Damon Ashworth Psychology

Tag: character development

  • Which Archetype Are You?

    Which Archetype Are You?

    Ever notice how any successful story throughout history tends to have a similar cast of characters?

    If you haven’t bothered counting, I’ll let you know that most characters will fall into one of 12 principal roles, and this explains why and how we can find favourite stories so relatable. Carl Gustav Jung, a famous psychoanalyst, defined these characters and their journey as Archetypes.

    What is an Archetype?

    An archetype is something that symbolises primary human motivations, drives, desires and goals. It influences how one finds meaning in life, what one values, and personality characteristics. Most people tend to identify primarily with one archetype, although it can be a mix of a few different ones.

    Below are the 12 archetypes, with a brief description below them:

    If you’re a visionary, you value innovation above all else. You look for patterns in the ordinary and try to create order out of chaos. You are intuitive and tend to find it much more comfortable than others to predict trends and look into the future accurately. You love to exchange ideas, share your opinions, and try out new gadgets. But you also tend to overthink things or catastrophise if stressed and overwhelmed. When this happens, you need to retreat to somewhere secluded and/or scenic to once again focus on your next innovative idea that you would like to put into action.

    The visionary archetype includes the designer, the detective, the director, the entrepreneur, the hermit, the futurist or the strategist.

    If you’re a caregiver, you value being compassionate, caring and kind to others, especially your family and friends. You struggle to say no to people because you love to help out and give as much as you can. Burnout is a risk if you spread yourself too thin, however. You are easy to get along with, flexible to various situations, and always willing to do what is required to adapt to and fit in with others without losing your sense of self. Your favourite activities involve spending time with those you love, and you are the person that people call or talk to if they have been going through something tough or are in crisis.

    The caregiver archetype tends to include the loving parent, the teacher, the nurse, the doctor, the best friend forever, the rescuer, the mentor, the healer, the veteran and the civil servant.

    The royal wants power and to be in control. They love being a leader and the boss and love living the high life and the sense of entitlement that comes with this. The royal is not afraid to throw money at a problem so that it will go away and is willing to use their status, title or name to get what they want and feel that they deserve. Activities, holidays and clothes all need to be the best that money can buy.

    Royal archetypes include the king, the queen, the prince or princess, the boss, the executive, the politician, the diva and the networker or social climber.

    The performer is all about entertaining others and being the centre of attention, even at social and family gatherings. Like Lady Gaga, they live for the applause and moving others emotionally or making them laugh. The performer wants to be seen and believes that being dramatic and in the right places with the right people is the best way to achieve this.

    The performer archetype includes the actor, the entertainer, the comedian, the clown or fool, the eccentric, the trickster, the storyteller, the spellcaster, the magician and the provocateur.

    The spiritual person has their faith as the cornerstone of who they are. They are belief-driven and pray and seek for what they know to be true to come to fruition. They love to engage in yoga, meditation, and connecting with others on a deeper level and feel very connected with others and the world around them. The biggest trap for the spiritual person is magical thinking and not doing enough to take action and change the questionable things in their lives. They instead have hope and faith that things will work out the way they want, even when all the evidence suggests otherwise.

    The spiritual archetype can include the shaman, the saint, the mystic, the guru, the angel, the missionary, the martyr, the disciple and the Samaritan.

    The tastemaker values the beautiful nature of things above all else. They pay attention to trends, fashion and decor, and ensure that whatever they have is as aesthetically pleasing as possible. But, unlike the royal, they don’t assume that this is just about what is most decadent or expensive. A tastemaker loves to explore new restaurants, shops, technology and holiday spots. Their weakness is judging others who do not prioritise aesthetics as much as them.

    The tastemaker archetype includes the fashionista, the goddess, the gentleman and the metrosexual.

    The explorer loves adventure, exploring the world, and seeking excitement wherever they are. They are curious about everything new and things they are yet to encounter, and as a result, they fear commitment and being stuck in one spot or tied down by someone else in any way. The explorer feels drawn to things unseen and undiscovered and is willing to be practical about what it takes to live their lives in this way. They love meeting new people and immersing themselves in new cultures and experiences.

    The explorer archetype includes the adventurer, the traveller, the seeker, the discoverer, the wanderer, the individualist, and the pioneer.

