What Do Clients Find Most Helpful About Therapy?

When clients first begin their therapy journey, they often ask to be taught specific skills that are going to help them achieve their particular goals.

Clients believe that if they can be taught these skills, they will be able to overcome their difficulties or the problems that led to them entering therapy, and they will have no subsequent complications or need for additional treatment going forward.

Cognitive Behavioural Therapy (CBT) is a short-term treatment that clients can easily understand. It is based on the premise that all difficulties arise from unhelpful cognitions (beliefs, expectations, assumptions, rules and thoughts) and unhelpful behaviours. CBT aims to help clients see that their cognitions and behaviours are unhelpful, and tries to teach them skills that can help them to replace these unhelpful cognitions and behaviours with more helpful ones. If this is achieved, the assumption is that clients will change and therefore improve.

I do believe that if a client is able to have more helpful cognitions and behaviours, then they will have significantly improved psychological health and overall well-being. I’m just not sure if I agree that the process that is required to get to this outcome is the same as what many CBT clinicians would believe. In fact, focus on distorted cognitions has actually been shown to have a negative correlation with overall outcomes in cognitive therapy for depression studies (Castonguay, Goldfield, Wiser, Raue, & Hayes, 1996).

What actually leads to improvements in treatment?

My previous article “What Leads to Optimal Outcomes in Therapy?” answers this question in detail and shows that the outcome is dependent upon (Hubble & Miller, 2004):

  • The life circumstances of the client, their personal resources and readiness to change (40% of overall outcome variance)
  • The therapeutic relationship (30% of total outcome variance)
  • The expectations about the treatment and therapy (15% of global outcome variance)
  • The specific model of treatment (15% of overall outcome variance)

For cognitive therapy for depression, both therapeutic alliance and the emotional involvement of the patient predicted the reductions in symptom severity across the treatment (Castonguay et al., 1996). Many therapists are now aware of these findings, but clients are generally not.

What do clients view to be the most valuable elements of therapy once they have improved?

By the end of treatment, especially if it is a successful outcome, clients tend to have a much different outlook on what they think are the most valuable aspects of therapy when compared to what they were looking for at the beginning of their treatment.

In Irvin Yalom’s excellent and informative book ‘The Theory and Practice of Group Psychotherapy’, he goes into detail about a study that he conducted with his colleagues that examined the most important therapeutic factors, as identified by 20 successful long-term group therapy clients. They gave each client 60 cards, which consisted of five items across each of the 12 categories of therapeutic factors, and asked them to sort them regarding how helpful these items were across their treatment.

The 12 categories, from least helpful to most helpful were:

12. Identification: trying to be like others

11. Guidance: being given advice or suggestions about what to do

10. Family reenactment: developing a greater understanding of earlier family experiences

9. Altruism: seeing the benefits of helping others

8. Installation of hope: knowing that others with similar problems have improved

7. Universality: realising that others have similar experiences and problems

6. Existential factors: recognising that pain, isolation, injustice and death are part of life

5. Interpersonal output: learning about how to relate to and get along with others

4. Self-understanding: learning more about thoughts, feelings, the self, and their origins

3. Cohesiveness: being understood, accepted and connected with a sense of belonging

2. Catharsis: expressing feelings and getting things out in the open

1. Interpersonal input: learning more about our impression and impact on others

The clients were unaware of the different categories, and only rated each of the 60 individual items concerning how helpful it had been to them.

What becomes apparent when looking at these categories is that giving advice or suggestions about what to do is often not found to be a beneficial element of the therapy process, even though this is precisely what most of the clients are initially looking for. What is far more important is the client developing a more in-depth knowledge of themselves, their internal world, and how they relate to and are perceived by others in interpersonal situations.


The top 10 items that the clients rated as most helpful were (Yalom & Leszcz, 2005):

10. Feeling more trustful of groups and of other people.


9. Seeing that others could reveal embarrassing things and take other risks and benefit from it helped me to do the same.


8. Learning how I come across to others.


7. Learning that I must take ultimate responsibility for the way I live my life no matter how much guidance and support I get from others.


6. Expressing negative and/or positive feelings toward another member.


5. The group’s teaching me about the type of impression I make on others.


4. Learning how to express my feelings.


3. Other members honestly telling me what they think of me.


2. Being able to say what is bothering me instead of holding it in.


1. Discovering and accepting previously unknown or unacceptable parts of myself.

Each of the 20 clients that made up these survey results had been in therapy for an average of 16 months and were either about to finish their treatment or had recently done so. Obviously, these items were about group therapy so the most important factors for change in individual treatment may be different. However, even with individual therapy, Yalom believes that in the end, it is the relationship that heals.

For more information, feel free to check out Chapter 4 in ‘The Theory and Practice of Group Psychotherapy’ by Irvin Yalom and Molyn Leszcz (2005), or any of the other studies out there that look into the outcomes or therapeutic factors involved in change across psychological treatment.

If you have ever wanted to discover and learn more about yourself, accept yourself more, express yourself better, take greater responsibility for your life, challenge yourself and develop more trust in others, longer-term psychological therapy may be just what you need!


Dr Damon Ashworth

Clinical Psychologist

How Have Intimate Relationships Changed Over the Years, and Where Does It Leave Us Now?


I just finished reading the book ‘Modern Romance: An Investigation’ by Aziz Ansari and Eric Klinenberg and was pleasantly surprised to see such a well-researched book written predominantly by a Stand-up Comedian (with a helping hand from a Sociologist).

For those of you who don’t know Aziz, his stand-up shows typically consist of interesting observations about relationships, as does his new series ‘Master of None’.

Considering that I’d already seen and liked both his stand-up and his show, I was definitely intrigued to see his name next to a book about Modern Romance in my local bookstore. Here’s what his research found:

How Has Dating Changed?


