Institute Inbrief - 03/03/2015
Welcome to Edition 220 of Institute Inbrief! In this edition’s featured article we’ll explore why motivational interviewing (MI) may be an effective treatment option for clients suffering from anxiety and anxiety disorders.
Also in this edition:
- Latest news and updates
- Articles and CPD information
- Wellness tips
- Therapist Q&A
- Social media review
Enjoy your reading!
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The impact of secondary exposure to trauma on mental health professionals
It has long been recognised that clinicians working with survivors of trauma can be affected by the nature of their work, and this can be a cumulative effect. More recently, attempts have been made to conceptualise the potential impact of secondary exposure to trauma. Some theorists consider that clinicians may develop secondary traumatic stress which encompasses symptoms of intrusion, avoidance and hyper-arousal, while others argue that therapists may also experience vicarious trauma, which refers to lasting alterations in basic cognitive beliefs. The cumulative effect of such exposure may also lead to symptoms associated with burnout including exhaustion, depersonalisation and reduced sense of personal accomplishment.
Motivational Interviewing and Anxiety
Alana reached the safety of home, threw the car keys down, and collapsed on the couch, exhausted. What a difficult day! She who hated going out at all had had to go to three whole things outside the house: unbearable! First she had to be at the school for parent-teacher meetings, and although her two primary-school-age daughters were doing well, it was draining to have to meet the teachers and focus on all the school program information. Afterwards, she had had to negotiate busy central-city traffic and parking for a medical appointment. Her results showed that the lump was benign, but she couldn’t help wondering if they had missed something; after all, many cases of cancer came to be terminal because of errors at the diagnostic stage... If all that weren’t bad enough, her trip to the local mall for groceries and a few other errands had ended badly.
Already agitated when entering the mall, Alana had gone into a panic attack which was noticed by fellow shoppers. There was a huge commotion as people rallied around to help; the mall’s first aid staff called an ambulance before the attack subsided. Alana was mortified to be the centre of so much unwelcome (if well-meaning) attention. At home now, she broke down and cried as she realised how ineffectively she was doing life.
One week later, she found herself in the offices of Hayley, a psychotherapist. “I’m not sure what I’m doing here,” she confessed, her face reddening. “You see, I’ve had some counselling before. It just didn’t work for me: endless forms to fill for ‘homework’ about what I’m thinking and always being forced to re-traumatise myself in the very situations that make me so anxious. I don’t know.” Alana looked pleadingly at Hayley. “I am chronically tired, sleeping poorly, and dearly want to get rid of this anxiety. It is so crippling; I can’t even take on a job, but I am really uncertain as to whether therapy – or anything – can help me.”
Alana, sadly, is not unique in her pain. Anxiety disorders are the most common mental illness in the United States, affecting 40 million adults age 18 and older (18 percent of the U.S. population) (ADAA, 2014). The percentage is similar in Australia, with 14.4 percent of Australians being affected by an anxiety disorder in any 12 month period (Mindframe, 2012). Even though only one-third of those in both countries seek treatment for the disorder, anxiety carries a huge disease burden, costing the United States more than $42 billion a year, almost one-third of the country’s total mental health bill (ADAA, 2014). Similarly in Australia, anxiety and depressive disorders are the third leading cause of disability burden, accounting for about 27 percent of the years lost to disability (Mindframe, 2012).
Yet even among the one-third of sufferers who have sought treatment, many, like Alana, have come away disappointed – and still anxious. If you were Hayley, what sort of approach would you want to use with a client like Alana? Would it help her move past the ambivalence and uncertainty she expresses above toward commitment to following a treatment plan? Would your recommended approach even have a means of dealing with such resistance to change? Motivational interviewing is a therapeutic approach gaining wide popularity in mental health practitioner circles as a respectful, client-centred means of working with clients to help them resolve ambivalence and build resolve: either to make change – the obvious endpoint of most therapy – or to maintain the status quo, if that is determined to be preferable.
