, or the conversation may go back and forth, depending on the situation’s requirements. Let’s take a closer look at each of these processes and how they work.
Engage them through reflective listening
This means establishing a trusting and mutually respectful relationship. In practical terms, it’s how we help people feel like we are someone they can trust and with whom they can share their personal experiences. Engagement can happen instantly, or it can take a while.
The best way to develop engagement is through reflective listening. Reflections consist of responding with a summary of what the person is sharing with you. Our natural tendency when listening is to ask questions continually. Reflective listening is different since it means limiting the number of questions you need to ask.
Reflections are more engaging than questions, helping facilitate empathy and a sense of understanding. To be optimally effective, try to use at least three reflections per open-ended question. For example:
Person: “I can’t believe I relapsed!”
You: “This (situation) really frustrates you” (reflection 1).
Person: “Yeah… I was doing so well… I hate when this happens!”
You: “And you want to gain more control over your drinking.” (reflection 2).
Person: “Yeah… I’ve been trying a few different things but I don’t know if I should go to treatment.”
You: “And you are still not sure if treatment is a good fit for you.” (reflection 3).
Person: “That’s right… I feel like I have a lot of support.”
You: What do you feel you need right now? (open-ended question).
Notice how reflective listening builds rapport while delving into the person’s underlying needs. Asking too many questions risks maintaining a surface-level conversation. Reflective listening delves into the other person’s experience while using infrequent open-ended questions to guide the conversation gently.
Since there are several different types of reflections, here is a brief definition and example for each:
This consists of reflecting the exact words or phrases used by the individual.
Person: “I feel guilty about my drinking because I often drink too much.”
You: “You feel guilty…”
When using a simple reflection, be careful not to sound like you are simply parroting the other person’s words. If done without a spirit of empathy, it can appear cold and mechanical.
FBI hostage negotiator, Chris Voss, shares he often used this kind of reflective listening by merely repeating the last two words the person said. Although I don’t personally recommend this when helping others, it can be a simple, fun exercise to practice reflection in everyday conversation.
This consists of finishing the other person’s sentences or paragraphs by guessing what they mean. It is also one of the most powerful forms of reflection. The key to this technique is that the dialogue should flow as if it were a single person speaking.
Person: “When I comes to drinking, I find it difficult to control myself.”
You: “…and you’re looking to gain back some control.”
Person: “yeah… I miss the way things were before I started drinking.”
You: “… spending quality time with the ones that matter.”
Note that you need to sometimes go out on a limb and take a guess at what phrase may accurately represent the other person’s experience. If you are not on the mark, the other person will correct you. If they correct you, adjust your reflection to fit their experience, maintaining a spirit of empathetic concern or curiosity.
Summaries are reflections that consist of paraphrasing two or more items someone has shared.
Person: “I tried going to a therapist to deal with my gambling because my partner was frustrated with my spending and told me I had to go, but I don’t think it helped because I keep wanting to gamble, but I also don’t want to upset my partner. I just feel lost and overwhelmed because my relationship is very important to me.
You: “So you’re feeling lost and overwhelmed because you enjoy gambling, but your partner thinks you are spending too much and wants you to get help. You value your relationship so you sought help, but you feel that it was not helpful for you.”
Summaries are most useful at the end of conversations or immediately after someone shared many concerns.
In summary, reflection builds connection and increases motivation by encouraging the other person to continue talking about their reasons for change. Rather than simply listening, asking questions, and offering feedback, incorporating a large dose of reflection into your conversations will help you better connect with others, in addition to increasing their likelihood of making a change.
Focus on the main issue
This consists of seeking and maintaining direction in the conversation. In practical terms, it’s how we help people share their most important concern.
Rather than making assumptions about what they need, focusing is a collaborative process, revealing what is best for them.
Focusing is tricky because we could take the conversation in so many places. How do you focus on one particular aspect of a person’s complex experience and list of challenges?
Open-ended questions are the most useful tools for this process. Some examples might include questions like “What is the most important issue for you right now?” and “What issue is your main priority right now?”
The key to focusing is to never make assumptions. The problem may seem “obvious” in the beginning, but this may or may not be the real issue. Guiding the focus of the conversation through open-ended questions ensures you are focusing on the most relevant aspects of their situation.
So how do you know when you’ve focused enough? Here are some quick tips:
Not yet Focused
- The person jumps around between ideas and topics
- The person reverts to small talk after disclosing an area of potential focus
- The person is still sharing important background information
- Person has directly identified a top area of priority
- You have confirmed the focus with the other person.
Evoke their reasons for change
This consists of increasing motivation by evoking the other person’s own arguments for change.
In simple terms, it’s how we help people increase motivation and maintain their commitment to change.
The best map is useless if they’re not ready to take the voyage.
Talking about our why is the fastest way to build motivational momentum. Clinical studies on this technique demonstrate that getting the other person to talk about their own reasons for change correlates with increased successful outcomes. Miller and Rollnick call this “change talk.”
Studies looking at this technique’s effectiveness show change talk is one of the significant predictors of change.
So how do you get the individual to state their own reasons for change? Listen carefully for a reason, and then reflect that reason back to them in your own words, encouraging them to continue talking about it.
Here is a simple example:
Person: “I guess if I stop coming to the casino so often, I could take better care of my elderly mother.”
You: “It looks like your mother means a lot to you…”
Person: “Yeah… she was always there for me, so I really want to be there for her.”
Whatever you reflect, you will hear more. Therefore, reflecting change talk gets you more change talk. Note that this also works in reverse. If you are not selective in your reflections, you may be encouraging more counter-change talk, keeping the person entrenched in past behaviors.
To unlock motivation, keep your ears on alert for change talk, focus your reflections, and encourage the other person to continue talking about their own reasons for change.
The purpose of evoking change talk is to increase intrinsic motivation, reducing ambivalence.
Those seeking change look toward a huge mountain ahead, ambivalent to whether they should make the trek. They want to get to the top, but also have reasons not to take the risk. Torn between these two competing desires, they are stuck.
When someone comes to us for help, it is tempting to start planning for change immediately. Before doing so, we need to take a step back, inquiring into the other person’s reasons for change. Evoking change-talk helps the other person build intrinsic motivation, a key indicator of successful long-term growth.
Special Evoking Technique: The Readiness Ruler
- Simply ask the person about their readiness to change on a scale from one to ten.
- Ask what made them choose that number instead of a one or two.
- Ask what it would take to get them to a number or two higher than the one they chose.
The readiness ruler is not a measurement tool. Rather, it is a technique designed to evoke change talk. Each step is designed for this purpose. It does not necessarily matter what number they say. What matters is how you engage the person relative to the number they chose.
Step number two might seem counter-intuitive. Why would you ask someone about their reasons for not being less motivated?
