Anger Management

Presentations to therapists for help with destructive anger seem to be increasingly common these days (Fauteux, 2010), with many clients coerced by workplace or family or mandated to come by the courts. Much of the time the problem anger occurs outside the therapy room and clients are at least minimally cooperative with their therapist in working to change how they deal with it. There is, however, another scenario in which therapists may be called upon to help clients deal with their anger. That is the situation in which the client gets angry in session and makes the therapist the target. While as mental health professionals we are trained to listen to clients who are expressing frustration, probably far fewer of us have been called on to de-escalate a situation in which a client is threatening violence to us. Would you know what to say or do in order to de-escalate from a client – or anyone – threatening to harm you if they don’t get what they want? Would you know – if all else fails – how to keep yourself safe in a violent situation? In this article, we share with you a set of responses for dealing with an angry person – safely – at each of seven levels of anger.

Fauteux’s scale of anger progression

Kevin Fauteux, Ph.D., social worker, and Clinical Director of the Derek Silva Community in San Francisco, has observed that encounters with angry clients seem to be more frequent and sometimes violent in recent times. He has developed a framework for managing such situations which identifies a progression of escalating anger and suggests responses which are appropriate at each level (Fauteux, 2010). We share his framework with you in the context of suggesting that, hopefully, you won’t have to call on it often (and certainly not on its higher levels of escalation), but that if you do, it is a way of responding which may best salvage an angry situation, returning to as calm and normalised an atmosphere as possible. Note that this framework is not for the purpose of long-term education and healing of clients with destructive anger who have agreed to work with you on their anger. Here we are only sharing responses that will help to calm a situation in which someone is spiralling out of control and keep you safe from physical violence.

The seven levels of escalating anger

Fauteux identifies seven levels, which we illustrate with the example of Felix, a 20-something client mandated to come do 10 sessions of anger management work with you instead of doing jail time for the assault of a fellow patron at a local bar. Felix is clearly given to understand that he must attend all ten scheduled sessions and cooperate with any homework or other tasks (plus adhere to several other conditions imposed by the court), or else his jail term (now suspended) will be reimposed. When Felix comes, he expresses gratefulness that he has been allowed to stay out of jail, and states that he does wish to handle his anger better, so he will try to work with you to learn what he needs to. You are delighted that he seems to be on board with what will happen, and you explain that the sessions are confidential, but not absolutely so. You add that, in this case, you are mandated to tell authorities – should they ask – the truth about Felix’s cooperation with the counselling; Felix states that he understands and accepts this condition.

All seems to be going well for three sessions, but then Felix unexpectedly misses both the fourth and fifth sessions, and does not respond to texts, emails, or calls. Shortly after his non-appearance at the two sessions, the corrections officer in charge of his case rings you asking if Felix has been attending all of the sessions. You are forced to admit that the last two have been missed. For the sixth scheduled session, Felix turns up. He has had a call from the corrections officer, who has informed him that, should he breach even one more aspect of his stay-out-of-jail conditions – no matter how small – he will be put immediately into jail, to serve the full term. Felix could present himself to you at any of the seven levels. Let’s see what his behaviour might look like – and what you should do in response – for each of them.

Frustration

If Felix comes in at the frustrated first level of anger escalation, he is angry and possibly yelling as a way of standing up for himself and ensuring that you see and hear his frustration. He is likely to feel that you slighted him or brought a potential jail term a step closer by telling the authorities that he skipped some counselling sessions. At this level of anger progression, Felix is not trying to control you; rather he is just “venting” frustration, so it is important for you to “get” why he is so frustrated. This means focusing not on the how of his expression of anger, but on the what. You need to validate him. This is not an admission that you think his shouting is appropriate or that you agree with it, only that you understand it; it is empathy: e.g., “I appreciate how upsetting this is for you, Felix, and I want to work with you to see how we can best deal with this situation”.

Defensive anger

The major shift in intensity of anger to this second level could be signalled by Felix – upon hearing your supportive acknowledgement (as noted above) – saying something like, “Screw your appreciation for how upset I am. Just sort it out for me!” Felix could be not only upset that he has corrections authorities threatening him with jail, but also that he may feel hurt or betrayed that you “put them onto him” by telling them that he skipped the sessions. So his yelling at this stage is not only because he is now in jeopardy of losing his freedom, but also because he feels somehow abandoned, disrespected, or betrayed. He thus uses anger to stand up to you in order to feel “bigger”. The person here has moved from shouting about frustration to yelling at you. Your job here is to listen to the “what” and the “how” of the yelling, and then to let the client know that you understand how they feel, but that shouting and/or swearing is unacceptable: e.g., “Felix, I know you’re really angry and that’s ok, but it’s not ok to yell at me.”

Difficult angry people

One group of angry people we sometimes deal with is constituted by those who are generally difficult: the ones that are always abrasive, argumentative, or obstinate. They tend to make unrealistic demands so as to always have something to complain about. Here the anger is about verbally “standing up to the other” in order to keep the other (meaning you) at an emotional distance; the consequent near-impossibility of relationship is preferable to you being able to hurt or disappoint them, which they see as inevitable. The main dynamic at this level is the person’s attempt to draw you into the anger, into a win-lose type of power struggle: a contest of wills and manipulation in which the client will feel in control.

If Felix begins to argue with you, saying – for example – that you screwed up his life with your “incompetence” and that you must “fix” it (say, by going back to the corrections officer and lying or something similar), your job is to recognise that defusing this level of anger happens first by you not getting dragged into it. Warning Felix that he won’t get what he wants if he keeps arguing with you inadvertently sets up a win/lose mentality in which you may believe you are refuting his difficult ways, but in actual fact, he has drawn you into his power struggle. If this occurs, you are likely to find yourself being compelled to win the argument rather than resolve the problem.

Instead, your goal will be to set up a win-win approach which does not make him feel like you’re trying to make him lose a contest of wills. You might here make statements like, “I’m sure we can sort this out, Felix, so let’s not argue about it.” You are able to take the wind out of the compulsion to compete with you when – despite what the person believed going into it – they find they are not in a contest with you.

Hostility

At this fourth level of anger, people are no longer merely using the angry energies to stand up for themselves; rather, they are now aggressively standing up against you. They may express less anger about what happened and become angry at you, cursing you not for what you do, but who you are. The maladaptive expression of anger as hostility is a verbal attack which is not trying to get you to listen; rather, it morphs from arguing (at the previous level) to bullying: from “you can’t push me around” to now “I will push you around”. It’s about control and about attempting to cruelly belittle or humiliate the other person (you), as opposed to earlier merely trying to compensate for the person’s felt humiliation. Here as anger defuser, you must walk a razor’s edge: not threatening the hostile person’s critical sense of control (making them think you are trying to take control from them), but also not allowing yourself to be intimidated by it. This is accomplished in two steps: 

  1. You let the other person know that you understand the intensity of their anger and that you are not going to get them to stop bullying you simply by demanding it. Thus, if Felix follows up calling you an incompetent, uncaring “[enter insult here]” with statements that he won’t leave until you fix his issue by ringing the corrections case manager, your response is not, “I will not allow you to talk to me this way”. The first step, the recognising of intensity, goes more like, “Felix, I can see you really mean what you say!”
  2. You let the other person know that, while you “get” the intensity of their feeling, you won’t be intimidated by it, nor can you be easily manipulated. You need Felix to understand both “I understand you mean business” and also that the hostility is unacceptable: “I get your message, but getting in my face won’t work with me”. You assert your control without making the client feel that you are trying to curtail their control.

Rage

At this fifth level, anger is not the problem; the problem is that it is uncontrollable. At earlier stages, a person might manage their anger by aggressively trying to control you. Now they explode in rage, losing all control. Where anger is not merely an extreme expression of a person’s angry feelings but an anger that the person can’t manage, it is rage. The DSM-5 refers to some people who are prone to rage as having “intermittent explosive disorder” (APA Dictionary of Psychology, 2020).

Weirdly, at this level the raging person needs your help to prevent their anger from spinning out of control. Thus, your task is to rein in their rage and restore the order that they cannot manage themselves, and you do it by staying in control yourself. Remaining calm demonstrates to the out-of-control person that you are not overwhelmed by the chaos of his anger and subtly sends the message that you will not let them be overwhelmed either. So if Felix should come to this level of raging anger, making statements such as that he “can’t take it anymore” or “This is making me crazy”, your approach is to: 1. Assure him that it’s going to be ok AND SO, 2. The rage has to stop.

