Friday, July 14, 2017

Check out this therapy plan for tackling stress and depression at work


Thanks to geralt from pixabay
When you go for therapy, a treatment plan is essential for tracking progress and reaching your goals.

Tony Soprano and Adrian Monk visit their therapists for years, talking about themselves and exploring their motivations in order to gain personal understanding. The positive is that it can be very revealing but the downside is that it can take a long time (read: expensive). Also, with a goal as vague as “self understanding”, it can be difficult to track and evaluate progress.

While I can provide that kind of service, I prefer to help my clients develop effective strategies for managing themselves. To do that, I use treatment plans that list goals, therapy strategies and timelines.

Check out how that works by looking at this hypothetical case.  

In our initial free session, Alex has decided to look for therapy because of stress, 
“I get this uptight feeling at work all the time. Every time the boss talks to me, I have this inner voice that says I suck. It’s getting to me so much that I’m having trouble sleeping. Help!”
In our first session, we find the following:
·        History reveals no family history of depression. Current physical health is excellent with medical exam for insurance showing no issues.
·        Alex scores 12 on the PHQ-9 depression inventory, indicating moderate depression. Items scored were low interest, low mood, sleep issues, little energy, feeling bad about yourself.
·        Alex scores 1 on the SBQ-R Suicide Behaviors Questionnaire-Revised, indicating almost zero risk of suicide.
·        The life stress evaluation form (Ellen’s design) highlights the following problem areas: a recent promotion, upgrading of home leading to renovations lasting 6 weeks, minor money budget issues, and upcoming large family gathering. Good solid marriage, nice kids, no issues with in-laws.

After a discussion, Alex decides on these therapy goals:
1.      Help me get over my depression
2.      Get me sleeping again
3.      Stop me thinking that I suck

I then go away, consider everything Alex has told me. I come to these conclusions:

First off, lack of sleep magnifies depression, fuelling the particular symptoms of low interest, low mood, and little energy. If we fix the sleeping problems, some of the depression will lift. It is my priority.

Second, I suspect the depression and “I suck” thoughts stem from pressure of promotion that are magnified by the stressful events at home - the renovations and the big family events. These mean extra money pressures and with the whole family focused on, “What’s new and exciting?” Alex is feeling the pressure to excel. This is a problem because of the recent promotion.

I think that when Alex understands why he’s thinking, “I suck” and learns to stop thinking it, his depressive symptom “feeling bad about yourself” will lessen.  Because of his new promotion, it would also help to give him an overall more secure sense of happiness at work.

So this is my plan:

The Big Picture
Alex is feeling less interest in daily life, is tired all the time and has unsettling “I suck” thoughts at work
Longterm Goal 1: Help Alex get back to an even keel, demonstrated by scoring 3 or lower on the PHQ-9
Longterm Goal 2: Help Alex to stop thinking, “I suck” and replace it with confidence, “I can do this” thinking.
Longterm Goal 3: Help Alex boost his overall happiness at work

#1 Problem Insomnia
Description: Alex can’t fall asleep, lying awake and worrying for hours
Goal: Help Alex go back to falling asleep within 15 minutes of going to bed.
Steps to Achieve Goal:
·        Sleep hygiene evaluation to pinpoint weaknesses and suggest improvements
·        Teach relaxation technique, choose Progressive Muscle Relaxation technique or Visualisation technique
Should take 3 sessions to reach goal

#2 Problem “I suck”
Description: when the boss talks to Alex, Alex’s first thought is, “I suck”.
Goal: Help Alex manage this by stopping the negative thought and replacing it with a positive thought of confidence
Steps to Achieve Goal:
·        We will tackle the “I suck” thoughts with Cognitive Behavioural (CBT) therapy
·        Should take 6 to 8 sessions to reach goal

#3 Problem depression at work
Description: Alex has been promoted and is feeling a little uncertain about his capabilities at work.
Goal: Help Alex boost his overall happiness at work
Steps to Achieve Goal:
·        Use Self Determination Theory to identify and boost areas that are weak: autonomy, competence and relatedness
·        We will identify Alex’s support structure in order to help provide long-term support.
·        Should take 5 to 8 sessions to reach goal

Plan and Schedule

Session
Process
Time and Cost
1
Discover background and broad goals
20 minutes, free
2
Set contract and evaluation
2 hours, RM100/ US$30

