Jodie is a 40 year old woman who is married with three children and works full-time in a professional career. She has been experiencing low levels of energy for approximately 18 months along with feelings of stress and overwhelm. While working with Jodie, the Professional Therapist adopts the use of art therapy techniques to allow the client to look outside the box and find novel ways to increase self-awareness, reduce stress, and improve her physical, mental, and emotional well-being. For ease of writing, the Professional Therapist is abbreviated to “T”.

Background

Jodie is the younger of two girls and is close to her family, although she reports she and her sister are totally different and don’t have much in common. She describes herself as an overachiever who not only did well at school but excelled in a number of extra-curricular activities at the same time, including the debating team, violin lessons, and representing her school in both hockey and track and field.

After leaving school she married at age 23 and she and her husband moved away from their families due to her husband’s work. Jodie applied to the local university to study law and was accepted, but could only study part-time due to the need to support her husband’s income while they saved for a house deposit. Jodie spent many years studying part-time while working, and during this time she and her husband took on a large mortgage and had two children.

After her graduation and returning to the city where their families lived, Jodie had another child and continued to work part-time. She says her husband suggested she stop work while the children were young but she did not feel she would be able to stay at home full-time as she had always worked. She says they did have a lot of support with the children from both families.

Jodie’s youngest child Isabel, who is now 12, has always displayed high levels of anxiety and struggles with change of any kind. This has made her relationship with the older children difficult as they have limited patience with her. Isabel has recently been diagnosed with a learning disorder and is receiving treatment for this.

At the same time Jodie says her husband has been experiencing bouts of depression because he is unhappy with his work and feels stuck. This has put a strain on their relationship and she feels overwhelmed and helpless at times when she thinks about her husband and daughter’s difficulties.

Issues Identified

A therapist’s initial role is to develop an understanding of the client and assess the issues of concern that have brought them to counselling so that together the counsellor and client can develop goals and strategies for reaching these goals, and identify any barriers that might hinder the process. In this role, T conducted an assessment of Jodie’s environment, beliefs, support network and needs to identify the following issues:

Career indecision – although Jodie enjoys working in the legal industry, she is not happy with the work she is currently doing, but needs to continue in her current position for at least another 8 months to complete her probation.

High levels of stress and fatigue – Jodie has become increasingly fatigued over the last 18 months and although she can see light at the end of the tunnel, she is concerned her health will begin to suffer.

Lack of enjoyable activities – Jodie has no activities or hobbies she does either by herself or with friends and family that give her something to look forward to, as she does not believe she has time for this with the demands of her work and home life.

Concern about family members – Jodie is concerned about the difficulties her husband and youngest daughter are experiencing and the impact this is having on the whole family, and she reports feeling somewhat guilty about not being able to fix these situations.

Counselling Sessions

Following the initial assessment of her concerns, Jodie was presented with the option of using art therapy as a means of exploring the above issues. The structure and format of this process was explained clearly to her so she had a good understanding of what would be involved. Jodie was happy to agree to this and explained she had tried ‘talk’ therapy before and while she had found it helpful she also felt the results had been limited.

Art therapy is based on the belief that the way in which the creative process allows for self-expression also helps the client to resolve conflicts, develop self-awareness and achieve insight.
T started the second session by stating: “To start us off, we’re going to get very clear on what you want these sessions to be about. We might focus on health, relationships, career, finances, or all of the above – any area where you want to experience a change. We’re going to start by looking at where you are right now and then work out where you’d like to go by setting an intention which will be like a map for your journey.”

The Intention

Jodie was then asked a series of questions in order to identify her ‘intention’. This step aims to identify what the client wants to change and, in particular, to capture the feeling the client wants to experience as a result of going through this change. T asked Jodie the following questions:

How would you describe your current life experience?
What is working and what isn’t working for you right now?
What would you like to be different in your life?
What kind of space or environment supports your wellbeing?
If you had unlimited money, time and energy, what would your ideal life be like?
Where would you like to receive insight and clarity in your life?
What would you like to focus on now?
What do you want to experience through the counselling process?
How would you know if you had experienced this?

Jodie’s answers revealed that if she had unlimited resources, she would spend more time with her family doing activities they could enjoy together. At the moment she felt she didn’t get to see her family often enough and when she did, she was too tired to feel anything but irritated with them. She also stated she would like to have more adventure in her life, such as overseas travel and getting her motorbike licence. Jodie described her current experience of life vas restrictive and draining, and wanted to focus on opening up to more fun and family time.

An intention is worded as an “I am” statement in order to give the client a here and now sense of the change they want to experience and how they will feel when this is reached. Jodie worded her intention in the following way: “I am experiencing optimal balance between work and family responsibilities, while living a full life with abundant energy”.

The Body Map

During the third session, T introduced ‘body mapping’, an innovative process created by Laura Hollick which can be used as a tool to access and understand the client’s inner world. Jodie identified two parts of her body to trace onto a large sheet of paper, one part she liked and another part that she either disliked or that was causing her discomfort. Jodie chose to trace her eyes and thighs.

At this point we put away Jodie’s intention so that she could let go of any attachment to the outcome of the body mapping process. At the start of this session, T gave Jodie the following guidelines:

“To enter the creative process of art therapy, try to let go of the outcome and any expectations of what you think things should look like. This will allow your inner wisdom and intuition to lead the process. Whatever happens, your role is to simply notice how you feel and enjoy the activity. Don’t worry about whether you’re doing it ‘right’, just do what you can during the time we have.”

To trace Jodie’s eyes, she decided she would lie down on her side and T would trace the profile of her face. Then she sat down on the paper and traced the tops of her legs so they were touching the earlier tracing of her eyes. T asked Jodie to note down any feelings that came up for her during this process and write these directly on to her body map, without editing herself. Jodie wrote a series of words such as ‘heavy’, ‘tired’, ‘can’t see’ and ‘stuck’.

T then introduced a ‘creativity door’ to start the art making process, asking Jodie to pull out three cards from a deck of Journey cards and place them on her body map side by side. From this Jodie interpreted the story she felt they were telling her and used this as a foundation for creating a collage on her body map. She felt the cards told a tale of someone following starting out on a journey without knowing where it would lead. She cut a number of images from magazines that she felt represented this story visually and pasted them on to her tracing so it became completely covered. This process took approximately 45 minutes.

At this point T asked Jodie to stand back from her body map and to share her impressions of what she had created. She felt her collage looked like a mountain. T asked her where she felt she was on the mountain and Jodie indicated the bottom. At the end of the session, T gave Jodie her body map to take home together with a list of questions to consider, answering the first four questions as if she were the collage:

How would describe yourself?
What is important to you?
How do you feel about your creator (Jodie)?
What do you want your creator to be aware of?

