If a friend or loved one doesn’t seem themselves, how do you spot the difference between a bad mood and something more serious? Drinking too much, being a party pooper, crying all the time or any other ongoing, significant change in a person’s behaviours, thoughts or feelings could be tell-tale signs of a mental illness. Learn the signs that could prompt you to think that a friend or family member is among the 1 in 5 Australians dealing with a mental health issue.
Often it’s not a single change but a combination. The following 9 signs are not to help you diagnose a mental health issue, but instead to reassure you that there might be good reason to seek more information about your concerns.
1. Feeling anxious or worried
We all get worried or stressed from time to time. But anxiety could be the sign of a mental health issue if it’s constant and interferes all the time. Other symptoms of anxiety may include heart palpitations, shortness of breath, headache, restlessness, diarrhoea or a racing mind.
2. Feeling depressed or unhappy
Have you noticed that your friend has lost interest in a hobby you used to share? If they’ve also seemed sad or irritable for the last few weeks or more, lacking in motivation and energy or are teary all the time, they might be dealing with depression.
3. Emotional outbursts
Everyone has different moods, but sudden and dramatic changes in mood, such as extreme distress or anger, can be a symptom of mental illness.
4. Sleep problems
Generally, we need 7-9 hours of sleep each night. Persisting changes to a person’s sleep patterns could be a symptom of a mental illness. For example insomnia could be a sign of anxiety or substance abuse. Sleeping too much or too little could indicate depression or an sleeping disorder.
5. Weight or appetite changes
Many of us want to lose a few kilos, but for some people fluctuating weight or rapid weight loss could be one of the warning signs of a mental illness, such as depression or an eating disorder. Other mental health issues can impact appetite and weight too.
6. Quiet or withdrawn
We all need quiet time occasionally, but withdrawing from life, especially if this is a major change, could indicate a mental health issue. If a friend or loved one is regularly isolating themselves, they may have depression, bipolar, a psychotic disorder, or another mental health issue. Refusing to join in social activities may be a sign they need help.
7. Substance abuse
Are you worried a loved one is drinking too much? Using substances, such as alcohol or drugs, to cope can be a sign of, and a contributor to, mental health issues.
8. Feeling guilty or worthless
Thoughts like ‘I’m a failure’, ‘It’s my fault’ or ‘I’m worthless’ are all possible signs of a mental health issue, such as depression. Your friend or loved one may need help if they’re frequently criticising or blaming themselves. When severe, a person may express a feeling to hurt or kill themselves. This feeling could mean the person is suicidal and urgent help is needed. Call Triple zero (000) for an ambulance immediately.
9. Changes in behaviour or feelings
A mental illness may start out as subtle changes to a person’s feelings, thinking and behaviour. Ongoing and significant changes could be a sign that they have or are developing a mental health issue. If something doesn’t seem ‘quite right’, it’s important to start the conversation about getting help.
The main idea of motivational interviewing is to purposefully create a conversation around change, without attempting to convince the person of the need to change or instructing them about how to change.
Motivational interviewing is a therapeutic approach that was originally developed in the alcohol and other drug field by William Miller and Stephen Rollnick (Miller, 1983; Miller & Rollnick, 1991). Previous approaches to the treatment of addiction behaviours tended to view continued substance use as evidence of inherent personality defects, such as denial.
This approach utilises the principles and practices of personcentred counselling to encourage the young person to move through the stages of change and to make personal choices along the way. A young person’s resistance is viewed as evidence of conflict or ambivalence and is met with reflection rather than a confrontational style (Rollnick and Miller, 1995).
The following are the key principles of motivational interviewing:
Acceptance facilitates change
Skilful reflection is fundamental
Ambivalence is normal
Awareness of consequences is important
A discrepancy between present behaviour and important goals will motivate change
Arguments are counterproductive
Defending breeds defensiveness
Resistance is a signal to change strategies
Labelling is unnecessary for change
Roll with resistance
Momentum can be used to good advantage
Perceptions can be shifted
New perspectives are invited but not imposed
The belief in the possibility of change is an important motivator
The young person is responsible for choosing and carrying out personal change
The young person should present arguments for change
PEEFT or more commonly referred to as Emotion Focused Therapy (EFT) integrates experiential perspectives, cognitive science, existential thought and contemporary emotion theory. It develops emotional intelligence, integrates experience and offers restructuring and transformation.