When asked about their reasons for not being less motivated (a 1-2 on the scale), they will need to respond with reasons why they are motivated. The question necessarily frames them as having some motivation, guiding them to elaborate on it. This elaboration is the essence of change talk. Using continued reflective listening is crucial to this step.
Question number two is focused on evoking, while question number three starts the initial planning phase. Strong change talk goes beyond vague desires, delving into someone’s reasons and deep internal need to change. Turning this desire into commitment and action involves collaborating on a plan.
Collaborate on a plan for change
Collaboration is like a dance. We give and take, meeting the person where they are, guiding the flow of the dance while remaining in harmony with one another. The goal is to guide them toward action, not force them into submission.
To use another metaphor, we must be like travel agents of change. We may be experts on the matter, but we can never really know what kind of trip will be best for the individual until we collaborate with them. Even when the plans are set, and the trip is booked, it is not our job to go on the trip with them. If things get rocky on the trip, they can call us for support, but it is not our responsibility to fly out and rescue them.
People need space to feel empowered when making changes. When we become confrontational experts, we disempower people, making them feel incompetent. When we collaborate with them, guiding the change-process, we empower them to take responsibility for changing, giving them the ability to see small rewards accumulate by their own volition. As these rewards start to accumulate, motivational momentum snowballs into committed action.
Collaboration solves underlying motivational issues by encouraging an active mindset rather than spurring temporary action driven by the desire to avoid criticism.
When helping people change, we are often tempted to take the lead. We want to direct them on making the change, telling them what they need to do, and perhaps even begin doing some of it for them. We may find ourselves working harder than the other person, wondering why they won’t take control over their life. If we find ourselves in this situation, it may feel like we are helping, but we have actually become part of the problem.
Special Planning Technique: Elicit-Provide-Elicit
Our contributions to a plan are better received when delivered in an elicit-provide-elicit sandwich.
This requires asking what they know about an area, providing relevant information (with permission), then asking their thoughts on the information. This technique helps bypass resistance when planning, allowing you to offer feedback without sacrificing collaboration:
You: “What do you think about counselling?” (elicit)
Person: “I think it would help me out a lot right now.”
You: “Can I tell you more about local services? (asking permission to provide)
You: “X is a great local resource…” (provide)
You: “What are your thoughts?” (elicit)
Common traps and roadblocks
Sometimes our interactions are smooth sailing. Other times, they feel heavy and difficult. You may be getting yes or no answers, “yeah buts…”, no eye contact, or the person may have difficulty opening up. Here are some common ways you might be caught in a communication trap.
The Expert Trap
This occurs when you present yourself as an expert on how the other person should be living. Being too directive creates a power-dynamic where the other person loses a sense of control over the process, decreasing motivation.
The expert trap might be tempting since it is easy to believe we know what’s best for someone. We may feel like we have access to all of the right tools and techniques, knowing exactly what the person needs to do.
The issue with jumping to solutions is that it does not work. How many people follow their family doctor’s expert advice, after being told they need to eat healthier and exercise more often?
Being an expert and presenting yourself as an expert are two different things. The founders of motivational interviewing, Rollnick and Miller, state that a true expert is invisible to the untrained eye.
Rather than creating a power dynamic where you are the expert, and the other person is a passive recipient of knowledge, it is more effective to see both of you as different types of experts. You may have expertise in psychological processes and coping skills, but the other person is an expert on the details of their own lives. As stated in the research here:
“The alliance between you and your client is a collaborative partnership to which you each bring important expertise.”
The Assessment Trap
Similar to the expert trap, putting too much emphasis on assessment places the other person in a passive role, similar to the doctor-patient dynamic. This can be a useful dynamic in many areas of physical health, but it can be a barrier to connection when helping someone with mental health and addiction issues.
Asking too many questions can intimidate and bombards the other person. Rather, it is more effective to evoke their experience through reflective listening. Luckily, process-based approaches such as Acceptance and Commitment Therapy (ACT) have moved away from diagnostic assessments, preferring a functional analysis of the thoughts, emotions, and behaviors, instead. You can learn more about ACT in my article here.
The premature focus trap
This entails trying to immediately solve the person’s problem, jumping to the solution rather than simply listening to build engagement and trust.
There may be times when you want to steer the conversation in a particular direction prematurely. Although we may feel like we have the answer, it is most effective to focus on areas that are right for the other person.
Ask yourself: Whose need am I meeting right now? Am I trying to meet my own need to provide information? Am I trying to gain a sense of importance by fixing the other person? Am I engaging with a spirit of compassion?
The Chat Trap
Although small talk can be engaging, the chat trap prolongs shallow conversation, neglecting focus and direction.
The chat trap lingers between engaging and focusing. The person may be engaged, but you may find yourself in a conversational tailspin, focusing on surface-level content.
This is perhaps most relevant when it comes to conversations with individuals we are highly familiar with. They are successfully engaged and comfortable chatting, so stepping out of this comfort zone takes a bit of courage from both yourself and the other person.
Motivational Interviewing is a powerful approach to helping people change. It starts by engaging the person through reflective listening, then focusing the conversation. It then consists of evoking their reasons for change and collaboratively planning for the change.
The acronym RULE can summarize motivational interviewing:
Resist the righting-reflex: Avoid trying to correct them or convince them.
Understand their motivation: Seek to understand their values, needs, and abilities.
Listen with empathy: Listen to their motives and potential barriers.
Empower them: Collaborate with them to build a realistic plan.
Reflective listening is a major aspect of motivational interviewing, so gaining comfort with this skill is one of the best things you can do to help sharpen your abilities. Below, you will find a list of resources focused on helping you delve deeper into the practice of motivational interviewing.
If you are curious about the psychological processes behind motivational interviewing, check out my article, “How Does Motivational Interviewing Work?” where I break down the various aspects of intrinsic motivation in plain language.
For free video demonstrations on how to do Motivational Interviewing, check out these great online modules by the British Medical Journal, here. I highly recommend it!
For the most comprehensive overview of Motivational Interviewing, by the founders themselves, check out the following book: Motivational Interviewing: Helping People Change.
If you are interested in Motivational interviewing training and events, check out the Motivational Interviewing Network of Trainers.
Lastly, if you want to connect with others interested in motivational interviewing, you can check out the Motivational Interviewing Practice Community on Facebook.
Psychological Flexibility is quickly becoming one of the key indicators of psychological health and well-being. Improving one’s psychological flexibility promotes mental health and helps a person take action toward valued directions in life. Improving psychological flexibility is the goal of Acceptance and Commitment Therapy (ACT), supported by over 330 clinical trials.
When learning ACT, it is easy to feel overwhelmed by the unique concepts. As an ACT practitioner myself, it took a while to feel comfortable with the language and unique process-based approach.
In this article, I summarize the six pillars of ACT in plain language, to hopefully benefit you or your clients. So how do you improve psychological flexibility?