This is not demanding that the person stop ranting. It’s more about letting him know that his out-of-control anger expressions can be and must be controlled. Thus, a statement to Felix might run something like, “Felix, this is manageable. We will work it out, but I need you to get hold of yourself.” Or alternatively, you could say, “I understand why you are angry, but I need you to control it a little.” Felix would need to understand that, without at least a bit of control, you would be unable to help him, and he might therefore lose all control.

Threats

If Felix’s anger, say at Level 5 (Rage) did not succeed in controlling you, he could re-double his aggressive efforts, possibly with statements such as, “I need those conditions rescinded or else I might just have to hurt someone” (presumably you). If pushing you around psychologically (as in earlier stages) didn’t work, he now could escalate to Level 6, where he threatens to physically push you around: mostly because he sees himself as being out of options to make you comply, apart from threatening. What should you do? Your list for de-escalation here consists of strong “do NOT do” actions as well:

You do not challenge Felix. A person in this situation would feel pushed into a corner upon meeting your aggressive response, and they would then have to follow through on their threats rather than “lose face” or look weak.

You do not want to look weak either, so your job is not to accept threatening behaviour. Rather, you acknowledge that you understand him: “Felix, I know you mean what you say . . .” – AND at the same time you let him know that you will not tolerate the threats – “. . . I also know you want this problem solved, so you need to stop the threats and let’s work on it.” Your job here becomes to help Felix see that he has choices, so you work with the side of him that can help engage in finding a solution before it’s too late.

You want to reinforce the idea that he has not reached a “point of no return”. You might say, “It’s not too late to settle this problem. You haven’t done anything wrong, so let’s put the gun away and figure it out.” You can also get him to think about consequences, such as by saying, “I know what you said, but think what would happen if you did it.”

You begin to look around. If you cannot de-escalate his threat, what objects in the immediate vicinity might you be able to use to defend yourself? Where are the doors and the windows in the room? You should try to position yourself so that you have access to exits and he is not between you and the best escape route.

Know that you do not have to wait until he attacks in order to call for help. Many organisations have a “code” phrase they can use so as not to alarm the threatening person into doing a rash action (such as firing the gun). Here you might say, for example, “Felix, I want to help you, but this situation is beyond my level of expertise/authority to deal with”. You then offer to summon a supervisor. Hopefully, your workplace/practice has a coded system, where you can use a non-alarming coded phrase, such as, “I’ll be late for my next appointment”: code for, “I need help here now!” One annual conference used to instruct attendees volunteering at the conference to call on the loudspeaker or in-room telephone, “Is NORA in the room?” NORA was an acronym for “Need Officer Right Away”, whereupon the hotel security would materialise immediately at the dialled-from location in the hotel.

You must keep calm, especially if you do not have the means to accede to the person’s demands. Thus you can say: “I want to help you, Felix, but guns make me very uncomfortable. Can you please put the gun away so that we can work at this calmly?” If you can’t de-escalate and you have to comply with his demands, so be it. Rewarding bad behaviour is preferable to ending up as a statistic. When all else fails, your primary concern needs to be safety.

Violence

Most angry people do not become violent. Hopefully, the strategies here will help de-escalate any angry client you might encounter before the encounter would escalate into physical violence. But sometimes anger does escalate into assault. The angry energies that, at earlier stages, energised Felix to stand up for himself now become energies which make him “stand up to knock you down”. In the first instance, the violence often has a goal: to get what he wants when nothing else will obtain it; he has reached a “boiling point” and when even threats do not work, he decides to hit or otherwise hurt you (which sometimes occurs with a warning and sometimes does not). At this level, you are about to be hurt; it is about to happen, and the situation is irreversible. De-escalation is no longer about defusing the anger; now it is about protecting yourself.

The first important thing is to remain calm (!@#!). If you can safely exit, do so. If you can call for help, do so. If you can do neither, what objects can you put between yourself and Felix? What barriers might protect you somewhat from the attack? If you are going to be hit, there are techniques – tactics from self-defence and other disciplines – that are helpful to know. Look into them now so that, should such a situation arise in the future, you are prepared to face it. Ultimately, you may decide to hit in return, as part of your self-defence. “Reasonable force” to protect yourself will likely be legal, but know that you will be hit back: probably much harder.

Conclusion

We don’t typically deal with such a grim, scary possibility as threats or violence to you from a client. We reiterate that most angry feelings don’t escalate into assault, and our sense is that many therapists will never need such information, as the vast majority of the time you and the anger client are probably dealing with tendencies toward anger which have manifested “out there”: outside of session. Beyond that, you may not agree with every detail of Fauteux’s progression. The general notion of escalation from frustration to violence is worth familiarising yourself with, however, in case you do find yourself, whether with a client or someone else, in a tense situation with the potential to explode.

Note: The material in this article is informational and does not show clients with destructive anger how to change their relationship with that emotion. Anger is a basic human emotion and a complex phenomenon; understanding how to re-calibrate the ways of dealing with it is essential understanding for both clinician and client.

References

  • APA Dictionary of Psychology. (2020). Anger. American Psychological Association. Retrieved on 7 April, 2021, from: Website.
  • Fauteux, K. (2010). De-escalating angry and violent clients. American Journal of Psychotherapy, Vol. 64(2), 2010, 195-213.

AIPC

Types of Love

It’s been over 2,500 years since Lao Tzu was around. His wisdom definitely stands the test of time, none more so than the 5 types of love.

The first 3 are ‘pathological contradictions’ of Love.

The last 2 are healthy expressions of it.

 

Possessive Love:

                

‘THAT IS, LOVING AN OBJECT BECAUSE WE ARE CAPABLE OF POSSESSING IT, OR AT LEAST BELIEVING WE POSSESS IT’

 

In the Tao they say that this is the lowest form of love, so much so it’s not really love at all. It’s the eternal quest for ‘things’ that we ‘must’ have. Be it money, material possessions or a partner. It’s the objectifying of people and things, think the Male chauvinist. This type of ‘love’ turns the pure, selfless act into a selfish and manipulative feeding of the ego.

 

We see this in the example of a Man and his ‘trophy wife’. He buys her things and says he loves her, but she’s merely a possession to him. Another sign of so-called ‘success’.

 

Codependent Love:

 

‘THIS IS ROOTED IN THE EXPERIENCE OF POWERLESSNESS AND EXPRESSES ITSELF AS AN ADDICTION TO CONTROL OR BEING CONTROLLED’

 

These relationships are far too common today. Think of the male who needs to control and know everything about his partner – where she is, where she’s going, where she’s been, who she sees, he checks her phone to see who she’s been messaging, he verbally abuses her and all her happiness and enjoyment must revolve around him. It’s possessive. 

Then from her side, she stays in the relationship because she’s become addicted to being controlled. She fears what will happen if she ever left, so she puts up with it.

 

It’s hard to see when she’s in it, but once she gets the courage to leave then we always hear “what was I thinking? Why did I stay so long?”

 

This is also a contradiction of love, but on a lesser level than the first, possessive type of love.

 

Romantic Love:

 

‘IT IS GENERALLY AN UNCONSCIOUS ESCAPIST ATTEMPT TO COMPENSATE FOR THE ABSENCE OF SELF-APPRECIATION’

 

This is the search for that ‘perfect’ mate. The one that will make everything ok in our world and make us ‘complete’.

These are two ridiculous notions. First, we’ll find someone who fits that ‘perfect’ image we’ve made up in our heads. And second, that we need someone to complete us.

 

We’re all perfect just the way we are. That imagined person in our head doesn’t exist so we’re just chasing a unicorn and trying to change people.

 

We’re already complete, just the way we are. So once we realise that we should set out to find someone that has also realised that they’re complete.

Then two complete people can come together and share their experiences of life. Not because they need that other person, but because they enjoy each other.

 

This is also a contradiction of love as it drives a wedge between the essential self and the imagined deficient self.

Subjective Love:

 

‘IT IS THE EXPRESSION OF A STATE OF LOVINGNESS. THERE ARE NO ULTERIOR MOTIVES, NO OBJECTS OF MATERIAL VALUE TO BE ACQUIRED. THE PERSON WHO EXPERIENCES THIS LOVE IS RELATIVELY WITHOUT ARMOUR’

 

This is the type of love where we’re not fixated on a single object or person. We’re not looking to possess, be co-dependent or change someone. Love is freely given and received.

 

This is a state of love where we start to live in harmony with all things. We start to love not just people, but plants, trees, rocks, animals, art, the sky, the stars…….the universe.

 

We don’t love with conditions, if someone doesn’t love us back that’s fine, we can still love them anyway.

