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3 Core Conditions for Therapeutic Change

3 Core Conditions for Therapeutic Change

The person-centered counseling approach was established in the 1940’s by humanistic psychologist, Carl Rogers. The goal of a person-centered therapy is to create the necessary conditions for clients to engage in meaningful self-exploration of their feelings, beliefs, behavior, and worldview, and to assist clients in their growth process, enabling them to cope with current and future problems.

A major concept of this approach is that people are generally trustworthy, resourceful, capable of self-understanding and self-direction, able to make constructive changes, and able to live effective and productive lives. Another key concept is that the attitudes and characteristics of the therapist, and the quality of the client-therapist relationship are prime determinants of the outcome of the therapeutic process.

Rogers maintains that therapists must have three attributes to create a growth-promoting climate in which individuals can move forward and become capable of becoming their true self: (1) congruence (genuineness or realness), (2) unconditional positive regard (acceptance and caring), and (3) accurate empathic understanding (an ability to deeply grasp the subjective world of another person).

1. CONGRUENCE (GENUINENESS)
Congruence refers to the therapist being real, authentic, and genuine with their clients. It’s called congruence because their inner experience and outward expression match. In being authentic, the therapist shows they are trustworthy, which helps in building a good therapeutic relationship with the client. It also serves as a model for clients, encouraging them to be their true selves, expressing their thoughts and feelings, without any sort of false front.

2. UNCONDITIONAL POSITIVE REGARD and ACCEPTANCE
Unconditional positive regard means the therapist genuinely cares for their clients and does not evaluate or judge their thoughts, feelings, or behaviors as good or bad. Each client is accepted and valued for who they are, as they are, without stipulation. Clients need not fear judgment or rejection from the therapist.

3. ACCURATE EMPATHIC UNDERSTANDING
Accurate empathic understanding means that the therapist understands their client’s experience and feelings in an accurate and compassionate way. The therapist recognizes that each client’s experience is subjective and therefore strives to see things from the client’s unique perspective. An important part of accurate empathic understanding is for the therapist to convey that they “get it” by reflecting the client’s experience back to them. This encourages clients to become more reflective with themselves, which allows for greater understanding of themselves.

If you’ve ever had an experience where you felt like someone just really got you…they completely understood where you were coming from, or could truly relate to the way you felt – that’s accurate empathic understanding.

Rogers asserts that empathy helps clients (1) pay attention and value their experiencing; (2) see earlier experiences in new ways; (3) modify their perceptions of themselves, others, and the world; and (4) increase their confidence in making choices and pursuing a course of action. Jeanne Watson (2002) states that 60 years of research has consistently demonstrated that empathy is the most powerful determinant of client progress in therapy. She puts it this way:

“Therapists need to be able to be responsively attuned to their clients and to understand them emotionally as well as cognitively. When empathy is operating on all three levels – interpersonal, cognitive, and affective – it is one of the most powerful tools therapists have at their disposal.”

 

References:
1. Watson, J. C. (2002). Re-visioning empathy. In D. J. Cain (Ed.), Humanistic psychotherapies: Handbook of research and practice (pp. 445-471). American Psychological Association, Washington, DC.
2. Corey, Gerald. Theory and Practice of Counseling and Psychotherapy. Belmont. Thomas Learning, Inc. 2005.

Mental Attitude

Mental Attitude

I recently came across Elbert Hubbard’s essay on “Mental Attitude” in a book I was reading, and I enjoyed it so much that I wanted to share it with others. For me, it speaks an optimistic message of how having the right combination of self-confidence, courage, and determination will lead you to success. I hope you enjoy it as much as I do!

Whenever you go out of doors, draw the chin in, carry the crown of the head high, and fill the lungs to the utmost; drink in the sunshine; greet your friends with a smile, and put soul into every hand-clasp.

Do not fear being misunderstood, and never waste a minute thinking about your enemies.  Try to fix firmly in your mind what you would like to do, and then without veering off direction, you will move straight to the goal.

Keep your mind on the great and splendid things you would like to do; and then, as the days go gliding by, you will find yourself unconsciously seizing upon the opportunities that are required for the fulfillment of your desire, just as the coral insect takes form the running tide the elements it needs.  Picture in your mind the able, earnest, useful person you desire to be, and the thought you hold is hourly transforming you into that particular individual.

Thought is supreme.  Preserve a right mental attitude – the attitude of courage, frankness, and good cheer.  To think rightly is to create.  All things come through desire, and every sincere prayer is answered.  We become like that on which our hearts are fixed.  Carry your chin in and the crown of your head high. 

 

Works Cited:
Knox, George.  Thoughts That Inspire.  Des Moines.  Personal Help Publishing Co. 1906.
Carnegie, Dale. How to Win Friends & Influence People. New York. Simon and Schuster, Inc. 1981.

