Treatment Methods

What happens at the first counselling or treatment session?

When I first meet you, I will ask you to fill in a few brief forms re your personal details, current levels of stress, anxiety and depression, general personality traits and lifestyle, plus a confidentiality agreement. I will then invite you to tell me about what is troubling you most right now, and has brought you to seek help. I may ask you about significant past events, family history, your general coping skills, personal strengths and other information that may be relevant to your current situation or emotional/mental condition.

How many sessions might I need?

Just the one, or a few, empathic counselling and treatment sessions may be all you need to help you gain the clarity or make the changes you are looking for.

If you are experiencing a long-term or deeply troubling situation, trauma or mental health condition, a number of counselling and treatment sessions over some months or years may be helpful. We will discuss various lifestyle changes and treatment methods that may help you in your recovery, or in creating the personal or relationship changes you are looking for, and how long this process may take. Depending on your situation, the number of sessions could range from six to twenty or many more, and will be reviewed regularly.

Long term therapy over one to five years is sometimes required for fundamental and lasting change of more serious mental health disorders, and I offer this where needed. Long term therapy can be very helpful where there are serious developmental (childhood or family of origin) or chronic experiences that have created debilitating and disruptive trauma/anxiety/dissociative conditions or personality problems/disorders for you.

Treatment Methods

Treatment methods and skills enhancements you and I may choose to use, depending on your situation and condition, may include the following:

Cognitive Behaviour Therapy (CBT)
Communication and Interpersonal Effectiveness Skills
Dialectical Behaviour Therapy (DBT) Skills
Distress Tolerance
Emotion Regulation
Eye Movement Desensitisation and Reprocessing (EMDR)
Grief/Bereavement Counselling and Grief Therapy
Interpersonal Psychotherapy (IPT)
Meditation
Mindfulness
Positive Psychology Strategies
Relaxation Skills
Schema Therapy
Somatic Experiencing

Please note: This page is not complete. I use various methods not yet outlined here.
Please contact Sharon (02 9144 6859) if you have any questions about treatment methods.



Cognitive Behaviour Therapy (CBT)

CBT involves understanding how you interpret events, experiences and sensations, and how this effects your emotions and behaviour. I work with you to identify thoughts and beliefs that are negative, biased, self-critical, limiting or otherwise distorted. These thoughts and beliefs are evaluated and replaced over time by more positive, balanced and functional thoughts and beliefs that incorporate strengths and successes.

The purpose of cognitive behaviour therapy is to increase self-awareness, allow self-understanding, and improve self-control. Techniques vary depending on the presenting issue, but may include writing down significant events and associated feelings, thoughts and behaviours as they occur; questioning and testing cognitions, assumptions, evaluations and beliefs that might be unhelpful and unrealistic; gradually facing and undertaking activities which may have been avoided; and trying out new ways of behaving and responding. Relaxation, mindfulness and distraction techniques are often involved.

Often short-term cognitive therapy is enough to help you overcome emotional problems, especially depression and anxiety, as research demonstrates. Research has also found however, that some clients in short-term cognitive therapy don’t get all the benefits they are looking for, or are internally challenged by deeper issues that go unaddressed. This has led to the development of Schema-Focused Cognitive Therapy, which I frequently use.

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Dialectical Behaviour Therapy (DBT) Skills

Dialectical Behaviour Therapy (DBT) is a form of therapy which was developed by psychologist, Dr Marsha Linehan (1993) for the treatment of Borderline Personality Disorder, particularly for those who were experiencing self-harm and/or suicidal urges. The DBT approach is increasingly being used in the treatment of a range of psychological disorders and difficulties, especially those that involve emotional dysregulation such as bulimia. Dialectical Behaviour Therapy combines Cognitive Behaviour Therapy techniques, with the following skills enhancement areas:

Mindfulness

(See below)

Emotion Regulation

Some children, young people and adults are emotionally intense and labile – being easily triggered into high emotional states by events/thoughts and then taking a long time to ‘calm down’. They can be intensely frustrated, angry, depressed, or anxious, and may self-harm, or have suicidal thoughts or intentions. These people usually benefit from help in learning to regulate their emotions.

