Damon Ashworth Psychology

Tag: treatments

  • It’s Okay to Still Fall into Life Traps… We All Do!

    Life traps are self-defeating ways of perceiving, feeling about, interacting with oneself, others, and the world.

    If you want to get a sense of what your life-traps may be, the book ‘Reinventing your life’ by Jeffrey Young is an excellent place to start, as it goes into 11 different ones. If you want a more in-depth analysis, however, then go and see a Psychologist who specialises in Schema Therapy.

    A Psychologist has much more thorough and scientific questionnaires that can give you results on 18 schemas (life-traps), help you identify your most common traps, and show you what you can do both in therapy and outside of it whenever you realise that you have fallen into a trap.

    My Life-traps

    I have taken the Young Schema Questionnaire (YSQ-L3) three times to help identify my main life traps. The first time was at the beginning of 2014 when I was stuck in the middle of a complicated relationship while also trying to complete the last part of my Doctoral thesis and play basketball at a semi-professional level.

    The second time was in April 2017, when I was in a Clinical Psychology job that I loved. I had also stopped playing basketball at such an intense level and played with some friends (and without a coach) twice a week, which was way more fun.

    The most recent time was August 2018, where I had just finished up my work in private practice in Melbourne, Australia and was about to leave my friends and family to volunteer for two years in Port Vila, Vanuatu, as part of the Australian Volunteers Program (funded by the Australian Government).

    I want to share these results with you to show you that:

    1. context influences personality and how people view themselves, the world and others,
    2. personality and ways of perceiving yourself, relationships, and the world can change, and
    3. Even though it is possible to grow and improve over time, we all still fall into traps at times, which is okay. It’s about identifying when you have fallen into a trap and then knowing what you need to do to get out of it.

    When looking at the results, a 100% score would mean that I have answered every item for that life-trap a 6, which means that they describe me perfectly. The higher the % score, the more likely I will frequently fall into this life trap.

    YSQ-L3
    2014 Results 2017 Results 2018 Results
    Schema or life-trap Schema or life-trap Schema or life-trap
    1. Subjugation – 75% 1. Self-sacrifice – 60.78% 1.Self-sacrifice – 60.78%
    2. Dependence – 64.44% 2. Punitiveness (self) – 57.14% 2. Emotional Deprivation – 59.26%
    3. Self-sacrifice – 61.76% 3. Emotional Deprivation – 51.85% 3. Punitiveness (self) – 50%
    4. Approval seeking – 54.76% 4. Unrelenting Standards/ Hyper-criticalness – 48.96% 4. Subjugation – 50%
    5. Punitiveness (self) – 51.19% 5. Approval Seeking – 48.81% 5. Unrelenting standards – 43.75%
    6. Unrelenting standards – 48.96% 6. Subjugation – 48.33% 6. Approval seeking – 41.67%
    7. Insufficient self-control – 46.67% 7. Negativity/ Pessimism – 43.94% 7. Vulnerability to harm/illness – 40.28%
    8. Emotional inhibition – 46.30% 8. Mistrust/ Abuse – 41.18% 8. Negativity/Pessimism – 39.39%
    9. Emotional deprivation – 42.59% 9. Dependence/ Incompetence – 41.11% 9. Dependence/ Incompetence – 38.89%
    10. Abandonment – 41.18% 10. Emotional Inhibition – 40.74% 10. Mistrust/Abuse – 37.25%

    What’s Changed?

    people riding canoe boat view from inside pipe

    By looking at the table above, the green items indicate an improvement in comparison to the prior assessment, meaning that these life-traps are a little bit less powerful for me. The yellow indicates no change since the last assessment, and the red indicates a worse score, meaning that these life-traps may have a more powerful sway over me.

    From 2014 to 2017, 7 out of the initial top-10 life-traps had improved, one stayed the same, and two had worsened. Two additional traps not included in the initial top 10 had worsened and made the list (Negativity/Pessimism & Mistrust/Abuse).

    From 2017 to 2018, seven out of the 2017 top ten life traps had improved yet again, with one staying the same and two becoming worse. One additional trap (Vulnerability to harm/illness) had increased. Still, I believe this was due to the medical and safety briefings that I had been going through in the preparation of moving to Vanuatu for 2 years.

    Overall, I am less likely to fall into any life trap in 2018 than in 2014 and 2017. For example, the average of my top ten in 2014 was 53.29%, whereas in 2017, it was 48.28%, and in 2018, it was 46.13%.

    I also rated 21 items a 6 (= describes me perfectly) in 2014, only five in 2017, and none in 2018. This means that I am much less likely to get completely pushed around by my life traps. However, they still have some sway on me, especially the self-sacrifice and the emotional deprivation schemas, and to a lesser degree, punitiveness and subjugation.

