The Choice Point
Imagine walking through a forest and you come to a fork in the road. One path leads you towards your dream destination but is a winding and treacherous road. The other path is smooth and straightforward, but leads you further away from your destination. Faced with that choice point, what would you choose?
This is a metaphor for the choices we make in our everyday behaviour. We make lots of different decisions everyday and sometimes they become so automatic that we don’t realise that they have become bad habits or unhealthy coping strategies that take us away from the person we want to be.
Challenging situations are a key time where we’re faced with that choice. Maybe you’ve had a hard day and would ordinarily reach for a cigarette. Maybe there is a social event coming up that you would usually avoid.
Take a second to think about your values and the kind of person you would want to be. What are some of your strengths? What kind of life do you want to live?
Now think about what small decisions you could make that move you towards the outcome you want, behaving like the person you want to be.
The next time you face a challenging situation, take a moment to pause and imagine yourself at that fork in the road. Consider which path you want to take, and what would help you be the best version of you.
DBT in Practice: GIVE and FAST Skills
As I wrote about in my last blog post, one of the major aims of DBT is deciding which different skills we can use to get our needs met effectively! Last post I wrote about the DEAR MAN skill in Interpersonal Effectiveness, which gives us an outline of how we can effectively assert our rights and values.
Today I want to talk about another two skills within the Interpersonal Effectiveness module – GIVE skills, which help us maintain relationships, and FAST skills, which help us maintain out self-respect.
The GIVE skill is really about helping us act in a way that maintains positive relationships, as often when we are highly emotional and wanting to get our needs met, we can act in ways which can detrimentally effect those around us, e.g. we can say or do things to hurt the person we are talking to when trying to get what we want.
GIVE stands for:
1. Be Gentle:
Be nice and respectful, don’t:
a. Attack - either verbally or physically, express anger directly and with words
b. Threaten – don’t use manipulative statements or hidden threats. If you need to describe consequences for not getting what you want describe them calmly and without exaggerating. Tolerate a no.
c. Judge – No moralising, no shoulds and shouldn’t’s, abandon blame
d. Sneer – no smirking, eye rolling, cutting off and walking away
2. (Act) Interested:
Listen and appear interested in the other person, listen to their point of view and maintain eye contact, don’t interrupt them. If they want to have the discussion another time be sensitive and patient.
3. Validate:
With words and actions show you understand the other person’s feelings and thoughts about the situation, try and see it from their point of view and say or act on what you see, e.g. “I see this is hard for you…”
a. Make sure you go to a private place to have this conversation if the person is uncomfortable speaking in a public place
4. (Use an) Easy Manner:
Use a little humour, smile, leave your attitude at the door
Now the FAST skill is more for when we want to maintain our self-respect in any given situation, to make sure we aren’t getting what we want at the expense of how we feel about ourselves.
FAST stands for:
1. Be Fair:
Be fair to yourself and the other person, validate your own feelings and wishes, as well as the other persons
2. (No) Apologies:
Don’t over apologise! No apologies for being alive or even making a request, for having an opinion, or for disagreeing. No looking ashamed, eyes and head stay up.
3. Stick to values:
Stick to your values, don’t sell out your values or integrity for reasons that aren’t VERY important. Stick to your guns and be clear on what you believe is the moral or valued way of thinking and acting!
4. Be Truthful:
Don’t lie, don’t act helpless when you aren’t. Don’t exaggerate or make up excuses.
Now we have all three of these skills in our toolbox – DEAR MAN for helping us effectively assert our rights and wishes, GIVE for helping us act in a way that we maintain positive relationships and FAST for helping us act in ways to keep our self-respect – think about which skill is most appropriate for you in any given situation, or perhaps use all of the above!
Remember to practice and if you have any questions about how to use DEAR MAN best, ask your individual therapist for help.
Why Dieting Doesn’t Work
Within Western culture, the mainstream beauty standard currently dictates that thinness is the ideal. Where there exists a specific standard, anything outside of that becomes problematic and unfavourable. The concept of Body Mass Index (BMI) is an extension of this weight-normative approach, asserting that there is a normal (narrow) range of acceptable and healthy weight, and that individuals should achieve and maintain a weight within these parameters. Such judgement encourages the development of weight bias and stigma in society, including within healthcare settings.
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Beliefs and preferences for or against particular shapes and sizes (directed towards self and/or other)
e.g. "I don't like my body shape"; "I don't like their body shape"
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Negative social impact of weight bias and discrimination. For example, having limited or no options for people living in larger bodies to sit, such as on a plane, or in a restaurant or cinema. This is particularly prevalent in medical settings where seating, gowns and examination tables are often unable to accommodate people with higher weight.
These forces of beauty standards, a weight-normative approach, weight bias and then weight stigma naturally builds pressure on individuals to focus on weight. Weight loss can reduce exposure to weight stigma and bias, and increase access to physical spaces. Losing weight and indeed eating disordered behaviours may also be actively encouraged by others given the cultural construction of beauty.
Consciously restricting or controlling food intake in order to lose weight or maintain a ‘suppressed’ weight encompasses a wide variety of behaviours, attitudes, body shapes and sizes. Weight suppression refers to the differential between your highest adult weight and your current weight. It can involve avoiding particular types of eating situations because of concern of the foods present. It could involve avoiding particular groups or types of food, or simply feeling like you’re constantly failing with what you’re eating.
Weight suppression (and dieting generally) has been likened to the concept of holding your breath underwater. We can hold our breath underwater for a certain period of time, and some people get really good at it and can stay under for extended periods, but eventually we all need to come up for air.
Weight suppression manifests differently for different individuals, and occurs across the weight spectrum. Being weight suppressed does not necessarily mean that you are underweight. No matter the variety, weight suppression can lead to uncomfortable, harmful and serious health consequences.
Mental Health Impacts:
Maintains an excessive focus on weight and shape and their importance
Level of control and restraint required creates stress and pressure that impacts upon mood and anxiety
Interferes with social functioning and relationships
Maintains body dissatisfaction
Feeds an externalised view of self (self-objectification) - judging yourself as if from the outside
Increased vulnerability to eating disorders
Physical Health Impacts:
Low energy availability
Reduction in basal metabolic rate
Changes to appetite hormones
Survival mechanism
Brain interprets losing weight and restrictive behaviours as being in the context of a famine, ramps up appetite stimulating hormones (e.g. ghrelin) and reduces satiety hormones (e.g. CCK)
Digestive changes
Internal distress and discomfort can be experienced with bowel changes, bloating and reflux
Increased vulnerability to binge eating and weight gain in the long-term.