What is it MI treats when anxiety is the issue?
To ensure that we’re all on the same page here, let us briefly define anxiety and anxiety disorders.
Anxiety is known experientially to some degree by nearly everyone at one time or another, anxiety is said to be: “A multidimensional emotional state manifested as a somatic, experiential, and interpersonal phenomenon; a feeling of uneasiness, apprehension, or dread. These feelings may be accompanied by symptoms such as breathlessness, a choking sensation, palpitations, restlessness, muscular tension, tightness in the chest, giddiness, trembling, and flushing, which are produced by the action of the autonomic nervous system, especially the sympathetic part of it” (Farlex, 2015a).
Anxiety disorders are: “A group of mental disturbances characterised by anxiety as a central or core symptom. Although anxiety is a commonplace experience, not everyone who experiences it has an anxiety disorder. Anxiety is associated with a wide range of physical illnesses, medication side effects, and other psychiatric disorders” (Farlex, 2015b)
The chief anxiety disorders which are included in the DSM-5 are grouped into three sections or chapters and include, in descending order of prevalence:
- Specific phobias or fear of certain objects or situations, such as spiders, heights, or flying: about 8.7 percent of the population
- Social Anxiety Disorder, or social phobia, fear of humiliation in social or public situations: 6.8 percent
- Post-Traumatic Stress Disorder and other trauma-induced anxiety disorders (now in their own chapter in the DSM-5), when someone persistently re-experiences a traumatic event, has distress associated with reminders of the event, and emotional detachment: 3.5 percent
- Generalised Anxiety Disorder, excessive uncontrollable worry in a number of areas, such as health, finances, work performance, or others’ wellbeing: 3.1 percent
- Agoraphobia/Panic Disorder/Panic attacks, a fear of being unable to escape or of being alone in the event of a panic attack (for agoraphobia), or sudden escalation of multiple somatic fear symptoms, such as shortness of breath or racing heart (for panic attacks); recurrence of these unexpectedly constitutes panic disorder: 2.7 percent
- Obsessive-Compulsive Disorder (OCD) and other obsessive or compulsive anxiety disorders (now in their own chapter in the DSM-5), comprising recurrent and intrusive thoughts, images, and impulses, such as fears of contamination and/or repetitive actions aimed at reducing anxiety or neutralising obsessive thoughts: 1 percent of the population (ADAA, 2014; Westra, 2012).
The problem with anxiety
There are few among us who have not experienced anxiety: the sweaty palms as you are led into the interview room for the BIG JOB you really want; the racing heart as you stand up to recite your wedding vows; or the jelly-like knees and adrenalin kick as you prepare to do your first dive. All of these and many more situations in life trigger the stress response in us that naturally creates moments of anxiety. Most of us, however, do not have anxiety disorders. We have the normal experience of anxiety in a situation that is novel or where there is potential or actual risk, we handle the situation, and we go back to feeling normal.
For those with anxiety disorders, life is not so simple. Anxiety is present in one manifestation or other in many, if not most, life situations. Even if there is not an immediate, objectively observed threat, the person with an anxiety condition may be creating anxiety by ruminating over terrible possibilities which he or she is certain are soon to occur and simultaneously working out how to avoid the dreaded events. It is one thing for us to state, as above, how much – actually how little – of the population (as a percent of the total) is suffering from a given type of anxiety. It is quite another to appreciate the impact of the disorder on a person’s life or the total cost of that disorder in terms of human suffering.
