Damon Ashworth Psychology

Category: therapy

Can Psychologists and Psychics Read Minds?
When I tell people that I am a clinical psychologist, people often ask, “Are you reading my mind right now?”

The fascinating thing about the question is that it isn’t what psychologists do.

Sure, I can pick up on other people’s emotions much more than I could before I started clinical work. I’ve also become more skilled at reading people’s body language and tone of voice and what this might mean. These skills could help me be a better poker player, but not a psychic.

Do people get a psychologist and a psychic confused?

I want to hope not, but I’m also sure that I’ve never met another psychologist who has claimed to be a mind reader.

Well, maybe some of my friends and I used to during our undergraduate studies, but we weren’t psychologists yet, and we weren’t psychics. Just using some silly tricks that we had read in the book ‘The Game’ by Neil Strauss, an exposé on the pick-up-artist community. So when anyone asked us if we could read their minds, we would say one of two things:

1. Think of a number between 1 and 10.

Go ahead, think of it.

It turns out that a surprisingly high number of people say 7. When people guessed this, and we got it right, they confirmed their beliefs that we were mind readers.

2. Imagine you are driving along a road in the desert, and in the distance, you see a cube up ahead on the side of the road. What size is the cube (small, medium, big)? Is the cube opaque (see-through) or solid? What colour is the cube? Now imagine that there is a ladder near this cube. Where is it?

With each response, an “hmm, interesting” was all we would say until the person answered all questions.

We would then give generic, generally positive responses such as:
- big cube = extraverted
- opaque = open and easy to get to know
- red = passionate
- the ladder on top of cube = high achiever
The funny thing was that people were generally pretty happy with their analysis and were sufficiently impressed with our mind-reading skills.

The Problem With Horoscopes

It often perplexes me how horoscopes in the newspaper apply to the 600 million+ people globally that have that star sign. But, of course, it’s also fascinating how many people read them each day and believe in what they say. But maybe that is typical of me as a Sagittarius to be a doubter and an unbeliever. Who knows.

In my year 11 Psychology class, I remember a little experiment that our teacher did with us. To begin with, we were all described our personality based on our horoscope. I have programmed this article to figure out your character based on your horoscope to give you a sense of its accuracy. Let me know how accurate my description of you is from 0 = poor to 5 = excellent:
1. You need other people to like and admire you.
2. You tend to be critical of yourself.
3. You have a great deal of unused capacity which you have not turned to your advantage.
4. While you have some personality weaknesses, you are generally able to compensate for them.
5. Disciplined and self-controlled outside, you tend to be worrisome and insecure inside.
6. At times you have serious doubts about whether you have made the right decision or done the right thing.
7. You prefer a certain amount of change and variety and become dissatisfied when hemmed in by restrictions and limitations.
8. You pride yourself as an independent thinker and do not accept others’ statements without satisfactory proof.
9. You have found it unwise to be too frank in revealing yourself to others.
10. At times, you are extroverted, affable, sociable, while you are introverted, wary, and reserved at other times.
11. Some of your aspirations tend to be pretty unrealistic.
12. Security is one of your primary goals in life.
How accurate was my assessment?

When we received this description in class, most of us rated it a 4 out of 5. However, it turns out that we were all given the same explanation regardless of our horoscope, and if you haven’t guessed it yet, I have done the same with you.

These 12 items are all known as Barnum statements, which Psychologist Bertram Forer first used in his 1948 study to observe this phenomenon. He found that people tend to believe that general and mostly positive personality descriptions apply specifically to them without realising that they could also apply to many others.

These findings have been duplicated several times since, with most results supporting the initial findings that these statements are about 85% accurate at describing an individual’s personality. Now commonly known as the Forer effect, it is one of the main reasons astrology, fortune-telling, some personality tests and other forms of supposed mind-reading are so popular and perceived as valid.

Well, Then Explain To Me How..?

Whenever I tell people that I doubt these things, most believers will come back to me with a testimony, either from their experiences or that of a family member or friend. They’ll tell me about a time when someone they saw could accurately know or predict something that they believe could not have been known in any other way.

Just because I don’t believe in mind-reading or fortune-telling or communicating with spirits does not mean that I can know with 100% certainty that they do not exist. If anyone could prove their gifts scientifically, I would be genuinely amazed. I’d even be happy to utilise and recommend their services.

Until I see much scientific proof, however, I recommend this. If a clairvoyant, fortune teller, medium, aura reader, or anyone else helps you feel better or gain more clarity on the path you would like to take going forward, then that is great. However, if they cause you to worry more about a horrible fate or not take control or action in your life, then that is not good. Especially if they are charging you a lot of money. If a psychologist is doing the same thing to you, this would be equally as bad.

