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.
On the go? Listen to the audio version of the article here:
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.
On the go? Listen to the audio version of the article 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.
On the go? Listen to the audio version of the article 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.
On the go? Listen to the audio version of the article here:
If you recently met with a therapist and felt let down by the experience, you are not alone. Working in the field, I have seen far too many clients finally reach out for help, only to be met with an ineffective, unprofessional, or inexperienced therapist. These experiences destroy trust and reinforce a sense of hopelessness, making the problem worse.
There are many good therapists, but they are often hard to find. The field of counseling and psychotherapy is filled with many different types of professionals, specializing in many different areas, with a wide range of quality and skill. So why is it so hard to find a good therapist?
It can be challenging to find a person who specializes in a specific area of concern. Also, there are many ineffective therapists, so persons seeking therapy need to be critical of the support they are receiving.
This article dives into this important issue, helping you understand why it’s often challenging to find the right therapist, in addition to offering practical suggestions on how to find a good therapist.
If you or someone you know is struggling with mental health or addiction issues, you can check out my resource page for suggestions on how to find help.
Not all Therapists are Specialists
One of the primary reasons many people have difficulty finding the right therapist is due to a lack of specialization. Many practitioners focus primarily on anxiety and depression.
According to a survey by the American Psychological Association, just over 40% of practitioners say they “very frequently” treat anxiety, compared to around 5% for addictions, and under 5% for Obsessive-Compulsive Disorder.
Finding someone who specializes in your specific area allows for better-targeted treatments, easier rapport regarding the specifics of your experience, and potential referrals to more relevant resources such as peer-support groups.
Although generalists can be helpful when using evidence-based treatment approaches, a specialist has developed a keen eye for spotting specific useful details. For example, someone who specializes in addiction may have a better sense of the particular types of denial and have more practice in the art of effective communication when dealing with resistance or fluctuating motivation.
I recommend finding a specialist who has a strong track-record helping people with your specific type of issue. In the past, it could be difficult to find a specialist in your local community, but in a world of ever-expanding online options, specialists are becoming increasingly more accessible.
Online counseling is an effective way to access specialized treatment. The scientific literature also confirms it is as effective as face-to-face counseling, as I shared in my article on online counseling. If you are looking for online support, I have provided a list of resources here.
Choosing the Right Specialist
Not understanding the different forms of specialization is another reason why it can be so challenging to find the right support. This is usually a result of lacking familiarity with the field of psychology and the other helping professions.
I’ve often heard people say they tried seeing a therapist but was simply only handed a bunch of pills and didn’t feel genuinely listened to. When I hear prescriptions are involved, my first question is usually, “did you see a psychologist or a psychiatrist?” Although they sound similar, they are very different types of specialists.
Here is a quick and simple breakdown of the various types of specialists. Since regulations vary by country and jurisdiction, I will provide a broad overview of the field:
Psychologists: These are persons with a doctoral degree in psychology who are licensed to diagnose mental disorders and treat them with psychotherapy. They are generally specialized in a specific form of therapy, focused on specific types of issues, and they do not prescribe medications.
Psychiatrists: These are medical doctors who focus on diagnosing and treating mental disorders with medications. Distinct from psychologists, their interactions with patients are far more evaluative and focused on selecting the proper medication to fit the disorder. Although the majority do not, some may offer therapeutic support.
Both psychologists and psychiatrists can use “Dr.” in their prefix, but psychologists hold a PhD (Doctor of Philosophy) or a PsyD (Doctor of Psychology), whereas psychiatrists hold an MD (Medical Doctor).
Mental Health Counsellors: These are persons with at least a Master’s Degree in psychology who are licensed to practice psychotherapy and treat issues similar to a psychologist. Mental health counselors offer therapeutic treatments similar to psychologists and may also specialize in a particular area.
Marriage and Family Therapists: These are professionals who generally hold at least a Master’s Degree, specializing in psychotherapy for couples and families. They focus on relational issues and look at family systems.
Social Workers: These are professionals who generally hold an Undergraduate Degree or Master’s Degree in social work and may receive licensure or registration by a governing body. There are a wide variety of social workers.
Those with an Undergraduate Degree who are licensed or registered can deliver counseling services but often work for public agencies as case managers delivering social services including assistance with employment, housing, and protecting vulnerable populations.
Those with a Master’s in social work who become licensed or registered generally specialize in an area and can offer psychotherapeutic treatment, similar to a Psychologist.