PEEFT was developed by Les Greenberg, Laura Rice and Robert Elliot in the 1980’s. The quality of the client-therapist relationship was emphasised and experiential techniques including Gendlin’s Focusing (working with the felt sense) and Perls’ Gestalt therapy (empty or two-chair work) are utilised. It is a proven effective technique of understanding the physiological, cognitive and emotional aspects behind symptoms and resolves maladaptive emotions in the present moment.
Emotions are seen as information providers, they tell us what is important and whether things are going our way, they are efficient, automatic signalling systems that involve us identifying our wishes and needs that subsequently lead us to adaptive action. Emotions help us integrate experience by giving meaning, value and direction through best counselling services Melbourne.
Process-Experiential Emotion-Focused practitioners work within a person-centred approach, attuning with their clients whilst being directive of process. PEEFT is suitable for children, adolescents, adults, individuals, couples, families, schools and organisations. It is manualised and has an expanding popularity, recognition and evidence base, including for depression. EFT is listed by the APA (and the APS) as an empirically supported treatment for depression.
Family Therapy – or to give it its full title, Family and Systemic Psychotherapy – helps people in a close relationship help each other.
It enables family members, couples and others who care about each other to express and explore difficult thoughts and emotions safely, to understand each other’s experiences and views, appreciate each other’s needs, build on strengths and make useful changes in their relationships and their lives. Individuals can find Family Therapy helpful, as an opportunity to reflect on important relationships and find ways forward.
Research shows Family Therapy is useful for children, young people and adults experiencing a very wide range of difficulties and experiences.
The earliest approaches to psychotherapy in the 20th Century focused on individual therapy, and the patient-therapist relationship as the best way to treat psychological problems. Patients were segregated from their families for therapy and treatment focused on their individual symptomatic behaviours.
The advent of family therapy ushered in a whole new way of understanding and explaining human behaviour. Family therapists shifted the focus of treatment in a way that allowed for social context, communication and relationship to have primary importance in therapy.
This way of working involves engaging with the whole family system as a functioning unit. While the individuals in the family are as important in family therapy as in individual therapy, family therapists also deal with the personal relations and interactions of the family members, both inside the family and in the therapeutic system which comprises the family, the therapist or therapists, and their broader community.
Family Therapy aims to be:
Inclusive and considerate of the needs of each member of the family and/or other key relationships (systems) in people’s lives
Recognise and build on peoples’ strengths and relational resources
Work in partnership ‘with’ families and others, not ‘on’ them
Sensitive to diverse family forms and relationships, beliefs and cultures
Enable people to talk, together or individually, often about difficult or distressing issues, in ways that respect their experiences, invite engagement and support recovery.
Sourced from: Association for Family Therapy & Systemic Practice UK
Couple therapy is a means of resolving problems and conflicts that couples have not been able to handle effectively on their own. It involves both partners sitting down with a trained professional to discuss their thoughts and feelings. The aim is to help them gain a better understanding of themselves and their partner, to decide if they need and want to make changes, and if so, to help them to do so.
Are Children Involved in Couple Therapy?
No. Couple therapy involves only the couple. Children may be affected either directly or indirectly by problems in their parents’ relationship, and to varying degrees, depending on factors such as their ages and the nature and severity of their parents’ problems. They may, as a result, become anxious and begin to exhibit their own problems, although not all of their difficulties necessarily stem from those of their parents. The children’s difficulties may improve as the couple’s relationship improves or the couple may become more confident in their own ability to help the children.