Tricks of the Trade

It doesn’t matter what field it is. Some people are generally warm, intuitive and empathetic, and genuinely want to help the people that they see. Other people may have less altruistic intentions and motivations for doing what they do.

I want people to be aware of the various tricks that certain people may use to convince others that they have the power to read people’s minds, communicate with spirits, or predict the future.

In ‘The Full Facts Book of Cold Reading’, Ian Rowland lists 38 persuasion techniques (including Barnum statements). Known as elements, they are used to extract information from clients, convince them that they know something about their character, about the facts and events of their life, and about the future. Some of my favourites are:

Elements to extract information:
1. ‘Jargon Blitz’ with a ‘Veiled Question’: Explain the traditional meaning of a tarot card, “the five of swords indicates a struggle in the affairs of the heart”. Then make a statement about the client’s life, “I sense your personal goals are taking priority over romance at this time”. Follow this with, “is this making sense to you?” If it is, you’ve got a hit. If not, they give you more information about their lives without realising that you have asked them a question.
2. ‘Vanishing Negative: State a negative question with ambiguous tone and phrasing, such as, “you don’t work with kids, do you?”. It can be a hit whether they agree or disagree, as the negative part of the question vanishes if they say they do work with kids — “yes, I thought so. A strong affinity with children is indicated….”
Elements about character:
1. ‘Rainbow Ruse’: Credit the client with both a personality trait and its opposite: “sometimes you are very outgoing and confident, even the life of the party when the mood strikes you, and yet there are other times when you can retreat into your shell, preferring to keep quiet or distance yourself from others.” It sounds perceptive but covers the whole scope of the personality trait.
2. ‘Jacques Statement’: Depending on their stage of life, talk about the usual crises that tend to occur around their age. Rowland shares his one for someone in their mid-thirties to early forties: “if you are honest about it, you often get to wondering about what happened to all those dreams you had when you were younger, and all those wonderful ambitions you once held dear. I suspect that deep down, there is a part of you that sometimes wants to scrap everything, get out of the rut, and start again, but this time do things YOUR way.”
Elements about facts and events:
1. ‘Fuzzy Fact’: Ask them a factual statement that is quite likely to be accepted initially and leaves space to become something more specific with additional prompting. For example, you can relate it to geography (“I see a connection with Europe, possibly Britain, or it could be the warmer Mediterranean part”). Or medical (“the gentleman with me now is telling me about a problem around the chest area”). It could also be an event (“There’s an indication here of a career in progress or transition. This could be your career, or it could be someone else’s career that affects you”).
2. ‘Good chance guesses’: Ask a question that has a higher chance of being accurate than the other person would think, such as “I see a house with the number 2” or “I see a blue car”. If they lived in a house with a #2 or owned a blue car once, it’s a hit. If not, it could be someone close to them or someone they knew, or even a neighbour, which makes it unlikely to be wrong.
3. Trivia stat: Most people have a box of old photos around their house that haven’t been sorted, or medical supplies that are years out of date, or a key that is now redundant, or books associated with an old hobby or interest. Most people will have had a scar on their left knee, been involved in some childhood accident that included water, have an item of clothing in their wardrobe that they can no longer fit into, and tried to learn a musical instrument as a child that they later gave up. Of course, people are not likely to realise how common these traits’ are, so they are also good chance guesses.
Elements about the future:
1. ‘Pollyanna Pearls’: State that whatever has been difficult lately is likely to improve: “It’s been a bit of a bumpy ride romantically these last few years for you, but the next year or so will be a lot easier!”
2. ‘Self-fulfilling Predictions’: When making predictions about mood or personality, these have the bonus of potentially becoming self-fulfilling: “You will begin to adopt a more confident and optimistic disposition. You will let go of old regrets and start being more compassionate to yourself and others. You will soon have a greater sense of connection and belonging with others!”
3. ‘Unverifiable Predictions: These can never be verified either way, so no chance of them being wrong. Here is Rowland’s example again: “Someone you know will harbour a secret grudge against you. They will plan to put obstacles in your way, but you will overcome their plans without even realising it.”
I’ve shared my ten favourite elements with you, but there are still another 28 in ‘The Full Facts Book of Cold Reading’. Check it out if you are interested in learning more about the persuasion techniques typically employed in the psychic industry.

Conclusion

Some people may be able to convince you that they can read your mind. But from my experience in life so far, I have never come across any substantial scientific evidence that suggests that this is the case.

The truth is that to understand and help people, I have to rely on how they present in session with me and what they say to me and how they say it. Communication with their partner, family members, friends or other treating doctors can also help at times (if the client consents to this).

If you see a psychologist, please do not assume that they can read your mind. If you’d like to speak about something, make sure that you say it. It is especially true if the session isn’t going how you want it to, if you are uncomfortable, or if the treatment isn’t as helpful as you’d like it to be.