- Be Willing to Feel Difficult Emotions
- Step Back From Your Thoughts
- Focus on the Present
- Focus on Connection, Not Comparison
- Live by Your Own Values
- Build Habits Based on Your Values
These six processes can be divided into three major areas: openness, awareness, and engagement. Let’s take a closer look at the meaning of these processes and how you can use them to improve psychological flexibility.
These processes consist of a sense of openness to painful emotions and difficult thoughts.
Be Willing to Feel Difficult Emotions
This is the ACT process of acceptance vs. avoidance. It is rooted in our yearning to feel and experience life. When we tell ourselves we need to avoid painful feelings, we begin to avoid more and more situations that could potentially lead to a painful outcome.
Rather than merely avoiding pain, one may begin to avoid positive situations as well, out of the fear that they can potentially result in pain. For example, a person may avoid feelings of love and intimacy out of a deeper avoidance of the potential pain if the relationship does not work out.
Acceptance opens a person up to a sense of willingness to experience emotions. This means one can flexibly open up to painful emotions and learn from them. Rather than viewing emotions as good vs. bad, a flexible approach views emotions as information.
Opening up to emotions does not imply being consumed by them. Rather, it means opening up to the lessons they are sharing with us.
Being willing to experience painful emotions also allows one to begin opening up to experiencing more pleasurable feelings as well. This leads to being able to savor life and fulfill our deep human yearning for feeling.
This metaphor for acceptance is called “ball in a pool,” cited from the ACBS website, here:
“Imagine what you’re doing with these (thoughts/distressing memories/feelings) is like fighting with a ball in a pool. You don’t like them, you don’t want them, and you want them out of your life. So you try and push this ball under water and out of your consciousness. However, the ball keeps floating back to the surface, so you have to keep pushing it down or holding it under the water. This struggling with the ball keeps it close to you and is tiring and futile. If you were to let go the ball, it would pop up, float on the surface near you and you probably wouldn’t like it. But if you let it float there for a while, with your hands off, it would eventually drift away and out of your life. And even if it didn’t, at least you’d be better able to enjoy your swim rather than spending your time fighting!”
Name the particular emotion you are feeling, curiously observing it like a scientist. What shape is this emotion? Allowing it to be there, breathe it in. What feelings come up in your body? Continue observing it curiously. You can even adapt this to fit with the metaphor of the ball in the pool. What color is the ball? Are there any designs on it? If you had to rate the ball on a scale of 1 to 10, what would you give it?
Why it Works
These techniques are designed to facilitate a process whereby a person stays in contact with difficult thoughts or emotions. The willingness to observe it in this way facilitates a degree of openness that changes one’s relationship to these emotions or thoughts.
Rather than being something one must fight, suppress, or avoid, flexibly making space for the pain also allows one to open up to pleasurable experiences, fulfilling the yearning to feel.
Step Back From Your Thoughts
This is the ACT process of cognitive defusion vs. cognitive fusion. This is a fancy way of saying, having some distance from your thoughts vs. being constantly identified with everything your mind tells you.
Throughout one’s day, the mind may make commentary regarding how things should be: “I should have done that better… he should do things a different way… The government should fix this.”
Although these thoughts could potentially be useful in helping us improve ourselves, others, and society, they are often intrusive and rigid, causing us to react rather than step back and act mindfully and effectively.
This temptation to be rigidly identified with our thoughts comes from the yearning for a sense of coherence and understanding. We want the world around us to make sense and we want a sense of understanding of how things work.
When one’s mind becomes too rigid, we try to impose a false sense of order on the world, treating life as a problem to be solved. Living more and more in your head, one may develop defense mechanisms such as rationalization and intellectualization.
You may feel like you need to be right, constantly debating, and looking for opportunities to argue your perspective. Learning to step back from your thoughts allows for increased cognitive flexibility, allowing you to mindfully engage in dialogue more openly with yourself and others.
Learning to talk to yourself more flexibly is the foundation of this process.
This popular ACT metaphor is called “Leaves on a stream” and can also be incorporated into a visualization during a meditation session.
Imagine you are sitting beside a gentle stream in the Fall. Leaves from nearby trees occasionally fall into the stream and are gently carried away.
As you watch the imaginary stream, bring your attention to your breath, noticing the sensations. As you keep the focus on your breath, you may have thoughts pop into your mind. Simply place that thought on a leaf and watch it float by. It may get stuck for a moment, but simply let go, gently bringing the attention back to the breath.
You can find a version of this metaphor as a guided meditation on YouTube here.
This exercise is designed to depict how you are not your thoughts. Rather you can be aware of your thoughts, choosing where you want to focus your attention.
This is the difference between saying, “I’m stupid,” and “I’m having the thought that I’m stupid.” Listening to the way someone phrases these kinds of statements gives you insight into their level of cognitive flexibility at that moment.
Pick a particular intrusive thought. Now imagine that thought is written on your hand. If you had to place that thought at any distance from your face, how close is that thought right now? How close is that thought when you’re in a particularly challenging situation?
If your hand is covering your eyes, notice how difficult it would be to engage in daily life with this thought so close. Now, move your hand away and slightly to the side.
Now you can see the thought clearly, in addition to the rest of the world around you. The thought will not go away, but this distance allows you to move forward effectively.
You can watch Russ Harris perform a version of this exercise here.
Next time this particular thought comes up, perhaps you can even give it a name. Some people use a name inspired by a suitable television character. When the voice in your head begins to take over, greet it like an old friend, thanking it for trying to help. If it is not useful right now, leave it alone and focus your attention on what matters most.
Why it Works
This is designed to facilitate a process whereby a person can flexibly relate to their thoughts rather than being dominated by them. When the mind becomes a dictator, we lose control of our focus, being pulled into rigid ways of being.
Getting some distance from our thoughts allows for a more functional way of being, engaging with issues pragmatically as they arise, rather than trying to impose a false sense of order onto the world. Gaining distance from the dictator within allows for greater wisdom and peace of mind.
These processes are focused on developing a sense of presence and awareness.
Focus on the Present
This is the ACT process of present moment awareness. This means flexible attention to the present moment as opposed to being caught up in thoughts about the past or future.
Although it is useful to consider the past and the future, getting caught up in thoughts about the past or future takes away from one’s ability to effectively engage in the world, potentially even affecting one’s relationships.
This process is often compared to mindfulness or meditation practice, but it does not require any kind of belief or spiritual tradition. As Daniel J Siegel states:
“Mental presence is a state of being wide awake and receptive to what is happening, as it is happening in the moment, within us and between the world and us. Presence cultivates happiness.”
Although it sounds simple, this can be a challenge in practice. Throughout daily life, we may drift into worries of the future or ruminations on past situations. These thoughts generally start with, “what if..” or “I should have…” and derail our focus on what can be done here and now to most effectively move forward.
