Author: ALL ROUND WELLNESS

Therapy: Is this how it should be?

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Stepping into the therapy room for the first time can be a daunting experience for some, and a complete relief for others.  There is no single way that therapy should be done, and no single way that it should feel.  There is no single approach to therapy that is the perfect solution to every problem and every client.  So how do you know if the therapy experience that you are having is working?

There are a few tell tale signs that all good therapy will have – and there are few tell tale signs that  let you know that you should probably find yourself a different therapist.  Regardless of which therapy professional you see (The Many Faces of Therapy), good therapy is certainly easy to tell apart from the not-so-good type of therapy.

So what should you be looking for, to know if your therapy experience is everything that it should be?

“How this therapist works fits for me”.

Different therapists will have different personal styles – we are all human after all.  You should feel like, even when you are feeling challenged by your therapist, that their personal style fits your needs and preferences well.  To understand more about the therapy relationship read What Makes Therapy Work.  You will know that your therapist is a good fit for you by how you feel during the vulnerable, difficult, challenging, and insightful moments of your therapy – you will feel supported (not forced), nurtured (not uncomfortably so), and respected as the driver of your own therapy experience while your therapist offers some navigation assistance.  Your red flags should be alerting if you feel that your therapist is forcing, controlling, directing, or harming you in any way. 

“When I don’t know the boundaries, my therapist does”.

You are not expected to automatically get how this therapy thing works – and that includes the boundaries involved in an good therapy relationship.  A good therapy experience will have occasions in which your therapists kindly and clearly alerts you to a boundary that is needed to keep your therapy relationship exactly that – a therapy relationship.  After all – this is not a new friendship in the making (although you will often feel that you and your therapist would make good friends!) – your therapist is a season in your lifetime, there for a special purpose. 

Your therapist will show you how to form, share, and farewell and healthy trusting healing relationship, and they will do this by keeping sound boundaries to protect that relationship. 

If your therapist is making a lot of contact with you between sessions, socialising with you outside of session, allowing you to call them whenever you please, or being overly affection or touchy – your red flags should be alerting.

“I don’t always come out of therapy feeling totally happy”.

If you are coming out of every session beaming with happiness and positives – you may find that your therapist isn’t doing so good for you.  This is why.  You likely came to therapy because you were struggling with something, right? Doesn’t it make sense that therapy is going to feel a little uncomfortable sometimes as you address this struggle?   During good therapy you should feel challenged, defensive, resistant, vulnerable, maybe even a little embarrassed to tell your story in its completeness.  Good therapy should include experiencing sadness, anger, confusion and all other emotions also.  People learn the most when they find their own discomfort.  But here is the thing – a good therapist will help you find these discomforts, while also supporting and nurturing your wellbeing.  Therapy should feel like the safest place to feel your discomforts – no judgement, no criticism, no punishment, and no disrespect.  So be ready for a journey through the whole spectrum of your emotions with the most trusted travel partner keeping you on track – sitting right beside you.

“Just for a change, it was all about me”.

Good therapy will be about you. Seems obvious right? This is your time, and while you are here, you are the most important topic of conversation!  Your therapist should be more interested in hearing your story, sharing your experiences, indulging in your insight building, than in themselves.   Don’t get me wrong, some therapists do have a very transparent and authentic personal style, and will share small insights into themselves or their own life experiences. This is usually done with a special focus on being relevant to your story – having a purpose to boost your understanding of your own experience, or to help you recognise that we are all humans having very human experiences.  This is totally acceptable in good therapy.  However, if you find that most of your session is not about you – or you feel that you are learning way too much about your therapists life – then your red flags should be alerting.

“ I don’t always understand what’s going on, but things are changing in my life for the better”.

