Tag Archives: cognitive behavioral therapy

Cognitive Behavioral Therapy improves your life.

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Woman thinking

Unhelpful Negative Thoughts create depression.
Photo courtesy of Pixabay.com

Cognitive Behavioral Therapy improves your life.

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

CBT is more than just a therapy.

CBT stands for Cognitive Behavioral Therapy. CBT has proven effective in treating severe mental illnesses, including depression and generalized anxiety. In some controlled studies, CBT therapy has been more effective than medication for treating various mental illnesses. CBT is so effective for treating even the most severe depression that it has become the treatment of choice for depression. For now, I’ll focus on how CBT reduces depression and increases subjective feelings of well-being which we sometimes call happiness or contentment. Just remember that cognitive-behavioral therapy can be highly effective for many other problems of living.

CBT can help you create your good life.

CBT goes beyond simply being a professional treatment for severe mental illness. CBT is effective for treating mild or even subclinical illnesses. The principles of CBT are also effective for helping people with low self-esteem and low self-confidence. In addition, cognitive-behavioral therapy principles are helpful in treating a variety of problems of everyday living, including frustration, guilt, and apathy. While CBT is a theory used by counselors and therapists, many people have been helped simply by reading books and hopefully blog posts that explain the principles of cognitive-behavioral therapy.

The origins of CBT.

CBT began in the late 1950s and early 1960s, though its roots go all the way back to the ancient Greeks. Before CBT, therapy was primarily divided into two distinct camps. Traditional Freudian psychoanalysis was long, involved, expensive, and focused mainly on exploring unconscious drives.

The other major therapeutic camp is the behavioral scientists, who believe that it was possible to shape behavior by reward and punishment. In a strictly behavioral model, the role of what you’re thinking is disregarded as either unknowable or irrelevant. While the stick and the carrot are still popular with some bosses and some educators, we have learned that human behavior sometimes defies the effects of rewards and punishment.

Today over three hundred different therapy theories have been described. Most are either focused on feelings, thoughts, or behaviors. CBT and related counseling theories have become the treatment of choice for depression and are helpful for many other problems.

What are the primary components of CBT therapy?

Cognitive-behavioral therapy focuses on the relationships between your thoughts, feelings, and behaviors. By examining your thoughts, you can learn to alter your feelings and your behavior. Once you know the basic principles of CBT, you will also find that a change in behavior can change feelings and, therefore, your thoughts about the situation. By two different routes, changes in thinking can result in changes in feelings. By following this thinking, your feelings are no longer controlled by outside influences. Now you can choose how you wish to feel about various situations.

How do thoughts play a role in your mental health?

Your cognitions are made up largely of your thoughts and beliefs and your perceptions. Your thoughts create your moods. This process happens very rapidly and goes almost unnoticed. For example, when most people are angry, they believe that someone or something externally made them angry. But when we study the phenomenon of anger more closely, we find that what you believe about what that other person did causes you to become angry. I’ve written more about this connection in some blog posts about anger and anger management.

Don’t fall into the trap of assuming just because you think something it must be true. Not everything you think is true. If you’ve ever seen something on the ground ahead of you, gone to pick it up, and then discovered that it wasn’t what you thought it was, you’ve experienced an example of how thoughts can appear very real even when they are just mistaken beliefs.

There’s also a particular connection between thoughts and the chemistry in your brain. Because of the prevalence of the use of some psychiatric medicines, some people have come to believe that depression is the result of a shortage of certain neurotransmitters in the brain. As we’ve learned more about brain chemistry, we come to find that thoughts are moved in the brain from one neuron to another chemically. Simply having more depressing thoughts reduces the prevalence of certain neurotransmitters, while more happy thoughts increase the prevalence of those neurotransmitters.

Don’t misunderstand. CBT does not propose to change the brain simply by thinking happy thoughts. In addition to a handful of prominent thoughts in your brain at any one moment, there are a host of other automatic thoughts taking place in the background. Humans are cognitive misers. We don’t think out each movement of our hands before we reach for a cup of coffee. The same thing happens when it comes to thoughts about life events. People get into the habit of automatic thoughts, which results in them interpreting life events as either positive or negative. CBT therapy seeks to find those recurring “unhelpful thoughts” and teach you to reevaluate them and dispute those that are not helpful.

People with depression have characteristic patterns of thinking.