Here is an ACT metaphor on present moment awareness adapted from “the mind as a GPS” description by Philippe Vuille here:
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.
Here is a simple guided meditation that can help develop present moment awareness:
As you sit with your feet on the floor, notice the sensation of your body in the chair. Now bring your attention to your breath, noticing the rise and fall of your chest. Now notice the sensation of your feet on the floor.
Notice any tension in your legs, arms, hands, shoulders, and face, letting it go. Bring the attention back to the breath for a moment.
Now expand your awareness to any sounds around you. Perhaps you may not have been aware of small sounds like a fan, the hum of electricity, people talking, or nature. Simply notice the sounds.
Keep the attention on the sounds while also noticing the breath.
You can now continue in this way for however long without the guidance.
If a thought pops up, you can use the previously described leaves on a stream metaphor to refocus your attention.
Why it Works
Getting pulled into the past and the future comes from our yearning for a sense of orientation. We want to make sense of our place in time, often ruminating or worrying. This mindless disconnection pulls us away from being able to flexibly engage in the present.
When we are engaged in noticing the present, we can act more effectively. As Mary Schmich states:
“Don’t worry about the future. Or worry, but know that worrying is as effective as trying to solve an algebra equation by chewing bubble gum.”
Being here and now allows for a more flexible, fluid, and voluntary approach to life. Through this mindful awareness, we can better meet our need for orientation without getting caught up in our thoughts, missing the metaphorical off-ramp.
Focus on Connection, Not Comparison
This is the ACT process of the observer self vs. the conceptualized self. This means the difference between perspective-taking and being trapped in an egoic sense of self.
This comes from the core yearning for a sense of belonging. When we feel like our sense of belonging is threatened, we may try to compensate by fostering a sense of specialness. Rather than having a genuine connection, we focus on how we compare to others.
Perhaps this is an attempt to gain a sense of security by carving out our place on top of a hierarchy. Social media has been a popular median for this type of social comparison. I discuss this further in my article, Is Social Media Making Us Less Social?
This attempt to fill one’s need for connection through ego inflation leaves us feeling even more alone. Rather than stuffing the ego full of status symbols and identities, developing the observer self allows for true connection.
The following description is adapted from the “torch in the dark” metaphor, illustrated by Russ Harris here.
Imagine you are in a dark room shining a flashlight on various objects that are around you. The light comes from the same source, and what you see depends on where you point the light.
Like the flashlight, you bring your attention to various things. Sometimes this awareness goes inward while other times it becomes aware of external objects. You are not the objects you illuminate. Instead, like the flashlight, you are the awareness noticing these objects.
The conceptualized self fixates on the objects, clinging to them for a sense of identification. It forgets that you are not these things. Rather, you are the awareness of these things.
Here is an ACT exercise by Russ Harris, shared here. It builds on mindfulness practice to develop a sense of oneself as awareness rather than identification with the contents of awareness.
“Notice how you’re sitting (5 secs)
Notice what you can see (5 secs)
Notice what you can smell and taste (5 secs)
Notice what you can hear (5 secs)
Notice what you’re thinking (5 secs)
Notice what you’re feeling (5 secs)
Notice what you’re doing (5 secs)
There’s a part of you in there that notices everything you see, hear, touch, taste, smell, think, feel, or do… is it good, bad, or ‘just there’?”
Why it Works
Developing a sense of oneself as awareness instead of being rigidly ego identified allows for greater flexibility in one’s interpersonal relations. Rather than trying to fill the need for belonging through a false sense of specialness based on social comparison, this process lets go of these attachments, allowing space for genuine connection.
Letting go of the conceptualized self allows for greater behavioral flexibility since the constant need to defend one’s ego falls away. Rather than being on high alert for any threat to one’s sense of self, one can focus on the present, more aware and engaged, better fueling a sense of connection and community.
These processes consist of knowing what you want and committing to taking action.
Live by Your Own Values
This is the ACT process of values-orientation. This means having a sense of the things you value rather than merely following orders or operating based on external social ideals.
This is based on our need for a sense of meaning and self-directed purpose. In the absence of a self-directed purpose, one may fill this need by turning to external standards of what one is told one “should” want. In our world of social media and rampant consumerism, this often manifests as a drive to acquire consumer products.
This need for purpose may also manifest as compliance or simply going through the motions of doing what one is supposed to do.
Both of these routes ultimately lead to this need not being met, resulting in a sense of emptiness or boredom. Developing a clear sense of one’s own values provides a sense of self-directed purpose.
This metaphor is adapted from “The Scoreboard” metaphor in The Big Book of ACT Metaphors:
Imagine playing your favorite sport. Throughout the game, the score goes back and forth, and there are several exciting moments. During the final seconds, your team pulls ahead. You look at the scoreboard and notice the number, indicating you’ve won.
Now, what if the scorekeeper were to come along at the beginning of the game and offer to put that same score on the board, without having to play the game? Would you take up that offer? If not, why wouldn’t you?
This is the difference between values and goals. Values are about the process of how the game is played, and goals are about the outcome. Although the goal is to win, the value is what keeps us engaged in the game.
Some values at play in this metaphor may include fairness, resilience, excellence, and teamwork. Goals without values seem empty, like putting the final score up without having to play the game.
Values can be found in three major areas of life: moments of sweetness, moments of pain, and role-models. These values exercises are adapted from The Big Book of ACT Metaphors:
When clarifying one’s values by looking at moments of sweetness, think back to a moment where you felt alive and engaged. Notice the details of this moment. What were you doing? Who was with you? What did you feel?
Slow down and see if you can emotionally connect to what you value about this moment. This same exercise can be applied to painful moments, pulling out values by noticing what was missing in those moments.
Values can also be found by looking at one’s role models. Pick a person you admire. What qualities of theirs do you admire?
Slow it down, emotionally connecting with the aspects of this person you admire. Now consider what values come from these qualities. Some examples might be compassion, creativity, genuineness, and selflessness.
Now how might you be able to live by these values yourself?
Why It Works
Connecting with one’s values leads to more psychological flexibility by offering a ‘why’ to fuel the ‘how’ and the ‘what’. We often prioritize knowing what result we want and how we will get that result, neglecting why we want it.
As Viktor Frankl writes in Man’s Search for Meaning:
“Those who have a ‘why’ to live, can bear with almost any ‘how’.”
Living in alignment with our values provides motivation in addition to psychological flexibility when obstacles arise. Like the game being more fundamental than the final score, values are more fundamental than the end goal. You do not have control over the end goal. You only have control over the way you engage in the task.
Victor Frankl goes on to highlight this fundamental ability to choose one’s valued way of being:
“The last of the human freedoms: to choose one’s attitude in any given set of circumstances, to choose one’s own way.”
Choosing one’s own way of being fulfills our human yearning for a sense of purpose and direction.