Therapy is a bit of an art.  This is not a chat with a friend.  Your therapist probably spent many years (and yes you should ask about this as part of choosing your therapist) studying and learning the refined art of therapy.  So you may not always completely know why they took a particular tack in your session or why they have asked you to try a particular exercise.   Often, regardless of giving as much explanation as possible, clients will still explain that they have no idea how EMDR (Eye Movement Desensitisation Reprocessing) works. Yet their safe therapeutic relationship and trust in me allows them to ‘give it a go’ and as a result see subtle yet significant changes occur in their lives following this treatment.  So if you aren’t supposed to understand it all completely – how do you know when you have entered red flag territory?  When the effect of any therapy technique is ongoing distress, feeling more unstable, or making you feel unsafe in any way – you are in the red flag zone.

“I feel like I am the one making my own choices”.

This one is pretty straight forward.

You are the expert on your life. You are also the one who will carry the consequences of any decisions that you make about your life as a result of therapy.

A good therapist will know and respect this. They will make sure that you also know this, and as such will walk with you, but will not drag you along. A good therapist will see that although you are struggling, you are also capable and have the right to your own choices.  Classic red flag examples include being told to leave a partner, to cut yourself off from friends or family, or that you have to engage in a treatment that you are not comfortable with.

So despite there being a whole range of pathways of training to become a therapist, regardless of the pathway or the profession, the journey that you take with a good therapist will be a distinctly different experience from the one that you will find yourself in with a ‘not so good’ therapist.

Notice your red flags – find the face of therapy that fits best for you – remember these common qualities that can be your sign posts along your therapy journey.

What makes therapy work?

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So you have decided to see a Therapist!

Where to start? Who to see? What to look for? What to expect?

What will make your visit to a Therapist helpful for you? 

How is seeing a Therapist any different to having a chat about your problems and concerns with a friend?

These are all valid and important questions to ask as you start your therapy journey.

Let me be clear about one pertinent point first – every profession has its ‘bad eggs’ who for whatever reason have done harm or done the wrong thing by their clients.  Therapy is no different – it has its bad eggs – although like all professions, most of its members are good people who want to skilfully and safely support others to a healthier and happier life.  If you see a therapist and find yourself feeling unhealthily uncomfortable or unsafe, trust your feelings and seek out a new therapist.

You have that right and you do not have to explain your actions at all. 

But do seek out a new therapist, because therapy can be an extremely positive and fruitful relationship for you to experience, as it encourages you learn and grow and create the life that you want.

So, back to the original questions – what to look for and how to make therapy helpful to you?  Interestingly enough, there has been a lot of research completed to help answer these questions.  The answers may surprise you! 

Feeling safe and heard in therapy will make your therapy more successful.

Margaret McCoy Lynch (2012) reports “The therapeutic alliance remains a key component of creating successful outcomes in psychotherapy. Empathy also continues to be an integral factor to not only forming the alliance, but also increasing a client’s ability to feel validated and understood. It appears that… no one type of therapeutic modality is superior to another.”

So given that it is a key component, what is therapeutic alliance? This refers to the quality of the relationship between yourself and your therapist.

Yes! Therapy is a relationship!  

Dr Lynne Knobloch-Fedders (2008) of The Family Institute of Northwestern University explains how Therapists build relationship to ensure good outcomes for their clients, explaining “The therapist’s ability to communicate empathy and understanding to the patient is very important. Another essential component is the therapist’s openness, flexibility and willingness to adapt the treatment to the patient’s needs. Skilled therapists actively solicit patients’ input about the goals and methods of treatment, in order to facilitate collaboration.”

Finding the therapist that is a ‘fit’ for you is more important than anything else.

Why should therapeutic relationship matter to you?

Think about it – imagine being able to sit with another person and share your concerns and difficulties, all the while knowing that you can trust this person to respect and care about you, to help you set goals that are focussed on what you feel is important to you, openly and flexibly communicating with you while supporting you collaboratively in making changes in your life for the positive.  

As far as interpersonal experiences go – how does this sound to you? Helpful? Positive? Beneficial? Nurturing? Safe?

It sounds quite different to .hanging out chatting with a friend’ doesn’t it? Of course it does! As supportive as our friends are for us, it is hard for them to stay focussed on what is best for us because they are also influenced by their own emotions about our situation. 

So working with a Therapist who you have a strong therapeutic relationship with can literally be a ‘life changing’ chat! The relationship that you have with your Therapist is the component of therapy that you need to have for your therapy to be successful.  