1. Distance

Back in 1932, a Sociologist named James Bossard examined 5000 consecutive marriage licences in the city of Philidelphia, USA, and looked into how close the partners had lived to each other before they married. Here’s what he found:

  • Same address – 12.64%
  • Same block – 4.54%
  • 1 to 2 blocks – 6.08%
  • 2 to 4 blocks – 7.3%
  • 4 to 10 blocks – 10.16%
  • 10 to 20 blocks – 9.62%
  • 20+ blocks – 17.8%
  • Different cities – 17.8%

This means that more than one-in-two individuals in Philidelphia in the 1930s were likely to marry someone who was already living in a ten block radius to them. More than one-in-six didn’t even have to cross the road to find the partner that they decided to spend the rest of their lives with.

Other Sociologists looked to see if this pattern remained in smaller towns, and found that it did whenever suitable marriage partners were available. John Ellsworth Jr., who examined marriage patterns in a Connecticut town of less than 4,000 called Simsbury declared:

“People will go as far as they have to to find a mate, but no farther.”

While this quote may still be somewhat applicable in modern times, it does seem that we are much more likely to date people of different origins, cultures and addresses to us, rather than settling down with someone who lived on the same street.


2. Places

Where we meet our romantic partners is much different too. Sociologist Michael Rosenfeld’s survey ‘How Couples Meet and Stay Together’ asked over 3,000 Americans adults of all ages when and how they met their spouse or romantic partner. Because the age of the respondents all differed, it made it possible to see how this had changed over the years between 1940 and 2010. Here’s what he found:

  • In 1940, the most common way couples met was through family (approximately 25%). The second was meeting through friends (21%), followed by meeting in church (13%), and being neighbours (12%).
  • In 1950, meeting via friends had become the most popular method to meet someone (approximately 26%). Meeting through family was still popular (24%), and was a clear second. Meeting in a bar or a restaurant (14%) was becoming more popular, and meeting at work (12%) or being neighbours (12%) was now more popular than meeting at church (10%).
  • In 1970, meeting through friends was now easily the most preferred method to find a partner (approximately 31%), with matching through family (20%) now being challenged by meeting at a bar or restaurant (18%). Meeting at work was fourth (15%), followed by neighbours, church and college.
  • In 1990, meeting through friends was just below 40%, finding your partner at work was now second (20%), followed by meeting at a bar or a restaurant (18%). Meeting through family and being neighbours had declined as ways to find a partner, and more people were meeting in college, presumably because more people were also going to college, and studying for longer. Some early-adopters were starting to date online too, but this was still the least favourite method of meeting potential partners.
  • Fast forward to 2010, and meeting through friends was still the most common way couples met, but it was under 30% for the first time since 1960. Meeting at a bar or restaurant was now fighting with meeting online for the 2nd most popular method, with both around 20% (for same-sex partners, meeting online was already the most popular option in 2005, and was up to about 70% by 2010). Meeting at work, meeting through family, being neighbours and finding dates through the church was now much less popular as ways to meet someone, and even meeting at college was beginning to decline. All thanks to the rise of the internet!

In a separate study looking at how Americans met their spouses between 2005 and 2012, Psychologist John Caccioppo found that more than one-in-three married couples met online (34.95%), which was more than work (14.09%), friends (12.4%) and a bar or club (5.68%) combined. All of the recent advances in technology, especially the internet and smartphones, really has changed the dating scene dramatically, including how we meet, who we meet, how many potential partners we can meet, and even how we communicate with each other.


3. Communication Methods

The first text ever was by a British engineer called Neil Papworth in 1992. It’s crazy to think how much this form of communication has grown in only 24 years. In 2007, text messages began to outnumber phone calls made in the US each month, and in 2010 approximately 200,000 texts were sent around the world each minute. Since 2010, the amount of people owning smartphones has dramatically increased, rising from 17 percent in 2010 to 58 percent in all American adults in 2014, and to 83% for those between the ages of 18 and 29. With greater smartphone use comes an increasing use in apps such as Facebook Messenger, WhatsApp and Viber, which only further increases the number of instant messages that are being sent in comparison to phone calls being made.

Calling vs Texting vs Face-to-Face?

First Dates

Seeing that text messages have been a more popular way of communicating since 2007, does this mean that it is now okay to text someone to ask them out on a first date?

  • In 2010, only 10% of adults under 30 used texts to ask someone out for the first time.
  • By 2013, a Match.com survey found that this number had increased to 32%, with face-to-face still leading the way with 37%, a phone call less popular at 23%, and e-mails virtually non-existent at 1%.
  • For adults over 30, this same Match.com survey found that a phone call (52%) was definitely the most likely method of communication when asking someone out on a date, followed by face-to-face (28%), text messages (8%) and e-mail (7%).

In the focus groups that Aziz and Eric ran about whether to phone or text, older females tended to appreciate phone calls and saw them as a sign of confidence and something which helped separate the person from other potential suitors. It also helped them to feel more safe and comfortable with going out on a date with someone that they may not know very well.

Younger females seemed just as afraid to receive phone calls as what younger males were in making them. They preferred not having to respond on the spot and being able to have time to think of a witty or genuine reply or to not even reply at all if they weren’t interested, and texting provided them with these options.

Breaking Up

What about breaking up – can this too be done via text without having to see the reaction of the heart that you are potentially breaking? It sure sounds more comfortable, but is it socially acceptable?

  • In a 2014 survey of 2,712 18- to 30-year-olds, 73% said that they would be upset if they were broken up with via text, social media or email.
  • In this same survey, out of those who had ended a relationship in the previous 12 months, 25% had used text, 20% had used social media, 18% had split face-to-face, 15% had broken up through a phone call, and 11% had used email.

With texting, those who had used this method to break up said that they did so because it was “less awkward” and easier to be “more honest.” I still think that it is wrong to end a long relationship over text, no matter how much easier it may be. Even though the majority of young adults still agree with me, their actions actually say the opposite. It’s only a matter of time before their attitudes begin to change in regards to this too.