Build Habits Based on Your Values
This is the ACT process of Committed Action. This is based on our core yearning for a sense of competence. When we do not have this need met, we may react by seeking external achievements, status, and engaging in addictive approaches to work.
Others may fall into the opposite trap, becoming paralyzed by perfectionism. To maintain a false sense of competence, a person may self-sabotage by failing to take action or complete a project to maintain one’s false sense of competence, fearing possible criticism.
Both of these approaches are disconnected from one’s values, relying on external validation and fear of judgment. Connecting to our values allows for a more flexible approach to taking action since the criteria for success is based on how one operates (values), not the end result (goal).
This process is focused on integrating increasingly larger habits of values-based actions into one’s daily life. There can be a degree of appropriate goal-setting in this process, so long as a commitment to values is the foundation.
This metaphor for committed action is called “waiting for the wrong train,” adapted from The Big Book of ACT Metaphors:
Imagine you are waiting for a train to go somewhere special. There are two trains indicating they are going to your destination. The first train looks odd, dirty, and uncomfortable, while the second one looks clean, comfortable, and luxurious.
You excitedly choose the second train, anticipating the trip ahead as you wait to board. The first train then leaves, and another odd-looking one going to your destination pulls up.
You keep waiting for the comfortable train all afternoon while the other trains come and go. Will the comfortable train ever leave the station?
This metaphor highlights how leaving your comfort zone is often required when stepping out on your life’s journey. Also, if you keep doing what you’ve been doing, you will keep getting what you’ve been getting.
This exercise is based on the ACT creative hopelessness technique:
Ask yourself, what do you want in life?
After you have a picture of what you want, ask yourself, what have you been doing to get that thing?
For each thing you have been doing, ask yourself, how has that been working?
The key here is to remain curious rather than critical.
If what you have been doing up until now has not been working, ask yourself, are you waiting for the metaphorical luxury train?
If so, would you be willing to try something new?
If you are committed to acting on this new path, what small thing might you do tomorrow to get the train moving?
How It Works
Building out patterns of committed action over time builds behavioral flexibility by moving toward a greater sense of genuine competence, based in one’s values, rather than being stuck in external validation-seeking.
The process of building out these behaviors in incremental habits allows for a greater level of practicality and a sense of long-term sustained progress.
Improving psychological flexibility is the core purpose of Acceptance and Commitment Therapy (ACT). This approach is supported by over 330 clinical trials. Improving psychological flexibility leads to better mental health outcomes, helping people meet core needs and take action toward a values-oriented life.
Here is a summary of the information presented in this article:
Be Willing to Feel Difficult Emotions
ACT Process: Acceptance
Explanation: Meeting one’s need to feel by being open to experiencing both painful and pleasant experiences rather than avoiding them
Metaphor: Fighting with a ball in a pool
Exercise: Name and describe an emotion
Step Back From Your Thoughts
ACT Process: Cognitive Defusion
Explanation: Meeting one’s need for coherence by gaining distance from one’s thoughts rather than imposing false rigid order
Metaphor: Leaves on a stream visualization
Exercise: Thoughts as your hand in front of your face
Focus on the Present
ACT Process: Present moment awareness
Explanation: Meeting one’s need for orientation by living in the present rather than ruminating on past experiences or worries of the future
Metaphor: Mind as a GPS
Exercise: Mindfulness meditation/ leaves on a stream
Focus on Connection, Not Comparison
ACT Process: Observer self/ transcendent self/ self-as-context
Explanation: Meeting one’s need for connection by taking a broader perspective rather than narrowly identifying with rigid conceptualized self-identities to seek specialness
Metaphor: Torch in the dark
Exercise: Noticing various senses
Live by Your Own Values
ACT Process: Values orientation
Explanation: Meeting one’s need for purpose and direction through core values rather than empty conformity to external standards
Metaphor: The scoreboard
Exercise: Moments of sweetness, moments of pain, and role-models
Build Habits Based on Your Values
ACT Process: Committed action
Explanation: Meeting one’s need for competence through habits of values-oriented actions rather than seeking validation through overwork or perfectionistic procrastination
Metaphor: Waiting for the wrong train
Exercise: Creative hopelessness adapted to the train metaphor
The explanations, metaphors, and exercises presented here are some of my personal favorites, but there are many more. Here are some helpful ACT resources:
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. As you may have noticed, I cited it several times throughout this article. 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.
Self-care is crucial for maintaining mental health. Though we often neglect self-care, distracted by the responsibilities of daily life. Our minds tell us self-care is selfish and that we need to focus on helping others instead.
Working in mental health and addictions, I am a strong proponent of self-care. I need to help myself before I can help anyone else. Going into potentially stressful situations while hungry, tired, and frustrated is a recipe for burnout, making it difficult to be helpful at all.
If you value helping others, you need to be able to help yourself first. Self-care is not selfish. Instead, giving people the best version of yourself allows you to be even more helpful while preserving your mental health in the long-run.
Here are some self-care tips for mental health:
- Practice saying “no”
- Ask for support when needed
- Let go of toxic relationships
- Meaningfully connect with others
- Focus on the present
- Get clear on your values
- Take time for yourself
- Focus on what you are grateful for
- Incorporate some form of exercise
- Spend time outside
- Incorporate healthy dietary habits
- Get quality sleep
Let’s delve into these tips, dividing them into three broad categories: interpersonal self-care, mental self-care, and physical self-care.
This form of self-care considers the quality of your social relationships. As social beings, the quality of our close social relationships is one of the most significant predictors of well-being.
Practice Saying “No”
This is about personal boundaries and assertiveness. If you lack these two skills, it is easy for others to take advantage of your kindness and willingness to help.
Although there is nothing wrong with helping others, it can be problematic when it comes at the expense of your health. You can only give what you can give yourself first.
Ask for Support When Needed
To use a popular self-care metaphor, you cannot pour from an empty cup. To give yourself to others, you need to refill your cup. This may sometimes require asking for support.
Although you may not want to feel like a burden, consider the fact that you would likely do the same favor for the person you are asking. You are just as worthy of support. As much as our modern world instills the value of independence, this is an unrealistic standard since we all depend on one another somehow.
Let Go of Toxic Relationships
You become most like the people with whom you surround yourself. If you find you are becoming cynical and resentful, consider the influence of those around you. It is tempting to get pulled into gossip and negativity, but like junk food, the short-term benefits outweigh the long-term costs.
Letting go of toxic relationships does not necessarily mean avoiding or confronting people. Instead, it means refocusing your attention on those that matter most, letting others be.
Meaningfully Connect with Others
Meaningful social connection fulfills our social needs. Loneliness and social isolation are significant contributors to mental health and addiction issues.
This may mean unplugging from your devices and social media for a while, but it could also mean using social media in ways that help you better connect with others. I explore this dynamic further in my article, “Is Social Media Making Us Less Social?”.
