Affirmations and Summaries

If all that I grasped from Miller and Rollnick’s book was how to do affirmations and summaries , I think my day was well spent! I loved the practice of role playing to summarize and affirm case studies of imaginary clients, and it was totally helpful. It put my senses of reflections in perspective and gave me an extra push to recognize strengths, efforts, values and skills in my clients😅 through these attuned reflections, aka affirmations!

Summaries can be transitional , linking as well as collective and can be rendered merely to fill an awkward pause in the conversation or as we are inundated with too much info and all you need is a break to collect your thoughts so far.

Unjumbled my day through this feat!

Enjoy a wonderful evening!



Cognitive distortions

Cognitive distortions arising from negative core beliefs are something to be deeply analyzed on a daily basis, for the automatic thoughts crossing our minds!

Taking a step back and looking at what just happened in our mind is all it takes to stay present with ourself and really being true to our personality.

Measuring the possibility of our core beliefs to be even slightly incorrect based on the existing evidence shown by the people around us and other environmental factors is very critical!

Here’s to looking closely at our thoughts that sometimes make no sense in hindsight! Lol!

Have a great weekend!



Person-centered theory

We know there is this medical model of psychiatry that comes with diagnoses and labels that hurt the client’s experience with an authority of the diagnostician. To help move away from the painful labels of the client, one can rely on what is called the person-centered theory or client-based theory. Person-based theory is that which places focus on the client as the expert in the therapeutic relationship between the psychologist/social worker and the client.

Motivational interviewing at its best

To me Motivational interviewing is the most person centered approach available for a therapist to adapt. I believe I like the rolling with resistance aspect of it the most, knowing there’s nothing worse than entering into an argument with a client or even worse get in to a heated conversation leading into a full blown conflict.

There’s the broader framework of stages of change that helps baseline the approach and introduce the client to a new perspective of what’s ahead of them in this therapeutic alliance.

I am also intrigued by the ability to appreciate and sit with the client during their ambivalence, although there’s a lot of stepping back in progress and sitting in silence of the client through their confusions about why they need to change.

Looking forward to starting a 6-week group therapy curriculum at work based on motivational interviewing soon!

Cbt as I understand it

The premise of cognitive-behavior therapy(CBT) includes the reorganization of an individuals own statements and beliefs to develop a synchronization with his or her behavior.  A relationship exists between thoughts (or cognitions), emotions, and behaviors that create cause and effect in how the individual experiences events and situations.  Human nature, says that individuals have the potential for rational and irrational thinking. This irrational thinking is identified as the basic problem in mental disorders of depression and anxiety where CBT is employed.

The constant rewiring of thoughts using positive rational statements forms the basis of Cognitive behavioral therapy. Examples of rewiring irrational thoughts with positive statements:

Rewire “I’m bad” with “I’m enough”

Rewire “I cant do this” with “I can try this”

Rewire “I’m weak” with “I’m strong enough to go for a walk”

So on and So forth simple translations/rewiring.

Trying to see the goodness in everyday life, when everything seems so gloomy, due to the automatic negative thought script running, is the real deal of cognitive behavioral therapy, as I understand it.

Hope this helps people in actively engaging in the therapy tactics as it is critical for recovery for the client to full engage and involve themselves in this REWIRING process.

Happy thoughts!

Critical thinking strategies

Critical Thinking in Everyday Life: 9 Strategies

Most of us are not what we could be. We are less. We have great capacity. But most of it is dormant; most is undeveloped. Improvement in thinking is like improvement in basketball, in ballet, or in playing the saxophone. It is unlikely to take place in the absence of a conscious commitment to learn. As long as we take our thinking for granted, we don’t do the work required for improvement.
Development in thinking requires a gradual process requiring plateaus of learning and just plain hard work. It is not possible to become an excellent thinker simply because one wills it. Changing one’s habits of thought is a long-range project, happening over years, not weeks or months. The essential traits of a critical thinker require an extended period of development.
How, then, can we develop as critical thinkers? How can we help ourselves and our students to practice better thinking in everyday life?
First, we must understand that there are stages required for development as a critical thinker:
Stage One: The Unreflective Thinker (we are unaware of significant problems in our thinking)

Stage Two: The Challenged Thinker (we become aware of problems in our thinking)

Stage Three: The Beginning Thinker (we try to improve but without regular practice)

Stage Four: The Practicing Thinker (we recognize the necessity of regular practice)

Stage Five: The Advanced Thinker (we advance in accordance with our practice)

Stage Six: The Master Thinker (skilled & insightful thinking become second nature to us)
We develop through these stages if we:
   1) accept the fact that there are serious problems in our thinking (accepting the challenge to our thinking) and

2) begin regular practice.
In this article, we will explain 9 strategies that any motivated person can use to develop as a thinker. As we explain the strategy, we will describe it as if we were talking directly to such a person. Further details to our descriptions may need to be added for those who know little about critical thinking. Here are the 9:
   1. Use “Wasted” Time.