I do not doubt that a client could successfully withhold or deceive me if they wanted to. Still, all this would do is create a barrier in the therapeutic relationship that would then prevent me from being able to help them in the best way possible.

Many people assume that others should know what they need and how to give it to them. But if both psychologists and psychics can’t even read your mind, then it is unlikely that someone else will be able to either. So the reality is that it is okay to ask for what you need and to teach others to support you in the ways that you find most helpful.

Dr Damon Ashworth

Clinical Psychologist
October 11, 2023
What if Being a Therapist is Unhealthy?

The Oura ring that I use to track my health gives me three primary scores every day. When I wake up, I receive a readiness score, a sleep score and an activity level score from the day before. All of these are out of 100, with the higher daily score perceived as better.

To achieve a high score on my activity level, I need to move every hour during the day, not spend too much time being sedentary and complete my daily energy expenditure goal. For example, on a recent day where I exceeded the 600 calorie goal from exercise, I managed to burn 628 calories by walking 9,015 steps or 9.1km.

As a clinical psychologist working in private practice, I often see 7 or 8 people for 50–60 minutes each, five days a week. There was essentially no break between clients except for maybe a lunch break in the middle of the day. Which meant that there was little chance of meeting my daily expenditure goal unless I did at least 90 minutes of walking either before or after work.

Add in the time needed to get to work and back home, plus marketing and consulting with doctors or referrers. Then treatment planning, further reading, and writing of case notes, reports and letters. It sure doesn’t leave much time or energy for the exercise I want to do. Let alone quality relationships, housework, hobbies, self-care, and sleep outside of my work responsibilities.

Photo by SHVETS production on Pexels.com

An Unhealthy Trap?

“If you weren’t loved for who you were, then what you are going to do is work to make yourself loveable. And the way you make yourself loveable is to be of service to everybody else and not have any needs yourself”
Gabor Mate

As a clinical psychologist, I have tested myself on many validated surveys. One that I particularly like is the Young Schema Questionnaire. It helps people determine which of the 18 maladaptive life traps or schemas they fall into most. Some of my top schemas from 2018 were: Self-sacrifice (1st), emotional deprivation (2nd), subjugation (4th) and approval-seeking (6th).

With these schemas, the predominant traps that I can fall into are sacrificing my needs for others and choosing relationships where others can’t meet my emotional needs. I can also pretend that I don’t have any requirements and try to be what others want me to be rather than who I am.

All of these qualities help me to be a good therapist. I can tune into what others want and need, put these things first regardless of what I want to talk about, disregard my own needs and be what others want me to be.

But what are the personal consequences for me?

Seeing too many clients in a week can make me emotionally drained, physically less healthy than I want to be and chronically fatigued. It can result in me cooking less for myself than I would like to. I instead resort to fast food on these nights because it is convenient and more manageable. My brain also tells me that I deserve to treat myself. So I spend more time sitting on the couch and watching TV or scrolling on the phone than I want to. I can’t be bothered being as creative or as expressive as I would like to be. And I isolate myself too much, choosing to take a break from the world instead of connecting with others in ways that I would like to.

What do I need?

Equal relationships. I need to put my needs at the same level as others. I need to choose friendships and partners that are as aware of my feelings and desires as they are of their own. I need them to be as encouraging towards me meeting my needs as we are towards meeting theirs. I need to be authentic and not be punished for this, even if it is different from what is traditional for society or what they want. I need to be aware of what I want and not feel ashamed of doing these activities or meeting these needs.

While this sounds nice and healthy, a therapeutic relationship is ideally not equal. The role is to be there for the other person to help them meet their needs, understand themselves and become the person they want to be. Yes, boundaries are essential to set and enforce, but for the long term benefit of the client, not for me.

Maybe I can look at a therapeutic relationship as equal in some way. It is at least transactionally. Nobody is forcing me to take on the role of therapist. I am choosing to do it. They are paying for a service, and I am being compensated financially for it. I enjoy helping others improve if they want to. I am also trying to be authentic as a person in my role as a therapist. However, the aim is to help meet the client’s emotional needs and improve their psychological well-being, not my own.

A supervisor of mine once said, “a needy psychologist is a dangerous psychologist”. Therefore psychologists who try to get any of their needs met with clients are stepping away from their proper role. Furthermore, they can harm the other person if they are not careful.

Yes, I can learn things along the way. I can also make genuine connections with the people that I see. However, it must be about what is best for the client, not myself as the therapist.

As long as I can ensure that my life outside of my job meets my needs, being a therapist is not a problem. However, I must achieve a healthy balance between helping others at work while having enough time and energy to help myself in the ways that I want in my life outside of it.

Is it possible to find a healthy balance?

To not be exhausted from my work as a therapist, seeing five clients has to be the maximum on any given day. However, I’m not too sure if this maximum would be achievable five days per week either. Two to four days per week seems much more desirable if a healthy balance is an overall goal.

