It’s easy to become emotionally disturbed when faced with a service-user, patient or client who self harms. Workers feel bad for the patient and bad about themselves for not being able to prevent it.
Unfortunately this emotional response – an element of High Expressed Emotion (HEE) known as Emotional over-involvement can make things worse. Try this instead.
“Very thorough and high quality…” Abi, Student nurse
Lifetime access for only £30.00
Do you work in mental health services?
Are you a support worker, student nurse or just an interested person who’d like to know how to make more sense of mental health and disorder?
Do you find it hard to see how all the different disorders and peoples’ approaches to them fit together?
Do you have difficulty getting other professionals to see things as you do?
Would you like to be more effective in working with the people you care for?
Then this online video course is for you.
People learn best when they have questions and they remember best when they have a ‘schema’, a ‘picture on the box’ to help make sense of what they’re taught. That’s what this training is all about. Over two and a half hours of video instruction alongside a range of information and exercises in the accompanying workbook help you to make sense of the seemingly overwhelming field of mental health and disorder.
And all for much less than the cost of a good night out.
You can have all this for less than you’d pay for a take-away meal for two. But unlike a take-away, the benefits of this training will last your entire career.
Click the link below to get full access to the course videos and workbook.
https://www.tamtalking.co.uk/p/onlive-video-training-the-picture-on-the-box/
Making sense of mental health
Mental health work needn’t drive you up the wall!
Mental health work can seem so complicated… and not just for beginners. Many seasoned practitioners go on for years without a clear idea of how the different diagnoses, conditions and coping strategies fit together. It’s like trying to make sense of a 1,000 piece jigsaw without any real idea of what the overall picture is supposed to look like.
The confusion that arises can lead to workplace stress, unclear aims and difficulties in following care plans with different workers pulling in different directions whilst the service-user or client gets stuck in the middle of a whirlpool of confusion.
This course is intended to provide the ‘picture on the box’. It shows clearly and simply exactly how the different types of diagnosis and conditions fit together and even maintain and exacerbate each other. Delivered either online or face to face (with appropriate distancing, of course) it’s available to staff teams anywhere in the world, just so long as they speak English and have a working internet connection.
The course involves…
Session 1
Anxiety (the gateway to mental disorder)
Freeze, flight and fight
Session 2
Depression (when you’re tired of trying)The opposite of the FIVE ‘F’S
Psychosis (The Devil makes work for idle hands)
Session 3
Personality disorder (9 statements of vulnerability)
The symptom groups – are the same as the 3 clusters… are the same as the vulnerabilities
3 models – All roads lead to the same destination
Session 4
Dependence and self-reliance
Therapeutic optimism Expressed emotion
Get in touch to book this training for your own staff. Go on, you know you want to!
Invitations by Email once £10 payment received.
Mention the word psychosis to most people and they immediately think of headline grabbing tragedies and untreatable, unmanageable people they’d rather not have anything to do with. This is inevitable given the way that the subject is covered in the press but it’s not really very accurate.
People diagnosed with psychosis, like people diagnosed with other mental health problems are more likely to harm themselves than others.
This hour long, online tutorial lifts the lid on the myths about psychosis and psychotic conditions like schizophrenia. It introduces participants to the practical, common sense things that they can do to support their relatives, their service-users and themselves. By breaking symptoms and problems down into manageable ‘chunks’ and by relating them to participants’ own experiences we build a clear understanding of what psychosis and schizophrenia really means.
The tutorial is open to anyone with an interest in the topic be they relatives, carers or, most importantly people with psychosis themselves.
“Rehearse death. To say this is to tell a person to rehearse his freedom. A person who has learned how to die has unlearned how to be a slave.”
(Seneca)
In the previous post I suggested that there’s no point in becoming distressed today because we think something might distress us later. That just increases the misfortune. Indeed, once we realise that most of the things people worry about never actually happen it becomes clear that it’s possible to ruin the quality of an entire life with pointless and unnecessary anxiety. If we expect next Friday afternoon to be distressing that’s one thing. But let’s not destroy today as well.
In the Christian tradition this seems to be what Jesus meant when he said
“….. do not worry about tomorrow, for tomorrow will worry about itself. Each day has enough trouble of its own.”
(Matthew 6:34)
I have long believed that Jesus (or whoever wrote the Gospels after his death) must have been familiar with the earlier works of stoic philosophers, there are just too many such coincidences for it to be otherwise in my opinion.
