Psychotherapy & Counselling -
|30th September 2016|
Counsellor, Consultant, PsychotherapistHi, and thanks for checking out my site. This page will tell you about me and my work and how to get in touch if you want to schedule an appointment or find out more. The next page, "About Psychotherapy," will tell you about the techniques that I use including my own Attachment Centered Therapy. "Qualifications," the third page, is my vita, as it does seem appropriate to let you know what my training and experience has been. Finally comes "Frequently Asked Questions" which is information that I thought many of you might want to know. Again, thanks for checking out my site, and let me know if I can help you.
I am a member of the UKCP (UK Council for Psychotherapy) and certified by them as an Integrative Psychotherapist through the Metanoia Institute. Please see the qualifications page for a full listing of training, qualifications, and experience.
I providing counselling, consulting, and psychotherapy services for addictions, co-dependency, relationships, family of origin, issues of trauma, abuse or neglect, developmental and personality problems, lifestyle development, personal growth and development and other life issues.
My practice is in Manchester and London at 10 Harley Street by appointment only.
Please feel free to contact me if you would like more information or to arrange an appointment.
Healing the Broken Bond: how attachment difficulties cause problems and what to do about it
I am also writing a book about attachment difficulties and Attachment Centred Therapy. I am posting excerpts from the book below, so please feel free to read it and if you have questions or comments please let me know using the email link. Thanks.
This installment is REBT: Rational Emotive Behaviour Therapy
REBT is the granddad of all CBT. It was the first and in my opinion is still the best. Please read below to find out more.
Areas of Specialization
Chemical DependencyI have worked in addiction treatment since 1988. I began my treatment experience working with chemical addictions, such as alcoholism, cocaine, marijuana, narcotics, prescription drugs and other drugs of addiction.
I have extensive training and experience in treating these problems, and I served on the board of directors of the Alabama Alcohol and Drug Abuse Association.
I have been certified as a Masters Level Addiction Professional, a Certified Criminal Justice Addictions Professional, and I was certified by the International Counseling and Reciprocity Consortium.
These certifications are not current, as I found that I just had too many certifications to keep up with them all, especially now that I am concentrating my work and training in Attachment.
Sexual Addiction CounsellingNext I moved into treating sexual addiction in 1992 when I entered private practice. I also treat relationship or romance addiction (sometimes referred to as "love addiction").
I have trained extensively with Dr. Patrick Carnes, acknowledged by many to be the leading researcher and writer in the field of sex and relationship addiction. I was a Certified Sex Addiction Therapist and a supervisor for counselors seeking certification.
I also served on the Advisory Board for Certified Sex Addiction Therapists, and am a past board member of the National Council on Sexual Addiction and Compulsivity (now known as the Society for the Advancement of Sexual Health).
Relationship, Couples and Marriage and Family CounsellingWe have long known that addiction is a family illness. Most people who develop problems with addictions come from families where addiction or co-addiction is present. In addition, the addiction has a grave impact on families where it is present.
It quickly became apparent to me that a knowledge of family dynamics and the best skills available for couples and family work were an important part of the recovery process. Many relationships survive the addiction only to fall apart during recovery.
I have trained with Dr. John Gottmann, the leading researcher in the U.S. in the field of marriage, relationship, and family counselling. I have worked with several systemic family therapy supervisors and participated in a systemic family therapy supervision group with Dr Don Brown in Birmingham Alabama for about 5 years. Thus my couples and family work is informed by Systemic Family Therapy.
In addition to doing therapy with addicts and their relations in recovery, I also provide marriage and family and couples counselling to others who do not have problems with addictions.
Co-dependency counsellingMany people who grow up in dysfunctional or addictive families become what we call "co-dependent". That is, they are excessively dependent on others for their own sense of self worth, or they compulsively caretake others, often getting into dysfunctional relationships that either they can't get out of, or if they do, they soon find another dysfunctional relationship to take it's place.
Because much of my work is done with people in later stage recovery when co-dependency issues begin to emerge, this field became a natural outgrowth of the other work that I do.
Eating DisordersWhile I do not deal with these problems primarily, I have seen many clients who have had these issues since addicts often have more than one addiction to deal with.
Attachment Centered TherapyThese days my work is centered on attachment. The reason for this is that I believe there is convincing evidence that almost all of the above problems stem from disruptions in attachment in childhood, and sometimes later years. For this reason I have undertaken to educate myself regarding attachment. To that end I have read hundreds of articles and books about attachment theory and research. I'm even working on a book of my own about it.
I have trained with Dr. Patricia Crittenden, who was trained by Mary Ainsworth, who was trained by John Bowlby, the originator of Attachment Theory. Dr. Crittenden has created the Dynamic Maturational Method of attachment analysis. You may visit her website to learn more about this.
I use the Adult Attachment Interview as a way to get started in therapy. This assessment provides a dynamic and revealing way to quickly identify what went wrong and why, and also immediately begins to provide the healing necessary to fix it.