Ellen develops therapy plan
Free
3
Insomnia:
·        Sleep hygiene evaluation to pinpoint weaknesses and suggest improvements
·        Teach relaxation technique
Homework: practice relaxation technique
1 hour, RM100/ US$30
4
Insomnia:
·        Check on how relaxation technique is working
·        Practice if necessary
“I suck”:
·        Explain and practice Cognitive Behavioural therapy (CBT)
·        Anticipate and model real life opportunities to practice over the next week
Homework: practice CBT
1 hour, RM100/ US$30
5
Insomnia:
·        Check on how relaxation technique is working
“I suck”
·        Review and practice CBT
Happiness at Work
·        Use Self Determination Theory to examine and boost autonomy, competence and relatedness.
Homework: practice CBT
1 hour, RM100/ US$30
6
Insomnia
·        Should be good now! But check
“I suck”
·        We should be seeing some positive results now from CBT.
·        Review and practice CBT
Happiness at Work
·        Develop support network to underpin successful change
Homework: practice CBT, practice leaning on support network
1 hour, RM100/ US$30
7
“I suck”
·        Review and practice CBT.
Happiness at Work
·        Use Self Determination Theory to examine and boost autonomy, competence and relatedness.
Homework: practice CBT, pay attention to boosting self determination
1 hour, RM100/ US$30
8
“I suck”
·        Review and practice CBT.
Happiness at Work
·        Use Self Determination Theory to examine and boost autonomy, competence and relatedness.
Homework: practice CBT, pay attention to boosting self determination
1 hour, RM100/ US$30
9
“I suck”
·        Review and practice CBT.
Happiness at Work
·        Use Self Determination Theory to examine and boost autonomy, competence and relatedness.
Homework: practice CBT, pay attention to boosting self determination
1 hour, RM100/ US$30
At this point we have done the minimum sessions: 6 of CBT and 5 Happiness at Work
We may need to do 2 more sessions here. But supposing we’re doing great! Then we move on to the final stages.
10
Redo depression inventory
Redo stress inventory
Examine goals and progress
Decide if more sessions are needed
1 hour, RM100/ US$30
11
Follow up two months after
15 minutes, free


Note that this assumes that you are doing the homework and not blowing it off, and that you don’t turn up in session four saying, “Can we just have a chat about my dad who used to beat the hell out of me when I was six?” Of course you can, but then we need a new plan of action to tackle that issue.

If you’re still reading, thanks!  I hope this gives you an idea of how therapy works and how you might use a treatment plan to track progress and effectiveness. It’s also essential for budgeting.

If you want to ask something, or are looking for a counselling psychologist, contact me at happy@lepak.com. 

Wednesday, June 21, 2017

How To Be Happy At Work - When You Don’t Like Your Job


Some of us are lucky enough to have a career that fascinates us. However, there are many more who exchange labour for money so that they can enjoy the other part of their lives. That’s perfectly fine but it can mean being less than enthusiastic about work. And when the job takes up 8 hours a day, 5 days a week, it can quickly become a miserable experience. If this is you, check out this suggestion for you to be happier at work.

While there are lots of different psychological approaches to working on this problem, one of my favourite go-tos is Self Determination Theory.

What is it?
Basically, this is a macro theory that suggests motivation relies on us having three things:
  1. Autonomy - having control over your own life.
  2. Competence - developing skills you are proud of and having them recognised
  3. Relatedness - being part of a team, or at least feeling connected to the people around you
Okay, now if Edward Deci and Richard Ryan ever see this over simplified summary of their forty odd years of research, they’d probably have fits. However, this is a simple blog post and it’s good enough for you to get started.

How do I use it?
Look at your work and analyse your average month.  Then ask yourself questions and use the answers to pump up your happiness potential.

Autonomy
Question 1: At what point in my work do I feel as if I’m Mistress of the Universe? Look for that feeling of control and purpose.
Question 2: What parts of my work mesh with my own beliefs about how life should be?

For example, suppose you work in a customer service centre and feel at the beck and call of faceless others. By asking these questions you might find that your core values include kindness and making a difference. If so, know that each time you help a customer, you are making the world a tiny bit better. If you shift perspective and tell yourself you really are spreading joy, work becomes more joyful.

Competence
Question 1: What do I do that’s fantastic?
Question 2: What do I do okay at that I want to become fantastic at?