But it’s important to be clear. Freedom from distress by avoiding the emotional content of anticipation (avoiding worry, in other words) isn’t the same as avoiding anticipation altogether. On the contrary, we must anticipate. In fact the stoics advised us to go further than most worriers do in our anticipation – but we do so without distress. We do it as an intellectual exercise. We visualise loss and misfortune and we imagine how we might cope with the worst. On the one hand his can prepare us for what tragedies may befall us. On the other it helps us to understand and appreciate what we already have.
“Take full account of what Excellencies you possess, and in gratitude remember how you would hanker after them, if you had them not.”
(Marcus Aurelius, meditations)
This is one of the ways that stoics are able to maintain emotional equilibrium when things go wrong for them. They understand that all things in life are transient and they prepare for the changes in advance – they are always prepared to ‘give back’, to ‘return’.
“But he who took it away is a bad man.” What difference is it to you who the giver assigns to take it back? While he gives it to you to possess, take care of it; but don’t view it as your own, just as travellers view a hotel.
Begin therefore from little things. Is a little oil spilt? A little wine stolen? Say to yourself, “This is the price paid for apathy, for tranquility, and nothing is to be had for nothing.” When you call your servant, it is possible that he may not come; or, if he does, he may not do what you want. But he is by no means of such importance that it should be in his power to give you any disturbance.
(Epictetus, The Enchiridion)
Stoics visualise the loss of the things they hold dear. They make a point of contemplating death, material losses, homelessness, hunger, injury and illness, unemployment, grief – all the unfortunate things that might happen for them. And then they imagine how they might deal with them. There are several advantages to this:
Of course that doesn’t mean stoics need to go around reflecting upon miserable possibilities all the time. That wouldn’t do at all. But every so often, once or twice a week perhaps it’s a good idea to stop and think about what we have (health, possessions, abilities, relationships, status etc) and how it might be taken away. I promise you – make this a habit and you’ll enjoy life a great deal more. You’ll also be much more resourceful and better prepared to deal with tragedy.
In a different, less obviously philosophical context I talk to anxious, worried people about the ‘three stage plan’ for dealing with anxiety. I’ve used it for years with good effect. Once again it’s an idea stolen from the stoics. This is how I described it in one of my mental health Ebooks:
“We can also help people to plan, both should the worst happen and also how to prevent it. This becomes a fairly straightforward three-point process:
Whatever else we do we must be honest, rational and realistic. Only then can we understand whether or not the anxiety, the perception of threat is justified. If it is then we can begin to work on making the situation safe with all the facts that we need. If it isn’t justified (if it’s what Freud called inappropriate anxiety) then we can have the confidence to work on activities designed to help the person to face the thing they fear.”
(Stuart Sorensen – Mental health and social care p.20)
When we take gratitude, negative visualisation and awareness of the eternal now (see yesterday’s post) together we have a powerful blueprint for dealing with anxiety and enhancing enjoyment of life as a whole. But don’t just take my word for it. Give it a go and see what happens.
Dealing with anxiety – the 3 stage process
“If you are distressed by anything external, the pain is not due to the thing itself, but to your estimate of it; and this you have the power to revoke at any moment.”
(Marcus Aurelius)
In a previous post (Irvine’s summary) I made the point that…
“People generally confuse the things they can control with the things they cannot. The result is frustration and wasted effort as we invest (waste) our emotional and practical energies in futile attempts to make changes that are beyond our ability.”
In therapy sessions with my patients and clients I often encourage people to distinguish between…
I describe these different categories as ‘spheres of influence’.
The basic idea is to help people to understand the difference between a problem and a fact…
Problems are things that can be solved.
Facts simply are – they cannot be changed.
One of the biggest sources of frustration and distress comes from the attempt to treat facts as though they were problems: from the attempt to ‘solve’ facts; from the attempt to do the impossible.
The past is always a fact – but so is the present and, very often, the immediate future. Some people lament the fact that the past cannot be solved, that it cannot be altered but that’s not really very helpful. If the goal is to be effective now there’s no benefit in obsessing about ‘water under the bridge’, no matter how difficult or unpleasant things might have been at the time. In the task of living we are always precisely where we are at this moment.