Dialectical Behaviour Therapy skills that are very helpful for emotion regulation include: identifying and labelling emotions, identifying obstacles to changing emotions, reducing vulnerability to emotion mind, increasing positive emotional events, increasing mindfulness to current emotions, taking opposite action, and applying distress tolerance techniques.

Trauma and developmental/attachment issues during childhood/adolescence are often behind emotional dysregulation, so trauma healing techniques and Schema Therapy can also be very helpful here. Strong emotional dysregulation often characterises anxiety and personality ‘disorders’, including borderline personality disorder, as well as post traumatic stress disorder and bipolar depression.

Distress Tolerance

Accepting, finding meaning for, and tolerating distress, is often a first step towards becoming more conscious of it, and its effects. Distress tolerance skills are naturally connected with mindfulness skills - the ability to accept, in a non-evaluative and non-judgmental fashion, both oneself and the current situation. This does not mean that the stance is one of approval or resignation - the aim is to learn how to calmly recognise negative situations and their impact, rather than becoming overwhelmed or hiding from them. We can then make wise decisions about whether and how to take action, rather than falling into intense, desperate or destructive emotional reactions.

Distress tolerance behaviours are concerned with tolerating and surviving crises and with accepting life as it is in the moment. Crisis survival strategies you may be guided to use may be: distracting, self-soothing, improving the moment, and thinking of pros and cons (Dialectical Behaviour Therapy). Acceptance skills include radical acceptance, turning the mind toward acceptance, and willingness (working within one's present situation) versus wilfulness (trying to impose one's will regardless of actuality).

Communication and Interpersonal Effectiveness Skills

Many people find communication with others difficult for a variety of reasons. These difficulties can be assessed and worked through at different levels. Fundamental micro-skills such as the use of eye-contact, facial expressions, body language, and tone of voice can be understood and practised within and outside of the therapy/treatment sessions. General communication skills for opening conversations, listening to others, being empathic, responding appropriately, making friends, managing difficult conversations, negotiating, being assertive, and resolving conflict can also be practised and strengthened. Couples seeking marriage guidance or couple therapy often improve their relationships by learning how to communicate more openly and effectively with each other. Depression and complicated bereavement/grief conditions can be lessened with increased communication and social involvement.

Where there is anxiety (including social anxiety or social phobia), skills can be practised and strengthened while the causes are treated, eg. trauma or negative schemas, so that social situations become far easier to handle, and even become enjoyable. Cognitive Behaviour Therapy, Schema Therapy, mindfulness, relaxation and trauma therapy are also useful.

Useful Dialectical Behaviour Therapy skills for improving interpersonal effectiveness may include being self-respectful; practising self-statements that are encouraging and effective; practising asking and saying 'no' with intensities relevant to the situation; expressing feelings or opinions clearly; being assertive, and negotiating with others.

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Eye Movement Desensitisation and Reprocessing (EMDR)

Eye Movement Desensitisation and Reprocessing (EMDR) is a form of psychotherapy that helps to resolve symptoms resulting from disturbing and unresolved life experiences and traumas. It is widely used to treat children, young people and adults after experiencing a traumatic event such as an assault or accident, or who suffer with post traumatic stress, post traumatic stress disorder, other anxiety disorders, depression, unresolved grief, attachment issues, addictions, core negative beliefs, relationship issues and other conditions.

EMDR is recognised as a highly effective treatment for trauma by the Australian Psychological Society, the Australian Centre for Posttraumatic Mental Health, the Clinical Division of the American Psychological Association, the American Psychiatric Association, US Department of Veterans Affairs and Department of Defence, The International Society for Traumatic Stress Studies, the Northern Ireland Department of Health, the Dutch Guidelines of Mental Health Care, and the Israel National Council for Mental Health, among many other mental health organisations. Most international health guidelines recommend EMDR as the first line of treatment for Post Traumatic Stress Disorder.

During EMDR sessions, the person is guided to bring particular memories into conscious awareness, with their associated beliefs, emotions and bodily sensations. By following the moving fingers of the therapist with their eyes (or through other bilateral brain stimulation methods such as tapping of hands, knees or clicking near the ears) for 30-second intervals, a naturally occurring pattern of activity occurs in the brain, which causes the stored trauma memory and associated beliefs, emotions and bodily sensations to quickly change. Once the trauma memory no longer triggers feelings of distress, the person is asked to associate more useful and positive self-knowledge to the now more distant trauma memory, and further sets of eye movements (or the other methods) follow. The EMDR process is complete when the new perspective feels true even when the old memory is recalled. This entire process can take as little as ten minutes, or as long as a full session. A deep feeling of relief, lightness, the burden having 'gone' or 'lifted', relaxation, contentment, safety, self-acceptance and inner strength is usually increasingly experienced throughout and at the end of the session.

