Tag: blog

  • 33 Thoughts About Turning 33

    33 Thoughts About Turning 33

    This will be an unfiltered post. No thinking things through. No edits. Just reflections on life, age, and anything else that pops into my head. Here goes nothing:

    1. Turning 33 feels weird.
    2. I feel old at times, especially in my body.
    3. I still feel like a child at other times, and I wonder whether I will ever feel like a proper adult.
    4. I can’t believe I have so much grey hair now.
    5. It’s strange to wonder where the time has gone.
    6. Yet when I think about it, I really have done a lot and had many amazing experiences in my time on this planet.
    7. I’m happier now than I have ever been before.
    8. We never really know how our life will turn out.
    9. I couldn’t have planned for what has occurred in my life, yet, amazingly, things have turned out the way they have.
    10. I’m excited about the future.
    11. I used to get scared about the idea of getting older, but I don’t anymore.
    12. I’ve stopped searching for the right answers these days and instead focus on asking and living the right questions.
    13. I don’t regret much from my past, even though some of it really sucked at the time.
    14. I still don’t fully understand people, even after I have studied psychology for 8 years, seen patients since 2010 and read over 200 psychology books.
    15. I will never fully understand myself or someone else, which is okay as long as I keep trying to learn and grow.
    16. 33 is a palindrome.
    17. When I was younger, I would have seen 33 years old as “really old” and “over the hill.”
    18. I thought that I would have been a parent by now.
    19. I am glad that I haven’t just tried to follow the crowd and live a traditional life.
    20. I used to think it was better to receive gifts from others, and now I can see how it is better to give.
    21. I worried and stressed way more than I needed to as a child.
    22. I focused on my body image and appearance way too much as a teenager.
    23. I’ve never really looked after myself that well regarding what I put into my body. This will eventually catch up to me if it hasn’t already.
    24. I’ve let go of being perfect, which feels great.
    25. Not everything happens for a reason, but we can learn something from everything that we go through.
    26. Everyone suffers in life to some degree.
    27. Everyone has baggage.
    28. Life isn’t about getting the best job, house, partner, but the best one for you and your lifestyle and values.
    29. No one truly knows what the future holds, and that is both exciting and scary.
    30. It’s much better to only focus on trying to change what is in my control.
    31. Having unconditional positive regard and compassion for others is tough to do but really rewarding if you can.
    32. Living an honest and ethical life is so much less tiring in the long run than being dishonest, self-centred and egotistical.
    33. There are many kind people out there, and being kind to others is the best way to see it.

    Thanks for reading these last three years, and happy holidays to you all!

    Dr Damon Ashworth

    Clinical Psychologist

  • How Do You Deal With Your Problems?

    How Do You Deal With Your Problems?

    Throughout my schooling years, I was a horrible procrastinator. I would leave everything to the last minute, sometimes even having to take a day off high school to finish an assignment that was meant to be due that day.

    Once I got to university, I couldn’t do this anymore, as the due date remained the same whether I went to classes or not. So I would instead consume a lot of energy drinks the night before an assignment was due and generally do the majority of the assignment in an anxious, tense and sleep-deprived state, printing it out and submitting it 20 minutes before the deadline.

    Exams were the same. I’d miss classes, not pay attention when I was there, and then try to cram an entire semester’s contents into the last 4 days before an exam. I would lock myself in my room and study up to 12 hours a day, only leaving for toilet breaks and something to eat until I was utterly exhausted. Luckily, I have a knack for remembering vast amounts of information in short periods of time, so I always passed, but it wasn’t easy or fun.

    I sometimes tried to start early but never found this effective, as the negative consequences seemed far away. So eventually, I figured I would follow the mantra, “if you leave everything to the last minute, it only takes a minute”. This mantra actually helped me fit a lot of things into my life by being more efficient, but it did have its limitations.

    Once I got to my Doctorate of Clinical Psychology degree at Monash University, I was suddenly faced with the prospect of having to do a 70,000-word thesis that was meant to take 3.5 years to do. How could I possibly cram something so big, especially when it consisted of making a research proposal, ethics application, recruiting participants, conducting a clinical trial, collating all the results, running data analysis and writing up the thesis and journal articles? It turns out I couldn’t.

    The thesis ended up taking me 4 years to complete, and there wasn’t too much of it that I enjoyed. Moreover, it required a direct challenge of my usual defence mechanisms, which was no easy feat, especially because I didn’t know what they were. I knew that I had always procrastinated with my studies, but I was never entirely sure why.

    What Are Your Defence Mechanisms?

    Fortunately, a fun test over at personalityassessor.com on coping styles’ titled ‘How Do You Deal?’ helped me identify which defence mechanisms I typically used. So if you are interested in knowing what yours are, I definitely recommend taking it.

    It is a bit time-consuming as there are 2 parts and over 200 questions, but I like this questionnaire so much because it is tough to fudge the test to get desirable results. This is because the survey doesn’t have face validity, and therefore doesn’t appear to measure how much someone engages in a particular defence mechanism. Two examples of questions are:

    “I am bothered by stomach acid several times per week” or

    “It is annoying to listen to a lecturer who cannot seem to make up his mind as to what he really believes”.

