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Part 3: Keys to Successful Therapy

Interview w/ Chris Edwards, Clinical Pysch.

Jasmine: So if anyone has Post Traumatic Stress Disorder, they definitely have to go and see a therapist. It's not really possible for them to sort through that by themselves.

Chris: I don't know. We only see the people that don't. And you know, it was once said that people couldn't overcome Obsessive Compulsive Disorder (OCD) without the help of a therapist. But certainly, when I have been lecturing different groups of people, I've heard of relatives of people who have OCD say that they had it, and they got rid of it without seeing anybody. Now I'm sure that the same is true of some of the other Anxiety Disorders. A good example of this is Goethe. Do you know Goethe?

Jasmine: No.

Chris: Goethe was a law student and is a world famous poet. When he was 20 years old, in the 1700s at Salsburg University, he was the first person to cure himself using exposure. Goethe said something like: "I ventured quite alone up into the cathedral spire and sat there for a period before venturing out and looking over the edge." He said "it was as if one was suspended by a balloon with nothing before ones eyes and nothing below. I repeated this so often until the perception became quite different to me." He then said: "I've derived benefits from these practices when going on geological surveys, when running across freeling beams on buildings, when pushing ones way to the front of a crowd for a better view of an important work of art in Rome."

What Goethe was talking about was exposure therapy; but the difference between Goethe and many other people is that Goethe initiated it himself. He was aware that if he did expose himself, that he could get better. Now the other thing about Goethe is that he had a sense of courage. In other words, he had changed his thoughts which allowed him to do it. So, he did his own cognitive therapy first. It's a really nice example.

It is really important because you can have a person who is very courageous in a whole lot of areas of their life and develop panic disorder and that's the only spot where they don't have courage. One of the main goals in therapy is to assist people to develop a sense of courage to work on their panic attacks.

Jasmine: What should a client with an Anxiety Disorder look for in a psychiatrist or psychologist or therapist? How do they know they are going to get someone who is going to help them?

Chris: Three things are important here - rapport, experience and qualifications. As a client you must feel comfortable with the therapist and be willing to work in a collaborative way to achieve a good result. So, if you are not comfortable or disagree with the approach being taken, you need to find a new therapist. People should ask the therapist about their qualifications. Psychiatrists training is fairly uniform, so the question of qualifications is not so important. On the other hand, psychologists have varying levels of qualification. People with Anxiety Disorders most often require assistance from a Clinical Psychologist who will have a Masters degree in Psychology and will most likely be a member of the APS College of Clinical Psychologists.

Jasmine: Are all Psychologists, at this level, trained in Cognitive Behavior Therapy?

Chris: Yes, these Clinical Psychologists will have a good knowledge of cognitive/behavioral therapies and the therapies that flow from them. The third and perhaps most important criteria is the therapist's experience. It is quite appropriate for people to ask their therapist how much experience they have had in treating Anxiety Disorders and how progress is measured.

Jasmine: Also, another problem. Many clients feel they don't have the right to direct their own therapy.

Chris: That's right. Essentially, the first criteria of good therapy is that the person feels comfortable with the therapist. For some reason, because individuals are all different and it might not be the fault of either, a person just might not feel comfortable. So, under those circumstances, they are better off finding someone who they do feel comfortable with. At the end of the assessment period, a person needs to make sure a that a clear model of how the treatment is supposed to work is described to them. Sometimes, they need it in diagrammatic or written form, so that they see what the therapist is trying to achieve.

The next step is that clear goals have to be set. Take, for example, the goal "I want to be relaxed". That's not actually a goal. A more appropriate goal might be that "I want to learn to challenge my thoughts when I experience certain physical sensations." You the know the consequences of the goal might be that the person does relax, but its not always the case. One of the big errors in thinking that people make is that they aren't well unless they are relaxed all of the time.

The next thing that you have to watch is that some things happen in therapy, but the most important things happen between therapy. So there's generally some kind of homework assignment that is set up between therapeutic sessions. There also needs to be a way of actually monitoring changes, so that you know things are working, that you review your progress with your therapist every 2 or 3 weeks. In other words, you problem solve at regular intervals. A good therapist will make sure this happens.

Jasmine: So you keep a diary?

Chris: It may be a diary. It might be a workbook which people fill in specific exercises or it might be a rating of the person's subjective level of anxiety week-by-week. There is a whole range of different ways in which the therapist comes to an agreement with a client in how they are going to measure change in therapy.

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