I wrote this blog a while ago when Bella was still a pretty small puppy.  She has now overcome her anxiety about the car.  In fact, she very readily jumps into the car because she knows that for the most part, going in the car means going somewhere fun – the beach, work, etc.  But I wonder if Bella’s experience with anxiety might just help some clients to learn about anxiety management.

Bella is the therapy dog at Broulee Psychology and she has a bit of a problem.  She gets anxious about going in the car.  Now I know where this stems from – we picked her up from Newcastle when she was a wee little pup.  This makes for a seven hour drive home to the far south coast and it was a particularly hot day (in the 40s I believe).  Poor Bella vomited the whole way, which is not too uncommon for a puppy, but did not make for a very good first experience with cars.  Her car sickness is improving as she gets older but she still does not like the car.

Now how does this relate to people anxiety?  Well, it relates in lots of ways!  To start, if Bella was able she would avoid the car all together as she does not like it and it makes her anxious.  She often drags her back legs when it’s time to get in the car and sometimes I have to lift her up to get in.  Usually once in, she is fine and loves arriving at our destination – even if it is just a visit to the vet for vaccinations!  She loves it all!

Being a therapy dog means lots of car trips.  She has to go in to the car for the usual trips to the vet and dog obedience but she also has to go in the car to the clinic and for fun trips to the beach.  She is in the car most days.  If she did not ever go in the car her world would be very small, confined to home and she could not work as a therapy dog.  This is fine for most dogs but not for Bella the Therapy Dog!  Also, if we avoided taking her in the car her anxiety would get bigger in relation to cars.  This could make the annual trip to the vet very difficult as she got older and bigger!

This is similar to many of my clients who experience anxiety – they want to avoid what makes them anxious.  This means that they avoid the anxiety but there are some pretty negative consequences too – their world gets very small and they might miss out on some pretty fun experiences.  Also, when people avoid things that make them anxious, their anxiety gets bigger in the long run.

So what do we do about Bella’s anxiety?  Well, we keep exposing her to the car and make it as positive an experience as possible.  Bella goes in the car most days and we give her treats along the way.  We try to keep car trips short so that she does not vomit and she gets very excited by the outcome of the trip – usually the beach or seeing people when out and about.

This is also similar to people anxiety as we do what psychologists call ‘exposure therapy’.  This means that we help clients expose themselves gradually to what makes them anxious.  Over time, we gradually increase the anxiety provoking experience until people get used to the experience and they are managing their anxiety.  This is no easy feat but it is often quite worthwhile depending upon the anxiety presentation.  Imagine being completely confined to your home for fear of anxiety.  This makes for a very small world.

The other similarity is that often our anxiety or other mental health presentations tend to stem from something – either a single event (such as with Bella) or an upbringing or a series of events.  Knowing the origin sometimes helps with our treatment, in particular with people.  This is why psychologists often want to ask lots of questions initially so that they can have a really good picture of what has been going on and for how long.

Bella is improving over time with getting in the car.  She is still not happily jumping in like Bronte (her older sister) but I am hoping that she may do soon, particularly as she gets bigger and harder to lift.  We will just keep exposing her and providing lots of positive reinforcement.  Sometimes learning to manage anxiety can be slow and take time – very similar to learning to manage people anxiety.  In the meantime, we should go easy on ourselves and be patient.

If you feel like your anxiety is overwhelming and you are struggling to get on top of it, working with a psychologist can help.  And who knows, maybe you and Bella could work together in session to learn the strategies.  Bella is a very good listener and she loves a pat.  Bella works with clients at Broulee Psychology to help make them feel more comfortable and at ease during their therapeutic work with the psychologist.

So you’ve decided to make an appointment to see a psychologist – good for you!  Maybe you got a referral from your GP because they thought it would be helpful or maybe you saw some marketing through Facebook or some other media and thought you’d give it a go.  Whatever the reason, hopefully this is the first step towards making changes in your life for the better.

But some people report seeing a psychologist for the first time can be a bit daunting.  So I thought this blog might help if people knew what to expect when they see a psychologist at Broulee Psychology for the first time.

The first step is calling reception to find out about making an appointment.  Sometimes there is a wait to see someone.  Unfortunately, this happens at times due to demand, particularly in a small town like ours where there are limited services available.  While on the waitlist, you may be offered cancellation appointments and if you are flexible, you are likely to get an appointment sooner rather than later.

Once you have an appointment, you will either be emailed some paperwork or asked to attend your appointment 10-15 minutes early to complete the paperwork.  This paperwork is similar to what any health professional, including your GP would ask you to fill out.  If you are unsure about any of the paperwork or need help with anything, you can bring it in with you to your session.  If you have one, you should also bring in your referral from your doctor as you may be able to claim Medicare rebates, if eligible.  This is usually explained prior to your appointment with reception or during your appointment with the psychologist.

Your initial appointment with the psychologist is different to other appointments with the psychologist.  During this initial appointment, the psychologist will introduce you to the service and make sure you understand some basic housekeeping, such as confidentiality, fees and rebates, cancellation policy, etc.  You will be given opportunity to ask questions if you have any.