T also asked Jodie to consider the following series of questions prior to the next session:

When you look at your collage, what do you notice?
What do you like about it?
What don’t you like about it?
What does it remind you of?
What comes up for you when you look at it?
What do you think your collage is trying to say to you?
What question do you have for your collage?
What is your collage’s response?
Do you have another question for your collage?
What is your collage’s response to your question?

The Insight

During the fourth session, T began to go over Jodie’s responses to the above questions with her. In order to decode the art and receive any insights relating to the intention, T needed to refrain from providing interpretations and instead asked Jodie to elaborate on her impressions to obtain her interpretation of her artwork.

Jodie explained that at first she had the same old feeling of overwhelm when she first looked at her body map – feeling that she was facing a mountain that she was too tired to climb. However she discovered as she went through each question that the mountain she had constructed contained many interesting things along the way that she wanted to stop and explore.

When Jodie asked her collage what it wanted her to know, the insight she received was that she needed to slow down and enjoy the journey rather than just focusing on reaching the summit. Within her collaged mountain were many enjoyable activities such as camping, motorbike riding, swimming and visiting a holiday retreat.

There were also two images of fire which Jodie felt represented her burning ambition. When she asked her collage for more information about this, she understood the response to be that while it was ok to have ambition, it should only represent part of her life, not take over completely. T then asked Jodie to look at her intention again and asked her how the insights she had gathered from her body map related to her original intention for the art therapy process: “I am experiencing optimal balance between work and family responsibilities, while living a full life with abundant energy”.

Jodie said she felt the mountain she had created out of her body map represented a rich and exciting life containing many aspects that she was missing out on because she was focused only on the end goal. She felt her collage had shown her that climbing the mountain was in itself as important to the journey as reaching the top was.

T told Jodie she had wondered if Jodie’s history of excelling at many things at once had become a habit that did not allow her the opportunity to stop and enjoy her life along the way to reaching her goals. Jodie agreed with this and stated that she had never looked at it this way before, but was grateful for the realisation that she could now give herself permission to allow the needs of herself and her family equal priority to her other achievements and goals.

The Action

To make the journey complete, T needs to ensure the client makes a physical action that results from the insight to anchor it in the real world, rather than having it remain as simply an idea. T asked Jodie the following question: “What is the most powerful action you can take to honor your insight?”

Jodie decided the action she would take to make her insight tangible would be to obtain her learner’s permit to ride a motorcycle. In order to stress the importance of this step, T asked Jodie to be as clear and specific as possible, asking her what exactly she would do to achieve this and when. Jodie contracted to go to the Department of Transport the following Tuesday morning to obtain her permit, and agreed to a follow-up call from T in a week’s time to hold her accountable or to offer support with this action if needed.

Session Summary

Jodie concluded from the art therapy process that although she had a mountain to climb, she did not need to climb it all at once. She was able to see that she could take small steps towards reaching her goals that would not result in her feeling overwhelmed and fatigued. She particularly saw that she could take time to enjoy the process of climbing the mountain, while noticing her tendency to want to do many things at once. When she noticed this, she was now aware enough to ask herself if it was in her best interests.

In taking time to schedule pleasurable activities into her busy routine, both by herself and with family and friends, she was able to feel some enjoyment in life again which boosted her energy levels. It also meant some of the tasks she had been doing no longer seemed so important and she was able to create a more effective work/life balance.

Art therapy allowed Jodie to take a new perspective when looking at her issues of concern and deepen her self-awareness to develop an understanding of what she could do differently to change her current situation.

Author Information:

Leanne Chapman graduated with a Bachelor Degree in Psychology from James Cook University and a Postgraduate Diploma of Professional Psychology from Bond University. She also holds a Diploma of Life Coaching. She worked as a registered psychologist for 15 years before making the decision to combine creative expression with personal growth. She then set about completing training in the expressive therapies field, including Art Therapy, Equine-Assisted Therapy, Therapeutic Journalling, and Symbol Work.

Leanne has written articles on creativity for numerous magazines and facilitated several courses at the Relaxation Centre of Queensland based on Julia Cameron’s bestselling book ‘The Artists’ Way’. Through her own healing journey, she experienced creative processes which she is now sharing through individual sessions, group work, and online classes.

Website: http://leannechapman.com/

“First impressions stick.”
“You never get a second chance to make a first impression.”

If there is any truth in these two popular notions, then anyone working with a helpee (e.g. a therapy client, a friend, a family member, etc.) within the context of providing mental health support should not underestimate the usefulness and importance of opening micro-skills.

Appropriate use of non-verbal micro-skills tells care recipients that you are with them and ready to listen. When you use opening micro-skills, you are inviting them to tell you more. While these are technically commands, they are “soft” ones, in that they are presented to the helpee in a manner that communicates, “It is okay to decline”. They help to create comfort in the helpee because they foster the courage to confide. The purpose of openers is to encourage disclosure without dominating the conversation. There are two broad categories of these skills: “encouragers”, such as “door openers” and “minimal encouragers”, and questions. First we consider t he encouragers.

Encourager micro-skill: door openers. Initiated by the helper, door openers are short, non-judgmental statements or questions which encourage exploration and discussion by communicating the availability of the helper. Helpees determine how deep they go with them. They are particularly common in the initial phase of a helping encounter, and may include observations by the helper.

Here are some examples:

• “What would you like to discuss today?”
• “What’s happening for you?”
• “Can you tell me more about that?”
• “You look discouraged today. Do you want to talk about it?”
• “What’s on your mind?”
• “I see you have some brochures for different medical centres. Would you like to talk about that?”

Door openers are useful because they aid helpers in beginning a conversation or getting helpees to expand on a topic. Also, they buy time for the helper to formulate a response.

Encourager micro-skill: minimal encouragers. From head nods to positive facial expressions to “uh-huhs”, these brief supportive statements signal attention and understanding. Minimal encouragers are (mostly) verbal responses that show interest and involvement, but have the purpose of encouraging the helpee to keep talking.

They are not intended to start a conversation, nor to stimulate discussion. They only communicate that the listener is on track. They allow the helpee to determine the primary direction of the conversation. With this micro-skill, the helpee is rewarded for continuing to talk.

Examples of minimal encouragers are:

• “Yes”
• “I’m with you.”
• “Okay.”
• “I see what you mean.”
• “Umm.”
• Silence, accompanied by positive facial expression, nods, or open gestures (Young, 2005).

Minimal encouragers are successful helper tools because of the paradox that they create. In using them, helpers most powerfully aid helpees by simply getting themselves out of the way.