When the distressing or traumatic event is an isolated incident, the memories and symptoms can often be cleared with one to three EMDR sessions. When multiple traumatic events have occurred in a person’s past - such as physical, sexual or emotional abuse, parental neglect, severe illness, surgical intervention, injury, war-related experiences – it may take a number of sessions to fully resolve the issues. EMDR is not suitable for all people. Some people will be helped to develop skills in managing and reducing emotions, before EMDR begins.

After EMDR processing, people generally report that the emotional distress related to the memory has gone, or greatly decreased, and that they have gained important insights into themselves and their lives. These changes usually result in spontaneous personal and behavioural changes, which can be further enhanced with subsequent EMDR procedures.

To date, I have used EMDR successfully to assist people in resolving the effects of such issues as serious physical assault, life-threatening accidents, sexual assault, traumatic bereavement (eg. sudden death by suicide or unknown health condition of loved one), post traumatic stress, addictions, anxiety, panic attacks, medical trauma, painful relationship endings, troubling/traumatic experiences as adolescents or adults in many forms, childhood trauma and developmental maladaptive beliefs/schemas, low self esteem, and dissociated aspects (or ego states) of the self.

Research and the extensively reported experiences of world-wide professional EMDR practitioners, demonstrate that EMDR is an extraordinarily effective treatment for most issues and disorders that people may experience. It is also used to increase a sense of calmness, safety and strength in people who feel vulnerable to anxiety, depression and emotional instability.

See Shapiro, Francine and Forrest, Margot Silk (1997, 2004) EMDR, The Breakthrough ‘Eye Movement’ Therapy for Overcoming Anxiety, Stress, and Trauma, Basic Books, USA; Servan-Schreiber, David (2003, 2004) The Instinct to Heal, Curing Depression, Anxiety and Stress Without Drugs and Without Talk Therapy, Rodale Inc., USA

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Interpersonal Psychotherapy (IPT)

Interpersonal Psychotherapy (IPT) is a brief psychotherapy that can effectively treat depression. It is also used to effectively treat bipolar disorder, anxiety disorders, substance abuse, eating disorders and borderline personality disorder. The goals of IPT are to reduce the symptoms of the condition (eg. to improve mood, energy, and attitude) and to help the person deal better with the life situations or people associated with the onset of their symptoms. Understanding the interpersonal context of the development of the depression or other condition may help to resolve it.

IPT is helpful in assisting people with complicated grief in relation to a loved partner, child, parent, relative, friend, or dear pet, who has died. The goals in treating complicated grief are to facilitate mourning by encouraging the person to think about and feel the loss in detail, and by discussing the sequence and consequences of events prior to, during, and immediately after and since the death. The person is then helped to re-establish interests and relationships.

IPT is also helpful in assisting people manage losses and changes which are defined as role transitions (such as divorce, change of job, moving home, alteration in economic status, retirement, or serious illness). The goal of therapy is to help the person mourn the old role – express their feelings of sadness, guilt, anger, and fear; let go of the old role; recognise the positive aspects of the new role; acquire new skills; and develop new attachments and support groups.

The resolution of interpersonal disputes such as two people having different expectations of their relationship (eg. marital conflict over responsibilities re children or finances) can be assisted towards resolution by IPT. The goals of treatment are to help the client/s identify the disagreement, choose a plan of action, and finally modify communication or expectations or both, so that the difference in opinion is resolved. A solution often exists, even though this seems unlikely to the client/s at first.

Interpersonal skills development is an aspect of IPT, used with people who are socially isolated, have long-standing problems in developing and sustaining close relationships, whose depression interferes with relationships, or who have social anxiety disorder (social phobia). The goal of therapy is to reduce social isolation by improving the person’s skills in spending time with and talking to others; increasing the person’s self-confidence; strengthening the person’s current relationships and activities; and helping the person find new ones.

