Words to beat ourselves up with

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As is often the case, the Journal of Behavioural and Cognitive Psychotherapy (May, 2020 just arrived ) has some great articles. One of which discusses chronic depression and its treatment with rumination focused CBT. Ed Watkins is best associated with it and his book on rumination was a revelation. It helped me understand the process of over-general memory and its links with unhelpful labels. This explains how people can describe themselves in unhelpful ways like “I’m lazy” “I’m useless” “I’m a failure” and why helping people to be more descriptive starts to break down such mood lowering short-cuts.

I am on a mission at the moment to encourage the effectiveness of clinical supervision by blending compassion focused work with techniques that encourage descriptive reflection with the hope of reducing rumination, blame and guilt and ultimately the mental health of nursing staff.

For far too long nurses have been dismissive of the restorative power of clinical supervision which is often viewed with suspicion and considered as just another task to tick off the long “To Do” list. Now is the time to at least plan to learn techniques that stabilise the nursing workforce through a frequently side-lined activity.

Clinical supervision has lost its credibility resulting in the proliferation of alternative support processes which frequently fail to take off for the same reasons – its another initiative, we haven’t got time, its another management tool to get management off the hook. I think it would be a safe bet, to say that the people who are currently accessing effective support are the ones in least need – sophisticated and psychologically minded and committed to trying the techniques that might help.

Try getting a busy staff nurse, who arrives home after a gruelling shift and to a family whose lives are on hold, to sit down, relax and reflect. Oh, and fit in some mindfulness exercises whilst you are at it.

Nurses do need support but they also need the time to access a process that needs to mature and that in need of enhancement of its restorative value through adding techniques that work. Wallbank (2016) makes a good case for the restorative aspects of clinical supervision as one that enhances self compassion and compassion for others, and that cant be a bad thing. The majority don’t need additional and new support mechanisms that seem alien and imported, so lets be grateful for what we already have.

Reading

Wallbank, S. 2016, “Restorative Supervision Implications for Nursing”. In: A Hewiston & Y Sawbridge (eds.) Compassion in Nursing: Theory, evidence and Practice. Palgrave, London.

Watkins, E. & Moulds, M. 2005, “Distinct Modes of Ruminative Self-Focus: Impact of Abstract Versus Concrete Rumination on Problem Solving in Depression”, Emotion, vol. 5, no. 3, pp. 319-328.

Watkins, E.R. 2009, “Depressive Rumination: Investigating Mechanisms to Improve Cognitive Behavioural Treatments”, Cognitive behaviour therapy, vol. 38, no. sup1, pp. 8-14.

Watkins, E.R. 2016, Rumination-Focused Cognitive-Behavioral Therapy for Depression, Guilford Publications Inc. M.U.A, New York

Learning to find joy in pain

I get this and I have experienced this myself – granted, not as painful as some people have had it. In this podcast, Meehan Krist eloquently describes living with uncertainty and her difficulty in deciding whether to bring a child into a world that is both “more terrible and more wonderful”.

Its a great listen that celebrates being human and a capacity to survive through learning, creativity, and embracing diversity.

For my part, my resilience lies in my love of learning and the joy and pain of helping young people who feel lost and anxious. More than this, I am currently helping others to help others through my teachings and supervision or by just sharing information including signposting uplifting podcasts that help us think differently.

https://www.bbc.co.uk/programmes/m000jp1y

Children our best enemy

Hi

I have been invited to do a talk about my work with children for BIG a mental health charity working in Bury, Manchester (thank you BIG staff).

The focus is on how through working with children it has helped me work with adults. It discusses the importance of containment when helping children with difficult, often embarrassing, emotions.

I have attached a podcast which previews the talk – I hope you enjoy the thick accent.

https://wordpress.com/media/audio/mood-coach.com

2020 visions

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Extraordinary times see ordinary people doing extraordinary things. And so despite the pessimism, the constant examples of care in the community offer considerable optimism.

Small groups of people are springing up with offers of help to those who have needs or find themselves on their own. Thus dark clouds are transformed with silver linings and I cant help but feel joy and faith in the future.

We need to find better descriptions for human beings than those written albeit poetically by Shakespeare when he describes the acts of humans as folly and as quickly forgotten just as fast as they were done:

“Out, out, brief candle! Life’s but a walking shadow, a poor player that struts and frets his hour upon the stage and then is heard no more: it is a tale told by an idiot, full of sound and fury, signifying nothing (Macbeth Quote (Act II, Scene I).”.

We can console ourselves with other great works that have described apocalyptic events and found the best (and the worse) in human nature. I am reminded of Cormac McCarthy’s “The Road” – which people love and people hate. I love the description of parental love which oozes throughout the novel made more potent due to its backdrop: a worldwide calamity.