Therapy that involves both the couple and their children is a different process called family therapy, which usually focuses on the relationships among family members rather than solely on the couple’s relationship. During the course of this therapy, however, the focus may shift to the parental couple for a period of time. If this occurs, children would no longer be involved in treatment. If parents are wondering whether their children should be involved in the sessions, they should discuss this with the therapist.
What is the difference between couple therapy and sex therapy?
Couple therapy focuses on the total relationship while sex therapy deals more specifically with sexual dysfunction. Other problems within a relationship often affect the sexual relationship, and the quality of their sexual relationship is important to many couples, so this may be discussed in couple therapy. However, a couple may experience sexual problems in an otherwise sound relationship. If this is the case, sex therapy may be beneficial. This treatment recommendation would be based on the therapist’s initial assessment of the problem.
What kinds of problems do people usually bring to couple therapy?
People seek therapy for a range of problems and every couple is different. Some of the most common complaints include lack of communication, frequent or constant arguments, unfulfilled emotional needs, financial concerns and conflicts about children.
You may be wondering why these problems sound like common issues that many couples resolve without professional help. Couples often seek help not because their problems are different from those of other couples, but because they are unable to resolve them. Sometimes, this is because of a buildup of frustration and disappointment over time, sometimes be-cause there is some other issue or meaning underlying the conflict. Other couples seek help as a result of a crisis in the relationship, such as an affair or apparent loss of affection and caring, or a traumatic event, such as an illness or loss in the family. (See the Appendix for examples of the kinds of situations for which couples seek help.)
What will the therapist do?
The therapist is a professionally trained, objective third party who will listen to both partners as they express their thoughts and feelings and help them identify and clarify problem areas.
Most therapists start with an assessment. In an assessment, the therapist asks about the problems and how both people see them, the history of the relationship, and the individual histories of the partners. This enables the therapist to develop a deeper understanding. Most therapists will discuss their impression of the situation with the couple at the conclusion of the assessment. The couple then can decide whether to accept the therapist’s recommendations about whether or not to enter therapy and what kind of therapy to pursue.
Once the couple enters therapy, the therapist’s interpretation of issues may offer the couple a new perspective, which permits a change in feelings and behaviour. The therapist may act as a mediator, attempting to clear up misunderstandings in communication. This is often difficult for people to do themselves because they are emotionally caught up in the situation. The therapist may also help the partners consider alternative ways of handling problematic situations.
EMDR (Eye Movement Desensitization and Reprocessing) is a psychotherapy that enables people to heal from the symptoms and emotional distress that are the result of disturbing life experiences. Repeated studies show that by using EMDR therapy people can experience the benefits of psychotherapy that once took years to make a difference. It is widely assumed that severe emotional pain requires a long time to heal. EMDR therapy shows that the mind can in fact heal from psychological trauma much as the body recovers from physical trauma. When you cut your hand, your body works to close the wound. If a foreign object or repeated injury irritates the wound, it festers and causes pain. Once the block is removed, healing resumes. EMDR therapy demonstrates that a similar sequence of events occurs with mental processes. The brain’s information processing system naturally moves toward mental health. If the system is blocked or imbalanced by the impact of a disturbing event, the emotional wound festers and can cause intense suffering. Once the block is removed, healing resumes. Using the detailed protocols and procedures learned in EMDR therapy training sessions, clinicians help clients activate their natural healing processes.
More than 30 positive controlled outcome studies have been done on EMDR therapy. Some of the studies show that 84%-90% of single-trauma victims no longer have post-traumatic stress disorder after only three 90-minute sessions. Another study, funded by the HMO Kaiser Permanente, found that 100% of the single-trauma victims and 77% of multiple trauma victims no longer were diagnosed with PTSD after only six 50-minute sessions. In another study, 77% of combat veterans were free of PTSD in 12 sessions. There has been so much research on EMDR therapy that it is now recognized as an effective form of treatment for trauma and other disturbing experiences by organizations such as the American Psychiatric Association, the World Health Organization and the Department of Defense. Given the worldwide recognition as an effective treatment of trauma, you can easily see how EMDR therapy would be effective in treating the “everyday” memories that are the reason people have low self-esteem, feelings of powerlessness, and all the myriad problems that bring them in for therapy. Over 100,000 clinicians throughout the world use the therapy. Millions of people have been treated successfully over the past 25 years.
