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Why SMART Goals Are Important For Mental Health
SMART Goals refer to goals that are:
- Specific
- Measurable
- Achievable
- Relevant
- Time-Bound
Calling your parents at least once a week would be an example of a SMART goal.
But why are SMART goals so important for mental health and moving towards our psychological goals? For example, why not just go through general therapy and just say you want to become happier?
The primary reason is because happiness means something very different for each person. This can be the same for people who want to feel less anxious, sleep better, or be more active.
In the case of happiness, this might mean improving social relationships for some people; for others, it might be feeling more confident about one’s ability at work.
Therefore, SMART goals help determine the specific changes in a person’s life that will lead to improvement and figuring out strategies to get closer to that goal.
Below, I discuss several reasons why SMART goals are important to mental health.
SMART Goals make goals more specific to the person
As mentioned above, SMART goals help move the general into the specific. It is a way to identify the peculiarities of a person’s goals that would truly benefit the person’s life.
For example, a person might have a general goal of sleeping better. A SMART goal for this person might be falling asleep quicker, staying asleep, or getting some more refreshing sleep.
Another example could be that a person wants to feel less anxious. In this case, a SMART goal might be spending less time in the evening worrying about school assignments or more confident when speaking to other people.
When thinking about how to get to a more specific goal, a strategy is to ask yourself: “if I were sleeping better, what would be different” or “if I were less anxious, what would that look like?”. Addressing these questions will provide helpful insight in what SMART goals to try out.
SMART goals help us test and experiment with negative beliefs
Oftentimes, people have negative thoughts such as “nothing will improve my mood” or “I can’t handle any uncertainty in my life”.
SMART goals offer us a way to test these problematic beliefs through specific and measurable goals. For example, setting a goal to take a walk in the evening to test the belief that “nothing will improve my mood” and measuring mood before and after. Another example is opting to try out a new restaurant without knowing the rating to begin tolerating uncertainty.
SMART Goals help make incremental changes
It’s easy to say that your goal is to be more active. It’s much harder to actually get started.
Some people, in a burst of motivation, decide on changes that are not sustainable or hard to follow through when we are feeling less motivated.
SMART Goals therefore help to ensure that the set goal is challenging but manageable. For example, instead of deciding to run a half marathon every day, you might start with a 10 minute jog twice a week.
Afterwards, you can continue making incremental improvements to get closer to your goals!
SMART Goals increase self-confidence
As above, completing SMART goals begin to increase our feelings of self-efficacy. That is, the confidence that we can take matters in our own hands to improve our current situation.
This can be true for a number of psychological challenges, such as anxiety, mood, and sleep. We are able to showcase that we have a direct impact on our well-being and are effective in working through the world around us.
SMART Goals add to the person’s clinical toolkit
Just like different tools are needed to handle different situations, clinical skills are the same – some work well in some situations and others work well in other situations.
Therefore, learning how to use SMART goals is like adding another tool into your clinical toolbox. They are not something that necessarily works for every situation, but helps to create versatility in the way to handle life’s challenges.
If you’re interested in creating SMART goals yourself, here’s a helpful post to get started!
Best wishes,
P
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Everything You Need To Know About CBT For Insomnia
Cognitive Behavioural Therapy for Insomnia (CBT-I) is considered the frontline, gold standard treatment for chronic insomnia.
However, people are generally less familiar with CBT-I compared to other available treatment options, such as sleep medication. Therefore, it can be helpful to understand more about what CBT-I is and how it works.
In this post, I discuss everything you need to know about CBT-I to hopefully make a more informed decision regarding treatment.
Acute vs Chronic Insomnia
CBT-I treats chronic sleep disturbances that are maintained by sleep anxiety and disruptions to natural sleep systems. Therefore, it’s important to distinguish between acute (short-term) and chronic (long-term) types of insomnia.
Acute insomnia is typically a response to stress. When we are preparing for an exam, planning a wedding, or transitioning into a new role at work, it makes sense (and evolutionarily advantageous) that we are stressed and sleep becomes worse for wear. Acute insomnia is not a concern and will usually pass once the stressor is over (e.g., you are finished your exams).
Unlike short-term sleep problems, chronic insomnia lasts well after the stressor is over; sleep problems begin to take on form of its own. Typically, chronic insomnia is defined by a period of sleep disturbances that last at least 3 months, occurring 3 times a week. That being said, many people with chronic insomnia have sleep problems lasting years.
A summary:
Acute Insomnia
- Short-term (lasts a few weeks to a month)
- Results from stressors in life
- Goes away once the stressor is over
Chronic Insomnia
- Lasts at least 3 months and occurs at least 3 times a week
- Caused by sleep-specific issues rather than on-going stressors
- Generally requires treatment to alleviate
What does CBT-I look like?
CBT-I includes multiple components of evidence-based therapies for insomnia. They are designed to treat the causes of insomnia.
Sleep restriction therapy
Sleep restriction therapy is a way to limit the amount of time a person spends in bed awake to put pressure on our sleep systems.