Therapists educate through a variety of training pathways, and engage in developing their skill in a range of treatment modalities, offering you a diverse and eclectic range of Therapists to engage.  

So as you begin your search – asking for recommendations from others, exploring google searches, speaking with other health professionals – stay focussed on finding the therapist who you feel is likely to be a good ‘fit’ for you.   Read and view their online bio’s to see how they feel to you, read reviews both positive and negative, and attend your first visit with a focus on asking questions and noticing how the relationship feels between yourself and the therapist.

References

Knobloch-Fedders, L., 2008, The importance of the relationship with the therapist: Research shows that the therapeutic relationship is one of the strongest predictors of successful treatment. https://www.family-institute.org/behavioral-health-resources/importance-relationship-therapist

McCoy Lynch, M., 2012, Factors Influencing Successful Psychotherapy Outcomes, MSW Clinical Research Paper.

THE MANY FACES OF THERAPY

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There is a tendency towards misconception when people start seeking out therapy. 

It seems everything that we see, read, and hear directs our understanding of what is actually available to us. As an individual person who is already struggling to make decisions and find solutions we actually become very easy to manipulate in this way. 

The familiar solution that springs to mind when seeking therapy is to see a Psychologist. Seeing a Psychologist gives you access to a range of therapeutic models and assessment tools that can help you understand your current psychological needs and experiences, and work through important issues to improve your condition. Further information about what Psychologists do can be found on the AAPi (Australian Association of Psychologists Inc) website.

Are you aware that there are also many other types of Therapists that can help you? Many people are completely unaware of the many therapy professions available to them when they are seeking therapy. A significant reason for this is that we are dictated to flow in the direction that funding is available for services in the form of rebates. 

As a Psychologist who has practiced for over 20 years, some people may question why I would choose to educate people about the broad range of therapy practitioners that are available to them, additional to Psychologists, in their community? It is really a matter of ethics. 

Currently in our communities, access to mental health services are stretched and often difficult for people to financially afford. It is only ethical to ensure that our public are aware of all options available when needed, rather than supporting a continued monopoly-of-sorts on mental health provision by only a few selected professions.  Afterall – it is not a profession or industry that determines whether you will get what you need from therapy – it is the Therapist that you choose based on best fit for you, and all people should have choice about who they access to work with.

Afterall – it is not a profession or industry that determines whether you will get what you need from therapy – it is the Therapist that you choose based on best fit for you, and all people should have choice about who they access to work with.

CHERIE DOROTICH

So who are these many faces of therapy that are available for you? 

One such profession that can support your mental health needs through therapy is Social Work. Many Social Workers are highly skilled, qualified, and trained in providing therapy for a broad range of mental health issues. You can find a Social Worker on the Australian Association of Social Workers website.

The AASW explains “Accredited Mental Health Social Workers (AMHSWs) are recognised providers with Medicare Australia and other programs, delivering clinical social work services in mental health settings and utilising a range of evidence-based strategies.”

You can also choose to work with a Counsellor. I have met many highly skilled and compassionate therapists who are Counselling trained, who pride themselves on providing professional therapy to clients that present to them. There is an assumption that Counsellors are not educated at a degree level – this is incorrect. In fact, Counsellors who are members of ACA (Australian Counselling Association) are required to have completed accredited courses of training, and maintain ongoing professional supervision and professional development – hallmarks of a professional and skilled Therapist.

Another rarely considered profession for therapy services are Occupational Therapists. Yes it is true that Occupational Therapists are more commonly known for working with mobility issues, however many are also mental health trained to work in therapy with clients. 

OTA (Occupational Therapy Australia) explains  “Occupational therapists in mental health use individual and group programs/activities to enhance independence in everyday activities. An occupational therapist may help to develop coping strategies for people overcoming their mental health issues or improving confidence and self esteem in social situations.”

Also often overlooked are our highly skilled Mental Health Nurses Practitioners who have been nursing trained and done further additional training in the mental health industry to provide therapy. You can find some additional information about Nurse Practitioners here .