During the pandemic lockdowns in Melbourne in 2020, I was working a lot more than that. One week, I did 39 hours of sessions with clients, or five straight days of nearly eight clients per day. On one day, I also saw ten clients without a lunch break. As all of the sessions were via Telehealth, I’m unsure if I even stood up out of my chair. Although I had the capacity to do this, it sure doesn’t mean that it was healthy for me.

“If you don’t know how to say no, your body will say it for you through physical illnesses”
Gabor Mate

Photo by Vidal Balielo Jr. on Pexels.com

On January 2nd, 2021, I suffered a stroke in my left cerebellum. I nearly died and was in a coma for a few weeks. After brain surgery and having part of my brain removed, the long road to recovery began.

I am luckily doing quite well now, only six months later. My personality and cognitive functions are essentially the same as what they were before the stroke. My balance and coordination have improved, but I will never return to playing sport at the level I did before the stroke.

Fortunately, I have a second chance at life. I could rush back to how I did things before. However, I want to live in a way that is positive for me and my health. I want to enjoy my life and the relationships that I have with others outside of my work.

I want to continue helping others meet their needs and express their feelings through their therapy. I don’t want to be a different psychologist from how I have been or care less about the people I see and talk with. However, I do not want to do this at the expense of my vitality and longevity.

I hope that I can find the balance that means that I can keep living this incredible life in a way that is enjoyable, nourishing and sustainable for me.

Dr Damon Ashworth

Clinical psychologist

July 20, 2021
The Four Ultimate Concerns in Life
I’ve been afraid to say this for a while because of how it will be perceived, but my favourite book of all time is actually a textbook. So before you think that makes me someone you would never want to speak to, I’ll ask if you have ever read anything by Irvin Yalom, American Psychiatrist and Author?

His book ‘Existential Psychotherapy’ is a true masterpiece he worked on for 10 years and is written as eloquently as any of his other titles, including ‘When Nietzsche Wept’, the best fiction novel award winner in 1992.

What is Existential Psychotherapy?

Existentialism is the philosophical exploration of existential issues or questions about our existence that we don’t have an easy answer for. We all suffer from anxiety, despair, grief and loneliness at times in our lives. Existential Psychotherapy tries to understand what life and humanity are about.

In the book, Yalom explores what he considers to be our four most significant existential issues in life:
1. Death
2. Freedom
3. Isolation
4. Meaninglessness
These existential issues or ultimate concerns are “givens of existence” or “an inescapable part” of being an alive human in our world. He shows how these concerns develop over time, how we can run into problems with each of these issues, and what they might look like in patients coming to therapy. He also talks about how we can try to live with these concerns to negatively impact our lives less, even if we don’t have clear-cut solutions to them.

Let’s go through each of these ultimate concerns…

1. Death

Homo sapiens, or humans, as far as I know, are the only species in the animal kingdom that are aware that one day they are going to die.

The first time I heard this, it fascinated me and made me wonder if life would be more comfortable not being aware that one day we cease to exist.

Imagine it. Life is going well. Then suddenly, it is no more. No worry about what the future holds. We are born. We experience life. Then we are no longer there. No fear. Just nothingness.

Being aware that we will die shapes and influences our lives much more than we would like to admit. This is because so many of our anxieties and phobias at their core are fear of some loss or death.

Irvin Yalom says that while the actuality of death is the end of us, the idea of death can actually energise us.

If we don’t know when we will die, being in touch with the fact that one day everything will vanish is enough to overwhelm some people and make them panic.

For others, it is enough to make them follow the maxim of carpe diem and helps them to seize the day by appreciating everything they have so that they can make the most of the precious time they have left on this planet. Time is really just a bright spark of lightness between two identical and infinite periods of darkness — one before we are born and one after.

Death is the ultimate equaliser, for no matter how much we have achieved or done with our time on this planet, the truth is that we will all one day die.

It is also true that we will not know exactly when death will happen. It might be with a car accident tomorrow, from cancer in ten years, motor neurone disease in twenty years, a heart attack in thirty years, a stroke in forty years, or during our sleep in fifty years.

Because our knowledge of our inevitable death is so inescapable and hard to confront and deal with directly, we instead focus on smaller and more manageable worries or concerns in our lives that we can do something about if we want to. If we successfully address all these minor concerns, however, we then come in contact with our fear of death again, and the cycle repeats itself.

Most people tend to have one of two basic defence mechanisms against their fear of death:

A. They can think that they are “special” and that death will befall others but not them, and try to be an individual and experience anxiety about life.

Or

B. They can think they are an “ultimate rescuer” and try to fuse with others and experience anxiety about death (their own mortality and that of their loved ones).

