Tips for ending therapy successfully

By Catherine Bishop.

I think we often focus on how to start therapy successfully and how to know if it is working but we can forget that ending therapy well is just as important. Here are some quick tips for ending therapy well:

1)      Start with spacing sessions out

Talk with your therapist about increasing the amount of time between appointments.  If you have been seeing your therapist fortnightly consider spacing sessions to monthly and then maybe to every second month.  This is a good way to allow time to strengthen the skills that you have already learnt in therapy and to see if there are any other skills that you may be missing.  Spacing sessions out is a good way for you to see how you will manage when you are no longer seeing your therapist and if there are any other challenges that you had not spoken about yet. 

2)      Don’t end therapy as soon as you start feeling better

A lot of people make this mistake of cancelling all their appointments as soon as they start to feel good. I find that many people that do this will then quickly return to therapy when things start to slip again.  It is great that you are starting to feel better but it is important to remember that this is a really good time to get more practice in the skills you have been learning in a supported way.  It is often easier to practice the skills when your emotions are not as overwhelming as when you first came in. It also means you have the opportunity to plan ahead for future challenges (see the next tip).  It is often forgotten that therapy is not just for people who are struggling with their mental health - sometimes when you are feeling well this can also offer a chance to explore other opportunities for personal growth and living a more meaningful and fulfilling life as you are no longer so consumed with big emotions. 

3)      Have a staying on track plan

Make a staying on track (or relapse prevention) plan with your therapist.  This should include strategies and skills that you have for coping; difficult situations that may come up in the future and how you are going to handle them; warning signs that things are starting to go downhill (so you can catch it early and use your strategies to get back on track); signs that you need some extra support again; and ways to get extra support (this may be from friends, family members, a partner, or professional supports such as your therapist).  Having a written plan is really useful for you to be able to go back to if you are stuck.  Hopefully you don’t need it but it’s better to have it in case you do – it’s kind of like taking your first aid kit on a bush walk – you don’t take it with the intention of getting bitten by a snake but it’s there if you need it.     

4)      Keep practising your strategies after therapy ends

Keep any handouts and your staying on track plan in a safe place and review these regularly.  Practice the skills you have learnt so you don’t get rusty and can easily use them when you need them.  Otherwise it can be very easy to forget.  The first question I ask people if they return to therapy is if they have been using their strategies!         

5)     Remember that you can always come back

The door won’t lock behind you.  Sometimes life challenges can bring up old problems again and you may need some support in refreshing your skills or learning some new ones.  Sometimes people just need a few extra sessions as a top up, kind of like your booster shot when you have a vaccination.  Often it is easier the next time as you already know how it works!    

Catherine Bishop is a psychologist and clinical psychology registrar at Healthy Mind Centre Launceston.

The Importance of Positive Attention

Most parents who are dealing with behaviour problems in their children notice that things are starting to get a bit negative around their home. More negative than positive. It starts to seem like much of the time, their interactions with their kids include some kind of asking them to do something (for the 100th time!), threatening consequences, or venting that no-one helps around here. From the kid’s perspective, their parents are always on their back or nagging about something. An excellent recipe for irritable households where no-one is enjoying anyone’s company much.

This happens even when the kids aren’t displaying serious behaviour problems.

For example, Mum and/or Dad are stressed because of XYZ and are feeling a little tired and irritable anyway, or maybe they are running late to school drop-off. And the kids just won’t get ready/make their bed/find their shoes, no matter how many times they ask or threaten to dock pocket money. Sound familiar?

The things is, when things are negative for a while, kids (and adults) can start to tune out and stop paying attention to what is being said. What is the point? They just get yelled at anyway and most interactions leave everyone feeling cranky. Why would anyone be tuned into that kind of relationship?

I want you to stop and think about a negative relationship that you have had with an important person in your life, or someone who was in an authority position. Perhaps an awful ex-boss or your cranky old maths teacher. What is it that defined that person? What were their attributes? How did these attributes affect your relationship with them? How motivated were you to work for them, going the extra mile to do your best? Hint: probably not very much.

Now, think about a really positive relationship you have had, an excellent supervisor or that awesome teacher you had in Grade 9. What was it about them that made them awesome? What were their personal attributes? How hard did you try to work your best for them? If you are like most people, you probably tried a whole lot more.