Depression in all its various shades and flavors is caused by patterns of pervasive negativity. In general, pessimists are more likely to be depressed, while optimists are more likely to be content with their life. We used to think that personality was pretty well fixed at birth. You were born either a pessimist or an optimist. Research across the lifespan has shown that personality does change, usually at a slow rate, but there are things that you can do to become more optimistic. We can debate whether the pessimist or the optimist sees the world more realistically, but what happens is that the optimist is happier and often more successful.

The negative thoughts which create and maintain depression are often distorted, inaccurate, and unrealistic. Unfortunately, depressed people rarely think to challenge these negative, unhelpful thoughts. Most negative thoughts are distorted, inaccurate, and unrealistic.

So, what can you do if your brain continues to replay negative, unhelpful thoughts?

The first step in the process of defeating depression, anxiety, and other life problems is learning to recognize when you have slipped into a pattern of negative, unhelpful thoughts and then, having recognized them begin to dispute those thoughts.

In some future posts, I want to walk you through the steps of recognizing and disputing unhelpful beliefs, improving your optimism and your outlook on life, and creating the happy, contented, well-functioning life we all deserve.

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now! And more are on the way.

For these and my upcoming books, please visit my Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

For videos, see: Counselorssoapbox YouTube Video Channel

Wrestling unruly feelings to the ground.

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By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Man with feelings

Managing feelings.
Photo courtesy of Pixabay.com

Getting misbehaving feelings under control is a three-step process.

It would be nice if you could keep these pesky feeling-gremlins out of your house and your life in the first place but somehow they keep getting in.

There are techniques for regulating which feeling you let into your place and which you choose to entertain. Those techniques for controlling access to your life are something that we teach and practice in doing Cognitive Behavioral Therapy. More on that later.

Not all negative or painful feelings need to be banished. Some feelings, sadness, anxiety, or loneliness are like distant relatives, fine in small doses, nice to see occasionally just to remind you who they are, but not someone you want moving in and living with you full-time.

But for now what if you discover that some unnecessary negative feeling has taken up residence in your life and you decide this is not cool with you. What do you do?

1. Find the feeling.

This can be a struggle at first. Unhealthy feelings can be like termites. You do not see them but all the while they are eating away at your mental health house.

We often are unaware of what feelings have moved in and taken over our lives until they have begun to be destructive.

Recognize that you are feeling something is the first step in getting these creatures to do our bidding.

Yes, feelings have their purpose. That pain in the neck feeling is telling you that this person is not a healthy relationship for you. Anxiety, that one is trying to keep you safe. If your anxiety tells you to duck when there is gunfire, then it is doing its job. If it tells you to stay home because leaving the house is too scary, tell that anxiety to take some time off.

Makes sure to check all around your body for those feelings. They may be hiding in the pit of your stomach or in your lower back. Not all of those aches and pains are real, physical pain. Some of those are pesky negative feelings that have moved in and are cramping up your nerve cells.

Get those feelings located and you may be able to get them to move to where they can do you some good.

2. Name that feeling.

Women seem to have a genetic advantage here. They have all kinds of feeling words. We men usually are only acquainted with three feelings by their first name. We are “good, bad, or pissed off.”

Learn the difference between excited and anxious. Get to recognize the difference between rage and it’s younger, smaller, sibling irritated.

Getting the right name on the feeling can help you get them to stay where they belong.

3. Apply your feeling control techniques.

There are whole books on how to control or make use of particular feelings. The one that gets the most press is the feeling of anger and its larger relative rage. Those two do a lot of damage.

Learn those ABC techniques for changing the way you interact with those feelings and you will find them better behaved. SAMHSA publishes a cool book on anger management available free from their website. Lots of programs use that book and others.

In CBT therapy we find that it is not always the feeling that is causing the problem. Your beliefs about why people are doing things may be generating lots of extra negative emotions.

Make sure you invite in lots of positive feelings. Having a huge gathering of happiness, acceptance, and patience makes those anger and anxiety feelings uncomfortable enough that they may leave. At least they will hole up in their room and not bother the rest of your feelings.

Are your feelings well-behaved, or do you need to do some work on emotional regulation, getting those feelings back to working for you instead of the other way around?

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

For videos, see: Counselorssoapbox YouTube Video Channel

How is youth mental health treatment different from adults?

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By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Crying child

Youth mental health.
Photo courtesy of Pixabay.com

What are the differences between youth and adult mental health treatment?

There are differences in the way a counselor might work with a child and how they might work with an adult. How to “treat” a mental health problem is a complicated subject. It needs several books to fully describe this, but let me focus here on just a few things that may influence how a professional might try to help with an emotional problem in a child.