2. A Problem A Day.

3. Internalize Intellectual Standards.

4. Keep An Intellectual Journal.

5. Reshape Your Character.

6. Deal with Your Ego.

7. Redefine the Way You See Things.

8. Get in touch with your emotions.

9. Analyze group influences on your life.
There is nothing magical about our ideas. No one of them is essential. Nevertheless, each represents a plausible way to begin to do something concrete to improve thinking in a regular way. Though you probably can’t do all of these at the same time, we recommend an approach in which you experiment with all of these over an extended period of time.
First Strategy: Use “Wasted” Time. All humans waste some time; that is, fail to use all of their time productively or even pleasurably. Sometimes we jump from one diversion to another, without enjoying any of them. Sometimes we become irritated about matters beyond our control. Sometimes we fail to plan well causing us negative consequences we could easily have avoided (for example, we spend time unnecessarily trapped in traffic — though we could have left a half hour earlier and avoided the rush). Sometimes we worry unproductively. Sometimes we spend time regretting what is past. Sometimes we just stare off blankly into space.
The key is that the time is “gone” even though, if we had thought about it and considered our options, we would never have deliberately spent our time in the way we did. So why not take advantage of the time you normally waste by practicing your critical thinking during that otherwise wasted time? For example, instead of sitting in front of the TV at the end of the day flicking from channel to channel in a vain search for a program worth watching, spend that time, or at least part of it, thinking back over your day and evaluating your strengths and weaknesses. For example, you might ask yourself questions like these:
When did I do my worst thinking today? When did I do my best? What in fact did I think about today? Did I figure anything out? Did I allow any negative thinking to frustrate me unnecessarily? If I had to repeat today what would I do differently? Why? Did I do anything today to further my long-term goals? Did I act in accordance with my own expressed values? If I spent every day this way for 10 years, would I at the end have accomplished something worthy of that time?
It would be important of course to take a little time with each question. It would also be useful to record your observations so that you are forced to spell out details and be explicit in what you recognize and see. As time passes, you will notice patterns in your thinking.
Second Strategy: A Problem A Day. At the beginning of each day (perhaps driving to work or going to school) choose a problem to work on when you have free moments. Figure out the logic of the problem by identifying its elements. In other words, systematically think through the questions: What exactly is the problem? How can I put it into the form of a question. How does it relate to my goals, purposes, and needs?
   1) Wherever possible take problems one by one. State the problem as clearly and precisely as you can.
2) Study the problem to make clear the “kind” of problem you are dealing with. Figure out, for example, what sorts of things you are going to have to do to solve it. Distinguish Problems over which you have some control from problems over which you have no control. Set aside the problems over which you have no control, concentrating your efforts on those problems you can potentially solve.
3) Figure out the information you need and actively seek that information.
4) Carefully analyze and interpret the information you collect, drawing what reasonable inferences you can.
5) Figure out your options for action. What can you do in the short term? In the long term? Distinguish problems under your control from problems beyond your control. Recognize explicitly your limitations as far as money, time, and power.
6) Evaluate your options, taking into account their advantages and disadvantages in the situation you are in.
7) Adopt a strategic approach to the problem and follow through on that strategy. This may involve direct action or a carefully thought-through wait-and-see strategy.
8) When you act, monitor the implications of your action as they begin to emerge. Be ready at a moment’s notice to revise your strategy if the situation requires it. Be prepared to shift your strategy or your analysis or statement of the problem, or all three, as more information about the problem becomes available to you.
Third Strategy: Internalize Intellectual Standards. Each week, develop a heightened awareness of one of the universal intellectual standards (clarity, precision, accuracy, relevance, depth, breadth, logicalness, significance). Focus one week on clarity, the next on accuracy, etc. For example, if you are focusing on clarity for the week, try to notice when you are being unclear in communicating with others. Notice when others are unclear in what they are saying.
When you are reading, notice whether you are clear about what you are reading. When you orally express or write out your views (for whatever reason), ask yourself whether you are clear about what you are trying to say. In doing this, of course, focus on four techniques of clarification : 1) Stating what you are saying explicitly and precisely (with careful consideration given to your choice of words), 2) Elaborating on your meaning in other words, 3) Giving examples of what you mean from experiences you have had, and 4) Using analogies, metaphors, pictures, or diagrams to illustrate what you mean. In other words, you will frequently STATE, ELABORATE, ILLUSTRATE, AND EXEMPLIFY your points. You will regularly ask others to do the same.
Fourth Strategy: Keep An Intellectual Journal. Each week, write out a certain number of journal entries. Use the following format (keeping each numbered stage separate):