The key difference between these two people is the degree of positive attention they provided.

When your child is feeling irritable from all the negativity in the house, what kind of boss do they see you as? The bad boss! So, how motivated are they going to be to work hard and go the extra mile for you?

Increasing the level of positive attention you pay your child will help to change that uneven balance of negative to positive interactions and help both the household, and the parent-child relationship to become a bit happier. This can be done in a variety of ways. Tune into our next blog post for some tips and tricks! (You can do this easily by following our facebook page or subscribing to our email list).

Olivia Boer is a Clinical Psychologist and Director of Healthy Mind Centre Launceston, a private allied health practice in Launceston, Tasmania. 

The ABCs of behaviour

Aay, bee, cee, dee, eee, eff... sorry, got a little off track there. Lots of ABCs going on both at home and at HMC Launceston these days. Which brings me to todays blog topic: What are the ABCs of behaviour. 

A is for Antecedents

Or Anticipating a behaviour, depending on who you talk to. For both options, it means what is happening immediately before a behaviour occurs. It can be something happening in the individual's environment, or it can be an internal event such as an individual's thought or feeling. 

B is for behaviour

This one is pretty obvious; it's the actual behaviour that occurs. Remember, behaviours can also be what we want to see occurring, not just a "problem behaviour" that we want to reduce in frequency (how often it happens), intensity (how big/strong it gets), or duration (how long the behaviour goes for).

C is for consequences

Understanding the consequences of a behaviour, or what happens immediately after a behaviour occurs, is almost as important as understanding the behaviour itself. This is because consequences are VERY important in determining whether a behaviour is more or less likely to occur again the next time the individual is in a similar situation. 

Why do we care about understanding behaviour?

Our actions can have significant implications for our social, emotional, and educational/occupational functioning. Being able to understand why a particular behaviour is occurring what what can be done to increase or decrease the likelihood of that behaviour occurring can make our lives, and the lives of those around us far more pleasant, happy, and less stressful. 

Putting it all together

Think about the following example: Jimmy, aged 4 and his Mum are at the supermarket. Jimmy doesn't want to stay next to the shopping trolley (even for some Coles Mini's at the end) and runs off to the other end of the supermarket isle (the Behaviour). What happened immediately before (Jimmy seeing a big long expanse of space to run in) and immediately after (Jimmy's Mum running after him yelling for him to come back, which is quite exciting for Jimmy whilst she chases him around the supermarket) can make Jimmy more likely to do the same thing next time him and his mum go shopping. By changing the antecedents (for example, Jimmy's mum clearly establishing rules, what will happen if he breaks the rules, and giving him his own shopping list to follow) and the consequences (for example, Jimmy's Mum requiring him to hold her hand throughout the rest of the shopping trip), we can expect that Jimmy's behaviour to be closer to what his mum would like, next time. 

One final point...

When we are attempting to shape/change another person's behaviour, it is important to remember that reducing a problem behaviour is not enough. We also need to reinforce the desired behaviour (what we want to see the individual doing next time), so the individual has something to replace their old behaviour with. 

If you need some help with behaviour (yours or someone else's), have a chat to one of our clinicians who can help you work it all out. 

Olivia Boer is a Clinical Psychologist and Director of Healthy Mind Centre Launceston, a private allied health practice in Launceston, Tasmania. 

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What causes children's misbehaviour?

It's really easy to blame someone when kids are being naughty, oppositional, or defiant. "They are just so difficult...", "She is doing this for attention!", or "He is just like his father!" are common ideas that come to mind. Especially when your child just won't cooperate, listen, or do what they are asked. 

Often, though, we might not understand the child's behaviour enough to accurately pinpoint what causes the behaviour, and why it keeps happening.

As parents, we try the strategies we have been told, the things we saw our friend do, or what our own parents did with us. And yet, the oppositionality continues. We read a parenting website, Google "What do I do when my kid won't behave?", and find ourselves getting frustrated and yelling more than we would like. Then they talk back to us and run off. 

There are a few key steps to understanding children's behaviour that we will be looking at over the coming weeks. The first is an idea discussed by Dr Russell Barkley, one of the pioneers in ADHD and Oppositional Defiant Disorder research, in his behavioural parent training work. Dr Barkley notes there are four main causes of, or contributors to children's misbehaviour. 