Regular eating is the foundation of all treatment of eating disorders. Dieting is one of the major predisposing factors in the development of eating disorders. Establishing regular eating by itself can begin to reverse the physical and mental health impacts of weight suppression.
If you are concerned about your eating or that of someone you love, don’t hesitate to connect to a health professional with expertise in eating disorders. ANZAED have a system that identifies clinicians with a special interest and training in eating disorders:
Practicing Self-Care
Self-care has become a buzzword in everyday life, as mental health has emerged as a priority and preventing burnout has become a central goal for many young people. If you’re anything like me, the word self-care conjures up an image of soaking in the bath or doing a skin care routine. And if that’s what you do for self-care and it works for you, awesome!
Unfortunately for some of us, myself included, it can feel sometimes that you’re engaging in what society views as “self-care” but it feels disingenuous somehow. Like you’re doing all the right things but it still isn’t replenishing you.
That’s because self-care is an individualised activity, and it differs from person to person. It’s up to you to find what fills your cup, and although the answers can’t be found in a simple Google search, here is a little activity to do to discover the activities that give you energy and wellbeing.
There are six types of activities that help us create value and meaning in our lives:
1. Giving to others and having a positive influence
Funny enough, one way to take care of yourself is to take care of others. Giving to others could range from something small like giving a compliment or listening to a friend vent, all the way to something bigger like volunteering your time at a local soup kitchen.
2. Being active
When we exercise, our brain releases feel-good chemicals called endorphins (the same chemicals are released when we eat chocolate!). Being active doesn’t necessarily mean we have to hit the gym or run a marathon. It also includes more moderate forms of activity like stretching or walking.
3. Embracing the moment
These are times when we’ve paid full attention with our five senses to something or someone with openness and curiosity. This could be listening to new music, or experiencing the taste of your favourite food, or maybe enjoying the smell of fresh laundry.
4. Challenging yourself and learning
Maybe there is an activity that you’ve been meaning to try but have been putting off because it is outside your comfort zone. Maybe it’s something you used to love doing but have stopped because you didn’t have the time or you thought you weren’t good enough at it. Whatever it is, making room for improvement and growth is a crucial part of filling our cup.
5. Looking out for your basic needs
Sometimes self-care is about going back to the basics – getting enough sleep, eating well and showering regularly. It’s also about being aware of our emotional needs, such as being kinder to ourselves after a hard day or letting ourselves have a cry if we feel overwhelmed.
6. Connecting with others
There is no better antidote than human connection with people we care about. This might involve friends, family, pets – anyone whose companionship and company adds value to your life.
Spending time to go through each of those six categories to find what activities serve to recharge your batteries can offer us a more meaningful and holistic way to practice self-care and prioritise looking after ourselves.
DBT in Practice - Understanding What Emotions Do For You
Often when clients come to therapy, they come with goals about their emotions, and more often than not, I see clients who have a goal of trying to feel less of something (e.g. feel less anxious, less depressed), with clients often thinking that if they feel less emotions, their lives will improve and goals will be achieved. However, changing emotions is a really difficult task, and a good first step is instead trying to understand a little bit more about what emotions actually do for us, and from there we can think a little bit more about whether or not we actually want to get rid of these important emotions.
In DBT we use a module called Emotional Regulation to try and, as the name suggests, regulate our emotions, and in this blog post I want to talk through the first goal of this module – to understand and name your own emotions.
So what do emotions do for us anyway? There are three main things that emotions do:
1. Emotions motivate and organise us for action
Emotions are “hard-wired” into our biology to prepare us for action and motivate our behaviour, for example, when we see a tiger running towards us, our immediate reaction (hopefully) is fear, which then motivates us to run for the hills away from the tiger! If we didn’t have this “shortcut” in our biology, it would mean that it would take us too long to think things through and we might not get away from the tiger.
Emotions can also be helpful in overcoming obstacles. For example, imagine a mother seeing her toddler run towards the road, her initial reaction would be fear, to both the child getting hit and the cars on the road hitting her, and fear about her child getting hurt and love of her child overrides her fear of getting hurt herself to help her protect her child.
2. Emotions communicate to (and influence) others
Whether we like it or not often our body language, tone, and facial expression convey our emotions, and this can change other people’s behaviour for the good and the bad. For instance, imagine your Mum bringing out your least favourite meal, you might (accidentally) show some disgust or dissatisfaction with the meal, meaning she is less likely to make it in the future! Another example could be when we are talking to our partner about something we like, and we demonstrate excitement, often our partner gets excited too!
3. Emotions communicate to ourselves
Finally, our emotions communicate important information to ourselves, also known as a “gut instinct.” Our emotions can be key bits of data in telling us how we feel about someone or something, for instance if we get a “bad vibe” from a person, our emotions can communicate to us to keep our distance. However, a word of caution with this, sometimes we can treat emotions as if they are facts about the world, and it’s important that we keep ourselves in check by “checking the facts” in a situation, e.g. “If I feel unsure that must mean I’m incompetent”, we can “check the facts” by looking at whether or not other people would feel unsure in a situation, or looking at our own track record, have we been unsure and competent before?
Below I have attached a bit of a “cheat sheet” about feelings and their functions, have a look through the below table and see if any of these emotions and the problems associated with them ring true for you.
I hope you got something out of this post, and maybe next time when thinking “I never want to feel X again,” we can make some space for understanding why we have that feeling in the first place.
Am I [insert valued quality] good/smart/attractive enough?
Do you often catch yourself measuring your ‘enoughness’?
Am I smart/attractive/interesting/good enough? Am I a good enough parent/friend/colleague/partner?
If you do, congratulations – you have an adaptively functioning human mind.
You see, we have inherited a mind that worked well enough to keep our ancestors alive long enough to reproduce. And central to survival, is our mind’s ability to keep us protected from both physical and social harm.
To stay alive, our minds need to be able to detect any threat to our physical safety with enough accuracy so that we can respond when in danger to move towards safety. If our minds do not perceive danger well or are ineffective at alerting us to the presence of danger, our chances of survival are reduced.
This explains why we have inherited a mind from our ancestors that is negatively biased, as a mind that is more negative is more likely to detect threat. This is why your mind will automatically take you over difficult events in the past (“Why did I say that!” ,“I wish that I’d done XYZ instead”) and predict negative situations occurring in the future (“What if the plane crashes?”, “What if I fail?”).
