‘There are no easy fixes with depression. Facing up to the underlying issues…. well it’s frightening, and it’s painful, and it’s going to take time…’
This statement by Elizabeth Pargetter’s counsellor on Radio 4’s The Archers will disappoint the new wave of brief therapists and therapeutic coaches. What a wasted opportunity by the BBC. Statistics tell us that a significant proportion of their listening audience will currently be experiencing emotional health issues and perhaps be considering approaching their GP or a therapeutic professional. What a tragedy to send out a message that will put many off seeking help at all.
As mental health professionals, our opening statement creates an expectation pathway for our client and directly affects clinical outcomes. Sending out messages of a long and/or painful experience is likely to either extend therapy or erect a barrier for some altogether. More to the point, it is not representative of therapy as it is today.
The excerpt below from my own opening statement to a new client with depression is very different from the Radio 4 version. It is designed to normalize therapy and to raise an expectation of early improvement.
Embedded positive messages to my client are in bold:
‘I’m a Fusion Therapeutic Coach. I work briefly and you should start to notice you feel better after every session. If you don’t, I’m not doing my job properly. So, all the pressure is on me and you can relax.
See how you feel at the end of today’s session. If you think this is helpful, consider booking 4 more sessions so you have a block of support in place. I’d rather you do that and cancel the last couple of sessions if you don’t need them than try to book me and find out I’m busy for several weeks.
Now, it’s over to you. Perhaps you could outline what is the essence of the problem that brings you here today’
Embedded interventions
‘I work briefly’: The message I am sending is that this is different. It’s not about you talking and me listening and nodding. The work we do together will be proactive and targeted at helping you feel better quickly.
‘notice you feel better after every session’: I am setting my client’s reticular activating brain filter (see below) to focus on and notice improvement. At the beginning and end of each session I will ask my client to scale their subjective wellbeing or use SUDS (Subjective Units of Distress) so they can see what difference the session has made. I will also assess clinical outcomes session by session (either with CORE, GAD 7, PHQ9 or the Fusion Continuum of Wellbeing Assessment.) I may even produce a graph to give my client a visual representation of their improvement.
‘You can relax’: most clients come into a first session very anxious, feeling ashamed or guilty, that they have failed in some way or are mentally ill. At the core of the Fusion Model is our innate ability to self soothe and relax at will through mindfulness-based techniques. With the evolution of consciousness, the human brain became able to tell the body to calm down. Many people do not realise they can do this and need teaching or reminding.
‘This is helpful’: Through experience, I know the way I work is very helpful for my clients and I need my clients to have a sense of that. My confidence in my working model helps restore hope. Many new clients may have already been labelled and medicated by their GP or had therapy that did not work for them. When people lose hope of feeling better, they can become suicidal so this early embedded presupposition is an important positive message to send.
‘You have a block of support in place’: I want my client to feel held and supported. Feeling safe is a primary human need. If there were bombs dropping outside the therapy room, my client’s instinct would be to fight or run. Polyvagal Theory informs us that there is an internal triage system in the brain that is primed to assess for safety. If unsafe, the autonomic nervous system engages fight/flight. If safe, the more recently evolved neo-cortex engages. It’s the neo-cortex we need to engage in the therapy room as it is the problem solving part of the human brain.
‘Cancel the last couple of sessions if you don’t need them’: The Fusion Model often resolves pathology in the first or second session. After that we are firmly into coaching territory when many clients are pleased to be free of the presenting problem but don’t necessarily want to cancel the remaining sessions. This is when we create a picture of their preferred future in the absence of the problem.
‘What is the essence of the problem that brings you here today’: Native American Indians have no word for depression. They state simply that ‘sadness walks alongside me.’ Asking for the essence of the problem puts my client into their Observing Self, separates them from the problem and also directly leads us to look for ‘the essence of the solution’ and ‘the focus for our work together.’
Therapy is changing
As you can see, words have power.
Significantly improving your clinical outcomes can start with something as simple as changing your introduction in that important first session with your client.
Therapy is certainly getting briefer, more targeted and more effective. The integration of counselling and coaching skills and tools is changing the professional landscape forever and word is spreading fast among practitioners and clients alike.
The reticular activating system (RAS), suicide prevention, affirmations, the Rewind Technique, Raising self esteem, Mindfulness Based Mind Management (advanced MBSR), worrying well, solution focus, guided visualisation, resolving addiction, epigenetics, mapping the connectome, polyvagal theory, secondary gain, trauma resolution, coaching for kids, treating depression, worrying well, working SMART, therapeutic stories, insight, psycho education, positive mental rehearsal, imagery, dissociation, goal setting, new paradigms, reframes, fast track learning, perception shifting, self actualisation, positive psychology, reframing, metaphor, personal empowerment, motivational thinking, resilience and resourcefulness, human flourishing, anchoring, rewiring your brain, the STOP System, the SAFE SPACE happiness recipe, holistic coaching and working on the continuum of wellbeing plus many other professional theories, tools and techniques underpin the content of the fast paced, fast track, Fusion training programmes.