Addiction Counselors: These are professionals who generally have a college certificate in chemical dependency, in addition to having several years of experience working in the field, focusing specifically on treating addictions.
This is a broad overview of the main types of therapists and counselors. Although each type of professional focuses on slightly different areas, it is possible to benefit from using many at the same time.
For example, you may see a psychologist to treat trauma, while seeing a psychiatrist to address chemical imbalances in your brain. You might also see a social worker who specializes in housing while seeing an addiction counselor to help cope with an addiction.
Knowing the difference between each type of professional helps manage your expectations, in addition to knowing which form of support best fits your needs.
In terms of my own background, I fit into the addiction counselor category. I received a PhD in sociology, which does not allow me to practice as a Psychologist. My career path is relatively unique since most Sociologists stay in research rather than working with people directly. To read more about my own unique path into the field, I tell my story here.
There are many Ineffective Therapists
Sadly, this is one of the biggest reasons why people find it so hard to find a good therapist. I’ve heard of too many cases where people had terrible experiences with therapists, leaving them feeling hopeless and destroying their trust.
Each time I hear these stories, I feel deeply sad for the individual who perhaps took their first step toward recovery, trusting another person with the most private details of their lives, only to be confronted by accusations, a lack of empathy, or the use of ineffective practices that do not suit their specific issue.
There are effective and ineffective practitioners at all levels. Someone’s role, specialization, education, and experience does necessarily make them an effective therapist. There is actually a study in the Journal of Counseling Psychology showing that a practitioner’s amount of experience does not predict positive client outcomes.
The most ineffective therapists can do active harm to clients. As Cris Reed shares on Quora:
I have seen A LOT of psychiatrists/psychologists/therapists/what-have-yous. Sadly, the vast majority of them just 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.
On the go? Listen to the audio version of the article here:
The other day I decided to take a look at the scientific evidence on counselling. As a counsellor myself, I’ve seen it work, but I was curious about what others are saying. I searched the phrase, “does counselling work?” and was surprised by the top result. An article in the Independent stated that although counselling works in the short-term, it has no long-term benefits.
Shocked by the conclusion, I dug deeper, looking into the studies they cited, in addition to doing my own review of the literature. I discovered that the studies on the short-term benefits of couselling did not provide an accurate picture of the evidence and did not consider the various forms of counselling.
After digging deep into the scientific literature on whether or not counselling works, I came to the following conclusion:
Counselling works in the short-term and long-term, so long as it is practiced by a skilled counsellor using evidence-based techniques, in addition to having strong empathic interpersonal abilities to facilitate a supportive therapeutic relationship.
As a counsellor, I’ve personally seen many long-term transformations, but as a researcher, I know I cannot rely on anecdotal evidence. This article is a summary of my review of the literature.
The titles of each study cited below are hyperlinked if you would like to read more.
Counselling Works in the Short-term
The scientific evidence unequivocally supports the effectiveness of counselling in the short term. Several high-quality studies point to these benefits.
The following Cochrane Review concludes that counselling works in the short-term but not in the long-term:
Counselling for mental health and psychosocial problems in primary care
Counselling is associated with significantly greater clinicalÂ effectiveness in short-term mental health outcomes compared to usual care, but provides no additional advantages in the long-term.
Why might there be no evidence for long-term effectiveness?
The above review focuses on a narrow definition of counselling, distinguishing it from cognative-behavioural therapy. This is problematic since many counsellors practice cognitive-behavioural approaches and other evidence-based techniques.
The following study also finds short-term benefits but fails to demonstrate long-term benefits by relying on a similarily narrow definition of counselling:
Acupuncture and Counselling for Depression in Primary Care: A Randomised Controlled Trial
In this randomised controlled trial of acupuncture and counselling for patients presenting with depression, after having consulted their general practitioner in primary care, both interventions were associated with significantly reduced depression at 3 months when compared to usual care alone.
The following systematic review and meta-analysis reinforces the evidence on the short-term effectiveness of counselling, but again distinguishes it from evidence-based mental health interventions such as cognative-behavioural therapy:
The clinical effectiveness of counselling in primary care: a systematic
review and meta-analysis
Counselling is associated with modest improvement in short-term outcome compared with usual general practitioner care, and thus may be a useful addition to mental health services in primary care.
The following study focuses on the effectiveness of counselling for quitting smoking, finding compelling benefits after six months:
Does individually-delivered counselling help people to stop smoking?