A breakdown of either of these defences can give rise to psychological disorders:
- narcissism or schizoid characteristics for the “special” defence, and
- passive, dependent or masochistic characteristics for the “ultimate rescuer” defence.
In general, trying to be an individual is a more empowering and effective defence than fusing with others. Still, the breakdown of either can lead to pathological anxiety and/or depression.

The way to feel better about death anxiety is through an exercise called “disidentification”:
1. To begin with, ask yourself the question “Who am I?” and write down every answer that you can think of.
2. Then, take one answer at a time, and meditate on giving up this part of yourself, asking and reflecting on what it would be like to give up this part of yourself and your identity.
3. Repeat this with all the other answers until you have gone through all of them.
4. You have now disidentified yourself from all parts of your identity. See how you feel, and if there isn’t still a part of you, that feels separate from all the labels you give yourself. This provides comfort and reduces anxiety about death and life for a lot of people.
What I try to manage death anxiety is to only focus on whatever is most important to me that I can do something about in any given moment. I try to appreciate and be grateful for the time that I have had with each important person in my life. I try to be as fully present in the moment and with others as I can be. I try to use every moment and meeting as an opportunity to impact someone’s life positively. That way, I’ll hopefully not have too many regrets and be glad for the time I have had on this planet, no matter how long it ends up being.

2. Freedom

The second ultimate concern is about freedom, responsibility and will.

Every country in the world talks about fighting for the freedom of its citizens and about taking away some people’s freedom to ensure the safety and security of all. Therefore, the existential dilemma is how much freedom do we give up to others to feel safe and secure, or how much safety and security do we give up to feel genuinely free? Are these concepts in direct opposition, or is it sometimes possible to have enough of both?

Responsibility means taking full ownership of:

“one’s own self, destiny, life predicament, feelings, and if such be the case, one’s own suffering” — Irvin Yalom

In the past, one’s life was set out for them by their parents or society, and many people struggled to fight for the right to live an authentic and genuine life.

These days, most people struggle instead with the amount of choice that they have in their lives. They come to therapy because they don’t know what they want to do or how to choose, given all of the available options. They also know that if no one else is telling them what to do, it is ultimately their responsibility if things do not work out the way they want them to. People wish to choose for themselves but fear not having someone to blame when things don’t work out.

There are various defences that we engage in to avoid responsibility and shield ourselves from freedom, including:
- compulsivity
- displacement of responsibility to another
- denial of responsibility (“innocent victim” or “losing control”)
- avoidance of autonomous behaviour, and
- decisional pathology
We can do something over and over again to relieve anxiety or stop thinking about things. This can present as OCD, hoarding, or any addiction ranging from technology to drugs and alcohol and even dependency on others.

We can try to coerce others to make decisions for us or seek out and find controlling partners, bosses or friends. But, we can also play it safe and try to do what we think everyone else does; focus on keeping up with the Joneses, engaging in passive activities that don’t require much effort, and feeling stuck in an unfulfilling relationship or career.

The problem with giving up the responsibility for how our lives turn out is that it creates an external rather than an internal locus of control. Depression and other forms of psychological disorders are more highly correlated with an external locus of control. It can also lead to learned helplessness, where people no longer feel like they can do anything to change their life in a positive direction.

The way to manage the responsibility and freedom paradox is to develop an internal locus of control. This is generally more beneficial for most people’s well-being unless we blame ourselves or change things out of our control. This includes what has happened in the past, what other people do or say, and acts of nature.

The serenity prayer nicely spells out how we should approach responsibility:

“God, grant me the serenity to accept the things I cannot change,
Courage to change the things I can,
And wisdom to know the difference.” — Reinhold Niebuhr

Paradoxical intention is a good antidote too. This means that we try to do the opposite of what we typically do for a period of time and keep an open mind and observe how things go. We can then see if the outcome is better than what we usually do or if it has taught us something about what will be best for us going forward.

Anything that creates a double bind is potentially helpful for encouraging people to take more responsibility in their lives. One way is to remind someone who struggles to make their own decisions that by not deciding, they are still making a choice not to choose. This means that no matter what they do, it is impossible not to make a decision that impacts the direction of their lives. Even if we choose to follow what someone else wants us to do, we still choose to do this. Therefore, why not take responsibility for our own lives and forge our own paths?

3. Isolation

There are three types of isolation:

“A. Interpersonal isolation: isolation from other individuals, experienced as loneliness

B. Intrapersonal isolation: parts of oneself are partitioned off from the self, and

C. Existential isolation: “an unbridgeable gap between oneself and any other being.”

A common way that people try to escape from existential isolation is to fuse with another fully. This is also a strategy for dealing with death anxiety, with people trying to be the “ultimate rescuer” of someone else. It can lead to an individual feeling temporarily less alone. Unfortunately, however, the less isolated we are from others, sometimes the more isolated we are from ourselves.

