Psychotherapy

The Greek origins of the word ‘psychotherapy’ literally mean the ‘healing of the soul’. Individuals, couples, families, and groups choose to engage in psychotherapy for a variety of reasons:  treatment of a diagnosed mental health condition such as depression or anxiety; when there is difficulty coping with a significant life event, transition, or changes in circumstances; if ordered by a court to undergo counselling in response to a specific situation (e.g. the Family Court may recommend that a parent attend therapy with regard to parenting and relationships); and some people choose to try psychotherapy as a means of understanding themselves better (pictured here is this maxim, largely attributed to Socrates, inscribed on the Arts building at UWA, which perhaps influenced my choice of career). In psychotherapy, clients explore their thoughts, feelings, behaviours, and relationships, with the aims of increasing insight and understanding, reducing symptoms, improving positive emotion and wellbeing, development of coping strategies, and overall better functioning in daily life including school, work, close relationships and self-care. An important part of effective therapy is the ability of the therapist to provide a safe, confidential, non-judgemental environment in which thoughts and feelings can be explored, and many clients experience the therapeutic relationship as healing in itself.

Following initial assessment a variety of therapeutic interventions may be explored depending on the unique needs of the client.

Psychoeducation

Psychoeducation involved informing clients and their families about the physiological, cognitive, emotional and behavioural aspects of their condition, in order to equip them with the knowledge to best manage their illness (and inform others). For example, educating clients about anxiety empowers them to feel more in control of symptoms that often feel beyond their control.

Schema Therapy

Schema therapy is a deeper form of CBT aimed at identifying underlying core beliefs or schemas that influence an individual’s thoughts, emotions and behaviour in maladaptive ways.  Schemas are extremely stable and enduring patterns, comprising of memories, bodily sensations, emotions, cognitions and once activated intense emotions are felt. By bringing these schemas into awareness, and exploring their origins (often from early childhood and significant challenging life experiences), clients are better able to challenge the underlying beliefs and assumptions, and create new healthier patterns of thought, emotion, and behaviour. Schema modes represent the emotional states, coping responses (surrender, avoidance, compensation), and inner critic that show up when our schemas are activated. Understanding these parts of ourselves, including identifying how certain coping modes developed in our early lives to protect our vulnerable child mode (and their painful feelings), can help to develop a stronger healthy adult mode which helps us to respond in a more competent and confident way to life’s problems. The healthy adult mode can learn to intervene with our inner critic modes, and respond to the painful emotions of the child modes in a soothing and compassionate way. Experiential techniques such as imagery rescripting and chair work are often helpful in working with schema modes.

Acceptance and Commitment Therapy ACT

Acceptance and Commitment Therapy (ACT) gets it name from one of its core messages: accept what is out of your personal control, and commit to action that improves and enriches your life. The aim of ACT is to maximise human potential for a rich, full and meaningful life. ACT (which is pronounced as the word 'act', not as the initials) does this by:

a) teaching you psychological skills to deal with your painful thoughts and feelings effectively - in such a way that they have much less impact and influence over you (these are known as mindfulness skills).

b) helping you to clarify what is truly important and meaningful to you - i.e your values - then use that knowledge to guide, inspire and motivate you to change your life for the better.

Eye Movement Desensitisation and Reprocessing (EMDR)

This processing technique can bring quick and lasting relief for many types of emotional distress. EMDR uses a natural function of the body, Rapid Eye Movement (REM), as its basis. The human mind uses REM during sleep time to help it process daily emotional experiences.  There is some evidence that the eye movements perform a similar function to those that occur during REM sleep (when we dream), which we already know to have a vital information processing function. The human mind uses REM during sleep time to help it process daily emotional experiences.  When trauma is extreme, this process breaks down and REM sleep doesn't bring the usual relief from distress. EMDR is thought to be an advanced stage of the REM processing. As the brain via the eye-movement processes troubling images and feelings, resolution of the issue can be achieved.

EMDR works by first "unlocking" the negative memories and emotions stored in the nervous system, and secondly, it helps the brain to successfully process the experience. The therapist works gently with the client, guiding him or her to revisit the traumatic incident. When the memory is brought to mind, the feelings are re-experienced in a new way. EMDR makes it possible to gain the self-knowledge and perspective that will enable the client to choose their actions, rather than feeling powerless over their reactions.