The other piece to our mind’s strategy – avoid social harm. One absolutely essential skill for survival in prehistoric times was belonging to the group. If the group kicked you out, you would not survive for long. Belonging to a group provided access to knowledge, resources, protection and divided roles to support a functional system that met the needs of its members.
So, how does your mind prevent you from being kicked out of the group? It compares you to every member of the tribe: “Am I fitting in? Am I doing the right thing? Am I doing it well enough? Am I doing anything that could get me thrown out?”
The mind that did that well and effectively was able to ensure the individual remained part of the group, and had optimised probability of survival as a result. This means our modern minds have also inherited this capability.
Although we remain a social species that thrives in connection with others, our social context has changed immeasurably. We are no longer part of a small group or tribe. Globalisation and technology have widened our sphere of connection, so that we can compare ourselves to everyone on the planet – the rich, famous, and beautiful, movie stars, top athletes, even fictitious superheroes.
And we don’t have to look far before we find someone who is “better” than us in some way – richer, taller, older, younger, more hair, better skin, more status, smarter clothes, bigger car, and so on.
As a result of all of this comparing, we’re all walking around with some version of the “I’m not good enough” story. For most of us, it starts in childhood; for a few people, it doesn’t start until the teenage years.
Which story sounds familiar to you? The “I’m too old/fat/stupid/boring/fake/unlikeable/lazy/incompetent, blah, blah, blah” or “I’m not smart enough/rich enough/slim enough and so on.”
The takeaway – if your mind compares you to others and finds yourself lacking in some way – you have a functional mind. There is no way to STOP these thoughts. Centuries of evolution has developed a fairly powerful system that is resistant to change.
Think about this process like a form of software that is now outdated. Pay as much attention to it as you would a spam email. I mean, sometimes it could be helpful – it may have some information that you can use in an adaptive way to help you achieve your goals or work towards wellbeing. However, most of the time – it is at best annoying static and at worst an intensely overwhelming and paralysing soundtrack to your days.
Therapy can help here – if you find these thoughts are having a lot of power and influence over your decisions, choices and actions. Unhooking skills help develop your capacity to gain distance from these unhelpful thoughts, so they have less power over you. This way, you have more space to choose how you’d like to show up in your life in a way that takes you towards becoming the person you’d like to be and the meaning and purpose you’d like to foster in your days.
How Can We Help Our Young People?
If I asked you, what is wrong with this plant? What would your first answers be?
It is unlikely you would tell me it was a problematic plant. That it was defective or had some genetic condition.
We can see that the plant needs something.
If a person is wilted, like that plant, we often see a different problem. We see it as a problem within them.
The medical model has such power in our culture. We are encouraged to find the right label (the diagnosis) and then start the solution (medication, therapy). Of course, there is an essential and important role for the medical model, but it is only part of the picture.
Our young people are struggling more than ever before. The mental health of young Australians is rapidly declining, and the evidence for this is increasingly solid, and represents a worldwide trend.
The recent National Study of Mental Health and Wellbeing revealed that the prevalence of operationally defined mental disorders in 16-24 year olds rose by 50%, from 26% in 2007 to 39% in 2021. There was a greater rise in young women compared to young men, with rates reaching 48%.
How can this be explained solely from a biological perspective? The world and environment that our young people are growing up in today is vastly different from past generations. It’s impossible to explain this trend without acknowledging and exploring context. I have been working with young people in therapy for over 10 years now, and have found a treatment approach that understands and addresses context to be invaluable.
DNA-V is a therapeutic approach designed for young people, developed by Louise Hayes and Joseph Ciarrochi. It is evidence-based and theoretically robust, integrating Acceptance and Commitment Therapy (ACT), positive psychology, evolutionary adaptation and is underpinned by contextual behaviour science. All that of means – it is an approach that stacks up scientifically and draws on tonnes of research.
It is designed to help people cope with challenges, stress and change. It aims to promote psychological strength and flexibility.
Importantly, it acknowledges the unique context of each young person:
· Their physical environment (school, community)
· Their relationships (socially and with their self)
· Psychological and learning factors (their inner world, experiences and history)
· Biological factors
Then comes the work – taking the young person through the different parts of themselves and their context and upskilling them.
Ultimately it comes down to building flexible strength. The young person is then able to persist with important things in their life that they care about and to change the behaviour that’s making their life worse.
To give you a quick peek into these parts and what they involve:
Discoverer (D) – trial and error behaviour that functions to expand and build skills, resources, and social networks.
Noticer (N) – behaviour that functions to increase the awareness of experience, both inside and outside your body.
Advisor (N) – refers to verbal behaviour that functions to save people from the need for trial-and-error learning so they can navigate efficiently and safely through the world.
Value & Vitality (V) – Our motivators. We all seek purpose, meaning, fun and connection.
Social Strength – Looking at our DNA-V (above) in the context of social connection.
Self-Strength – Looking at how we use our DNA-V to build our self-image (e.g. I am anxious – vs – I am a woman, and anxiety is one part of me).
We then work to develop people’s skilled use of D, N, and A, and improve their ability to flexibly shift behaviours, depending on what they value and what the situation permits and demands.
Adolescence is an incredibly turbulent, challenging and significant time. To nurture the human potential inside each of our young people, we need to invest in their mental wealth.
We owe it to our young people to do all we can to equip them with the skills to arrive in adulthood as resilient, connected, aware and productive members of society.
If you think this approach could help a young person you know, check out https://dnav.international, or get in touch with me.
Dealing with Imposter Syndrome
We’re two months into the new year. Chances are you’ve got some major life changes happening – maybe as a new parent, a new degree, or maybe a new job. Everything is going well so far…so why do you feel like a fraud?
Imposter syndrome is a psychological phenomenon where you might find yourself self-doubting your accomplishments and feeling like a fake, even in domains where you have previously had success or typically excel in. It may manifest as a feeling of unease, the fear that you might be “exposed” eventually, attributing any success to external forces, and may also include negative self-talk.
Some people might view imposter syndrome as a positive – it can provide the motivation to keep doing better so no one finds you out. However, this typically comes with ever-present anxiety, and accompanying behaviours such as over-preparation, resulting in a recipe for burnout.
Even worse, it could set up a vicious cycle where you might believe that the only reason no one caught you for the fraud that you are is because you went above and beyond. This means that even though you had the experience of doing well and achieving success, it does nothing to change your beliefs about yourself.
So what can we do about it?