Accepting that, accepting the fact that the past is no longer ours to change means that we can also begin to see it as no longer our concern. It’s true that there may be issues arising from past events or mistakes that we need to deal with but any actions we need to take will be taken in the present or the future – not the past. We can learn from the past but we need never be concerned about it because it’s gone.
That brings us to the present – the only thing we ever really have to call our own. And it’s fleeting. In fact, by the time you notice the present moment it’s already gone into the past and is no longer your concern. Yes – I know that sounds a bit weird but please, give it some thought – it’s important, especially when dealing with long-term hardship. Understand the concept now and you’ll find it much easier to bear life’s misfortunes later. You’ll be much more effective as you work to change and overcome them too.
Life is a series of moments, most of which are actually pretty neutral. It’s anxiety and anticipation that spoils our days, not the enduring event because most events don’t actually endure all that long. People endure hours of misery when they don’t need to because they’re forever focussing upon either the past (which is no longer their affair) or the future (which may be theirs to plan for but is not yet theirs to experience).
Even at times of hardship the eternal now is relevant. How bad is your situation at this very instant? Why let your mind focus on experiencing hardship before it needs to? Why experience the thing you dread before it happens?
It’s far more constructive to plan for the future than to imagine it negatively and suffer all the emotional distress that such imaginings bring. Make it a habit never to allow yourself to experience misfortune in your mind before it actually happens but to plan to deal with potential future problems instead. And understand that if you expect pain – there’s no need to be distressed by it until you actually feel it. Even then stoicism advises us not to worry about pain but that’s for another post. We need to cover some more basic stuff first.
Remember ‘the eternal now’. Do you have physical comfort and freedom from abuse right now, at this precise moment? Then you have all that you could possibly need. This moment in life is a success. Use the current success to plan with a clear head how to solve the problems of the future. Don’t squander it trying to solve the past (which is a fact, not a problem). Be glad of your immediate situation. The only alternative is to cancel out all those moments of contentment and comfort with futile focus upon the past which you can never change or the future which you have not yet reached.
The life well-lived involves taking time to appreciate the good moments (which generally far outweigh the bad).
“Begin the morning by saying to thyself, I shall meet with the busy-body, the ungrateful, arrogant, deceitful, devious, unsocial. All these things happen to them by reason of their ignorance of what is good and evil.”
Meditations (Marcus Aurelius) Book 2
I’ve used this quote before but it’s a good one so I’m returning to it. In these few words you’ll find the essence of what we mean by ‘No surprises’.
It doesn’t mean ‘No changes’ – that really would be dull.
Nor does it mean control everything so you know what’s coming – that would be both impossible and (even if it were possible) entirely counter-productive.
Rather it means that we can understand the nature of the world and of the people who inhabit it. Understand that people are fickle, that misfortune is a very regular occurrence and that we do not need to be surprised by the things we have foreknowledge of.
We may not know precisely who will treat us poorly today, tomorrow or indeed on any other day but we know that someone will – and that’s enough. We also know the ways in which we may be mistreated, at least in general terms and so we can prepare for them ‘thematically’.
We know that misfortune comes in themes. That there are groups of issues that share the same characteristics and we can prepare ourselves to deal with, to cope with these characteristic annoyances in advance.
Is anxiety a choice?
Is an anxiety disorder a choice?
Can a person choose not to be anxious?
Last night I had an interesting conversation with a stranger in the car park of my local supermarket. We’d exchanged a few pleasantries in the queue for the checkout – like me he refuses to use automated checkouts because, also like me, he’d much prefer that people keep their jobs.
We happened to have parked our cars next to each other on the way in and so the conversation continued in the car park, this time the subject was cars, driving and the rather nasty bump he’d had to the front of his vehicle. That conversation reminded me of today’s topic on anxiety.
Some time ago, one dark winter morning I found myself driving to work down unlit country roads in the rain. Visibility was poor and so I wasn’t going particularly fast which turned out to be a really good idea.
Also on the road on that dark, wet morning was a cyclist. A cyclist who was dressed in dark clothing with no lights and no helmet. To be honest I don’t even know how this guy might possibly have seen where he was going without lights – it really was that dark. However, presumably he could. I couldn’t see him though.
As I approached this invisible cyclist he pulled out into the middle of the road intending to turn right. You can guess what happened next. That’s why it’s such a good job I wasn’t going very fast. If I’d been driving at the legal speed limit instead of to the actual conditions I’d probably have killed him.