Encourager micro-skill: questions. While non-verbal language and encouragers are foundational to the helper’s micro-skills, it is questions that provide a systematic framework for directing the helping session. They can aid a helping interview to begin, and move it along smoothly. Questions can open up new areas for discussion, and issues can be pinpointed and clarified. All of this helps care recipients explore themselves and their issues. All schools of psychology recognise questions as an essential component, and they are particularly prominent in some theories, such as re-careering, brief counselling, and cognitive-behavioural approaches.

The major function of questions is to help the helpee to talk more freely and openly, to check perceptions, or to provide specific information. Your skill in questioning as a helper can have these results:

• Bringing out more of the helpee’s story, enriching their world, and aiding in keeping the story going;
• Making an effective assessment of a helpee’s issue. Questions are the backbone of effective assessment. The who, what, when, where, how, and why of journalism is recommended as a ready system for helping the helpee to elaborate;
• Guiding the manner in which a care recipient talks about an issue. “What” questions bring out facts, and “How” questions tend to promote discussion about processes, sequences, or feelings. Concrete specifics can be brought out with such questions as, “Could you give me a specific example?”
• Assisting the helpee to search for positive assets, because stories presented in the helping session are often negative, and full of problems. The positive asset search is a concrete way to approach positive regard and respect for the client;
• Helping to open or close talk according to the individual need of the interview. For instance, helpers would not want to have a helpee begin to open up right at the end of the helping session (Ivey & Ivey, 2003).

The shadow side of questions. Questions are powerful, useful, and necessary. But they must be utilised sparingly, with great caution. The wrong sort of question can close helpees down rather than open them up. When responding to your questions, helpees talk within your frame of reference, not their own. Questions can potentially take self-direction away from the helpee (Ivey & Ivey, 2003).

And too many or poorly phrased questions can cause the helpee to feel interrogated rather than supported and comforted, increase their dependence on the helper, and encourage socially acceptable answers rather than honest ones. The following problems in using questions crop up frequently with beginning or unskilled helpers:

Bombardment/grilling. Too many questions tend to put helpees on the defensive.

Multiple questions. Helpers sometimes ask a helpee several questions at once. Although the helpee may be glad to have a choice as to which question to answer, it often feels like bombardment.

Questions as statements. Helpers sometimes make a statement in the form of a question which pushes their agenda or point of view. It is probably better to just be direct about the fact that a statement is being made, rather than try to disguise it as a question.

Questions and cultural differences. Members of some cultures receive questions, even rapidly asked questions, with ease, but in other cultures, receiving a number of questions promotes distrust of the helper. Also, as there is often a power differential between helper and helpee, questions can imbalance the power even more, as they give control to the question-asker (the helper).

‘Why’ questions. These may be necessary occasionally, but generally cause great discomfort in helpees, because many people remember being scolded or punished as a child after they were asked why questions.

Questions and control. While questions can be useful in bringing an out-of-control session under direction, questions can also be used unfairly and intrusively for the helper’s gain rather than that of the helpee. If this happens, the relationship built by use of attending skills is destroyed.

We will be concerned here with the two main types: closed and open questions.

Closed questions. These are questions that lead to a specific, often very short, answer. It may be an answer like “yes” or “no”. They have the advantage of focusing the interview and obtaining information, but the burden of guiding the talk (and therefore the “power” or position of dominance in the session) remains with the question-asker (usually the helper). With these, the helpee may choose to expand on the answer, but is not likely to do so. Closed questions often begin with is, are, or do: for example, “Do you love your girlfriend?” “Is that why you came to see me?” “Are you employed?”

In responding to a closed question (especially if it is a leading question), helpees often feel restricted in the type of information that they are “allowed” to add back in. They may perceive that the helper has an agenda that they should somehow respect. Thus, they may not feel comfortable to talk freely. For example, how would you respond to a (closed) question such as, “Do you think that you did that because your father never paid much attention to you?” It is worth noting that lawyers use closed questions to constrain and focus the direction of people on the witness stand. Helpers don’t generally have the same goals as barristers (Geldard & Geldard, 2005).

Open questions. In contrast, open questions cannot be answered in a few words. They encourage a person to talk, and provide maximum information. They persuade helpees to answer by giving them the opportunity to refuse. The helpee responding to an open question is given lots of scope, and “allowed” to freely divulge additional material, which enriches the response. Open questions often begin with what, how, why, or could. Generally more useful to helpers, these can facilitate deeper exploration of issues.

Examples of open questions are: “What is your relationship with your parents like?” “How did you come to this decision?” “Could you tell me more about your involvement with that?” Open questions, by their nature, encourage helpees to talk about things that are interesting and meaningful to them rather than those that are so to the counsellor (Geldard & Geldard, 2005; Ivey & Ivey, 2003).

References:

• Ivey, A. E., & Ivey, M.B. (2003). Intentional interviewing and counseling: Facilitating client development in a multicultural society (5th ed.). California: Thomson Brooks/Cole.
• Geldard and Geldard (2005). Basic personal counseling: A training manual for counselors. Australia: Pearson.
• Young, M.E. (2005). Learning the art of helping: Building blocks and techniques. New Jersey: Pearson/Merrill Prentice Hall.

Source: www.mhss.net.au

• Regulating conversations
• Communicating emotions
• Modifying verbal messages
• Providing messages about the helping relationship
• Giving insights into self-perceptions
• Providing clues that people are not saying what they are thinking (Highlen and Hill, 1984).

When sitting with a helpee (this could be a client or a friend you are providing emotional support), you have multiple channels of non-verbal communication at your disposal.

Eye contact. The most important indicator that someone is listening, eye contact is a powerful communication tool. Making eye contact with the helpee conveys the helper’s confidence and involvement, and can be used to communicate caring and comfort. It needs to be used with caution, however, as there is wide variance between cultures as to the meaning of eye contact. Western cultures associate lack of eye contact with dishonesty, indifference, or shame, and also – in academic circles –  a lack of respect.

Conversely, in some cultures eye contact means the opposite. Navajo students at the University of New Mexico, for example, look down rather than looking the professor in the eye in order to convey humility and respect. If you do not look at helpees, they may think that you are not interested. If you stare fixedly, they may become uncomfortable, or perceive either seduction or aggression. In general, a moderate amount of eye contact, along with closely observing helpees to notice the effect on them, is recommended. When you really want to be heard by your helpee, eye contact will make your message more potent (Young, 2005).

Posture/Body position. Posture may be the most frequently noticed aspect of “body language”. The goal is to go for a relaxed body position. This may include leaning slightly forward, as part of your way of communicating involvement and interest. Being relaxed without informally lounging says, “I am comfortable with myself, and I have time to listen to you” (Young, 2005). To be tense would be to shift the focus off your helpee onto yourself, and might also spark tension in the helpee (Egan, 2006).