Healing the Broken Bond: how attachment difficulties lead to problems and what to do about itRational Emotive Behaviour Therapy
REBT was one of the first therapies that I learned about. This was when I was a student in theatre performance and production at Birmingham-Southern College under Dr. Arnold Powell. But my mentor in regard to therapies was my friend and at that time associate professor as well, John Kitchens, as I mentioned earlier on. He introduced me to the idea of REBT, or RET as it was known at the time. This was a very exciting idea to me. It is really an age old proposition, that it’s not what happens to us but what we tell ourselves about what is happening – what we believe about the event – that creates our feelings and behaviour in response. So in this system, which uses the A, B, C mnemonic device, the A becomes the ‘Activating Event’: that is, the thing that happens; the B becomes the ‘Belief’ or what we tell ourselves: our opinion; the C becomes the ‘Consequence’ which is an emotional reaction to what we have told ourselves about the event. This consequence can be either a feeling state (fear), a behaviour (running away), or both, or a combination of the two as when a behavioural impulse is described as a feeling state (I feel like running away).
The trouble with a statement that uses a behavioural description to describe a feeling state is that it does not always elicit caregiving. For example, Racine, after she had broken up with Max, felt uncomfortable with being in his presence because he was being very punitive toward her. This discomfort was great, and she expressed it to her mother as ‘I want to leave that college. I don’t want to go there anymore.’ What she was really trying to express was her feeling of discomfort at having to be around Max. Her goal presumably, in expressing this to her mother, was to elicit comfort from her mother. Her mother, being a good performance oriented A4, was alarmed by her daughter’s apparent disregard for the importance of education above all else. This alarm then prevented mom from giving daughter the support and comfort that she needed, and it cut off the possibility that mom could use the emotional coaching approach advocated by Dr. John Gottman in his book, Raising an Emotionally Intelligent Child, which I recommend to any parent wanting to know how best to parent children, and I also recommend it to my adult clients as a way for them to self assess the type of parenting that they had.
It is worth saying at this point, for those who may wish to debate the point, that the proposition that the belief, opinion, or what one tells oneself, or the B part of the ABCs of emotions, comes before the C, or the consequence in feelings or behaviour, is not always entirely accurate. In fact, I am presenting a very cogent argument (well I think it’s cogent anyway) to the opposite effect. So since I will be contradicting myself I suppose it best to anticipate and address the contradiction now rather than later. First I want to emphasize that what I am interested in is results. One theme that is emerging from this book is that it is often what we believe that creates our reality. So what REBT does is help us to create our reality – a better reality – based on changing our beliefs. Whether it is strictly so that an emotion happens in relation to an event based on what we tell ourselves is not really important to me. What is important is that if we operate that way using this system then we can get a better result than if we don’t. We can make a strong argument that the reverse is also true: that an event occurs, we have an emotional reaction, and then we make up something to tell ourselves to explain the emotion. Again, neither way of looking at it is true all the time, and both are useful in their own way at different times.
REBT is simply a tool. One problem with CBT practitioners (see the blind men and the elephant) is that they confuse the tool with the job. You can teach someone how to use the tool without teaching them how to do the job, because there are usually many tools and techniques and materials that go into good workmanship, while driving nails with a hammer all day long doesn’t take much skill and perhaps produces nothing. So part of the concept of Attachment Centred Therapy is about what to use in a particular phase of the work. And I think knowing that is more of an art than a science.
But back to REBT strictly: here is an example of where the concept seems clearly to be useful and valid. Let’s say that there is a general election and the Tories win a clear majority. If I believe that the Tories are going to save the country from ruin then I am happy and I will have a drink or two to celebrate with friends. On the other hand if I believe that under the Tories we are going to hell in a hand basket then I am unhappy and I will have a drink or two to commiserate with friends. This is a clear example where the proposition behind REBT is almost certainly true: the event is exactly the same but the outcome in feelings is exactly opposite because the beliefs about the event are exactly the opposite. We will see this principle applied in a different way in the section about marriage and family therapy where we will encounter negative attributes of meaning versus positive attributions of meaning.
On the other hand, clever psychologists have shown that there are certain things that are intrinsically emotion producing. For example being alone in the dark is intrinsically fear inducing. Even as adults we experience this. Even more clever psychologists have shown that when we see fear on someone else’s face – even when it is so fleeting that we don’t consciously recognize it as fear – then we also feel fear in sympathy. These both seem to be biological adaptations that have been hard wired into our brains through genetics over millions of years of programming experience. Those who had the traits out-survived those who didn’t have them. But here is where the difference comes in: in those last experiments, when people who already had a high level of anxiety saw those faces, they became acutely aware of the innate feelings of fear and this further increased their anxiety. For those who already had a low level of anxiety, their mid-brains had been programmed to filter out the unconscious fear response, and so they never consciously felt a feeling of fear!