Let’s not fail to highlight the profession of Psychotherapy. Often people assume that this is the same as seeing a Psychologist or a Counsellor, however this is not entirely true.  While there are similarities, there are also vast differences in terms of the therapies experience that you will engage in.   Psychotherapy is a diversely skilled profession in its own right. 

PACFA (Psychotherapy and Counselling Federation of Australia) explain “Although counselling and psychotherapy overlap considerably, there are also recognised differences. While the work of both Counsellors and Psychotherapists with clients may be of considerable depth and length, the focus of Counselling is more likely to be on specific problems, changes in life adjustments and fostering the client’s wellbeing. Psychotherapy is more concerned with the restructuring of the personality or self and the development of insight.”

Every profession brings with them a cast of quality skilled professionals who can guide you through therapy to achieve the outcomes that you are seeking. Every profession brings with them different tool kits which have emerged from different models and theories, to help you do this. The key value in acknowledging all therapy professions exists in precisely this diversity. After all – I am sure that you are not a one- size-fits-all person right? 

Possibly the key factor that gave Psychology it’s stand out profile as the one-stop-shop for mental health treatment, is the feature that Psychologists use psychometric testing for assessment and diagnosis as congruent with the medical system. It can label you to determine which treatment protocol or medication applies. 

Think about it – while such assessment and diagnosis has its place in the therapeutic realm, is this all that YOU are looking for? Is this EVEN what you require?  Is this the therapy ingredient that will get you living life well again? Do you even WANT this as a part of your therapy experience? Because therapy IS an experience! It is an important and transformational experience when provided by a Therapist who knows how to bring the essence of humanity to their therapy.  

Therapy IS an experience!

I may cop some flack for that previous comment, however it is important that the everyday person can easily understand what is offered so that they are also able to make informed choice about who they wish to see. 

So how do you choose a Therapist to work with you through your difficult times? There is much credible research that demonstrates that the key to client outcomes in therapy is the ability of the Therapist to create a sound and safe working relationship with their client (1) 

This is barely something that can be taught while achieving our degrees at university. This is a quality that is specific to the Therapist’s nature and intention in choosing their profession. It is a skill that Therapists develop through experience with other humans (clients). This is determined by the Therapist that you choose simply because they are a good fit for you and what you need. 

The results of the meta-analysis indicate that the overall relation of therapeutic alliance with outcome is moderate, but consistent, regardless of many of the variables that have been posited to influence this relationship.

Martin, D. J., Garske, J. P., & Davis, M. K. (2000)

So next time you are seeking therapy during a difficult time, make sure that you choose a Therapist that you feel comfortable with and that you feel is a good fit for you in the way that they work. Also, if you choose wrong the first time – shop around until you find the right person. 

Psychologists, Social Workers, Occupational Therapists, Counsellors, Psychotherapists and Mental Health Nurse Practitioners are ALL potential therapy professionals that you can access – each with varying provision of medicare or private health rebates available. 

Don’t allow yourself to be limited by the restricted information and direction that you are sold. If you are going to invest in your own wellbeing by attending, then also invest by looking around for the best person for the job – not the closest, not the cheapest, not the one you were told to go to – invest in yourself more than that. 

To share space and vulnerability with another human being, with the aim of improving your own mental health, is daunting at least and terrifying for most. So allow yourself the time to find the Therapist, regardless of degree or profession, that is going to work the best for you and your therapy goals. 

Therapy is a human art. 

Humans are individuals. 

The Art for Individuals. 

As such it can not be ‘owned’ or delivered effectively by any single professional pathway. 

References:

(1) Martin, D. J., Garske, J. P., & Davis, M. K. (2000). Relation of the therapeutic alliance with outcome and other variables: A meta-analytic review. Journal of Consulting and Clinical Psychology, 68(3), 438–450. https://doi.org/10.1037/0022-006X.68.3.438

NEWS UPDATE: COVID-19

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WHAT WE ARE DOING TO PREVENT THE SPREAD OF ILLNESS

As you know, the health of our clients, our team and the community are first and foremost our focus, both mental AND physical as we know these to be closely linked. With the cold and flu season drawing closer and with COVID-19 occurring we wanted to update you on the impacts to your sessions and the practice.