People with insomnia often spend an excessive amount of time in bed because they feel fatigued and desire more sleep. This counterproductively leads to a significant amount of time spent awake (e.g., sleeping 6 hours but spending 10 hours in bed). An analogy to this problem is like wearing a size 10 shoe when you have size 6 feet – it feels uncomfortable.
Therefore, sleep restriction therapy brings down the amount of time we spend in bed to be closer to how much sleep we are producing. The idea is that the more time spent outside of bed will increase pressure for sleep, allowing for more deeper, consolidated sleep to occur (reduced nighttime awakenings).
Stimulus control
In insomnia, the bed becomes associated (like Pavlov’s dog) with wakefulness. This is because people with insomnia spend so much time tossing and turning, ruminating, and worrying in bed. Over time, our brain begins to make a connection with the bed and being awake.
Stimulus control is a strategy meant to restore the association that bed equals sleep, rather than the bed being a place of fear and uncertainty. This is typically done by using the bed only for sleep and getting out of bed if sleep is not coming (doing some pleasant, such as reading a book, in the meantime).
Cognitive therapy
People with insomnia have unhelpful beliefs about sleep that increase the feelings of pressure of needing to sleep. And as we know, the more we try to sleep the further away sleep gets.
Unhelpful beliefs include: “I need 8 hours of sleep or I won’t be able to function”, “I can’t handle being awake in the middle of the night”, and “I’ll never be able to fall asleep”.
Therefore, cognitive therapy, which tackles and tests these beliefs, help to reduce anxiety and set more heathy expectations of sleep and functioning. For example, testing the question “is it really true that you are unable to function without sufficient sleep?”. In this case, the person can probably come up with examples in the past where they have been able to perform relatively well despite a poor night’s sleep.
Relaxation and Mindfulness practices
Exercises like regular relaxation and mindfulness practices can also be helpful as part of the CBT-I package to reduce general arousal levels and our reaction to scary thoughts or feelings. These practices can facilitate better sleep.
Sleep hygiene
Sleep hygiene include best practices to optimize the environment and behaviours for sleep, such as not drinking coffee in the evening and setting up a nighttime routine. Although these practices can be helpful to support sleep health, sleep hygiene not a standalone effective therapy for insomnia.
Effectiveness of CBT-I
CBT-I is a very effective therapy for insomnia symptoms. CBT-I works in a number of different populations suffering from comorbid conditions, meaning that most people can benefit from CBT-I. Clinical trials at our research laboratory finds that approximately 4 out of 5 people go from being above the insomnia threshold to becoming a good sleeper within four sessions.
Besides sleep, CBT-I also interestingly improves other outcomes, such as mood (Lau et al., 2022), anxiety (Zhang et al., 2015), and chronic pain (Finan et al., 2014). All in all, CBT-I is very effective when recommendations are followed.
CBT-I vs Sleep Medication
CBT-I and medication (e.g., the ‘Z-drugs’) are both evidence-based treatments of chronic insomnia. There are pros and cons of using either treatment.
Medication is effective and simple to use. There is also evidence that medication is equally as effective as CBT-I. However, medication tends to treat insomnia symptoms but does not address the causes of insomnia. Therefore, sleep problems tend to come back if medication is continued. Moreover, some medications cause side effects and generally is not preferred by patients nor providers.
On the other hand, CBT-I has greater durability and its effects last well after treatment is completed. This is because CBT-I restores one’s own confidence in sleeping well and addresses the underlying causes of insomnia.
The drawback of CBT-I is that it requires persistence and effort to see desired benefits. Following the recommendations can be tough and may not be consistent with everybody’s needs and values. For example, some people prefer not having to follow a standard schedule or a specific time in bed, which would pose a barrier to CBT-I.
Strategies to get the most out of CBT-I
Below are a few approaches that you can take to most effectively benefit from CBT-I:
1. Be willing to try out the recommendations! Some of the recommendations of CBT-I feel counterintuitive – such as getting out of bed when sleep is not coming. “But what if I never fall back asleep?”. Anxious thoughts might keep you from fully engaging. However, being curious and experimental in your approach will take you far to break out of the sleep anxiety and get your sleep back on track.
2. Sleep data from a sleep diary can be helpful. If you are working with a therapist, then completing a sleep diary can be helpful to get a sense of your general sleep patterns. Sleep diaries are self-report daily dairies that ask questions such as “when you got into bed” and “how long it took you to fall asleep” to get a picture of your sleep. The therapist can then provide individualized recommendations to support your sleep needs.
3. Reflect on your sleep goals and beliefs. Some sleep goals can be tricky because they don’t reflect reality. For example, many people come in with the goal of sleeping 8 hours but the number of hours we produce is actually completely unique to our own body. Other people might think that better sleep will mean that they have lots of energy throughout the day. However, fatigue is multifaceted and there can be a number of factors that could be contributing to feelings of tiredness (such as lack of activity or caffeine rebound). If you’re interested, here is an article on six strong goals for sleep.