A Young Woman’s Personal Experience with Anxiety

A Young Woman’s Personal Experience with Anxiety

Anxiety is something that everyone deals with, to some extent, during their life. For some people it’s a passing experience of feeling stressed and overwhelmed. For others, though, anxiety can be crippling. I mean truly, intolerably, despairingly crippling.

You can’t sleep, you can’t eat, you can’t focus. Your work suffers; your relationships suffer.  You question everything you do, and everything you say. Your mind never stops churning things over. You’re filled with feelings of self-doubt and never being good enough. It’s pure agony.

The term “anxiety” gets thrown around for everything, ranging from feeling nervous to experiencing unrelenting, incapacitating panic attacks. Because of this, there are people who equate “feeling stressed” to knowing what having an anxiety disorder feels like. Unfortunately, this attitude feels discrediting and invalidating to the person who truly experiences the wrath and magnitude of anxiety.

Anxiety can manifest itself as a condition, such as a phobia, social, or generalized anxiety; or on a greater level, it can present comorbidly with other conditions, such as Depression, ADHD, Schizophrenia, and so forth. Anxiety is not a character flaw. I repeat: ANXIETY IS NOT A CHARACTER FLAW. Anxiety is a neurological imbalance. It is the result of obtaining some unfortunate genetics and/or exposure to certain life experiences. None of those things are your fault in any way.

I am the youngest child of two girls. Some people believe that being the youngest child makes you “selfish.” I would say that I do, in fact, have a tendency towards selfishness. But my selfishness isn’t due to being the youngest child; rather, it’s a result of having to manage my anxiety.

For instance, I can’t be the person who goes and offers comfort to a friend in the middle of the night because of a break-up, or some other challenging situation. I have to be selfish; I need to sleep. Because altering my routine and extending myself could offset my own mental stability. I need to rest. I need to relax. I need time to myself.

I have to “be selfish” in order to operate in a fast-paced, high-producing, performance-based society. I’m at a disadvantage to others, who function at a higher level, and with more ease. Because of my anxiety, my mental and emotional reserves are easily and quickly depleted.

I want to be there for my friends in the middle of the night, when they are hurting, but the fact of the matter is that I can’t. I have to take care of myself. This doesn’t mean that I don’t care. It doesn’t discredit me as a kind-hearted person. I absolutely want what is best for the people around me. I simply need my time, time when I am off limits, time to recuperate.

I’ve learned from past mistakes of over-extending myself. There have been times when I’ve tried to be everything to everyone. I went out of my way, above and beyond, to be there for people. Even when I did all that I could, I still felt this hankering guilt that it wasn’t enough; that I wasn’t enough.

I have since learned that the care and support I am able and willing to offer others is enough. I have since learned that I am enough. I realize that I owe it to myself (and others) to take care of me. I have to care for myself at least as well as I care for others. Self-care is a requirement for others-care. And when you think about it, there’s really nothing selfish about that.

 

* Special thanks to my considerate, generous, hard-working, and capable niece for sharing her story, in hopes of providing understanding and validation for those who face their own struggles, and in hopes of providing insight for others to develop empathy for such challenges. 

6 Principles for Meaningful Living

6 Principles for Meaningful Living

The Happiness Trap: How to Stop Struggling and Start Living [A guide to ACT: the mindfulness-based program for reducing stress, overcoming fear, and creating a rich and meaningful life] by Russ Harris

Acceptance and Commitment Therapy is based upon six core principles that work together to help a person develop a mind-set known as “psychological flexibility.” Psychological flexibility is the ability to adapt to a situation with awareness, openness, and focus, and to take effective action, guided by your values. For short, psychological flexibility can be thought of as Mindfulness + Values + Action.

  1. DEFUSION is creating distance and separating from unhelpful thoughts. It entails recognizing that most of our thoughts are neither true nor false; rather, most of our thoughts are actually opinions, judgments, beliefs, and morals and related plans, goals, wishes, and values. The idea is not to determine whether a thought is true or false, but whether it is helpful. One way to create distance from an unhelpful thought is to simply insert the following phrase in front of the thought: “I’m having the thought that…” or “I notice I’m having the thought that…” DEFUSION recognizes that thoughts may or may not be true; therefore, we mustn’t automatically believe them. It also recognizes that thoughts may or may not be important; therefore, we only pay attention if they’re helpful.

Thought Defusion PICTURE for blog post

  1. ACCEPTANCE (EXPANSION) literally means “taking what is offered.” It is fully opening yourself to your present reality – acknowledging what is, right here and now, and letting go of the struggle with life as it is in this moment. This philosophy is encapsulated in Russ Harris’s “Serenity Challenge” (his version of the Serenity Prayer): Develop the courage to solve those problems that can be solved, the serenity to accept those problems that can’t be solved, and the wisdom to know the difference.