Texting Guidelines for Dating:

  1. Do not just say “hey”, “hi”, “what’s up?”, “what’s going on?”
    • Generic messages like this tend to be a real turn-off for some people, especially females that receive a lot of texts like this from several different guys. It is much better to ask a specific question about them or something that refers back to the last time that you spoke.
  2. Do not just engage in endless banter that never leads to a real world catch-up.
    • Endless banter gets boring eventually, and older women, in particular, have less patience for constant text exchanges.
  3. Do not just ask someone if they want to “hang out sometime?”
    • It’s confusing as to whether hanging out is a date or just friends, and it may never lead to an actual date. Instead, invite them out to a particular event, or ask them to meet you at specific time and place.
  4. Do try to proof-read your text messages for correct grammar and spelling.
    • This is often a major turn off, as is shortening words or using text-slang. Determine the audience first, but if unsure, stick to “tonight” rather than “2nite”.
  5. Do use a bit of playfulness and humour, but with caution.
    • Make sure that you have a similar sense of humour before engaging in anything too risky or crude, and remember that it can be challenging to pick up on tone in text messages.
  6. Follow the other basic rules around texting:
    • Wait a while to text back instead of doing it right away, especially early in the dating process. Waiting a while implies that you have a busy life, and also builds the suspense, which can increase emotional intensity and a sense of attraction in the person who has to wait.
    • If you have already sent a text, do not send another message to the same person until you hear back from them unless it is an absolute emergency.
    • Write a similar amount in your texts to what the other person does. If you increase it slightly, they should too if they like you due to our tendency to reciprocate. If they do not, then this may mean that they are not aware of the cultural norms around texting, or they are just not that into you.
    • If you are not interested, others will tell you to be upfront and honest with them, but most people actually either pretend to be busy or stop texting back.


4. Expectations

When choosing a partner, it seems that our expectations of what the other person needs to provide us have continued to increase over the past 50 years:

  • Before the 1960s, most people were happy enough with settling for a “companionate” or good-enough marriage. People didn’t spend forever looking for passion and love (even though this may have developed over time). In fact, many people saw passionate love as too volatile or irrational a thing to use as the basis for whether or not they should marry someone.
  • When looking for a prospective husband back in 1939, men with a dependable character, emotional stability, maturity and a pleasing disposition were all more highly sought after by women than men whom they felt mutual attraction and love for.
  • Even by the early 1960s, 76% of women were willing to marry a man that they didn’t love.

    “Marriage was an economic institution in which you were given a partnership for life in terms of children and social status and succession and companionship.” – Esther Perel

  • When looking for a prospective wife in 1939, men also highly valued emotional stability, maturity, a dependable character and pleasing disposition, and interestingly also appreciated ambition and industriousness over mutual love and attraction.
  • By the early 1960s however, only 35% of men admitted that they were willing to marry a woman that they didn’t love. This is presumably because they already had more legal rights and financial freedom, and weren’t looked down upon as much for moving out of the house and enjoying single life before getting married.
  • By the 1980s, things had definitely changed, with 86% of men and 91% of women in the US saying that they needed romantic love to marry someone.
  • In 2008, mutual love and attraction were now rated as the #1 factor that both men and women looked for in a prospective partner or spouse.

No longer do people settle just settle for companionship or what is good enough. We also want passion and the perfect life partner who completes us, gives us belonging and identity, mystery and awe, and makes us happy. Some people even declare that they are looking for their soul mate, and refuse to settle for anything less.

This search for the perfect partner seems to take a lot of emotional investment, trial and error, potential heartbreak, and much stress and indecision. If we do actually find our soul mate, the potential pay-off should theoretically be much higher than it is for an old-fashioned “companionate” marriage. However, with more possible options available to us, and so much higher expectations regarding what we are looking for, how are we ever meant to know if we have found the one, or if we should settle down and get married?


5. Marriages

At what age do we get married?

From 1950 until about 1968, the average age of first marriages in the US was about 20 for females, and 23 for males. In the mid-1970s this age started to rapidly increase until it briefly stagnated at about 24 for women and 27 for men between 1999 and 2004. It then began to rise again to about 27 for females and 29 for males in 2014. In bigger cities such as New York, this number is now thought to be over 30 for both males and females.

After how long do we tend to get married?

Before the 1960s, the average couple wed after just six months, according to Stephanie Coontz, author of ‘Marriage, A History’. The dating period, as well as the engagement period, tend to be much longer these days, with some couples even choosing to live together in a de-facto relationship without ever marrying.

Do we even need to get married anymore?

Before the 1960s, getting married, buying a house, and moving out of the parental home was the first significant steps after adolescence that signified the transition to adulthood. Single women rarely lived alone, and many families discouraged their daughters from moving into shared housing with other girls who were working. Their parents were heavily involved in all of their decisions, even who they dated, and typically always knew about their whereabouts.

Women of previous generations would sometimes get married just to get out of the house and get their first taste of adulthood and freedom. However, once married, they were not really more free to do what they wanted, instead of having to depend on their husbands for legal and financial purposes whilst being fully responsible for looking after the house and the children.

Although things still aren’t fully equal with men and women, with women typically earning less and having to do a greater proportion of the housework and child-rearing, they have been given equal legal rights regarding property and divorce. This, alongside the greater acceptance of various lifestyle choices, including being able to move out without getting married, either to live alone, with friends or with a partner, has made it so that marriage is now a choice, rather than a necessity.

6. Choices

Thanks to the advances in technology, we now have more potential options available to us at the click of a mouse or swipe of a button than we have ever had before.

Thanks to the greater rights and freedom provided to most women in Australian culture, we also have a new developmental period between adolescence and adulthood called emerging adulthood (ages 18-29). This is a phase where people are able to go to university, start a career, travel, move around a bit, and have some fun and relationship experiences before settling down and getting married.