Combining the results of the studies showed that having individual counselling could increase the chance of quitting by between 40% and 80%, compared to minimal support.
The above evidence demonstrates the effectiveness of counselling at the three to six-month mark. Let’s now consider studies on the benefits of counseling in the long-term.
Counseling Works in the Long-term
This longitudinal study followed up twenty-one months after counselling ended, finding the positive effects were maintained:
A naturalistic longitudinal evaluation of counselling in primary care
Patients who received counselling made highly significant improvements compared with those on the waiting list. These improvements were maintained throughout the long-term follow-up. This would indicate that generic counselling has positive effects that can be maintained for a long period of time after counselling has been completed.
The following study delves into the specific processes responsible for the long-term effects of counselling:
The long-term effects of counselling: The process and mechanisms that contribute to ongoing change from a user perspective
Mechanisms integral to sustained impact were: the active engagement of people during and between sessions to work toward their own solutions; and acquisition through the change process of skills which could be further built on after the counselling ended.
This means counselling works in the long-term when client autonomy is supported. This means having clients practice skills between sessions, which can be applied independently after counselling is complete.
Evidence for Various Types of Counselling
The studies supporting the short-term benefits of counselling generally defined it as a client-centered emotionally supportive role, neglecting the fact that many counsellors are qualified practitioners of various evidence-based techniques.
The following study demonstrates the long-term benefits of cognitive-behavioral approaches:
CBT as an adjunct to usual care that includes antidepressants is clinically effective and cost effective over the long-term for individuals whose depression has not responded to pharmacotherapy. In view of this robust evidence of long-term effectiveness and the fact that the intervention represented good value-for-money, clinicians should discuss referral for CBT with all those for whom antidepressants are not effective.
The above study demonstrated positive effects over forty-six months. The long-term effectiveness of this approach may be attributed to its emphasis on facilitating independent coping skills. Once practiced, clients can continue to use these skills when counselling has ended.
Internalizing effective coping skills may be the key to long-term effectiveness. This is reinforced by studies on the effectiveness of self-help methods. According to thirty-three studies in A meta-analytic study of self-help interventions for anxiety problems, using self-help methods without having engaged in counselling can also be effective long-term.
Beyond a cognative-behavioral counselling approach, several other forms of counselling also have strong evidence for their effectiveness.
According to a meta-analysis of eighty-six studies on the effectiveness of humanistic therapies, this approach shows substantial stable gains over time:
In randomized clinical trials with comparative treatment control clients, clients in humanistic therapies generally show amounts of change equivalent to clients in nonhumanistic therapies, including cognitive behavioral therapy.
Motivational Interviewing is the most recent counselling approach based on a humanistic foundation and is particularly effective for addiction. For the evidence on the effectiveness of its approach see the following list summarizing the research: Systematic and Meta-Analyses of Research on Motivational Interviewing
Lastly, the most recent form of behavioral therapies are also strongly supported by research. Acceptance and Commitment Therapy is considered a third-wave behavioral approach, focusing on process rather than the content of cognitions. For a list of the 330 randomized controlled trials conducted on this approach, click here.
Does Online Counselling Work?
Since the world has recently turned to online platforms, this question is more relevant than ever. I reviewed the evidence for online counselling in my article Does Online Counselling work?Â and came to the following conclusion:
According to recent evidence, online counselling is effective for treating mental health and addictions. Multiple studies show it is generally as effective as face-to-face counselling and has the benefit of expanding access to mental health and addiction treatment.
For a more detailed review of the evidence on online counselling, check out the full article here where I summarize several high-quality studies on online counselling for mental health and addiction.
There is a large amount of strong evidence pointing to the fact that counselling works in the short-term. Although the evidence is mixed on the long-term effectiveness of counselling, this can be primarily attributed to a narrow definition of counselling that does not include many of the evidence-based techniques cited above.
If you are interested in taking a deeper look at the research on this topic, you can find several studies summarized in this systematic review of the evidence.
Beyond the scientific evidence, I have personally seen the transformative effect of counselling in my work in various roles within the addiction field. Throughout counselling, clients find a safe outlet for expressing difficult thoughts and emotions, in addition to learning how to more effectively cope when these difficulties are present.
Counselling works by helping clients overcome mental barriers to living the life they want. A collaborative counselling relationship fosters a deep sense of trust and mutual respect, helping someone become the best version of themselves.