19 Oct 2008

College Notes for today (October 8th)

It was back to the books for the first part of today's lesson, yes I know, how academic. It was a refreshing change to hit the books, especially after the intensity of Monday's class.
The main textbook we have used this term is "An Introduction to Counselling" By John McLeod. I think the introduction part of the title fools you slightly, as its not an introduction at beginners level, but it is a great textbook. I really need to start reading more textbooks, just so I can get back into reading non-fiction. They never seem to make them as fun as reading Harry Potter.

Anyhoo back to class stuff, Wednesday is theory based, so I will refer back to what we looked at last Wednesday which was relaxation and automatic negative thoughts. This leads onto fear, negative self statements and the use of CBT styled techniques of coping.

Quick Summary of what we covered:
What is CBT about?
1.CBT is less concerned with insight and more orientated towards client action to produce change.
2.Challenging irrational beliefs.
3.Reframing the issues with facts.
4.Rehearsing the use of different self-statements in role plays.
5.Negative self-statements, in a job interview for example "I will fail" or "Here I go again".
6.What helps? Thinking out loud, thought listing etc.
7.Graded hierarchy of fear eliciting situations.
8.Three types of experience associated with high levels of relapse = Downers, rows and joining the club.

Quick Glossary of Terms.
Fear is according to the dictionary:A painful emotion or passion excited by the expectation of evil, or the apprehension of impending danger; apprehension; anxiety; solicitude; alarm; dread.
Negative self statements (Negative self talk) is something I will definitely be coming back to, but basically they are the negative thoughts that pop up in your mind. The thoughts that tell you that its scary, its too hard, no one likes you etc.
CBT is Cognitive Behavioural Therapy.
Agoraphobia The word derives from the Greek, the agora being the market place, or place of assembly, and a phobia being an irrational fear.

Tonight we watched several videos clips of a lady suffering with Agoraphobia and her sessions with a Cognitive Behavioural Therapist.

The sessions:
Firstly the clients background was taken, past medical history etc. This is important because then you can see clearly the clients capacity to cope with things and how motivated they are too change. In this case she was highly motivated for change, enthusiastic and had overcome a lot of things in her past.

What was she afraid of?
1.Fear of falling down, so escalators were particularly scary for her.
2.Fear of flying, falling from the sky.
3.Being a passenger in a car, especially in the front seat. Being on the motorway was especially terrifying.

What happened to cause this fear?
She had fallen badly at the theatre and was treated badly by the staff both at the theatre and hospital. Once she was back at home, she was left in pain, helpless and frustrated, waiting for further treatment.

How is this fear affecting her life?
1.I think the most poignant thing the lady said is "This is making my life smaller". She wasn't going out and socialising any more.
2.Nightmares, both on and off pain medication where vivid and frightening. A recurring feeling of terror, falling and screaming.
3.Husband, depressed and emotional at the thought of losing his partner of 40 years.
4.Wont go back to that hospital ever now, so now pays for private treatment out of her own money.

What can she do?
1.Firstly she needed to practice relaxing, don't force anything. You don't need to close your eyes if you don't want to. Focus on breathing, deep breathing.
Scale your anxiety and then reduce it by using a relaxation technique.
2.Keeping a thought record.
3.Challenging fear head on with trips on a escalator and short car journeys.
4.Breaking the cycle of fear.
5.Reframe the negative thoughts with facts.
6.Realising the Fear is not stupid, its natural to have a bodily response to fear, but is what you are doing really that frightening?

I have not included everything that happened on the videos as that would take me forever to write about, I have just highlighted the things that stuck out the most to me.

I created some flow charts that are, I hope, easy to understand. They are not based on a phobia, but an automatic negative thought that anyone might have.
Click to biggify
(questions in comments, will answer if I can)
Here is the notes I used to create this Doodle
Online stuff that I plan to have a look at further:

1.What is CBT?.
2.Understanding CBT.
3.Anxiety and Panic Attacks.
5.Negative Self-Talk.
6.How do you talk to yourself?.
7.Reserve Negative Self-Talk.
8.What creates Negative Self-Talk.

Interesting Thought: A lion walks into crowded room and provokes a feeling of fear. People are scared, run away, stay frozen on the spot, scream, cry.That's not a stupid thing, its a natural reaction to fear.
That is what anxiety is.
It doesn't have to be Lion though.

Personal Journal Entry:
It was good getting back into the theory side of things and digging into the textbook, something that I know I need more of. CBT style of counselling is something that I have always felt uncomfortable because it seem so direct and less about a good client relationships. Now I am definitely seeing the benefits of this style of counselling. I think this will also benefit me when I am working with clients on placement, as time is going to be limited in some cases and it will provide the client with tools that they equip themselves with.
I still don't really like spending lesson time watching videos, as I feel I would much rather spend this time in skills practice and learning new interventions.


  1. For the fear dragon, I'm thinking a manicure and pedicure, along with a visit to the dentist for porcelin vaniers. Along with your suggestion of wearing pink, might make him/her less scary... ;)

  2. I completely love this new notes thing you are into.. Thanks for sharing :)

  3. Having spent a lot of time working with young people involved with substance abuse and having experienced extended periods of time on prescribed drugs ( for a spinal injury ) - mainly synthetic opiate painkillers and benzo-diazapene's - something that is quite often overlooked is the effect that drugs have on the mind and the way that one's fears etc are magnified/distorted by them. Do patients get any form of advice or counselling about the effects of them? Are they warned of the possibility of paranoia for instance as well as the negative physical effects? At no time have I ever been advised of the mental health implications of the medication I have been given in the past and it has only been my own wariness and desire to find out exactly what I have been prescribed that has helped me to be able to say of a fear, for instance "Aha, No need to panic: It is just the drug" and thus my mind can come to rest once more. If you don't know that you are stoned/tripping it must be very scary.
    Excellent post.

  4. Awesome post! I like the idea of a thought record, rather then calling it a journal. :)

  5. So, Dr Pitt, next time I can see you I can lie on your couch and we can go over my Bigfootitis, right?

  6. OK, who decides what is rational and what is irrational? I'm so glad you're doing this - I so need therapy...

  7. yeah. um. wow. I am in I.O.P. classes specifically for Cognitive Behavioural Therapy.

    maybe one day YOU can be my shrink!

  8. I've had a bit of this but not long enough!
    I'm a horrible negative thinker - I really have to work on that all of the time. It's very true that we are what we think!

  9. I saw you were following me on Twitter so I decided to read your blog - I think posting your college notes is such a good idea! Must really help you to learn a bit more, wish I had thought of that! Anyway, it interests me even more because I have a few 'issues' at times with anxiety and the negative self talk... I'm definitely going to keep reading :)