    The advocate is always being a champion for a good cause and hoping that things will get better if they fight for what they believe in. They may tend to get too caught up personally in the cause but are willing to back up what they believe in by getting signatures for a petition, fundraising money for a campaign, or organising a protest. They also try to live their lives in a way that is consistent with their values and standing up for those less fortunate or those without a voice, such as flora and fauna.

    The advocate archetype includes the hero, the environmentalist, the crusader, the vegan, the lawyer, the feminist, and the human rights advocate.

    The Intellectual takes pride in their extensive knowledge about things that are important to them. They are always seeking new information and trying to apply it in a useful way to increase their wisdom. The intellectual can come across as a know-it-all, but they never feel like they have enough new things to learn. They love to spend time reading books and going to museums and are happy to impart their knowledge to anyone willing to listen.

    The Intellectual archetype includes the philosopher, the student, the geek, the sage, the scientist, the theologian, the crone, the inventor, and the judge.

    The rebel’s core values are justice and autonomy. They are fiercely independent and cannot be contained by the social niceties, order and dutifulness. They do what they want at all times, and like adventure and excitement, challenging convention and being deliberately provocative too. They are at risk of not thinking through the consequences of their decisions, and as a result, can overconsume drugs or alcohol or get into trouble with the law, at work, or with those closest to them.

    Rebel archetypes include the warrior, the hedonist, Don Juan, the femme fatale and the wild man or wild woman.

    The athlete lives for staying active, fit, and in shape. They love to compete in anything involving physical activity and are happiest when they have achieved a big, athletic goal. The athlete tends to turn everything into a competition, which can annoy others, but they are just as happy pushing themselves to improve their health and body. Clothing is worn for comfort and performance only, not aesthetics. The athlete loves to attend sporting events and is also happy to watch sport on the TV.

    The Athlete archetype includes the competitor, the outdoorsman, the dancer, and the tomboy.

    The creative loves being original and genuinely expressing themselves. The creative hates to repeat or copy what others have done before them. They are happiest creating something from nothing, and this may include a piece of art, but it could also be a meal, an outfit, a room in a house or even an idea. The creative tends to be a perfectionist, which can make it difficult to begin a new project. Once you get started, you tend to get into the zone until a project is complete or you need a break.

    The creative archetype includes the artist, the chef, the child, the poet, the novelist, the shapeshifter and the romantic.

    What Are Your Main Archetypes?

    At archetypes.com, it’s possible to find out which archetypes you are most similar to. This may help you identify what journey you need to take in life or what areas may be best for you to focus on going forward. Included below are my results:

    I’m pretty happy with these results and not surprised by my top 2, but I was surprised to see visionary my third highest archetype. I’ve never thought of myself as imaginative or innovative, but I do want the world to change for the better and am willing to do what I can to improve the mental health of others.

    Based on these results, it’s apparent that I love to help others. Still, I need to be cautious about taking on excessive responsibility for others or feeling too guilty or inadequate when I can’t help as much as I would like to. I love to learn and be curious about new things, but I still need to be humble and understand that there’s still so much that I’ll never know. I also need to realise that not everyone wants to learn as I do, which is okay. Lastly, when I have an innovative idea, it is vital that I put this plan into action to make a real difference. I would also benefit from connecting with others and collaborating with the right people to help make these dreams a reality.

    I know that archetypes and the test are not highly scientific, but I still found them useful to think about what story I am trying to live out and what values or principles I am being guided by. Caring for others, learning new things, and creating positive change is what I care about. What about you?

    Dr Damon Ashworth

    Clinical Psychologist

  • The 10 Best Laws of Power

    The 10 Best Laws of Power

    A fascinating book that I read towards the end of 2017 was ‘The 48 Laws of Power’ by Robert Greene.

    Since the book was first released in 1998, it has sold over 2 million copies worldwide and has influenced many successful people, from Will Smith to Kanye West, Jay-Z and 50 Cent, who later co-wrote a New York Times’ bestseller with Greene.

    It is also the most highly requested book in U.S. prisons due to the synthesis of Machiavelli, Sun Tzu and other famous writers’ key prescriptions for effectively managing power struggles in difficult environments.