Best wishes,
P
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When Do SMART Goals NOT Work (Strategies To Fix It)
SMART Goals are a fantastic strategy that is commonly used in many different professions to develop specific and actionable steps to moving towards a goal.
This is also true in a therapy environment, where therapists will set SMART goals with patients to support their desire to improve their mental health.
SMART Goals represent goals that are: Specific, Measurable, Actionable, Realistic, and Time Bound.
Examples of SMART Goals include:
- Going for a walk twice a week for 15 minutes
- Saying hello to 5 strangers a day
- Waiting at least 10 minutes before smoking when urges occur
Although SMART Goals are an excellent tool, there are certain instances when SMART Goals may not work the way we want it to and we may feel discouraged. Consequently, it is important to know when these times might occur and what to do to overcome these difficulties.
Below, I discuss 7 reasons when SMART Goals may fail and strategies to work through these problems.
1. The SMART Goal is too hard
The first reason is that the SMART goal is simply too hard – and therefore unrealistic (at least at the time when it was set).
For example, a person wanting to be active might set the SMART goal of working out two hours a day 5 days a week. This goal may be too much too soon if you have been relatively sedentary for the last while.
Therefore, consider whether the SMART goal is well-calibrated to the your needs. A more appropriate goal to generate some momentum might be to be active 3 days a week, 15 minutes at a time (but you know yourself best!).
2. The SMART Goal is too easy
On the opposite spectrum, SMART goals can be less effective if they are too easy to complete (e.g., doing 5 jumping jacks, once a month).
SMART goals should be achievable but challenging enough to stimulate growth in your daily life and get you closer to your goals.
3. The SMART Goal is not relevant to the broader goal
There are some cases where the SMART Goal is not relevant to the main goal. For example, setting a SMART goal of waking up at 8:00am everyday with the goal of being more social.
In this case, there is little overlap between the two goals unless the person spends the extra time they have by getting out of bed early to socialize with friends or other people.
Sometimes a goal appears relevant but may not be the type of goal that is specific to what the person truly needs. For example, somebody who wants to be more social may set a goal to speak to 3 strangers every week.
However, their actual goal of developing a deeper social circle might require a different social goal. For example, spending more time and resources into existing relationships. Therefore, a better SMART goal might be to plan outings with friends and loved ones rather than talking to unfamiliar people.
4. There’s not enough intrinsic reason to be engaging in the goal
Sometimes, people set goals that they think they should be doing rather than engaging in activities that they find to be truly meaningful.
For example, some people might set a goal to meditate everyday for 5 minutes. Although meditation can be very beneficial, some people begin to meditate solely for the sake of meditating. This can often lead to poor results because the person may not truly understand why they’re doing what they’re doing.
Therefore, it’s important to engage in some reflection about the reason why we set goals. Is it to be more responsive in our actions, rather than reactive? Is it to live a more meaningful and active life? Reflecting on our values can be an important process to understand why we are putting in the hard work.
5. We don’t know if the SMART Goal worked
Sometimes, SMART Goals ‘fail’ because we are not sure if the activity actually helped to make any improvements.
It is there important to track how we feel before and after completing the SMART goal. For example, we may have the belief that ‘nothing will help with my mood’. After setting a goal to take a walk in the evening for 15 minutes, it can be helpful to rate your mood levels from 1 to 10 before and after to see if any change has occurred to test this negative prediction.
6. We don’t have a deadline for the SMART goal
Of course, the last letter of SMART goals stands for Time-Bound. There must be a deadline by which we need to complete a goal. If not, we can push it later and later – many fellow procrastinators can vouch for this.
Therefore, deciding on a specific time that works best to accomplish the goal and setting an alarm can be helpful to make sure we avoid procrastination.
7. Other barriers exist for SMART Goals
Outside of procrastination, there can be any number of reasons that create barriers to completing our set goals.
For example, anxiety might make us avoid going to the gym or speak to unfamiliar people. Our mood might also make it harder for us to get the momentum needed to start an activity.
Therefore, it’s important to troubleshoot issues that might come up. For example, you might decide to do some relaxation exercises to increase the likelihood of following through with a goal. Or you might put on your shoes 30 minutes before deciding to go for a jog to make for a smoother transition. Another strategy might be to just get started by promising to read only one page rather than thinking you need to read the whole chapter. Be flexible and creative in your approach to tackling barriers!
Conclusion
SMART Goals can be great evidence-based tool to support your needs. However, barriers can exist that make SMART goals less effective and we need strategies to overcome these obstacles. Hopefully this post was helpful in understanding a few of these possible issues that might come up and giving you a few tools to resolve them!
Here’s an article on setting your own SMART Goals today!
Best wishes,
P
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6 Reasons Why You Might Be Sleepy
When we think about sleepiness, it is first important to distinguish between being “sleepy” and being “tired”.
People often use them interchangeably, but there’s actually an important difference. Whereas sleepiness refers to being able to fall asleep at any given moment (e.g., head rolling, nodding off), being tired is a general lack of energy either physically or mentally (e.g., feeling foggy after a 3 hour exam). You can be tired without being sleepy – just like in cases of insomnia.