Most of the time we have conditions on our love;

‘I’ll love you if you love me back’

‘I’ll love you if you’re there for me’

‘I’ll love you if you never leave me’

‘I’ll love you as long as you keep acting this way’

 

These aren’t real love.

When we drop the conditions we shed our armour, we live in harmony, we love everyone and everything just the way it is. We experience life in a loving way.

 

Become Love:

 

‘IT IS THE EXPERIENCE OF OUR TOTAL HUMANITY, STRIPPED OF EVERY SHRED OF ALIENATION, STRIPPED OF EVERY PREMISE OF AGGRESSIVE CIVILISATION. IT IS COMPLETE SELF AND SOCIAL ACTUALISATION’

 

This is the ideal state of being that Lao Tzu defines as pure love or the Great Integrity.

 

He describes it as a state that can not be reached as long as we live in an acquisitive society. Within civilisation, this pure love can only be dreamed of, sensed or tentatively experienced.

This type of pure love requires a transcendence of all the fragmentation that have defined our personal and social lives over the past millennia.

It is nothing less than the total liberation of each and all of us. For us to experience the universe on its own terms.


 

So according to Lao Tzu if we’re lucky we might get a temporary moment in time to feel the 5th love.

But the 4th is definitely attainable in this life and is something I feel we all should be aiming for.

 

LOVE YOURSELF AND OTHERS WITHOUT CONDITIONS.

 

Possessive Love:

                

‘THAT IS, LOVING AN OBJECT BECAUSE WE ARE CAPABLE OF POSSESSING IT, OR AT LEAST BELIEVING WE POSSESS IT’

 

This is the lowest form of love, so much so it’s not really love at all. It’s the eternal quest for ‘things’ that we ‘must’ have. Be it money, material possessions or a partner. It’s the objectifying of people and things, think the Male chauvinist. This type of ‘love’ turns the pure, selfless act into a selfish and manipulative feeding of the ego.

 

We see this in the example of a Man and his ‘trophy wife’. He buys her things and says he loves her, but she’s merely a possession to him. Another sign of so-called ‘success’.

 

Codependent Love:

 

‘THIS IS ROOTED IN THE EXPERIENCE OF POWERLESSNESS AND EXPRESSES ITSELF AS AN ADDICTION TO CONTROL OR BEING CONTROLLED’

 

These relationships are far too common today. Think of the male who needs to control and know everything about his partner – where she is, where she’s going, where she’s been, who she see’s, he checks her phone to see who she’s been messaging, he verbally abuses her and all her happiness and enjoyment must revolve around him.

Then from her side, she stays in the relationship because she’s become addicted to being controlled. She fears what will happen if she ever left, so she puts up with it.

 

It’s hard to see when she’s in it, but once she gets the courage to leave then we always hear “what was I thinking? Why did I stay so long?”

 

This is also a contradiction of love, but on a lesser level than the first, possessive type of love.

 

Romantic Love:

 

‘IT IS GENERALLY AN UNCONSCIOUS ESCAPIST ATTEMPT TO COMPENSATE FOR THE ABSENCE OF SELF-APPRECIATION’

 

This is the search for that ‘perfect’ mate. The one that will make everything ok in our world and make us ‘complete’.

These are two ridiculous notions. First, that we’ll find someone who fits that ‘perfect’ image we’ve made up in our head. And second, that we need someone to complete us.

 

We’re all perfect just the way we are. That imagined person in our head doesn’t exist so we’re just chasing a unicorn and trying to change people.

 

We’re already complete, just the way we are. So once we realise that we should set out to find someone that has also realised that they’re complete.

Then two complete people can come together and share the experiences of life. Not because they need that other person, but because they enjoy each other.

 

This is also a contradiction of love as it drives a wedge between the essential self and the imagined deficient self.

 

R. Hassan, TCFH

Psychiatrist, Psychologist, Counsellor, Therapy…

In short:

A psychiatrist is a medical doctor who specializes in diagnosing and treating mental health conditions. A psychiatrist can prescribe medication.

A psychologist is not a medical doctor and can’t prescribe medication. Psychologists use treatments and tools like psychological testing to inform strategies for therapy.

A Counsellor is not a medical doctor and can’t prescribe medication. Counsellors tend to adopt a more person-centred approach for therapy.

Therapy takes place over a longer period and tends to delve into various facets of a person and their being.

– PTPC

Relationship Counselling – Intro

“Relationship counselling usually refers to interventions that involve a couple attending multiple sessions with one counsellor, generally together but individual sessions for one or both partners may also be included.” (Hunter & Commerford, 2015, p. 12)

Generally speaking, the term ‘relationship’ can encompass a wide range of relationships, such as the relationship between romantic partners, the relationship between a parent and child, the relationship between relatives, and the relationship between friends. However, for the context of this article, the focus will be on romantic/intimate relationships. It is also important to note that reference to a ‘couple’ is inclusive of marital relationships, de facto relationships, and both heterosexual and same-sex relationships. As such, in our context, relationship counselling involves helping a couple in an intimate relationship to improve and enrich their lives together.

While relationship counselling involves many of the same counselling techniques as individual counselling, counselling a couple is very different to counselling an individual. The following extract aptly summarises some of the challenges of relationship counselling.

“Individual therapy is a smaller world—just you and the client. Your focus can be simple and direct. The process seems easier to control. There is one voice to listen to, one side to take…. Couple therapy can certainly have moments of intimacy like individual therapy but it’s often analogous to a two-ring circus, with each of the partners doing his or her own act for the therapist, or perhaps more accurately, like a courtroom, with each trying to persuade you that his reality, not the other guy’s, is right. And so they stack up facts, and as emotions rise, so does their stack, with both partners pulling up more examples (“What about that time last Christmas when you…”) or offstage collaborators (“My mother said the same thing just yesterday that you…”). Their hope, of course, is that you sift through all this information and angst and judge who is at fault, who is the innocent victim.” (Adapted from Taibbi, 2017, pp. 2-3)

Additionally, Payne (2010) outlines the following challenges of relationship counselling:

The need to manage three-way communications. One of the most fundamental differences between individual counselling and counselling a couple in session together is that there are three people in the counselling room – the counsellor and both members of the couple. Counsellors must adapt their approach to facilitate three-way communication. The counsellor must ensure that both members of the couple are engaged in the counselling conversation and they may even need to adapt their approach. For example, silent time that might be given for reflection in individual counselling is likely to be interrupted by one of the partners in relationship counselling. 

The immediacy of emotions and conflict. The feelings and attitudes expressed during relationship counselling sessions are usually immediately reacted to by the other partner. This can result in the escalation of conflict as the partners speak about previously withheld or misunderstood thoughts, feelings, or events. It takes a skilled counsellor to help clients by maintaining a safe and therapeutic relationship and offering helpful strategies for the couple to use. Additionally, effective relationship counsellors need to continually observe the interactions and reactions of each individual in order to facilitate effective counselling.

Remaining neutral. This means that the counsellor must remain a neutral party and not be perceived as ‘taking sides’ with one or the other partner. Relationship counsellors must rise to the challenge of ensuring both parties feel heard and supported. They must be tactful to ensure fairness, equity, and safety to allow all parties an opportunity to engage in the counselling process.

Managing split agendas. Relationship counsellors must work with the goals and agendas of the couple as a whole as well as the individuals within the couple. Sometimes the partners will have very different goals for counselling and the relationship counsellor will need to successfully balance each partner’s goals/agenda.

Managing ethical issues. Counselling couples can raise some challenging ethical dilemmas due to the nature of a counsellor’s legal and ethical responsibilities. A relationship counsellor has a responsibility to the couple – there is a duty of care to protect them from harm, both individually and as a unit. However, this may not be as easy as it seems. For example, one partner may try to collude with the counsellor to keep a secret, one partner may attend counselling but not participate equally, or one partner may continually speak for their partner rather than allowing them to express themselves. Each of these represent specific ethical dilemmas that relationship counsellors must navigate. 

When making the transition from working as an individual counsellor to working as a relationship counsellor, counsellors must be fully cognisant of these differences and the impact that such differences will have on their practice. Of course, it is also recommended that counsellors take the time to consider the complexities and challenges of relationship counselling and obtain specialist supervision as they embark on this career path. 

The evolution of relationship counselling

Relationship counselling, as we know it today, is very different to its very first form. Historically, relationship counselling first emerged in the 1930’s in the form of ‘marriage counselling’ that was mainly carried out by clergy and medical professionals (e.g., gynaecologists) who would provide advice on adjusting to the practical aspects of married life (Gurman, 2010). However, just like the field of individual counselling, the field of relationship counselling has evolved since its inception. Relationship counselling has been influenced by the evolution of individual counselling theories, the development of family therapy approaches, and the evolution of specific theories for relationship counselling. 

