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Institute Inbrief - 17/03/2015


Welcome to Edition 221 of Institute Inbrief! Stress is any pressure, demand, or threat placed on an organism (say, a human being) that causes a need to re-establish balance or “equilibrium”. In a two-part article series, we look at stress management from the perspective of a helper: that is, anyone who is currently providing emotional or psychological support to a friend, client or loved one.
In this first article, we explore three critical components of a stress management program: self-awareness, self-regulation, and balance. We also identify sources and signs of stress that, as a helper, you must be on the lookout for.
Also in this edition:
  • Latest news and updates
  • Articles and CPD information
  • Wellness tips
  • Therapist Q&A
  • Social media review
Enjoy your reading!
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Imagine Being Passionate About Your Work
And Assisting People Every Day Lead Better Lives
It’s rare these days to hear people talk about their work with true passion. You hear so many stories of people working to pay the bills; putting up with imperfect situations; and compromising on their true desires.
That’s why it’s always so refreshing to hear regular stories from graduates living their dream to be a Counsellor. They’re always so full of energy, enthusiasm and passion. There’s no doubt that counselling is one of the most personally rewarding and enriching professions.
Just imagine someone comes to you for assistance. They’re emotionally paralysed by events in their life. They can’t even see a future for themselves. They can only focus on their pain and grief. The despair is so acute it pervades their entire life. Their relationship is breaking down and heading towards a divorce. They can’t focus on work and are getting in trouble with their boss. They feel they should be able to handle their problems alone, but know they can’t. It makes them feel helpless, worthless. Their self-esteem has never been lower. They’re caught in a cycle of destruction and pain.
Now imagine you have the knowledge and skills to help this person overcome their challenges. You assist to relieve their intense emotional pain. You give them hope for the future. You assist to rebuild their self-esteem and lead a satisfying, empowered life.
As a Counsellor you can experience these personal victories every day. And it’s truly enriching. There is nothing more fulfilling than helping another person overcome seemingly impossible obstacles.
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Spotting the Narcissist
In Narcissistic Personality Disorder (NPD) individuals have an inflated sense of their own importance and a deep need for admiration – whether they have done anything to be admired for or not! A person with NPD is preoccupied with issues of power, personal adequacy, prestige, and vanity. Such a person lacks empathy and exudes a sense of superiority, but beneath the mask of super-confidence rests an extremely fragile self-esteem.
In our YouTube video, viewed by nearly 80,000 people around the world, Richard Hill explores the symptoms that characterise narcissism, how Narcissistic Personality Disorder (NPD) initially develops, and why we often let narcissists get away with their behaviour. The consequences of someone acting narcissistically are huge; Richard explores those and also provides a few survival tips for dealing with a narcissist.
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Helping and Stress Management: Part 1
Stress is any pressure, demand, or threat placed on an organism (say, a human being) that causes a need to re-establish balance or “equilibrium”. The Oxford Dictionary online adds that stress is “a state of mental or emotional strain or tension resulting from adverse or demanding circumstances.”
In this two-part article series, we look at stress management from the perspective of a helper: that is, anyone who is currently providing emotional or psychological support to a friend, client or loved one. Hence, the concepts outlined in this series apply to therapists as well as people without any specific counselling or mental health training.
In this first article, we explore three critical components of a stress management program: self-awareness, self-regulation, and balance. We also identify sources and signs of stress that, as a helper, you must be on the lookout for. In the second article (next edition) we’ll share a number of strategies for dealing with common stressors.
The prime factor in responsible self-care – and thus effective stress management – is self-awareness. For helpers, being self-aware is one of the factors significantly associated with effectiveness of the helping (Strupp, 1996). It is a pre-requisite to being able to regulate ourselves. Acting with self-awareness involves observing our own physical and mental/emotional experience without distorting or denying it. Only when we can do that can we become aware of our deeper needs, limitations, and concerns, and thus evaluate appropriate actions (self-regulation) in order to return to a state of balance.
If we cannot face ourselves in this way, we run the risk of acting from emotions and drives that we have locked out of awareness. Without awareness, we run a serious risk of harming our care recipients. It can happen through either neglect or exploitation of them as we attempt to meet needs for belonging, esteem, intimacy, or power and status through our interactions with them. It is not always easy to allow into awareness the internal conflicts and tensions that exist within ourselves as we try to meet various demands. The content that has not been worked through is sometimes raw and primitive-feeling, and it is often threatening to our sense of self. In part 2 of this series we will detail numerous stress management strategies that have increased self-awareness as their goal.