When it comes to being sleepy, there are several reasons why a person might feel a sense of drowsiness throughout their day. In this post, I discuss several reasons for why you might be sleepy.
1. You are sleep deprived
The first reason for why you might be sleepy is that you are sleep deprived. Whether it’s from work, taking care of kids, or social activities, you may not be getting the number of hours you need to feel rested.
It is important to also note that the number of hours each person needs can differ: some people are 8-hour sleepers, others might need more or less than that. Getting the right number of hours for you is important to reduce sleepiness.
2. Your sleep drive is high
Similar to the first reason, another reason is that your sleep drive (propensity to fall asleep at any given moment) is very high.
Sleep drive begins to build after a good night’s sleep. Based on our activities throughout the day, and how long we are awake for, our sleep drive builds up. If your schedule tends to be quite active, then it would make sense that the build-up of sleep drive is high, and sleepiness can be present.
Evidence of high sleep drive include:
- Falling asleep in under 10 minutes on average
- Evening drowsiness
- Spending more than 90% of the time you spend in bed sleeping.
In these cases, you likely can produce a little more sleep so it can be helpful to increase the amount of sleep opportunity you have by spending a bit more time in bed.
3. It could be natural fluctuations throughout the day
There are certain time points throughout the day where sleepiness is ‘unmasked’ because of circadian factors. These are typically around the late afternoon period (labelled the ‘post-lunch’ dip) and during the evening when sleepiness comes out. In these cases, they are a biological shift and will go away if you can push through.
4. You are bored
When there is a lack of stimulation, sleepiness can come out because our mind may begin to focus its attention on evidence of tiredness or sleepiness, such as heavy eyes or an achy body.
In this case, try to find something interesting to do!
5. There could be an underlying sleep condition
There are a few different sleep disorders that can manifest sleepiness:
Hypersomnia. In hypersomnia, you may feel excessively sleepy and/or sleep longer than usual at night. Stimulants are the first-line treatment for hypersomnia.
Sleep apnea. Sleep apnea refers to obstructions in the breathing airways that lead to mini-awakenings in the middle of the night. This can lead to sleep deprivation and thus sleepiness during the day. If you notice excessive sleepiness and loud snoring/gasps during the night, a sleep study can be helpful to determine whether sleep apnea is present.
Narcolepsy. Narcolepsy leads to suddenly falling asleep because of a deficiency in a neuropeptide (i.e., orexin) that regulates wakefulness. Stimulants are the primary treatment for narcolepsy.
Beyond sleep conditions, other medical conditions can also lead to issues with sleep, like chronic kidney disease, cancer, and anemia. Therefore, checking with your medical provider can be helpful if the sleepiness or fatigue is unexplained.
6. Sleepiness can arise as a side effect of medication
Sleepiness can also result from a side effect of medication (e.g., pain medication, cold medication, anxiety medication, etc.). Should symptoms persist and cause issues, please check with your doctor.
Best wishes,
P
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How Effective Is Cognitive Behavioural Therapy For Insomnia
Introduction
Cognitive behavioural therapy for insomnia (CBT-I) is a research-supported treatment and is considered the first-line intervention for chronic sleep problems by the American Academy of Sleep Sciences.
In this post, I discuss how CBT-I works, whether it is effective in treating sleep and other problems, and how to get the most out of treatment.
How CBT-I Works
CBT-I works by tinkering with our sleep systems to make it work for us, rather than against us.
When we are struggling with insomnia, we naturally engage in behaviours that counterproductively affects our sleep. For example, we might stay in bed longer, cancel plans, take naps – these behaviours affect our sleep drive (what we need for deep sleep)and circadian rhythm (because we are going to bed and waking up at regular intervals), which is what we need to get the deep sleep that we need.
We might also stay in bed feeling frustrated, which can increase sleep anxiety and overtime lead to creating an association between the bed and wakefulness – known as conditioned arousal.
CBT-I therefore uses strategies to 1) increase sleep drive; 2) balance the circadian rhythm; and 3) reduce sleep anxiety.
What the research says about CBT-I
Overall, the research for CBT-I is very promising. Studies show that people with different medical and psychological comorbidities (e.g., depression) can benefit from CBT-I (Wu et al., 2015).
In our own clinical trials at the Sleep and Depression Laboratory at Toronto Metropolitan University, we see remission rates between 70 to 80%. That means, nearly 4 out of 5 people coming into treatment go from being a poor sleeper to a good sleeper within four sessions of CBT-I.
One particular advantage of CBT-I compared to sleep medication is long-term durability. Oftentimes, people who get off medication will notice that their sleep problem return; on the other hand, people who finish up CBT-I tend to stay a good sleeper years after treatment (Blom et al., 2016). This is because CBT-I targets the causes of insomnia.
Even more, research from our lab suggests that you don’t have to stay with the recommendations forever after treatment to retain its benefits (Lau et al., 2022). Therefore, you can have your cake and eat it too!