Even though health professionals have heard it for years from their clients in myriad variations, studies now assert that anxiety, in all of its shades, is largely responsible for impairment in educational and career development, family life, and relationships, to say nothing of the difficulty achieving a sense of joy and contentment in life. Health professionals are keenly aware of the extra space in emergency departments and general practice consulting rooms that anxious patients take up through their excessive worry (Mendlowicz and Stein, 2000, in Westra, 2012), as people with an anxiety disorder are three to five times more likely to be hospitalised for psychiatric disorders than those who do not suffer from anxiety disorders. In the United States, nearly $23 billion is spent annually for health care services by anxiety-ridden patients seeking relief from symptoms mimicking physical illnesses (ADAA, 2014). And the symptoms persist, usually worsening, if they are not treated, as such clients limp along, chronically unhappy and often depressed.
So it makes sense to treat anxiety, and it is entirely treatable. Yet achieving freedom from anxiety seems to be counterintuitive in many ways. That is, it seems quite reasonable that if someone like Alana were to appear in our rooms, we would be able to gently “talk some sense” into her, by helping her to see how illogical her many fears were, and how it makes more sense to face her fears (in small, gradually increasing doses) in order to move past them. It seems totally sensible that we might suggest a program of identifying her fearful thoughts, getting her to replace them with less maladaptive cognitions, all the while having her affirm her competence and freedom from fear as she behaves in new ways. The support we could help her set up for this could also improve her relationships, strained by crippling fears. Surely, the discomfort and resultant exhaustion of being in dread of everyday situations (such as encounters with teachers, traffic, and mall crowds) is awful enough that a sufferer would be motivated to follow whatever treatment plan their health professional suggested in order to feel better: surely!
Unfortunately, the counterintuitive truth we refer to is that, even those who are highly motivated to succeed – like Alana – experience a significant amount of ambivalence at making a change (from a life full of anxiety to one without it). Even otherwise diligent, treatment-compliant types like Alana still may experience that action-oriented therapies, such as Cognitive-Behavioural Therapy or CBT, do not meet their therapeutic needs in the process of attempting change; this is so because of the customary presence of ambivalence.
Why we might use MI to treat anxiety
Westra notes that ambivalence to change is extremely common, even among those who have committed to treatment. She claims that up to two-thirds of individuals who have decided to enter a treatment program for mental health problems can be classified as being in either the pre-contemplation stage (not yet actively considering change) or the contemplation stage of change (considering change, but conflicted about it) (Westra, 2012). Such individuals, in their uncertainty or indecision about changing, are unlikely to use change-oriented strategies, like the CBT approach. Rather, the early stages of change are characterised by alternating movement toward and away from the contemplated change. Such a “two-steps-forward-one-step-back” journey is a normal response to change, because, while people desire change, they also fear it. Continuing to do things “the way I’ve always done it” is seductive; it is familiar and sometimes rewarding, as the client sees that maintaining the status quo “sort of” or “almost” or “sometimes” works and changing has big costs.
Moreover, research has shown that a significant proportion of clients (up to 94 percent of OCD-diagnosed clients in one study) have concerns about the treatment itself (Purdon, Rowa, & Antony, 2004). Clients with anxiety, particularly, can convince themselves that how things are now is “not that bad”. Even the thought of engaging change behaviours to reduce anxiety can be anxiety-producing! A treatment failure might make the individual feel even more hopeless. A treatment success, conversely, will put pressure on the person to always perform at a higher, non-anxious level (Kushna and Sher, 1989).
In the context of ambivalence, clinician attempts to logically talk people out of anxiety, forcing confrontation with their worries and fears (including with exposure), has been shown to increase, not decrease, clients’ capacity for change (Moyers, Christopher, Houck, Tonigan, & Amrhein, 2007). As practitioners, we might like to call this typical client response illogical or even pathological; at the very least, it shows a strong effort by clients to self-protect. Motivational interviewing therapists contend that to help people change we need to not only understand this self-protectiveness, but also respect and work with it.