Now, in case you don’t already get it, despite the italics, this is a huge difference. What it means is something like this: if you and I go into a waiting area filled with people, and if I am already at a high level of anxiety even before I walk in, then the faces that show micro-expressions of fear (as most or many will when a new stranger enters the waiting area – they might be a threat!) then I will become acutely aware of my own feelings of anxiety and that will further reinforce my belief that I am a highly anxious person or that I am in a dangerous place. You on the other hand are at a low level of anxiety that you don’t really appreciate since you have no highly anxious state to compare it to, your unconscious mind will do the job that it was trained to do and eliminate the micro-expressions of fear from conscious awareness as they do not need any executive decision to be made, and so you will feel perfectly relaxed and comfortable sitting in the waiting room. Our subjective experience of entering the waiting room will then reinforce our predispositions. You will become more secure and confident as a result of your experience, and I will become more fearful and insecure. The rich get richer and the poor get poorer. So here we have what is more likely to be the case between the two propositions: does the belief produce the feeling or does the feeling produce the belief? It is most likely to be an interaction between the two processes of varying degrees one way or the other. Regardless, REBT is a very useful tool for dealing with the ‘C’ part of the equation: the consequences, emotional or behavioural.
After we find the belief, then we are ready to go on to the next step in the process, and that is to examine the belief to determine if it is a rational or irrational belief. This is where the R comes into REBT. Ellis’ belief was that rational beliefs produce healthy and helpful emotional responses, while irrational beliefs produce unhealthy and counterproductive emotional responses. To determine whether or not the belief is rational or irrational you ask three questions about the belief. The first question is whether or not the belief (and the consequent emotional response) is helpful in dealing with the situation in the long run? If not, then the belief is irrational because it isn’t long term helpful.
If yes, then we can go on to question number two: is the belief based on known facts and reality? This question is not so easily answered as it might appear at first blush. Often clients will answer ‘yes’ because they are answering it based on their own private story of known facts and reality. Unfortunately the GIGO principle applies here: garbage in, garbage out. If a person’s own experience has been distorted and warped by dysfunctional or worse damaging experience, then their own store of facts and reality is not going to be a useful base for comparison. We must utilize the known facts and reality of people in general in order to accurately answer this question. Thus the belief that ‘you can’t trust anyone’ might be more or less true in one person’s facts and reality, but fortunately for most of us we realize that most of us are trustworthy, at least to some extent or the other. Again if the answer is ‘no’ then we have an irrational belief.
If yes, then we go on to question number 3, is it logical? This question I find to be more difficult than the other two.
Some clients take to REBT readily and some never seem to like it or use it. The client who took to it most was a young woman who had enormous attachment issues, but when we tried to go into the attachment work, after the first AAI session, in which we dealt with her relationship with her mother, she came back the next week to say that she didn’t want to do anymore AAI work. The next day after our session she had been riding the bus, she said, and she began thinking about her mom and the work we had done the day before. She suddenly felt tremendously sad and started crying, and she told me that she never wanted to feel that way about her mom again so she didn’t want to do any more attachment work. She did however take to the REBT like a duck to water, and it was perfectly suited to her predicament, which was that when she knew her mother was planning to leave to go somewhere without her, whether it be for a week or a weekend, she felt tremendous anxiety, couldn’t sleep, catastrophized and produced somatic symptoms such that she would often have to be hospitalized.
Of course it was easy to identify the beliefs, the activating events, and the consequences in these recurring scenarios. Because these situations were fraught with difficulties there was often complicating intrigue around them, such as mom secretly making plans to go away that she didn’t share with her daughter, the client and also collusion with others to manage her daughter’s anxiety. Inevitably the client discovered her mother’s deception, and this unfortunately compounded the problem. Meanwhile the mother became more quietly desperate in her attempts to get away from her daughter’s neediness, and this in turn made the daughter more needy. And the client, who was very bright and training to be a helping professional herself, could quite easily see the irrationality of her beliefs when examined through the prism of the three questions. So this leads us to the last phase of the REBT process.
D and E, which follow logically after A, B, C, as most of us know by now, stand for D: Disputing the Irrational Belief; and E: Effective New Emotional Responses. In disputing the irrational belief you tell yourself something that meets the three question criteria discussed previously: 1. It is useful in dealing with the situation in the long run; 2. It is based on known facts and reality (of the human race, I should add); and 3. Is it logical?
Of course, simply telling oneself something one time on one day is not going to make much of a difference. So the REBT system has ‘zig-zag’ form for reinforcing new beliefs. In addition I recommend that they take the new belief and make it into an affirmation which they tape to the mirror so that they will see it each day, at least twice, and that they repeat it to themselves three times while looking at themselves in the mirror. This is most effective when the beliefs are about themselves and their own self-worth. So, for example, someone who has very low self-esteem and thinks they are unlovable and unworthy the affirmation might be, ‘I am a lovable, worthwhile person.’ Most people who try to do this find it a bit repugnant at the start because the UM will actively resist this discordant thought and will produce visceral and emotional reactions against it. In that case I recommend that they metaphorically take a step back and make the affirmation, ‘I would like to believe that I am a lovable and worthwhile person.’ I have never had this approach fail, though interestingly I have never come across it before in the affirmation books.
At any rate, after a while they find that they can tolerate giving themselves the unedited affirmation once again, and so proceed to change their beliefs about themselves.
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