We all tend to fall into negative thinking traps – 15 of them to be exact. The particular set of traps related to imposter syndrome are
· Discounting the positive (“I got a really good grade but it was probably just luck or a fluke”)
· Minimisation (“I got a promotion at work, but it’s probably not that much of a title bump or a pay raise. It’s not a very important role at the company”)
· Emotional reasoning (“I feel like a fraud, therefore I don’t belong here. Others might not know it yet, but as soon as I stuff up they’ll kick me out of here”)
Now that we know that there are thinking biases that we make, we can scrutinise those thoughts a little more when they come up. Ask yourself:
· Are there any other alternative explanations?
· Is there any evidence for this thought? Is there any evidence against this thought?
· Might other people have different interpretations of the same situation? What might they be?
· Is my thought a likely scenario or is it the worst case scenario?
· What are the advantages and disadvantages of thinking this way?
Now this likely won’t get rid of the imposter syndrome feeling all at once, but it is a good start to examining your negative beliefs about yourself and your skills. Instead of taking our thoughts at face value, reflecting the truth, we can recognise that our thoughts can sometimes be distorted.
If imposter syndrome is still taking a toll on you, speak to a professional such as a psychologist for more help!
The BMI is BS
BMI has become not only an assessment of size, but has absurdly served as a representation of health, character, morality and social value.
There is so much judgment, shame, and contempt associated with flawed and imperfect BMI values.
BMI has become integrated into the Western medical model, so much so that it is almost universally and unquestioningly accepted as a valid measure of health.
The reality of BMI however, is at best invalid, and at worst, actively harmful.
It was first developed 200 years ago by a Belgian astronomer (Adolphe Quetelet) who believed that taking the mean height and weight of a bunch of French and Scottish men in the military would give the ‘ideal’ measurements for the human man. This work operated within the boom of racist science, and was used to judge fitness for parenting and justify the sterilisation of minority groups.
The original developers of the BMI made it clear it was never intended as a measure of individual body fat, build, or health. He developed it as a way of measuring populations, not individuals, and it was designed for the purposes of statistics, not individual health.
In the early 1900’s, U.S. life insurance companies started to develop tables of their policy holders’ height and weight to guide pricing structure. This was incredibly biased, as it was comprised of largely privileged white males that had access to life insurance, and height and weight were often self-reported and inaccurate. These tables were then picked up by physicians and used to evaluate their patient’s weight and health.
By the early 2000’s, the BMI’s flawed and imperfect measure had become a routine part of doctor visits.
Cultural views have hardly shifted since then, even though the science has started to. Science has repeatedly demonstrated that the BMI is a measure built by and for white people and does not cater for cultural or gender differences.
The science has disproved many common myths about size, health, and weight loss for years. Yet, instead of recognising the evolving and increasingly complex science around fatness, people stick stubbornly to an idea that allows them to freely marginalise fat people.
The BMI is a product of its social context. And, even according to its biggest champions, is not an effective measure of fatness, much less overall health.
My next blog will explore… if not BMI, then what is an indicator of overall health?
DBT In Practice – Obtaining Objectives Skillfully with DEAR MAN
When we think about Dialectical Behaviour Therapy, or DBT, we are always thinking about skills, and a large part of our DBT journey is working out what different skills can we use to get our different needs meet as effectively as possible and practicing them as much as we can.
In DBT, one module of skills that we work on is Interpersonal Effectiveness, or how can we get our needs in relationships met. In interpersonal effectiveness, we have three main skills which can be used for different priorities:
1. DEAR MAN– helping us effectively assert our rights and wishes
2. GIVE – helping us act in a way that we maintain positive relationships
3. FAST – helping us act in ways to keep our self-respect
Today, I wanted to go through the DEAR MAN skill, which is an acronym which serves as a guideline for how we can get what we want out of a conversation with a friend or family member. Reasons for using this skill could include:
- Obtaining our legitimate rights
- Getting another person to do something you want them to do
- Saying no to an unwanted or unreasonable request
- Resolving an interpersonal conflict
- Getting your opinion or point of view taken seriously
DEAR MAN stands for:
1. Describe: Describe the current situation, stick to the facts, tell the person exactly what you are reacting to (e.g. you told me you would be home by 7 and you didn’t get home until 11)
2. Express: Express your feelings and opinions about the situation, don’t assume the other person doesn’t know how you feel (e.g. when you come home so late I worry about you)
3. Assert: Assert yourself by asking for what you want or saying no clearly (e.g. I would really like it if you would call be when you’re going to be late)
4. Reinforce: Reward the person ahead of time by explaining the positive effects of getting what you want or need (e.g. I would be so relieved, and a lot easier to live with, if you do that)
- Don’t forget to reward the behaviour after (e.g. I really appreciated you letting me know plans changed)
5. (Stay) Mindful: Keep your focus on your goals, maintain your position, don’t get distracted or off topic.
- Broken record: Keep asking, saying no, or expressing your opinion over and over
- Ignore attacks (within reason): If another person verbally attacks, threatens, or tries to change the subject, ignore it, just keep making your point (e.g. I would still like a call), or if in crisis, remove yourself from the situation and contact crisis services like 000 or 1800 RESPECT
6. Appear confident: Appear effective and competent, use a confident voice and physical manner, make eye contact!
7. Negotiate: Be willing to give to get. Offer and ask for other solutions to the problem, reduce your request, say no but offer to solve the problem another way, focus on what will work (e.g. How about if you text me when you think you might be late?)
Remember to practice what you are going to say ahead of time to try and get the best outcome, and remember practice makes perfect! Best of luck with this new skill, and if you have any questions about how to use DEAR MAN best, ask your individual therapist for help.
Helpful Tips for Holiday Stressors
The holiday season can bring lots of joy, connection and excitement, however it can also mean high expectations and disappointment. Spending more time than usual with family members can be challenging and lead to volatile emotions.
Some simple tools or skills from the Dialectical Behaviour Therapy (DBT) and Compassion-Focused Therapy (CFT) frameworks can be helpful to try.
STOP: Stop, Take a step back, Observe the situation, Proceed mindfully
Take a pause before reacting – perhaps count to 10, breathe 5 times in and 5 times out, focus on feeling your feet on the ground
Consider the whole situation – what else is going on? what is the bigger picture? what is the background situation?
Reflect on how to respond effectively – what is your important goal here, what do you want to achieve?
TIPP: Temperature, Intense exercise, Paced breathing, Progressive muscle relaxation – if feeling quite distressed
Use a temperature change to regulate your emotions – splash cold water on your face, drink iced water, hold ice cubes for a moment, even have a shower if you can.