During emerging adulthood, we end up greatly expanding our pool of potential romantic partners. Once you include online dating and other apps for meeting people, the number of possible partners grows exponentially, especially in bigger cities like Melbourne.

But does having more choices make it easier to find “the one”?

Research on the paradox of choice would suggest not. As I’ve already mentioned in a previous post, Barry Schwartz, a Psychologist, describes an experiment that was done at a supermarket where they offered 24 different samples of jelly (jam) to customers on day one, and only 6 different samples of jelly on day two. The day with only six options outsold the day with 24 possibilities by ten times the amount.

Too many options lead to indecision and paralysis, as well as higher discontent after a decision has been made. So before you are searching for a partner, especially if it is online, do make sure that you have a sense of what is truly important to you, and what is not, and try to limit your search to these options. Then if you find someone who seems to be alright, give them a real chance before moving onto the next one. You’re likely to be more satisfied on a long-term basis if you do.


Dr Damon Ashworth

Clinical Psychologist

My Top 5 Psychology TED Talks


In order of least views to most, I will present my favourite TED talks, along with a brief description of what they are about, why I think that they are great and where you can find out more information about these concepts if you are interested. Enjoy!

5. The Surprising Science of Happiness by Dan Gilbert  (13 million views)

Summary: Human beings are the only animals that are able to simulate experience and imagine what something will be like before we do it. This capacity to visualise future experiences is a helpful tool to have and is one of the main reasons why humans have been able to make all of the advances that we have since the industrial revolution. Our experience simulator does have its limitations, however, and is often not accurate due to what is known as an impact bias.

An impact bias is the tendency to overestimate the impact that a future event will have on our emotional life and overall levels of happiness. The most striking example, which I’ve previously mentioned in another article, is that 12 months after becoming a paraplegic, or 12 months after winning the lottery, an individual’s level of happiness is usually the same as what it was before the event took place. This is the same with activities such as weight loss, moving houses, relationship break-ups and infidelity, and getting a promotion at work. Whether it is a positive or negative event, they will consistently have less impact, less intensity and lesser duration than what people will expect them to have.

When things work out the way that we want them to, this is known as Natural Happiness, and most people understand why someone is happy. It makes sense. What doesn’t make sense is Synthetic Happiness, which is the happiness that is created by our “psychological immune system” when we don’t get what we want. Research has shown that even though other people respond to examples of Synthetic Happiness with a “yeah right!” response when they hear about it, it is every bit as real and as enduring as Natural Happiness.

What I liked about it: Even when things don’t go as planned or we don’t end up getting what we want, most of the time our “psychological immune system” will step into action and help us feel pleased not in spite of, but because of what has occurred. While most of us might picture ourselves being miserable if things don’t work out, the truth is that we will generally be okay, so don’t spend too much time fretting over all of the bad things that may occur in the future. Humans are amazingly resilient, even in the face of the worst possible outcomes.

On the positive side, we should also try not to sacrifice too much good stuff (fun, leisure, play, excitement, adventure) in the here and now for that eventual pay-off that is likely to be less rewarding and less enduring than you imagine. It is much better to create the type of life that we want now than always putting it off until a later date (after I finish studying; after I get married; after I retire; after I lose weight etc.).

If you’d like to learn more: Read the book ‘Stumbling on Happiness’ by Dan Gilbert.

4. The Power of Introverts by Susan Cain  (14 million views)

Summary: Our society, especially in the West, tends to value being social and outgoing, or being an extrovert, above all else. An extrovert is someone who craves large amounts of stimulation, both environmentally and socially, to feel most alive and capable. Introverts, on the other hand, tend to feel most comfortable, switched on, energised and creative when they are in low key or isolated environments.

The key to maximising everyone’s talents is to find the level of stimulation that is best for each individual. However, our schools and workplaces and even our social settings tend to be set up to allow the extrovert to thrive, which only further disadvantages the introvert and diminishes their performance, confidence and level of well-being. Introverts often feel different from mainstream society or ashamed of who they are, but between a third and a half of all individuals are introverted. It’s just that they are often quieter, and tend to get lost in the crowd.

What if instead of trying to force introverts to thrive in an extroverted world we could instead diversify things so that we are appealing to everyone’s strengths. What if each student and worker could study and perform in the environment that best suited them? Introverts often have talents and abilities in the areas where extroverts are the weakest, so accepting, encouraging and celebrating the strengths of introverts as well as extroverts would actually help society to flourish better as a whole.

What I liked about it: Growing up I always knew that I became overstimulated and struggled to perform at my best in loud, busy environments. I hated going out to clubs on the weekend and tended to enjoy smaller gatherings to large crowds or festivals. I even found large lectures to be much more difficult to concentrate on than a small tutorial or studying at home by myself. Some of my favourite pastimes include spending a big chunk of time by myself relaxing, reflecting and/or reading a book. I love excitement and adventure too, so may be considered to be an ambivert, but definitely need my quiet times to recharge and keep functioning at my best. Accepting myself for who I am and working with my strengths is much better than trying to force myself to be like someone else or whatever it is that society values the most.

If you’d like to learn more: Read the book ‘Quiet: The Power of Introverts in a World That Can’t Stop Talking’ by Susan Cain.

3. The Power of Vulnerability by Brené Brown  (24 million views)

Summary: Brené Brown is a social worker who has spent her career studying human connection, imperfection, shame, fear and vulnerability. She believes that human connection is why we are here on this planet, and it is what gives us meaning and purpose in life. She says that what prevents us from being able to truly connect with others is shame and fear and that to connect, empathise, belong and love we need to be truly seen, which takes extreme courage and vulnerability. It is possible to be worthy of love, connection and belonging without being perfect. We just need to be compassionate towards ourselves and believe that we are worthy. While it may seem appealing to be certain or to not be afraid before we act, it is actually through leaning into the discomfort, embracing vulnerability, and having the willingness to take emotional and social risks that we will find the most rewarding experiences and deepest levels of connection.