You may also wish to consider “matching” your helpee’s posture. The idea is that, early on, you mirror the way the helpee is sitting (without being unnatural, which would seem gimmicky to the care recipient). Done skilfully, this tends to communicate somewhat more intimacy to the helpee, rather than that you are superior as the helper. If, after a while, you sense that rapport has built up between you, you may slightly shift your position and observe whether the helpee follows you. If they do, it means that rapport has been established, and the helpee will be likely to experience a reduction in tension (Geldard and Geldard, 2005).

Facial expressions. Psychologists have distinguished six primary emotions: sadness, joy, anger, surprise, disgust, and fear. These register in our facial expressions regardless of culture (Ekman, 1975). In addition to the basic emotions, we can distinguish many more facial expressions, with estimates reaching 5000 (Blum, 1998). This means that, as a helper, you can gain much information from close observation of your helpee’s expressions. When they do not match what the person is saying, you have detected incongruence, and this tends to be an indicator of lack of self-awareness, conflict, or even deceit (hence the expression that someone acting in a hypocritical manner is “two-faced”).

Moreover, the sensitivity human beings have towards facial expression means that, as a helper, your facial expressions – whether you are aware of them or not – will communicate much to a helpee. In the Freudian tradition of helping, it was not deemed appropriate for the helper to have any overt reaction to the client’s emotions. The person-centered therapists, working in the tradition of Carl Rogers, believed that genuine expression was important for congruence. Whether you are in one of these camps theoretically at polar opposites to one another or somewhere in between, it is clear that your face can help the helpee to disclose more, or – if the helpee detects disdain, boredom, or that he is being made fun of – shut the door entirely.

Gestures. These physical motions are an element of attending that we use both to convey emotion and to emphasise important points. If our arms flail wildly, we are drumming our fingers, frequently shifting body position, checking the watch, or playing with something, we signal anxiety, impatience, or boredom. Looking like a stone statue, however, may communicate aloofness or lack of interest. Again, as with facial expressions and body position, the recommended approach is that you are moderately reactive, indicating friendliness and warmth. Your gestures should be casual, natural, and not distracting. Occasional head nodding for encouragement may be included (Young, 2005).

Tone of voice. The way that you use your voice in a helping encounter encompasses pitch, volume, intensity, inflection, speed of speaking, spacing of words, the type of emphasis, pausation, silence, and fluency. Just as we can tell much about the helpee’s emotional state from their tone of voice, so too does the helpee make assumptions based on hearing the helper’s voice.

If the helper conveys empathy and a calm concern with a relaxed, clear voice, the helpee receives the message that, despite the emotional turmoil with which he may have entered the helping session, the helper will not be overwhelmed. There is the sense that the helper has the capacity to stabilise the situation, and the helpee feels more calm and hopeful. You may wish to communicate that you understand the helpee’s feelings. Rather than exactly matching a helpee’s tone of voice (which might be quite agitated), this communication is best done through slight elevation of the voice or emphasis of certain words. The helpee then hears that you were listening to the emotions as well as the facts.

Physical distance and touching. Perhaps none of the non-verbal micro-skills are more vulnerable to cultural differences and ambiguous interpretation than physical distance or touching. Proxemics, the study of space utilisation in human interactions, dictates that the closer the distance, the more personal the interaction. Some cultures, such as Latin-based peoples, are comfortable speaking with as little as 4 inches between them, whereas people in Australia and New Zealand require a much larger “bubble” of personal space.

The “appropriate” distance in the United States is 90 – 120 cm (between 3 and 4 feet). If you put a desk or table between yourself and the helpee, it increases the feeling of formality, and also the emotional distance between you. On the other hand, if you are squashed with only a very small distance between you, the helpee may feel intimidated and anxious. Most probably, if you are setting up a helping meeting, the chairs should be between 1.6 metres (about 5 feet) and about 450 cm (about 18 inches). You may wish to let helpees arrange the chairs to a distance that suits them.

Touching is similarly open to interpretation. Using it during a helping encounter communicates caring and concern, especially when the helpee is dealing with grief. It also is shown to have a positive impact on the helping relationship. Touch can enhance bonding between the helper and depressed helpees, and may be used to emphasise important points. It does seem to increase the ability to influence the touched person (Driscoll, Newman and Seals, 1988; Willison & Masson, 1986).

Some counselling experts do not believe that hugs have any place in the helping relationship. Others have the experience that appropriate touch can enhance the session. If you do use it, these three guidelines are helpful to observe:

• Touch should be appropriate to the situation
• Touch should not impose a greater level of intimacy than the helpee can handle
• Touch should not be patronising, or otherwise communicate a negative message (Fisher, Rytting, and Heslin, 1976).

A hug can be a special gesture at the end of a helping meeting, but it can also seem insincere if it is forced or if it is used routinely. Even if you do not touch or hug, you can convey the all-important sense of warmth through the other non-verbal means we have discussed. You will know that you have been successful when helpees open up, and/or when they appear visibly more calm and comforted.

References:

• Blum, D. (1998). Face it! Psychology Today, 31(5), 32 – 70. In Young, M.E. (2005). Learning the art of helping: Building blocks and techniques. New Jersey: Pearson/Merrill Prentice Hall.
• Driscoll, M.S., Newman, D. L., & Seals, J.M. (1988). The effect of touch on perception of helpers. Counsellor Education and Supervision, 27, 113—115. In Young, M.E. (2005). Learning the art of helping: Building blocks and techniques. New Jersey: Pearson/Merrill Prentice Hall.
• Egan, G. (2006). Essentials of Skilled Helping: Managing problems, developing opportunities. California: Thomson-Wadsworth.
• Ekman, P. (1975). Universal smile: Face muscles talk every language. Psychology Today. 9(4), 35 – 39. In Young, M.E. (2005). Learning the art of helping: Building blocks and techniques. New Jersey: Pearson/Merrill Prentice Hall.
• Fisher, J.S., Rytting, M., & Heslin, R. (1976). Affective and valuative effects of an interpersonal touch. Sociometry, 39, 416-421. In Young, M.E. (2005). Learning the art of helping: Building blocks and techniques. New Jersey: Pearson/Merrill Prentice Hall.
• Geldard and Geldard (2005). Basic personal counseling: A training manual for counselors. Australia: Pearson.
• Highlen and Hill (1984). Factors affecting client change in counseling. In Brown, S.D., & Lent, R.W. (Eds). (2008). Handbook of counseling psychology (4th ed.), pp 334 – 396. New York: Wiley.
• Willison, B.G., & Masson, R.L. (1986). The role of touch in therapy: An adjunct to communication. Journal of Counseling and Development, 64, 497—500.
• Young, M.E. (2005). Learning the art of helping: Building blocks and techniques. New Jersey: Pearson/Merrill Prentice Hall.