1. Situation. Describe a situation that is, or was, emotionally significant to you (that is, that you deeply care about). Focus on one situation at a time.
2. Your Response. Describe what you did in response to that situation. Be specific and exact.
3. Analysis. Then analyze, in the light of what you have written, what precisely was going on in the situation. Dig beneath the surface.
4. Assessment. Assess the implications of your analysis. What did you learn about yourself? What would you do differently if you could re-live the situation?
Strategy Five: Reshape Your Character. Choose one intellectual trait—intellectual perseverance, autonomy, empathy, courage, humility, etc.— to strive for each month, focusing on how you can develop that trait in yourself. For example, concentrating on intellectual humility, begin to notice when you admit you are wrong. Notice when you refuse to admit you are wrong, even in the face of glaring evidence that you are in fact wrong. Notice when you become defensive when another person tries to point out a deficiency in your work, or your thinking. Notice when your intellectual arrogance keeps you from learning, for example, when you say to yourself “I already know everything I need to know about this subject.” Or, “I know as much as he does. Who does he think he is forcing his opinions on me?” By owning your “ignorance,” you can begin to deal with it.
Strategy Six: Deal with Your Egocentrism. Egocentric thinking is found in the disposition in human nature to think with an automatic subconscious bias in favor of oneself. On a daily basis, you can begin to observe your egocentric thinking in action by contemplating questions like these: Under what circumstances do I think with a bias in favor of myself? Did I ever become irritable over small things? Did I do or say anything “irrational” to get my way? Did I try to impose my will upon others? Did I ever fail to speak my mind when I felt strongly about something, and then later feel resentment? Once you identify egocentric thinking in operation, you can then work to replace it with more rational thought through systematic self-reflection, thinking along the lines of: What would a rational person feel in this or that situation? What would a rational person do? How does that compare with what I want to do? (Hint: If you find that you continually conclude that a rational person would behave just as you behaved you are probably engaging in self-deception.)
Strategy Seven: Redefine the Way You See Things. We live in a world, both personal and social, in which every situation is “defined,” that is, given a meaning. How a situation is defined determines not only how we feel about it, but also how we act in it, and what implications it has for us. However, virtually every situation can be defined in more than one way. This fact carries with it tremendous opportunities. In principle, it lies within your power and mine to make our lives more happy and fulfilling than they are. Many of the negative definitions that we give to situations in our lives could in principle be transformed into positive ones. We can be happy when otherwise we would have been sad.
We can be fulfilled when otherwise we would have been frustrated. In this strategy, we practice redefining the way we see things, turning negatives into positives, dead-ends into new beginnings, mistakes into opportunities to learn. To make this strategy practical, we should create some specific guidelines for ourselves. For example, we might make ourselves a list of five to ten recurrent negative contexts in which we feel frustrated, angry, unhappy, or worried. We could then identify the definition in each case that is at the root of the negative emotion. We would then choose a plausible alternative definition for each and then plan for our new responses as well as new emotions. For example, if you tend to worry about all problems, both the ones you can do something about and those that you can’t; you can review the thinking in this nursery rhyme:

“For every problem under the sun, there is a solution or there is none. If there be one, think til you find it. If there be none, then never mind it.”
Let’s look at another example. You do not have to define your initial approach to a member of the opposite sex in terms of the definition “his/her response will determine whether or not I am an attractive person.” Alternatively, you could define it in terms of the definition “let me test to see if this person is initially drawn to me—given the way they perceive me.” With the first definition in mind, you feel personally put down if the person is not “interested” in you; with the second definition you explicitly recognize that people respond not to the way a stranger is, but the way they look to them subjectively. You therefore do not take a failure to show interest in you (on the part of another) as a “defect” in you.
Strategy Eight: Get in touch with your emotions: Whenever you feel some negative emotion, systematically ask yourself: What, exactly, is the thinking leading to this emotion? For example, if you are angry, ask yourself, what is the thinking that is making me angry? What other ways could I think about this situation? For example, can you think about the situation so as to see the humor in it and what is pitiable in it? If you can, concentrate on that thinking and your emotions will (eventually) shift to match it.
Strategy Nine: Analyze group influences on your life: Closely analyze the behavior that is encouraged, and discouraged, in the groups to which you belong. For any given group, what are you “required” to believe? What are you “forbidden” to do? Every group enforces some level of conformity. Most people live much too much within the view of themselves projected by others. Discover what pressure you are bowing to and think explicitly about whether or not to reject that pressure.
Conclusion: The key point to keep in mind when devising strategies is that you are engaged in a personal experiment. You are testing ideas in your everyday life. You are integrating them, and building on them, in the light of your actual experience. For example, suppose you find the strategy “Redefine the Way You See Things” to be intuitive to you. So you use it to begin. Pretty soon you find yourself noticing the social definitions that rule many situations in your life. You recognize how your behavior is shaped and controlled by the definitions in use:
“I’m giving a party,” (Everyone therefore knows to act in a “partying” way)