Resistance in therapy
Engle and Arkowitz (2006) assert that a lot of what clinicians tend to see as resistance is actually clients dealing with ambivalence. It explains why CBT and similar action-oriented practitioners chronically complain of low levels of compliance with homework and other treatment procedures. Kazantzis, Lampropoulos, & Deane (2005) have identified that in surveys of CBT-oriented practices, failing to do the assigned task is a commonplace occurrence, with only a minority of clients actually being fully compliant. Even more, resistance to therapist direction has been identified as a strong predictor of both subsequent engagement with the tasks of treatment (Jungbluth & Shirk, 2009) and also outcome (Aviram & Westra, 2011).
A client requires a fairly high level of motivation in order to be able to implement treatment actions toward change. Limited engagement with treatment tends to be responsible for limited response rates to treatments. Even though CBT has well-established efficacy for the treatment of anxiety and depression, there is still a sizable minority of clients for whom treatment is ineffective. A large study of depressed adolescents, for example, showed that the response rate at termination of treatment for subjects receiving CBT was 48%; this rose to 65% six weeks later (TADS, 2007), meaning that at best one in three clients was still unresponsive. Similarly with anxiety, Westen and Morrison (2001) have shown that a substantial proportion of clients does not engage or respond appropriately, despite documented efficacy and manualised procedures.
The core value of MI is that, by working with client ambivalence – as demonstrated in the person’s resistance – and respecting the client’s autonomy and capacity to choose change if and when it feels right, MI achieves high levels of client engagement, which creates high levels of outcomes.
This article was adapted from the upcoming “Treating Anxiety with Motivational Interviewing” Mental Health Academy CPD course. Learn more at www.mentalhealthacademy.com.au.
Further reading:
References:
Anxiety and Depression Association of America (ADAA). (2014). Facts and statistics. Anxiety and Depression Association of America. Retrieved on 21 January, 2015, from: hyperlink.
Aviram, A. & Westra, H.A. (2011). The impact of motivational interviewing on resistance in cognitive-behavioral therapy for generalized anxiety disorder. Psychotherapy Research, 21(6), 698-708.
Engle, D. & Arkowitz, H. (2006). Ambivalence in psychotherapy: Facilitating readiness to change. New York: Guilford Press.
Farlex. (2015a). Definition of anxiety: Anxiety. Free Dictionary. Farlex, Inc. Retrieved on 21 January, 2015, from: hyperlink.
Farlex. (2015b). Definition of anxiety: Anxiety disorders. Free Dictionary. Farlex, Inc. Retrieved on 21 January, 2015, from: hyperlink.
Jungbluth, N.J. & Shirk, S.R. (2009). Therapist strategies for building client involvement in cognitive-behavioral therapy for adolescent depression. Journal of Consulting and Clinical Psychology, 77, 1179-1184.
Kazantzis, N., Lampropoulos, G.K., & Deane, F.P. (2005). A national survey of practicing psychologists’ use and attitudes toward homework in psychotherapy. Journal of Consulting and Clinical Psychology, 73(4), 742-748.
Kushna, M.G. & Sher, K.J. (1989). Fear of psychological treatment and its role in mental health treatment avoidance. Professional Psychology: Research and Practice, 20, 251-257.
Mindframe. (2012). Facts and stats about mental illness in Australia. National Media Institute. Retrieved on 21 January, 2015, from: hyperlink.
Moyers, T.B., Martin, T., Christopher, P.J., Houck, J.M., Tonigan, J.S., & Amrhein, P.C. (2007). Client language as a mediator of motivational interviewing efficacy: Where is the evidence? Alcoholism: Clinical and Experimental Research, 31(S3), 40S-47S.
Purdon, C., Rowa, K., & Antony, M.M. (2004). Treatment fears in individuals awaiting treatment of OCD. Paper presented at the meeting of the Association for Advancement of Behavior Therapy, New Orleans, LA.
TADS Team. (2007). The Treatment for Adolescents with Depression Study (TADS): Long-term effectiveness and safety outcomes. Archives of General Psychiatry, 64, 1132-1143.
