The CBT'ers Club Summer 2015 Newsletter

The CBT’ers Club (Scotland)

May/June 2015 Newsletter Next meeting of the cbt’ers club eating disorders and stereotypes mindfulness and cbt babcp scotland branch events and cpd .... and lots more!

Mental Health is Everyone’s Business Copyright 2015 by Alexandra O’Brien © All Rights Reserved.

Next meeting of The CBT’ers Club Hello everyone, Thank you to those who came along to the last meeting at the start of April.

The focus was on self-harm. It was a really interesting gathering involving watching some film, handouts, talking about our own experiences, looking at treatment plans as well as relating self-harm to compassion focused therapy and the various drive systems (that part was unplanned!). We also managed some updates and time for peer group supervision. It was great to see everyone there, so thank you for coming along.

NEXT MEETING OF THE CBT’ERS CLUB WHEN: Saturday 6th June 2015, 11am-1.15pm.

WHERE: The Meeting Rooms/The Training Suite, Petal, The Connal Building, 4th Floor, 34 West George Street, Glasgow City Centre, Glasgow, G2 1DA. The cost of this meeting will be £5 and go towards the cost of room hire tea/coffee, certificates, printing etc. The venue we usually use in Byres Road is no longer available as the charity I founded and was director of, No Bodies Perfect, is now in the process of legal dissolution (as some of you will know). I have to now pay for a room for us to meet in. This fee will increase over time as we develop into a business . Rooms, too, are expensive and other costs need to be met.

This alternative venue is in the middle of Glasgow city centre. Places will be limited to 6/7 people as I don’t want to rent a larger, more expensive

room if I don’t know who is attending. The training suite at this venue is too large and I have opted for a small meeting room. The venue is next to Queen Street Station. It is also a minute’s walk from Buchanan Street Subway, 5 minute’s walk from Buchanan Bus Station and 5-10 minute’s walk from High Street Station.

I will bring CPD Certificates of Attendance for those attending. Please give 3 days notice if you can’t make the meeting as I don’t want to get Certificates printed and then you don’t turn up - a fee will apply for wasted Certificates.

I have been informed by COSCA that meetings of The CBT’ers Club will contribute towards your CPD hours (which is currently 54 for accreditation as far as I can remember).

Remember, there are CBT-related things posted on our Facebook page so please feel free to ‘Like’ The CBT’ers Club. We had a ‘profile’ until recently, but Facebook converted it to a page, so many posts were lost, as were ‘friends’.

The new link is: https://www.facebook.com/pages/The-CBTers-Club-Sc otland/915816201766650?ref=aymt_homepage_panel Many of you have suggested that this meeting focuses on ‘Psychological Assessments/Tools’ so we will explore this at the meeting. Please feel free to bring along any tools, assessments etc you wish to discuss or share with the group. If there is anything in particular you would like to discuss or share at the meeting in relation to this topic, please also bring this to the group. Consequently, here is the Agenda for the next meeting: * Using Psychological Assessment Tools in CBT (video footage/powerpoint followed by discussion, samples/examples and experiences) * Peer Group Supervision (for trainee and qualified counsellors and psychotherapists) * General discussion and updates * Topics/Themes/Activities for the next meeting

If you can't make a meeting for whatever reason, please do let me know in as much advance as possible, as other people may wish to come and I also need to ensure Certificates are done in advance. Hopefully this sounds reasonable.

BABCP Scotland Branch A Brief Introduction to Compassion Focused Therapy Presnted by Mary Welford

Thank you for your time and interest in The CBT'ers Club. Closing date for confirming attendance is: Friday 29th May 2015. Please RSVP via r email if you wish to attend the next meeting on Saturday 6th June 2015 by the date above. Please email cbtersclub@yahoo.co.uk to confirm your attendance.