In practicing EXPANSION, the aim is to observe your emotions, not think about them. The four steps of EXPANSION are (1) Observe, (2) Breathe, (3) Create Space, and (4) Allow.

  • Observe the sensations in your body (i.e. a lump in your throat or a knot in your stomach) and focus your attention on that sensation with curiosity.
  • Breathe into and around the sensation with a few deep, slow breaths co provide a center of calm within you, like an anchor in the midst of a storm to hold you steady.
  • Create Space with your breath flowing in and around the feeling, giving it plenty of room to move around.
  • Allow the sensation to be there (even if you don’t like it or want it); simply let it be. Acknowledge any urges to fight with the feeling or push it away, and bring your attention back to the sensation.

Expansion PICTURE for blog post

  1. CONTACT WITH THE PRESENT MOMENT (CONNECTION) means being fully aware of you’re here-and-now experience, fully in touch with what is happening at this moment. The goal is to pull yourself out of the past or the future and bring yourself back to the present – right here, right now.

Why practice Connection?

  • so you can appreciate the richness and fullness of life
  • because the only moment we have is NOW
  • so that you can take effective, mindful, value-driven action (which requires being aware of what’s happening, how you’re reacting, and how you wish to respond).

CONNECTION happens through the OBSERVING SELF; it involves bringing full attention to what is happening here and now without getting distracted or influenced by the thinking self.

  1. THE OBSERVING SELF (as opposed to the THINKING SELF) is a viewpoint from which you can observe thoughts and feelings. It’s essentially pure awareness; without the observing self, you would have no capacity for self-awareness. Your thoughts, feelings, and sensations change continuously; sometimes they’re pleasant, sometimes painful, helpful, happy, calm, angry, etc. The observing self can’t be judged as good or bad, right or wrong, because all it does is observe, nor does it judge or criticize you (because judgments are thoughts, which come from the THINKING SELF); it simply sees things as they are. You can think of the observing self as being like the sky, while thoughts and feelings are like the weather – constantly changing.
  1. VALUES are (1) Our heart’s deepest desires: how we want to be, what we want to stand for, and how we want to relate to the world around us, and (2) Leading principles that can guide us and motivate us as we move through life.

To identify what your values are, here are some questions to ask yourself:

  • Deep down inside, what is important to you?
  • What do you want your life to be about?
  • What sort of person do you want to be?
  • What sort of relationships do you want to build?
  • If you weren’t struggling with your feelings, or avoiding your fears, what would you channel your time and energy into doing?

Values are not the same thing as goals; a value is a direction we desire to keep moving in, and ongoing process that never reaches an end, while a goal is a desired outcome that can be achieved or completed. For example, getting married is a goal, whereas being a loving and caring partner is a value. One can think about their values in relation to different domains of life, such as Family, Marriage/Intimate Relationships, Friendships, Employment, Education/Personal Development, Recreation/Fun/Leisure, Spirituality, Community Life, Environment/Nature, and Health.

Values PICTURE for blog post

  1. COMMITTED ACTION entails setting meaningful goals for your identified values. Use the following steps to create a Committed Action Plan for yourself:
    • Summarize Your Values for each domain. For example, “In the domain of Family, I value being honest, respectful, authentic, and supportive.”
    • Set an Immediate Goal – something that can be accomplished right away. For example: “During my lunch break, I’ll call my husband and encourage him because I know he’s having a stressful day.”
    • Set Short-Term Goals: ask yourself what small things you can do over the next few days and weeks that are consistent with your identified values.
    • Set Medium-Range Goals: think of larger challenges you can set for the next few weeks and months that are consistent with valued living.
    • Set Long-Term Goals: decide upon major challenges you can set for the next few years that will continue to take you in your valued direction. A good question to ask yourself is, “Where do I want to be five years from now?”
Ten Rules for Confidence

Ten Rules for Confidence

[from The Confidence Gap: A Guide to Overcoming Fear and Self-Doubt, by Russ Harris]

Rule 1: The actions of confidence come first; the feelings of confidence come later.
The concept of confidence is defined as “an act of trust or reliance” (trusting and relying on one’s abilities and competencies), rather than viewing confidence as “having a feeling of absolute certainty or assurance.” This is a better approach, because if you wait for the feelings of confidence to come before taking any sort of action, then there’s a chance you might end up waiting forever. That’s not very effective. Harris offers four steps to follow in order to become more confident in any action: (1) Practice the skills, (2) Apply them effectively, (3) Assess the results, and (4) Modify as needed.

