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Therapy Information
Dr Liz Cooper is a Clinical Psychologist who is experienced in a large range of therapy approaches and techniques including:
- EMDR
- Nature Based Therapy
- Cognitive Behaviour Therapy (CBT)
- Acceptance and Commitment Therapy (ACT)
- Mindfulness Based Cognitive Therapy (MBCT)
- Interpersonal Psychotherapy (IPT)
- Dialectical Behaviour Therapy (DBT)
- Time-limited Psychotherapy
Eye Movement Desensitisation Processing (EMDR)
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Acceptance and Commitment Therapy
What is Acceptance and Commitment Therapy?
The general goal of ACT is to increase psychological flexibility – the ability to contact the present moment more fully as a conscious human being, and to change or persist in behavior when doing so serves valued ends.
Psychological flexibility is established through six core ACT processes. Each of these areas are conceptualised as a positive psychological skill, not merely a method of avoiding psychopathology.
Psychological flexibility is established through six core ACT processes. Each of these areas are conceptualised as a positive psychological skill, not merely a method of avoiding psychopathology.
Acceptance
Acceptance is taught as an alternative to experiential avoidance. Acceptance involves the active and aware embrace of those private events occasioned by one’s history without unnecessary attempts to change their frequency or form, especially when doing so would cause psychological harm.
For example, anxiety patients are taught to feel anxiety, as a feeling, fully and without defense; pain patients are given methods that encourage them to let go of a struggle with pain, and so on. Acceptance (and defusion) in ACT is not an end in itself. Rather acceptance is fostered as a method of increasing values-based action.
For example, anxiety patients are taught to feel anxiety, as a feeling, fully and without defense; pain patients are given methods that encourage them to let go of a struggle with pain, and so on. Acceptance (and defusion) in ACT is not an end in itself. Rather acceptance is fostered as a method of increasing values-based action.
Cognitive Defusion
Cognitive defusion techniques attempt to alter the undesirable functions of thoughts and other private events, rather than trying to alter their form, frequency or situational sensitivity. Said another way, ACT attempts to change the way one interacts with or relates to thoughts by creating contexts in which their unhelpful functions are diminished.
There are scores of such techniques that have been developed for a wide variety of clinical presentations. These techniques attempt to reduce the literal quality of the thought, weakening the tendency to treat the thought as what it refers to (“I am no good”) rather than what it is directly experienced to be (e.g., the thought “I am no good”). The result of defusion is usually a decrease in believability of, or attachment to, private events rather than an immediate change in their frequency.
There are scores of such techniques that have been developed for a wide variety of clinical presentations. These techniques attempt to reduce the literal quality of the thought, weakening the tendency to treat the thought as what it refers to (“I am no good”) rather than what it is directly experienced to be (e.g., the thought “I am no good”). The result of defusion is usually a decrease in believability of, or attachment to, private events rather than an immediate change in their frequency.
Being Present
ACT promotes ongoing non-judgmental contact with psychological and environmental events as they occur. The goal is to have clients experience the world more directly so that their behavior is more flexible and thus their actions more consistent with the values that they hold.
This is accomplished by allowing workability to exert more control over behavior; and by using language more as a tool to note and describe events, not simply to predict and judge them. A sense of self called “self as process” is actively encouraged: the defused, non-judgmental ongoing description of thoughts, feelings, and other private events.
This is accomplished by allowing workability to exert more control over behavior; and by using language more as a tool to note and describe events, not simply to predict and judge them. A sense of self called “self as process” is actively encouraged: the defused, non-judgmental ongoing description of thoughts, feelings, and other private events.
Self as Context
As a result of relational frames such as I versus You, Now versus Then, and Here versus There, human language leads to a sense of self as a locus or perspective, and provides a transcendent, spiritual side to normal verbal humans.
This idea was one of the seeds from which both ACT and RFT grew and there is now growing evidence of its importance to language functions such as empathy, theory of mind, sense of self, and the like.
In brief the idea is that “I” emerges over large sets of exemplars of perspective-taking relations (what are termed in RFT “deictic relations”), but since this sense of self is a context for verbal knowing, not the content of that knowing, it’s limits cannot be consciously known.