The way a counselor works with clients is sometimes referred to as our “theoretical orientation.” How I see your issue determines how I might try to help you. I can’t speak for therapists of other theoretical orientations but I would describe my approach as largely Cognitive Behavioral Therapy, that with a dash of learning theory and occasionally a pinch of narrative therapy.

This stuff is largely “skills-based.” I figure that the client is trying the best they can but that there are things they may not know and if they knew them they could do better. I could try to tell them, sometimes that works but mostly they need some help it trying on new behaviors and seeing what works for them and what does not.

Lots of people have “stories” they tell themselves about them. By story I do not mean that this is either true or false, it just is the way that person explains themselves and their life.

That story might sound like “I am such a loser.” Or “I can’t do anything right.” Kids get one thing wrong and they may start saying that they are a failure. See how having a single story that describes you rather than the thing you were not able to do could color your life experiences?

So adults have more experiences in life and may have more ways of thinking of new stories for their life than a younger person. What I am saying is that I would try as much as possible to tailor my approach to the individual, not some specific category or label.

In career counseling, the approach would be very different in working with a person who had worked at lots of jobs and was just downsized than it might be with a client who was very young and had never had a job.

What are some considerations in creating a treatment for a specific client?

Age is only a small part of the picture.

I would want to know in addition to the client’s age something’s about their abilities and their life experiences. Age, I.Q, and developmental stages are all in the mix. So might things like learning disabilities, intellectual disabilities, and other developmental issues.

The approach for someone who has a form of Autism Spectrum Disorder might be different from a younger person who had a less severe challenge. The key, for me, is really getting to know the person and match my efforts to them rather than memorize a particular formula for a given age, I.Q. or disorder.  Here are some things a therapist might do as the child moves through the lifespan and becomes a young adult, a mature adult, and evenly an older adult.

1. Activities build relationships.

With adults, it is often possible to sit down and have a talk with them. The younger the child, the more the anxiety or the more “inside themselves” they are the more we need to work on forming a relationship.

One way to create that relationship is to do things with the client. (Yes even with a five-year-old I think of this person as a “client.”) How would I have wanted to be approached when I was that age? If I can’t remember ever being that age, I take a guess at what that might have been.

So the counselor might play a game, not to waste time but to get the client to feel comfortable. Even with very adult clients, I find they will say more about their lives when we are doing something than when they are sitting in a chair and I am cross-examining them.

2. Pictures versus words in therapy.

Very young people and some adults are better at seeing than describing, they just do not have the words to tell me their story. I ask them to draw me a picture. A rainbow tells me one thing and a tornado-like creature in black and red tells a very different story.

3. Skills training is important.

You need to practice skills if you want them to be there when you need them. Adults practice golf swings. Younger people may need to practice introducing themselves, making friends, and sharing appropriately. A whole lot of people tell me right up front they have an “anger management problem” they do not seem to understand that managing anger is a skill like most other things in life and you can learn that skill.

The younger or more impaired the person the more they need help in learning appropriate skills.

4. Involvement of your support system makes a difference.

With children or youths, I like to know the involvement of the support system. The more people on your side the better your chances. Some people have a parent or caregiver that can help the client through things. Other young clients have no one on their side.

Sometimes I am working on helping the caregiver to learn to help the youth and other times I am helping the client learn how to cope with their less-than-perfect caregiver.

There are a whole lot of specialized treatments for all sorts of mental, emotional, and behavioral problems that a child may experience. This post has not even begun to look at all those possibilities but I hope it has given you some small idea of the ways in which a professional counselor might be able to help a child or their caregiver through a child’s emotional problems.

If you work with children consider taking the Youth Mental Health First Aid training when it is offered in your area.

Related articles

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

For videos, see: Counselorssoapbox YouTube Video Channel

What kind of person are you? Can people really change?

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By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Change

Change.
Photo courtesy of Pixabay.com

Are people just that way or can they change?

There are certain things about you and about others around you that are just the way people are. There are other things that change with time, with the situation, and with who you decide to be. The trick is to know what about you is just you and what things are possible to change.

There is a world of difference between being an “angry person” and being angry right now.

Some people think that they are always angry, sad, and so on and this provides a rationale for not trying to change. It also can be an excuse for bad behavior.

Someone in your life gets angry, says or does hurtful things, and then later says “that is just the way I am, you know I get angry a lot, deal with it.” It is hard to take that over the long haul. Being always full of negative emotions drives others away.

You may have said that yourself about certain characteristics you see in yourself or others see in you. But is this true or is change possible?

Spoiler alert – I believe people can and do change. They recover from what others have done to them and from what they have done. That change is often not easy and changing may have a price.