 Cognitive Behaviour Therapy

Cognitive Behaviour Therapy (CBT) is a relatively short term, focused approach to the treatment of many types of emotional, behavioural and psychiatric problems. The application of CBT varies according to the problem being addressed, but is essentially a collaborative and individualised program that helps individuals to identify unhelpful thoughts and behaviours and learn or relearn healthier skills and habits.

Circle of Security - Parenting

Children can be tricky to manage at times, and parenting in the 21st century is becoming more stressful and complex than ever before. To the lament of most parents, kids don’t come with an instruction manual and we are often left scratching our heads, or just feeling guilty, when our little ones have a meltdown (although, sometimes its us having the meltdown).

Enhanced parenting techniques can help improve your enjoyment and interaction with your child. With this aim in mind, the Circle of Security program, through practical real-life vignettes, helps to show parents that children ARE the instruction manual for parenting.

The Circle of Security provides parents with a map for understanding children’s behaviour, from which they can identify their child’s needs and respond accordingly. Parents become more confident about knowing when they need to be supporting their child’s exploration, welcoming them in for love and comfort, and when to take charge with firm tenderness.

 Therapy for Children

Treatment for children is tailored individually to the age and developmental needs of the client, their presenting concerns, and the unique family around them. Research shows that for younger children the involvement of their caregivers is important for successful treatment, and often treatment will require regular parent/caregiver sessions to support their ability to help the young child.

Essential to successful therapy with children is education about different feelings: what they feel like in ourselves and what look like in others and being able to recognise and name them is the key to developing self-regulation. A variety of strategies to help children manage their emotions will be shared, and parents are encouraged to help children name emotions, and model appropriate ways of managing their own feelings.

Play therapy is often a part of treatment with children of all ages, as it is a helpful way for them to express and work through difficult feelings, and provides much insight for the therapist to understand their troubles. Creative approaches are often used to help children identify and make sense of their different feelings.

Schema Therapy is now available for school aged children and adolescents, and is a very effective approach that helps young people identify emerging beliefs about themselves and the world, and recognise their emotions, coping modes, and also focuses on their strengths and positive modes.

The GoZen program, a cartoon based intervention incorporating aspects of psychoeducation, CBT, and mindfulness is used with this primary school aged children for treatment of anxiety.

Neurofeedback

Neurofeedback is form of biofeedback involving the retraining of brain waves. Biofeedback is the process of learning to control physiological functions by the use of instrumentation. Biological signals are fed to trainees with the goal of gaining mental control over subconscious biological processes. Biofeedback is a self-regulation skill and always rewards the trainee. Neurofeedback works by utilising the natural plasticity of the brain – the ability to learn and adapt to the world around us. Neurofeedback training is used to regulate symptoms of conditions which appear to be associated with irregular brain activity, including but not limited to ADHD, difficulties associated with autism spectrum, depression, anxiety, stroke, and seizure disorders. Training is recommended on the basis of empirical observation of improvement in clients with similar conditions, with consideration of the individual’s current neuropsychological and emotional functioning. In addition to clinical applications, neurofeedback is widely used by elite athletes, business executives, and others dedicated to attaining peak performance, as brainwave retraining assists the development of calm, relaxed focus.

Neurofeedback is best understood as training the brain to the optimal level for each individual. The procedure is simple: small sensors are placed on the scalp and held in place with a special gel.  These pick up tiny electrical signals from the person’s head (electroencephalogram - EEG to record brain waves). An amplifier then converts these waves into a visual image with accompanying sounds (a computer game) which allows the person to monitor their performance.  For the game to work, the person has to learn to produce the appropriate brain waves.  In most cases clients will notice changes in symptoms following even the first session, with many reporting that they feel calmer, more relaxed, and focused (depending on what we are training). These effects usually wear off after 24-48 hours, but with regular training effects last longer and longer between sessions. Over time with regular neurofeedback treatment sessions individuals are able to sustain their regulated brainwaves, and in doing so a permanent reduction in symptoms.

Clients who find neurofeedback effective in reducing their symptoms often choose to include training in their regular sessions, as an addition to psychotherapy.

 Image courtesy of the University of Western Australia