Person-Centred Therapy - The Basics!
What is it?
Person-centred therapy (PCT) is a school of counselling which started with the renowned American psychologist Carl Rogers in the 1940’s.
It’s also sometimes called Rogerian Counselling, Client-Centred Counselling, or Humanistic Counselling. It is one of the three key schools or modalities of psychotherapy.
Carl Rogers believed that people have the resources within themselves to drive personal progress and development. He called this idea ‘self-actualising’. He was also convinced that individuals, not therapists, are best placed to know and heal themselves. He rejected the idea that therapists were the all-knowing experts. Instead, he focused on a relationship of equals, which was built on trust, honesty, and congruence.
The client and the therapist work together to build a warm, trusting therapeutic relationship where the client remains responsible for the progress, instead of handing over power to the therapist.
Rogers thought that his client's concept of self was tremendously important,
In a similar way to Cognitive Behaviour Therapy (CBT), Rogers felt that, although the past may have useful information and help clients to understand where difficulties may come from, it was more important to focus on the present and the future.
What is most important in the Rogerian approach is the quality of the relationship between the therapist and the client. It needs to be non-judgemental, warm, and trusting. The core concept in this kind of counselling is that the therapist takes a perspective of unconditional positive regard towards the client.
To the extent that there are techniques in Rogerian counselling, they are based around ways of building a strong therapeutic relationship, often called a therapeutic alliance. Counselling in this approach means active listening, non-judgemental acceptance of the client, and reflecting back and summarising what the therapist has heard in order to clarify and allow the client to hear what was previously a disconnected set of thoughts.
On a personal note, I am often astonished at the power of hearing your own words spoken back to you. This can lead either to the client rejecting what they have just heard back, or to a feeling of real validation and a clarification of what they think.
This process can be a really powerful force for change. I tend to use PCT in the early part of my work with clients, as it is so good for building trust and helping to develop a good working relationship.
Understanding Social Anxiety
What is it?
Social anxiety, or social phobia, is an overwhelming fear of social situations. I think it's best understood by looking at the symptoms people experience when they suffer from it.
People with social anxiety are constantly haunted by worries about what others think of them. They suspect that they are being judged negatively, that people don't like them, or that they are deficient in some way.
Such thoughts can be particularly invasive when people are faced with unknown situations, especially when they think they might be scrutinised and judged.
This unpleasant and debilitating fear leads to people avoiding social situations like parties, after- work drinks, and birthday celebrations.
Unfortunately, when you repeatedly avoid social situations, your anxiety only becomes stronger and deeper, and so do the unwanted negative thoughts about being judged and failing.
There can also be physical symptoms like flushing of the neck or face, heart racing, and sweating. Not only are these symptoms embarrassing, even frightening, they create yet more anxiety because you feel that others can see how uncomfortable you are.
As with all anxiety disorders, when social anxiety is left untreated over time, life becomes smaller, and the anxiety is triggered by a greater range of situations.
For example, imagine you decide not to go to a party alone because you picture standing by yourself, feeling self-conscious. Then you decide not to go to the regular after-work drinks on Fridays anymore because you think you are not as interesting as your workmates, and you will be judged.
After a while, this could lead to your experiencing anxiety at the thought of just sitting down with your work colleagues in the staff canteen for lunch. Your mind is filled with thoughts such as, "I won't be able to make conversation. They may think I'm boring. I've got nothing interesting to say. I'll go red, I’ll be flustered." It is easy to see how this process erodes self-confidence and leads to a smaller, less rewarding life.
I work with my clients to discover where the anxiety comes from, to examine the ways in which it manifests itself, and to identify the maintenance cycle that keeps it all going.
This process makes sense of what is happening to you and allows you to feel hopeful that, together, we can do something about your anxiety. The next step is to identify what we can do to change your ingrained responses, to reduce your unwanted symptoms, and to move on with your goals.
Understanding and Working With Anxiety
What is anxiety?
Anxiety is characterised by powerful feelings of unease, worry, and fear which are often accompanied by physical symptoms like shaking, sweating, and dizziness.
Unpleasant thoughts or images of failure, embarrassment, or danger are added to the mix, creating a debilitating condition that causes real suffering for many people in the UK.
Obsessive Compulsive Disorder (OCD), Post-Traumatic Stress Disorder (PTSD), Panic Attacks, Social Phobias and General Anxiety Disorder (GAD) are all forms of anxiety which I see on a weekly basis in my practice.
The cost of anxiety
Anxiety issues are often limiting, baffling, and embarrassing. I hear of how my clients' lives have narrowed and how they avoid the basic pleasures of life, as well as their responsibilities. Self-esteem, confidence, and a sense of self are all eroded by anxiety. The good news is that they can all start to improve when it is effectively treated.