One way of understanding this is that who you are and who you can become is the difference between states and traits.

A trait is presumably a stable characteristic.

This can apply to outside characteristics like hair and eye color and to inside qualities like anger or kindness. True you can dye your hair or wear contacts to change your eye color. These efforts to change yourself do not change the underlying you. Some people might say that these efforts fall under the heading of deception or telling lies.

These underlying qualities may change as you get older. One way of explaining this is called gene expression. So the gene that gave someone Black hair in their twenties may give them gray hair in their eighties. Emotional expressions that worked for you at 9 months old will probably not work so well at 90.

Are some people born with particular emotional temperaments? Could you just be born blue-eyed and sad, or brown-eyed and angry? If you were just born that way could you learn to control or regulate those feelings? (CBT therapy and neuroplasticity research tells us this is way more doable than we used to think.)

People are not born with only one feeling. So even the irritable baby who cries a lot sometimes smiles. Angry people have episodes when they are not angry or at least less angry. (Watch for a future post on Reactive Attachment Disorder which talks about the challenges of learning new ways of feeling if you did not learn them at an early age.)

What is causing those feelings to change as situations change?

It is possible for something to “cause” or “trigger” an emotional state. One question that I ask in counseling is “What makes you happy?” And then – “What makes you sad.” Some people can quickly give me lists.

People who say nothing makes me happy, that is a red flag they may have depression.

Research has shown us that the brain continues to grow and create new connections throughout the lifespan. If you learned to be sad or anxious very early in life you can learn new ways of feeling.

Granted if you learn one language as a child and then at eighty try to learn another it is much more difficult but the good part is that no matter what age most people can still learn new information.

Learning to regulate your emotions and to move from an angry state to a calm one is possible if you chose to learn this skill. In fact, you can learn to not get angry in the first place. This does not mean you let people walk all over you and just bite your tongue. You can learn other skills to reduce the causes of your anger also.

If your life is full of anger, anxiety, or sadness you can learn skills to reduce the impact of those feelings on you and to create a new happy life. The cost of this? Some effort on your part and the need to stop making others responsible for how you feel.

To change your emotional life you need to take charge and get to work on new emotional skills. More in upcoming posts on this topic.

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

For videos, see: Counselorssoapbox YouTube Video Channel

Should your therapist tell you what to do?

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By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Therapist

Therapist.
Photo courtesy of Pixabay.com

Do therapists and counselors tell people what to do?

Most counselors and therapists will tell you that they do not, under any circumstances, tell clients what to do. Frankly, I think many of my colleagues are fooling themselves more than they are fooling their clients when they say that they do not tell clients what to do.

There are good reasons to tell someone to do things and there are also good reasons to not tell people what to do. This is especially true in something as close and confidential as the counseling relationship.

Clients have told me that they get very upset with their therapists either because the therapist keeps telling them to do something that is inconsistent with their goals and beliefs or because they ask the therapist what they should do and did not get an answer.

There are three questions to examine here. Why do therapists avoid telling clients what to do? Why after saying they would never do this do they then go ahead and try to influence the client’s behavior in more subtle ways, and lastly why counselors can and should tell clients what to do.

Two reasons why the therapist should avoid telling the client what to do.

The goal of counseling is to help clients learn to solve their own problems. Telling clients what to do “fosters dependence” meaning if we make the decisions for you then you do not learn to make them for yourself.

Rather than telling you what to do the counselor should be helping you learn about yourself, what are your values and goals, and then learn how to make the choices that are right for you, not the ones that are good for the therapist.

Second, it is your life, not ours. I do not want to tell someone to get married or divorced and then have to take the blame for things that turn out badly. We are not fortune tellers and do not know what the future holds. You need to pick the outcome that is best for you. While we may have opinions, they are our opinions.

How therapists try to tell you what to do anyway.

Therapists and counselors have opinions, often strong opinions about things. We see certain things as bad for you and other things as good. Not all professionals agree on which is which.

Some marriage therapists refer to themselves as “Gorilla divorce busters.” They believe that all marriages should be saved. So if you go to them for help, no matter how badly you feel in this relationship expect this professional to try to talk you into working on the relationship and out of getting a divorce.

Some therapists take a pro one gender stance. Lots of times this is a pro-feminist stance. They seem to always align with the woman. The message is the man is the problem, get rid of that guy and things will be better.

Personally, over time my position on these gender issues has changed. Most of the time it is neither person’s fault, and if they get divorced they will each be back with a new partner. Pick a partner and you pick a set of problems. So I encourage them to learn the skills they need for a good relationship and practice this with their current partner first.