“Couple therapy has historically been a stepchild of sorts in the therapy field, in which individual and family therapy models have been adapted and applied to it. Traditionally couples relied upon their doctors or their ministers to help them with their relationships. The first professional marriage counseling centre wasn’t established until 1930, and for the next several decades couple work was incorporated into psychoanalytic models. In the late 1950s early family therapists began writing about marital therapy from a communications framework. Over the last 10 to 15 years therapists/researchers such as John Gottman (2007), the developer of the marriage laboratory, and Susan Johnson (2004), the co-developer of emotionally focused couple therapy, and Harville Hendrix (2007), the creator of imago therapy, have looked more closely at the unique dynamics of happy, as well as unhappy couples, applying what they’ve discovered to the shaping of the therapy process.” (Taibbi, 2017, pp. 4-5)

There are a wide range of theoretical approaches that can inform the work of relationship counsellors today. Many relationship counsellors practice from a particular theoretical/therapeutic approach, while other practitioners choose to adopt an eclectic or integrative approach given the complexity and diversity of issues presenting in relationship counselling (Gurman, 2010; Snyder & Balderrama-Durbin, 2012). 

“There are two distinct categories of couple therapies. The first includes those originating early in the history of the broader field of family therapy. Although core attributes of these methods have endured over several generations of systems-oriented therapists, they have been revised and refined considerably. Examples of such time-honored approaches are structural, brief strategic, object relations, and Bowen’s approaches. Couple therapies also include a second wave of more recent approaches developed within the last few decades that have become very influential in practice, training, and research – for example, cognitive-behavioral and integrative behavioral; narrative and solution-focused; emotionally focused and Gottman’s; and integrative approaches.”
(Adapted from Gurman, Lebow & Snyder, 2015, p. 2)

As mentioned in the extract above, some major theoretical approaches to relationship counselling stem from theories developed for the field of family therapy. These theories usually emphasise a systematic view of the relationship and propose that changes in the relationship dynamics are necessary for the positive development of the relationship. While many relationship counsellors today do still apply theories and techniques from the field of family therapy in their work with couples, strict use of these family therapy approaches is more often used in work with families, and it is more common for relationship counsellors to apply the general family therapy concepts or ‘second wave’ approaches when working with just couples in relationship counselling. 

When deciding upon an approach to use, it is generally best practice to consider the efficacy of each approach (i.e., how effective the approach is in improving couple relationships). Unfortunately, while there have been great strides taken in recent years in regard to efficacy research in individual counselling, there has not been as much research conducted on the efficacy of the various approaches to relationship counselling. The research that has been conducted does show that, overall, relationship counselling is generally effective.  However, there is limited evidence suggesting any single approach to be more effective than the others (Hunter & Commerford, 2015). In fact, there are number of limitations in research conducted on relationship counselling due to the following factors:

  1. Many couples experiencing relationship distress do not seek professional assistance
  2. The effects of relationship counselling tend to deteriorate over time
  3. Relationship counselling is not effective for all couples
  4. Couples having the most relationship difficulties tend to benefit least from relationship counselling
  5. There are large number of widely applied approaches to relationship counselling that have not been rigorously evaluated for their effectiveness
  6. There is not a lot of ‘transportation’ of research studies to the ‘real world’ of counselling
  7. Research continues to largely involve married, middle-class, heterosexual white couples
  8. The majority of research has been done by a small number of researchers who are highly invested in the models of relationship counselling they are testing
  9. There is limited understanding of why or how different approaches to relationship counselling are effective (Hunter & Commerford, 2015)

Moreover, within the limited number of recent studies conducted on the efficacy of relationship counselling, the available research is mostly American or UK-based – there is a significant gap in research on Australian couples and families (Evans, Turner & Trotter, 2012). At this stage, evidence-based research in relationship counselling still has a long way to come. Therefore, regardless of which theoretical orientation you choose to take in your work as a relationship counsellor, it will be important to continually stay abreast of research in the field and seek out ongoing opportunities for professional development and education to help remain up to date with any best practice developments and ensure your continued effectiveness. 

Editor’s Note: This is an excerpt from the unit Provide Relationship Counselling in AIPC’s Graduate Diploma of Relationship Counselling.

References:

  1. Evans, P., Turner, S. and Trotter, C. (2012). The Effectiveness of Family and Relationship Therapy: A Review of the Literature. Melbourne: PACFA. Retrieved from https://www.health.gov.au/internet/main/publishing.nsf/Content/phi-natural-therapies-submissions-containerpage/$file/PACFA%20Family%20Therapy%20lit%20Review.pdf
  2. Gurman, A. S., Lebow, J. L., & Snyder, D. K. (2015). Clinical handbook of couple therapy (5th ed.). New York, NY: The Guildford Press.
  3. Hunter, C., & Commerford, J. (2015). Relationship education and counselling: Recent research findings, CFCA Paper no. 33, pp. 1-24. Retrieved from https://aifs.gov.au/cfca/publications/relationship-education-and-counselling
  4. Payne, M. (2010). Couple counselling: A practical guide. London: Sage Publications.
  5. Snyder, D. K. & Balderrama-Durbin, C. (2012). Integrative approaches to couple therapy: Implications for clinical practice and research. Retrieved from https://pdfs.semanticscholar.org/1744/fd7ca1e6e2d66f141196a313495e51fea358.pdf
  6. Taibbi, R. (2017). Doing couple therapy: Craft and creativity in work with intimate partner (2nd ed.). New York, NY: The Guilford Press.

AIPC

Anger

All human beings experience anger at least occasionally. It’s a natural emotion helping us recognise that we or someone or something we care about has been violated or treated badly. When we feel threatened or our goals are thwarted, anger is a coping mechanism that enables us to act decisively, especially in situations where there is little time to reason things out. It can motivate problem-solving, goal-achievement, and the removing of threats. It serves a protective function and is not always a problem (Lowth, 2018; Stosny, 2020; Zega, 2009).

But anger is a complex emotion, and all too often manifests maladaptively in peoples’ lives, when they perceive excessive need for protection, protect the “wrong” things, or use anger to thwart their longer-term best interests. The result is problem anger.

Perhaps because it is so multi-faceted, misperceptions about anger abound, and the question arises: how shall we regard anger? Folk wisdom often would say that the best thing to do is just let it all out, but is it? People complain that they cannot control it, that the tendency to be easily angered is inherited, but again, is there evidence for that? Here are common myths people tend to hold about anger, and factual statements following them identifying why learning to deal with problem anger is time well spent.

Myth 1: “Anger is inherited.”

This is the person that may try to claim that their father was short-tempered and they have inherited that trait from him, so there is nothing they can do. Such a stance implies an attitude that the expression of anger is a fixed, unalterable set of behaviours. Research shows, however, that expression of anger is learned, so if we have – say, through exposure to aggressive influential others, such as parents – learned to be violent in our expressions, we can also learn healthier, more appropriate, pro-social ways of dealing with it.

Myth 2: “Anger and aggression are the same thing.”

Fact: Nope. Anger is a felt emotional state. Aggression is a behaviour, sometimes carried out in response to anger, but not the same as it. A person can be angry, yet use healthy methods of expression without resorting to violence, threats, or other aggression. Anger does not always lead to aggression. In fact, some experts claim that most daily anger is not followed by aggression. When it does result in aggression the “I3 Model” (pronounced “I cubed”) is deemed responsible. This suggests that aggression emerges as a function of three interacting factors, which all begin with “I”:

Instigation, an event which instils an urge to aggress as a result of, say, being addressed rudely or learning that one’s partner has had an affair (or a relatively “minor” event, such as being cut off in traffic);
 
Impellance, meaning a force that increases the urge to act in response to an instigating stimulus. These could be strong hormonal releases or a belief system which says that the instigating event should not be tolerated, or even a sociocultural norm which demands that instigating stimuli be responded to immediately and harshly (such as punching back someone who has hit you);
 
Inhibition, referring to forces that typically work to counter aggression, such as cultural norms, awareness of negative consequences, or perspective-taking or empathy (Kassinove & Tafrate, 2019).

Myth 3: “Other people make me angry.”