    Some of the 48 laws do seem contradictory, and others seem a little repetitive. Still, there are some truly great bits of advice for effectively managing situations where power may play a role. This might be a corporate environment, a difficult but smaller workplace, a large social group, to really anywhere where there is a power imbalance between people or a formal or informal hierarchy.

    Here are my 10 favourite laws, including a description of each law from the following website. The parts that I especially like are bolded. Enjoy!

    Law 4: Always Say Less than Necessary

    When you are trying to impress people with words, the more you say, the more common you appear, and the less in control… Powerful people impress by saying less. The more you say, the more likely you are to say something foolish.

    Like the Danish proverb that says, “deep rivers move with silent majesty, shallow brooks are noisy”, law 4 reminds me only to say things that I believe will be of value. It also helps me stay within my circle of competence and not give advice on things that I do not know much about.

    Law 9: Win through your Actions, Never through Argument

    Any momentary triumph you think gained through argument is really a Pyrrhic victory: The resentment and ill will you stir up is stronger and lasts longer than any momentary change of opinion. It is much more powerful to get others to agree with you through your actions, without saying a word. Demonstrate, do not explicate.

    A parent who smokes but tells their children not to is unlikely to be successful at persuading their children because “actions speak louder than words”. The better option is not to smoke or quit if you want to set a good example. As Mahatma Gandhi said, “you must be the change you wish to see in the world”.

    Law 13: When Asking for Help, Appeal to People’s Self-Interest, Never to their Mercy or Gratitude

    If you need to turn to an ally for help, do not bother to remind him of your past assistance and good deeds. He will find a way to ignore you. Instead, uncover something in your request, or in your alliance with him, that will benefit him, and emphasise it… He will respond enthusiastically when he sees something to be gained for himself.

    As sad as this may appear, most people are self-motivated and want to do the right thing if it makes them look good. For example, a hybrid car such as a Toyota Prius sells well because it is known as a hybrid car. It screams out, “I care about the environment,” in a way that the Toyota Camry Hybrid does not because the hybrid version of the Camry looks almost identical to the regular Camry. The 2014 sales in the US of each car highlights this point: Prius = 194,000; Toyota Camry Hybrid = 39,500; Toyota Camry (non-hybrid) = 428,600. Figure out how what you want will benefit the other person or help them look good before you ask for a favour, and you are much more likely to get them on board.

    Law 18: Do Not Build Fortresses to Protect Yourself — Isolation is Dangerous

    The world is dangerous and enemies are everywhere — everyone has to protect themselves. A fortress seems the safest. But isolation exposes you to more dangers than it protects you from — it cuts you off from valuable information, it makes you conspicuous and an easy target. Better to circulate among people, find allies, mingle.

    Many people that I see try to protect themselves at the cost of a real sense of connection and belonging with others. This law helps by reminding me of the dangers and costs of not opening up to honest people you can trust.

    Law 23:Concentrate Your Forces

    Conserve your forces and energies by keeping them concentrated at their strongest point. You gain more by finding a rich mine and mining it deeper, than by flitting from one shallow mine to another — intensity defeats extensiveness every time.

    This reminds me of the saying, “jack of all trades; master of none”. If you want to make progress in anything, it is important to prioritise and put your energy into the activities and thought patterns that will give you the best results. Law 23 also helps me to build upon my strengths rather than worrying too much about my weaknesses.

    Law 25:Re-Create Yourself

    Do not accept the roles that society foists on you. Re-create yourself by forging a new identity, one that commands attention and never bores the audience. Be the master of your own image rather than letting others define it for you.

    I often encourage my clients to clarify their most important values and see how these differ from what their family, friends, culture, or society may want. The idea of working hard and not enjoying life until retirement is not a role that I want to accept, even though this is considered normal in many respects by society. It’s much better to create and live a sustainable life for myself, whatever that may look like. Then it won’t matter if and when I retire, especially if I keep loving what I do for work.

    Law 28: Enter Action with Boldness

    If you are unsure of a course of action, do not attempt it. Your doubts and hesitations will infect your execution. Timidity is dangerous: Better to enter with boldness. Any mistakes you commit through audacity are easily corrected with more audacity. Everyone admires the bold; no one honours the timid.

    Law 28 reminds me not to doubt myself once I have settled on a course of action and fully commit myself to it for a set period of time instead of remaining uncertain or indecisive. Once a decision is made, it is much better to give it 100% until the next decision needs to be made. Uncertainty only leads to more stress and anxiety and less satisfaction in the long run.