I also recognize that sometimes even if both people change, the damage they did to each other may mean that they just can’t be together.

Personally, I have worked with so many people who have a substance use disorder that I tend to think most people need to give the drugs or alcohol up. If the couple has most of their fights while drinking I tend to think we need to talk about Alcohol abuse. If the client says they do not want to quit, I go with that. But next week when they get drunk and hit each other again I may ask about that drinking thing again.

I can think of a bunch of other issues that turn up in counseling that might prompt a counselor who has strong opinions to try to influence their client even after that professional says they never tell their clients what to do. Abortion, Homosexuality, and other sexual behaviors all may evoke that behavior in the therapist.

When should a counselor tell a client what to do?

I think, and I may well be in the minority on this, that there are times the counselor may need to tell the client what to do. I usually do this more in the way of providing information or making suggestions, but the point is clear that I think this is what the client should do.

When might a counselor do that? Mostly when I have some information that the client needs and the client does not have that information, some of this borders on social work. I do not do that but I do clinical counseling and there are similarities.

If the client does not have a job, I might do some testing, talk about their job history, and which was their favorite job, and then I might suggest some careers that would be good for the client. I might also suggest some websites to visit and some ways to revise their resume.

If the client is homeless I might suggest some places to go for housing. I might also revisit the drinking problems and suggest that if they stay sober their housing opportunities increase.

When doing Cognitive Behavioral therapy I may give homework. We sometimes call this “conducting behavioral experiments.” I ask the client to do something and then in the next session we talk about how that went. If they did not do the experiment we talk about what got in the way of doing this exercise.

Most of this “advice-giving” is done when the client is trying to adjust to a change in their life and they just do not know where to go or what to do. This “telling” also works best when it is done in the form of suggestions and the client is free to do or not do these things. Either way, I am willing to keep seeing the client and together we work on finding the solution to their problems that work best for them.

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

For videos, see: Counselorssoapbox YouTube Video Channel

What are evidence based practices?

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By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Counseling questions

Counseling questions.
Photo courtesy of Pixabay.com

Update on the national registry of evidence-based programs and practices, 2/19/18.

SAMHS recently sent out a press release saying please disregard the National Registry of Evidence-based Programs and Practices.

The new administration questions whether some of these programs and practices listed there were added without much real evidence. The original post follows.

What are evidence-based practices?

How many evidenced-based practices are there anyway and why should you care? Should you care if your counselor or therapist is using an evidence-based practice, and what are those things anyway?

The talking cure and case studies.

In the beginning of psychotherapy, it came as a shock that just talking could help someone. Freud came up with a whole lot of ideas about how and why things were creating problems for clients. If you see early childhood sexual conflicts and the unconscious as the source of the patient’s issues you go in one direction.

So as the practice of psychotherapy grew, those practitioners, often called analysts, started trying all sorts of interventions. Some worked and some didn’t and often we had no idea what worked, for whom, and when.

Analytical psychotherapists started writing up case studies about clients they had treated. Then other psychotherapists tried similar interventions and often got different results.

How are we to know what works when? Is it the characteristics of the psychotherapist, the client or the intervention that is causing the results we see?

When someone else pays they care if your treatment is working.

If you are paying for your treatment then you can see whomever you want, but as there became more government and insurance funding we need a way to check and see if what others are paying for is really worth the money.

Some therapists, particularly Cognitive-Behavioral Therapists, believed that if a technique is valid then it should work most of the time and no matter who did the technique. That notion has spurred a lot of research.

What we find is that the larger the group in the study the more reliable the results of the study, all other things being equal. So more and more theories have been studied in larger and larger trials. We are starting to see that some interventions work most of the time, for most people, when the therapist does them correctly.

One way to further this process has been to create a “National Registry of Evidence-Based Practices.” New interventions, treatment manuals, etc. are registered here and as the research is conducted it gets added to this database.

SAMHSA (Substance Abuse and Mental Health Services Administration created a National Registry of Evidence-based Programs and Practices.  

Currently, the registry contains listings for over 300 different programs and practices that are registered and for which reports and evaluations are available. Some of these treatments are much better than others. Some treatments have a few or only one study showing they worked. Other treatments have hundreds of studies and thousands of clients and are much more recognized as worth the cost.

Over time we should be able to see what works and what does not. Understand that no treatment or intervention is guaranteed to cure every client every time. But some treatments are clearly worth their costs and others are rarely of value.