IPT is effective with both adults and young people.

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Meditation

Meditation is connected with the practice of mindfulness at a deeper level. The purpose of meditation is to find the stillness within you. This stillness is always there, underneath, around or behind the movement of your ‘felt sense’ (inner sensations and subtle feelings), emotions and mind/thoughts. Once your stillness is reconnected with consciously, you quite naturally go ever more deeply and broadly into ‘being’ within, with the unfolding self-knowledge, detachment, truth, love, beauty, joy, connection with Life and gratitude this brings.

I encourage you to practice meditation by first focusing on your body - through your breath to begin with, and then within each part of your body from the tips of your feet to the top of your head, using your increasingly conscious inner sense. I may lead you into meditation practice within sessions, and ask you to practice at home. Over time, you will find that you will become more in touch with the subtle, inner sensation of the life within your body, and the stillness, radiance and fulfilment within. You will then have the knowledge of this inner state within you as you go about your daily activities.

Over time, meditation practice helps you to master your mind. This begins with recognising that the mind itself is your main problem – it continually pulls you out of your sense of stillness and contentment within your body and being (while pretending to be your best friend). While the mind is allowed to wander at will, you tend to have thoughts and worries which reconnect you with your negative emotions. This causes you to be fearful, anxious, depressed, guilty, doubtful, discontented etc. With meditation practice, you can come to see that you prefer to be in the stillness of your body and being, as it is a much more calm and beautiful place to be – whilst of course, attending to areas of your life that need to be addressed.

I recommend this excellent book to my clients: Barry Long (1995) “Meditation, A Foundation Course” Barry Long Books, plus all of Barry Long's work, if they are drawn to go deeper into meditation, love, life, truth, death and God.

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Mindfulness

Mindfulness is the practice of being with your senses, feelings and thoughts fully, yet with perspective. It helps you accept and tolerate the sensations, emotions and thoughts you may notice throughout your day, and assists with challenging habits and addictions or when facing past traumas or currently difficult situations.

Mindfulness and the meditative practices used to encourage it are derived from wisdom-tradition practices that have been with the human race for thousands of years. Mindfulness improves wellbeing, self-awareness, emotional regulation, communication skills, and conflict management, and reduces the symptoms of various mental health disorders, such as anxiety and depression. Mindfulness allows you to become more ‘present’, in the moment, now, with all that is here, in curiosity, kindness and acceptance, and to connect enduringly with your inner stillness, joy and timeless being. Mindfulness can help you become genuinely more balanced, patient, trusting, open, gentle, empathic, grateful, kind and self-compassionate. It can help you become more non-judging and accepting of yourself and others.

Mindfulness practices can include conscious sitting, breathing, showering, dressing, walking, eating, cleaning etc. They can include such practices as being mindful of the ‘felt sense’, inner sensations and feelings, as they change within your conscious awareness in certain situations or throughout the day.

For people who suffer with health anxiety, or other anxiety conditions including panic feelings, panic attacks or panic disorder, ‘symptom surfing’ or ‘panic surfing’ are very helpful mindfulness techniques. These techniques promote the practice of becoming increasingly curious and self-aware of the sensations in your body, plus your thought processes, which are causing you to escalate feelings, fears and beliefs that you have an undiagnosed physical illness, or will panic, pass out or not cope in particular situations. The techniques assist you to recognise, manage, detach from and reduce the habitual escalation that causes you anxiety and life-limitation.

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Positive Psychology

Positive psychology is a relatively new area of psychology that seeks to understand and help people have positive, strengthening, meaningful and fulfilling feelings and experiences.

Practical strategies that I may encourage you to try may include:

Enhancing pleasure – savouring the experience of pleasure, becoming absorbed in your senses, mindfulness practice, sharing experiences with others, and seeking a variety of experiences and pleasurable events over time;

Engagement – nurturing strong personal relationships, seeking out ‘flow’ experiences (when challenges and skills are both high), and identifying and using your strengths and virtues; and

Finding meaning – becoming more grateful, thanking people for what they give you, performing kind acts towards others, weighing up your life and making changes where necessary, learning to forgive and be less judgemental of yourself and others, and finding a connection to a larger purpose, eg. giving service to others and spirituality.