EMDR therapy is an eight-phase treatment. Eye movements (or other bilateral stimulation) are used during one part of the session. After the clinician has determined which memory to target first, he asks the client to hold different aspects of that event or thought in mind and to use his eyes to track the therapist’s hand as it moves back and forth across the client’s field of vision. As this happens, for reasons believed by a Harvard researcher to be connected with the biological mechanisms involved in Rapid Eye Movement (REM) sleep, internal associations arise and the clients begin to process the memory and disturbing feelings. In successful EMDR therapy, the meaning of painful events is transformed on an emotional level. For instance, a rape victim shifts from feeling horror and self-disgust to holding the firm belief that, “I survived it and I am strong.” Unlike talk therapy, the insights clients gain in EMDR therapy result not so much from clinician interpretation, but from the client’s own accelerated intellectual and emotional processes. The net effect is that clients conclude EMDR therapy feeling empowered by the very experiences that once debased them. Their wounds have not just closed, they have transformed. As a natural outcome of the EMDR therapeutic process, the clients’ thoughts, feelings and behavior are all robust indicators of emotional health and resolution—all without speaking in detail or doing homework used in other therapies.
EMDR therapy combines different elements to maximize treatment effects. A full description of the theory, sequence of treatment, and research on protocols and active mechanisms can be found in F. Shapiro (2001) Eye movement desensitization and reprocessing: Basic principles, protocols and procedures (2nd edition) New York: Guilford Press.
EMDR therapy involves attention to three time periods: the past, present, and future. Focus is given to past disturbing memories and related events. Also, it is given to current situations that cause distress, and to developing the skills and attitudes needed for positive future actions. With EMDR therapy, these items are addressed using an eight-phase treatment approach.
Phase 1: The first phase is a history-taking session(s). The therapist assesses the client’s readiness and develops a treatment plan. Client and therapist identify possible targets for EMDR processing. These include distressing memories and current situations that cause emotional distress. Other targets may include related incidents in the past. Emphasis is placed on the development of specific skills and behaviors that will be needed by the client in future situations.
Initial EMDR processing may be directed to childhood events rather than to adult onset stressors or the identified critical incident if the client had a problematic childhood. Clients generally gain insight on their situations, the emotional distress resolves and they start to change their behaviors. The length of treatment depends upon the number of traumas and the age of PTSD onset. Generally, those with single event adult onset trauma can be successfully treated in under 5 hours. Multiple trauma victims may require a longer treatment time.
Phase 2: During the second phase of treatment, the therapist ensures that the client has several different ways of handling emotional distress. The therapist may teach the client a variety of imagery and stress reduction techniques the client can use during and between sessions. A goal of EMDR therapy is to produce rapid and effective change while the client maintains equilibrium during and between sessions.
Phases 3-6: In phases three to six, a target is identified and processed using EMDR therapy procedures. These involve the client identifying three things:
1. The vivid visual image related to the memory
2. A negative belief about self
3. Related emotions and body sensations.
In addition, the client identifies a positive belief. The therapist helps the client rate the positive belief as well as the intensity of the negative emotions. After this, the client is instructed to focus on the image, negative thought, and body sensations while simultaneously engaging in EMDR processing using sets of bilateral stimulation. These sets may include eye movements, taps, or tones. The type and length of these sets is different for each client. At this point, the EMDR client is instructed to just notice whatever spontaneously happens.
After each set of stimulation, the clinician instructs the client to let his/her mind go blank and to notice whatever thought, feeling, image, memory, or sensation comes to mind. Depending upon the client’s report, the clinician will choose the next focus of attention. These repeated sets with directed focused attention occur numerous times throughout the session. If the client becomes distressed or has difficulty in progressing, the therapist follows established procedures to help the client get back on track.