Other people try to overcompensate for their feelings of isolation by never relying on anyone and trying to be fully independent. Both extremes can have negative consequences.

The main thing we can do to manage our feelings of isolation is to realise and accept that we are social creatures and have always relied on others to survive. This drive creates a desire to feel closer to, more understood, and more connected to people than we can ever achieve and sustain.

Growing up, many people feel loved and comforted in an unbalanced relationship towards their needs being met over their parents. They then try to reenact this within their adult relationships and usually end up feeling resentful, angry and disappointed as a result.

Yalom believes that a good relationship involves “needs-free love”, which is about loving someone else for their sake. This is opposed to “deficiency love”, a selfish love where we only think about how useful the other person may be to us. Creating a relationship where you want the best for the other person is a healthier way to manage interpersonal isolation than demanding for them to meet every need for you.

Some of the best solutions to intrapersonal isolation are to have time to get to know ourselves through practices such as journaling, therapy and meditation. Introverts may need to have more of this time than extroverts, so it’s important to tune into how agitated or lonely you feel to know if you have found the right balance or not.

Unfortunately, existential isolation cannot be fully breached, and therefore needs to be accepted, as it is out of our control. To feel the pain that comes with this isolation and our desire not to have it is challenging, but it can help reduce the intensity of the feeling. Being grateful for the meaningful connections we have in our lives and trying to strengthen them without losing our sense of self is another way to lessen the intensity of the feeling.

4. Meaninglessness

According to Yalom and many non-religious philosophers, humans are meaning-seeking creatures in a world without a universal sense of meaning. As a result of this, most of the world turn to a religious or spiritual belief system of one type or another that clearly lays out the meaning of the world and our purpose in it. People who truly believe these systems often provide a lot of clarity, reassurance, and guidance. The tricky part is that these belief systems can vary widely, and it is hard to know which one is more correct than another or if some of them are even harmful.

What we do know is that most belief systems tend to agree that

“it is good to immerse oneself in the stream of life”.

People can try to find meaning through:

A. Hedonism: Seeking out pleasure and positive experiences and trying to avoid pain,

B. Altruism: Dedication towards a cause that helps other people, and

C. Creativity: Transcending oneself through art.

Many philosophers believe that both the search for pleasure and the search for meaning are paradoxical. By this, they mean that happiness and meaning or purpose in life are tough to achieve when they are aimed at directly, but possible if they are aimed at indirectly.

So if you or someone that you know is complaining about a lack of meaning in life, try to see if there are other issues. If possible, address these other issues first, and see if your worry about meaninglessness has lessened or gone away.

The best indirect way to increase a sense of purpose and meaning in life is to build kindness, curiosity and concern for others. This is often best done by helping out with a charity, joining a club, fighting for a cause, or attending a group activity or group therapy.

Yalom strongly believes that a desire to engage in life and satisfying relationships, work, spiritual and creative pursuits always exists within a person. Therefore, the key to managing meaninglessness is to remove the obstacles that prevent the individual from wholeheartedly engaging in the regular activities of life.

We may never be able to find the absolute meaning of life. However, what we can do is work at creating a life that is personally meaningful to us.

Dr Damon Ashworth

Clinical Psychologist
January 25, 2019
Are You Asking the Right Questions In Your Search For a Therapist?
If you were searching the web as a consumer, looking for the best Psychologist, would you know what to search for?

If you said that you would look for someone experienced, it is a good guess, but years of experience don’t seem to make too much of a difference in improving therapeutic outcomes (Minami et al., 2009).

What may be necessary is that they are a Psychologist and not a Counsellor. In Australia, anyone can call themselves a Counsellor and open up a practice, even without training. However, if they are a Psychologist, they have to have completed at least four years of undergraduate training, plus a post-graduate degree or at least two years of formal supervision. Psychologists are also obliged to abide by the Australian Psychological Society’s (APS) code of ethics, whereas Counsellors are not.

If you said the company they worked for or how much they charged, these are both good guesses. However, private practice Psychologists are self-employed and set their price for their service, or a company employs and sets their price for them. Therefore, it is unlikely that all Psychologists within the same practice are equally effective, even if they are charging the same amount.

The current recommended rate for a 45–60 minute Psychological consultation in Australia is set at $238.00 by the APS, but all Psychologists have the discretion to vary this fee. For example, services in more affluent locations often charge more, whereas services in poorer areas often charge less.

More expensive Psychologists may believe themselves to be better Psychologists too, but this doesn’t mean that they are. The self-evaluations of therapists are often not very accurate, with a largely positive bias suggesting overconfidence in their general abilities. In a 2012 study by Walfish, McAllister, O’Donnell, and Lambert (2012), they found that out of the 129 therapists surveyed, 25% estimated that their therapy results were in the top 10% compared to the other therapists. Not a single therapist believed that they were worse than the average. If this sample represents the general population, this means that at least 50% of Psychologists don’t realise how bad they are and may therefore not be aware of what they are doing wrong and what they need to do to improve.