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Relaxation Skills

Relaxation skills are important for everyone, and can take a variety of forms, depending on what is most useful to you and the lifestyle you lead. The ability to relax allows you to manage stress, tension, anxiety, depression, grief, trauma, anger, physical pain, change/transition, relationships and communication issues more easily and objectively.

The relaxation skills which I encourage and teach people to use may include: quick relaxation practices; guided breathing practices for deep relaxation and anxiety management; self-soothing activities; pleasurable and fun activities; physical activities which induce relaxation either during the activity or afterwards, eg. yoga, tai chi, walking, cycling, sports; mindfulness practice; meditation practice and time management skills to name a few.

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Schema Therapy

Schema Therapy is a more expansive level of Cognitive Behaviour Therapy (CBT) which gets to the core of people’s negative and maladaptive beliefs. It can be particularly helpful in the treatment of anxiety, depression, trauma, substance abuse, eating disorders, psychosomatic disorders, relationship difficulties, and borderline and other personality or attachment disorders.

An ‘early maladaptive schema’ is an extremely stable and enduring pattern that develops during childhood or adolescence and is elaborated throughout your life. You view the world through your ‘schemas’. Schemas are important beliefs and feelings about yourself and your environment which you accept without question. Schemas are self-perpetuating, and are very resistant to change. For instance, children who develop a schema that they are ‘incompetent’ rarely challenge this belief as adults. Even overwhelming ‘success’ in their lives is still not enough to change the schema. The schema fights for its own survival, and usually, is quite successful. The schema usually does not go away without deep insight, stillness or guided therapeutic, behavioural change.

Even though schemas persist once they are formed, they are not always in your awareness. Usually they operate in subtle ways, in the subconscious.  However, when a schema erupts or is triggered by events, your thoughts and feelings are dominated by it. It is at these moments that you are likely to experience strong negative emotions, confusion and dysfunctional thoughts.

Schemas may include deep-seated beliefs regarding emotional deprivation, abandonment/instability, mistrust/abuse, social isolation/alienation, defectiveness/shame, social undesirability, failure to achieve, functional dependence/incompetence, vulnerability to harm and illness, undeveloped self, subjugation, self-sacrifice, emotional inhibition, unrelenting/unbalanced standards, entitlement/self-centredness, insufficient self-control/self-discipline, approval-seeking, negativity/pessimism and punitiveness.

Schemas are assessed through discussions, questionnaires and history-taking. Once the schemas are recognised, I will support you in making perceptive and behavioural changes to lessen the impact of, or dissolve your schema/s.

Childhood and adolescent experiences are behind many schemas. Therefore, Schema Therapy alongside the use of trauma therapy, eg. EMDR, has the potential to process and resolve the traumas behind the emergence of schemas. A wondrous and life-renewing experience!

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Somatic Experiencing

Somatic Experiencing* methods help people develop the body awareness to slowly release the physical/emotional/sensorimotor/neurological effects of the instinctive ‘fight', 'flight', 'freeze’ or 'collapse' responses in relation to perceived life-threatening or overwhelming experiences.

Techniques include re-establishing physical/body boundaries, grounding and centreing, building innate body resources, getting in touch with the ‘felt sense’ (connected with mindfulness), tracking the activation of sensations, images, thought and emotions, pendulation – tracking rhythms of inner expansion and contraction, discharging the stuck activation of the fight and flight responses, exploring strength and resiliency versus collapse and defeat, uncoupling fear from the immobility response, returning to equilibrium: becoming more comfortable with the external environment, and settling and integrating into a new sense of presence and calm.

*See Levine, Peter. A. (2008). Healing Trauma. A Pioneering Program for Restoring the Wisdom of Your Body, Sounds True, Inc., USA; Levine, Peter. A. and Kline, Maggie. (2007) Trauma Through A Child’s Eyes, North Atlantic Books and ERGOS Institute Press, USA; Levine, Peter. A. (1997) Waking the Tiger, Healing Trauma, North Atlantic Books, USA; Scaer, Robert. (2005) The Trauma Spectrum. Hidden Wounds and Human Resiliency. W.W. Norton & Company, Inc., USA

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You are welcome to contact me to make an appointment:

Sharon Rasco, Counsellor and Psychologist (MAPS)
30 Marlborough Place, St Ives, NSW 2075
Email: srasco@counselling-psychology.com.au