Also, consider that it matters who did the research and how many people were in the sample. A study of two friends does not mean as much as a study of 10,000 randomly selected clients. Not every counselor has the same level of skill. So in evidence-based practices, it would be reasonable to emphasize treatments that are “manualized,” meaning that there is an instruction book and we can see if the therapist is actually giving the client the treatment that is prescribed by a particular evidence-based practice.

While not all evidence-based practices are equal and some of those on our current list are sure to fade away with time, this system of asking practitioners to prove that what they are doing for or with clients is beneficial to those clients is certainly a huge step forward.

A program or practice inclusion does not necessarily mean that a practice works or that it will work all the time with every client. What it does mean is that these programs and practices have documentation to tell others how they should be conducted and research to document when and where they have been effective or not effective.

SAMHSA notes that “NREPP is not an exhaustive list of interventions, and inclusion in the registry does not constitute an endorsement.”

Whatever the drawbacks having a place where providers can go to look for programs and practices that may be helpful in designing treatment programs is hugely helpful in moving the mental health and substance abuse professions forward.

There was a time not that long ago when each place was doing their own thing sometimes with good and sometimes with poor results. We now have better ways of establishing that the treatment provided is generally effective in treating a particular condition.

Some of the programs included in the registry are expensive to get trained and certified and others are free or nearly so. Clearly, some practices were listed by their originators to sell more books and trainings; others are listed because the developer wants people to try them and to promote research. A few of the programs were developed by SAMSA or other government programs and the materials are all available to download for free.

A quick scan of the list came up with some treatments worth looking into.

Brief Marijuana Dependence Counseling

Mental Health First Aid

Seeking Safety

Take a look, and let me know what other Evidenced Based Practices you find interesting.

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

For videos, see: Counselorssoapbox YouTube Video Channel

Where have all the feelings gone? Emotions or rational logic?

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By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Where have all the feelings gone?
Photo courtesy of pixabay.

Good feelings, bad feelings, too many or too few feelings, which is it?

You need feelings skills.

Feelings, sometimes called emotions, are one of the major things that send people to therapy. Learning appropriate feelings skills is a part of recovery regardless of what you are recovering from.

One way to define a goal of therapy is having a happy life. I have liked that definition from the first time I heard it. Some people are in so much pain that having a happy life is beyond their expectations; they might define their goal as having less pain. Reducing pain is, in my opinion, one way of describing “Happying up” your life.

Is it OK to be happy?

Recovering people are often uncomfortable with the whole idea of having a happy life. They have spent a good part of their life chasing happiness by using drugs, alcohol or sex in an effort to make them happy. Society tends to equate a good time or being happy with doing drugs or reaching for something outside yourself to make you happy.

The idea that there is something out there that can make you happy is a great deceiver. It comes as a shock to some of us that you can be happy and have fun without reaching for those outside objects.

True happiness comes from inside. Setting things right with yourself and then the rest of the world can fit in its proper place.

Are you too emotional?

Excesses of negative emotions, anger, sadness, anxiety, and so forth, are the major cause of people who come for treatment. They often define their problem as too many feelings. They say that they are “too emotional.” By two emotional they appear to mean they are flooded by negative, unpleasant emotions.

There are also those who come to the counseling room and report that they are just numb. They have lost the ability to feel anything. Sometimes they self-injure, cut, or mutilate themselves in an effort to feel again.

The great irony of using pain to feel again is that often the cause of numbness has been an intense unbearable pain. The emotional part of the body has shut down the feeling systems to protect these folks from an overload of negative emotions.

To move from an excess of negative emotions or numbness to a place where you can feel happy positive feelings require several things.

Recognize that you are feeling.

You need to get past the numbness by recognizing that you are having feelings. You need to allow yourself to experience emotions. For someone engulfed in pain and negative emotions, this can be overwhelming. We call learning to sit with negative emotions and not be swept away by them “distress tolerance.” Sometimes it is OK to feel bad, just for now. If you can hang on, those bad feelings will subside.

If you want a happier more positive life you also need to be able to recognize the positive emotions when you have them. Some people were taught that it was bad to have feelings. Turns out that avoiding emotions and trying to run you on rational logical principles only is not the solution.

Logic and rational thinking are not always correct. So just going by rules and regulations may not be the answer either.

Just because you believe it does not make it true.

In CBT therapy we spend a lot of time looking at irrational or faulty beliefs. In other forms of therapy, the emphasis is on talking through all your feelings and having someone who can really understand what you are going through. Turns out that depending on the situation both approaches can work and the same person may need to do work both on their feelings and their thinking.