What are we doing about COVID-19 and to prevent colds and flus in general?

As per the requirements from the Department of Health, all team members who have been to China, Iran or the Republic of Korea are excluded from returning to work for 14 days from the date they left that country. This is also the case for team members who have been in contact with a confirmed case or who are having pre-cautionary testing. Generally, any team member who is feeling unwell or showing signs or symptoms of being unwell, will remain at home.

What can you do?

Firstly, please remain calm and communicate your needs to us so that we can assist in any way possible and reasonable.   Many people are experiencing excessive fear, however it is important that we respond calmly to the current situation. 

We request you follow the guidelines and recommendations set by the Department of Health and self-exclude if you have been to any of the countries with exclusion periods or have been in contact with someone with confirmed or suspected COVID-19.  https://www.health.gov.au/resources/collections/novel-coronavirus-2019-ncov-resources

We also ask that you not attend the practice when you are unwell regardless of whether you think this may be COVID-19 or a cold or flu. https://www.health.gov.au/resources/publications/coronavirus-covid-19-know-the-signs

Please make sure you are practicing excellent hygiene as hand washing and containment of bodily fluids continue to be the best defence against the spread of cold, flus and COVID-19.  https://www.health.gov.au/resources/publications/coronavirus-covid-19-stop-the-spread

Cancellations

While All Round Wellness does have (and enforce) our cancellation policy, if you cancel outside of the 48 hour period, there will be no fee charged. We do however, request you provide us with as much notice as possible as we have a lengthy list of people waiting for appointments.

Online Appointments are available

If you do wish to keep your appointment and would like to instead complete a video session with your clinician, please feel free to contact the practice and we will be more than happy to arrange this for you.

Please provide at least 24 hours notice for this where possible so we can set up the online session.

We will continue to keep you updated if there are any changes or concerns, however if you have any difficulties at all, please do not hesitate to contact us on via the following options:

Phone: (08) 9583 5945
SMS: via appointment reminder reply mobile number
Email: allroundwellness.mandurah@gmail.com
Web Form: https://all-round-wellness.com/contact/

Regards
Cherie Dorotich
Director & Principal Psychologist in Clinical Practice

Transitioning to Parenthood

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Discussing the transition to parenthood (Psychologist: Kylie Rees)

Parenthood is such a significant phase of our lives. As we begin this journey, so many aspects of ourselves as individuals, as part of our couple, and as a member of our family and our community, begin to transform and develop. This is often a period of our life that we require support throughout.

Why Group Therapy?

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Many clients look a little perplexed when a therapist suggests that they consider engaging in some group therapy alongside their current individual sessions.  Common responses that therapists hear include “What can I get out of that that I am not already covering herein session?”  or ” I don’t want to talk about my stuff in a group, and I don’t want to hear everyone else’s problems!”

Yet there are a couple of pertinent differences between individual and group therapy that may sound cliche – but actually can make all the difference to your therapeutic outcomes.

The benefit of hearing someone else’s experiences is that this can help us reflect on ourselves; better understand other’s in our lives; and comprehend “why” we react the way we do.  You see “storytelling” has been a vehicle of personal development and learning throughout history, and these days we rarely spend enough time amongst our “tribe” hearing the valuable lessons as told through a story.  Hearing your experiences being told to you with a few degree’s of separation (being someone else’s story) can be enlightening and inspiring.

It is often through this that people also recognise their own value and strengths, as we are usually much more prepared to see this in others (as they tell their stories) than we are willing to credit ourselves (within our own very similar natured stories). 

Furthermore, group therapy provides you the dynamic of relationship to learn from.  Rather than just one (always appropriate, responsive, supportive confidant) as with an individual therapist, a whole group of individuals who are experiencing you and your story as it reflects to them can provide valuable challenges and growth, that the sole therapist can not. 

Everyone feels nervous coming into a group program – it requires trust…and courage – but most experiences that heal and develop us do.