The second critical element to managing ourselves and our stress is the ability to self-regulate. We manage our bodily and emotional drives, impulses, and emotions both consciously and unconsciously. When we are stressed, activities such as rest, physical exercise, and leisure activities serve to restore our balance, thus regulating us. Being able to self-regulate is not easy as we attempt to manage our emotion, our energy, and the amount of stimulation we receive: too much stimulation and we feel overwhelmed and in the “groan zone”: too little and we are in the “drone zone”.
In order to regulate mood and emotion, we must be able to defuse emotionally charged experiences (such as those found at times when helping), and come to a balance. Managing stimulation, both internally and in our external life (including how we relate to food, drink, people, and work), is crucial in order to keep ourselves on course. The goal with stress management is to learn what we need to do to bring ourselves into equilibrium: a balance achieved by self-regulation, which was made possible by self-awareness. In part 2 we will name some stress management strategies for self-regulation.
The world’s religions, most scientific literature (Treadway, 1998), and most cultures’ traditions of common sense and wisdom agree: as human beings, we need balance. That is, we most capably give ourselves an antidote to the stresses of life if we have nurturing connections with ourselves, between ourselves and significant others, and between ourselves and a higher power (however we conceive it: “the universe,” “God,” “the transcendent,” or our “higher self”). Balance is essential for tending to our core needs and concerns, on all the levels of body, mind, and spirit. It is not a static thing.
Balance requires constant adaptation to achieve the state of “dynamic equilibrium” (an ever-shifting balance) wherein our needs are most well catered for. It may not be easy, especially for helpers. We are constantly pulled to ignore the needs of ourselves in order to care for others. Yet the rewards of going for this third component of self-management are big; we gain a sense of self-esteem, of mastery, and a deep trust that indeed we are capable of being the captain of our own ship. Balanced, we can navigate effectively through even the stormy waters of life (adapted from Baker, 2003).
Sources of stress
Stress as a perceived demand or threat can come to us from multiple sources, and usually many are occurring at once. Personal stressors refer to perceptions, events, or occurrences that are personal to us, such as problems in relationships, self-doubt, fears, and questions about our own worthiness. Rigid or unrealistic attitudes belong to this category, as when we are perfectionistic, place unrealistic expectations on ourselves or others, or decide that we cannot possibly be happy if we do not attain ______. General environmental stressors refer to external factors such as having insufficient money, substandard housing, or a poor physical environment (say, one which is polluted, too hot or cold, or dangerous). Special environment stressors include those areas of perceived pressure or threat to do with particular aspects of our environment, such as work and family events.
An example of how all three sources could contribute at once can be found in the example of the woman who, for instance, has an argument with her partner in the morning (personal). She is upset because the apartment they are living in is expensive, but still cold and humid (general environmental). The woman goes to work feeling stressed already, but upon arriving, gets a dressing-down from the project manager over something that has gone wrong in the new multi-million dollar computer system that is being trialled (special environment).
Here is what is interesting about stress management, however. The woman will respond to all of these events according to her mental/emotional makeup, level of coping skills, and even, how well she feels physically on the day. Someone else may respond totally differently, or she herself may respond differently on another day. Thus, it is crucial to note that stress is at least partly a function of our reaction to perceived threat, pressure, or demand.
That said, texts to train helpers in helping work are uniformly clear: helping work is inherently stressful, both from environmental factors (such as helping in a difficult environment, like a disaster zone or an agency where there is unrealistic expectation about how much work can be done) and also factors internal to ourselves, like the self-doubts and frustrations that arise from being in relationship with helpees who may not progress, or who may not appreciate what we are doing for them.
Studies have shown that, for helpers, the most single stressful behaviour on the part of helpees is that of suicidal behaviour (Deutsch, 1984; Farber, 1983). Additional sources of stress for the helper may be more common among mental health supporters. One of the studies showed that the following were most common:
  • Being unable to help distressed helpees feel better
  • Seeing more than the usual number of helpees
  • Not liking helpees
  • Having self-doubts about the value of helping
  • Having conflicts with colleagues
  • Feeling isolated from other helpers
  • Over-identifying with helpees and failing to balance compassion with appropriate work actions
  • Being unable to leave helpee concerns behind when away from work
  • Feeling sexual attraction to a helpee
  • Not receiving expressions of gratitude from helpees (Deutsch, 1984).