This form of self-care requires using effective psychological strategies to maintain mental resilience. This involves mindfulness, personal boundaries, and clarity regarding your values.
Focus on the Present
Worrying about the future or ruminating on the past takes you away from the present moment. Since the present moment is the only place you can effectively deal with issues that arise, worry and rumination threaten self-care, keeping you stuck in your head.
One helpful exercise consists of directing your attention to the sensations in your body. Notice the sensation of your body in the chair, notice your feet on the floor, and notice the rise and fall of your breath. See my article on How to Stop Living in Your Head for more exercises.
Get Clear on Your Values
Are you in the habit of asking yourself what you want? We can sometimes go through periods of focusing so much on others that we lose touch with our own values.
For example, if you value creativity, how can you bring this value into your daily life more often? If you value authenticity, how can you bring this quality to each interaction? Without clarifying your values, it is easy to lose touch with your own sense of self, finding yourself merely responding to the environment’s demands.
Take Time for Yourself
Carving out alone time is a crucial feature of any self-care plan. If you have a busy lifestyle with several responsibilities, it may be challenging to find the time. This is where the interpersonal self-care tips come in.
Are you overbooked because you have been unable to say “no”? Are you unwilling to accept support when necessary? If you cannot find time for yourself, resort back to the interpersonal self-care skills for personal boundaries.
Focus on What You Are Grateful For
Gratitude may feel like one of those self-care buzzwords. We know it’s good for us, but we don’t think about it too often. The reason why gratitude has acquired such a strong reputation as the greatest virtue is due to the strong research backing its effectiveness:
“…people who were asked to write a gratitude letter once a week for three weeks were significantly happier, less depressed, and more satisfied with their lives at the end of the intervention.”
Physical self-care is an essential but often neglected way to improve one’s mental health. Since the mind and body are so intertwined, optimizing one’s diet, exercise, and sleep, vastly improve mental resilience.
Spend Time Outside
Spending time outdoors is an easy way to get natural vitamin D from moderate exposure to the sun. Roughly twenty minutes of mid-day exposure to the sun can have a significant impact on your well-being. Research demonstrates the power of vitamin D for mental health:
“…treatment of inadequate vitamin D levels in persons with depression and other mental disorders may be an easy and cost-effective therapy which could improve patients’ long-term health outcomes as well as their quality of life.”
Incorporate Some Form of Exercise
The American Psychological Association released an article stating psychologists have often neglected the power of exercise in their practice. They summarize a study on the effect of exercise on Major Depressive Disorder (MDD), concluding:
“The efficacy of exercise in patients generally seems comparable with patients receiving antidepressant medication, and both tend to be better than the placebo in patients with MDD.”
Incorporate Healthy Dietary Habits
Limiting sugar intake may be the single best way to immediately improve one’s mental health. High levels of sugar consumption are associated with anxiety, depression, dementia, and several other illnesses. A study on sugar intake and mental health found:
“…men in the highest tertile of sugar intake from sweet food/beverages had a 23% increased odds of incident [common mental disorder] CMD after 5 years.”
Get Quality Sleep
We’ve all heard the familiar rule that we should be getting at least 8 hours of sleep each night. This is generally a rough guideline, and each individual requires a different amount of sleep.
Beyond the amount of sleep, quality of sleep is just as important. This means sleeping in a dark room without disruptions and maintaining a regular sleep schedule. A report by Harvard Health states:
“…sleep disruption — which affects levels of neurotransmitters and stress hormones, among other things — wreaks havoc in the brain, impairing thinking and emotional regulation. In this way, insomnia may amplify the effects of psychiatric disorders and vice versa.”
Engaging in interpersonal, mental, and physical self-care has numerous mental health benefits. Beyond the mental health benefits, self-care allows you to be the best version of yourself so that you can more effectively be of service to others. If you value helping others, the best way to do so is by helping yourself first.
This is the same reason why persons on an airplane are directed to put their own oxygen mask on first. You can’t be of use to anyone else if you can’t breathe.
Hopefully, these tips have helped and inspire you to take action on a path toward improved self-care. If you’re interested in checking out my other articles on mental health, you can find those articles here.
Persons with mental health or addiction issues often deal with stigma. In turn, stigma negatively affects mental health. This downward spiral makes it harder to seek treatment, leaving people feeling even more socially isolated.
Stigma consists of a label used to exclude an individual, causing them to internalize this label as part of their identity. They generally consist of labels based on negative stereotypes about a specific demographic. For example, the word “junkey” can be stigmatizing for persons with an addiction. So how does this affect someone’s mental health?
Stigma affects mental health by inflicting further harm on already vulnerable populations. A person may internalize a stigmatizing label, causing further isolation, distrust, and low self-esteem, resulting in increased anxiety or depression.
Anxiety is the fight or flight response to stigma, whereas depression is the purposelessness and hopelessness resulting from this downward spiral.
In this article, I share the experience of Stephanie, a fellow recovery advocate who experienced a great deal of stigma during active use and recovery.
How Stigma Triggers Anxiety
Persons already suffering from mental health or addiction issues often experience anxiety. A stigmatizing social environment amplifies this anxiety. As Stephanie states:
“When I got off the drugs my anxiety went right through the roof. It told me I was a mess and no good and that it would be years before I ever was trusted or treated “normal”. When people stigmatized me, it confirmed those anxious thoughts for me. A lot of my recovery work has been on my anxiety. It was bad before I used, but after it was worse.”
While in a vulnerable state of recovery, she had to navigate family, friends, and professionals who treated her differently due to her addiction. She states:
“It’s not so much what they said as how they treated me. They were cold and avoided conversations with me. There were a lot of snide comments about how I should make better choices… everybody wanted to make sure I understood how much I hurt the people around me… they didn’t seem to think I knew.”
This sense of being different from everyone else leaves a person feeling isolated. Without a sense of social support, persons who are already vulnerable experience increased anxiety, particularly in social situations. As Stephanie states:
Social situations could mean answering a lot of questions based on stigmatic things people heard and believed about addiction. It could mean people talking horribly about me because of the life I previously led. It could mean running into people from my past that could tell others around me that didn’t know… because of the stigma and negative perceptions, I had horrible anxiety when having to go into social situations. Until I was strong enough to use an education “shield” to deflect the anger towards the stigma and educate the person using the stigma, I would avoid all social settings at all costs.
As the isolation and anxiety spiral further, it makes it increasingly difficult for a person to pull themselves out of this difficult place.
How Stigma Affects Identity
As stigma takes over one’s identity, a person begins to internalize stigmatizing labels. This process can also be called “self-stigma”. The labels become anxious thoughts, replaying like a broken record. Stephanie’s mind raced with self-stigmatizing thoughts:
“You are a fuck up… You cant do this… You are not good enough… No one likes you… You can’t work… You’re stupid… You won’t get better… You will never stop… No one will take you seriously… Everyone is better off without you…”
This self-stigma is further reinforced when interacting with others who make off-handed remarks regarding any of these anxious thoughts. Stephanie felt like she was living in a constant state of judgment:
“It made it worse and harder to navigate the world. I was afraid that everyone would hate me. I was always second-guessing everything I did and how people perceived me.”