What is known is that some Psychologist’s do consistently outperform other Psychologists (Wampold & Brown, 2005). In a 2015 study by Brown, Simon and Minami (2015), they looked at 2,820 therapists, with a combined sample size of 162,168 cases. The researchers found that the lowest-performing therapists required three times more sessions to produce successful outcomes than the average therapist. They also needed as much as seven times the number of sessions as the highest-performing therapists. So choosing the right Psychologist is a crucial task. But,

What characteristics do the best Psychologist’s have, and what do they do that makes them so successful?

1. They practice a specific model of treatment that is most recommended for your condition or is a good fit for the type of therapy you are interested in

(Model of Treatment = 15% of overall outcome variance)

There are many different schools of Psychotherapy, such as CBT, ACT, DBT, Positive Psychology or Psychodynamic Psychotherapy. They will all have research supporting their treatments as effective, especially with specific conditions (such as DBT for Borderline Personality Disorder or CBT for Panic Disorder).

What they won’t often advertise is that no matter what school of therapy it is:
- None of them will help every client
- The drop out rates can be pretty high
- Clients who do drop out prematurely tend to fare worse than clients who can complete treatment, and
- Other psychotherapy schools tend to produce similar results.
So yes, therapy helps, sometimes, and for some people. However, it is perplexing to think how the research findings are all so similar in the different schools of psychotherapy (Wampold, 2001) until it is made clear that non-specific treatment factors are shared across the various schools of psychotherapy. These non-specific factors are described below and together contribute 85% of the overall outcome variance in psychotherapeutic studies (Hubble and Miller, 2004).

Whilst one mode of therapy may not generally be more effective than another, the goodness of fit does seem to be necessary. So try to choose a Psychologist who has experience in treating your particular concern, as well as an approach or therapy model that seems to make sense or appeal to you.

2. They help you to hope, expect and believe that you can improve

(Expectancy of Treatment Effects = 15% of overall outcome variance)

An individuals’ belief that they can improve has a powerful impact on their actual improvement (Bergsma, 2008). More considerable reductions in symptom severity occur post-treatment in those with higher expectations of benefit at pre-treatment (Ogles, Lambert, & Craig, 1991; Rutherford, Sneed, Devanand, Eisenstadt, & Roose, 2010).

Greater expectations can improve hope and increase goal-directed determination, which has been shown to predict treatment completion (Geraghty, Wood, & Hyland, 2010).

Greater expectations of treatment outcomes can also improve distress tolerance. These skills can reduce distress and depression severity across treatment (Williams, Thompson, & Andrews, 2013).

Essentially, the more you expect that a Psychologist can help you, the more likely it is that you will have hope, persist with treatment, and get better.

3. They develop a warm, caring and trustworthy environment where you feel safe to explore and grow

(Therapeutic Alliance = 30% of overall outcome variance)

Another critical issue influencing treatment outcomes is adherence to the treatment interventions, recommendations and strategies. A positive therapeutic alliance can improve compliance with treatment recommendations, which plays a vital role in the overall success of a psychotherapy treatment (Wampold, 2001).

A positive therapeutic alliance improves outcomes by providing professional input and ensuring effective implementation of the strategies. In addition, if a therapeutic alliance can be established, developed and maintained (Cahill et al., 2008), patients are less likely to drop out of treatment and more likely to achieve clinically significant improvements (Miller, Hubble, & Duncan, 2008).

Regardless of the theoretical orientation or the therapist’s experience, the best outcomes happen when therapists are flexible to the needs of the patient and responsive to the feedback that patients provide. They also repair any ruptures in the therapeutic alliance as quickly as possible (Cahill et al., 2008; Miller et al., 2008).

Other research suggests that it is crucial to meet relatedness needs, dependent upon the therapist displaying warmth and genuine involvement in the treatment. As a result, the client feels a sense of caring and connection in the relationship (Ryan & Deci, 2008).

Essentially, the more you can relate to the Psychologist and feel that you are allies working towards a common objective, the more likely you are to improve.

4. They make sure that therapy is the right step for you at the moment and help you to develop the skills, knowledge and motivation needed to improve successfully

(Client’s Life-Circumstances, Personal Resources and Readiness to Change = 40% of outcome variance)

The client is the most significant factor in determining whether or not treatment will be successful, which may be surprising to some people. However, suppose their current life circumstances are unstable, unpredictable, and emotionally or physically unsafe. In that case, it will be difficult for the one hour of therapy every week or two to be sufficient to overcome all of the adverse events that are taking place between sessions.