Westen, D. & Morrison, K. (2001). A multidimensional meta-analysis of treatments for depression, panic, and generalized anxiety disorder: An empirical examination of the status of empirically supported therapies. Journal of Consulting and Clinical Psychology, 69(6), 875-899.
Westra, H.A. (2012). Motivational interviewing in the treatment of anxiety. New York: Guilford Press.
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Take your happiness to the next level
You’ve ticked off all the items on the “Good Life” list: you exercise daily, have a healthy diet with good general health and sufficient sleep, and your interesting job affords you many luxuries. Beyond that, your primary relationship is going well and you enjoy your friends and hobbies. You say you are satisfied, but secretly you know: happiness still eludes you. What has gone wrong?
A new take on wellbeing: Gross National Happiness
Like increasing numbers of people, you could be waking up to the need to take your happiness quest to the next level. There is a new mindset for happiness gaining ground: namely, that greater wealth does not yield greater happiness and in fact true happiness is not attained only by self-focused individual effort. Back in 1972, the then King of Bhutan realised this, promoting the concept of Gross National Happiness, and even saying that it was more important as a measure of wellbeing than the Gross Domestic Product.
The United Nations picked up on the idea, adopting a resolution in 2012 which proclaimed March 20th the “International Day of Happiness”. It recognises happiness and wellbeing as universal goals and aspirations of human beings around the world. Significantly, the U.N. said the world needs a new economic paradigm to achieve this, one recognising that sustainable social, economic, and environmental development are equal contributors to gross global happiness.
Wealth up, happiness not
You may agree with this general idea, but wonder what it has to do with you. Here are some telling statistics. The average income in the United States is about five times higher than it was in 1900. Australians are about eight times richer than a century ago, as our GDP has increased significantly since then. But surveys measuring happiness (which have only been conducted since the 1940s) show little or no increase in happiness levels over the last five decades. In fact, many argue that our collective happiness has decreased slightly. What’s going on?
It’s the Joneses, mate: they’ve got a new luxury car
Happiness researchers explain that, while people who are really poor are less happy than those who are well off, greater income does not produce greater happiness once people have their basic needs met. All of society’s wealth has been increasing, so while people are absolutely better off than before, we are relatively no better off than our fellows, whose wealth has also been growing. Happiness psychology understands that result, noting that we are forever comparing ourselves to others, and if we feel like we are coming off second best in the comparison, we are dissatisfied.
Yet pursuing greater acquisitions (you know: the need to “keep up with the Joneses”) in order to favourably compare is leaving us restless and unhappy. India and Nigeria, for example, have purchasing power of 5 and 6, respectively (on a scale of 100) and life satisfaction scores of 6.7 and 6.59. Meanwhile, the United States has top purchasing power of 100, yet its life satisfaction score is only 7.73: barely better for all the extra capacity to buy stuff.
When young Australians were studied recently, 80 percent said that they were satisfied with their lives – including lifestyle, work or study, relationships, accomplishments and self-perception – but 50 percent were experiencing one or more problems associated with depression, anxiety, anti-social behaviour, and alcohol use.
The happiness riddle
So how do we convince the bluebird of happiness to come sit on our shoulder? The Happiness Assembly notes research which claims that, while we can thank about 50 percent of our happiness state on our genes (e.g., traits of extraversion or optimism) and 10 percent on external circumstances (making it hard to be happy when one is being tortured, imprisoned, or in pain), fully 40 percent of our happiness quotient is within our individual power to grasp.
But here’s the catch: more and more research is showing that it doesn’t happen when we operate from our old mindset of only tuning into self-focused personal gain and maximising short-term profit. Looking out for “me” at others’ expense is a selfishness which separates and isolates us. Rather, what brings the most profound contentment is following a purpose-filled life of meaning and meaningful connections with others. Paradoxically, it is this way of doing life – being connected to and looking out for others – which creates (sustainable) wealth and true wellbeing for us.