What I liked about it: Not only does Brené Brown talk about vulnerability, but she also leads by example by opening up about her own struggles with vulnerability. She shows that life isn’t about waiting until we’re perfect or bulletproof before we act upon something or try something out, as seductive as infallibility may be. If we don’t take risks or be vulnerable, the quality of our relationships are sacrificed, and we miss out on opportunities that we may never be able to get again. When we are vulnerable, we don’t waste our precious time or turn our backs on our potential strengths. We manage to connect with others and contribute in a way that is uniquely ours.

If you’d like to learn more: Read the book ‘The Gifts of Imperfection: Let Go of Who You Think You’re Supposed to Be and Embrace Who You Are’. Even better is the book ‘Daring Greatly: How the Courage to Be Vulnerable Transforms the Way We Live, Love, Parent, and Lead’ by Brené Brown.

2. Your Body Language Shapes Who You Are by Amy Cuddy  (33 million views)

Summary: It has been known for quite a while that our body language impacts how others perceive us to be and how successful our interactions with others are. Amy Cuddy has researched our nonverbal behaviour further and shows that this can also impact our thoughts, feelings, hormone levels and subsequent behaviour. By holding any two of the five “power poses” shown in the talk for only 60 seconds each, it has been shown to increase testosterone levels and feelings of power while reducing cortisol levels and feelings of stress. If done before important meetings, speeches, exams, job interviews or other stressful occasions, it may even change how you perform, and how successful you eventually become. Like Amy says, power posing allows us to “fake it until we become it!”

What I liked about it: The concept of power posing brings about all types of possibilities for helping people with anything that they usually lack confidence in or feel a high degree of stress doing. If only 2 minutes of power posing can increase their likelihood of success, then it is something that should be taught everywhere, from homes to schools to workplaces. In the last chapter of Amy Cuddy’s book ‘Presence’ she includes some examples of people (and even horses) that have successfully applied power posing in their lives.

The Imposter Syndrome is another critical issue that Amy touches on during her talk, and it is an experience that a lot of us (between 60-70%) have at one point or another in our life. I know that I did when I first made the state Volleyball team as a junior and when I first started studying my Doctoral Psychology degree. The Imposter Syndrome is where people feel like they are a fraud or that they shouldn’t be in the position that they are in because they “don’t deserve it” and/or that “somebody has made a mistake”. They worry that although they have been able to convince people so far of their capabilities, it is really just a matter of time before people catch them out for the imposter that they really are. Realising just how common this is, and that in time it can go away, would provide hope to anyone watching who is going through a similar experience.

If you’d like to learn more: Read the book ‘Presence: Bringing Your Boldest Self to Your Biggest Challenges’ by Amy Cuddy.

1. Do Schools Kill Creativity? by Sir Ken Robinson  (38 million views)

Summary: Our current Education system is outdated and fails to adequately prepare the children of today for the uncertainty and unprecedented growth that is likely to take place in the future.

The current hierarchical structure of subjects tends to place maths and languages at the top, followed by the humanities, and then the arts. Even within the arts there exists a hierarchy where art and music are considered to be of a higher status than drama and dance.

Somehow as we go up in school levels, the creative pursuits are pushed aside, devalued and even stigmatised instead of the more serious subjects that are supposed to ready us for the workplace. But schools are still preparing us for the needs of industrialism, not for the rapidly evolving society where we are not even aware of what is ahead of us in five years time, let alone what the world will be like in 2065.

Wouldn’t it be better to help each child to utilise their creativity in figuring out where they are most “in their element”, and encourage them to pursue a career that is consistent with both their strengths (what they are good at) and their passions (what they enjoy)?

What I liked about it: Considering that we’ll never exactly know what it is that we are preparing students for, teaching them to be curious, creative, innovative, flexible and resilient should be at the top of the list of the skills to help develop in children. If we can do this, then no matter what takes place in the future, the children of today will be in the best position to adapt, grow and evolve.

We should also let go of thinking of intelligence so narrowly and see that it is diverse, dynamic and distinct. We should start looking for and nurturing the unique capacities of each child instead of trying to force them into becoming A+ Maths and English students. Ken uses an example of Gillian Lynne, who at 8 years of age was diagnosed by her school as having a learning disorder, or what would these days be labelled as ADHD. Nowadays she would likely be put on Ritalin to help reduce her restlessness and remain focused in class, but luckily the specialist that she saw noticed her need to move and dance to music and told her mother to enrol her in a dance school instead. Gillian did this, began to flourish, and went on to choreograph “Cats” and “Phantom of the Opera”, entertaining millions, and making millions in the process.

If you’d like to learn more: Read the books ‘The Element: How Finding Your Passion Changes Everything’ and ‘Finding Your Element: How to Discover Your Talents and Passions and Transform Your Life’ by Ken Robinson and Lou Aronica.

Feel free to comment about which ones you liked the best, or if there are other TED talks that you would have included in your list.

Dr Damon Ashworth

Clinical Psychologist

Why Psychopaths Sometimes Succeed, and How You Can Too!

Q: What do James Bond, Dexter Morgan, and Hannibal Lecter all have in common?

Apart from being fictitious characters, they are all fascinating to their millions of fans, and they are all Psychopaths. They all kill without any remorse and do what is required to be done to get what they want.

The main difference is that Bond does not break the law and has a moral code, killing for The Queen and His Country. Dexter breaks the law but follows his moral code, and kills other serial killers for society and the city of Miami’s benefit (most of the time anyway). Hannibal breaks the law and has no moral code, killing whomever he pleases, especially those with poor manners.

What is a Psychopath?