The point here is that the stressors are many, and the sources varied. The helper is particularly vulnerable to stress from such factors due to the personal nature of the work and the high hopes for “being cured” from the helpee.
Symptoms of stress
The following list shows what symptoms we might see at moderate to severe levels of stress:
  • Poor eating
  • Poor Digestion
  • Nausea
  • Dizziness
  • Sweating
  • Chills
  • Broken Sleep
  • Excessive dreams
  • Rapid breathing
  • Racing heart
  • Aching muscles
  • Undue anxiety
  • Undue fear
  • Undue concerns
  • Low self-esteem
  • Mood swings
  • Sudden anger
  • Feeling alone
  • Feeling lost
  • Feeling guilty
  • Wanting to hide
  • Easily upset
  • Confused thinking
  • Poor decisions
  • Poor attention
  • Disorientation
  • Slowed thinking
  • Reduced scrutiny
  • Memory lapses
  • Forgetfulness
  • Abnormal ‘after the event’ thoughts
  • Undue dreaming
The presence of only one or two of these symptoms could be from other sources, but when several are present, the chances are good that stress is causing them. If you are experiencing the symptoms, you may know your own body/mind well enough to know whether the symptoms are probably “just” stress or they indicate something else. If you are supporting someone who is undergoing a challenging period, strongly urge them to see a doctor and get the symptoms checked out. If the stress becomes chronic, serious health consequences follow. Diseases such as the following have been identified as stress-linked:
  • High blood pressure
  • Angina (chest pain due to inadequate oxygen to the heart)
  • Atherosclerosis (hardening of the arteries)
  • Thrombosis (blood clot problems)
  • Coronary heart disease
  • Migraine
  • Back problems
  • Ulcer
  • Asthma and allergies (Clarke, 1998)
In Part 2 of this series (next edition), we’ll share an inventory of some of the more well-known stress management strategies, including methods to tend to the body and mind/emotions, and the importance of emotional integrity.
Baker, E. K. (2003). Caring for ourselves: A therapist’s guide to personal and professional wellbeing. Washington, D.C.: American Psychological Association.
Deutsch, C.J. (1984). Self-reported sources of stress among psychotherapists. Professional psychology: Research and practice, 15, 833-845.
Farber, B.A. (1983). Psychotherapists’ perceptions of stressful patient behaviour. Professional Psychology: Research and Practice, 14(5), 697 – 705.
Strupp, H.H. (1996). The tripartite model and the Consumer Reports study. American Psychologist, 51, 1017-1024. In Baker, E. K. (2003). Caring for ourselves: A therapist’s guide to personal and professional well-being. Washington, D.C.: American Psychological Association.
Treadway, D. (1998). Riding out the storm. The Networker, 1-2, pp 54 – 61. In Baker, E. K. (2003). Caring for ourselves: A therapist’s guide to personal and professional well-being. Washington, D.C.: American Psychological Association.
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The power of compliments
Picture yourself in the following situation: you are on your way to a social gathering, waiting for the green pedestrian traffic light to light up. You’re wearing your new clothes. You notice the person next to you, and with a smile, they say “I really like your outfit – it looks great!” Your intuition tells you that the comment is sincere, and happily (and also honestly) you reply – “Thank you and you look great too!” As you walk away, still smiling, you are thinking to yourself: “Wow, that was nice!”
Why compliments are so important to us?
Compliments address the basic human need for recognition. Psychologist William James noted that the deepest principle in human nature is to be appreciated. Poortvliet explains that “nothing stimulates more and increases productivity and commitment faster than sincere appreciation.” Compliments are an exquisite element of our communal social life. Done right, they create a positive energy which eases the atmosphere between people and helps them perform better.