Not everyone is a good candidate for therapy, and therapy isn’t everybody’s cup of tea. For example, suppose a client prefers not to question things, has significant cognitive disabilities or memory difficulties, is currently manic or severely delusional or psychotic, or is too emotionally labile or reactive in close interpersonal settings. In that case, therapy can have no effect or be potentially harmful.

Lastly, if a client does not believe that they have a problem, then there is not too much that can be done by a Psychologist to help them, even if their family or friends or partner or the legal system believes that a problem exists. Unless the client can create intrinsic motivation for change, positive change is unlikely to occur.

Before seeing a Psychologist, you need to be sure that:
- You want to change or improve something about yourself
- You are willing to put in the time and effort that it requires
- You are eager to explore things to develop and grow, and
- Now is a good time for you to begin the amount of treatment (both frequency and duration) recommended for you.
If you follow these recommendations when seeking out a Psychologist, it will not guarantee a successful outcome, but it will help. I wish you the best of luck with your search and therapeutic experience!

Dr Damon Ashworth

Clinical Psychologist
August 5, 2017
What Do Clients Find Most Helpful About Therapy?
When clients first begin their therapy journey, they often ask to be taught specific skills to help them achieve their particular goals.

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

Cognitive Behavioural Therapy (CBT) is a short-term treatment that clients can easily understand. CBT is based on the premise that all difficulties arise from unhelpful cognitions (beliefs, expectations, assumptions, rules and thoughts) and unhelpful behaviours. Therefore, CBT aims to help clients see that their cognitions and behaviours are unhelpful and tries to teach them skills that can help them 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 believe that if a client can have more helpful cognitions and behaviours, they will have significantly improved psychological health and overall well-being. I’m just not sure if I agree that the process required to get to this outcome is the same as what many CBT clinicians would believe. For example, focus on distorted cognitions has been negatively correlated with overall outcomes in cognitive therapy for depression studies (Castonguay, Goldfield, Wiser, Raue, & Hayes, 1996).

What leads to improvements in treatment?

The 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 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 therapy (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 compared to what they were looking for at the beginning of their treatment.

Irvin Yalom’s excellent and informative book ‘The Theory and Practice of Group Psychotherapy’ goes into detail about a study 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 valuable 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.

When looking at these categories, 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. Instead, it is far more critical to develop a more in-depth knowledge of themselves, their inner 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.

All 20 clients had been in therapy an average of 16 months and had finished or were about to complete their treatment. These items were about group therapy, so the most critical factors for change in individual treatment may be different. However, even with individual treatment, Yalom believes that the relationship heals in the end.

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.

Suppose you have ever wanted to discover and learn more about yourself, accept yourself more, express yourself better or develop more trust in others. In that case, longer-term psychological therapy may be just what you need!

Dr Damon Ashworth

Clinical Psychologist
June 30, 2016
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 with your presenting issue or the reason that you came to treatment. Next, they will ask when this issue began and if you’ve experienced similar or other problems in the past. Next, 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 typically ends with clarification of treatment goals and a collaboratively decided upon plan to help you address your presenting problem and achieve your treatment goals. This process may occur in only one session or spread out over multiple sessions to collect a more in-depth history. 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 might 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. They also have questions to determine if you are lying or portraying yourself in an unrealistically positive or negative way. However, they are time-consuming to fill out and score up, so it is essential to determine if it is worth the cost for the extra accuracy that it may bring in helping you 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 recommended for clients who haven’t benefited as much as they would like from traditional Cognitive Behavioural Therapy (CBT).

There are also free personality assessments that anyone can access on the Internet. My personal favourite and one that I 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. I like the IPIP-NEO the most because 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 provides me with a much higher understanding of who they are, how they see themselves, and why they may struggle with the things they do. 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 overcome any cognitive biases that I have to empathise with the clients I see more accurately.

I have also sometimes recommended the Meyers-Briggs Type Inventory, and this can be good for determining what career may be suitable for you. However, I don’t find it useful because it categorises everyone into 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) often used in business settings or the Enneagram of Personality (9 types). However, other people swear by their accuracy and usefulness in helping us 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 psychologists use include the Rorschach Inkblot Test and the Thematic Apperception Test (TAT). These tests aim to clarify further what may be happening in someone’s subconscious or beyond 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 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 the therapist can determine a complete picture of the client. Other creative forms of expression, including drawing, painting, writing, sculpture, music, dance, and even dream interpretation and analysis, are other projective tools that a therapist can utilise within or outside of therapy. The interpretation of these forms of expression is even more subjective than projective tests. Still, it 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 what we think about and do.

To summarise, a Psychologist can definitely help you 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 their work. There are some great books out there on Personality and 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 time to move onto the next big question — “What is important to me, and what do I want to do?”

Dr Damon Ashworth

Clinical Psychologist

July 8, 2015