This prevented her from being able to reach out for help. Living in this state of anxiety led her to believe there was no way out:
“I was hopeless and believed that I would not be able to get help. In my own head, I was a lost cause.”
What Stigma and Anxiety Have in Common
Stigma and anxiety are both based on fear. We fear the unknown, and a person using stigmatizing language often does not know or understand the experiences of those they stigmatize.
Beyond the realm of mental health and addiction, we can find a great deal of stigma in the politics of immigration. Before the pandemic captured all of the headlines, immigration was one of the biggest global issues. This included issues like Brexit, Trump’s statements regarding Mexicans and other minority groups, and the surge in nationalism.
Stigma does not often come from true hatred. Even when hatred does exist, the issue goes much deeper. Beyond hate, anger, and frustration, you can often find fear. Immigrants and other minority groups can provoke fear among those who lack familiarity with such groups.
When we feel threatened by economic uncertainty, fear often gets projected outward as anger. Immigrants and other minority groups often become scapegoats for this fear.
Now, more than ever, we need to keep our fear in check. As we navigate a world full of heightened fear of contagion, we need to consider the humanity of others, rather than resorting to broad stigmatizing labels.
Stigma affects the mental health of persons who are already vulnerable by further instilling a sense of social isolation. This social isolation increases social anxiety, potentially leading to internalized self-stigma. Self-stigma makes recovery increasingly challenging as it becomes reinforced by others, leading to further marginalization and a sense of hopelessness.
Recovering from stigma requires separating yourself from the negatively spiraling self-reinforcing thought loops. Rather than identifying with a self-stigmatizing thought, greet it like an old friend, welcome it in, and tell it you have more important things to focus on right now. Then focus on those more important things, letting it be.
Recognize persons who perpetuate stigma are often doing so based on fear or ignorance. Their reactions to you say more about them than about you.
Lastly, stigma makes it difficult to trust others enough to reach out for support. This is a large part of what kept Stephanie stuck in her addiction. When she gained the courage to reach out for help, she broke the power of stigma, finding a supportive treatment facility. Through the support of staff at Aegis Health Group in Windsor, Ontario, she was able to rebuild trust, coping skills, and the confidence to succeed in her recovery.
Unfortunately, many people do not encounter supportive professionals the first time they reach out. Like so many others, Stephanie had to reach out to various sources before finding the right fit for her. If you have been unable to find the right support, persistence will likely pay off when you find the right fit. I discuss this topic further in my article here.
If you would like to learn more about Stephanie’s story of recovery from addiction, you can find it in my article here. If you want to reach out to her, you can contact her on her personal Facebook page here.
If you recently met with a therapist and felt let down by the experience, you are not alone. Working in the field, I have seen far too many clients finally reach out for help, only to be met with an ineffective, unprofessional, or inexperienced therapist. These experiences destroy trust and reinforce a sense of hopelessness, making the problem worse.
There are many good therapists, but they are often hard to find. The field of counseling and psychotherapy is filled with many different types of professionals, specializing in many different areas, with a wide range of quality and skill. So why is it so hard to find a good therapist?
It can be challenging to find a person who specializes in a specific area of concern. Also, there are many ineffective therapists, so persons seeking therapy need to be critical of the support they are receiving.
This article dives into this important issue, helping you understand why it’s often challenging to find the right therapist, in addition to offering practical suggestions on how to find a good therapist.
Not all Therapists are Specialists
One of the primary reasons many people have difficulty finding the right therapist is due to a lack of specialization. Many practitioners focus primarily on anxiety and depression.
According to a survey by the American Psychological Association, just over 40% of practitioners say they “very frequently” treat anxiety, compared to around 5% for addictions, and under 5% for Obsessive-Compulsive Disorder.
Finding someone who specializes in your specific area allows for better-targeted treatments, easier rapport regarding the specifics of your experience, and potential referrals to more relevant resources such as peer-support groups.
Although generalists can be helpful when using evidence-based treatment approaches, a specialist has developed a keen eye for spotting specific useful details. For example, someone who specializes in addiction may have a better sense of the particular types of denial and have more practice in the art of effective communication when dealing with resistance or fluctuating motivation.
I recommend finding a specialist who has a strong track-record helping people with your specific type of issue. In the past, it could be difficult to find a specialist in your local community, but in a world of ever-expanding online options, specialists are becoming increasingly more accessible.
Online counseling is an effective way to access specialized treatment. The scientific literature also confirms it is as effective as face-to-face counseling, as I shared in my article on online counseling. If you are looking for online support, I have provided a list of resources here.
Choosing the Right Specialist
Not understanding the different forms of specialization is another reason why it can be so challenging to find the right support. This is usually a result of lacking familiarity with the field of psychology and the other helping professions.
I’ve often heard people say they tried seeing a therapist but was simply only handed a bunch of pills and didn’t feel genuinely listened to. When I hear prescriptions are involved, my first question is usually, “did you see a psychologist or a psychiatrist?” Although they sound similar, they are very different types of specialists.
Here is a quick and simple breakdown of the various types of specialists. Since regulations vary by country and jurisdiction, I will provide a broad overview of the field:
Psychologists: These are persons with a doctoral degree in psychology who are licensed to diagnose mental disorders and treat them with psychotherapy. They are generally specialized in a specific form of therapy, focused on specific types of issues, and they do not prescribe medications.
Psychiatrists: These are medical doctors who focus on diagnosing and treating mental disorders with medications. Distinct from psychologists, their interactions with patients are far more evaluative and focused on selecting the proper medication to fit the disorder. Although the majority do not, some may offer therapeutic support.
Both psychologists and psychiatrists can use “Dr.” in their prefix, but psychologists hold a PhD (Doctor of Philosophy) or a PsyD (Doctor of Psychology), whereas psychiatrists hold an MD (Medical Doctor).
Mental Health Counsellors: These are persons with at least a Master’s Degree in psychology who are licensed to practice psychotherapy and treat issues similar to a psychologist. Mental health counselors offer therapeutic treatments similar to psychologists and may also specialize in a particular area.
Marriage and Family Therapists: These are professionals who generally hold at least a Master’s Degree, specializing in psychotherapy for couples and families. They focus on relational issues and look at family systems.
Social Workers: These are professionals who generally hold an Undergraduate Degree or Master’s Degree in social work and may receive licensure or registration by a governing body. There are a wide variety of social workers.
Those with an Undergraduate Degree who are licensed or registered can deliver counseling services but often work for public agencies as case managers delivering social services including assistance with employment, housing, and protecting vulnerable populations.