    I’m not sure which defence mechanisms these questions are tapping into or if the correct answer is true or false. However, previous research has shown that specific patterns of responses on the questionnaire are quite good at identifying people who regularly use 10 common defence mechanisms, including repression, displacement, denial, regression, projection, reaction formation, intellectualisation, rationalisation, isolation and doubt. My results were astonishing to me.

    My Defence Mechanisms

    I first took the ‘How Do You Deal?’ questionnaire in February 2013. I had just finished a year-long practical internship at Peter MacCallum Cancer Centre, and I found supporting individuals with cancer really rewarding and meaningful, but also quite challenging as I had lost a dear friend to cancer when I was 21. In addition, I wanted to finish my thesis by July but was falling way behind, and I was also a month away from getting married and moving in with my then fiancé. So I had many big changes coming up, and I was both stressed and scared about how everything would go.

    Here are my February 2013 results, alongside the descriptions of these defence mechanisms given by the personality assessor website:

    1. Denial — 94th percentile — extremely high

    Denial is a defense mechanism where people avoid thinking about problems, or even pretend like their problems don’t exist. For example, someone might deny that they have a drug problem. Or someone might deny that they’re currently having conflict in their romantic relationship.

    Since denial can be subconscious, people who use denial might honestly believe that their problems don’t exist!

    2. Isolation — 91st percentile — extremely high

    Isolation is a defense mechanism where people compartmentalize their thoughts and feelings so that their thoughts don’t affect their feelings.

    Isolation differs from denial. Using denial, a person with a drug problem might refuse to even see that they have a drug problem. Using isolation, a person with a drug problem would acknowledge they have a problem, but would not let the fact they have a problem affect their feelings. If intellectualization is all about staying in your head to avoid your heart, isolation is about keeping your head and your heart separate.

    3. Displacement — 81st percentile — very high

    Displacement occurs when we “take out” our frustrations on someone/something else. For example, imagine that you hate your boss. It might have dire consequences if you expressed your hate toward your boss. So, if you displaced those feelings, you might go home and yell at your family.

    This is different than projection. In projection, we don’t see our own feelings — we see them in other people (e.g., I am not angry, my boss is). In displacement, however, we still “own” our feelings (e.g., I am angry) but we “take out” those feelings on the wrong target (e.g., angry at boss, but kick dog instead of boss).

    4. Regression — 73rd percentile — high

    Regression is a defense mechanism where people essentially start acting or thinking like a child. The idea is that when life feels too overwhelming or our problems feel too big, that we regress to an earlier, easier time when other people (our parents) used to take care of us. As such, regression can include:

    * desiring for other people to take care of your problems for you

    * acting dependent on other people

    * acting like a child (e.g., temper tantrums)

    * refusing to take responsibility for your actions

    5. Doubt — 72nd percentile — high

    The defense mechanism of doubt occurs when people doubt their senses or thought processes when they encounter problems. For example, imagine a good friend tells you they don’t really like you. You might utilize the defense mechanism of doubt by thinking “I must have misunderstood what they meant.”

    Doubt is kind of like a mixture of denial, intellectualization, and rationalization. Doubt lets us deny that our problems are real (or avoid making big decisions we’re afraid of) by questioning our ability to accurately see the world and make good decisions. In contrast to denial, when people use doubt, they are aware of their problems on some level.

    6. Rationalization — 68th percentile — high

    Rationalization is when people excuse their actions with usually irrational false explanations. For example, if someone binges and eats an entire large pizza, they might think “Well, the food was going to waste anyway! I might as well have eaten it.”

    Rationalization is kind of like a mixture of denial and intellectualization. Essentially, rationalization allows people to “explain away” their problems (usually bad habits, personal flaws, etc.) with a superficially valid explanation. The biggest difference between rationalization and intellectualization is that intellectualization is used to avoid feelings, whereas rationalization is used to avoid seeing our own personal flaws.

    7. Intellectualisation — 64th percentile — high

    Intellectualization occurs when people avoid painful feelings by thinking oftentimes inappropriate impersonal thoughts. For example, if someone’s pet dies, they might think, “Pets die every day. Why should I be upset?”

    Basically, the idea is that people who use intellectualization minimize their problems — or at least their feelings — and avoid the pain in their hearts by staying lodged solidly in their heads.

    8. Projection — 47th percentile — about average

    Projection occurs when we project our own thoughts and feelings onto other people. For example, you might really hate your boss. If you used the defense mechanism of projection, you might be unaware of your own feelings toward your boss, but instead think your boss hated you. This defense mechanism would allow you to deny your feelings and, in turn, believe that any conflict between you and your boss is your boss’s fault (not yours).

    Projection basically lets us believe that are problems aren’t really ours — they’re someone else’s!