A study by Japanese scientists asked 48 subjects to learn and perform specific finger exercises on a keyboard as fast as possible. The subjects were separated into three groups. One group received individual compliments from an evaluator. A second group watched another participant receive compliments, and the third evaluated their own performance on a graph. When the participants returned to perform the exercise sequence a day later, those who had been complimented performed significantly better than either of the other two groups. The researcher explained the result through the (prior) discovery that, when receiving a compliment, the same area of the brain is activated as when receiving money; it’s a powerful social reward.  
Compliments are a mark of awareness and refined consciousness. There is, however, a catch. To gain the benefits of them, we need to have some skill.
The fine art of complimenting: A two-way process
Honest compliments validate our efforts, unlike flattery, which has other motives. They break the ice, stimulate conversation, and motivate future success. But sometimes our achievements do not receive positive acknowledgement from others, partly because some people are not fluent in the language of positive emotions. And some of us blunt the best efforts of compliment givers through discomfort in accepting praise! So how should we give and receive compliments?
Be sincere. There’s no controversy here. A genuine, congruent expression of praise or appreciation is a potent tool for improving and maintaining relationship. “Congruent” means that the verbal and non-verbal elements match up. Saying the person’s name, making eye contact, smiling, and leaning in toward the person you are complimenting all highlight your verbal message. So, too, does an unhurried delivery. 
Be specific. While it’s nice to hear, “You did a good job on that project,” the person has a much better chance of hearing the praise – and repeating current success in future – if you say what was especially good. So you might add in, “Your innovative design, overall organisation, and ability to sense market needs were particularly helpful”: name whatever was specifically great.
Add in how the praiseworthy effort has positively affected you, the organisation, or something else. Did you meet a deadline better for their effort? Find a more creative solution? Did the organisation unite better for an important cause? Chances are, honing in on this will tap into core meaning and values, with profound significance for the recipient.
Try giving the compliment as a question. It can be simple, like, “I love those earrings; where did you get them?” Or you could ask a follow-up question, such as: “You really connected with the audience during that talk. Was it hard to come up with relevant material?”
Be moderate. Over-the-top gushing can cause the recipient to feel self-conscious and make it harder to accept your compliment (how effusive you can be varies from culture to culture).
Receiving compliments
Secretly, most of us long to be well-thought of, but sometimes our issues create difficulties in accepting praise. The most common of these issues is low self-esteem; which prevents us from accepting compliments. We may be a perfectionist, having unrealistically high expectations of ourselves and truly believing we don’t deserve the praise. Many millions of people hate compliments because of Social Anxiety Disorder, a condition which causes people to fear being judged and therefore avoid situations where they will be the centre of attention. So how should we receive a compliment?
Smile graciously; return eye contact, and say, “thank you”. As with giving the compliment, a smile shows appreciation and sincerity (laughter, of course, communicates the opposite).
Add something relevant. The person complimented on those earrings can add, “I got them at that shop by the waterfront; they have unique pieces there.”
Don’t automatically compliment in return. It seems insincere and like you are just trying to be polite, or even approval-seeking.
Don’t deny, deflect, or ignore the remark. For example, if someone were to say “You sang beautifully tonight,” and you respond with “it was really mediocre,” you could be perceived as discounting the compliment giver’s judgement, rather than simply being modest. 
For some people, giving and receiving compliments can take some practice, but positive feedback is crucial for validating our sense of ourselves. So why not?
Written by Dr Meg CarbonattoB.S., M.A., and Ph.D.
This article was originally published in Asteron Life’s Balance Blog. AIPC regularly contributes to Balance’s wellbeing blog category.
Interpersonal Therapy: History and Theoretical Background
Interpersonal psychotherapy has been defined as a time-limited, dynamically-informed psychotherapy which aims to alleviate clients’ suffering while improving their interpersonal functioning. It is concerned with the interpersonal context: the relational factors that predispose, precipitate, and perpetuate the client’s distress. It is widely, but not exclusively, used to treat mood disorders. Rather than examine internal cognitions, as the other empirically-based intervention for mood disorders – Cognitive-Behavioural Therapy – does, IPT focuses specifically on interpersonal relationships, with the goal of assisting clients to either improve their relationships or else change their expectations about them. Moreover, IPT helps clients to build up their social supports so that they can manage themselves better through times of interpersonal distress (Stuart, 2006; Robertson, Rushton, & Wurm, 2008).