Use a short burst of intense exercise to release stress hormones – do some star jumps, walk briskly around the block, skip rope.
Do some calm breathing to soothe your nervous system – use an app like Calm or Breathe, or just focus on lengthening your out-breath and perhaps pairing this with a mantra like “relax” or “calm” or something similar.
Scan your whole body, starting with your toes – focus on tensing (on an in-breath) and then relaxing (on an out-breath) each set of muscles from your toes and feet, legs, stomach and torso, shoulders, arms and hands, until you end with scrunching up your face. Then tense your whole body and relax it completely.
Self-compassion (rather than self-criticism):
Notice that this moment is challenging and allow that difficult feeling to exist without magnifying or minimising it.
Know that others also experience challenging and difficult moments, to reduce feelings of isolation and increase feelings of connection and support.
Be kind to yourself. Consider what would be helpful right now (or later, if you can’t do it now) – use your five (external) senses as a prompt (seeing, hearing, touching, smelling, tasting).
Wishing you a safe and enjoyable holiday period from all of us at Dr Amanda Hale Clinical Psychology. We look forward to supporting you with improved mental health next year.
Why is emotional intelligence important to foster in children?
Emotional intelligence is the ability to understand, use and manage one’s own emotions. Some researchers believe that emotional intelligence is a better predictor of children’s future success in life than intelligence quotient (IQ). Your child’s mastery of understanding and regulating their emotions will help them in life in many ways. They will be more confident, have richer social connections and perform better academically.
Children are required to regulate their emotions all the time. For instance, when they’re playing during recess and the bell rings for class. They need to down-regulate their excitement and focus their attention on the teacher.
Emotional intelligence is learned. A way to help children understand and handle their emotions is through emotion coaching. You can teach children about emotions by comforting them, listening, understanding their thoughts and feelings, and helping them understand themselves.
Emotion coaching in a nutshell – 5 simple steps:
Be aware of your child’s emotional expressions (lower intensity displays). Catch emotions when they’re small rather than after they’ve erupted.
Recognise emotion as opportunities to connect or teach.
Help your child learn to label their emotions with words.
Listen with empathy and validate your child’s feelings. Don’t jump to the reason too soon.
Set limits when you are helping your child to solve problems or deal with upsetting situations appropriately. If there are consequences, they would be age appropriate, fair and always followed through.
Over the next few days, when your child expresses challenging emotions, put the steps above to work and discover the benefits of emotion coaching. Remember, it is best to begin practising them in a neutral situation where emotions aren’t too strong!
Assessment for Neurodiversity
Neurodiversity: Autism, ADHD, PDA and mental health – Part 3
Navigating assessment for Autism and/or ADHD
Paediatricians, psychiatrists and psychologists can assess for Autism and ADHD. Who you consult depends in part on your goals: do you wish to access medication for ADHD? If yes, then you need to see a paediatrician or a psychiatrist, as they can prescribe meds. If no, you can be assessed by a psychologist.
A paediatrician will see children and young people under 16. For adolescents from 14 years old, a youth-focused psychiatrist would be suitable. And a psychiatrist will assess an adult. Psychologists who offer assessments have particular skills and training in this area and may see people of all ages. A psychologist assessment is based on comprehensive clinical interviewing, history-taking and uses screening questionnaires.
Assessments by paediatricians and psychiatrists tend to be shorter in length but can be harder to access than assessments by psychologists due to long waitlists. It is important to seek out a neurodivergent affirming (NDA) clinician for your assessment, as they will provide you with a balanced view of strengths and challenges, and validate your experiences. This is particularly the case if you believe you are high-masking, have a PDA profile, or are AuDHD, as some clinicians are more experienced in distinguishing these features.
Guidelines to support the diagnosis (aka discovery) of ADHD (Australian ADHD Professionals Association (AADPA), 2022) have recently been updated, while those for Autism (Whitehouse A. J. O. et al., 2018) are currently being updated.
Considerations for assessment
Being assessed can be a very affirming experience, confirming your suspicions of ‘being different’. It can explain your questions, experiences and differences. Most importantly, it can provide you an opportunity to really get to know yourself, accept yourself wholeheartedly and advocate for what you need at home, at work and in educational contexts.
Once you receive a diagnosis, this can help you get access to supports such as NDIS (if applicable). Your diagnosis will form part of your medical records and can be disclosable for migration and other purposes.
Features of neurodivergence
Some things that people may struggle with include sensory processing, interoception (awareness of body cues, such as hunger, thirst) and emotion regulation (e.g., feeling overly reactive). Other concerns might include attention, motivation, focus and handling interruptions. Some people also have difficulty managing time (e.g., often being late) and belongings (e.g., forgetting things) and with schedules and routines. Processing may occur differently, for example, things may seem to encompass many more steps than they do to others, leading to overwhelm. And processing speed can be affected, so that you may feel like you take a beat longer to register what people say and to respond. Sleep may be more difficult or deeper for you, or you may feel unrefreshed by sleep. Some people report feeling as though they don’t know who they are, which is likely related to long term masking.
Role of therapy in treatment
Therapy can help you discover more about yourself, whether this is through official assessment or not. You can learn to know and accept your unique qualities, which include your strengths. This can help you to make adjustments in your environment to become more supportive of your needs. And it can help you to develop more reasonable expectations for yourself, including planning downtime when needed.
How to support neurodivergent family and friends
It is not helpful to think in terms of “superpowers”, as this can minimise the challenges experienced by neurodivergent folk, leading to them not receiving the support they need in other areas.
Be curious and non-judgemental
Let them know that you care and are interested in their experiences!
Unhelpful
Isn’t everyone a bit Autistic/ ADHD? (invalidates their experiences)
You can’t be Autistic, you get on with people (yes, of course!)
You can’t be ADHD, you’re good at deadlines (yes, some, but not all)
You can’t be Autistic/ ADHD, you seem fine (yes, but what about the masking and anxiety)
Helpful
You’re safe with us
You can be the authentic you, with us
We will support you
We care for you and what you need
* Note that our knowledge regarding these topics is evolving quickly as much-needed resources are now being made available to explore them; the information and terminology used in this blog is based on current thinking, and is likely to change as we learn more.