There is also a connection between intuition and using feelings to help you make good decisions. There is also a connection between the various senses and the way in which we all experience our emotions.

In keeping with the theme of this blog, recovery from substance abuse and mental illness and generally having a happy life, we will spend some extra time exploring feelings, the senses, and the role of logic and intuition and having a happy recovered life.

Related articles

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

For videos, see: Counselorssoapbox YouTube Video Channel

DBT Treatment for Borderline Personality Disorder – Dialectic Behavioral Therapy

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By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

DBT therapy – mindfulness.
Photo courtesy of pixabay.

Does treatment for Borderline Personality Disorder work?

Lots of treatments for Borderline Personality Disorder have been tried over the years. One treatment, Dialectic Behavioral Therapy (DBT) has lots of evidence that it works and is effective.

The problem in treating Borderline Personality Disorder.

Lots of clinicians (Counselors and Therapists) do not use DBT and don’t want to learn it. In fact, plenty of clinicians I know don’t even like seeing BPD clients. Some clients don’t like going for DBT either, despite the glowing testimonials we hear from clients who say DBT changed their life.

If DBT is so effective for treating BPD, why do so few clinicians want to use it and why aren’t their lines of clients waiting for treatment?

BPD is a painful disorder. Treating BPD is like treating a burn victim. They are in terrible pain. Just touching them (emotionally) may cause them to feel the pain. Helpers don’t like to hear their clients scream in pain. Clients in pain tend to lash out. Clients with BPD are more likely than other people to lash out at the therapist, walk out of session, and even go out and try to hurt themselves.

Their pattern of unstable relationships is so pervasive that they have difficulty forming a healthy relationship with the clinician. Just when we think we are helping them they may quit treatment and blame the clinician for their increased pain. They are also more likely to file complaints with the licensing board or even a lawsuit because they feel therapy did not help them and now their pain is even worse.

Despite all these issues DBT does work and does help clients with BPD.

About Dialectic Behavioral Therapy (DBT.)

DBT was developed by Marsha Linehan (Ph.D.) at the University of Washington. Her book Cognitive-Behavioral Treatment of Borderline Personality Disorder is a classic in the field and her workbook has lots of useful exercises for clients to use. I have had the pleasure of hearing Marsha Linehan speak a number of times but can’t say I am fully trained on DBT. What follows is my horrifically oversimplified understanding of what DBT is and how it works.

DBT is a blend of Cognitive Behavioral Therapy, that change your thinking, to change your feelings, to change your behavior stuff that I like to use, and “stuff” Marsha Linehan calls mindfulness. The pain from BPD is so intense that the normal reaction would be to run away.

Mindfulness involves stress reduction, meditation, and ways to be able to reduce and tolerate that pain. By reducing the need to run from pain the pain can be shrunk to a manageable size. This skill is called “distress tolerance.”

Since many clients with BPD (maybe all) came from non-affirming environments they struggle with issues of self-worth and self-acceptance. Clients with the full-blown disorder not just some small level of BPD traits have lots of self-harming and self-destructive behaviors which they use to get away from the negative feelings.

Treating DBT has been described as “like driving a car with one foot on the gas and one on the brake.”  It makes for a bumpy ride for both the clinician and the client.

The client needs to learn to accept and like themselves just the way they are. The clinician continually tells the client that they are a worthwhile human just the way they are.

The client needs to change. They need to stop doing those self-destructive, self-sabotaging behaviors, which are keeping them stuck in an unhappy life. Now comes the tricky part.

When the clinician says “I want you to change” the client hears “I am no good and need to change to be accepted.” The clinician then says “You are accepted just the way you are, but I still want you to change.”

The struggle here is to have clients accept that the goal is not for them to be a certain way to be acceptable, but that what we are looking for is “progress not perfection.”  Any good coach or teacher wants to see their student’s progress and do better, that does not mean there is anything wrong with them if they do not become the best at their discipline.

There is a second challenge for those with BPD and those who treat them which DBT seeks to address.

People who have BPD do not live in the meadow full of flowers in the springtime, they live in the hurricane. If they are ever in a calm place, they know this is the eye of the hurricane and the next blast of the storm is a moment away.

Because the volume on their emotions is turned up so loud, there is always the crisis of the day, hour, or minute. When you are living in an emotional hurricane it is hard to think about disaster preparedness.

The clinician who does DBT has to limit the time they spend on today’s crisis so they can work on developing skills to prevent or cope with future crises. This “let’s not talk about your urges to cut on yourself or use drugs right now, let’s work on your skills” attitude is hard for clinicians and clients who are used to that warm fuzzy empathetic listening stuff.