Luckily there are established, evidence-based techniques to help with the anxiety issues above. We can work using a cognitive and behavioural approach to pursue the change you are looking for.
First, we can look at any historical reasons that might explain why you are suffering from anxiety. We won't dwell in the past, but in my experience, it is important to discuss the possible causes for the symptoms. We will look at the specific symptoms that are most distressing for you. What is triggering your anxiety? What makes it worse, and keeps it going?
Identifying the thoughts you have and the way they link with your emotions and behaviours gives us the essential information we need to help you make sense of your symptoms.
From here we will do a series of exercises and experiments to start to challenge the very foundation of your anxiety.
For more information please feel free to contact me here!
Anxiety Maintenance Cycles
One key area to understand when working with anxiety is what creates and maintains the unwanted anxious emotions? We use the concept of a maintenance cycle to show how your thoughts, emotions, physical sensations and behaviours work together to make you feel bad. When we understand what's going on behind the scene, we can start to take back control and make some changes.
OCD - An Introduction
What is it?
So many of my clients come to me suffering with the symptoms of OCD that I thought I would write a set of articles about it to answer some of the common questions that come up in our sessions.
This article is an introduction to OCD. Over the next few months I will add to the subject, with relevant links to make it easier to find what you are looking for.
OCD is an anxiety disorder where the sufferer is dogged by unwanted thoughts, called obsessions. These are usually (although not always) accompanied by a strong desire to carry out an activity or behaviour of some sort to get rid of the unwanted obsession. These behaviours are the compulsions that are talked about in OCD.
What is an obsession?
In OCD the disturbing thoughts are called ‘obsessions,’ and they are usually unpleasant with very negative and disturbing content. They are intrusive and unwanted; regardless of your desire, they just seem to pop into your head without being invited.
Obsessions are really varied; however, some unwanted thoughts might be about being responsible for causing, or failing to prevent, harm to yourself, your loved ones or others. For example, the thought of killing your child or a stranger might be the core of an obsession.
People who suffer from OCD may interpret the thoughts they have to mean something really bad about themselves, such as that they are going mad, or that they are a danger to others.
What is a compulsion?
The compulsions in OCD can be thought of as the way that the discomfort from the obsessions is reduced.
They are often tasks or behaviours that are repeated over and over again, perhaps in a specific order. They may become ritualised over time. Common compulsions include arranging objects in a particular order, washing yourself over and over, cleaning, tapping, and saying prayers.
Compulsions don’t have to be physical behaviours; they can also be mental acts such as seeking reassurance, checking you are safe or checking you are not sexually attracted to someone inappropriate.
Compulsions are a coping mechanism. They seem as if they help with the problem.
You may think ‘Where’s the harm?’ However, the reality is that they are maintaining the problem, and as time goes on they are likely to become less and less effective at reducing the unwanted thoughts.
You may feel that if you do not carry out a ritual, you will be responsible for some harm coming to someone, so it is really important to carry out the compulsion. This can be very intrusive and time consuming. OCD sufferers may also decide to reduce the impact on their lives by avoiding triggers altogether. So if, for example, they have trouble locking the door and walking away, they avoid the whole situation by asking their partner to lock it for them. But avoidance is not a long-term solution, either.
What is not OCD
In the media we often hear people say ‘I’m a bit OCD’ as a way of referring to their desire to have things neat. However, a desire to have things neat, tidy or clean is not the same as OCD.
What causes OCD?
The causes of OCD are not totally understood. In the UK it is considered a type of Anxiety Disorder, whereas in the USA it has been reclassified in a separate category, as an Obsessive-Compulsive Spectrum Disorder, along with hoarding and compulsive skin-picking.
It is helpful to consider the causes of OCD in three ways. The most important for anyone trying to fight an OCD problem is to understand what keeps your OCD symptoms going.
The second might be to identify what triggers your OCD. The third, and perhaps least important for actually changing, is to grasp what might have made you more prone to OCD in the first place.
I will go into all three of these in future articles, but the key thing I want to say at this point is that the causes of OCD are ‘biopsychosocial’. That means that it is partly caused by biological or genetic factors, partly by sociological factors, and partly by your own psychology.
Possibly the most important thing for someone who is suffering from OCD to be
aware of is that the things they are so scared of doing, like harming someone else, sexually abusing a child, or going crazy, they are in no way likely to do. In fact, the situation is the opposite; whatever the sufferer is worried about, he or she will not do.