    9. Repression — 37th percentile — low

    Repression occurs when people push down or block-out memories or desires that they feel are threatening. For example, someone might repress painful childhood memories and try to not think about them. As another example, someone might repress their attraction to a friend that they fear wouldn’t reciprocate their interest.

    Repression is similar to denial, but slightly different. Denial is about convincing yourself that your problems don’t exist. Repression is about blocking out part of yourself — memories or desires, usually — perhaps to avoid creating a problem!

    10. Reaction formation — 15th percentile — very low

    Reaction formation is a fascinating defense mechanism where we do the opposite of what we really want to do. For example, imagine you are very attracted to another person. If, for some reason that attraction is a problem (e.g., you are married, they are married, etc.), you might start to feel the opposite toward them — you may think they are disgusting and/or actively dislike them.

    Reaction formation allows you to avoid your problems — and also creates a buffer to ensure you avoid your problems. In the example above, you’re not merely repressing your attraction toward the other person — you’re actually feeling negative feelings toward them. These negative feelings will ensure the attraction doesn’t resurface.

    Seeing that my marriage ended up being far worse than I had predicted, I maybe should have paid attention to these results a bit more, especially my denial and doubt scores.

    It did help with the writing up of my thesis. I stopped trying to avoid the problem, started coming into the lab from 9 am — 5 pm every weekday regardless of how I felt and began making some real and consistent progress without cramming for the first time in my life. I finished a full draft of my thesis by September 2013, started working as a Psychologist in private practice shortly after that, and submitted the final copy of my thesis for examination in February 2014.

    Have My Defence Mechanisms Improved?

    I retook the ‘How Do You Deal?’ questionnaire at the end of April 2017. I now live a life that is much more consistent with the experiences I want to have rather than what society says that I should be doing. I believe that I am a lot happier and in the best place that I have ever been psychologically. But have my defence mechanisms actually changed?

    Defence Mechanisms 2013 2017
    Denial 94th percentile 75th percentile
    Isolation 91st percentile 92nd percentile
    Displacement 81st percentile 77th percentile
    Regression  73rd percentile 68th percentile
    Doubt 72nd percentile 64th percentile
    Rationalisation 68th percentile 53rd percentile
    Intellectualisation 64th percentile 18th percentile
    Projection 47th percentile 56th percentile
    Repression 37th percentile 20th percentile
    Reaction formation 15th percentile 9th percentile

    As you can see, eight of my results had improved, with denial dropping 19 percentile points and losing its position as my most used defence mechanism. This is great, as I am now more aware of my issues and can actually do something about them.

    My most noticeable improvement was my reduction in intellectualising things, but I also repress things much less than I used to, rationalise my actions less, and doubt myself less too. This means that I am now turning into what I feel and need more, not just remaining in my head. By understanding and accepting my emotions rather than avoiding them or explaining them away, it really does make it easier to know what action I need to take. Regular journaling, mindfulness and therapy have definitely helped me to create these changes. So has being more honest and authentic with others.

    The two defence mechanism scores that have increased are projection and isolation. The increase in projection isn’t helpful, as this means I could be externalising some problems rather than taking responsibility for my role in creating them. The high isolation score isn’t so bad, though, as separating my head and heart is something that I have worked on to make sure that I am making decisions in line with my values and not my fears going forward. If this never changes, that will be fine by me.

    Can We Change How We Deal With Problems?

    It’s not possible to completely avoid engaging in defence mechanisms. We all have different coping methods, and many of these coping styles are developed in childhood and modelled on what everyone else in our family did.

    However, some defence mechanisms are more helpful than others, and they can change in time with deliberate practice. Head researcher of the Grant longitudinal study, George Vaillant, has separated defence mechanisms into immature, intermediate and mature defences. Acting out, projection, passive-aggressive behaviour, and denial are considered immature. Reaction formation, repression and displacement are intermediate defences. Mature defences include:

    1. humour: seeing the funny side of things,
    2. sublimation: channelling difficult emotions into something prosocial and constructive,
    3. anticipation: planning for upcoming situations that might be challenging,
    4. suppression: not reacting to your feelings or letting them show if this would interfere with you achieving your goals, and
    5. altruism: deriving pleasure from helping others.

    A 2013 study by Malone and colleagues found that men who used more mature defence mechanisms between 47 and 63 years of age had better health between 70 and 80. This was mostly because the people who regularly engaged in more mature defence mechanisms had better social support and stronger interpersonal connections than individuals who used immature defence mechanisms (Malone et al., 2013).

    If you want to build up healthier coping strategies, understanding which defences you currently use is a great place to start. The best way to do this apart from taking the ‘How Do You Deal?’ questionnaire is consulting with a therapist, especially a psychologist or a psychiatrist trained in psychoanalysis or psychodynamic psychotherapy. Friends and family might be able to point out some potential defence mechanisms that you use, but I think it is better to get this feedback from professionally trained and impartial. They can then help you replace these defences with more mature and adaptive coping strategies to have more supportive relationships and better long-term health and well-being.

    Dr Damon Ashworth

    Clinical Psychologist

  • What Do Clients Find Most Helpful About Therapy?

    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