    Law 29: Plan All the Way to the End

    The ending is everything. Plan all the way to it, taking into account all the possible consequences, obstacles, and twists of fortune that might reverse your hard work… By planning to the end you will not be overwhelmed by circumstances and you will know when to stop. Gently guide fortune and help determine the future by thinking far ahead.

    This reminds me of the benefits of thinking into the future and clarifying how I would want my life to look. For example, if I had a 50th birthday and someone close to me stood up and spoke about the person I had been for the past 18 years, what would I want to hear them say? Based on my response to this, it is then important to see if my 1-, 5- or 10-year plan is helping me to head in that direction. If not, more planning and some big changes may be required, as long as my plans are flexible enough to change as I continue to grow with time.

    Law 35: Master the Art of Timing

    Never be in a hurry — hurrying betrays a lack of control over yourself, and over time. Always (be) patient, as if you know that everything will come to you eventually. Become a detective of the right moment; sniff out the spirit of the times, the trends that will carry you to power. Learn to stand back when the time is not yet ripe, and to strike fiercely when it has reached fruition.

    Patience is a massively underrated value, especially in today’s society. How often do you see people multitasking or telling you how busy they are? I know I sometimes do. But slowing things down and really making sure that my attention is 100% on what is most important in any given moment is a great recipe for long-term happiness and well-being. While it is important to “strike while the iron is hot”, I think it is also important not to be too reactive and make sure that the decisions you make are really consistent with your values and long-term plans. Knowing how to say no to the wrong things in life is also a crucial element of success.

    Law 45: Preach the Need for Change, but Never Reform too much at Once

    Everyone understands the need for change in the abstract, but on the day-to-day level people are creatures of habit. Too much innovation is traumatic, and will lead to revolt. If you are new to a position of power, or an outsider trying to build a power base, make a show of respecting the old way of doing things. If change is necessary, make it a gentle improvement on the past.

    Trying to change my eating habits has taught me this law better than anything else recently. As soon as I try to be too restrictive, I rebel against any prescriptions. Long-term sustainable changes are again much better than short-term dramatic changes. The 20-minute walk that you manage to do is better than the 10km run you do not, so start small and try to build up slowly. If you can do this, changes are much more likely to stick.

    If you want to see the remaining 38 laws, please click here or purchase the book. Some of the laws seem pretty ruthless, but pretending that they don’t exist in power dynamics is much more dangerous than learning how they work.

    I also recommend checking out my dealing with toxic people article for more information on successfully managing and surviving difficult interactions.

    Dr Damon Ashworth

    Clinical Psychologist

  • The Top 20 Movies of My Lifetime (10-1)

    The Top 20 Movies of My Lifetime (10-1)

    Looking at the American Film Institute’s 100 Greatest American Films of All Time list that came out in 1998, most films are super old. For example, ‘Citizen Kane’ (1941) ranked at #1, ‘Casablanca’ (1942) ranked at #2, ‘The Godfather’ (1972) ranked at #3, ‘Gone With the Wind’ (1939) ranked at #4 and ‘Lawrence of Arabia’ (1962) ranked at #5.

    I loved ‘The Godfather’ but fell asleep in ‘Casablanca’ and ‘Lawrence of Arabia’. However, I agree with ‘Gone With the Wind’ being up there, especially seeing that it is the highest-grossing movie of all time, adjusted for inflation. I also need to see ‘Citizen Kane’ before making any judgments on it, but I tend to like modern movies more than most movie critics.

    Out of the entire top 100, only 8 came out after 1985, the year that I was born:

    • Schindler’s List (1993) — #9
    • The Silence of the Lambs (1991) — #65
    • Forrest Gump (1994) — #71
    • Dances with Wolves (1990) — #75
    • Platoon (1986) — #83
    • Fargo (1996) — #84
    • Goodfellas (1990) — #94
    • Pulp Fiction (1994) — #95

    None of these movies made my top 20 countdown either, so clearly, the movie critics and I don’t always see eye to eye.