If you know anyone who would be interested in joining the Club, please feel free to let them know about us - they are welcome to email us for more information. Similarly, if you know someone who would like to be on our mailing list or if you would like to be removed from your mailing list and updates, please do let us know and I/we shall do that too. Our official website is being developed and will hopefully be available after the summer.

Thanks for your time and I look forward to hearing from you soon.

Best wishes, Alexandra and The CBT'ers Club

What: A Brief Introduction to Compassion Focused Therapy When: Friday 12 June 2015, 9.30am to 4.00pm (registrations from 9.00am) Where: Stirling Court Hotel, University of Stirling, Stirling, FK9 4LA About the workshop: Compassion Focused Therapy (CFT) was developed by Paul Gilbert as a means of addressing psychological difficulties underpinned by shame and self-criticism. The model draws on social, evolutionary (especially attachment theory) and neurophysiological science to understand emotional regulation and our basic social motivational systems.

The ‘Transdiagnostic’ approach now has a growing evidence base. In recent years the application of compassion-based approaches has been used with NHS staff teams, the armed forces, business settings and within education. This is partially due to recognition that such environments are often largely threat and target focused.

To book or for more information: Registration Form: http://www.babcp.com/Training/Events.aspx Registration fees: BABCP Member: £85, Non-member: £105 Last date for registrations: 5 June 2015 Lunch and refreshments included and CPD Certificates will be provided

anyone – male of female – with an eating disorder to seek help as soon as possible. Increasing awareness of eating disorders and challenging stereotypes is one way of encouraging more people to acknowledge their problems, come forward and access any help and support that is available. The more people that do this, the more likely that eating disorders are recognised, stereotypes challenged and stigma reduced.

Eating Disorders and Stereotypes

By Alexandra O’Brien ‘‘Eating disorders are experienced by young females, in their late teens, and who come from middle-class backgrounds’. This is the description of eating disorders declared by most of the books I have read about eating disorders. And believe me, I have read rather a lot! Of course, this description is completely inaccurate, and probably most of you reading this, will agree. Eating disorders do not discriminate. They creep upon anyone – male or female – of any age or background. Eating disorders don’t care whose life they destroy. The textbooks, therefore, have it all wrong.’’ (Alexandra O’Brien, 2012).

Eating disorders are traditionally perceived as a ‘young female illness’. This is still a popular stereotype and only serves to strengthen the reluctance of males and older females to seek support for their eating and food problems. It is important, however, for

I think this message is slowly, but surely, making itself known, but there is still a very long way to go, and this is partly due to the ignorance and distorted picture of eating disorders portrayed by both health professionals and the media, the majority of whom have absolutely no idea of what it is like to be tormented night and day by an eating disorder. I don’t know how many people I have spoken to who say that their GP or therapist seems like a nice person, but that s/he has absolutely no idea of what eating disorders are all about except from what they have read in a dreary and outdated textbook about eating disorders.

Sound familiar anyone?

The fact of the matter is this: eating disorders are NOT only experienced by young females, in their teens, who are well-educated and from a middle-class background. Eating disorders can affect anyone, regardless of age, gender, sexuality, education, occupation, religion, culture or ethnicity. This fact is what makes eating disorders so profoundly frightening and puzzling.

The stereotypes surrounding eating disorders is never-ending, and I am sad to say that even medical professionals and some eating disorder ‘specialists’ do not understand eating disorders and still use language such as ‘ you don’t look ill’ or ‘how can you have an eating disorder, you are not slim and you go to work’.

It’s a worrying thought to be honest, that professionals who are supposed to be caring and supporting us when we are having a difficult time still say these things and view sufferers in terms of the outdated and inaccurate stereotypes that even to this day are

seen as representative of the eating disorder experience. Just as no one person is the same, no one eating disorder is the same, so why treat them so? Some stereotypes surrounding eating disorders include: * Eating disorders are a choice. * Eating disorders are uncommon. * Eating disorders are about appearance, beauty and looking a certain way. * Eating disorders only occur in young females. * Eating disorders are caused by the unhealthy body ideals that we see in the media. * Recovery from eating disorders in rare. * People with eating disorders are easy to spot because they are extremely thin. * Anorexia Nervosa is the only serious eating disorder. * A person cannot die from Bulimia Nervosa. * Eating disorders are solely a problem with food. * You’re not sick until you are emaciated. * You can’t suffer from more than one eating disorder at a time.