Fact: How often in common parlance do we say things like, “He made me so angry!” or “You make me so mad I could kill you!”? Even though we may occasionally speak about people causing emotions other than anger, it is far more frequent to hear such statements in regard to anger. We can choose whether or not we let someone else’s behaviour make us happy, sad, or something else, but we often think and talk about it as if anger is caused directly by others. With the undiscerning listener, an angry person thus gets to use anger as an excuse for unacceptable behaviour. Ultimately, it is not the other person’s behaviour that causes our anger, and in fact, it’s not even their intention, though that may influence our behaviour. Being precise, we must acknowledge that it is our interpretation of their intention, expressed in their behaviour/language, which is causative.

Myth 4: “I shouldn’t hold anger in; it’s better to let it out” (either by venting or catharsis).

Fact: If by “holding it in” someone means that they suppress anger, it’s true; ignoring it won’t make it go away and squashing it down is not a healthy choice. Neither, however, is venting. Blowing up in an aggressive tirade only fuels the fire, reinforcing the problem anger. Ditto the use of pillow-punching or other means of catharsis; this may come as a surprise to therapists trained a few years ago, when catharsis was an anger management technique in good standing. Now researchers have found that, even though we feel better in the moment after hitting something, our brain notices, subtly changing its wiring. Then the next time we are angry it softly whispers, “Hit something; you’ll feel better”. The time after that, the wiring is stronger in the brain towards a hitting catharsis, and the angry-brain-voice speaks a little louder. Continuing in this vein means that eventually, we could decide to hit something more alive than a pillow. Rather than either angry venting or catharsis is the use of skills to manage the angry impulse.

Myth 5: “Anger, aggression, and intimidation help me to earn respect and get what I want.”

Fact: People may be afraid of a bully, but they don’t respect those who cannot control themselves or deal with opposing viewpoints. Communicating respectfully is a far superior way to get (most) people to listen and accommodate one’s needs. While the momentary power that comes with successful intimidation may feel heady in the moment, it does not help build the healthy relationships that most people coming to counselling yearn to have.

Myth 6: Anger affects only a certain category of people.

Fact: Anger is a universal emotion that affects everyone. It does not discriminate against people of any particular age, nationality, race, ethnicity, socioeconomic status, education, or religion. It is tempting for some people in the educated middle classes to believe that anger is more prevalent among the poor, or those who are less educated or lacking in social skills. Reality does not bear this out, although the expressions of anger do vary among different social groups. Remember, anger is just an emotion, one which does not make people “good” or “bad” for having it.

Myth 7: “I can’t help myself. Anger isn’t something you can control.”

We don’t always get to control the situations of our lives, and some of them may trigger our anger. In fact, we don’t (in the short-term) control whether we have angry feelings or not; they just come – although there are longer-term ways to work on them that sees them less easily provoked, and therefore less prone to have the experience of anger. What we do have is the short-term choice to control how we express that anger. Sessions with a therapist for the purpose of learning how to better handle anger means having more choices of response, even in highly provocative situations.

Myth 8: “When I’m angry I will say what I really mean.”

Fact: This is rarely true. Uncontrolled angry expressions are more about gaining control of or hurting others, not saying what a person’s deepest truth is. 

Myth 9: “By not saying what I’m thinking in the moment, I’m being dishonest and will be even angrier later.”

Fact: There is a strong pull to “speak our mind” when angry. But it is at this time that a person’s judgment is most severely flawed. To speak from anger is to allow the impulsive part of the brain to overrule the rational part. Better for relationships, career, and pretty much everything else to wait until that reasoning part can regain control.

Myth 10: “Men are angrier than women.”

Fact: The sexes experience the same amount of anger, says research; they just express it differently. Men often use aggressive tactics and expressions, whereas women (often constrained culturally) more frequently choose indirect means of expression, such as found in passive-aggressive tactics. This could mean getting back at someone by talking negatively about them or cutting them out of their lives (categories adapted from: Therapist Aid LLC, 2016; Segal & Smith, 2018; Morin, 2015; Morrow, n.d.; Better Relationships, 2021; Gallagher, 2001).

Thought for reflection

Anger has many facets to it, and we have introduced some information here that may seem either startling or counterintuitive. As you think back in what ways, if at all, might your views about anger have shaped how you behave? How you respond to others? 

And here’s the ultimate question: How might hearing these myths help you seek more adaptive ways to deal with problem anger? 

References:

  1. Better Relationships. (2021). Common myths about anger. Anglicare Southern Queensland. Retrieved on 13 April, 2021, from: Website.
  2. Gallagher, E. (2001). Anger. eddiegallagher.com.au. Retrieved on 13 April, 2021, from: Website.
  3. Kassinove, H., & Tafrate, R.C. (2019). The practitioner’s guide to anger management: Customizable interventions, treatments, and tools for clients with problem anger. Oakland, CA: New Harbinger Publications, Inc. 
  4. Lowth, M. (2018). Anger management. Patient. Retrieved on 7 April, 2021, from: Website.
  5. Morin, A. (2015). 7 myths about anger and why they’re wrong. Psychology Today. Retrieved on 13 April, 2021, from: Website.
  6. Morrow, A. (n.d.). Anger myths. Stress and Anger Management Institute. Retrieved on 13 April, 2021, from: Website.
  7. Segal, J., & Smith, M. (2018). Anger management: Tips and techniques for getting anger under control. Helpguide.org. Retrieved on 9 April, 2021, from: Website.    
  8. Stosny, S. (2020). Beyond anger management. Psychology Today. Retrieved on 9 April, 2021, from: Website.
  9. Therapist Aid, LLC. (2016). Anger warning signs. Therapist Aid LLC. Retrieved on 7 April, 2021, from: Website.
  10. Zega, K. (2009). Holistic Psychotherapy (159). Retrieved on 7 April, 2021, from: Website

AIPC

Building Trust

Simply said: A relationship in which Trust is missing is not a fun relationship. Without trust in your marriage you live a life of ill ease and cannot feel safe sharing your emotional, physical and spiritual self with your partner. In most relationships trust is not a concern at the beginning when you make your commitment to your partner. Love overrides all doubts and blind spots you may have, and as such you pass the first stage of your relationship in a blissful state.

Sometimes this bliss goes on forever as your relationship grows and matures, but for a good number this is not the case. Mistrust in its various disguises slowly insinuates itself into your marriage.

Your lack of trust may arise out of an infidelity or a fear of an infidelity. You may begin to realise that you have married an alcoholic or an angry person and cannot trust your safety in their presence. Or the emotional closeness you once thought you shared with your partner has suddenly vanished and you no longer can trust your feelings with this empty shell of a person that has replaced it.

A discussion on trust and its misuse can wander off in many directions. So perhaps the best place to start is at the beginning when your relationship has just formed and you have taken the first steps to live a life together. As we said earlier the joys of initial love usually override any insecurities and doubts that you may be feeling. And this therefore is the best time to secure your partnership against the uncertainties and apprehensions that may begin to seep into your relationship with the passing of time.

Let us look at Four actions you can take to build a foundation based on trust.

Affirm your Values

Values are the beliefs that you hold that determine the actions you take. For a relationship to be able to journey a lifetime together it is pretty important for both partners to share some basic values and to come to some agreement on the ones that they differ in. For example, if one partner holds deep religious views and wants to raise their children within the faith, and the other partner is very much against religion, then this relationship will most likely experience conflict unless a compromise can be reached.

Similarly when it comes to a value such as trust you cannot just assume that you and your partner have the same understanding as to what trust means. Depending on your family upbringing and your life experiences you will have formed your own ideas as to how you perceive trust in a relationship.

Clarity as to what this value means to both of you, and acceptance of a common meaning will enable you to strengthen your relationship and close the door to any ramifications due to mistrust.

Communication

As cliché as this may sound deliberate communication in which you stay focused and respectfully discuss your opinions is one of the cornerstones of all successful relationships. It is during this beginning stage of your relationship that you can establish a communication style free of assumptions and one in which you and your partner listen to what each has to say, confirm your understanding and then respond appropriately.

An open, non judgemental, supportive communication model encourages you and your partner to continuously affirm your values, discuss trust issues and determine actions to buttress your relationship against the perils of mistrust. This ability to communicate honestly is a force that your partnership slowly begins to appreciate as issues, some perhaps relating to trust, emerge in your relationship.

Address the Past

As a rule, it is best to bring your partner up to speed on your past before committing to a relationship based on trust. The fewer secrets you bring to your marriage the less opportunity for the seeds of mistrust to be sown. There may be issues from your past that if carried into the present could be a source of irritation and a springboard for future doubts and relationship instability.