The treatment for OCD looks at how to reduce engagement with the unwanted obsessions and how to break the compulsive behaviours, which are key to the maintenance cycle at the heart of OCD. I will go into the treatment more fully in a future article.
Understanding Panic Attacks and Panic Disorder
What is a panic attack?
A panic attack is the name given to a frightening set of symptoms characterised by strong emotional feelings, physical sensations, and unpleasant thoughts.
The emotions are of strong fear, anxiety, or terror. These emotions are accompanied by physical sensations, such as increased heart rate, palpitations, chest pains, difficulty breathing, numbness, dizziness, dissociation, abdominal cramps, and dry mouth.
The unpleasant thoughts that can come during a panic attack include, “I’m going to pass out; my heart is going to explode; I’m going to have a heart attack or stroke; I’m going to suffocate; I’m going to soil myself in public; I’m going to be humiliated; I’m going mad; I’m going to die.”
Usually an attack will peak after 10 -15 minutes, with the worst of the symptoms calming down after that.
As with all anxiety issues, avoidance and safety behaviours are likely to surface. Sufferers will want to avoid the situations that might bring on the panic or where they would not want to have a panic attack, for example on public transport or in a place they fear they cannot escape from.
Many people will experience a panic attack in their lives, so having a panic attack does not mean you have panic disorder. Panic attacks are often seen in other kinds of anxiety disorder such as OCD, PTSD, or social phobia.
What is panic disorder?
To be diagnosed with panic disorder you have to have experienced at least four of the following symptoms:
- Palpitations, pounding heart, or accelerated heart rate
- Trembling or shaking
- Sensations of shortness of breath or smothering
- A feeling of choking
- Chest pain or discomfort
- Nausea or abdominal distress
- Feeling dizzy, unsteady, lightheaded, or faint
- Feelings of unreality (derealisation) or being detached from oneself (depersonalization)
- Fear of losing control or going crazy
- Fear of dying
- Numbness or tingling sensations (paresthesias)
- Chills or hot flushes
Moreover, when people are suffering from panic disorder the attacks appear to come out of the blue, with no obvious trigger. The panic attacks have to be persistent, and the sufferer must have experienced fear of having another panic attack for at least one month.
The best way to define panic disorder, as distinguished from just a panic attack, is that it is strongly linked to the fear of having a panic attack. I like to think of it as a fear of fear.
Misinterpretation of normal symptoms:
If you remember the kinds of thoughts panic sufferers are likely to have, you can see one of the reasons that panic attacks turn into a full disorder.
Such thoughts are due to a misunderstanding or a misinterpretation of the unpleasant physical symptoms that are common when an attack occurs.
For instance, it is common to feel palpitations, a racing heart or chest pains when having a panic attack. This can be misunderstood by the sufferer as very convincing evidence that they are having a heart attack and are going to die. In fact, it is quite common for people to call an ambulance when they have a panic attack for the first time.
One thing that happens when someone is suffering from this “fear of fear” is that they start to focus more on physical sensations as a misguided way of protecting themselves.
For example, as a way of not allowing a heart attack to happen they are very aware of their heart rate. When their heart rate naturally goes up, after walking up a hill or perhaps while experiencing some mild anxiety about a required activity, they will notice the heart increase. This is likely to make them afraid: “Perhaps I am going to have a panic attack. Yes, my heart rate is definitely increasing.”
So a perfectly natural variation in heart rate, which most people would never notice or care about, leads to some quite frightening thoughts about an imminent panic attack. Unfortunately, this can become a vicious cycle in which the physical symptoms increase, the anxiety increases in its turn, and the physical sensations increase even further. The outcome for someone with panic disorder is that they then have a full-blown panic attack.
Strategies for treatment:
One key element of dealing with panic attacks is simply to look at the lifestyle factors that aggravate panic. This can be as simple as making changes to how you exercise, sleep, and relax, your alcohol consumption, recreational drug use, and nutrition.
There are two further key strategies for treating panic disorder which draw heavily on the concepts of behavioural and cognitive psychology. The first deals with reducing the symptoms and severity of a panic attack once it has started. This can be done with techniques based on relaxation, breathing, external focus and distraction. They are simple enough to learn, and with practice you can develop a tool that is truly useful when you think a panic attack is around the corner.
This is an important part of the treatment. However, the real meat of the treatment is based on how to reduce the likelihood of a panic attack happening in the first place.
This can be done by looking in more detail at the vicious cycle of how physical sensations, emotions, catastrophic thoughts, avoidance and safety-seeking behaviours all work together to dig you further into your panic disorder.
As with most anxiety treatments, it is challenging work, but I believe well worth your while. In future articles I will look in more detail at how to beat your panic disorder.