Research and Theory suggest that a Psychopath has notable differences to regular individuals in four areas of life, including:

  • Interpersonal:
    • being able to lie and manipulate others with ease and without being caught
    • being tricky or sly
    • enjoying conning people without feeling “shaky” while doing it
      • essentially being deceptive with minimal difficulty
  • Affective:
    • being rude and unkind to others
    • being selfish and putting themselves first
    • not being afraid to hurt or step on others to get what they want
      • essentially no remorse, guilt or empathy
  • Lifestyle:
    • breaking rules
    • engaging in dangerous activities for the thrill of it
    • putting their own enjoyment before their commitments
    • choosing to not pay for services
      • essentially being undependable, reckless and impulsive
  • Antisocial:
    • stealing
    • breaking into buildings and/or cars
    • hanging out with gangs and/or other criminals
    • vandalism
    • being arrested
      • essentially breaking the law

Psychopathy, like most things in life, exists on a continuum. While the dangerous psychopaths, such as serial killers, get the most press and infamy, there are many seemingly successful people out there in society who display many of these same psychopathic personality characteristics, without the lawbreaking behaviours.

Cooke and Michie (2001) argue that psychopathy only incorporates three correlated factors, including the interpersonal, affective and lifestyle factors, disregarding the antisocial features that are commonly thought to be a core factor of psychopathy. Conversely, Hare (2003), the author of the Hare Psychopathy Checklist that is typically used to diagnose Psychopaths, believes that these antisocial characteristics are an essential element and a fourth factor that is necessary for the diagnosis of psychopathy.


Is there such a thing as a ‘Good Psychopath’?

If antisocial behaviours are not essential for the diagnosis of Psychopathy, or if these antisocial tendencies can be directed towards prosocial goals, it may be possible that someone who displays many psychopathic personality traits could, in fact, use them for good. Some researchers say that up to 1% of the population could be considered Psychopaths, suggesting:

  • They may be the company CEO, who is able to make the tough call to buy out another company for millions of dollars or fire a hundred staff members in the afternoon without batting an eyelid.
  • It could be the Special Forces Agent who is able to assassinate an enemy without feeling any fear or remorse.
  • Or it could be the neurosurgeon who is able to keep a steady hand and relaxed mind even though they know that one wrong move can potentially lead to permanent brain damage or death for the patient.

Whatever their role, they are able to focus on the task at hand and do what needs to be done in any given moment because it is in their best long-term interest as well as their group, company or organisation and/or the customer, shareholder or patients.

Dr Kevin Dutton and Andy McNab refer to these individuals as ‘Good Psychopaths’, and in their book ‘The Good Psychopath’s Guide to Success’, they believe that many lessons can be learned from these individuals that can help all of us to get the most out of our lives.


The following list is traits that Good Psychopaths have that anyone can develop and train over time.

Good Psychopaths:

1. Deliver what they promise, regardless of what it takes, rather than back out due to fear or excuses

Good Psychopaths do what is needed, and go for what they want. They know how to win, and switch on when it matters most and the pressure is on. They get things done when they say they will rather than putting things off and procrastinating. Procrastination uses up a lot of mental resources and is an emotional coping strategy wrongly applied to a practical task. It drains willpower quickly, which is a finite resource. Good Psychopaths instead focus on the reward that comes from completing the job and are motivated by this. They don’t try to waste time being afraid or providing reasons for why they haven’t done it yet. They just do it.

2. Take responsibility for their own actions

Good Psychopaths are not deterred by failure or the punishment of making mistakes and instead focus on the rewards of success. They step up and nail it when the pressure is on and when it really counts.

3. Are true to themselves and what is best for them rather than trying to please others

Good Psychopaths have immense self-belief and act as their own person regardless of what everyone is doing or what everyone else wants them to do. They know everyone can’t be pleased, and therefore focus on what is under their control and likely to make them happy. They don’t care if they stand out from the crowd and never vote against themselves.

4. Take punishment and negative consequences as they come rather than running away

Good Psychopaths take it on the chin when they have done something wrong, focus on what they did well, accept the consequences, and then do what needs to be done rather than beat themselves up with self-criticism, guilt or shame. They don’t have regrets and see every mistake as a minor setback and an opportunity to learn, rather than an unchangeable character flaw that they will never be able to overcome. Once they have learned what they can from their mistake and accepted the consequence, they make a plan to not repeat the same mistake again, and then let it go.

5. Move on swiftly after setbacks or disappointments, rather than dwelling on the past

Good Psychopaths do not get stuck in obsessing over what went wrong and wishing that they could turn back time. Once their plan is in place to prevent committing the same error in a similar situation in the future, they move forward, live in the present, and do what is best for themselves.

6. Stick to their decisions

Good Psychopaths have a fantastic capacity to just focus in on what is essential to any conclusion that they have to make. They think about the pros and cons rationally and give an accurate weighting to each of these factors. They then make a decision after an allocated period of time and stick to this decision resolutely for an allotted period of time moving forward rather than continuing to think about the pros and cons or doubting themselves. If more information presents itself later that might indicate that another option is better, they determine once again what the best decision is to make after an allocated period of time and then stick to this decision resolutely.

7. Are professional when someone has treated them poorly, rather than vengeful

Good Psychopaths study people and know how to persuade others to get what they want. They are able to get inside the mind of others and think what they think or feel what they feel. The main difference is that they can switch off their emotions and empathy when needed too, depending on what will benefit them the most in any given situation. In mock business scenarios, Good Psychopaths make way more money than usual participants when negotiating because they aren’t bothered by another party’s attempt to screw them over, and continue to make the right rational choice that will serve them best in the long-term. This is in comparison to most ordinary people, who will respond in kind when someone has been unfair towards them in a negotiation, even if it means that they are worse off in the long run. A Good Psychopath doesn’t care about what is fair or who is winning, they only care about what is going to be best for them.