Not only do these stereotypes influence the perception of health professionals, the media and of the public generally, but they even have sufferers begin to question their eating disorder and the difficulties and problems they are going through. No Bodies Perfect receive lots of enquiries from people asking if they have an eating disorder or if their eating and food behaviours warrant them accessing services or receiving help and support.

One of the best things about No Bodies Perfect (and the work I do in eating disorders) is that we/I never ever discriminate on whether someone has a ‘full-blown’ eating disorder; has been formally diagnosed; or meets certain ‘criteria’. We welcome anyone – men and women – who feel that their relationship with food and eating is affecting their life in some way. As far as we are concerned, if your relationship with food and eating is affecting your life in

some way – socially, emotionally, psychologically, physically, occupationally etc – and if food is controlling your life in some way, then you deserve help and support with such difficulties.

As far as I am and No Bodies Perfect is concerned, if someone says that they have difficulties with food and eating in some way and that it also affects their life in some way, then they may have an eating disorder and need help and support. Diagnostic criteria, especially for eating disorders, are basically there because there is a lack of resources and the number of people eligible to receive ‘formal’ treatment must therefore be limited in some way. This can be dangerous as perhaps a ‘controllable’ range of behaviours can very easily turn into a very serious illness with devastating consequences. Not only that, but they serve to perpetuate and maintain the stereotypes linked with eating disorders.

Eating disorders are not a ‘diet’. Eating disorders are a mental health illness that can impact upon all areas of the sufferer’s life and have negative, often life-threatening consequences. They are characterised by having a difficult, negative or dysfunctional relationship with food and eating. Eating disorders are not about beauty, appearance or looking a certain way. In fact, they have little to do with food, but lots to do with gaining control and finding a way of coping with life. Control of eating and food provides a way of also coping with often painful, difficult or distressful thoughts, emotions, experiences or memories, by blocking them out, denying them, or dealing with them via one’s relationship with food and eating. For those with eating disorders, life seems easier to manage through the control of food.

People can look ‘normal’ and be of a ‘normal’ weight but are, underneath, very ill and debilitated by their eating disordered thoughts, feelings and behaviours. Most people with an eating disorder do not fit into a specific category. We are all different and this is a stereotype that is often portrayed by members of the medical profession and the media, which must be challenged.

Neither are eating disorders about food. They are about experiencing and coping with difficult or painful feelings and emotions.

Often we cannot deal with these emotions. They may be too painful, overwhelming, confusing or we may not like what the emotions are trying to signal to us. We might try to numb the feelings; ignore them; hide them; deny them or even try to forget about them. We can only do this for so long – eventually we have to face the feelings and emotions. Eating disorders can often develop in response to what is going on inside of us. We can use food, eating, weight and exercise as a way of dealing with these powerful feelings and emotions. It may seem like a way of coping with life at the time, but it is a way of coping that will, ultimately, hurt you.

Increasing awareness of eating disorders and challenging stereotypes is one way of encouraging more people to acknowledge their problems, come forward and access any help and support that is available. The more people that do this, the more likely eating disorders in will be recognised and diagnosed by health professionals. Only then can we begin to develop more specialised services specifically for sufferers. It is vital to start working towards understanding the unique challenges and experiences that eating disorder sufferers’ face and tailor help and support specifically individual people, not generalised stereotypes. Undoubtedly, however, with increased awareness comes increased specialised treatment and training for eating disorders, which, currently, seems very scarce in Scotland.