Using effective communication you and your partner can open each piece of baggage you bring with you to your relationship, review the contents and decide what to do with it. This exercise not only reflects an honest ability to share your past, but also a sincere desire to ensure your past does not effect your future together.

If in the past you have been a gambler, a womaniser, a shopaholic, a viewer of pornography, a workaholic and so on,  you and your partner can discuss these behaviours, accept them and then consider the options to address them. It is better to know these facts when you begin your relationship, rather than to hide them and then have these details pop up  shattering the trust you have built up.

Not everything about your past needs to be exposed but if there are any hidden ex husbands, wives or children, their sudden appearance later in your relationship could be devastating. As well if there are certain actions you have taken in the past that you are not happy about you might need to trust your partner and tell them about it. A decision may be made to just bury this information and go forward.

Sometimes you will easily embrace aspects of each other’s past and at other times you may be upset knowing what your partner has done, but information exposed and dealt with can cause less damage than harmful secrets.

Set Boundaries and Guidelines

Once the above three actions have been initiated you are now ready to transfer your knowledge and skills into establishing some boundaries and guidelines that will reinforce the trust you want to carefully nurture in your relationship.

There may be certain behaviours that you find unacceptable as they threaten the intimacy of your relationship. These need to be spelled out, negotiated and then finalised as an agreement between you and your partner. For example you may feel uncomfortable that your partner is receiving txt messages from ex lovers, or you may believe that your partner is going out to dinner too frequently with unknown members of the opposite sex.

If your guidelines stipulate that such behaviour is unacceptable then you and your partner can relax into a relationship in which trust can thrive.

You may also give some thought to drawing up a document outlining the boundaries that you have both agreed on. I know that it might sound a bit practical and unromantic, but if you use a little creativity your document can reflect the care and respect you feel for each other.

There are no guarantees that the love, joy and trust that veils your relationship when you first make your commitments to each other will always be there. But if you begin your relationship in trust and take steps to respect this trust then you and your partner can feel safe and secure to grow and blossom both as individuals and as a couple.

Z. Starak

RCT

What is Root Cause Therapy?

Root Cause Therapy is a type of complementary medicine that is based on the belief that many health problems can be traced back to an underlying physical or emotional cause. By identifying and addressing the root cause, it is believed that symptoms and other health problems will improve or even disappear altogether.

Root Cause Therapy works on all levels of consciousness to address mental, physical, emotional and spiritual blockages that cause disharmony in your body. It is based on Guided Self-Healing (GSH), a powerful mind-body intervention that tracks down the root cause of any physical or energetic blockage.

How Does Root Cause Therapy Work?

Combining elements of talk therapy and cognitive behavioural therapy, Root Cause Therapy takes a comprehensive approach to addressing a wide range of conditions. The steps vary depending on the practitioner, but they generally consist of three steps, which are as follows:

  1. Identifying the root cause: This step involves working with a practitioner to identify any potential root causes of your health problems. 
  2. Addressing the root cause: Once the root cause has been identified, the appropriate steps will be taken to address it. This stage may involve guided imagery, breathwork and regression techniques.
  3. Continued support: Once you have started on your Root Cause Therapy journey, it is important to receive continued support from your therapist. This can help you stay on track and ensure that you are making progress towards your goals.

What are the Benefits of Root Cause Therapy?

Receiving Root Cause Therapy has lots of advantages. For one thing, it allows you to clear your mind and consciously identify your negative thinking and behaviour patterns. It is not necessary to be unconscious or asleep in order to address the negative contents of your subconscious mind. Additionally, there is some scientific evidence to back up claims that Root Cause Therapy can help with a variety of health issues, including:

  • Post-traumatic stress disorder (PTSD)
  • Low self-esteem
  • Allergies
  • Heavy metal toxicity
  • Chronic pain
  • Digestive disorders
  • Fatigue
  • Anxiety
  • Depression
  • Arthritis
  • Chronic fatigue
  • Cancer
  • Skin conditions
  • Insomnia
  • Addiction or substance abuse
  • Relationship conflicts
  • Suicidal thoughts

What Can You Expect From Root Cause Therapy?

If you are interested in trying root cause therapy, there are a few things you should know before getting started.

Root cause therapy sessions can span one or more hours. During this time, you will be asked questions about your health history, lifestyle habits, and any other relevant information. It is important to be honest and open in order to get the most out of the session.

It’s important to understand that Root Cause Therapy is not a quick fix. It’s not like taking a pill and having the symptoms go away only to return after a few hours or days later. It takes time for the body to recover and resume normal function. Because your symptoms developed gradually, it will take time to reverse the process.

The frequency of your treatment sessions will be determined by the condition you are treating. Following the initial treatment, your therapist will discuss with you on the frequency and following visits.

Is Root Cause Therapy Safe?

Root Cause Therapy is a safe and effective treatment option for many people. However, it is always important to consult with your primary healthcare provider before starting any type of new treatment. It can be an effective way to improve your health and wellbeing.

NTP

Grief

What is Loss?

Loss is being parted from someone or something that is really important to you. Loss can come
into our lives in lots of ways, and it affects each of us differently.

What is Grief?

There are a number of definitions about grief, including –
“… intense sorrow, especially caused by someone’s death.” ~ Google and Oxford Dictionaries
“… keen mental suffering or distress over affliction or loss; sharp sorrow; painful regret.” ~ Dictionary.com
“… deep sadness caused especially by someone’s death.” ~ Merriam-Webster

What Types of Loss can Cause Grief?

Honestly – any type of loss can cause grief as grief is a reaction to a loss.

Understanding and Managing Grief

There are a wide variety of ways to grieve that differ by the griever’s personality, beliefs, cultural background, and other factors as grief is an individual experience to a loss.

“The pain of the soul and heart is much more powerful that the pain of the body”

The Prophet

Understand and allow yourself the space to feel any or all of the following as they are feelings felt when grieving:

  • A constant fog over your thinking
  • Memory and concentration problems
  • Trouble keeping track of belongings
  • Fatigue, muscle pain, headaches, stomach trouble, chest pain
  • Lack of initiative, inability to perform usual functions
  • Irritability, mood swings, anxiety, anger and frustration
  • Fear of performing even familiar activities
  • Feeling hyped up, wired; exaggerated startle response
  • Disorientation
  • Nightmares, trouble falling asleep or staying asleep
  • Unpredictable bouts of crying
  • Avoiding friends and family, hiding out
  • Despair, fears about a desolate future, helplessness
  • Appetite changes
  • Constant yearning, pining for what you have lost
  • Sighing repeatedly
  • Regret, guilt
  • Feeling visited by a lost loved one
  • Change in sexual interest
  • Idealizing or waiting for return of a loved one
  • And much more

Above all, if you experience thoughts or plans about suicide, call for help at once. 

What about the time-worn advice to let go and get on with your life, to shed your baggage and let go of your past?

You don’t have to. You don’t have to let go of who or what you are grieving. You get to keep the keep the parts you can and transform your relationship with the rest.

How can this work? 

In between face-to-face visits with loved ones, you carry around your experience with the person, and a deep knowledge that allows you to make predictions about what they would say to you about what is going on in any moment. In fact, you often hear their voices in your head even when you least expect.

There is no reason to give this up. 

There is no switch to pull that will make it all right. The job in grieving is to reassemble a life piece by piece until it starts to make sense. Including the imprint of who and what you have held dear will help provide continuity and meaning. 

Every day of grief can be a challenge, but it will be a better day for your effort to engage with it. Creating a set of daily practices will strengthen you to handle it in the best possible way.

Possible practices could be:

For your body – you need to become an expert in self-care. You already know what soothes you, so build it in to each day. Physical exercise can trigger chemicals that increase a sense of well-being, and when will you ever need that more? If it is too much to even get yourself out of the chair, recruit a member of your support team to join you.

​For your mind – do what you can to clear and calm it. Embrace mindfulness, or remaining in the present moment, no matter how you are feeling. If you feel sad, or quiet or blah, stay with it and let the present moment be what it is. It will move on and so will you. Meditate, spend time in nature or with a pet, garden, listen to music, watch firelight, or visit an art museum.

​To tend your emotions – which may be all over the place day to day, or even moment to moment. Talk with someone regularly, just to stay in touch. If you can manage at least one conversation each day, even just a brief check in, you will keep your connections open for the times when you most need them. There are great benefits to putting your feeling into words. For starters, your friend can listen and truly hear you, and you can hear yourself.​

For your spirit – practice expression each day, through writing, storytelling, drawing, painting or scribbling, or other activities that you might lose yourself in for a while. If you have religious practices that comfort you, set aside time for them.