In Conclusion

Good Psychopaths are not ruled by emotion and know that they can feel one way, but act in another. They use feelings as a guide for behaviour when they are helpful, and disregard them when they are not. They have “ice in their veins” when the going gets tough, and switch off the emotional response and physiological symptoms that come with anxiety, allowing them to remain calm and perform at their best, even while everyone around them crumbles under pressure.

The best way for non-psychopathic individuals to develop these traits* is through a practice called Mindfulness Meditation, as well as through learning the various interventions that are available through Cognitive Behavioural Therapy. The more that we can learn to utilise non-judgmental, open and present-focused awareness, as well as plan, set goals, and reason, the more likely we are to develop and apply the positive qualities that Good Psychopaths have, without having to suffer from any of their deficits. If you would like to learn these skills further, please make an appointment to see a Psychologist.


Dr Damon Ashworth

Clinical Psychologist

*Disclaimer: In no way am I saying that being a Psychopath is a desirable outcome. However, it is no secret that these individuals are sometimes wildly successful, especially in our Capitalist Society. By understanding how Good Psychopaths work and learning the same skills that help them to get ahead, we will offset any of the natural benefits that they have, and hopefully, eclipse them in any areas that they are weak (e.g. genuine feelings and concerns for others). This will potentially reduce the overall suffering that these individuals can inflict upon society by limiting their power.



Personality Assessments – The Way to Figure Out Who We Are


There are many different assessments tools that Psychologists can use to help you answer the big question – “Who am I?”

I will introduce these to you now so that you can determine if you’d like to give any of them a try:

#1 – Psychiatric Assessment

Many Psychologists will take a clinical history during the first session, which is usually the assessment phase of therapy. They may typically start off with your presenting issue, or the reason that you came to treatment. They will ask when this issue began and if you’ve experienced similar or other problems in the past. They will ask about other current psychological, emotional or physical symptoms that you may be struggling with. They will then see if you’ve had previous treatment before, how you found it (helpful or unhelpful and why), and if you are on any medication or suffering from any medical condition. They will then briefly go into your family history, occupational and educational history, ask about your interests and hobbies, and the main supports and relationships in your life. The assessment phase then typically ends with clarification of treatment goals and a collaboratively decided upon a plan to help you address your presenting problem and achieve your treatment goals. This process may occur in only one session or could be spread out over multiple sessions so that a more in-depth history can be collected. Psychologists are likely to revisit these issues at various points during the subsequent treatment. However, the information obtained during this assessment is usually enough for Psychologists to get a good sense of who you are, what you struggle with, and what treatment may help you achieve your goals, address your concerns, and improve your quality of life.

#2 – Self-Report Personality Assessment

There are three self-report questionnaire based personality assessments that Psychologists may give to you in session if it is essential to be thorough and accurate in determining who you are, what you struggle with, and what your diagnosis may be (if you have one). These are the 567-item Minnesota Multiphasic Personality Inventory (MMPI-2), the 344-item Personality Assessment Inventory (PAI), or the 175-item Millon Clinical Multiaxial Inventory (MCMI-III). These Personality Assessments have good psychometric properties, meaning that they are reliable, valid and useful, and also have questions in them to determine if you are lying or portraying yourself in an unrealistically positive or negative way. They are time-consuming to fill out and score up, however, so it is essential to determine if it is worth the cost for the extra accuracy that it may bring in helping you to figure out who you are.

Another self-report questionnaire that can be given in session to determine what you are struggling with is the Young Schema Questionnaire, but this is likely to be only used if you are undergoing Schema Therapy. This is a longer-term type of therapy that is recommended for clients that haven’t benefited as much as they would like from traditional Cognitive Behavioural Therapy (CBT).

There are also free personality assessments that can be accessed on the Internet. My personal favourite and one that I like to recommend as a homework task for clients who want to find out more about themselves is the IPIP-NEO, based on the five-factor (Extraversion, Agreeableness, Conscientiousness, Neuroticism & Openness to Experience) personality model. There is a short-form (120-item) and a long form (300-item) version, but I usually recommend the short-form, as it produces similar findings in less than half the time. What I like about the IPIP-NEO the most is that it gives you a percentile score on 30 different facets of personality and compares how you see yourself to how other people of the same age from the same country and of the same gender see themselves. I then typically get clients to bring and share their responses if they would like to, which then provides me with a much higher understanding of who they are, how they see themselves, and why they may struggle with the things that they do. I believe that it is much better and more comfortable to accept the client for who they are and help bring out the best in them through treatment rather than force them to change into something that maybe doesn’t suit their natural temperament or personality style. It also helps me to overcome any cognitive biases that I have so that I can better empathise and accurately resonate with the clients that I see.

I have also sometimes recommended the Meyers-Briggs Type Inventory, and this can be good for determining what career may be suitable for you. I personally don’t find it as useful, because it categorises everyone into one of 16 personality types, which isn’t much more than the 12 different star signs. I have a similar issue with the DISC personality assessment (4 types) that is often used in business settings or the Enneagram of Personality (9 types). Other people swear by their accuracy and usefulness in helping us to understand who we are and why we do what we do, so please feel free to check them out and see for yourself if you are interested.

#3 – Projective Personality Assessment

The two primary projective tests used by Psychologists include the Rorschach Inkblot Test and the Thematic Apperception Test (TAT). These tests aim to further clarify what may be going on in someone’s subconscious or outside of their awareness by assessing how they interpret vague or ambiguous inkblots or pictures. Because they are deliberately ambiguous, it is thought that what the individual says is actually their subconscious processes being projected onto the images. There are structured ways for these tests to be administered and scored so that the interpretations become more valid and accurate. However, the descriptions are still in many ways subjective, and the same client responses may be interpreted in different ways by different Psychologists, or even by the same Psychologist depending on who the client is. I, therefore, believe that projective tests can be useful, but only alongside other clinical information or forms of assessment so that a complete picture of the client can be determined. Other projective tools or pathways to mental processes that can be utilised within or outside of therapy include any creative form of expression, including drawing, painting, writing, sculpture, music, dance, and even dream interpretation and analysis. The interpretation of these forms of expression is even more subjective than projective tests but can provide a nice window into who we are if we are willing to free associate and delve deeper into figuring out the potential meaning inherent in the things that we think about and do.