(This article featured in the No Bodies Perfect Winter 2012 Newsletter and cited on other media and newspaper publications).

Scottish Mental Health First Aid for Young People Scottish Mental Health First Aid for Young People What: this course is designed for adults who support young people between the ages of 11-17, to teach you to better understand mental health and how it affects young people. This course provides 14 hours of CPD (includes pre- & post-course self-learning).

When: Thursday 28th of May 2015; or Saturday 12th of September 2015; or Thursday 3rd of December 2015 Where: Glasgow (see website for location).

Aims: * to show how mental health first aid can be applied in a crisis situation * to reduce stigma around mental health issues * to enable participants to provide initial support to young people in crisis * to recognise and promote understanding of common mental health problems, including: depression and anxiety, eating disorders, self-harm, suicide and substance misuse, plus other areas.

The course will give you the knowledge to apply these aims in a real life situation. The following is a brief outline of what is covered on the course: * guidance on being a Mental Health First Aider * mental health problems that affect young people

Relationship First Aid

* the recovery message * the impact of alcohol and drugs on a young person’s mental health * introduction to suicide intervention * listening skills * understanding cyber-bullying * understanding depression * how to offer first aid to someone experiencing depression understanding anxiety * understanding psychosis * how to offer first aid to someone experiencing a psychotic epi sode * understanding eating disorders

Do the challenges your clients face impact upon their relationships…or vice versa?

The course is presented by a qualified SMHFA-YP instructor and quality is continuously monitored by NHS Health Scotland.

How well do your clients engage and communicate with you?

Why do they react in the way they do?

The course does not train people to be mental health workers. It offers basic general information about mental health problems.

The knowledge presented and understanding developed in the course helps to remove stigma and fear and to give confidence in approaching a young person in distress.

Mental Health First Aid is an initial response to distress and all participants on the course understand that this help is to support young people in crisis, and when appropriate, signpost them on to other suitable professional help.

The Relationship First Aid Skills Framework will enable you to: * Identify early where your clients might be struggling with relationships * Have confidence to open up this conversation with them * Create more effective relationships with your clients * Achieve better outcomes for both your clients and your organisation * Equip your clients with an effective communication tool * Signpost your clients to specialist support

Course Cost: £75 per person (tea & coffee provided, please bring own lunch)

Course Cost: Full 2 day programme: £85 per person; Half-day short course: £25 per person

For more information abd how to book: please contact The Spark Training to book a place on the SMHFA – YP course. The link is: http://www.thespark.org.uk/professionals/smhfa-yp/

To book or for more information: contact Training@thespark. org.uk or see the link: http://www.thespark.org.uk/professionals/ relationship-first-aid/

What: an experiential skills-based programme When: Monday 11th and Monday 18th May 2015; or Wednesday 23rd & Wednesday 30th September 2015 Where: Inverurie (see website for location).

7 Factors That Affect Private Practice Income

2) The Number of New Referrals Acquiring new clients is, of course, an excellent way to increase income, but it can be hard to predict the ebbs and flows of exactly when new individuals will seek your services, so it’s not a guaranteed strategy. I have found that it’s helpful to begin tracking the number of new referrals and then chart them so you can anticipate and prepare for business lulls in coming years.

Maintaining a successful therapy private practice takes a lot of time, effort, and skill. There are countless aspects of your business that require painstaking attention in order for things to run smoothly. It can be difficult to work so hard and still sometimes experience economic uncertainty, so it’s important to analyze the causes of financial inconsistencies.

Here are 7 factors that affect private practice income:

3) Economic Climate The general state of the economy can greatly impact whether clients will go to sessions as often or are willing to pay out of pocket. For some individuals, therapy is considered a necessity while others may be view it as a luxury. Your income as a practitioner is in part dependent on the current economy of your community and state.

by Julie Hanks

1. Client Retention Rates The ability to keep a client engaged in meaningful and helpful therapy is a learned skill that greatly impacts your private practice income. It doesn’t get as much attention as generating new referrals, but in my experience it is equally important. While it would inappropriate to continue seeing an individual who no longer needs or desires therapy, keeping clients committed to the therapy process and attending sessions regularly not only helps them adequately work through their struggles and meet their goals, it also helps practitioners maintain their business. Conversely, clients who prematurely discontinue therapy put both themselves and their mental health professionals at a disadvantage.