Fortunately, amazingly even he was OK apart from a few bruises. The ambulance came and took him to hospital where he was checked over. The police arrived and took my details, including my negative breath/alcohol test and I called in to work to explain that I wouldn’t be in that day. What happened next was revealing, especially about anxiety, phobias, avoidance and the ease with which normal freeze, flight or fight responses can become pathologies if we’re not careful.
My plan had been to return to work the following day. However within an hour or two of getting back to my accommodation I’d started to think. I actually believe that it would have been much easier to deal with the anxiety that followed if the accident had been my fault. If I’d done something wrong I could just decide to correct the flaw in my driving and make sure that nothing like this happened again. But that’s not what happened.
No matter how hard I tried I couldn’t think of any aspect of my driving that morning that I can change for the better. I hadn’t been drinking, I wasn’t going particularly fast, I was awake and alert, I was certainly concentrating due to the poor conditions, my car was in good condition and roadworthy and I was correctly positioned on the road. There was nothing I could think of to do that might prevent something like this happening again and if it does the next one might be fatal. That’s a really scary prospect.
It’s interesting that even though this is the first such accident I’ve had in over 30 years of driving all across UK, all that evidence of safe driving paled into insignificance against this one event. That’s because of a particular mental shortcut, an heuristic we know as the availability heuristic. I mentioned heuristics in an earlier video as part of my evolutionary psychology series. Click the link at the top of the screen for more information.
The availability heuristic is an evolved mental strategy that gives precedence to recent events. In a changing environment it’s useful – it allowed our ancestors to recall and give weight to the location of food, of predators and a whole host of other, changing environmental and behavioural artefacts. In the modern world it’s still extremely valuable but it has its drawbacks. One such drawback is the over-emphasis we give recent events. Here’s how it can turn useful anxiety into pathological disorders.
My emphasis on this single, recent memory caused me to work hard to find a way to avoid similar problems in the future. So far so good – we can all see the benefit of that. Unfortunately, the only thing I could come up with to avoid a repetition of this awful event is to stop driving. That’s rather less positive – especially in the light of the odds, bearing in mind my years, even decades of driving without hitting anyone, cyclist or not. But recent memories are the thing and that’s why I seriously considered not driving, giving up my job because I’d have no way to get to work without my car and I even spent time trying to rework my finances to allow me to retire early, all because I didn’t want to drive.
Now think about this. If I’d actually stopped driving that day what would my most recent driving memory be? Obviously it would be the traumatic memory of hitting, and initially thinking I’d seriously injured or even killed a cyclist. If that’s the result of the availability heuristic, the result of my most recent memory then my anxiety about driving will never dissipate. Not only that, the sense of fear I’d feel when contemplating driving, coupled with the relief I feel when deciding not to constantly reinforces the heuristic every time I think about getting back into the car.
Even though I know all this it took me three more days to pluck up the courage to drive my car again. I chose a quiet, sunny afternoon in broad daylight and drove around quiet country roads and literally had to force myself to turn the key and start the engine. That gave me a new memory but not enough to overcome the power of the traumatic heuristic. Powerful, traumatic memories take a lot of subsequent memories to take away the fear they generate. And the longer we avoid the issue the harder the trauma is to overcome. And that’s the point of this little video.
If you have an anxiety state that doesn’t seem rational, regardless of the emotion you feel, it’s important to ignore the emotion. Do this as soon as you can to build up new memories that can take advantage of the availability heuristic. That’s what people mean when they tell people to get back on the horse. Don’t let anxiety overcome rationality or you might find that your life choices become governed by fear to such an extent that avoidance shrinks your world, your opportunities and your options over time until there’s almost nothing left.
And it all begins when we give in to traumatic memories because of the availability heuristic.
Most people are surprised to learn that they maintain (and often actually create) the problems they face. Often people will work hard to resist this idea and that can be difficult to overcome but it’s worth the effort. Until people understand their own role in maintaining their difficulties they cannot really take responsibility for solving them. After all – if you don’t think you’re a part of the problem you won’t think that you need to change your behaviour to change it.
Chronic dissatisfation and attempts to achieve that which is beyond our control. These are the two main sticks we use to beat ourselves. Stoic philosophy helps us to overcome both these handicaps and concentrate instead upon striving to achieve what we can and being not just satisfied but actually joyful along the way. We can achieve truly great things when we direct our energies in the right direction.
Mind The Care Training 