Living with Grief

Resilience is a choice, and daily actions put it in motion. The more you can manage to take action, the more imagination, creativity and optimism you will unleash. Some days the initiative you need won’t seem to be there, and you may have to strong-arm yourself to act, or borrow the energy from someone else.

A profound loss also brings a new attention to various areas of your own life. Depending on which stage of life you are in, this will be expressed in different ways. Young people may find direction. Those in midlife may be moved to examine how they have lived while they can still make adjustments. Older people may take the opportunity to look back and make sense of their lives.

A loss reaction can occur, being able to acknowledge and accept the significance of a loss is important.

It is important to remember that grief and loss is complex and a few insights to remember are that we all respond to changes in our life in different ways – there is no right or wrong way to grieve. There is also no timeframe to grieving.

References:

Kübler-Ross, E. (1969). On Death and Dying: What the dying have to teach doctors, nurses,
clergy, and their own families. New York, USA: Scribner.
Worden, W. (2009). Grief Counselling and Grief Therapy – A Handbook for the Mental Health
Practitioner. New York, USA: Springer Publishing Company.

Waves of Grief & Habits for Wellbeing

Mental Health

Understanding Mental Health

Mental health can be defined as a wellbeing state whereby individuals realise their own potential. They could also cope with the common stresses of life and able to work in a fruitful and productive manner while contributing to their community in positive manner (World Health Organization [WHO], n.d., as cited in Queensland Health, 2017). It is often viewed as a positive concept related to social and emotional wellbeing of individuals and their communities. However, mental health exists on a continuum and is not fixed; it could range from an individual functioning healthily to another individual experiencing severe symptoms of mental health conditions. These mental health conditions are also known as mental health disorders or mental illnesses.

Mental Health in Australia

It was estimated that almost half (46%) of the people in Australia aged 16-85 experienced a mental disorder during their lifetime (AIHW, 2020). With the high prevalence of individuals experiencing mental health conditions in the country, Australia has a wide range of mental-health related support services are available in the country for individuals to access. The aim is that with the appropriate supports and interventions, individuals are able to manage and improve their symptoms/mental health conditions, and to maintain mental health. Ultimately, the goal is for individuals to achieve recovery in their own terms (Department of Health, 2021). Keeping in mind that restrictive practices were commonly used in the past, Australia is committed to minimise and if possible, eliminate the use of seclusion and restraint among individuals who are receiving mental health-related support (AIHW, 2020)

Types of Mental Illness

Individuals can experience mental illness when their thinking, emotional state, and/or social abilities are being affected. Typically, this manifests as a disturbance to their work, daily functioning, and/or interpersonal relationships; these disturbances can take place suddenly or gradually in the long run. While different types of mental illness have their own specific set of symptoms, there are still some general signs of mental illness that you should be familiar with. Individuals displaying the below signs may be experiencing mental health conditions, and appropriate support should be provided such that they can receive the relevant treatments to achieve recovery. Listed below are some signs of mental illness that you should be familiar with:

  • unusual or illogical thoughts
  • unreasonable anger or irritability
  • poor concentration and memory, not being able to follow a conversation
  • hearing voices that no one else can hear
  • increased or decreased sleep
  • increased or low appetite
  • lack of motivation
  • withdrawing from people
  • drug use
  • feelings that life is not worth living or more serious suicidal thoughts
  • becoming obsessed with a topic, like death or religion
  • not looking after personal hygiene or other responsibilities
  • not performing as well at school or work

The signs above are helpful in assisting you to identify whether your clients and/or those around you may be experiencing mental illness. However, you should always remember that these signs are not definitive that they are experiencing mental illness, and you should never provide a clinical diagnosis of your clients’ situation unless you are qualified and trained to do so (e.g., psychiatrist, clinical psychologist).

Depression

Depression is one of the most common mental illnesses in Australia, whereby around one million people in Australia experience depression every year, or around 1 in 16 Australians. Depression can influence how an individual think, act, and feel, whereby they may feel hopeless, guilty, worthless, and unmotivated to carry out their daily activities. According to Mind (2017), individuals who are experiencing mild depression may still lead their life as usual, but everything may become harder or less worthwhile for them to perform. On the other end, those who experience severe depression may have suicidal thoughts and behaviours, which can be life-threatening.  Depression can also be described as an individual experiencing extreme distress whereby they are in a persistent depressed mood for at least two weeks.

We all can experience symptoms of depression from time to time and that does not mean that we are depressed. It is important to understand there is a difference between the symptoms of clinical depression and an individual feeling unhappy or sad. But of course, if you think that your client or anyone around you may be experiencing depression, in line with your duty of care, you should always direct them to the appropriate support for further care (Betterhealth Channel, 2018).

There are several types of depression that are all characterised by intense low mood, though with some important differences. These include major depression; melancholia; dysthymia; psychotic depression; antenatal and postnatal depression; and seasonal affective disorder.

Just as other mental illnesses, there is no single specific cause that leads to an individual experiencing depression. Every individual who experiences depression has their own personal circumstances that contribute to their mental health condition. Despite not knowing the exact cause of depression, it is still extremely helpful to understand the different factors that play a part in an individual developing depression (Healthdirect, 2020b).

The type of treatment administered for individuals with depression is dependent on a few factors such as the type of depression, severity of symptoms and whether it is a first or recurring depressive episode. With that said, depression is commonly treated with antidepressant medications to assist individuals to manage their symptoms by regulating their mood. However, it may require some time for the antidepressant to work fully, and it may also require the individual and their doctor to work together to find the right type of antidepressant and dosage. This is often complimented with other treatment approaches such as lifestyle changes, psychological treatments (e.g., CBT and mindfulness), community support programs (e.g., training and education, mutual support groups) and physical therapies (e.g., electroconvulsive therapy; SANE Australia, 2021).

Anxiety and Anxiety Disorders

It is a fairly common experience for individuals to experience anxiety when faced with threat, danger, or stress, e.g., facing a job loss, major accident or sudden death of a loved one. These life events typically induce feelings like being upset, uncomfortable, and tense (e.g., pounding heart and rapid breathing) but they usually go away after a short period of time. However, for individuals who have anxiety disorders, their anxious feelings are often excessive and irrational, which could interfere with their daily lives as these feelings are persistent. Hence, similar to depression, not everyone who experiences anxiety have anxiety disorder.

About 25% of Australians have an anxiety disorder that requires treatment and support, while another 25% of Australians experience less severe anxieties such as fear of snakes or spiders.

While most of the anxiety symptoms are common between the different anxiety disorders, there are still some stark differences between each of them. A few of the most common anxiety disorders include generalised anxiety disorder; social phobias; panic disorders; agoraphobia; obsessive compulsive disorder; and trauma and stress-related disorders (Betterhealth Channel, 2020).

There are no known exact causes of anxiety disorders, and it is usually due to a mix of different factors. When determining which treatment or intervention for an individual with anxiety disorders, there are many considerations to take into account. For example, what type of anxiety disorder and its severity; individuals with milder form of anxiety disorders may alleviate their symptoms by implementing lifestyle changes while those who have more severe forms of anxiety disorders may require medicine. Typical treatments for anxiety disorders are as below include cognitive behaviour therapy; exposure therapy;  anxiety management and relaxation techniques; and medication (Betterhealth Channel, 2020).

  • Anxiety management and relaxation techniques: for example, deep muscle relaxation, meditation, breathing exercises and counselling.
  • Medication: this may include antidepressants and benzodiazepines

Bipolar Disorders

Bipolar disorder is a severe mental health condition that was known as manic depression. This is because individuals who have bipolar disorders experience extreme moods; low (depressed) and high/excited (manic). Individuals who experience these mood and energy changes can also experience changes in their behaviour, which changes their daily functioning. While it is a common experience that our mood shifts to respond to the different life events, individuals who have bipolar disorders tend to have their moods fluctuate more than usual. According to Healthdirect (2020a), about 1 in 50 Australians (1.6%) are affected by bipolar disorder each year; more women are affected than men.

Individuals will experience extreme moods at different times for a period of time: manic (or hypomanic) episodes and depressive episodes. Different individuals experience the moods for different periods of time, whereby an episode can last for weeks for some, and it can last for months for others. Individuals will develop different symptoms depending on whether they are experiencing a manic or depressive phase (Healthdirect 2020a). Some individuals with bipolar disorder may also experience psychotic symptoms. These symptoms include hearing voices or delusions that are usually in the context of their current mood state/episode. For example, if the individual is in a depressive episode, they may believe they have severe physical health problems or they are in poverty. Individuals experiencing a manic episode might think they have special powers or special mission (Queensland Health, 2017).