When the client reports no distress related to the targeted memory, (s)he is asked to think of the preferred positive belief that was identified at the beginning of the session. At this time, the client may adjust the positive belief if necessary, and then focus on it during the next set of distressing events.
Phase 7: In phase seven, closure, the therapist asks the client to keep a log during the week. The log should document any related material that may arise. It serves to remind the client of the self-calming activities that were mastered in phase two.
Phase 8: The next session begins with phase eight. Phase eight consists of examining the progress made thus far. The EMDR treatment processes all related historical events, current incidents that elicit distress, and future events that will require different responses
Schema Therapy (or more properly, Schema-Focused Cognitive Therapy)is an integrative approach to treatment that combines the best aspects of cognitive-behavioral, experiential, interpersonal and psychoanalytic therapies into one unified model. Schema-Focused Therapy has shown remarkable results in helping people to change negative (“maladaptive”) patterns which they have lived with for a long time, even when other methods and efforts they have tried before have been largely unsuccessful.
The Schema-Focused model was developed by Dr. Jeff Young, who originally worked closely with Dr. Aaron Beck, the founder of Cognitive Therapy. While treating clients at the Center for Cognitive Therapy at the University of Pennsylvania, Dr. Young and his colleagues identified a segment of people who had difficulty in benefiting from the standard approach. He discovered that these people typically had long-standing patterns or themes in thinking, feeling and behaving/coping that required a different means of intervention. Dr. Young’s attention turned to ways of helping patients to address and modify these deeper patterns or themes, also known as “schemas” or “lifetraps.”
The schemas that are targeted in treatment are enduring and self-defeating patterns that typically begin early in life. These patterns consist of negative/dysfunctional thoughts and feelings, have been repeated and elaborated upon, and pose obstacles for accomplishing one’s goals and getting one’s needs met. Some examples of schema beliefs are: “I’m unlovable,” “I’m a failure,” “People don’t care about me,” “I’m not important,” “Something bad is going to happen,” “People will leave me,” “I will never get my needs met,” “I will never be good enough,” and so on.
Although schemas are usually developed early in life (during childhood or adolescence), they can also form later, in adulthood. These schemas are perpetuated behaviorally through the coping styles of schema maintenance, schema avoidance, and schema compensation. The Schema-Focused model of treatment is designed to help the person to break these negative patterns of thinking, feeling and behaving, which are often very tenacious, and to develop healthier alternatives to replace them.
Schema-Focused Therapy consists of three stages. First is the assessment phase, in which schemas are identified during the initial sessions. Questionnaires may be used as well to get a clear picture of the various patterns involved. Next comes the emotional awareness and experiential phase, wherein patients get in touch with these schemas and learn how to spot them when they are operating in their day-to-day life. Thirdly, the behavioral change stage becomes the focus, during which the client is actively involved in replacing negative, habitual thoughts and behaviors with new, healthy cognitive and behavioral options.
Cognitive behavioural therapy (CBT) is a talking therapy that can help you manage your problems by changing the way you think and behave.
It’s most commonly used to treat anxiety and depression, but can be useful for other mental and physical health problems.
How CBT works
CBT is based on the concept that your thoughts, feelings, physical sensations and actions are interconnected, and that negative thoughts and feelings can trap you in a vicious cycle. CBT aims to help you deal with overwhelming problems in a more positive way by breaking them down into smaller parts. You’re shown how to change these negative patterns to improve the way you feel. Unlike some other talking treatments, CBT deals with your current problems, rather than focusing on issues from your past. It looks for practical ways to improve your state of mind on a daily basis.
Uses for CBT
CBT has been shown to be an effective way of treating a number of different mental health conditions.