CBT-I helps more than sleep problems
Beyond improving sleep problems, such as difficulty falling asleep, staying asleep, waking up too early, CBT-I can also impact other important mental and physical health areas.
For example, there’s a lot of research that CBT-I improves symptoms of mood and anxiety (Ye et al., 2015). The improvements in sleep and energy can also impact physical issues, such as chronic pain and fatigue (Jungquist et al., 2010).
How to benefit more from CBT-I
Below are a few strategies to get the most out of your CBT-I experience.
1. Work with a therapist
Although there are self-help books and apps for CBT-I, such as Goodnight Mind by Dr. Colleen Carney, a therapist can be helpful in providing the most effective recommendations by analyzing your sleep diary. The sleep diary is a way of tracking your sleep to understand how to best tinker with your behaviours to support sleep health.
2. Try out the recommendations
The recommendations of CBT-I can sometimes be difficult to follow, such as only getting into bed when sleepy and getting out of bed when sleep is not coming. These recommendations sometimes increase our sleep anxiety, which tells us to stay in bed. However, giving the recommendations a real college try can be helpful to support efficacy and not fall into a vicious trap.
3. Use a sleep diary
As discussed above, a sleep diary gives us a sense of patterns in our sleep that can inform recommendations. Using a sleep diary (see here for an example: see here) can be helpful in understanding possible problems. For example, if you are generally producing 6 hours of sleep but spending 9 hours in bed, then that can be a reason why sleep feels light and non-restorative. Again, a CBT-I therapist can use this information to support their recommendations for therapy.
Best wishes,
P
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Using Acceptance And Commitment To Improve Your Mental Health
We suffer more in imagination than in reality.
SenecaLife is hard – no two ways about it. In these tough times, our mind can be our greatest asset or our worse enemy.
Take for example, two people suffering from chronic low back pain. The first person feels incredibly angry and resentful – “why did this have to happen to me?”, “this pain is unbearable”. The second person thinks to themselves: “it sucks this happened, but there’s no point focusing on what could have been”, “I am committed to living my life regardless of the pain”.
Whereas the first person resists their reality, the second person accepts what is. Both people experience the same pain, but the first person’s distress is magnified because of their intense focus on the affliction.
Acceptance and commitment therapy
The acceptance and commitment model was developed by Dr. Steven Hayes, an American clinical psychologist.
The idea is that what we resist, persists; on the other hand, with acceptance comes the ability to truly face our problems head on and move towards our goals.
The person who resists their pain can’t help but focus on their pain and what it means in terms of limiting their life and increasing their suffering. Resisting is like trying hard not to think of a white elephant – you can’t help but think of it even more.
On the other hand, the person who accepts their pain can now move forward to finding ways to improve their condition.
In this way, acceptance doesn’t mean giving up. It means that we come to terms with our reality and make a conscious committed decision to live out our best life anyways (our best life being those consistent with our values).
How to practice acceptance and commitment strategies
Below are some steps to applying acceptance and commitment to your own problems:
1. Accept what we cannot change and focus on what we can change
I may never be six feet tall or fully recover from my own back pain. However, I choose to play with the cards I am dealt because there’s no point spending extra brain power on things that will never change.
What I can do is focus on things I can change. For example, staying active and giving time for mobility work to reduce my back pain. Or to work on improving indicators of physical attractiveness by staying relatively fit.
2. Determine your values
Nietzsche once said: “he, who has a why to live for, can bear almost any how”.
Making a change in spite of the problems you are experiencing can be extremely challenging. Many fall to despair and give up because they do not have a why.
Therefore, it’s important to consider what reasons you have to accept your reality and commit to living a worthwhile life. These are where values come into play.
Consider values such as:
- Family
- Friends
- Health
- Love
- Work
- Fulfilment
- Activity
- Other important concepts in your life
For example, a person might decide to work on their back pain to be able to fully engage with their children in their playtime and adventures (family). Others want to continue being able to traverse in different places in the world (activity).
When the going gets hard, focus on the reasons you are committed to making a change.
3. Make a pros and cons list
There are going to be reasons to change as much as they are reasons to stay exactly the same. Technically, avoiding pain or fear of failure are perfectly good reasons to not change.
Therefore, a pros and cons list can often be helpful to determine whether you should change. Make a list of reasons to change and stay the same while considering different values and how important they are to you. Afterwards, you can then make an informed decision based on this list.
4. Commit!
Now that you have had an honest reflection about your values and have made a decision, you now commit to the course – no matter how hard.
We don’t do it because it’s easy; we do it because it’s the right thing to do and it’s the person you want to be.
Further ways to support acceptance and commitment
Beyond the steps outlined above, having a regular practice of mindfulness meditation can be a great way to detach ourselves from negative thoughts and feelings to our situation.
Mindfulness helps by allowing us to take space to act responsively, rather than reactively, to these experiences and become better able to refocus on our values and stay committed.
Mindfulness practice does not have take a significant amount of time; even a few minutes a day or engaging in certain activities (e.g., eating, listening to music) in a mindful manner can be very beneficial.
Best wishes,
P
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Rapport Building Strategies To Improve The Therapeutic Relationship
“It is the relationship that heals.”