Clients can leave a skills-based session thinking that the counselor didn’t listen to them and doesn’t care. The counselor may worry “what if they do cut or self-harm? Will it be my fault because I wanted to work on stress reduction skills?” Sticking to the skills-building curriculum can be difficult for both.

One ethical principle that clinicians have learned is that it is not helpful to keep the client dependent on their counselor to cope with life. Our goal should be to get the client to the place where they can function without the clinician. Sometimes that is uncomfortable for both client and counselor.

So DBT is very useful in treating BPD because it increases the client’s self-confidence and self-esteem while teaching them the skills to believe they can cope with life’s problems without having other people do it for them.

Other posts on Borderline Personality Disorder include:

What is Borderline Personality Disorder?

What causes Borderline Personality Disorder?

Levels or types of Borderline Personality Disorder

Treatment for Borderline Personality Disorder

If any of you have been to someone for Dialectic Behavioral Therapy or have had another treatment for Borderline Personality Disorder, would you be willing to leave a comment and tell us how it worked or didn’t work for you?

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

For videos, see: Counselorssoapbox YouTube Video Channel

Overcoming anxiety by computer

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By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Computer

Internet.
Photo courtesy of Pixabay.com

Treating anxiety by Computer.

There is an interesting new study on an experimental treatment for anxiety using an interactive computer program. The study, done in Israel and partially funded and conducted by U. S. researchers looked at treating teenagers for anxiety using a new computerized treatment. Anxiety disorders are the most common mental health diagnoses in America and approximately 25% of teens are diagnosed with an anxiety disorder at some point in their teenage years.

Cognitive Behavioral Therapy (CBT) is commonly used to treat anxiety disorders and has been shown to be especially successful at reducing anxiety symptoms. About 70% of the time CBT reduces or eliminates anxiety symptoms in children and teens. Unfortunately, CBT treatment is not available to all the teens that need it. Without therapy, the only alternatives are medications, which may have strong and permanent side effects or letting the child suffer untreated. Most adults who suffer from anxiety disorders first experienced the symptoms as children or teens but the symptoms when untreated or undertreated.

Why factors might explain why CBT helps only 70% of those who go for therapy? How can we explain that a computer program worked to treat anxiety disorders?

People with anxiety disorders unconsciously pay more attention to threatening things than non-anxious people. Paying attention to threats and having some anxiety is protective when you are in a dangerous situation. The problem for chronic anxiety sufferers is that they pay too much attention to threats in situations that are not that threatening. People with anxiety disorders have difficulty moving their focus from a potential threat to another non-threatening item.

Now this problem of focusing on the negative is not limited to anxiety provoking things. The same principle has turned out to be effective for treating chronic pain and depression. People with chronic pain are extra attuned to their pain. They tend to focus on the pain to the exclusion of everything else.

When people with chronic pain are taught to focus on other things, pleasant positive things and they learn techniques to shift their focus from the pain to something positive they report the pain is reduced or eliminated. When you are having fun you forget your pain if only for a moment. This ability to shift focus also may explain why laughter and jokes are also an effective treatment for reducing symptoms of many common mental health problems.

Reducing symptoms is not the same as a permanent cure. But not having anxiety or pain even for a while is a great thing. And the more the symptoms are reduced the more likely you will be able to live with your condition. Recovery from many conditions does not mean completely eliminating the problem. Recovery may mean for some people an improvement in their quality of life.

We have known that thinking has a huge impact on feelings for a very long time. People with a negative bias, they think everything about themselves, the world, and the future is bad, are more likely to be depressed.

So if you are anxious, depressed, or in a lot of pain and your current treatment is not helping, consider working on changing the things you focus on. Working with a good counselor or therapist can help you learn to shift focus. So can a good self-help book.  However, you learn the techniques you will need to practice shifting your focus from the negative problem-based view to the positive recovery and resiliency point of view. My thought is that the computer-based system helped people with excess anxiety because it included a lot of practice at changing their focus in a short period of time. Even without the computer program, the more you practice shifting your attention the better you can become about changing the way you look at things.

The full article on the computer based anxiety treatment experiment is available at the NIMH site.

http://www.nimh.nih.gov/science-news/2012/computer-based-treatment-eases-anxiety-symptoms-in-children.shtml

Try this experiment, try shifting the things you pay attention to and see if your anxiety, pain, or depression shrinks. If you do this experiment leave a comment on this blog and let the rest of us know how it worked out.

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

For videos, see: Counselorssoapbox YouTube Video Channel