1. Child Factors

These include a wide range of child-specific problems including temperament (including inherited predispositions toward irritability, low frustration tolerance, and anger), impulsivity, attentional problems, learning problems, intellectual and developmental difficulties, sensory sensitivities, activity levels, emotional regulation ability, physical characteristics (including motor coordination, stamina, and appearance), etc. It is not difficult to see how these child-specific elements can lead to conflict with parents or caregivers. It is also easy to see how child misbehaviour can be solely attributed to these characteristics. However, according to Dr Barkley, another key element that contributes to child misbehaviour is parent factors. 

2. Parent Factors

Parent factors are not that different to child factors, but they definitely impact how parents interact with their children and manage their kids' behaviour problems. Parent factors can include things like (you guessed it!): temperament, impulsivity, learning and intellectual difficulties, emotional regulation ability, physical characteristics, etc, etc. Pretty much all the same things that kids bring to the equation. Because (and it's really important to remember this), parent-child interactions are bi-directional. They go two ways; parent to child, and child to parent. Unless one of you is a robot of course, and in that case, you are reading the wrong blog. 

3. Family Stress Events

There are a wide range of stressful events or situations that families can experience, that can also contribute to children's misbehaviour. These can include significant or catostrophic events like the death of a family member, exposure to family violence, family separation or restructuring, loss of stable housing, or loss of financial security. Less severe events also are worth a mention here, including financial strain, marital discord, tense relationships with relatives, etc. 

Now, at this point a lot of families tell me they can't do anything about these factors. And they are largely right. We are stuck with genetic predispositions, can't do a lot about our in-laws, and that physical characteristic is largely permanent. There may be some things you can do to modify some of these factors though. And, if you can, the time is now. Go and seek some financial counselling, set some limits with your extended family members, and get a health check-up with your GP. 

This brings me to the final factor, the one you really CAN do something about. 

4. Situational Consequences. 

Now, I'm not going to go into detail here as this area definitely deserves it's own post. But for now, be assured that understanding how that happens around the same time as the child's behaviour can a) help you to better understand why the problem behaviour keeps happening, and b) help you to understand what needs to happen to change it. 

Keep a lookout for our next post to learn more, and leave a comment if there are any topics you would like us to explain further. 

Olivia Boer is a Clinical Psychologist and Director of Healthy Mind Centre Launceston, a private allied health practice in Launceston, Tasmania. 

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Help! My child won't do what they are asked and my home is becoming a miserable place.

To follow on from our series on stress, I thought I might shift into another problem we commonly see at HMC Launceston: unhappy homes and negative relationships between parents and their kids or teens. To the point where you love each other of course, but you really don't like each other sometimes. Obviously, this is a huge source of stress for all involved. And sometimes things get to the point when you need a bit of help. An outside perspective with some ideas about why all those things you are trying (time out, reward charts, negotiating like a rational person) aren't working. 

The thing is, kids and teens often aren't logical and rational. 

Especially when big feelings are involved. Add in some big feelings from parents, who may be struggling with their own emotions, thoughts, behaviours, and life-stressors, and it's no wonder things start going downhill. 

The thing is, most humans benefit from more structure. Most kids definitely benefit from clear behavioural expectations and routines, and parents certainly benefit from being proactive rather than reactive, and being confident in their parenting plan. This is where something called "Behavioural Parent Training" comes in. 

Behavioural parent training doesn't mean you need to be trained on how to parent. 

As parents, we are typically the ones who know our children the best of anyone. Especially in the younger years. And you definitely know your family. But parents typically don't have a background in a behavioural science, such as psychology, and this is where a health professional might come in. We walk the path together and combine our respective expertise; your expertise on your family and your child, and our expertise on the application of behaviour change theory.

Our next blog series will be all about the important things to know when things aren't going so well at home. We will be investigating some the works of a pioneer in this area, Dr Russell Barkley, a clinical psychologist in the US and international expert on ADHD, as well as a couple of other key researchers in the field. Follow our blog series through facebook (@hmclaunceston) or the HMC Launceston website for more tips and to find out more!

Olivia Boer is a Clinical Psychologist and Director of Healthy Mind Centre Launceston, a private allied health practice in Launceston, Tasmania. 

 

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