Self as context is important in part because from this standpoint, one can be aware of one’s own flow of experiences without attachment to them or an investment in which particular experiences occur: thus defusion and acceptance is fostered. Self as context is fostered in ACT by mindfulness exercises, metaphors, and experiential processes.
This idea was one of the seeds from which both ACT and RFT grew and there is now growing evidence of its importance to language functions such as empathy, theory of mind, sense of self, and the like.
In brief the idea is that “I” emerges over large sets of exemplars of perspective-taking relations (what are termed in RFT “deictic relations”), but since this sense of self is a context for verbal knowing, not the content of that knowing, it’s limits cannot be consciously known.
Self as context is important in part because from this standpoint, one can be aware of one’s own flow of experiences without attachment to them or an investment in which particular experiences occur: thus defusion and acceptance is fostered. Self as context is fostered in ACT by mindfulness exercises, metaphors, and experiential processes.
Values
Values are chosen qualities of purposive action that can never be obtained as an object but can be instantiated moment by moment. ACT uses a variety of exercises to help a client choose life directions in various domains (e.g. family, career, spirituality) while undermining verbal processes that might lead to choices based on avoidance, social compliance, or fusion (e.g. “I should value X” or “A good person would value Y” or “My mother wants me to value Z”).
In ACT, acceptance, defusion, being present, and so on are not ends in themselves; rather they clear the path for a more vital, values consistent life.
Committed Action
Finally, ACT encourages the development of larger and larger patterns of effective action linked to chosen values. In this regard, ACT looks very much like traditional behavior therapy, and almost any behaviorally coherent behavior change method can be fitted into an ACT protocol, including exposure, skills acquisition, shaping methods, goal setting, and the like.
Unlike values, which are constantly instantiated but never achieved as an object, concrete goals that are values consistent can be achieved and ACT protocols almost always involve therapy work and homework linked to short, medium, and long-term behavior change goals. Behavior change efforts in turn lead to contact with psychological barriers that are addressed through other ACT processes (acceptance, defusion, and so on).
ACT has been found to be effective in helping experiencing a large range off emotional and behavioural difficulties including depression, anxiety, posttraumatic stress, drugs and alcohol and work related stress/burnout.
Unlike values, which are constantly instantiated but never achieved as an object, concrete goals that are values consistent can be achieved and ACT protocols almost always involve therapy work and homework linked to short, medium, and long-term behavior change goals. Behavior change efforts in turn lead to contact with psychological barriers that are addressed through other ACT processes (acceptance, defusion, and so on).
ACT has been found to be effective in helping experiencing a large range off emotional and behavioural difficulties including depression, anxiety, posttraumatic stress, drugs and alcohol and work related stress/burnout.
Cognitive Behaviour Therapy
Psychotherapy is a form of treatment for emotional and psychological problems where a person talks with a mental health professional such as a psychiatrist, psychologist or counsellor. Cognitive behaviour therapy (CBT) is a form of psychotherapy that helps a person to change unhelpful or unhealthy thinking habits, feelings and behaviours.
CBT involves the use of practical self-help strategies, which are designed to bring about positive and immediate changes in the person’s quality of life.
CBT is used to treat a range of psychological problems including:
- Anxiety
- Anxiety disorders such as social phobia, obsessive-compulsive disorder or posttraumatic stress disorder
- Depression
- Low self-esteem
- Uncontrollable anger
- Irrational fears
- Hypochondria
- Substance abuse, like smoking, drinking or other drug use
- Eating disorders
- Insomnia
- Marriage or relationship problems
- Certain emotional or behavioural problems in children or teenagers.
CBT is also used to help many more psychological problems. In some cases, other forms of therapy used at the same time may be recommended for best results.
The core philosophy of CBT is that thoughts, feelings and behaviours combine to influence a person’s quality of life. For example, severe shyness in social situations (social phobia) may stem from the person thinking that other people will always find them boring or stupid.
This automatic belief causes the person to feel extremely anxious at social gatherings. Their behaviour may include stammering, sweating and other uncomfortable symptoms. The person then feels overwhelmed with negative emotions (such as shame) and negative self-talk (‘I’m such an idiot’). Their fear of social situations may become worse with every bad experience.