4) Season/Time of Year The time of year can affect when current and/or potential clients ramp up their therapy time, as well as when they often take breaks. In my experience, the last two weeks of December is when everyone (clients and providers) take time off for the holidays. Just as with new referrals, tracking the dips in client numbers can help you save for those times when you will not be getting paid.

5) Fee Collection You may have a steady stream of clients, but your income can be significantly lowered if a number of them have outstanding financial balances. How much money do people owe you? Are you good at collecting your fees? If you work with insurance companies, are you able to get reimbursed in a timely manner? All of these play a major role in the financial stability of your private practice.

6) Moving Office Location Relocation will almost certainly affect your private practice income.

Depending on how far you move, it can take time to develop relationships, create a strong web presence, and acquire referral sources for therapy. Even if you are moving to another location in the same city, you may find that this may temporarily impact your client hours.

7) Leave of Absence/Taking a Vacation One of the biggest complaints I hear from private practitioners is that if they are sick and have to miss a few weeks, they are left without an income. Taking some time off from seeing clients means we are not getting paid; understandably, this can create financial concerns.

These and other factors (some within your control, others not) can greatly affect how financially stable your practice will be. And as one of my goals is to help therapists experience income stability, I again strongly encourage you to pursue multiple income streams as a way of advancing professionally, serving your community, and also providing for your own needs.

WOULD YOU LIKE TO WRITE FOR THE NEWSLETTER OR INCLUDE SOME NEWS IN OUR NEXT EDITION? If you have an idea or some news you would like to share, a book review you have written, want to write a piece for the newsletter or wish to share your experience of an event or training you have attended, please let us know and we can include it in the a future edition of the newsletter. Just email us at cbtersclub@yahoo.co.uk Thanks!

Brief Therapy Agency: Training & CPD Essential Skills for Short-Term Counselling What: a one day course is designed for a) counsellors working in short-term practice after training in a long-term or open-ended model and/or; b) counsellors wanting to enhance their existing short-term skills and knowledge When: Wednesday 1st July 2015-05-07 Where: The Training Suite, 34 West George Street, Glasgow City Centre, Glasgow, G2 1DA We will focus on short-term counselling covering typical six, three and single session models. These skills are essential for counsellors working in agencies offering short-term therapy and employee assistance programmes, and for clients with poor attendance patterns, restricted availability or limited funds. Course cost: ÂŁ100 Advanced Supervision Skills What: a two day course is designed for active supervisors who want to explore the supervision process in greater depth.

When: Thursday 2nd and Friday 3rd July 2015 Where:The Training Suite, 34 West George Street, Glasgow City Centre, Glasgow, G2 1DA For further information or to book these courses: Telephone: 07806 873 273 Email: info@brieftherapyagency.co.uk Web: www.brieftherapyagency.co.uk

Mindfulness and Third Wave Cognitive Behavioural Therapy

By Alexandra O’Brien

According to Dr Jon Kabat-Zinn, who first developed Mindfulness in a therapeutic setting in the 1970s: ‘Mindfulness can be cultivated by paying attention in a specific way, that is, in the present moment, and as non-reactively, non-judgementally and open-hearted as possible’.

With the above definition in mind, I tried out some Mindfulness-based practices on clients who demonstrated the following: a) overthink, ruminate or worry too much about some things, coupled with b) the tendency to avoid, suppress or push away other things.

I have recently applied some of these techniques to current clients and who demonstrated the above characteristics as part of their emotional problems and difficulties.