Source: www.mhss.net.au

Stress is not a diagnosis but a process happening over time. The level and extent of stress a person may feel depends a great deal on their attitude to a particular situation. An event which may be extremely stressful for one person can be a minor event in another person’s life. Stress is not always a bad thing because some people thrive on it and even need it to get things done. However, when the term ‘stress’ is used in a clinical sense, it generally refers to a situation that causes discomfort and distress for a person and that is the area we will look at in this article.

Regardless of who you are or what you do, chances are you spend a lot of time entrenched in the busyness of life, worrying about getting everything done, and feeling out of control. We feel obligations and pressures which are both physical and mental and the attached stress, which can be quite debilitating, is not always obvious to us. Most people don’t handle their stress well. They focus on the unpleasant and unexpected things that happen daily. This should just be called ‘life’; however, we need to learn to handle the stressors that life sends our way.

There is a major difference between stressors – those things that happen every day that have the potential for driving us crazy, or making us angry, frustrated, and hurt, and stress – the way we choose to respond to these stressors. You make a choice about how situations will affect the rest of your day.

We cannot help but allow our daily routines to take over our lives. Working, studying, running the errands, groceries, kids, deadlines, projects, budgeting – the list can go on and on. And the things that are supposed to make our lives essentially easier are the same things that often cause us the most stress. For example, think about your computer, your car, and all the gadgets in your household that just happen to breakdown right when they are most needed.

Backaches, headaches, strokes, migraines, sleeplessness, anger and hostility etc. are showing us that we are more stressed than ever before. Even our hobbies and interests are stressful and demanding activities.

Different types of Stress

One of the reasons why people have a hard time ending stress is that they are not addressing the core issues within their lives. Following are six categories of stress.

1. Work/Study-Related Stress

The workplace and the school are very stressful environments. Deadlines are a major cause of Work/Study Related Stress. Other factors that might contribute to this type of stress are conflict with your boss/co-workers and/or teachers, changes that happen abruptly, where you cannot cope with them, threats to job security, or a fear of having a failing mark.

2. Relationship/Family Related Stress

Family related stress includes divorce/separation issues, extra-marital affairs, child-rearing, teenage break ups and unwanted pregnancies among others. This area is a major stressor for most people and oftentimes, stress coming from this area can have a major impact in other areas.

3. Environment Related Stress

Environment related stress is where the normal daily routine of a person is bombarded by disturbances and changes that the person cannot cope with. Disturbances include noise from the surroundings (i.e. jackhammer in a nearby construction site, traffic noise, etc.), and weather disturbances among others. Changes in the environment such as moving to a new state, having a new job or having a completely different lifestyle are stressors too.

Critical incident stress (CIS) is the emotional stress that individuals experience after being exposed to a specific incident that is perceived as traumatic. It is very common and normal for people to experience a range of reactions to critical incidents which may be cognitive, physical, behavioural or emotional in nature (Carlier, Voerman & Gersons, 2000). Different people have different reactions. Some people have limited reactions that last only a few days while others may take weeks or months to feel comfortable again. Others can even have a delayed onset reaction too. There are also some reactions that suggest a person is having difficulty coping with the incident.

4. Psychological Stress

Psychological stress can include fear of an individual which can either be real or be a phobia which is not grounded in reality. Sleeplessness, anxieties and worries are sometimes caused by unrealistic fears which have no basis. The subconscious of a person and/or his/her belief systems, cultural background and social activity can all contribute to a socio-psychological stress complex.

5. Financial Stress

Feelings of helplessness in financial terms are one of the most common causes of stress, and because the economic well-being of an individual is connected to other areas of his/her life, a financial problem can also have spill over effects in areas such as relationship and health.

6. Health Related Stress

The health of a person is the wellspring of his life. Health related stress ranges from sleeplessness to drug abuse. Illnesses are also sources of stress. Some of the most common illnesses can be the most major stressors – such as influenza, asthma or psoriasis.

These categories are not isolated from each other. Mostly, one stressor can lead to other forms of stress. The categories can mix and match to create more stress and pressures can creep in from an area of one’s life to another. Above all this, the degree of stress can be mild to extreme. A suffering from stress in one area could not possibly isolate this area from infecting and inflicting damage to other areas of life.

The Fight or Flight Response

The fight or flight response is a primitive inbuilt response to stress or threat. Also referred to as hyperarousal or an acute stress response, it occurs in both animals and humans, enabling us to deal with threatening situations by preparing us for action. This is very useful if attacked because our bodies will be highly alert and strong, allowing us to either stay and fight the enemy or flee as fast as we can.

When the fight or flight response occurs, the sympathetic nervous system goes into action, releasing the hormone adrenalin into the bloodstream. This causes the heart to beat faster to deliver oxygen to the muscles, which become tense and ready for action. Breathing becomes more rapid and shallow, increasing oxygen supply to the blood.

The digestive system slows down to divert energy to the muscles and in more extreme hyperaroused states the body may even discharge the content of bladder and bowls to further prepare the organism for intense fighting or fleeing. Sweating also increases to keep the muscles cool for when they begin to work hard. In this way, the organism enters a state of increased alertness, vigilance and a preparedness for some form of physical action involving either fighting the threat or fleeing from the threat.

The fight or flight response evolved in prehistoric times when survival relied on both aggressive, combative behaviour and flight from a predator. In modern times, this response has remained with us and has been recognised as the first stage of the general adaptation syndrome that regulates stress responses among vertebrates and other organisms (Andrews, Crino, Hunt, Lampe, & Page, 1996).

The Fight or Flight Response:

• The brain becomes aware of danger.
• Hormones are released and the involuntary nervous system sends signals to various parts of the body to produce the following changes:
• The mind becomes alert
• Blood clotting ability increases, preparing for possible injury
• Heart rate speeds up and blood pressure rises
• Sweating increases to help cool the body
• Blood is diverted to the muscles, which tense ready for action
• Digestion slows down
• Saliva production decreases, causing a dry mouth
• Breathing rate speeds up, nostrils and air passages open wider to allow more air in quickly
• Liver releases sugar to provide quick energy
• Sphincter muscles contract to close the openings of the bowel and bladder
• Immune responses decrease to allow for a massive response to immediate threat.