After this, the psychologist will want to know the reason you have come to get help.  From there, psychologists often collect a lot of information about you in order to get a really good picture of what has been going on for you.  This will help with making goals for work together and setting treatment plans for ongoing work together.

This appointment is slightly different for child clients.  For children, your psychologist will want to speak to parents on their own first.  This is because children should not be present when parents are talking about “problems” and young children can be distracting when they are not involved in the session.  This provides parents an opportunity to talk freely about what has been happening.

But back to adult clients – Often times clients may get emotional when talking about what has been happening for them.  This is very normal and clients should not feel embarrassed if they cry.  Therapy is a safe space where clients can express emotions and cry.  There are always tissues available!

Clients sometimes report feeling drained and tired after their first therapy sessions.  This is because you may have discussed lots of information, much of which is not usually the topic of conversation with friends and family.  It is important to be aware that sessions usually get easier and if they do not, this can be discussed with the psychologist.  After the first session, it might be nice for clients to have the rest of the day off and do something nice, such as going for a walk, a swim at the beach or walk the dog.

It is important that you are open and honest with the psychologist.  If you are concerned about something or feel uncomfortable in any way at any time during a session, it is best to share this information so that together you and the psychologist can make things more comfortable for you.

The session after the first session, often called a subsequent consultation, is often different to the first session.  After initial history collection is finished (and sometimes this can take more than one appointment), goals are discussed and treatment planning is complete, it is time to get started in therapy.  This usually involved a short catch up at the start of the session then beginning to engage in therapy goals.

It is also important to be aware that therapy is an active process.  It is not something that is done to you rather it is done with you.  Your psychologist acts as a guide to assist you to implement strategies to make changes in your life.  This can sometimes be difficult but you can feel confident in having someone helping you along the way.

If you are ready to make some changes in your life in order to live a more fulfilling and rewarding life then working with a psychologist might be helpful. You can contact Broulee Psychology on 0490 210 034 or by email info@brouleepsychology.com.au to find out more.

I have been a child psychologist since I began my career in psychology 15 years ago.  Working with children and adolescents is considered a specific skill as a psychologist – not all psychologists work with this population.  In fact, many do not work with children and adolescents at all.  And that’s ok because it does require some additional patience and creativity.  But I love it and I really enjoy the mix of working across the entire lifespan.

But let’s get back to the main message of this blog – the role of play in therapy.  When working with children and adolescents, using play, including games and activities, is essential.  Play is the language of children.  When I see an adult in my office, they happily sit on the couch and answer questions, talk about their lives, thinking through scenarios, etc.  I cannot do this with children.

One of the main differences as I see it between children and adults in therapy is that children are brought to therapy by an adult, usually their parents but it could be their grandparents, foster parents, other carer, etc.  Children often do not see themselves as having a problem that requires fixing.  They do not know what a psychologist does and how it all works.  So one of my first and most important goals in working with children is to make them comfortable and wanting to be there.  I do this with play.

We play lots of games at the start, such as Uno (and Uno Attack – if you’re a parent and you don’t have this game, I highly recommend it), Connect 4, and my all time favourite – Exploding Kittens.  Yep it sounds a bit gross but it’s a really fun card game that the kids absolutely love. And I’m always on the hunt for new (short and easy) games for kids so if you have any recommendations for me, comment below or send me a message.

The other day I had two different kids in my diary to see me (at different times of course).  Both of these kids ran through the door the moment I went to the waiting room.  Job one done!  They are excited to see me and want to engage.  Once this happens, I can start using games as a reward for work completed in session.  This goes a bit like this, “we might do some work on the board first then play a game”.  Excellent!

Sometimes when we have some particularly difficult work to do, such as being really cognitively involved or a bit difficult to discuss, we might sandwich this with games.  This means that I will play a game, do some work then play a game at the end.  And sometimes when engagement is reduced as can happen over time, we return to step one and just do games for a session.

Now you may be thinking to yourself – a psychologist charges money to parents to play with children?  I actually had someone say this to me once – a fellow psychologist no less (he obviously did not work with children, thank goodness).  Even if our entire session is playing games, we talk while playing.  Children are often much more open to talking while they are busy playing.  It can often be a great transition into the work we do – often on the whiteboard because kids love writing on the whiteboard!  I mean who doesn’t really?  As a parent, you might even notice this yourself with your kids.  If they are busy doing something else (as long as it is not too engage, ie. TV or video games) then they will be more open.  Often parents tells me that kids talk more in the car or when they are out walking.  It’s often a bit too daunting to talk face to face in a sit down, formal setting.

If you have a child at home who is experiencing anxiety or who is just not quite themselves or you are just having difficulty with their behaviour, then it might be helpful to see a psychologist.  Sometimes this may just be a trained professional telling you that a particular behaviour is normal or it may lead to further discussions and strategies.

Let’s work together to make change!