While there are different types of bipolar disorders, the two most common types of bipolar disorders are listed below (Healthdirect, 2020a):

  • Bipolar I Disorder: Individuals who have extreme, long-lasting highs (mania) and depressive episodes are diagnosed with it. Individuals who experience psychosis may also be diagnosed with this.
  • Bipolar II Disorder: Individuals who experience highs that are less extreme (hypomania) and depressive episodes are diagnosed with it; a hypomania episode may last for only a few hours or days.

Individuals with bipolar disorders typically requires long-term medication to help manage their symptoms. Other than medications, they may also receive psychological therapy and alter their lifestyle. Individuals with bipolar disorders are typically prescribed with medications to alleviate their mood swing symptoms, e.g., mood stabilisers and/or antipsychotics (if there are psychotic symptoms present). Some individuals may receive electroconvulsive therapy (ECT) for individuals who do not respond to treatments for their mood episodes (Healthdirect, 2020a).

Schizophrenia

About 1 in 100 Australians are affected by schizophrenia, which is characterised by disruptions to thinking and emotions. Individuals with schizophrenia typically experience reality in an altered way, which are usually manifested in psychotic symptoms. According to Betterhealth Channel (2014), 20% to 30% of individuals with schizophrenia experience only a few brief psychotic episodes (i.e., psychosis) while it is chronic for others. During a psychotic episode, individuals can lose touch with reality and have reduced motivation, flattened emotional expression, and may find it challenging to process information. You should also keep in mind that individuals with schizophrenia are at a higher risk of suicidal behaviours.

Schizophrenia has a wide range of symptoms and it can vary across everyone and they are typically categorised into psychotic symptoms and non-psychotic symptoms. These symptoms can have negative consequences in the individual’s life, especially in relation to their daily functioning. As a result, individuals may be socially isolated and alienated by those around them. This is because individuals who experience the symptoms are often unable to participate in normal conversations or social events. Some of them may also lack enough motivation to carry out simple daily activities such as bathing or cooking. Some individuals with schizophrenia may also lack insight into their behaviours’ appropriateness and how that could appear to others (Betterhealth Channel, 2014).

Some individuals can recover from schizophrenia completely while some others may experience episodes, whereby they experience their symptoms come and go. Typically, individuals with schizophrenia receive a few different types of treatments to help manage their symptoms and achieve the best outcomes in their life. Medications such as antipsychotics are the main form of treatment for schizophrenia to help reduce and manage psychotic symptoms. Individuals would also receive psychological interventions to assist them to have a better understanding of their symptoms and learn how to manage and cope with them. Interventions usually include CBT and family therapy. Individuals with more severe symptoms (or out of control) could be admitted into hospital for further medical care to manage these symptoms (Healthdirect, 2020d).

Personality Disorders

Individuals who have personality disorders experience long-term thinking patterns, and behaviours and emotions that are extreme, inflexible, and dysfunctional. Consequently, individuals may find it challenging and distressing to perform daily activities. It can also be challenging for them to change or alter their behaviours and/or adapt to different situations; some individuals find it difficult to form positive relationships with others and/or maintain work.

It is important to recognise that personality disorders are distinct from personality traits. The latter can be explained through theories such as different personality types. For example, some individuals are more conscientiousness, whereby they are more careful and are able to exercise high self-discipline to achieve their goals. On the other hand, individuals with personality disorders often experience severe symptoms that could cause distress to their life and often find it challenging to control their own behaviour (Healthdirect, 2020c).

There are a wide range of personality disorders and hence different ways to classify these disorders. In general, they exist on a spectrum along with the normal personality traits, which means that some individuals may possess some features of a personality disorder without necessarily having the entire disorder, i.e., not experiencing every symptom of the disorder; some individuals could also exhibit symptoms of more than one personality disorder. With that said, personality disorders are loosely classified into three main groups, or clusters.

  • Cluster A: Individuals are described as having odd or eccentric thoughts and/or behaviours.
  • Cluster B: Individuals are described has having unstable emotions and dramatic impulsive behaviours.
  • Cluster C: Individuals are described as having anxious and fearful thoughts and behaviours.

The main form of treatment for personality disorders is psychotherapy, which can effectively help individuals to manage their symptoms. Psychotherapies can also assist them with working on their lifestyle such as establishing satisfying and stable interpersonal relationships and making positive behaviour changes. These therapies include CBT, dialectical behaviour therapy (DBT), psychodynamic psychotherapy, and psychoeducation.

Editor’s Note: This is an excerpt from the unit Provide Recovery Orientated Mental Health Services in AIPC’s Diploma of Mental Health.  

References

  1. AIHW. (2020, July 23). Australia’s health 2020https://www.aihw.gov.au/reports-data/australias-health
  2. Betterhealth Channel. (2014, May 31). Schizophrenia. https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/schizophrenia#current-treatments-for-schizophrenia
  3. Betterhealth Channel. (2018, July 24). Depression Explained. https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/depression
  4. Betterhealth Channel (2020, May 18). Anxiety disordershttps://www.betterhealth.vic.gov.au/health/conditionsandtreatments/anxiety-disorders
  5. Department of Health. (2021, March 17). About mental health. https://www.health.gov.au/health-topics/mental-health-and-suicide-prevention/about-mental-health
  6. Healthdirect. (2020a, September). Bipolar disorder. https://www.healthdirect.gov.au/bipolar-disorde
  7. Healthdirect. (2020b, December). Depression. https://www.healthdirect.gov.au/depression
  8. Healthdirect. (2020c, December). Personality disorders: An overview. https://www.healthdirect.gov.au/personality-disorders
  9. Healthdirect. (2020d, December). Schizophrenia. https://www.healthdirect.gov.au/schizophrenia
  10. Mind. (2017). Understanding mental health problems. https://www.mind.org.uk/media-a/2942/mental-health-problems-introduction-2017.pdf
  11. Queensland Health. (2017, June 6). Signs of mental illness. https://www.qld.gov.au/health/mental-health/signs
  12. SANE Australia. (2021, April 20). Depressionhttps://www.sane.org/information-stories/facts-and-guides/depression

AIPC

Communication Upskilling

There are specific things to do that can help improve your communication skills:

1.  Listen, listen, and listen. People want to know that they are being heard. Really listen to what the other person is saying, instead of formulating your response. Ask for clarification to avoid misunderstandings. At that moment, the person speaking to you should be the most important person in your life. Another important point is to have one conversation at a time. This means that if you are speaking to someone on the phone, do not respond to an email, or send a text at the same time. The other person will know that she doesn’t have your undivided attention.

2.  Who you are talking to matters. It is okay to use acronyms and informal language when you are communicating with a buddy, but if you are emailing or texting your boss, “Hey,” “TTYL” or any informal language, has no place in your message. You cannot assume that the other person knows what the acronym means. Some acronyms have different meanings to different people, do you want to be misunderstood? Effective communicators target their message based on who they are speaking to, so try to keep the other person in mind, when you are trying to get your message across.

3.  Body language matters. This is important for face-to-face meetings and video conferencing. Make sure that you appear accessible, so have open body language. This means that you should not cross your arms. And keep eye contact so that the other person knows that you are paying attention.

4.  Check your message before you hit send. Spell and grammar checkers are lifesavers, but they are not foolproof. Double check what you have written, to make sure that your words are communicating the intended message.

5.  Be brief, yet specific. For written and verbal communication, practice being brief yet specific enough, that you provide enough information for the other person to understand what you are trying to say. And if you are responding to an email, make sure that you read the entire email before crafting your response. With enough practice, you will learn not to ramble, or give way too much information.

6.  Write things down. Take notes while you are talking to another person or when you are in a meeting, and do not rely on your memory. Send a follow-up email to make sure that you understand what was being said during the conversation.

7.  Sometimes it’s better to pick up the phone. If you find that you have a lot to say, instead of sending an email, call the person instead. Email is great, but sometimes it is easier to communicate what you have to say verbally.

8.  Think before you speak. Always pause before you speak, not saying the first thing that comes to mind. Take a moment and pay close attention to what you say and how you say it. This one habit will allow you to avoid embarrassments.

9.  Treat everyone equally. Do not talk down to anyone, treating everyone with respect. Treat others as your equal.

10.  Maintain a positive attitude and smile. Even when you are speaking on the phone, smile because your positive attitude will shine through and the other person will know it. When you smile often and exude a positive attitude, people will respond positively to you

Manpower Group: Professional Development