Rule 2: Genuine confidence is not the absence of fear; it is a transformed relationship with fear.
People believe many myths about fear, such as: fear is a sign of weakness; fear is the enemy; fear holds you back; confidence is the absence of fear. But the truth is that when anyone steps out of their comfort zone, takes a risk, or faces a challenge, they will experience fear. That’s not a sign of weakness; it’s the natural human response. Fear doesn’t have to be viewed as an enemy, or something to hold you back, rather, it can be used as a motivating source of energy to be used for your benefit. It is not true that confident people don’t feel anxious or afraid, but perhaps they have figured out how to handle it and channel it effectively.

Rule 3: Negative thoughts are normal. Don’t fight them; defuse them.
Dealing with negative thoughts can be annoying, but the fact that we have them is actually a good thing! It’s a sign that our brains are working: trying to anticipate what could hurt us or harm us, trying to predict what might go wrong, etc. If your mind has negative or anxious thoughts, congratulations – you have a normal brain. Negative thoughts are not inherently problematic, they only become so if we get all caught up in them, give them all our attention, treat them as the gospel truth, allow them to control us, or get into a fight with them. The goal is defusion: separate from your thoughts and realize that they are simply words.

Rule 4: Self-acceptance trumps self-esteem.
Having high self-esteem means evaluating oneself positively. The trouble is that it gets hard to do this when one is not successful, or when one makes mistakes. On the other hand, self-acceptance means accepting oneself in spite of deficiencies. It involves letting go of all self-judgments. It doesn’t mean that we stop paying attention to the way we behave, and the impact of our actions; it simply means that we let go of blanket self-judgments. When we make a mistake, we reflect on it and assess our actions. Harris puts it well when he poses: “If beating ourselves for every mistake we make was productive, wouldn’t we all be perfect by now?”

Rule 5: Hold your values lightly, but pursue them vigorously.
Values are one’s guiding principles of behavior, according to what is important to them in life. Harris likens values to a compass: they give us direction, guide our journey, and help us stay on track. (Goals are what we want to achieve along the way). Examples of values include: adventure, authenticity, connection, contribution, courage, creativity, flexibility, honesty, humor, intimacy, open-mindedness, respect, self-awareness, spirituality, and trust. One reason to hold your values lightly is the tendency for them to turn into inflexible requirements, such as, “I must be adventurous at all times.” Remember, the goal is to live by guiding values, not rigid rules.

Rule 6: True success is living by your values.
This means using one’s values to set goals, and to sustain movement toward set goals. You don’t have to wait until you achieve a goal in order be successful; you can be successful right now through living by your values. Maybe a goal of yours is to become a doctor because you hold the value of helping others. It will take you several years to actually become a doctor, but you can do many things to help people along the way.

Rule 7: Don’t obsess about the outcome; get passionate about the process.
Process is the way you go about doing something, whereas outcome is the result of what you’ve done. The idea here is not to give up on your goal(s), but to shift the emphasis to engaging fully in the process, and embracing it as an opportunity for learning, rather than obsessing about the outcome.

Rule 8: Don’t fight your fear: allow it, befriend it, and channel it.
Russ Harris Speaks of using “The ABC of Fear-Whispering” for dealing with fear (A=allow, B=befriend, C=channel). Trying to fight against or avoid an emotion oftentimes just makes the unpleasant emotion stronger. So, instead of fighting your experience of fear, try simply allowing it to be. Harris encourages befriending one’s fear: building a positive relationship with it. You don’t necessarily have to like it, but haven’t you ever been friendly to a person whom you don’t necessarily like? It’s kind of like that. Also, fear is worth befriending if it helps you live by your values, achieve your goals, perform at your peak, and live a richer, more meaningful life. Fear is kind of like nervous energy, but it can be less scary if you frame it as feeling “excited” or “pumped” instead. Think to yourself, “How can I make good use of this energy? What can I channel it into?” Use your fear to your benefit. And remember, you can have fear and confidence at the same time. If you recall Rule 2: Genuine confidence is not the absence of fear, it is a transformed relationship with fear.

Rule 9: Failure hurts – but if you’re willing to learn, it’s a wonderful teacher.
In the words of John Dewey (American philosopher): “Failure is instructive. The person who really thinks learns quite as much from his failures as from his successes.” Just like fear, failure is a fact of life. It’s also a natural part of learning; we reflect on what didn’t work, and think about what might work better next time. It is productive to acknowledge what went “wrong,” while also appreciating what went well. It provides good feedback from which to learn!

Rule 10: The key to peak performance is total engagement in the task.
Peak performance requires practice, defusing from reasons not to do it, making room for discomfort or fear, and fully engaging in the process. The key to peak performance is having focused attention on the task at hand. This requires mindfulness: defusing from unhelpful thoughts, such as, what you look like, what others are thinking, judging your performance, thinking about past or future events, etc. While you can’t eliminate unhelpful thoughts or feelings, you can make space for them while remaining focused and engaged in what you are doing in the present moment. It is in this state of mindful, focused action that we perform at our best.