The General Adaptation Syndrome

General adaptation syndrome describes the body’s short-term and long-term reaction to stress. Originally described by Hans De Solye in the 1920s, the general adaptation syndrome describes a three stage reaction to stress covering our initial reaction to the stressor, our resistance and adaptation to coping with the stressor and our eventual exhaustion after dealing with the stress whereby in normal circumstances we will recover from that exhaustion and live to deal with stressors another day.

Alarm reaction phase

During the alarm reaction phase, a stressor disturbs homeostasis. Homeostasis is a point of balance or internal biological equilibrium. The brain subconsciously perceives the stressor and prepares the body either to fight or to run away (the “fight or flight” response).

When the mind perceives a stressor, the cerebral cortex, is called to attention. If the cerebral cortex consciously or unconsciously perceives a threat, it triggers an autonomic nervous system response that prepares the body for action. The autonomic nervous system is the portion of the central nervous system that regulates bodily functions that we do not normally consciously control. When we are stressed, the rate of all these bodily functions increases dramatically to give us the physical strength to protect ourselves against an attack, or to mobilize internal forces.

In addition to this, the hypothalamus, a section of the brain, functions as the control centre and determines the overall reaction to stressors. When the hypothalamus perceives that extra energy is needed to fight a stressor, it stimulates the adrenal glands to release the hormone epinephrine, also called adrenaline. Epinephrine causes more blood to be pumped with each beat of the heart, dilates the air sacs in the lungs to increase oxygen intake, increases the breathing rate, stimulates the liver to release more glucose, and dilates the pupils to improve visual sensitivity. The body is then poised to act immediately.

Other physical responses to stress during this stage include “butterflies” in the stomach, an elevation in blood pressure, dry mouth and tensing of muscles. In some instances if too intense or if for too long the individual may find it difficult to concentrate on preparing well to deal with the stress properly. The alarm reaction directs resources away from the digestive and immune systems to more immediate muscular and emotional needs. In normal circumstances the alarm reaction phase will not last for very long, in some instances it may only be for a few seconds, in other instances longer. The alarm reaction phase is only meant to be a preliminary phase of activating the body and mind into dealing effectively with the presenting stressor or threat.

Resistance (adaptation) phase

As we move from the initial alarm reaction phase, as a preparatory response to the presenting stressor, we then move onto the resistance or adaptation phase. It is in this phase where the body is now actively dealing with the stressor. If this adaptation phase continues for a prolonged period of time without periods of relaxation and rest to counterbalance the stress response and allow time for the body to replenish and repair from the exertion required to execute the appropriate stress response, sufferers become prone to fatigue, concentration lapses, irritability and lethargy as the effort to sustain arousal slides into negative stress.

At the most fundamental level of response the organism is going to be either fighting or fleeing in some way, in an attempt to resist the negatively perceived consequences of the threatening stressor. This resistance may be required for either, a few moments, days, months and sometimes even years. The form of resistance employed will have varying degrees of success depending on how well it is employed and how relevant it is in dealing with the stressor situation. Regardless of the length of time, once the threatening stressor has been dealt with effectively the organism is able to return to its pre-activated state and recover from the ordeal. It is in the process of recovery that adaptation occurs.

Every organism has restricted resources to adapt to stressors. Therefore, whenever someone has to adapt to a stressor they will lose “adaptation energy” meaning that they will have less resources to adapt next time they are confronted with a stressor unless they adapt successfully.

Successful adaptation from resistance is when the body and mind adapts to a point of being more capable in its capacity to resist if ever confronted by the stressor again. In this sense, successful adaptation means the organism has increased its biopsychosocial level of fitness whereby it can take on the same threat more effectively next time or successfully take on a bigger threat next time.

It is through this process of adaptation that we learn how to cope better and deal with things more effectively. At a physiological level successful adaptation actually means getting physically fitter. Psychosocially it means having greater levels of resilience, working better coping strategies and having more appropriate emotions and thought processes around the challenging situation.

Problems occur at the resistance/adaptation phase if the combined biological, psychological and social responses employed do not deal with the threat effectively or if the threat is chronic whereby it eventually wears down the capacity of the organism to resist the threat or deal with it properly. This problem leads us to the exhaustion phase of the general adaptation syndrome.

Exhaustion phase

A person can only fight or flee for so long before they begin to wear down in their capacity to resist and deal with it. If the stressor environment is chronic and excessive without any real opportunity to recover or adapt successfully, the organism will begin to show signs of adaptation failure. Systems begin to break down and we become more susceptible to a range of biopsychosocial symptoms. If we persist in functioning at this level, death can occur.

References:

• Andrews, G., Crino R., Hunt, C., Lampe, L., & Page, A. (1996). The treatment of anxiety disorders. New York: Cambridge University Press.

Anger is not a form of aggression, and most often does not lead to aggression! Rather it is a felt experience that typically follows unwanted, aversive interactions with close friends, colleagues, and family members. Although anger is common, and sometimes useful, it can become an independent problem with many negative consequences, requiring treatment in the context of individuals, couples, or family therapy in private practice or institutional settings.” (Kassinove & Tafrate, 2002, p.12)

Anger is not aggression, hostility or violence (although these may result from the experience of anger); rather anger is an internal event, a feeling, a physiological reaction. For this reason, some clients may find it challenging to articulate their experience. ‘Feeling angry’ can manifest in a variety of ways. Two clients may state that they feel angry, yet the variation between their experiences may be as broad as the intensity difference between mild irritation and frenzied rage.

In this article we explore six anger management strategies counsellors can utilise with clients.

Strategy One – The Anger Episode Record

To begin the management of anger, both counsellor and client require an understanding of the client’s expressive patterns. This can be achieved by encouraging clients to complete an Anger Episode Record. This is a record of each trigger, appraisal, experience, expressive pattern and outcome the client encounters during an established time period.

Trigger:

The target for my anger was…
The situation surrounding my anger was…

Appraisal:

The thought I had about the trigger was…

Experience:

The intensity of my anger was (a scale of 1 to 10 can be used to define intensity)…

Outcome (positive):

A list of positive short-term outcomes…
A list of positive long-term outcomes…

Outcome (negative):

A list of negative short-term outcomes…
A list of negative long-term outcomes…

The sample template (above) is an example of how a client might record this information. Recording information in this way fosters self-reflection and promotes personal awareness. Additionally, this information can act as a foundation on which cognitive approaches can be launched.

The anger episode model illustrates the linear process from the experience of a trigger through to the final outcome. The cycle of anger presented below (see figure below), demonstrates how this linear process is embedded within a continuous cycle of learning.

Cycle of Anger: http://www.counsellingconnection.com/wp-content/uploads/2008/01/anger-cycle.gif

Source: Williams, E. & Barlow, R. (1998). Anger Control Training. London: Winslow Press.