As Irvin Yalom, an esteemed psychiatrist so eloquently put, a positive therapeutic alliance is essential to the patient’s outcome in therapy.
There may be many reasons for the relationship to be healing. It may foster belief in the patient that there are other people that truly understands their problem and cares for them. Strong relationships may also enable the trust needed to try out the recommendations provided by the therapist. Or genuine and empathetic interactions are just naturally healing in and of itself.
Regardless, the fact of the matter is that building a positive rapport is important. Below, I discuss different ways that a therapist can develop a positive relationship with their patients.
Show that you care
Patients often believe that you are their to simply collect a paycheck. Or they may think that you have so many patients, there is no way you care that much about them.
And it’s your job to show them otherwise.
In showing care, it’s really the little things that count. Sometimes, even checking in for their thoughts during session or saying that you’ve been thinking about them outside of the session can have a positive impact. Like most people, patients find a lot of meaning in the little acts.
In terms of specific skills, the use of accurate empathy can be very helpful to show that you really understand this person’s feelings because you are attending well to what they are saying.
Show you understand the problem
Before showing competence in dealing with a patient’s problem, you must show that you understand the problem itself.
Active listening strategies, such as reflections and summaries, can be a great way to showcase to the patient that you understand their problems well. You’ll know you have hit the jackpot when you hear the patient say something along the lines of “that’s exactly it!”.
Be open and transparent
Although you are the expert in the room in terms of psychology and mental health, you are not expected to be the expert in everything.
It’s okay to say I don’t know. And that you will get back to them to make sure you’re giving them the most helpful up-to-date information. And it’s okay to have feelings – positive and negative about a person or a situation.
Patients are smart enough to know when you are hiding something or pretending to know something you don’t. And they will appreciate your honesty.
If you have a dilemma, share it with them and get their thoughts on the matter. This is beneficial to help the patient take more responsibility for the therapy and takes pressure off you to be the person to have to solve every problem.
Be collaborative
If you are the expert in the psychological matters, the patient is the expert of themselves and their own psychological world.
Therefore, it’s important to work together in pursuit of goals in therapy. Look to check-in and ask for the patient’s feedback, bringing them in when discussing possible solutions rather than just assigning them to the patient.
Questions such as: “what do you think about this?”, “does this fit right for you?”, and “how do you feel therapy is going between us?” can be helpful to show collaboration and that you place importance in what the patient is thinking.
Demonstrate genuine positive regard
You probably won’t enjoy working with every patient you meet throughout your career.
However, I have never met a patient without a single quality that I could appreciate – whether it’s their diligence towards their work, their curiosity in experimenting with different skills, or their resilience in the face of their suffering and harsh life experiences.
In some cases, it’s also helpful to understand where behaviours that you see in a negative light come from. For example, some patients may come in with a lot of distrust and anger; however, you may come to an appreciation that this anger may have protected this person from a lot of pain in the past. This understanding of the patient’s struggles and problem-solving may allow for greater appreciation of the person themselves.
Show appropriate humour
Sometimes, a few light-hearted jokes done appropriately can be very helpful to add some levity and diffuse potentially distressing situations.
Of course, it’s important to be judicious in your application of humour – being considerate of the patient and your relationship with them.
Be non-judgmental
One final way that can be helpful to build rapport is through taking a non-judgmental approach. To be able to see the person as they are without personal bias and prejudice.
Mindfulness practice can be a useful tool to be consciously aware of our own thoughts and feelings and be able to let them go. By doing so, we can take a beginner’s mind to a patient’s problems and work with them in a unique and personalized manner.
Best wishes,
P
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7 Key Skills Needed For Graduate School In Clinical Psychology
Graduate school in clinical psychology requires juggling multiple roles: courses, research, clinical work, lecturing, writing, among dozens of other tasks.
To more easily acclimate, there are certain skills that I have found to be really important to have when entering graduate school in clinical psychology. Below are a few skills (some softer; others harder) that are useful to cultivate to successfully navigate all the trials and tribulations that grad school has to offer.
1. Being familiar with the research process
Surprisingly, a clinical psychology program doesn’t require too many pre-requisite clinical skills (being a generally caring and empathetic human is typically sufficient to begin); however, having a strong understanding of the research process is needed.
There is significantly less handholding for research and thesis development: you’re expected to know how conduct a literature review, submit an ethics application, determine a methodology to test your research question, and disseminate this work at conferences and publications. Of course, support from your supervisor will be available, but it’s important to have a good sense of the research flow from the start.
2. Writing well academically
I wrote ‘academically’ because there is a certain style of word choice, structure, and cautious interpretation that captures writing well in academia. This style may not map on well to other types of literary endeavours – God knows I’m terrible at writing poetry and fiction.
Generally, writing well academically means writing in a precise way with a clear and concise structure. Reading research articles in your field is a good strategy to get a sense of what gets published. If you’re having some challenges developing strong writing, HemingwayInCollege has some useful articles that may support your academic writing.