To summarise, a Psychologist can definitely help you to figure out who you are and why you do things, and they are provided with a lot of training to do so. Friends and family can give us useful feedback, but remember that even Psychologists aren’t allowed to assess or treat their friends or family because they are likely to be too biased in the work that they do. There are some great books out there on Personality, as well as the free tests on the Internet that have been mentioned above. The more specific, thorough and scientifically validated the personality assessment is, the better,  more accurate, and more useful it is likely to be, but this can be both time consuming and costly. The IPIP-NEO is a great place to start if you are merely curious but not willing to spend any money just yet.

Once we have figured out who we are, it is the time to move onto the next big questions – “What is important to me, and what do I want to do?”

Dr Damon Ashworth

Clinical Psychologist

Feel the fear, and do it anyway

I’ve been thinking for awhile about what would be the best way to start off a psychology-related blog. I have some great ideas for blog series that I would like to do, but none of them seemed fitting for an introduction to the site.

Then I realised what was happening…

I was letting perfection get in the way of production. I was procrastinating. I was being held back by FEAR.

Dr Russ Harris speaks about FEAR as an acronym for things that can keep us stuck and prevent us from making the changes that we would really like to make in our life:

F – fusion with unhelpful thoughts – An example of this is “that’s not the best way to start a psychology blog – keep brainstorming until the perfect idea or solution presents itself!” By allowing myself to believe what my mind said, I kept putting off what I actually wanted to do, which is share some of the things that I have learnt and found helpful through my eight years of University study and the hundreds of psychological books and journal articles that I have read along the way.

E – expectations that are unrealistic – If I have never written a blog before, how can I know what style is the right way to express what it is that I have to say? I can’t. We learn through trial and error and experience. Sometimes I’m sure that I will write a piece and be happy with it, but other times this won’t be the case. Some articles may get good feedback, and some may not. All I can do is give it a go, reflect upon it afterwards, get feedback from others, and make changes as required until I find the right voice for myself and my potential audience. What’s more important is that I enjoy the process of clarifying my thoughts and share them with whoever is interested in a way that they can hopefully understand. I believe it was Hemingway who said that the first draft of anything is rubbish (italicised word is my paraphrasing). If a literary great didn’t expect to produce a fantastic story the first time he wrote it, is it realistic for me to hope for more?

A – avoidance of discomfort – Does putting my thoughts into writing pose any real threat to me? No. It can actually help me clarify my ideas further and assist the clients that I see by allowing me to get my points across more concisely. Will putting my writing out there expose me to judgment and potential ridicule from others? Possibly. Does staying in my comfort zone and doing what feels safe or secure lead to me living a happy fulfilled life? No. Quite the opposite. It, therefore, becomes a choice, between discomfort and growth or comfort and stagnation. Whether it is worth it or not is up to the individual, and depends on the situation and how they feel about it.

R – remoteness from values – Values are guiding principles for life. We need to get in touch with what is really important to us or what we care about deep down if we are going to persist through discomfort in the pursuit of a goal. For me, writing a blog is about helping people to be informed about psychological theories and empowered with strategies that can make a difference in their lives. There is so much conflicting information out there about what can help, and sharing what rigorous scientific studies have found in collaboration with my own personal experience will hopefully be useful for anyone that chooses to read it. It will also give any potential clients an idea about the approaches that I have towards my life and work, and help them make a more informed decision on if I am the right Clinical Psychologist for them. By connecting with these values, it is much easier for me to persist in writing this blog and the articles that will follow.

With that in mind, what do you fear and what holds you back from making the changes that you would like to make? Is it any of the four things mentioned above? If so, can you challenge or detach from those thoughts, set more realistic expectations for yourself, get in touch with your most important values, and persist with the discomfort in pursuit of the type of life you would like to lead? Maybe not straight away, but hopefully with practice, reflection, feedback and support from others.

The first self-help book that I ever read was ‘Feel the Fear and Do It Anyway’ by Susan Jeffers. It transformed my life to think that I didn’t need to stop feeling scared before I did something. Even though anxiety often feels like it is a life or death situation, especially when it comes to social anxiety, it never typically is. So now I embrace whatever awkwardness I can, and challenge myself wherever possible. Through a process called habituation, it actually does get more comfortable in time.

For any anxiety-based psychological treatment, exposure to the feared stimulus will be recommended at some point in the treatment and is a crucial component to the most successful outcomes. But it is also important to start slowly, and begin with tasks that feel a little bit challenging and scary, and then slowly work your way up to more challenging and scary tasks once your confidence has built up.

If you want to try this on your own:

1. Develop a list of tasks that you are afraid to do, but they would not actually harm you if you were to do them.

2. Rank these from least scary or challenging to most scary or challenging.

3. Starting with the least scary first, set a goal for yourself on when you will tackle the task and be as specific as possible with date, time, location and duration.

4. Attempt the task, and if possible, remain in the situation until the anxiety has subsided (usually about 10 minutes).

5. If you are unable to complete the task, try with something more manageable that brings a little fear or discomfort but not too much, and gain confidence with this before reattempting the initial task.

6. Repeat until habituation has taken place and you are feeling more confident and less anxious doing that task.

7. Move onto the next most scary or challenging task on the list.

To do it in this step-wise manner would take a long time, but as long as you are progressing, then you are learning the skills to challenge any fears that come your way.

Remember, feel the fear, and do it anyway (unless it really is too dangerous and unsafe)!


Dr Damon Ashworth

Clinical Psychologist