The aim of introducing some Mindfulness-based exercises to these clients was to attempt to give the client back some control over their attention so that, moment by moment, they could experience themselves and the world around them without the self-critical voice and selfjudgement that they carry around with them. The objective, therefore, was to assist the client in being able to bring current, moment-tomoment awareness to what s/he is doing while s/he is doing it and being able to tune in to what is going on in their mind and happening to their body and their outside world, moment by moment. The end result, over time, would be to assist the client, through Mindfulnessbased exercises, to respond more compassionately to the things that affect them. Many of my clients, past and present, comments that they think, do, feel and behave automatically, as if they are a ‘robot’ or

operating on ‘auto-pilot’. With this in mind, I decided to incorporate some Mindfulness-based exercises that might challenge this and assist them in responding differently to thoughts, feelings, situations, events and so on, clients would describe how they would get trapped in ‘auto-pilot’ and that they did, said or thought things automatically, even habitually, often without really noticing or being aware of what was going on or happening.

Similarly, other clients expressed that they don’t have a choice, especially with regards to the thoughts and feelings they experienced, these ‘just happened’ and s/he had no say in the matter – s/he had these thoughts and feelings and expressed having no real choice in the matter.

Upon reflection, my deeper understanding of Mindfulness has allowed me to consider the potential usefulness of Mindfulness is these cases. Consequently, I began adopting some more Mindfulness into sessions (and/or as homework) could challenge their experience of being ‘trapped in autopilot’ and the belief that ‘I don’t have a choice’ Admittedly, I have not used many Mindfulness-based exercises during my experience as a cognitive behavioural psychotherapist, although I have adopted some similar Mindfulness-based exercises in my previous practice in clinical hypnotherapy (LCCH) and in my past training as an accredited stress management counsellor (ISMA). However, I have attempted to familiarise myself with some exercises that I think would be useful for some current clients specifically in a CBT context.

Some of the Mindfulness-based exercises and practices I have recently used with clients include: * Mindfulness of Emotions Imagery/Visualisation/Scripts (for distress intolerance) * Mundane Task Focussing and Attention Training

* Mindful Breathing/Meditation * Body Scan (with adaptations) * Mindful Eating

* Diaphragmatic Breathing * Mindful Sleeping * Walking Mindfulness

In summary, Mindfulness was an approach that I was very wary of given my own personal experience of Mindfulness and the knowledge I already have. However, I do feel that, with further reading and incorporating some Mindfulness exercises into my current work with clients, such as mindful breathing or mindful sleeping. I am starting to change my acceptance of Mindfulness as a third wave approach that can be incorporated into cognitive behavioural psychotherapy. I am not sure I will be completely convinced of the effectiveness or usefulness of Mindfulness, however, I am more open to this approach and willing to incorporate aspects of it into my work. Some books I have as part of my personal collection: * Shamash, Alidina (2010). Mindfulness For Dummies. John Wiley and Sons. * Teasdale, JD, JMC Williams and Segal, ZV (2014). The Mindful Way Workbook. Guilford.

Some other books include: * Crane, Rebecca (2009). Mindfulness-Based Cognitive Therapy: Distinctive Features. Routledge. * Segal, Zindel V, Williams, J Mark G and Teasdale, John D. (2012).

Mindfulness-Based Cognitive Therapy for Depression. Guilford Press.

Hayes, Steve and Levin, Michael A (2013). Mindfulness and Acceptance for Addictive Behaviours: Applying Contextual CBT to Substance Abuse and Behavioural Addictions. New Harbinger.

Tools, Worksheets and Assessments In each newsletter, we will include a couple of tools, worksheets, assessments etc that may be useful to readers. These will be chosen randomly and may be useful to some and not others. If you have a worksheet, tools, exercise etc you would like to share with others, please let us know and we will include. It must be in a jpeg format to be ncluded. Thanks!

Thanks for reading this edition of The CBT’ers Club Newsletter!