“The funeral is Tuesday,” (There are specific social behaviors expected at a funeral)

“Jack is an acquaintance, not really a friend.” (We behave very differently in the two cases)

You begin to see how important and pervasive social definitions are. You begin to redefine situations in ways that run contrary to some commonly accepted definitions. You notice then how redefining situations (and relationships) enables you to “Get in Touch With Your Emotions.” You recognize that the way you think (that is, define things) generates the emotions you experience. When you think you are threatened (i.e., define a situation as “threatening”), you feel fear. If you define a situation as a “failure,” you may feel depressed. On the other hand, if you define that same situation as a “lesson or opportunity to learn” you feel empowered to learn. When you recognize this control that you are capable of exercising, the two strategies begin to work together and reinforce each other.
Next consider how you could integrate strategy #9 (“Analyze group influences on your life”) into your practice. One of the main things that groups do is control us by controlling the definitions we are allowed to operate with. When a group defines some things as “cool” and some as “dumb, ” the members of the group try to appear “cool” and not appear “dumb.” When the boss of a business says, “That makes a lot of sense,” his subordinates know they are not to say, “No, it is ridiculous.” And they know this because defining someone as the “boss” gives him/her special privileges to define situations and relationships.
You now have three interwoven strategies: you “Redefine the Way You See Things,” “Get in touch with your emotions,” and “Analyze group influences on your life.” The three strategies are integrated into one. You can now experiment with any of the other strategies, looking for opportunities to integrate them into your thinking and your life. If you follow through on some plan analogous to what we have described, you are developing as a thinker. More precisely, you are becoming a “Practicing” Thinker. Your practice will bring advancement. And with advancement, skilled and insightful thinking may becomes more and more natural to you.

Paul, R. & Elder, L. (2001). Modified from the book by Paul, R. & Elder, L. (2001).

Source: Critical thinking 




Infertility and Mental Health

Infertility is perceived as a problem across virtually all cultures and societies and affects an estimated 10%-15% of couples of reproductive age. In recent years, the number of couples seeking treatment for infertility has dramatically increased due to factors such as postponement of childbearing in women, development of newer and more successful techniques for infertility treatment, and increasing awareness of available services. This increasing participation in fertility treatment has raised awareness and inspired investigation into the psychological ramifications of infertility. Consideration has been given to the association between psychiatric illness and infertility. Researchers have also looked into the psychological impact of infertility and of the prolonged exposure to intrusive infertility treatments on mood and well being. There is less information about effective psychiatric treatments for this population; however, there is some data to support the use of psychotherapeutic interventions.

Psychological Impact of Infertility

Parenthood is one of the major transitions in adult life for both men and women. The stress of the non-fulfillment of a wish for a child has been associated with emotional sequelae such as anger, depression, anxiety, marital problems, sexual dysfunction, and social isolation. Couples experience stigma, sense of loss, and diminished self-esteem in the setting of their infertility (Nachtigall 1992). In general, in infertile couples women show higher levels of distress than their male partners (Wright 1991; Greil 1988); however, men’s responses to infertility closely approximates the intensity of women’s responses when infertility is attributed to a male factor (Nachtigall 1992). Both men and women experience a sense of loss of identity and have pronounced feelings of defectiveness and incompetence.

Psychological Distress, Psychiatric Illness and Infertility: Cause or Effect?

Stress, depression and anxiety are described as common consequences of infertility. A number of studies have found that the incidence of depression in infertile couples presenting for infertility treatment is significantly higher than in fertile controls, with prevalence estimates of major depression in the range of 15%-54% (Domar 1992; Demyttenaere 1998; Parikh 2000; Lukse 1999; Chen 2004). Anxiety has also been shown to be significantly higher in infertile couples when compared to the general population, with 8%-28% of infertile couples reporting clinically significant anxiety (Anderson 2003; Chen 2004; Parikh 2000).