    In 2008, the AFI came out with their 10th-anniversary list, and ‘Raging Bull’ (1980) and ‘Singing in the Rain (1952) had replaced ‘Gone With the Wind’ and ‘Lawrence of Arabia’ in the top 5. The top 100 choices were still predominantly old movies, with only 14 movies released after 1985:

    • Schindler’s List — #8
    • The Lord of the Rings: The Fellowship of the Ring (2001) — #50
    • Unforgiven (1992) — #68
    • Saving Private Ryan (1998) — #71
    • The Shawshank Redemption (1994) — #72
    • The Silence of the Lambs — #74
    • Forrest Gump — #76
    • Titanic (1997) — #83
    • Platoon — #86
    • The Sixth Sense (1999) — #89
    • Goodfellas — #92
    • Pulp Fiction — #94
    • Do the Right Thing (1989) — #96
    • Toy Story (1995) — #99

    There were two movies from my top 20 countdown in the list, which makes me feel a little better. Interestingly, ‘Fargo’ and ‘Dances With Wolves’ became less admired over time and dropped out of the list. On the other hand, ‘Unforgiven’, ‘The Shawshank Redemption, ‘Titanic’, ‘Do the Right Thing’ and ‘Toy Story’ became more admired since 1998 and made the 10th-anniversary list after missing the first countdown. I hope they come out with another list in 2018 to mark the 20th anniversary and look forward to seeing what they include.

    After seeing a movie these days, I get interested in knowing what movie critics thought of the movie. Rotten tomatoes is a great website that accumulates all of the professional movie critics reviews on a particular movie and gives an aggregate score out of 100% based on how many reviews are positive for the film. Here are the Tomatometer ratings for numbers 20 through to 11 in my top 20 movies of my lifetime countdown:

    #20 — The Conjuring (2013) — 86%

    #19 — The Castle (1999) — 88%

    #18 — Midnight in Paris (2011) — 93%

    #17 — Groundhog Day (1993) — 96%

    #16 — Donnie Darko (2001) — 86%

    #15 — Before Sunrise (1995) — 100%

    #14 — The Truman Show (1998) — 94%

    #13 — The Sixth Sense (1999) — 85%

    #12 — Inglourious Basterds (2009) — 89%

    #11 — Good Will Hunting (1997) — 97%

    To qualify for this countdown, I need to have seen the movie, enjoyed it, and found that it had an emotional impact on me somehow. Here is my top 10, with their IMDb star rating and their rotten tomatoes Tomatometer score:

    # 10 — Eternal Sunshine of the Spotless Mind (2004) — IMDb star rating: 8.3/10, rotten tomatoes Tomatometer = 93%

    The tagline for the movie says it all: “You can erase someone from your mind. But, getting them out of your heart is another story.” A strange but touching movie about a couple who keep going to a memory clinic to try and erase the memories of someone they love in the hope that they can move forward with their lives. However, without even knowing why, something keeps bringing them back together. Seeing that Jim Carrey now has 2 movies in my top 20, it seems that he should have played serious roles more often.

    # 9 — Requiem for a Dream (2000) — IMDb star rating: 8.4/10, rotten tomatoes Tomatometer = 78%

    I feel like this should be shown to anyone who thinks that drugs are cool, especially teenagers. I haven’t spoken to anyone who has watched this movie and hasn’t had a strong visceral reaction to it, either positive or negative. It may be why it has the lowest Tomatometer score out of any movie on my countdown. The director Darren Aronofsky achieved more critical acclaim for his 2010 movie ‘Black Swan’, which was also quite unsettling to watch, but this one had more of an impact on me.

    # 8 — The Lion King (1994) — IMDb star rating: 8.5/10, rotten tomatoes Tomatometer = 92%

    Drawing inspiration from William Shakespeare’s ‘Hamlet’, I was obsessed with ‘The Lion King’ when I was younger, and it first came out. The story and the music were amazing, and I bought the soundtrack on CD and the movie on VHS as soon as they were released. It’s heartbreaking, uplifting and hilarious, and my favourite Disney cartoon of all time.