On a practical level
Paramahansa Yogananda, who founded an organisation showing how all religions had the same universal truths, said it most simply when he noted, “If you want to be happy, you must include others in your own happiness.” Yogananda practiced what he preached by making sure that, every day, he did three things: exercise, meditation, and helping someone. You don’t have to be rich or famous to do this (though you may leverage more resources if you are). What about these ideas?
- Offer to help clean your sick neighbour’s house or weed her garden
- Sponsor a child through an international charity (such as World Vision)
- Make regular visits to a lonely community member
- Volunteer your services to Lifeline, a local op shop, or somewhere that suits your interest and skills
- Mentor a beginner at something you do well.
- And note your sense of life satisfaction as you are doing these things, or afterwards. It might just be as high as Bhutan’s!
Written by Dr Meg Carbonatto, B.S., M.A., and Ph.D.
References:
Rhodes, M. (2014). The universal language of happiness. Live Happy Magazine. Retrieved on 17 February, 2015, from: hyperlink.
Hatfield/Dodds, S. & Coggan, A. (2008). The pursuit of happiness: sustaining human well-being. ECOS, Aug-Sept, 2008.
Sinha, B. (2014). Happiness, wellbeing, Gross National Happiness and sustainability education. European Academic Research, Vol. II (7), October, 2014.
Stephens, I. (2012). Gross Domestic Happiness. ApaCenter. Retrieved on 17 February, 2015, from: hyperlink.
The Happiness Assembly. (n.d.). Spread happiness. The Happiness Assembly. Retrieved on 17 February, 2015, from: hyperlink.
The Wellbeing Manifesto. (n.d.). What is wellbeing? The Wellbeing Manifesto. Retrieved on 17 February, 2015, from: hyperlink.
UN Web Services Section. (2014). International Day of Happiness. International Day of Happiness – 20 March. Retrieved on 17 February, 2015, from: hyperlink.
Yogananda, P. (1997). Journey to self-realization: Discovering the gifts of the soul. Los Angeles: Self-Realization Fellowship Press.
Grief and the Four Tasks of Mourning
Grief is the universal, instinctual and adaptive reaction to loss, and particularly, the loss of a loved one (Dialogues in clinical neuroscience, 2012). It is a natural response and can be anything from missing out on a scholarship to the loss of limbs through an accident to loss of a car or other possessions through theft. Surely the most painful loss is that of someone we love through death.
Loss is an emotional wound, and like physical wounds, requires time to heal: not just a few days or weeks, but months rolling into years. The process of grieving, or mourning, allows people to come to terms with their loss. This does not mean that the person who died is forgotten, but that those left behind come to accept that the person is no longer around. Grieving has as many forms as there are people grieving. It is guaranteed to be painful, hard work which sucks up a huge amount of emotional and physical energy. It is also highly individual. Let’s look into what our psyches are trying to help us do as we go through the process of grieving: the tasks of mourning.
What does resilience look like?
Most of the time when mental health professionals talk about resilience, they are referring to psychological hardiness, primarily, and physical toughness secondarily. Yet the term “resilience” was first used in the physical sciences to describe the behaviour of a spring (Plodinec, 2009). In fact, the word “resilience” is derived from the Latin resalire, to spring back. In the 1970s and 1980s, the term began to be co-opted by ecological and psychological communities.
The ecologists used it to describe ecosystems that continued to function more or less the same in spite of adversity (Holling, 1973), and the psychologists noted that groups not changing their behaviour in spite of adversity were resilient ones (Masten, 1990). The engineering community also got in on the act, referring to physical infrastructure as being resilient if it was able to absorb and recover from a hazardous event (Plodinec, 2009).
Q&A with Toula Gordillo (Clinical Psychologist)
Q. I am a parent in a blended family. We have three boys between us, ranging from 12 to 17 years. The boys are very active, noisy, do little work around the house, spend a lot of time on the computer and playing sport. I am very involved in their lives – spending time with them, trying to understand their generation, and supporting them.