The causal role of psychological disturbances in the development of infertility is still a matter of debate. A study of 58 women from Lapane and colleagues reported a 2-fold increase in risk of infertility among women with a history of depressive symptoms; however, they were unable to control for other factors that may also influence fertility, including cigarette smoking, alcohol use, decreased libido and body mass index (Lapane 1995).

Proposed mechanisms through which depression could directly affect infertility involve the physiology of the depressed state such as elevated prolactin levels, disruption of the hypothalamic-pituitary-adrenal axis, and thyroid dysfunction. One study of 10 depressed and 13 normal women suggests that depression is associated with abnormal regulation of luteinizing hormone, a hormone that regulates ovulation (Meller 1997). Changes in immune function associated with stress and depression may also adversely affect reproductive function (Haimovici 1998). Further studies are needed to distinguish the direct effects of depression or anxiety from associated behaviors (e.g., low libido, smoking, alcohol use) that may interfere with reproductive success. Since stress is also associated with similar physiologic changes, this raises the possibility that a history of high levels of cumulative stress associated with recurrent depression or anxiety may also be a causative factor.

Psychological Distress and Infertility Treatment

While many couples presenting for infertility treatment have high levels of psychological distress associated with infertility, the process of assisted reproduction itself is also associated with increased levels of anxiety, depression and stress (Leiblum 1987). A growing number of research studies have examined the impact of infertility treatment at different stages, with most focusing on the impact of failed IVF trials. Hynes and colleagues assessed women at presentation for IVF and then following failure of IVF. They found that women presenting for IVF were more depressed, had lower self-esteem and were less confident than a control group of fertile women and, after a failed IVF cycle, experienced a further lowering of self-esteem and an increase in depression relative to pre-treatment levels (Hynes 1992). Comparisons between women undergoing repeated IVF cycles and first-time participants have also suggested that ongoing treatment may lead to an increase in depressive symptoms (Thiering 1993). The data, however, is still controversial since other studies have found minimal psychological disturbance induced by the infertility treatment process or IVF failure (Paulson 1988; Boivin 1996). In light of the discrepancy in results, there has been increasing interest in the factors that contribute to dropout from infertility treatment since this population is often not included or decline to participate in studies. Whereas cost or refusal of physicians to continue treatment have been cited as reasons for discontinuing treatment, recent research suggests that a significant number of dropouts are due to psychological factors (Domar 2004; Hammarberg 2001; Olivius 2004).

The outcome of infertility treatment may also be influenced by psychological factors. A number of studies have examined stress and mood state as predictors of outcome in assisted reproduction. The majority of these studies support the theory that distress is associated with lower pregnancy rates among women pursuing infertility treatment (Boivin 1995, Thiering 1993, Demytenaere 1998, Smeenk 2001, Sanders 1999).

Psychological Interventions

In light of data suggesting that psychological symptoms may interfere with fertility, success of infertility treatment, and the ability to tolerate ongoing treatment, interest in addressing these issues during infertility treatment has grown. Some interventions designed to alleviate the symptoms of stress, depression and anxiety in infertile women and men have been researched.

Several studies suggest that cognitive behavioral group psychotherapy and support groups decrease stress and mood symptoms, as well as increase fertility rates. In a study by Domar and colleagues of 52 infertile women, a 10-week group behavioral treatment program significantly reduced anxiety, depression and anger (Domar 1992). In a year-long follow-up study, Domar compared pregnancy rates of women undergoing assisted reproduction who were randomized to a group cognitive behavioral therapy (CBT) designed to decrease depression and anxiety, a support group, or to no group treatment. Viable pregnancy rates were 55% for the cognitive behavioral group, 54% for the support group and 20% for the controls (Domar 2000). A study where the intervention group received couples counseling directed toward education and addressing stress throughout their IVF cycle and the control group received only routine medical care, the intervention patients had lower anxiety and depression scores, in addition to significantly higher pregnancy rates (Terzioglu 2001).

Although there have not been systematic studies in infertile women examining the impact of other types of psychotherapy, treatments that decrease psychiatric symptoms and stress in the general population will likely benefit this population.

While there is little data regarding the pharmacologic treatment of patients with infertility, pharmacotherapy remains an important option for women and men who develop depression in the context of infertility and its treatment. Many women avoid pharmacologic treatment for fear that medication may impact their fertility or may affect the outcome of their pregnancy; however, there are no data to suggest that commonly used antidepressants negatively affect fertility. Furthermore, data accumulated over the last decade suggest that certain antidepressants may be used safely during pregnancy.