Simply put: we love doing things we do well, and we often do well at the things we love. So when you pick a work skill and turn it into your super power, you will get a thrill every time you use that work skill. This pushes up your overall happiness level. Bonus: if you become a true skills ninja, you may be able to get a job you like better!  

Relatedness
Question 1: Do I feel connected to the people around me? And if I don’t how do I make that happen?

For me this is a fundamental part of happiness. People who feel cut off from the world around them fall into despair. There’s no getting away from it: we need to feel connected, even if it’s only to one or two people.

So my advice is, if you can connect to the people you work with in a friendly way, you will feel happier about work. Make friends, and then spread your wings and start connecting with others in your field. LinkedIn is good for that!

If you want more
Like I said, this is a super short blog post that introduces one of the ways you can go about improving your happiness at work.

I’ve made it look like a simple 1-2-3 but clearly there’s a lot more to the theory and what goes into using it in therapy.  This is a conversation starter; it’s not a substitute for proper professional help.

If you are stressed and depressed, and you need help, please do contact me: Ellen Whyte at www.lepak.com

Saturday, June 3, 2017

Check out my feature in Malaysia Womens Weekly

When you've had a shock diagnosis, your thinking can become a bit wobbly. Check out my feature article, "Why we buy quack medicines when we're ill" and the tips on how to cope when someone you love has a health crisis in this month's Malaysia Womens Weekly 



Wednesday, May 31, 2017

Good news - for you!

I've just come back from a long visit to my mum in Spain. It was glorious, and we had a blast. Also lots of pudding with fresh raspberries and blackberries. Yum!


It was lovely but Spain still has a huge unemployment problem (about 20%) which got me thinking about money.  I mean, beyond the fact that I would like to have more of it.

By all accounts, there is a worldwide trend where normal working people get poorer while the 1% gets richer.
Graph from WEF Global Risks 2017 report

The IMF warns that income equality in the USA is getting worse and worse, while the World Economic Forum reports it's not too hot in Europe either

I also get email from people who say they need help but can't afford it. I have several income streams, and I'm doing okay, so for 2017 I'm dropping my prices.

The first discussion lasts about 15 minutes and it's free.
Sessions last about 1 hour and are RM100 by direct deposit and $30 or £25 by Paypal.
The final review session lasts about 15 minutes and it's free.

So if you need help but haven't been able to afford it, email me.  

Wednesday, April 5, 2017

Work versus blog!

I'm inundated in work, and having a blast, but knowing this blog is sitting here is a tad frustrating.

When I started the web site, I said I would not blog, as I didn't want the pressure. But it is one of the best ways to communicate, and as I work with strangers, I caved.

Although I have this feeling that I should write here often, my head tells me my heart is wrong. To be successful, you need to focus on what matters. To me this means: fulfilling my appointments with current clients, and meeting my magazine, newspaper, and novel deadlines.

My head tells me blogging is an extra. If it doesn't happen, it's not a big deal.

My heart kicks in and whines, "But...but... we want to be perfect!"

And that's where stress comes from.

So if you don't see me updating my blog, it's because I'm being sensible.

If you're stressed, why not examine your life and see if there's something you're doing that's not essential? Because being perfect is an impossible goal. Being happy is a perfectly possible goal. You just need to see your head and your heart in context.


Monday, February 13, 2017

Try This Simple Tip When Your Mother In Law Drives You Crazy

When you are so frustrated you want to scream or burst into tears this gives you perspective – without turning you into a doormat.


When you’re in a sticky situation, facts, assumptions and emotions all swirl together, blending into each other. Being upset blinds us to facts. And when we are overwhelmed, we tend to jump to conclusions rather than see what is truly happening. This means we’re likely to make mistakes.

There is an old saying, count to ten. Taking a time out can help. But in complex emotional situations, assumptions and biases can obscure issues. You can count to 10 as many times as you like and you still feel frustrated!

Suppose you are in this situation:

You and your husband had a nice dinner with his sister and her husband. The next morning you get a call from your mum-in-law. “You didn’t invite me!” She calls you insensitive, accuses you of trying to cut her out, and has a complete meltdown.

If this happened, you’d probably feel as if you were a monster. Selfish, unthinking. You might quickly promise never to do it again just to keep the peace. Or you might feel so angry and annoyed that you vow never to see her again. Neither will make life happier for you.