When I was younger (before I was a clinical psychologist), I wanted desperately to see a psychologist so that I could tell them all my problems.  You see I had what I now would term ‘adolescent angst’ and sometimes I did not get along with my parents, which is pretty normal.  I had a view of what therapy was back then and most of this came from television.  I saw people laying down on or sitting on a couch, talking about what was bothering them and then feeling better.  Amazing.  This then became a driving force behind my training in becoming a clinical psychologist.  I wanted to make people feel better – what a great job!  I now know that this view I had was not quite accurate.  I have now done eight years of university training in addition to many, many courses and workshops on therapy.  Therapy is very different to what I thought it was.  However, this does make me think about what many of my clients’ perceptions of therapy are and where these perceptions come from.

Many people come to see me thinking that they are going to talk about their problems (otherwise known as ‘venting’) and then they will feel better.  Although this can sometimes be the case, more often than not, clients do not get better just after talking about their problems.  Sometimes this may happen initially but the problems return.  Other times, clients may actually feel worse because they spent their 50 minutes talking about all the things that bother them but nothing changes.  If this is what therapy is then seeing a psychologist means seeing someone forever because nothing is changing and the same patterns remain and probably always will.  This is not very promising for the profession of psychology and is definitely not very helpful when you consider that Medicare allows for only 10 rebated sessions per calendar year.

So what is therapy?  Therapy is an active process of making change.  But who makes the change?  It is the client that makes change.  The psychologist acts as a guide to help the client makes changes.  This includes identifying patterns present and working through collaboratively how change can happen so that clients can begin to have a more fulfilling and rewarding life.  Therapy is not meant to be an ongoing, forever process.  If therapy is done well and done collaboratively then the client should make improvements and get better, thus no longer requiring therapy.  Also known as the psychologist’s ultimate goal – to no longer be needed.

Some of the big things that I see as important in therapy is a psychologist who is actively involved – not just sitting back, listening and reflecting.  Of course there is a time for this in any therapeutic intervention but it is not all that is involved.  But most of the change comes from the client.  Clients that get better attend sessions on a regular basis and do the work in between sessions.  The more work done between sessions, the more practice undertaken by the client, the better the outcomes are.  Therapy is HARD.  Often clients want to avoid therapy because of this but avoidance leads to more problems.  Working through the initial hard stuff can mean a client gets to have a better life and isn’t this what it is all about?  There is no easy answer, no medication that will magically make it better.  Therapy is HARD but isn’t it worth it?  You only have one life.  Let’s make it the best that it can be.  Only you can choose happiness.  No psychologist, GP or any other person can create that for you.

If you are ready to make changes for the better in your life, give the team at Broulee Psychology a call to discuss whether therapy is right for you.  There is no time like the present – let’s work together to make change.

No one likes to do things that they do not like.  My personal experience of avoidance involves the dentist.  Sorry to any dentists out there (mine included because she is actually quite lovely) but I do not like going.  But I have to go.  I am an adult and these are the only teeth that I will ever have.  Even though there is initial discomfort, there is long term gain in terms of the health of my teeth.  So I go every six months even though I would love to avoid it.  And I feel proud of myself for going, even though I would prefer not to.

I’ve been working therapeutically with people for a long time now and I see avoidance as central to many mental health conditions.  Let’s take depression for example – when people feel depressed they often report that they do not feel like doing anything.  They want to stay home, avoid all social interactions, even avoid basic self-care and hygiene.  Initially this feels somewhat comforting but in the long term, it is highly detrimental to one’s mood.  Depression tends to get worse when avoidance is high.  People need social connection and enjoyment to feel good.  The main therapeutic work for depression is getting people active again, engaged and connected.  Once this initial hurdle is overcome, people generally start feeling better and want to do more.  It’s not easy but getting going can sometimes be enough to get things moving in the right direction.

What about anxiety?  I see so many people who experience panic attacks and daily anxiety.  The quickest way to get rid of a panic attack is to avoid what makes you panic (also known as the ‘triggers’).  Unfortunately this quick fix has some pretty devastating consequences.  When you avoid, panic gets worse and people have to avoid more.  All of a sudden, someone’s world becomes very small and they cannot do anything without fear of another panic attack (this is called panic disorder).  The only way to learn to manage anxiety and panic – do what makes you anxious.  This may sound contradictory but it is the only way.  I know this may sound very scary but working with a qualified and caring psychologist can be extremely helpful in taking a gradual, less scary approach to reducing avoidance.  Yes, medication can also help but only to some extent.  I think of medication (for anxiety or depression) as a crutch that allows the real work to be done.

So have a think about the things that you avoid – a really good think because avoidance can be deceiving.  Maybe it is walking down the street on your own, driving a car or flying in an air plane.  Maybe it is avoiding going to a party or a job interview.  Maybe you used to do more than you do now but you just lost that enjoyment.  Of course, we all avoid and sometimes this is appropriate.  I avoid things that I deem to be legitimately dangerous, such as driving recklessly.  However, if my brain is telling my body that walking down the road is unsafe and sends out a panic attack as a result then there is a real problem and getting some help would be beneficial.

If you are ready to reduce your unhealthy avoidance and make some changes to your life then maybe now is a good time to give the team at Broulee Psychology at call to discuss whether now is the right time for therapy.  We can help you gradually reduce your avoidance and get control of your mental health in a non-judgemental and caring way so that you can get back to living the life that you want to live.