My husband thinks I do not have high enough expectations of them and I am inconsistent in terms of discipline. I think he doesn’t spend enough time building the relationship with the boys and he complains that he often feels unappreciated for his efforts. We don’t agree on parenting and the division is putting huge pressure on our family. What can we do?
A. Obviously every family works differently but generally both parties need to recognise that parenting can be difficult, and requires strategies. Parenting someone else's child can be even more difficult, requires even more strategies and the step parent may need even more encouragement from the partner. Try to find an area in which both of you agree. Concentrate on common areas/ideas and show your sons that you are united in some things. Always show a "united front" to your children and do not disagree in front of them. Disagree in private when issues can be discussed later.
If your boys detect that you and your husband don't agree on something, understand that they may try to use this division to their advantage and play one parent against the other. This is relatively normal. If you and your husband do not agree on something, try not say anything at the time. Instead, walk away but ensure that it is discussed in private at a later time. Talking in the bedroom after the event, or outside over a cup of coffee or glass of wine, can be a good start!
Ensure that the bulk of the discipline is conducted by the biological parent. In many cases, if the step-parent and the parent say exactly the same thing, the teen/pre-teen will listen to the biological parent more. Again, this is fairly normal and you and your husband as the step-parent should try to not take offence if the boys listen more to their biological parent (obviously this can also depend on the age of the child, the relationship between the step-parent and the child, how long the step-parent has been part of the family etc.).
Try to understand that in some cases the youth may believe that step-parent cannot tell them what to do as they think "you are not my parent". They might even say this to the step-parent. Try not to take this personally if this occurs. Lastly, both of you can do things together as a family. Remember the saying, “the family that plays together stays together”. Have fun as a family!
Message to Counsellors/Psychologists: Counselling parents of blended families can be particularly challenging! Normal teenage behaviours can be difficult, but particularly in a blended family when parents/step-parents may have very different views.
In a nutshell: Try to assist parents to be united in their views and disagree in private. Encourage them to demonstrate cohesion to the children/youth as much as possible and the step-parent generally needs to take on a mentor/friend role, more so than a disciplinarian role. This approach generally works the best and above all, encourage them to spend time having fun together. With more fun within the family, and fun between the parents themselves, parents can feel more appreciated and are more likely to enjoy the parenting role with less division and criticism of each other and their parenting methods.
Toula Gordillo is a Clinical Psychologist, AIPC private assessor/tutor and regular contributor for Institute Inbrief. Toula has an extensive work history as a Clinical Psychologist, Teacher, and Guidance Officer. For more information, visit www.talktoteens.com.au.
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A healthy heart is both physical and emotional
There is exciting news! Groundbreaking research from the U.S. National Institute of Health has identified the biological mechanism that allows our emotional health to create good heart health. Candace Pert and her team have found a love affair going on within our molecules. Bits of protein on the ends of our cells form receptors, which collect chemical information our bodies need. But they can’t get it around to all the body alone; they need the help of ligands, which carry the information. Ligands – typically meaning, peptides and hormones within the body – bind with the receptors when they sense a good match in what Pert calls “love on a molecular level”.
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"Human beings can change, and if someone has truly changed, forgiveness is not indulgence toward his past deeds but an acknowledgement of what he has become. Forgiveness is intimately linked to the possibility of human transformation."
~ Matthieu Ricard
Many students of the Diploma of Counselling attend seminars to complete the practical requirements of their course. Seminars provide an ideal opportunity to network with other students and liaise with qualified counselling professionals in conjunction with completing compulsory coursework.
Seminar topics include:
- The Counselling Process
- Communication Skills I
- Communication Skills II
- Counselling Therapies I
- Counselling Therapies II
- Legal & Ethical Framework
- Family Therapy
- Case Management
Not sure if you need to attend Seminars? Click here for information on Practical Assessments.
Click here to access all seminar timetables online.
Course information:
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