CBT aims to teach people that it is possible to have control over one’s thoughts, feelings and behaviours. CBT helps the person to challenge and overcome automatic beliefs and use practical strategies to change or modify their behaviour. The result is more positive feelings, which in turn lead to more positive thoughts and behaviours.
CBT focuses on changing unhelpful or unhealthy thoughts and behaviours. It is a combination of two therapies: ‘cognitive therapy’ and ‘behaviour therapy’. The underlying belief of both these techniques is that healthy thoughts lead to healthy feelings and behaviours. Some of the underlying theories of these two approaches include:
Cognitive therapy – the aim here is to change the way the person thinks about the issue that’s causing concern. Distorted or unhelpful thoughts cause self-destructive feelings and behaviours. For example, someone who thinks they are unworthy of love or respect may feel withdrawn in social situations and behave shyly. Cognitive therapy challenges these unhelpful thoughts. Many techniques are available. One technique involves asking the person to come up with evidence to ‘prove’ that they are unlovable. This may include prompting the person to acknowledge the family and friends who love and respect them.
This evidence helps the person to realise that their underlying belief is false. This is called ‘cognitive restructuring’. The person learns to identify and challenge unhelpful thoughts and replace them with more realistic thoughts. Behavioural therapy – the aim here is to teach the person techniques or skills to alter their behaviour. For example, a person who behaves shyly at a party may have negative thoughts and feelings about themselves. They may also lack social skills.
Behavioural therapy teaches the person more helpful behaviours. For example, the person may be taught conversational skills which they practise in therapy and in social situations.
Negative thoughts and feelings ease as the person discovers they can enjoy themselves in social situations. CBT has a good success rate because it combines the techniques of these two very effective therapies.
The core philosophy of CBT is that thoughts, feelings and behaviours combine to influence a person’s quality of life. For example, severe shyness in social situations (social phobia) may stem from the person thinking that other people will always find them boring or stupid.
This automatic belief causes the person to feel extremely anxious at social gatherings. Their behaviour may include stammering, sweating and other uncomfortable symptoms. The person then feels overwhelmed with negative emotions (such as shame) and negative self-talk (‘I’m such an idiot’). Their fear of social situations may become worse with every bad experience.
CBT aims to teach people that it is possible to have control over one’s thoughts, feelings and behaviours. CBT helps the person to challenge and overcome automatic beliefs and use practical strategies to change or modify their behaviour. The result is more positive feelings, which in turn lead to more positive thoughts and behaviours.
CBT focuses on changing unhelpful or unhealthy thoughts and behaviours. It is a combination of two therapies: ‘cognitive therapy’ and ‘behaviour therapy’. The underlying belief of both these techniques is that healthy thoughts lead to healthy feelings and behaviours. Some of the underlying theories of these two approaches include:
Cognitive therapy – the aim here is to change the way the person thinks about the issue that’s causing concern. Distorted or unhelpful thoughts cause self-destructive feelings and behaviours. For example, someone who thinks they are unworthy of love or respect may feel withdrawn in social situations and behave shyly. Cognitive therapy challenges these unhelpful thoughts. Many techniques are available. One technique involves asking the person to come up with evidence to ‘prove’ that they are unlovable. This may include prompting the person to acknowledge the family and friends who love and respect them.
This evidence helps the person to realise that their underlying belief is false. This is called ‘cognitive restructuring’. The person learns to identify and challenge unhelpful thoughts and replace them with more realistic thoughts. Behavioural therapy – the aim here is to teach the person techniques or skills to alter their behaviour. For example, a person who behaves shyly at a party may have negative thoughts and feelings about themselves. They may also lack social skills.
Behavioural therapy teaches the person more helpful behaviours. For example, the person may be taught conversational skills which they practise in therapy and in social situations.
Negative thoughts and feelings ease as the person discovers they can enjoy themselves in social situations. CBT has a good success rate because it combines the techniques of these two very effective therapies.
Dialectical Behaviour Therapy
Dialectical behaviour therapy (DBT) is a psychosocial treatment developed by Marsha M. Linehan specifically to treat Borderline Personality Disorder.