Those with a Master’s in social work who become licensed or registered generally specialize in an area and can offer psychotherapeutic treatment, similar to a Psychologist.
Addiction Counselors: These are professionals who generally have a college certificate in chemical dependency, in addition to having several years of experience working in the field, focusing specifically on treating addictions.
This is a broad overview of the main types of therapists and counselors. Although each type of professional focuses on slightly different areas, it is possible to benefit from using many at the same time.
For example, you may see a psychologist to treat trauma, while seeing a psychiatrist to address chemical imbalances in your brain. You might also see a social worker who specializes in housing while seeing an addiction counselor to help cope with an addiction.
Knowing the difference between each type of professional helps manage your expectations, in addition to knowing which form of support best fits your needs.
In terms of my own background, I fit into the addiction counselor category. I received a PhD in sociology, which does not allow me to practice as a Psychologist. My career path is relatively unique since most Sociologists stay in research rather than working with people directly. To read more about my own unique path into the field, I tell my story here.
There are many Ineffective Therapists
Sadly, this is one of the biggest reasons why people find it so hard to find a good therapist. I’ve heard of too many cases where people had terrible experiences with therapists, leaving them feeling hopeless and destroying their trust.
Each time I hear these stories, I feel deeply sad for the individual who perhaps took their first step toward recovery, trusting another person with the most private details of their lives, only to be confronted by accusations, a lack of empathy, or the use of ineffective practices that do not suit their specific issue.
There are effective and ineffective practitioners at all levels. Someone’s role, specialization, education, and experience does necessarily make them an effective therapist. There is actually a study in the Journal of Counseling Psychology showing that a practitioner’s amount of experience does not predict positive client outcomes.
The most ineffective therapists can do active harm to clients. As Cris Reed shares on Quora:
I have seen A LOT of psychiatrists/psychologists/therapists/what-have-yous. Sadly, the vast majority of them just didnâ€™t give a shit. I had a therapist that started checking her watch two minutes into an hour long therapy session, before weâ€™d even talked about anything.
She continues, sharing the following regarding her medication:
…the psychiatrist who took me off meds that were working, put me on ones that didnâ€™t work, refused to listen to me, or my husband, or my THERAPIST that the pills were making me suicidal, just kept increasing the dose… I know someone else who saw him for some very serious issues and he told her she just needed to pray.
Although these may sound like isolated incidents, they are not. Situations like this are far too common. I’ve heard of many instances where mental health professionals have been actively destructive to their clients.
Fortunately, I have seen more examples of effective therapists than ineffective ones. It may be difficult to find the right type of practitioner with the right level of skill and compassion, but it is possible with a bit of effort and insight into what to look for in a good therapist.
How to Find a Good Therapist
Ask someone you trust. If you know someone who has sought support for mental health or addiction issues, it could be helpful to inquire about their experiences with therapists. If they had a positive experience with a particular person, this does not guarantee you will also connect the same way, but it increases the odds of finding the right fit.
See if you can schedule a free consultation. Many therapists offer free 10-15 minute phone consultations. This allows you to get a good sense of their interpersonal style and whether or not this is someone you will feel comfortable with.
Ask questions about their approach. Although merely feeling comfortable with this person is a significant factor in therapeutic success, you also want to know if they use evidence-based practices. Some of these may include Cognitive-behavioural Therapy, Acceptance and Commitment Therapy, Dialectical-behavioural Therapy, and various mindfulness-based techniques.
Trust your instincts. If you feel like something is not right, take a step back and follow your gut feeling. A therapeutic relationship should feel very comfortable, despite the difficult subject matter. The therapeutic process will feel like a challenge, but the relationship needs to be based on comfort, mutual respect, and trust. If there is any question of whether or not you can fully trust this person, it is time to reassess your therapist.
Notice red flags. If you’re not familiar with therapy, these may be easy to overlook. Some red flags include the following:
- They form a description of your issue that does not feel accurate
- Blaming, shaming, or judging you
- They share too many personal details, rather than focusing on you
- They seem inexperienced in your area of concern
- You feel pressured to accept their version of reality
- They are not open to feedback
- They seem distracted during the session
- They give too much praise and reassurance
Although this last point about positive feedback may seem counter-intuitive, praise and reassurance can sometimes serve as a way of making the client dependent on the therapist for external validation, rather than dealing with deeper issues regarding self-esteem.
An over-reliance on positive affirmations may also be a red flag since research demonstrates they are not generally effective. For more on this topic, see my article: Do Positive Affirmations Work? A Look at the Science.
Use clear and assertive communication. It is okay to say you disagree with your therapist. If they interpret your situation in a way that doesn’t feel right, it is okay to correct them or share that you feel misunderstood. You are in control and can decline to discuss specific topics until you are ready. Also, if something is not working, you can request trying a new approach. If your therapist is not receptive to appropriate feedback, it might be time to reassess the working relationship.
Switch therapists, if you’re not feeling supported. It is perfectly normal if you do not find the right therapist the first time you reach out for support. I have seen several instances were people have sought help from three or more therapists before finding one suitable for them. Like dating, you may not find the right fit early on in your search, but if you are persistent, finding the right person makes all the difference.
Where to Find a Therapist
Ask Local Service Providers. If you are not familiar with the services available locally, try reaching out to a local agency to inquire about the type of services they offer, in addition to other services available locally.
Persons who work in the field will generally have a strong understanding of quality services that might fit your needs. Another benefit of local agencies is that many are government-funded and therefore offer support for free or at a reduced cost. One drawback to receiving government-funded support may be long wait times.
You can find local mental health agencies by doing a quick google search, or you can check out MentalHealth.gov if you are in the US.
Use the Psychology Today Directory. This is a listing of therapists and counselors who offer private support, meaning their services are generally not publicly funded. If you have health insurance, a portion of their services may be covered.
The main benefit of using this directory is the ability to search for a local specialist, in addition to filtering results by type of insurance coverage. Another advantage is the lack of wait times and the ability to immediately reach out to several different professionals who may provide a free phone consultation.
If you are interested in checking out the Psychology Today Directory, you can find it here.
Try online counseling services. Online counseling services such as BetterHelp.com offers online support via text, audio, and video calls. They are not publicly funded, nor do they generally accept insurance coverage.
The main benefit of online counseling services is their accessibility, ease of access, lower cost, and the ability to switch counselors any time with a simple click of a button. Like any service provider, the range of counselor quality varies widely, so it is essential to look for red flags and change counselors until you find the right support.
No amount of education, training, or certification can weed out every ineffective therapist. I cringe every time I hear horror stories, hoping these experiences don’t cause people to give up hope.
With enough persistence and a bit of luck, you will likely find the right support. Ask someone you trust, reach out to a local organization, or use online directories to search for specialist support.
If you have any questions, feel free to contact me or leave a question below this article, and I will personally do my best to assist.