You can gain perspective by retelling the story impersonally. Like this:

Jack and Jan invite Rob and Jasmine for dinner. The next day, their friend Sam calls up, screaming that he feels left out. What do you feel now?

If you take away the factors of age and family, you’ll see that this situation isn’t about you or about dinner. Sam clearly has issues he’s trying to push onto jack. Your mum-in-law has issues of her own that she’s pushing on to you.

These issues might include control, loneliness, competition, and more. Whatever is at the root of their behaviour, perspective can help you make better decisions. Like in this example, common sense suggests that if you give in, you run the risk of having to live your life according to their rules – which they will change to suit them. That is going to be very stressful.

A sensible approach is to acknowledge their feelings, without being drawn into discussing who’s right or wrong. For example, “I’m sorry you feel left out.”

You don’t need to promise never to do it again. It’s tempting sometimes – just to keep the peace – but it’s reasonable for you to see your friends. So in future, when you’re in a sticky emotional situation, take a breath, step back and recast events in the third person. Tell yourself a story stripped of emotion. Then examine it again.

It can help you gain perspective – and in turn that can help you come up with better ways of coping that keep the peace with even the trickiest mother-in-law, without turning you into a doormat.

I wrote this originally for Malaysia Womens Weekly. Check it out, and enjoy!

Monday, February 6, 2017

Secret Clues Someone You Love is Dangerously Depressed

Especially in stressful times like these, when the world economy seems stagnant 
and the future is far from clear.

Thanks to RyanMcGuire @ Pixabay

Depression can show itself in many different ways: feeling sad or blank for days at a time, being dead tired and not taking joy from favourite pastimes are classic signs. But depression can also reveal itself in unusual ways. 

These are clues to watch for in the people you love – and in yourself. If you spot these symptoms, approach the subject gently, and talk to a professional therapist or doctor about getting a diagnosis and formulating solutions that work for you.

#1 Ragged nails and messy hair
Uncombed hair, smelly skin, ragged fingernails – it might look like a person is just being careless or disrespectful, but depression can also cause self-neglect. So if someone used to be clean and tidy but now they live in unhygienic surroundings or don’t eat properly it can be a clue that they’re clinically depressed.

#2 Sudden Anger
We often assume a depressed person is withdrawn and quiet. But sadness can sometimes surface as rage. Typically, it’s a rapid angry reaction that’s unreasonable and out of proportion. It’s happens when feelings of guilt, rejection and loss get so bottled up that they erupt as sudden anger – watch for it especially if stress as well as depression are involved.

#3 Working Way Too Much
Faced with intense dark feelings, some people try to avoid these emotions. They might sleep too much, take drugs, or drink too much, but some bury themselves in work. The problem with this symptom is that we often perceive working long hours as being ambitious or trying to provide for a family. So look for other clues: does this behaviour typically seem more like a compulsion? Perhaps he’s clearly exhausted yet he’s up every night trying to finish that report? Or she escapes into her email inbox the second you try to talk to her about her worries.


#4 Forgetting Ordinary Tasks
Depression can make it very hard to concentrate – depressed people tend to forget all kinds of weird things, from leaving their keys in the fridge to leaving the milk out in the hall again. Or they may often forget appointments or constantly be late. Forgetting things is a tricky depression symptom to spot because stress can also make people forgetful – it’s like the brain is just too “full” with worry to remember much. So look for other clues as well, like….

#5 Not being able to make even small decisions
Depression can go hand-in-hand with hopelessness. People get the idea that no matter what they do, it will all go wrong. Victims of depression get wrapped up in thoughts of the bad things to come, that they become unable to make even a tiny decision. Shall I get out of bed? What to have for breakfast? What shall I wear?… it’s all too much. They become apathetic and almost paralysed by indecision. You can go out to work and come back hours later… and they’re still in bed.

#6 Too Much Partying
Dancing on the tables can just be high spirits, but it can also be a form of distraction. If you don’t want to face your dark feelings or you’re frightened of feeling “numb”, it’s tempting to distract yourself by drinking too much or burying yourself in frantic activity. But instead of going out feeling like fun, it feels like desperation, and there’s an undercurrent of hopelessness.

This article written by me, Ellen Whyte, originally appeared on Malaysia Womens Weekly.