3. Having (some) knowledge of statistics
Having a foundational knowledge of statistics is also a very helpful skill in graduate school. Although nothing fancy is needed especially early on in your career, some basic understanding of statistical tests (e.g., t-tests, regressions, correlations, ANOVAs) can be helpful along with application of statistical software (e.g., SPSS or R).
One resource that I have found helpful in my work is Laerd Statistics, which goes through step-by-step on how to conduct different statistical analyses.
4. Presenting in a translational manner
As a bridge between the academic and the broader community, it is helpful to be able to discuss research in an easy-to-understand, translational manner. This extends to working with patients, presenting research to peers, or giving talks at conferences – people prefer learning in a digestible way.
Therefore, ‘theory-of-mind’ (also known as perspective-taking) is important to decide how your audience would like to absorb information.
5. Receiving and providing feedback
Another skill is to be able to receive feedback in an open and positive manner. As a trainee, it is your responsibility to take constructive criticism from supervisors (among others) and use it to further your own development.
Although easier said than done, remember that negative feedback is not a reflection on you as a person nor how your supervisor sees you; it’s simply part of a process to help develop your competency and do quality work.
Beyond receiving feedback, you’ll also be in a position to supervise more junior students (e.g., thesis) or mark assignments if you’re taking a teaching assistant role. Therefore, it’s important to learn how to provide constructive feedback that is actionable, engenders hope, and reinforces the students’ strengths.
6. Warm and empathetic communication style
Being empathetic and collegial goes a long way beyond just working with clinical patients. You will be working with a number of different people – faculty members, collaborators, peers, administrative staff, and so on.
Taking a friendly and kind demeanor in your interactions will ensure a smooth experience and make others look upon you more fondly. To be honest, a positive impression will get others to root for your success and open many doors. In a lot of life, it’s less about what you say, but rather how you say it and whether the people you are saying it to like you.
7. Time management and values clarification
Grad school is like a gas: it will take as much space in your life as you give it. Moreover, there are going to be many tasks all pulling for your time: readings, exams, clinical work, marking, research, among others.
Therefore, time management is important to ensure that you are keeping on top of your work. One strategy to proper time management is values clarification. This is essentially a fancy term that decides what is truly important to you to get out of graduate school.
For example, it was important to me to attend research conferences and conduct guest lectures in my first year. Therefore, I took a ‘good is good enough approach’ to other areas, such as class assignments and readings to make sure I got the experiences I wanted. Graduate school is certainly what you make out it and there’s no one path to succeed! Therefore, make sure you reflect upon your own path and what is most important for you to prioritize.
Best wishes,
P
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6 Reasons To Choose Clinical Psychology As A Profession
A clinical psychologist is an individual that specializes in assessment and treatments of mental health disorders.
Traditional routes to a profession in clinical psychology requires completion of a doctoral degree, which typically takes 5 to 6 years. In addition, clinical psychologists complete an additional year of internship prior to becoming an autonomous practitioner. That’s a lot of time.
Given the amount of commitment and dedication this profession requires, one question that comes to mind for many people is whether a profession in clinical psychology is worth it. This post goes through 6 reasons for why somebody might choose clinical psychology as their profession.
Clinical psychology is meaningful work
Being in the moment of therapeutic change and seeing the work you are doing with a patient have substantial change in their lives is an incredibly meaningful and life-affirming experience.
If the goal of life is to develop competence and use that to deliver value unto others, then a profession in clinical psychology will provide that in spades. In this field, you’ll be able to work with people who have experienced significant traumas, suffered from years of depression, and inhibited by stress and anxiety – and play an important role in alleviating this suffering. It’s an incredible process.
Beyond clinical work, there are many areas in which a clinical psychologist can conduct meaningful work – in their research, their teaching and mentorship of students, and consultations with other professionals.
There are many roles that a clinical psychologist can play
As alluded to above, one fantastic aspect of being a clinical psychologist is that they can play a number of different roles throughout their career and on a day to day.
Clinical psychologists can work in a combination of clinical work, research, teaching, supervision, consultation, and program evaluation/development. This varied and dynamic livelihood ensures that you never get bored of what you are doing – or if you are getting tired, you can always make a switch in the same profession!
The demand for jobs is higher than the supply
You might be surprised that pretty much every graduate from a reputable clinical psychologist program gets hired. There are no shortage of jobs for clinical psychologists and it is unlikely for robots to take our jobs any time soon.
Therefore, a clinical psychologist has significant freedom in deciding their location of work (though you would have register in the specific College of Psychologists in the area you want to work) and specific schedule, especially in the case of private practice.
This demand is typically for more clinical-focused work; in cases where you want to do more research (e.g., academia), then the demand may be higher than the supply. In this case, you’ll want to emphasize your research
Clinical psychology provides a reasonable livelihood
While you’re probably not going to be a multi-millionaire and getting on private jet flights anytime soon, the pay-off is quite reasonable insofar that finances are likely not going to be an issue.