Recommended resources to learn more include:
Books
12 Principles for Raising a Child with ADHD – by Russell A. Barkley, 2021
Supporting Autistic Girls and Gender-Diverse Youth – by Yellow Ladybugs, 2023
The Rainbow Brain – by Sandya Menon, 2023
Unmasking Autism: The Power of Embracing Our Hidden Neurodiversity – by Devon Price, 2022
Online
Autistic Self Advocacy Network www.autisticadvocacy.org
How to ADHD https://www.youtube.com/c/howtoadhd
Neurowild @neurowild_
TV
Heartbreak High www.netflix.com – featuring Autistic and Queer characters and actors
References
Australian ADHD Professionals Association (AADPA). (2022). Australian evidence-based clinical practice guideline for Attention Deficit Hyperactivity. . https://www.aadpa.com.au/guideline
Whitehouse A. J. O., Evans K., & Eapen V. (2018). A National Guideline for the assessment and diagnosis of Autism Spectrum Disorders in Australia. Cooperative Research Centre for Living with Autism.
Neurodiversity: Autism, ADHD, PDA and mental health – Part 2
CHALLENGES AND STRENGTHS
Challenges
Living in a world which is designed for neurotypical people can be challenging for neurodivergent folk. It can be like living in a country without speaking the language fluently – imagine the effort that goes into trying to communicate in a second language: it’s not intuitive, and can be exhausting! This is known as the double empathy problem – that neurokin (those of similar brain types) find it easier to communicate with each other and harder to communicate across brain types.
These challenges can be made worse if you are insufficiently supported. This can occur because you unconsciously suppress your own needs, to fit in, perhaps because you don’t know you are neurodivergent. Or it may be that your environment is not sufficiently adapted to your known needs. People may experience meltdowns, e.g., shouting, screaming, becoming physical, or shutdowns, e.g., inability to communicate or move. Meltdowns and shutdowns are exhausting and can take days to recover from. It is important to remember that these are signs from our body that we need to do things differently.
School “can’t” (feeling unable to attend school) can occur when the demands of school and social interactions are seen as more than a person can cope with.
Mental health
Anxiety and low mood (depression) are more common in neurodivergent people. There are a few possible reasons for this. Neurodivergent folk often need to put in much more effort to “fit in” or feel accepted. They also tend to receive greater amounts of negative feedback regarding their behaviour, for example, “hurry up, pay attention, stop talking so much” – although not meant as criticism. They may become particularly sensitive to noticing negative comments and find these very distressing, sometimes known as rejection sensitivity dysphoria.
Neurodivergent individuals are also more likely to experience trauma during their lifetime. This can be what is known as small t’s or big T’s. Small t’s are regular and distressing experiences such as outlined above, while big T’sare major life events. Neurodivergent people may be more vulnerable to interpersonal trauma because of their different way of relating to others, which can be exploited.
There is a higher risk of disordered eating in those with Autism and ADHD (Bleck et al., 2015; Carpita et al., 2022). For Autistic people, this is thought to be due in part to sensory sensitivities and difficulties interpreting internal body cues. For ADHDers, it may be related to difficulties with attention and self-regulation.
Perhaps not surprisingly, there is a greater risk of substance (including alcohol) misuse, self-harm and suicidal ideation in the neurodivergent community, because of the additional challenges that they can face.
Other health challenges
Lived experience accounts from Autistic people have identified higher rates of Epilepsy, Ehlers Danlos Syndrome (EDS) and Postural Orthostatic Tachycardia (POTS). Epilepsy is a neurological condition which can cause seizures, EDS is a connective tissue disorder which may show up as hypermobility of joints, leading to injuries. POTS is a blood circulation disorder which can cause low blood pressure and unconsciousness.
Strengths
Autistic individuals often have strong urges for social justice, whether that means standing up for others who are marginalised, or becoming activists (think: the inspirational Greta Thunberg and Grace Tame). They may also feel close connections with animals, like the amazing Temple Grandin, an innovator in horse-training. Perhaps because of their attention to others and masking abilities, they may become actors like Chloé Hayden, writers like Amy Thunig, or researchers like Dr Jac Den Houting.
ADHDer talents include creativity, fearlessness and inventiveness. These are traits of entrepreneurs like Mia Freeman, Richard Branson and Abbie Chatfield (How to ADHD, on youTube), public speakers and authors such as Em Rusciano, singers Mel B and Solange Knowles and sportspeople like Simone Biles.
Gender
Fun fact! Queerness (gender and/or sexual identities other than straight or cisgender) is more common in Autistic individuals. This may be because they are less constrained by societal expectations and have a broader outlook.
* Note that our knowledge regarding these topics is evolving quickly as much-needed resources are now being made available to explore them; the information and terminology used in this blog is based on current thinking, and is likely to change as we learn more.
References
Bleck, J. R., DeBate, R. D., & Olivardia, R. (2015). The Comorbidity of ADHD and Eating Disorders in a nationally representative sample. The Journal of Behavioral Health Services & Research, 42(4), 437-451. https://doi.org/10.1007/s11414-014-9422-y
Carpita, B., Muti, D., Cremone, I. M., Fagiolini, A., & Dell’Osso, L. (2022). Eating disorders and Autism spectrum: Links and risks. CNS Spectrums, 27(3), 272-280. https://doi.org/10.1017/S1092852920002011
Neurodiversity: Autism, ADHD, PDA and mental health
What is Neurodiversity?
Neurodiversity refers to the full range of brain types which exist. Neurotypical brains make up the majority, while neurodivergent brains include Autistic, ADHD (Attention Deficit Hyperactivity Disorder), Specific Learning Disorders (commonly termed dyslexia, dysgraphia, dyscalculia and dyspraxia) and more.
As we move away from a medicalised model, we understand that ‘curing’ neurodivergence is not possible or desirable. For example, Autistic traits such as hyperfocus and hyper-empathy, and ADHD traits including exploration and curiosity are highly desired in many contexts including research, medicine, creative arts and business (Sedgwick et al., 2019).
How does therapy support individuals with neurodivergent brains?
Current psychological practice aims to help individuals to understand their wants and needs, their significant and different strengths and their relative challenges. Psychologists work with individuals to help them to self-advocate and adapt their environment to be more supportive of their needs. This could mean using headphones to quiet a busy environment, replacing bright fluorescent lighting or planning downtime during the day to recover after intensive stimulation such as team meetings.
What is Autism?
Our understanding of Autism continues to develop. The original diagnostic criteria was based on young, male experiences and ‘symptoms’ in USA. In Germany, research with a different sample of young boys led to the development of a separate diagnostic category of Aspergers. From 2013, the diagnosis of Aspergers has been covered by Autism (American Psychological Association, 2022).