    Here is Young’s description of these schemas:

    SELF-SACRIFICE: Excessive focus on voluntarily meeting the needs of others in daily situations, at the expense of one’s own gratification. The most common reasons are: to prevent causing pain to others; to avoid guilt from feeling selfish; or to maintain the connection with others perceived as needy. Often results from an acute sensitivity to the pain of others. Sometimes leads to a sense that one’s own needs are not being adequately met and to resentment of those who are taken care of.

    EMOTIONAL DEPRIVATION: Expectation that one’s desire for a normal degree of emotional support will not be adequately met by others. The three major forms of deprivation are:

    1. Deprivation of Nurturance: Absence of attention, affection, warmth, or companionship.
    2. Deprivation of Empathy: Absence of understanding, listening, self-disclosure, or mutual sharing of feelings from others.
    3. Deprivation of Protection: Absence of strength, direction, or guidance from others.

    SUBJUGATION: Excessive surrendering of control to others because one feels coerced — usually to avoid anger, retaliation, or abandonment. The two major forms of subjugation are:

    1. Subjugation of Needs: Suppression of one’s preferences, decisions, and desires.

    2. Subjugation of Emotions: Suppression of emotional expression, especially anger.

    Subjugation usually involves the perception that one’s own desires, opinions, and feelings are not valid or important to others. Frequently presents as excessive compliance, combined with hypersensitivity to feeling trapped. Generally leads to a build up of anger, manifested in maladaptive symptoms (e.g., passive-aggressive behaviour, uncontrolled outbursts of temper, psychosomatic symptoms, withdrawal of affection, “acting out”, substance abuse).

    PUNITIVENESS: The belief that people should be harshly punished for making mistakes. Involves the tendency to be angry, intolerant, punitive, and impatient with oneself for not meeting one’s expectations or standards. Usually includes difficulty forgiving mistakes in oneself, because of a reluctance to consider extenuating circumstances, allow for human imperfection, or empathize with one’s feelings.

    Three out of my top four life traps have improved since 2014, but emotional deprivation, unfortunately, continues to climb with each assessment. I think that self-sacrifice, subjugation, and emotional deprivation schemas may be common life traps for people who decide to become psychologists. The therapeutic relationship is meant to be one-sided and focused on the patient or client’s needs, not the psychologist’s needs. For this reason, psychologists must get their relational needs met outside of their job and get their own therapy if needed to ensure that they can have a space about them. I wonder how these life traps will continue to evolve over the next two years in Vanuatu…

    How Can Life-traps Be Overcome?

    The first step to changing anything is awareness. If you are not aware that you are falling into any traps, it means that you either don’t have any, or you are so enmeshed in your experience that you cannot see them.

    Once you are aware of your traps, the next step is to understand them and why they occur for you. Most life traps originate in childhood typically, which is why most psychologists and psychiatrists will ask about your upbringing and your relationship with your parents in particular.

    Life traps are actually considered to be adaptive ways of coping with maladaptive environments. This means that your life traps were probably quite useful in the particular family dynamic that you had, or you wouldn’t have developed them in the first place. For example, my family often called me a martyr when I was younger because it didn’t matter what I wanted. In reality, it was just much more comfortable to let everyone else decide and take charge. Then if things didn’t work out, others couldn’t blame me. I saw it as a win-win but often didn’t get what I wanted because I didn’t speak up and then complained that my parents loved my siblings more, who were more than happy to speak up and ask for what they wanted.

    However, once you move out of the family home, these coping methods are generally ineffective. They tend to become maladaptive ways of interacting with yourself, others or the world. If I keep playing the martyr and refuse to speak up as an adult, my needs still don’t get met. As a result, I may become excessively demanding of others as a counterattack measure (not likely for me), or I may try to escape from all relationships where I need to speak up about my needs. Either way, it keeps the life trap going, and it isn’t helpful.

    I need to realise that there are relationships out there where it is beneficial for me to speak up, as people then know what I want and respond effectively to the situation at hand. It still doesn’t “feel right” when I think about telling others my wants or needs (and I’m not sure if it ever will), but I logically know that it is the best approach for me to take going forward. If I want to break free from my main life traps, I must learn to speak up reasonably when important to me (and others). By doing this, eventually, the life traps will become much less prevalent and less powerful too.

    If you have been trying with therapy for a long time but don’t think you are getting anywhere, please seek a Psychologist with experience in Schema Therapy. Also, if you are stuck in a relationship where your needs aren’t being met, it could help too.

    Learning about Schema Therapy and undergoing training in it has taught me more about my own personal life traps than anything else that I have done before and really does give me a sense of what my most significant challenges are going forward. I’ve made a lot of progress so far, but there is still a long way to go, and that is okay. I know that I will continue to improve with acceptance, self-compassion, patience, reflection, and perseverance, and I am confident you can too!

    Dr Damon Ashworth

    Clinical Psychologist

    P.S. For a full description of the other 14 maladaptive schemas, please click here.

  • 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