Our role as counsellors is to effectively thwart the momentum of this learning cycle by assisting clients to modify their response at one or more of the key points within the cycle. Through the completion of the anger episode record (strategy 1), it is anticipated that clients will have an enhanced awareness of their personal triggers, appraisals and expressive patterns. Awareness, of course, will do little to alter behaviour if clients are not encouraged to engage in corresponding action.

It is therefore essential that any increase in awareness be coupled with appropriate strategies for initiating desired change.

Strategy Two – Challenging Thoughts / Appraisals

Once appraisals of triggers have been identified, it can be beneficial for both counsellor and client to consider the appraisal and evaluate its validity. This can be achieved through a number of questioning techniques below).

Examining the evidence:

What is the evidence to suggest that the appraisal is accurate?
What is the evidence that supports the appraisal?
What is the evidence against the appraisal?

Looking for alternatives:

Is there an alternative explanation?

Questioning the effect:

What is the effect of my believing this appraisal?
What could be the effect of changing my thinking?
Action planning
What should I do about it?
Double standards
What would I tell________ (a friend) if he or she were in the same situation?

Source: Adapted from Beck, J. (1993). Cognitive therapy: Basics and beyond. New York: Guilford Press.

Example Transcript:

Rachel (client): At work the other day I got so mad at Don. He kept interrupting me. It was infuriating!
Counsellor: Yes…
Rachel: It’s because he doesn’t respect what I have to say. He thinks I’m stupid.

In the above transcript, the client has identified both a trigger and an appraisal of her anger. The trigger is Don’s interrupting behaviour which the client has appraised as an indicator that he thinks she is stupid. As conversation continues, the counsellor decides to challenge the client’s appraisal.

Counsellor: Tell me, Rachel, if Don interrupted Gail [Rachel's respected manager], what reason would you give me for why that occurred?
Rachel: Gee, if Don interrupted Gail I would say that he was trying to impress her by dominating the meeting and appearing to be full of ideas.
Counsellor: Right…

The counsellor has used the double standards technique in this example.

Strategy Three – Using Self-Calming Statements

“What we think affects the way we feel. Distorted thinking can increase the likelihood of negative emotions such as anger, while calming or challenging thoughts can reduce the impact of these feelings. Self-calming statements are thoughts that can be (1) prepared in advance to anticipate and cope with a situation or trigger; (2) used to cope with the situation or trigger when it arises; and (3) used to calm ourselves down after the situation or trigger has passed.”

Distorted thought – “He’s getting at me”
Self-calming statement – “Don’t take it personally”

Source: Williams, E. & Barlow, R. (1999). Anger control training: The anger control training guide (part 3). London: Winslow Press (p. 83).

Formulating self-calming statements: Self-calming statements can be formulated to assist clients in each stage of responding to a trigger (before provocation, during provocation and after provocation). When an anger-provoking event can be anticipated, clients can formulate self-calming statements that enhance coping skills.

For example, a statement such as – “Remember, this is a fair request. You’re doing the right thing by standing up for yourself” – may effectively act as a calming force for an individual about to enter into a confrontational discussion or negotiation.

A statement such as – “I don’t have to feel intimidated” – can act to calm a client during the discussion or negotiation. And statements such as – “I handled that well” – can reassure the client after the event has passed.

Strategy Four – Relaxation

The body tends to respond in an innate flight or fight response when faced with an anger-provoking situation. That means that reactions within your body call you to ask yourself whether you should leave the situation (flight) or use your newly produced adrenalin and cortisones to get through (fight).

The body often responds to anger by:

• Increasing sweating to help cool the body
• Slowing digestion to preserve energy for a fight/flight response
• Increasing blood pressure to maximise oxygen production
• Tensing shoulders and back muscles to ready the body for action
• Dilating pupils to maximise focus on the threat

Because of the state of high tension the body endures during an anger experience, clients may benefit from the use of relaxation strategies. When you are in a relaxed state, your body responds in a number of ways:

• Metabolism slows, as do physiological functions such as heart rate and blood pressure.
• Muscle tension decreases.
• Brain wave patterns shift from the faster waves that occur during a normal active day to the slower waves, which appear just before falling asleep or in times of deep relaxation.

Not all relaxation exercises suit everyone. It is important, therefore, to try a number of techniques to find one which suits your client. The following selection of exercises have been included because they take only a few minutes to perform and may be used almost anywhere.

Technique One – Erasing Stress: Erasing stress is a visualising technique. It allows you to visualise the thought or situation which is constantly on your mind or inciting anger and helps erase it from your thoughts.

1. Sit or lie in a comfortable position. Breathe slowly and deeply.
2. Visualize a situation, a person, or even a belief (such as, “A situation at work which is confronting” or “A home renovation which is causing disruption in the household”) that causes you to feel angry.
3. As you do this you might see a specific person, an actual place, or simply shapes and colours. Where do you see this stressful picture? Is it below you, to the side, in front of you? How does it look? Is it big or little, dark or light, or does it have a specific colour?
4. Imagine that a large eraser, like the kind used to erase chalk marks, has just floated into your hand.
5. Actually feel and see the eraser in your hand. Take the eraser and begin to rub it over the area where the stressful picture is located. As the eraser rubs out the stressful picture it fades, shrinks, and finally disappears. When you can no longer see the stressful picture, simply continue to focus on your deep breathing for another minute, inhaling and exhaling slowly and deeply.

Technique Two – Discovering Muscle Tension: Discovering muscle tension is an excellent technique for understanding the effects that stress or anxiety has on your body. This technique provides an opportunity to discover the difference between a relaxed muscle state and a tense muscle state. Identifying this can assist in acknowledging the level of stress in your muscles.

1. Lie on your back in a comfortable position. Allow your arms to rest at your sides, palms down, on the surface next to you.
2. Raise just the right hand and arm and hold it elevated for 15 seconds.
3. Notice if your forearm feels tight and tense or if the muscles are soft and pliable.
4. Let your hand and arm drop down and relax. The arm muscles will relax too.
5. As you lie still, notice any other parts of your body that feel tense, muscles that feel tight and sore. You may notice a constant dull aching in certain muscles.

Technique Three – Progressive Muscle Relaxation: Discovering muscle tension exercise is an excellent exercise to try before the Progressive Muscle Relaxation exercise.
Lie on your back in a comfortable position. Allow your arms to rest at your sides, palms down, on the surface next to you.