Recently, research has focused on less typical experiences of Autism, initially thought to be ‘female’ experiences (Bargiela et al., 2016; Hull et al., 2020). These are now more accurately called ‘atypical’ or ‘internalised’ experiences or symptoms, which occur across the gender spectrum.
Internalised experiences of Autism include masking (e.g., forcing eye contact despite this being uncomfortable, and denying urges to ‘stim’ or fidget) and camouflaging (e.g., learning and copying neurotypical social interactions and speech tones). Masking and camouflaging are extremely effortful, as they suppress innate needs, and can lead to meltdowns and shutdowns (Hull et al., 2021). These are very distressing for individuals affected as well as their loved ones. Chronic mental health concerns such as anxiety and depression may also occur when the environment is not supportive of Autistic people’s differences.
What is ADHD?
ADHD is another neurodevelopmental difference. When most people think of ADHDers, the image is of hyperactivity, impulsivity and loud fidgeting, typically in young males. However, the most common experiences of ADHD include inattentive presentations, which encompass difficulties with sustained attention and concentration, and may look more like daydreaming, being late for appointments and losing important items. The inattentive type of ADHD is associated with more masking, anxiety and difficulties with friendships (Quinn & Madhoo, 2014).
Can Autism and ADHD co-occur?
Autism and ADHD co-occur in approximately 40-70% of people (Rong et al., 2021), which can exacerbate difficulties experienced. PDA (Pathological Demand Avoidance aka Pervasive Drive for Autonomy) is considered to be a subtype of Autism (PDA Society, 1997-2023) which occurs most commonly in AuDHDers. PDA is believed to be an extreme form of anxiety which occurs in response to demands. It can look like an inability to fulfil basic and desired functions such as personal hygiene needs and can be extremely debilitating.
Exceptional intellectual ability and intellectual disability are likely no more common in Autistic or ADHDer folk than in other folk, despite the stereotypes of Rainman and Sheldon.
How can a psychologist help?
Understanding your (and your children’s) brain type and associated strengths and challenges can be really important for mental wellbeing. With the support of a neurodivergent-affirming (NDA) psychologist, you can learn more about yourself and your personal needs and preferences, and develop your self-advocacy skills to improve your environment.
* Note that our knowledge regarding these topics is evolving quickly as much-needed resources are now being made available to explore them; the information and terminology used in this blog is based on current thinking, and is likely to change as we learn more.
Recommended resources to learn more include:
Books
Different, Not Less: A Neurodivergent's Guide to Embracing Your True Self and Finding Your Happily Ever After – by Chloé Hayden, 2022
Driven to Distraction: Recognizing and Coping with Attention Deficit Disorder – by Edward M. Hallowell, John J. Ratey, 2011
The Brain Forest – by Sandya Menon, 2023
Online
Additude magazine https://www.additudemag.com/
Yellow Ladybugs https://www.yellowladybugs.com.au/
Podcasts
The ADHD Adults Podcast https://www.adhdadult.uk/podcast/
The Neurodivergent Woman https://www.ndwomanpod.com/
Neurodivergent Lou @neurodivergent_lou
Cognitive Therapy in a Nutshell
One of the big truths that we continually refer to in therapy is this – how we think about a situation affects how we feel and then what we do. Often, when we are in highly stressful situations, our brains have a way of making us think the worst possible scenario will happen! Cognitive therapy aims to help us re-train the brain into recognising that our thoughts are just that, thoughts, and reminds us that our thoughts are not necessarily true.
One of the ways in which we can start to challenge our perceptions of the world is beginning to notice common ways of thinking that all of us engage in from time to time. Have a look at the below list and see if any of these happen for you:
1. Filtering – Focusing solely on the negative and ignoring all the positive
2. Overgeneralisation – Assuming all experiences and people are the same, based on one negative experience
3. Catastrophising – Assuming the worst-case scenario, magnifying the negative and minimising the positive
4. Control fallacies - Thinking everything that happens to you is either all your fault or not at all your fault.
5. Blaming - Pointing to others when looking for a cause of any negative event, instead of looking at yourself
6. Emotional reasoning - Believing “If I feel it, it must be true!”
7. Global labelling/mislabelling - Generalizing one or two instances into an overall judgment, using exaggerated and emotionally loaded language
8. Heaven’s reward fallacy - Believing that any good act on your part will be repaid or rewarded
9. Polarised thinking - Black and white thinking, not seeing the grey
10. Jumping to conclusions - Being convinced of something with little to no evidence to support it
11. Personalisation - Believing that you are at least partially responsible for everything bad that happens around you
12. Fallacy of fairness - Being too concerned over whether everything is fair
13. Should’s - Holding tight to your personal rules on how people ought to behave
14. Fallacy of change - Expecting others to change to suit your needs or desires
15. Always being right - Believing that it is unacceptable to be wrong
All of these different ways of thinking, also known as “cognitive distortions ”, happen to all of us from time-to-time! There may be some that you think all the time and others which have never occurred to you.
The trick is starting to recognise what situations these different types of thoughts occur in for you and then start labelling them. From there, we can get a little bit of distance from these thoughts and stop letting them be in the driver’s seat!
If you’re noticing that any of these thoughts in particular stick out to you, let your therapist know, and you can start using the power of cognitive therapy to gain control back of your brain.
Mindfulness of Emotion
At times we can feel overwhelmed by the intensity of emotion that we may be feeling. This might make us want to distract ourselves to avoid discomfort. What we might find is that the emotion continues to linger in the background and we feel it again soon enough.
One strategy for helping us to accept, sit with and transform the intensity of an emotion we are experiencing is called Mindfulness of Emotion.
We can achieve this by following the below steps:
Close your eyes, take some deep breaths and tune into your body and emotions. Notice what emotion/emotions you may be feeling and where in your body you may be feeling it.
Begin to describe the feeling:
What colour would you give it?
What shape would you give it? (e.g. cloud/spiky ball/bouncy ball)
What is it doing? (e.g. still, vibrating, bouncing around)
How heavy is it?
Sit with this visual of the feeling and tell the feeling that it's okay that it is there and that it can stay for as long as it needs to before it's ready to go.
We can then tell the feeling that we are going to give it some more space and visualise the space around it growing bigger and the object getting smaller in comparison. Sit with this visualisation.
By following these steps what you may find is that the intensity of the emotion you are feeling eases and you feel more balanced and grounded.
We hope you enjoy giving Mindfulness of Emotion a go!
What is DBT and is it for me?
DBT stands for Dialectical Behaviour Therapy, and it’s a term no doubt many of us have heard in our therapy journey. But what exactly is it and how does it work?