Hospital positions typically pay around low six figures, which can be supplemented or replaced by private practice (in which sessions can range between 200 to 300 dollars an hour). This is a fairly comfortable salary depending on costs of living and your desired quality of life.
The trade-off of course is the significant amount of time spent being poor in graduate school. Although the pay in graduate school can be reasonable, the fact of the matter is that your starting line is going to be a little later than folks who begin working right after undergrad. Pros and cons!
You can apply what you learned to your own life
Assuming you’re practicing what you preach, understanding how mental health problems develop and become maintained in vicious cycles can be the key to getting out of these traps. As a clinician, you’ll have expert insight into specific evidence-based strategies that are effective in treating your own challenges.
For example, embodied mindfulness is an important concept in psychology. Therefore, it is not uncommon that therapists have their own mindfulness practice, which can significantly improve various aspects of health and well-being.
You also (hopefully) do not consider seeking therapy as stigmatizing and may even look for your own therapy!
Clinical psychology is a respected profession
Although we like to make self-deprecating jokes that clinical psychologists are not real doctors (i.e., they receive a PhD, not MD), it’s a pretty shiny degree to have. And being an expert in the field of mental health, especially with all the societal problems that have been emerging, are looked relatively fondly upon others who understand how important this area is.
Hopefully this was helpful to sway you into thinking a little more about clinical psychology as a possible profession! If you’re interested, here’s a post on how to prepare for a career in clinical psychology!
Best wishes,P
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Examples Of SMART Goals For People With Insomnia
People with insomnia often have a simple goal for their sleep: to sleep better and feel better.
However, what better sleep looks like from person to person can be very different. Some individuals have greater difficulty falling asleep, whereas others might struggle more with waking up in the middle of the night.
Moreover, sometimes people may have somewhat perfectionistic goals when it comes to their sleep.
For example, they might say: “I want to go to bed at 11:00pm, fall asleep immediately, stay asleep throughout the night, and wake up at 7:00am – feeling fully rested the whole day”.
These goals may not be achievable given what we know about sleep. Moreover, some of these goals may actually not be healthy! For example, falling asleep immediately once going to bed may be a sign of excessively sleepiness (which could mean sleep deprivation, or medical problems like sleep apnea).
Below, I discuss some SMART goals that are adaptive and specific to sleep.
SMART Goals for Sleep
Insomnia is defined by difficulty falling asleep, staying asleep, and/or waking up too early. People with insomnia also have daytime challenges, such as fatigue, irritability, and difficulty concentrating.
Therefore, goals for insomnia are usually related to these symptoms. Below are a few SMART Goals that are well-calibrated to our knowledge in sleep science to guide your own goal setting.
Goal 1: To fall asleep on average between 10 to 30 minutes.
Generally, good sleepers fall asleep between 10 to 30 minutes most days. An average of below 10 minutes means that a person is excessively sleepy. We also use the word ‘average’ because everyone experiences poor nights – these are common for all sleepers and not a cause for concern (unless it’s happening several times a week).
Goal 2: To generally stay asleep and fall back asleep if awakenings happen
Most people wake up several times over the course of a night. Most are amnestic (people don’t remember) or they last only a few minutes. Therefore, staying asleep completely is not likely; however, most people I’ve worked with are more than happy if they can just get back to sleep rather than tossing and turning for hours on end.
Goal 3: To find the right number of hours and sleep schedule for them
The 8-hour myth is just that – a myth. People vary in their sleep needs and chronotype: that is, how many hours they need to function and when they prefer to go to sleep and wake up.
Therefore, trying to a force an 8-hour schedule when you need less (or more) is counterproductive and can lead to sleep problems. A more helpful goal is to determine the right schedule that will allow for deep, restorative, and consistent sleep to occur (which your insomnia therapist can help with!).
Goal 4: To determine whether improved sleep leads to improved energy, and identify other strategies to reduce fatigue
Many people ascribe their low energy levels to poor sleep. However, the fact is that sleep is only one part of the overall picture.
Fatigue is multifaceted. Many things can bring about fatigue: lack of light exposure, caffeine rebound, too much activity, too little activity, not being hydrated, poor diet – the list goes on.
Therefore, it’s important to be aware of other factors that may be contributing to lack of energy. In my own practice, I often work with clients to understand that the treatment may improve sleep, but we should act like curious scientists about changes in the daytime.
Goals for Sleep Anxiety
One additional aspect of insomnia is anxiety. People with insomnia tend to experience worry about not being able to sleep and the impact of not getting enough sleep.
One additional goal then may be to increase confidence in producing high quality sleep. From a paradoxical lens, our desire to want sleep tends to push sleep further away (kind of like the idea of love is just around the corner when we least expect it).
Therefore, a radical acceptance approach can be very helpful. Radical acceptance means fully accepting the fact that sleep might not come – and that’s okay. Although this thought might seem very scary to some individuals, many of my patients have come to the realization that being awake in the middle of the night is not as dangerous as they thought. In fact, this time becomes seen as a positive experience where they can engage in activities (e.g., watching shows, reading a book) that they typically cannot during the busy-ness of the day.
Best wishes,
P
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