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Treating Substance Addiction
Treating any type of substance abuse and substance addiction is challenging because they both have so many dimensions and they both disrupt so many aspects of the individual’s life. Effective treatment programs typically incorporate many components, each directed to a particular aspect of the condition and its consequences. Ultimately, treatments aspire to help the individual stop using substances in an abusive or addictive way which would usually entail maintenance of a drug-free lifestyle, and achieving a productive level of functioning in the family, at work, and in society.
Because addiction is a disease, people cannot simply stop using drugs for a few days and be cured. Most patients require long-term or repeated episodes of care to achieve the ultimate goal of sustained abstinence and recovery of their lives. (National Institute of Drug Abuse, NIDA, 2009).
Click here to continue reading this article.
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Q&A with Toula Gordillo (Clinical Psychologist)
Q. I’ve heard that many therapists use stories and images when counselling young clients. How effective are these tools? Are they only applicable to young people?
A. If you think about society as a whole, there are a number of differences that can cause division among individuals. These differences can create significant problems in understanding, which in turn may reflect in the difficult circumstances surrounding people’s lives. Division may occur between age, gender, attitudes/perceptions, culture, socio-economic status, level of educational achievement, etc. There’s even a digital divide between those who embrace technology and those who do not use or understand it. So how do we overcome these divisions and help individuals to create cohesion in order to work through their issues? Therapists may use stories and images to help ‘close the gap’ or ‘create a bridge’ between individuals to enhance common understanding.
Individuals relate to stories and images in one way or another, and have done so since the beginning of time. Stories and images are present in every culture and may be delivered through oral storytelling (e.g. song-stories, verbal narratives), in written format (e.g. written ancient and modern stories, pictures and diagrams, drama and movies, etc.) and in digital format (computer interactive stories, digital song-stories, etc.). Stories and images are arguably the most effective way to assist clients achieve greater insight. 
Within the counselling context, stories and images can be enormously helpful, but they have to be delivered in a way that is personally relevant and meaningful for the individual if they are to be truly effective. This is when a skilled counsellor/psychologist can help. They can assist clients understand their own story (narrative), and then see the narrative from a different perspective, using strategies such as cognitive reframing (seeing their own story from a different point of view).
Stories and images need to be delivered in consultation with clients, using regular check-ups to see how they would like to receive the information. For example, if a client likes to read, then the therapist might provide relevant short stories to read for ‘homework’ between sessions; and later discuss them in-session. If, however, the client prefers music, then the therapist may play a short song-story during the session to be discussed, or provide you the client with a link to watch/listen on the internet and then discuss during the next session.
Traditional counselling methods such as CBT, solution-focused therapy and positive psychological methods can all be delivered through stories. Clients can then form an image in their mind, based on the story, and through the counselling process understand the story in relation to their own situation. Through this process, the client aims to create their own ‘Significant Story’. This method forms the basis of Story Image Therapy & Tools (SITT) and research has shown that this counselling method can be enormously helpful and effective for individuals of all ages.  
Message to Counsellors/Psychologists: Two people may read/experience the same story and interpret it differently. Individual narratives form the basis of Narrative Therapy, and by extension, Story Image Therapy & Tools (SITT). The story forms an image in the person’s mind and from the image created, the individual internalises the information.
Counselling parents of teens and pre-teens can be quite challenging. Stories and images can be used to deliver historical, cultural and psychological information and create positive changes in a young person’s life. By educating the parents in the value of stories and images, discussed in a positive environment, therapists can help promote behavioural changes and provide important psychological information for younger individuals.
Toula Gordillo is a Clinical Psychologist, AIPC private assessor/tutor and regular contributor for Institute Inbrief. Toula has an extensive work history as a Clinical Psychologist, Teacher, and Guidance Officer. For more information, visit  
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DSM-5 updates: Assessment instruments
We’ve previously published an article with information and resources to help you understand the differences between the DSM-IV and its latest version, the DSM 5. In this post, we turn our focus to DSM-5-relevant instruments to assess clients.
With the advent of the DSM-5 in 2013, clinicians wondered if instruments formulated on the basis of the DSM-IV and current in the DSM-IV years would be valid and reliable measures now with the DSM-5 description of personality disorders. A comprehensive review of all measures used to assess personality disorders was undertaken by Furnham, Milner, Akhtar, and DeFruyt (2014).
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