1. Inhale and exhale slowly and deeply.
2. Clench your hands into fists and hold them tightly for 15 seconds. As you do this, relax the rest of your body. Visualize your fists contracting, becoming tighter and tighter.
3. Then let your hands relax. On relaxing, see a golden light flowing into the entire body, making all your muscles soft and pliable.
4. Now, tense and relax the following parts of your body in this order: face, shoulders, back, stomach, pelvis, legs, feet, and toes. Hold each part tensed for 15 seconds and then relax your body for 30 seconds before going on to the next part.
5. Finish the exercise by shaking your hands and imagining the remaining tension flowing out of your fingertips.

Technique Four – Focusing: This exercise can be used to block out negative or intrusive or inflammatory thoughts. Focusing on one item slows your thought processes and helps to increase your concentration. At first, the focusing technique can be challenging, because the mind automatically starts thinking about other areas of your life.

1. Select a small personal object that you like a great deal. It might be a jewelled pin or a simple flower from your garden. Focus all your attention on this object as you inhale and exhale slowly and deeply for one to two minutes.
2. While you are doing this exercise, try not to let any other thoughts or feelings enter your mind. If they do, just return your attention to the object. At the end of this exercise, you will probably feel more peaceful and calmer. Any tension or nervousness that you were feeling upon starting the exercise should be diminished.

Strategy Five – Assertiveness Training

Assertiveness training is commonly reserved for individuals who find it challenging to express their anger rather than those who over-express it. Nonetheless, an awareness of assertive communication can assist in modelling suitable reactions and responses for clients who are uncertain about their ability to communicate appropriately in high-pressure or anger provoking situations.

Assertive communication demands the use of direct, honest and appropriate expression of personal opinions, needs or desires. By communicating assertively, you are more likely to achieve your purpose. Using more forceful strategies such as verbal attack or harsh criticism ignites negative responses from others and can cause relationship tension.

TIP – When formulating assertive responses it may be helpful to remember the use of “I” messages. Starting a sentence with “you” can come across as a judgement or condemnation of the other person. By focusing more on yourself, it conveys less blame and more personal ownership of your feelings. This might be a helpful formula – “I feel _________, when _____________.”

For example: Instead of saying, “You never do anything around the house”, try “I feel frustrated when I have to do so much around the house.”

Points to remember:

1. Be conscious of your body language
2. Try to ensure that your non-verbal messages reflect confidence – stand tall, maintain eye contact and try to relax
3. Use a firm tone but maintain a pleasant demeanour
4. Don’t assume the motives or thoughts of the other person, ask questions and try to understand their point of view
5. Remember to listen
6. Try to find a compromise.

Consider the following scenario: You have just settled on the couch to watch your favourite TV show. Fifteen minutes into the program your partner arrives home and says, “Quick change the channel. The football is on!” and proceeds to grab the remote.

What would be a verbally aversive response to this situation?
What would be an assertive response to this situation?

Additional reading: Teaching Clients to Become Assertive

Strategy Six – Creating a Relapse Prevention Plan

“Relapse prevention began with the work of Marlatt and Parks (1982) and Marlatt and Gordon (1985) who noted that after success with the treatment of various behavioural problems – such as smoking, drinking, overeating, drug addiction, obsessive compulsive disorder and gambling – clients very often fell back into their old behaviours. In fact, between 50% and 90% of clients who are successful in the reduction of overeating, smoking and other problem eventually relapse.

Relapse is not the same as treatment failure, in which there is little or no progress at all. Rather, the terms “lapse” and “relapse” refer to slight or almost total increases in problem behaviours, after improvement has already been shown. In all likelihood, this occurs because we don’t focus formally on consolidating and maintaining treatment gains. Thus, an important final step in any anger management program is preparing clients, in advance, for the likely scenario that anger will reappear.” (Kassinove & Tafrate, 2002, p. 245-246)

A relapse prevention plan can assist clients in managing setbacks as they occur throughout the process of change. Relapse prevention is a form of self-management. Without such a plan, a ‘lapse’ may provoke a return to old behaviours. According to Parks & Marlatt (2000) the cornerstone of relapse prevention is the acquisition of effective coping skills. Coping skills enable the client to better understand and manage lapses as they occur. Coping skills can be developed via the following processes.

It may be helpful for clients to establish an initial awareness and understanding of the likelihood of lapses occurring throughout their change process. By acknowledging that lapses are probable and common, clients are less likely to catastrophise the lapse or abandon treatment due to a perceived lack of progress.

Clients can benefit from sharpening their awareness of high-risk triggers. Particular people, situations or environments are likely to be more challenging for clients who are seeking to manage their anger. By raising awareness of these triggers, clients can commit to engaging in pre-confrontational strategies. This means that clients can mentally and physically prepare for triggers, through relaxation, soothing self-talk and other cognitive strategies.

Cognitive distortions that lead to all-or-nothing thinking can challenge the client who experiences a lapse. As such, it can be valuable to work with clients on being able to acknowledge shades of grey. That is, to be able to experience a lapse without abandoning the long-term plan.

Caring for one’s self can play a vital role in the way in which a lapse is firstly perceived, and then managed. Clients who are well rested, healthy and have managed their time and priorities well are far better positioned to approach the management of a lapse with a confident mindset.

Tips for Managing Anger Relapses (Client Resource)

Everyday demands

Everyday stressors, such as work, children and tight schedules can heighten anxiety and contribute to feeling overwhelmed. When we are stressed, we are less likely to respond in a measured and considered fashion to provoking situations, choosing instead to respond with impulsive expressions of our immediate feelings.

To avoid this result, it can help to be mindful of your schedule. Avoid taking on responsibilities or favours that you don’t have time for. Use spare time to pursue leisure and relaxation activities. Prioritise your self-care and maintain a balanced lifestyle. Of course, the achievement of these aims can be difficult when the demands on our time are so great. Nonetheless, without paying careful attention to our lifestyle habits, we are vulnerable to the effects cumulative stress can have on our ability to manage expressions of anger.

Thinking only of short-term gains

A confrontational or provoking situation can ignite reactions in individuals that have far-reaching and long-term effects on relationships. This often occurs during the heat-of-the-moment as tensions and anxieties blind us to the longer-term consequences. It can therefore be highly beneficial to plan, plan, plan for an anticipated encounter.

An awareness of likely triggers enables you to predict which situations are likely to be challenging or confrontational for you. Imagine, for example, that you have just received another credit card bill in the mail – you have overspent and know that your partner will not be pleased. Instead of waiting for your partner to react before formulating your response, you could spend a few moments considering how you could best respond to this likely future event. You may, therefore, decide it is best to take accountability, to apologise and offer a commitment to lessen spending in the future. This, of course, is preferable to a response made in haste that is defensive, attacking, or derogatory.

Source: http://www.mentalhealthacademy.com.au/