I have yet to do big events with big significance but have done many small events with small significance and for the moment I am satisfied with that. Learning to live with blame and responsibility, but quietly and without resorting to anger – that alone makes life significant.

We don’t know what the future brings – catastrophe and redemption sit alongside each other and we can all strive to performing small events which have great significance.

Positive – positive – positive ..

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Difficult to find any positivity with all that’s going on but I am feeling positive about next week. Teaching new students, providing supervision to eager supervisees, and then holidays.

I am also feeling positive on the back of some of my reading. In a couple of weeks I will be teaching case formulation and in preparation looking at books on this. Ann Garland who wrote an excellent book on persistent depression has a chapter in a book on case formulation and she makes difficult material easy to understand.

People with depression find it hard to remember positives, through no fault of theirs. Ann Garland describes the research on the depressive process that leads to difficulties in accessing pleasurable memories.

Ed Watkins has more recently made a case for helping people describe in detail their past difficulties and how this can help people to achieve a more balanced memory of the past. This made me consider how person centred counselling may also facilitate this process.

Interestingly, Ann Garland points to difficulties in goal setting for people with low mood and makes me wonder whether this reinforces the importance of enabling people to specify in detail future goals to be achieved.

The speed of EMDR is scary

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I have just completed part one of my EMDR training.

Like many other participants on the training, it is hard to believe the speed and power of the process.

Within seconds quite difficult memories are surfaced, and without care it is easy to appreciate how re-traumatisation can happen. That is not to say that I don’t appreciate the need for past events to be processed rather than ignored. It is just that the pace is quite frightening and one that I wasn’t prepared for.

I was slightly disappointed by the unmet promise that EMDR offers a less confrontational approach to dealing with trauma – this wasn’t my experience on this training. I will need to do much more reading, training and supervision in order to explore a more gentle approach to the provision of EMDR.

I will use my early experience of CBT practice which was both “clunky” and awkward to stop me making that mistake with EMDR. Thus a gentle approach will be my special goal as I aim to work with people who have a history of “let downs” as well as traumatic events. People deserve nothing less than to work with a practitioner who is determined to offer an alternative experience to what they may have had in the past.

Feeling the fear – helping people to face up to difficult things

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It is such a privilege working with young people and their families and one I take very very seriously. My work sees me helping people approach rather than avoid situations.

I spend a lot of my time reflecting on my time with avoidant people and how to make difficult things easier and also questioning whether in making it easier I may not be helping.

I am constantly on the look out for books that help me to do difficult things better and came across a gift of a book: Exposure Therapy for Anxiety which is written by Jonathan Abramowitz and his colleagues. It is a recent book having been published last year (2019).

I loved the book in that it helped me scrutinise my work and helpfully steered me towards doing exposure work even more effectively. Although it wont necessarily lessen the stress of facing up to what is avoided, it gives me the courage to keep on helping young people when it gets tough – and in a caring way.

I guess the only shortcoming that stuck out for me was the very only occasional minimising of the experience for people who find their anxiety overwhelming. The chapter on social anxiety (like all the other chapters) is full of helping strategies but I wish they didn’t write as if confronting social situations is that easy. The nature of social anxiety often means that young people beat themselves up for some of the things they said or things they did, or didn’t say or didn’t do at a social event. Its often the hours after that the person dreads.

There has been research (I need to relook for it) that says if we interrupt the post-mortem process following a public outing then this may reduce the negative impact and encourage future socialising. Of course, we need to do this without somehow giving the message that experiencing negative emotion is a truly awful thing.

The book borrowed from a local trust library is now on my buying list and one that I will be recommending to the students I teach.

Its more than just cricket

When teaching students about complex terms such as transference and countertransference, I am always on the lookout for useful short cuts. That is those stories that engage people through understanding such stuff that could easily switch them off – “I just don’t get it”.

This podcast featuring Mike Brearley is full of insights into quite challenging psychological processes. Mike Brearley is a well known cricket captain known for his ability to manage people. He makes a strong argument for learning self awareness – and yes that it can be learnt.

Here he describes psychoanalysis and its links with emotional intelligence and is worth listening to just for the confession tat he has never heard of Daniel Goleman!

https://www.bbc.co.uk/programmes/p06tn8x5

Surviving and thriving in practice

Great to be teaching nursing students at university about surviving and thriving in clinical practice. First experiences can make and break some people and we can waste so much potential. We can not afford to recruit and lose future nurse professionals. Busy developing a toolbox that students can use when they hit difficult times – more or less bound to happen and they can use such experiences productively.