In addition to depression or anxiety disorders, CBT can also help people with:
obsessive compulsive disorder (OCD)
post-traumatic stress disorder (PTSD)
eating disorders – such as anorexia and bulimia
sleep problems – such as insomnia
problems related to alcohol misuse
CBT is also sometimes used to treat people with long-term health conditions, such as:
irritable bowel syndrome (IBS)
chronic fatigue syndrome (CFS)
Although CBT can’t cure the physical symptoms of these conditions, it can help people cope better with their symptoms.
What happens during CBT sessions
If CBT is recommended, you’ll usually have a session with a therapist once a week or once every two weeks. The course of treatment usually lasts for between five and 20 sessions, with each session lasting 30-60 minutes. During the sessions, you’ll work with your therapist to break down your problems into their separate parts – such as your thoughts, physical feelings and actions.
You and your therapist will analyse these areas to work out if they’re unrealistic or unhelpful and to determine the effect they have on each other and on you. Your therapist will then be able to help you work out how to change unhelpful thoughts and behaviours.
After working out what you can change, your therapist will ask you to practise these changes in your daily life and you’ll discuss how you got on during the next session.
The eventual aim of therapy is to teach you to apply the skills you’ve learnt during treatment to your daily life. This should help you manage your problems and stop them having a negative impact on your life – even after your course of treatment finishes.
Pros and cons of CBT
Cognitive behavioural therapy (CBT) can be as effective as medication in treating some mental health problems, but it may not be successful or suitable for everyone.
Some of the advantages of CBT include:
it may be helpful in cases where medication alone hasn’t worked
it can be completed in a relatively short period of time compared to other talking therapies
the highly structured nature of CBT means it can be provided in different formats, including in groups, self-help books and computer programs
it teaches you useful and practical strategies that can be used in everyday life – even after the treatment has finished
Some of the disadvantages of CBT to consider include:
you need to commit yourself to the process to get the most from it – a therapist can help and advise you, but they need your co-operation
attending regular CBT sessions and carrying out any extra work between sessions can take up a lot of your time
it may not be suitable for people with more complex mental health needs or learning difficulties – as it requires structured sessions
it involves confronting your emotions and anxieties – you may experience initial periods where you’re anxious or emotionally uncomfortable
it focuses on the individual’s capacity to change themselves (their thoughts, feelings and behaviours) – which doesn’t address any widerproblems in systems or families that often have a significant impact on an individual’s health and wellbeing
Some critics also argue that because CBT only addresses current problems and focuses on specific issues, it doesn’t address the possible underlying causes of mental health conditions, such as an unhappy childhood.
Child Centered Play Therapy is a deeply respectful, heartful and effective form of counseling and psychotherapy for children from 2-10 year old. It is a humanistic Play Therapy modality that provides wonderful opportunities for early intervention with children. Child Centered Play Therapy fosters the child’s innate potential and encourages the unique development and emotional growth of the child.
In this non directive Play Therapy approach, the Play Therapist enters the world of the child, following the child’s lead, developing a safe place and a relationship of trust. Children often have difficulty trying to say in words what they feel and how experiences have affected them. Play is the natural language of children and the toys can be their words. Through the toys, art materials and other things in the playroom, children can express their thoughts and feelings, explore relationships and share about their experiences.
Child Centered Play Therapy helps children work through emotional, psychosocial, developmental and behavioral difficulties and helps address family problems.
Play Therapy sessions are usually held in a therapeutic playroom that has a range of carefully selected toys and materials. Sometimes Play Therapy sessions will be offered in other settings such as in a hospital setting.
In Child Centered Play Therapy, the child selects the toys to play with. The Play Therapist may join in the play on the child’s direction or invitation. Limits are set as and when needed to support the Play Therapy process. This is done in an empathic and respectful way that helps children make choices and develop self responsibility.
In working with a child in Play Therapy, parents / carers are an important part of the process. There is an assessment done by the Play Therapist / Mental Health Professional to determine that Child Centered Play Therapy is recommended. During the process of the Play Therapy, there will be regular contact with the parents/carers by phone and in scheduled meetings.
Play Therapy supports the child’s innate capacity for inner growth, development and healing. It is designed to help children grow up as happy as possible.