    # 7 — Back to the Future (1985) — IMDb star rating: 8.5/10, rotten tomatoes Tomatometer = 96%

    A movie that nearly wasn’t made. When the writer and director first sent the script of ‘Back to the Future’ around to the Hollywood studios, nobody wanted to touch it. The studios knocked it back about 50 times, and it wasn’t until the director had success with another movie that it was greenlit for production. A movie about a hero who befriends a weird old scientist who takes him back into the past where he has to evade his biological mother, who is crushing on him, seems like a weird premise for a movie. However, it became a massive box office hit with two sequels and a huge fan base even to this day. Time travel, when done well, is another truly magical aspect of going to the movies. Being able to learn about where you have come from and what your parents were like when younger is another really fascinating thing that we will never be able to see unless they captured it on video.

    # 6 — The Usual Suspects (1995) — IMDb star rating: 8.6/10, rotten tomatoes Tomatometer = 88%

    “The smartest trick the devil ever pulled was convincing the world he didn’t exist”. A very clever movie by Bryan Singer and the best in his career, in my opinion, although some of his X-Men movies were good too. But, like ‘The Sixth Sense’, it also has a twist at the end that completely changes the viewing experience of the movie. Who is Keyser Söze? It would be best to watch to find out and then see it a second time to see what signs you missed.

    # 5 — The Matrix (1999) — IMDb star rating: 8.7/10, rotten tomatoes Tomatometer = 87%

    I remember the marketing campaign in Australia when it first came out — “What is the Matrix?” It gave nothing away about the movie and yet made me feel like I had to watch it or I would miss out. Once I saw it, it blew my mind. Probably the most original action movie that I have ever seen. It has been copied and emulated many times since, so it probably doesn’t seem groundbreaking these days, but the bullet-dodging and slow-motion sequences were amazing. I wish they didn’t bring out the sequels, as they took away some magic from the first movie. If you had a choice, would you take the red pill and be exposed to the truth, or would you take the blue pill and live in ignorant bliss?

    # 4 — Inception (2010) — IMDb rating: 8.7/10, rotten tomatoes Tomatometer = 86%

    Another very creative and inventive premise with great visual effects. I think Christopher Nolan is a great director, and he likes to get his audiences to think. The difference between reality and dreams is something that has come up a few times on this list. Still, Inception takes it to a whole new level, saying that we can implant an idea into the subconscious mind of someone else during their sleep to impact their behaviour when they are awake. The way that time is altered at the different levels of dreams is great. Also, the spinning top at the movie’s end leaves the interpretation of what happened wide open.

    # 3 — Fight Club (1999) — IMDb star rating: 8.8/10, rotten tomatoes Tomatometer = 79%

    David Fincher is another of my favourite directors. He has an especially great knack for turning good books into excellent films, including this, ‘Gone Girl’ and ‘Girl With a Dragon Tattoo’. The antisocial, antimaterialistic and anarchistic nature of this film really appealed to me at the time. It made me question what I thought I knew about what was important in this world. It didn’t make me want to start a fight club or punch anyone, but to live a life that was more autonomous and genuine. The surprise ending is almost as good as ‘The Sixth Sense’ and ‘The Usual Suspects’ too.

    # 2 — The Dark Knight (2008) — IMDb star rating: 9.0/10, rotten tomatoes Tomatometer = 94%

    This movie is epic in scale and is really all about Heath Ledger as the Joker. I was concerned that he wouldn’t size up to Jack Nicholson’s version, but he surpassed it in every way possible and stole the scene whenever he was on the screen. It is one of the greatest performances of all time, in my opinion, and he truly deserved the Oscar for the role, especially considering the toll that it seemed to take on his emotional and psychological well-being. It was annoying that the character of Rachel changed from Katie Holmes in ‘Batman Begins’ to Maggie Gyllenhaal. Apart from that, this is the greatest Batman movie of all time, and the car chase scene through the tunnel is also the best chase scene of all time.

    # 1 — The Shawshank Redemption (1994) — IMDb star rating: 9.2/10, rotten tomatoes Tomatometer = 91%

    The highest-rated movie of all time on IMDb and, therefore, well-deserving of the #1 movie on my list. Interestingly, this wasn’t a big hit when it first came out but continued to build an audience over time once released for home movie consumption. Morgan Freeman is always great in movies, especially when he plays the narrator, but this one is his best. The ending is exceptionally uplifting, too and would give hope to even the most cynical viewer out there.

    Thanks for checking out my list. Do let me know if you agree or disagree with any of these titles in the comments section below or if you think another title should have made the countdown!

    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