DBT is a type of cognitive behaviour therapy which was designed by Marsha Linehan, an American psychologist, for use specifically with people with Borderline Personality Disorder (BPD) or those who have difficulties with emotion regulation. DBT has also been used extensively in the treatment of substance use, anxiety, depression, PTSD, and eating disorders, and has been used with both adults and adolescents.
In DBT therapy, clients will learn skills to:
- Build acceptance of themselves and others
- Build skills to identify and regulate their emotions
- Improve interpersonal relationships
- Manage and survive crisis situations
Comprehensive DBT involves three core components, individual therapy, skills training, and phone coaching, but DBT skills can be taught and practiced in individual therapy to assist clients in their individual therapy journey. However, if you feel that learning these skills in a group environment may be helpful for you, speak with your individual therapist about different options.
There are four different skill sets discussed in skills training
1. Mindfulness
Mindfulness in summary is the ability to pay attention, on purpose, to the present moment. Mindfulness skills are the core of all other DBT skills, and they allow us to focus on the here and now instead of being pulled into ruminations about the past or anxiety about the future.
2. Interpersonal Effectiveness
These skills are about learning to get our interpersonal needs met in adaptive ways – allowing us to set appropriate boundaries and ask for what we need in relationships.
3. Emotion Regulation
These skills allow us to first identify and understand our emotions, then teach us skills to change the emotions we feel are getting in the way of our goals.
4. Distress Tolerance
Distress Tolerance skills are some of the most helpful skills in DBT and involve learning to understand what our emotions are telling us and manage these emotions without making things worse.
The DBT commitment:
DBT is a lot of work! A lot of the skills discussed within DBT may be very different to ways that you would usually cope with life stressors, so you will need to be willing to try something different. DBT also does not work over night, and for it to be as effective as it can be, you will need to be practicing these skills outside of sessions, and your therapist can help you identify any barriers in the way. Finally, DBT is not one-size-fits-all, and there may be some skills which you find are not helpful for you, but I encourage you to try them all out anyway, you never know, you might just find an incredibly useful skill along the way.
If you feel any of these different skills may be helpful for you, speak with your individual therapist.
Is Online Trolling the Sign of Our Cultural Demise?
Dr John Gottman has spent four decades researching and formulating an understanding of relationships and communication.
His famous theory describes four communication styles that are more likely to contribute to problematic and destructive dynamics within relationships. These are termed the ‘Four Horseman of the Apocalypse’ – modelled on the Christian reference to a prophecy of future tribulation by the ‘horsemen’ of death, famine, war and conquest. Gottman’s terms within the context of a relationship include criticism, contempt, defensiveness and stonewalling.
Contempt is the worst of the four horsemen. It is the most destructive negative behaviour in relationships, and the number one predictor of relationship breakdown. Gottman considered the expression of contempt in a relationship to be the most important sign that the relationship is in trouble.
What does contempt look and sound like? It describes a range of behaviour that can include sarcasm, condescension, hostile humour, name-calling, mimicking and body language such as eye-rolling and sneering.
Why is contempt so destructive? It is an expression of cruelty. An act and expression of disrespect that conveys disgust and superiority. At the heart of it, the message is: “I’m better than you. And you are lesser than me.” It is deeply personal, and is an attack on someone’s sense of self. Functionally, it inevitably leads to more conflict, and can facilitate a cycle of destructive interaction that only moves the pair away from reconcilitation and resolution.
Not only can contempt have devastating emotional consequences for the partner and relationship, but the presence of this pattern has physical consequences. Research has found that couples who are contemptuous of each other are more likely to suffer from infectious illnesses.
In the context of a relationship, this pattern can be acknowledged, addressed and rehabilitated, if both parties are willing and wanting to work on the relationship.
It is the contempt that can be observed on social media, towards strangers and public figures that has led to my reflections on the four horsemen recently. As a culture, we have never before been exposed to the scale and relentlessness of abuse the internet and modern media affords. If contempt within a couple signals the imminent collapse and downfall of a relationship, what does the presence of contempt within media, within our online world, signify? If research in relationships is anything to go by, it is a sign that certain parts of the media and online world are spiralling towards dangerous and destructive conflict, social breakdown and poor emotional and physical consequences. In the words of Gottman, this display of contempt culturally could perhaps be the most important sign of impending societal collapse.
So, what do you want to get out of therapy? The ‘miracle question’
Goal setting is a central element of many psychological therapies. However, people often feel quite overwhelmed or demoralised by distress or problems, and this can get in the way. So, when asked about what outcome they would like from therapy, or how they would like things to be different, many people struggle to identify clear and achievable goals.
Before looking at some ways of clarifying your goals for change, it is worth noting that any goals should:
· Be important to you, and not driven by others’ perspectives
· Focus on what you want to do (or how you want to behave) differently. Ideally, such goals are not about how you want to feel (e.g. “have better self-esteem”; “feel happier”) or what you want to have/get.
· Be stated as things you want to do more of or differently in your life, not as undesirable things you want to stop doing or to get away from (e.g “stop having panic attacks”).
· Be something you can start and maintain by yourself (under your control). Your goal can’t depend on something or someone else changing, or changing first.
One way to help identify potential goals is to use what has been termed the ‘miracle question’. This exercise gives you the opportunity to explore possibilities for change, by focusing on moving toward a more satisfying life. Here is a version of it for you to try:
Suppose that one night while you were asleep, there was a miracle and the difficulties you’re struggling with are no longer a problem for you. However, because you were sleeping you don’t know that the miracle has happened. So, when you wake up, what will be different that will tell you that a miracle has happened, and that your difficulties no longer bother you?
It is important to visualise the evidence of the miracle, creating a detailed, practical description of your life where current difficulties are not a problem for you anymore. Some questions that might guide this process include:
· How would you know the miracle had happened?
o What would you notice?
o What would be different?
o What would you see?
o What would you hear?
· What might you have started doing that you weren’t doing before?
· What would you be doing differently or more of?
o Towards/with others
o At home
o At work
o In your spare time?
· What might others close to you notice that would tell them that the miracle had happened – that things are different or better for you?
· Can you think of a time when things were a bit like this day after the miracle?
By exploring the miracle solution carefully (ask yourself the above questions multiple times, be specific and detailed in your answers; be careful to avoid ‘feelings’ goals), and elaborating on what would be different in terms of behaviours, multiple possibilities for steps towards change may start to emerge. In this way your (imagined) future can inform the present.