While DBT was designed for Borderline Personality Disorder, it can also be used with people experiencing a range of emotional and behavioural difficulties including depression and anxiety.
The treatment itself is based largely in behaviourist theory with some cognitive therapy elements as well. There are two essential parts of the treatment, and without either of these parts the therapy is not considered “DBT adherent”.
1. An individual component in which the therapist and client discuss issues that come up during the week following a treatment target hierarchy. Self-injurious and suicidal behaviours take first priority, followed by therapy interfering behaviours. Then there are quality of life issues and finally working towards improving one’s life generally.
During the individual therapy, the therapist and client work towards improving skill use. Often, skills group is discussed and obstacles to acting skilfully are addressed.
2. The group, which ordinarily meets once weekly for about 2-2.5 hours, in which clients learn to use specific skills that are broken down into 4 modules: core mindfulness skills, emotion regulation skills, interpersonal effectiveness skills and distress tolerance skills.
The Four Modules
Mindfulness
The essential part of all skills taught in skills group are the core mindfulness skills. Observe, Describe, and Participate are the core mindfulness “what” skills. They answer the question, “What do I do to practice core mindfulness skills?” Non-judgmentally, One-mindfully, and Effectively are the “how” skills and answer the question, “How do I practice core mindfulness skills?”
Interpersonal Effectiveness
Interpersonal response patterns taught in DBT skills training are very similar to those taught in many assertiveness and interpersonal problem-solving classes. They include effective strategies for asking for what one needs, saying no, and coping with interpersonal conflict.
Borderline individuals frequently possess good interpersonal skills in a general sense. The problems arise in the application of these skills to specific situations. An individual may be able to describe effective behavioural sequences when discussing another person encountering a problematic situation, but may be completely incapable of generating or carrying out a similar behavioural sequence when analysing her own situation.
This module focuses on situations where the objective is to change something (e.g., requesting someone to do something) or to resist changes someone else is trying to make (e.g., saying no). The skills taught are intended to maximize the chances that a person’s goals in a specific situation will be met, while at the same time not damaging either the relationship or the person’s self-respect.
Borderline individuals frequently possess good interpersonal skills in a general sense. The problems arise in the application of these skills to specific situations. An individual may be able to describe effective behavioural sequences when discussing another person encountering a problematic situation, but may be completely incapable of generating or carrying out a similar behavioural sequence when analysing her own situation.
This module focuses on situations where the objective is to change something (e.g., requesting someone to do something) or to resist changes someone else is trying to make (e.g., saying no). The skills taught are intended to maximize the chances that a person’s goals in a specific situation will be met, while at the same time not damaging either the relationship or the person’s self-respect.
Distress Tolerance
Dialectical behaviour therapy emphasizes learning to bear pain skilfully. Distress tolerance skills constitute a natural development from mindfulness skills. They have to do with the ability to accept, in a non-evaluative and non-judgmental fashion, both oneself and the current situation. Although the stance advocated here is a non-judgmental one, this does not mean that it is one of approval: acceptance of reality is not approval of reality.
Distress tolerance behaviours are concerned with tolerating and surviving crises and with accepting life as it is in the moment. Four sets of crisis survival strategies are taught: distracting, self-soothing, improving the moment, and thinking of pros and cons. Acceptance skills include radical acceptance, turning the mind toward acceptance, and willingness versus wilfulness.
Distress tolerance behaviours are concerned with tolerating and surviving crises and with accepting life as it is in the moment. Four sets of crisis survival strategies are taught: distracting, self-soothing, improving the moment, and thinking of pros and cons. Acceptance skills include radical acceptance, turning the mind toward acceptance, and willingness versus wilfulness.
Emotion Regulation
Borderline and suicidal individuals are emotionally intense and labile – frequently angry, intensely frustrated, depressed, and anxious. This suggests that borderline clients might benefit from help in learning to regulate their emotions. Dialectical behaviour therapy skills for emotion regulation include:
- Identifying and labelling emotions
- Identifying obstacles to changing emotions
- Reducing vulnerability to “emotion mind”
- Increasing positive emotional events
- Increasing mindfulness to current emotions
- Taking opposite action
- Applying distress tolerance techniques