What I’ve realised over the last couple of weeks

I think I’m starting to feel more patient about my DP process this time around. As a result this post may not be so heavy on realisations I’ve had since the previous one. I have been doing my best to focus on what I’m telling myself in previous posts, which is to – “slow things down “-, instead of getting hooked into thinking about new reflections. Though I have discovered italics and bold this post, so that’s fun.

I did however start thinking of new prompts for self-reflection on my therapy gaps, such as – what if I think about my therapy gaps as like schema ‘coping styles’ or processes. As an example, what if I take my fear of being unhelpful in therapy and think about how I surrender to, avoid or overcompensate that fear when it crops up in sessions. In more detail, I might avoid my fear by putting off bringing up a topic I’m worried about to a client or overcompensate by over-explaining a concept into the ground. I’ve not used this idea a whole lot yet but perhaps I’ll use it when reflecting on challenging sessions by asking myself “what was the underlying fear that came up for me?”, reflect on how those coping styles occurred and what therapeutic principles I could have used instead to manage the situation.

Now that I think about it, my other main reflection this time around may actually connect to the schema coping style idea. This reflection is just something I noticed myself doing with new clients over the last fortnight. Sometimes to reinforce the structure of therapy to new clients I explain the role of three pillars in therapy: 1. Psychoeducation 2. Coping skills 3. Recognition skills. I find that a lot of client’s understandably come in keen to jump straight into coping skills. Which I can see why – coping skills on face would seem quick, easy and logical as a first step. Personally, I have become wary of this over time, as I have seen many client’s dive straight into coping skills very early in therapy, then because the skills are yet to develop they forget to use the skill altogether in their moment of need out in the real word. Lately when I would inevitably ask clients “which of these pillars would you like to start on?”, they almost always say “I’d like to learn those coping skills”. Then in an effort to help the client make an informed decision I would explain the benefits and costs of starting on coping skills and explain my experiences above. I think part of that is fine, as I’m aiming to help the client set manageable expectations on what they are about to embark upon; where not setting such expectations can be a therapy gap of mine. HOWEVER, in having that discussion with client’s I noticed myself “taking the reigns” and pressing the idea of starting on psychoeducation or recognition skills first – probably losing some of the client’s buy in as a result. That doesn’t sound very client lead so in future when I explain therapy structure I will instead let the client lead their own learning.

What I’ve managed to do since my last post

I have been working on adding an extra question to my SRS debrief with clients, which is: “are there any specific moments in the session that resulted in the overall SRS score dropping a couple of points from last session” (e.g. if the total SRS score went from a 34 in the previous session to a 32 at the current session). I’m still getting used to how to raise and word the question in sessions, but I’ll see as I improve on that if it will then help client’s recall specific moments from the session.

Next, I have been practicing a new explanation of therapy goals to clients, including the difference between “means” and “goals”. I explain to new client’s that when people come to see me, they may want their symptoms to improve (e.g. anxiety), but what they really tend to want out of therapy is for their life to improve; the rationale for the ORS is to measure how their life changes throughout therapy and to indicate to myself and the client if the therapy is helping – or hindering – that improvement. I therefore refer to means as “how do you want your symptoms to improve?” and goals as “how would your life change if your anxiety was no longer in the way, what would you do differently?”. Essentially hitting on the point that treating symptoms may be an important step along the road, but improving your life is the true end-game.

I have also been trying to slow things down in therapy sessions to focus on client’s making gradual changes versus trying to give them the whole kit and kaboodal at once. For example, seeing how client’s go with simple thought/emotion recording exercises and noticing skills before going straight into something like thought defusion; which at the end of the day requires the ability to recognise your own challenging thoughts before you can defuse them. This includes finding simpler ways to just identify their challenging thoughts by reviewing common examples and discussing them or exploring emotions they experience through something like an ‘anger iceberg’. These ideas seem to help me not lead clients so much or over-explain, plus client’s seem to better resonate with exploring what they go through in a way that is still guided but much more lead by them and open-ended. We then might use all of this together to then discuss the link between their thoughts, emotions and behaviours.

I’m looking at these changes as ways to explore therapeutic principles with client’s before encouraging techniques. I have no idea if that’s what I’m actually doing, but this way of thinking helps me stay grounded more often in sessions, instead of getting taken away by a flight of ideas.

Finally, session filming is on pause while Sydney remains on lockdown, so I haven’t had any progress there yet.

Where to next?

Well I think I’ve set at least one job for myself, which is to let clients decide for themselves where they want therapy to go and how they want it to start, instead of me pushing them in a certain direction.

I’ll be working on extending the SRS debrief, with the new kind of question I’m asking clients, which will hopefully help them provide feedback of specific moments in the session that influenced their SRS feedback.

Once I’m happy with where my SRS debriefing skills are at I will then likely start to move toward my next ‘stretch goal’, which will be either to expand on how I’m exploring goals with clients or improve my explanation of my role in therapy and the therapy structure, by learning to use the ‘three-legged’ stool analogy.

In the meantime I’m slowly (had to use it one last time) adding steps to how I plan to use written reflections on challenging sessions, as reflection is still mostly in my head. I’ve found a way of tracking, at least for now, the feedback that client’s give in session and now I hopefully have the prompts I want to use in order to reflect and write, by using the schema coping style idea. I’m thinking about raising this at my next coaching session before I start this though, which is at the end of the month, to ensure I’m still taking all these changes gradually.

I’m on leave today (YAY!) until 24/07 so I might post-pone my next update by a week, depending on how much content I have in mind across the next fortnight, but I’m focusing more on having a long awaited break…in lockdown…at home…. but I’m still excited!

Till next time and as always – thanks for reading.

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