Damon Ashworth Psychology

Tag: mental health

  • Are You Asking the Right Questions In Your Search For a Therapist?

    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

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

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

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

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

    Considering that I liked his stand-up and show, I was intrigued to see his book about relationships in my local bookstore. Here’s what his research found:

    How Has Dating Changed?

    1. Distance

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

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

    More than half of Philidelphia in the 1930s married someone who lived in a ten-block radius to them. More than one-in-six didn’t even cross the road to find their marriage partner.

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

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

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

    2. Places

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

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

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

    3. Communication Methods

    The first text ever was by a British engineer called Neil Papworth in 1992. It’s crazy to think how much this form of communication has grown in only 24 years. In 2007, text messages began to outnumber phone calls made in the US each month, and in 2010 the world sent approximately 200,000 texts each minute. Since 2010, the number of people owning smartphones has dramatically increased in the USA. It rose from 17% in 2010 to 58% in 2014. 83% of 18- to 29-year-olds already owned a smartphone in 2014. With greater smartphone use comes an increasing use in apps such as Facebook Messenger, WhatsApp, and Viber, which further increases instant messages sent.

    Calling vs Texting vs Face-to-Face?

    First Dates

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

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

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

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

    Breaking Up

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

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

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

    Texting Guidelines for Dating:

    1. Do not just say “hey”, “hi”, “what’s up?”, “what’s going on?”

    • Generic messages like this tend to be a real turn-off for some people, especially females who receive many texts like this from several different guys. It is much better to ask a specific question about them or something that refers to the last time you spoke.

    2. Do not just engage in endless banter that never leads to a real-world catch-up.

    • Endless banter gets boring eventually, and older women, in particular, have less patience for constant text exchanges.

    3. Do not just ask someone if they want to “hang out sometime?”

    • It’s confusing whether hanging out is a date or just friends, and it may never lead to an actual date. So instead, invite them out to a particular event, or ask them to meet you at a specific time and place.

    4. Do try to proofread your text messages for correct grammar and spelling.

    • Incorrect spelling is often a major turn off, as is shortening words or using text slang. Determine the audience first, but stick to “tonight” rather than “2nite” if unsure.

    5. Do use a bit of playfulness and humour, but with caution.

    • Make sure that you have a similar sense of humour before engaging in anything too risky or crude, and remember that it can be challenging to pick up on tone in text messages.

    6. Follow the other basic rules around texting:

    • Please wait a while to text back instead of doing it right away, especially early in the dating process. Waiting a bit implies that you have a busy life and builds suspense, increasing the emotional intensity and attraction in the person who has to wait.
    • If you have already sent a text, do not send another message to the same person until you hear back from them unless it is an absolute emergency.
    • Write a similar amount in your texts to what the other person does. If you increase it slightly, they should too if they like you due to our tendency to reciprocate. If they do not, this may mean that they are not aware of the cultural norms around texting, or they are just not that into you.
    • If you are not interested, others will tell you to be upfront and honest with them, but most people actually either pretend to be busy or stop texting back.

    4. Expectations

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

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

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

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

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

    This search for the perfect partner seems to take a lot of emotional investment, trial and error, potential heartbreak, and much stress and indecision. However, if we find our soul mate, the potential pay-off should theoretically be much higher than for an old-fashioned “companionate” marriage. However, with more possible options and higher expectations, how can we know if we have found the one to marry?

    5. Marriages

    At what age do we get married?

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

    After how long do we tend to get married?

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

    Do we even need to get married anymore?

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

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

    Although things still aren’t fully equal with men and women, with women typically earning less and having to do more housework and child-rearing, they now have equal legal rights regarding property and divorce. Alongside the greater acceptance of various lifestyle choices, including moving out without getting married, marriage is now a choice rather than a necessity for many women.

    https://youtu.be/cYdsWtku9gg

    6. Choices

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

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

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

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

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

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

    Dr Damon Ashworth

    Clinical Psychologist

  • Feel the fear, and do it anyway

    Feel the fear, and do it anyway

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

    Then I realised what was happening.

    I was letting perfection get in the way of production and procrastinating. FEAR was holding me back.

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

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

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

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

    R — remoteness from values — Values are guiding principles for life. If we persist through discomfort in pursuing a goal, we need to get in touch with what is really important to us or what we care about deep down. For me, writing a blog is about helping people be informed about psychological theories and empowered with strategies that can make a difference in their lives. There is so much conflicting information about what can help. Sharing what rigorous scientific studies have found in collaboration with my own personal experience will hopefully be useful for anyone who chooses to read it. It will also give any potential clients an idea about my approaches towards my life and work and help them decide if I am the right clinical psychologist. It is much easier for me to persist in writing this blog and the following articles by connecting with these values.

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

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

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

    If you want to try this on your own:

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

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

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

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

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

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

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

    Doing it step-wise would take a long time, but as long as you progress, you learn the skills to challenge any fears that come your way.

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

    Dr Damon Ashworth

    Clinical Psychologist