An Exciting Announcement

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Steve is thrilled to announce that he has been chosen to join a select number of intrepid classic car owners to bring the Firle hill climb back to life after a break of some 48 years. Thanks are due to the Bo-Peep Drivers Club who is putting on this special event in aid of the Chailey Heritage Foundation.

The Firle hill climb came into existence at the end of World War II due to lack of available motor racing circuits, which were then still being used by the military. The search was on for any suitable venue and as luck would have it, a small winding lane in Sussex was identified as the ideal place for a hill climb. The site is not actually at or in Firle but a little way along the road at Bo Peep Lane. The Bentley Drivers Club and later the British Automobile Racing Club went on to develop the hill climb into an increasingly popular event through the fifties and into the sixties. Alas, tragedy struck in 1967 following an unfortunate incident between some walkers and a car which left the road and collided with the unfortunate walkers. It was decided that the event was no longer manageable and so the last hill climb is recorded as taking place in September 1967.

On September 20th 2015, after a gap of some forty eight years, there will once again be the sight and sound of some fantastic automobiles climbing the hill at Bo Peep. There are too many to list all of them, but they include Alvis, Austin, Austin Healey, Bentley, Fiat, Ford, Jaguar, Lagonda, Lotus, MG, Morris, Reliant and Triumph.

 MG 001

Steve will be driving his MGB which he hopes to modify to full hill climb spec, albeit on a shoestring and he is busy budgeting for roll cage, seats, harness, etc. Prior to the charity event he will be taking his MG along to various events with the Bo Peep drivers club to publicise the hillclimb. Steve has a facebook site and would be delighted if you had time to visit www.facebook.com/mgbhillclimbchallenge 

Bo Peep Drivers club founder, Rob Bryant, said he was delighted to get a hill climb reinstated after getting permission to close Bo Peep Lane in Alciston, a village close to Firle Beacon, to host the event. He said: ‘A year ago I thought it would be a great place for a hill climb event and then discovered the history…The event is along the lines of a mini Goodwood with themed 1950s, ‘60s and ‘70s dress, drivers’ lounge, a band and a charity auction’.

Funds raised will aid the Chailey Heritage Foundation, a school for children and young adults with a variety of complex disabilities. The following paragraph forms part of the vision statement that Chailey Heritage Foundation work to achieve.

“Every young person at Chailey Heritage School will be given every opportunity to make progress towards fulfilment. We will never, ever give up looking for ways to support our young people to make their own choices in life, and to achieve their own desired destinations.”

Until next time, Steve.

We would be delighted if you visit our facebook sites:

www.facebook.com/yourmentalhealthmatters

www.facebook.com/bexhillmindfulnesscentre

www.facebook.com/mgbhillclimbchallenge

Steve Clifford                                                                                                                             Senior Accredited Integrative Psychotherapist.                                                                 Accredited Cognitive Behavioural Psychotherapist.

Image: http://commons.wikimedia.org/wiki/File%3AJohn_Cobb_(motorist).jpg

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10 steps to greater self-confidence

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Here at my practice in Bexhill I see lots of people who struggle with self-confidence. Why is it that low self-confidence is such an issue? There can be many reasons. Often low self confidence has its roots in our early relationships; sometimes bad childhood experiences such as bullying and abuse shape the way we view ourselves. The cumulative effect of “put downs” and ridicule lead us to form a view that we are somehow less worthy than others. .This view of ourselves becomes a rigid template upon which we hang our identity. Yet, so often, these, “beliefs,” are never challenged or even questioned. They are accepted as established facts, yet these so called “facts” are just “opinions”.

It is time to challenge and re-shape these opinions. Here’s how:

1. The first step in improving self-confidence is to accept responsibility for change and growth.

2. Stop spending time aimlessly drifting; stop procrastinating and do things on time. Recognise your own needs: sleep, relaxation and a good diet.

3. Are you a dreamer? If so, make some goals so that your dreams can come true.

4. Take risks, share in groups, give feedback to others. Don’t be too proud to ask for help and admit you’re wrong. Don’t refuse help when it is offered.

5. Start asserting yourself and stop saying yes when you really want to say no. Stop being a “people pleaser”.

6. You are an OK person. You do not need to depend on others for a sense of importance. You are of equal worth.

7. Speak up, believe in yourself. Remember, no one can insult you or put you down unless you allow them to so.

8. Behave towards yourself as you would a friend you care about. Listen to your inner compassionate voice not your inner critical voice.

9. Lower your expectations of yourself. No one has to be perfect.

10. Remember you are unique; you have a lot to offer, you are special and there is only one of you in the world. You are a worthwhile person.

Begin to make changes now. Good luck.

Until next time, Steve.

We would be delighted if you visit our facebook sites:

www.facebook.com/yourmentalhealthmatters

www.facebook.com/bexhillmindfulnesscentre

www.facebook.com/mgbhillclimbchallenge

Steve Clifford                                                                                                                             Senior Accredited Integrative Psychotherapist.                                                                 Accredited Cognitive Behavioural Psychotherapist.

Image: http://commons.wikimedia.org/wiki/File%3ACarolperfil.jpg

If you see a therapist, how many sessions are you likely to need?

Is this one question or many?  If you see a therapist, how many treatment sessions are you likely to need?  Sometimes that’s a little like asking “If I go on a journey, how long should I travel for?”  Happily though, we do now have enough research evidence to be able to respond fairly helpfully to this “how many treatment sessions?” question.  To give useful answers though, it’s probably sensible to break the very general “how many sessions?” query into a number of more targeted sub-questions.

These sub-questions could include “On average, how quickly am I likely to feel appreciable benefit?”, “How many sessions will it take to achieve full recovery?”, “Are there some kinds of problem that are likely to need more treatment sessions than others?”, “Is there any point in getting ‘top-up’ sessions after the main therapy has finished?”, “How would I know if the therapy isn’t working?” and “If the therapy isn’t working, what’s the best thing to do next?”  Let’s look at these sub-questions in a bit more detail.

How quickly am I likely to feel appreciable benefit?  A good place to look for answers to this question is in the 2013 sixth edition of the excellent Handbook of psychotherapy and behavior change.  In his chapter “The efficacy and effectiveness of psychotherapy”, Michael Lambert reviews relevant publications and concludes (p.204) “Therapy is highly efficient for a large minority of clients, perhaps 30% of whom attain a lasting benefit after only three sessions.” and when monitoring for “reliable improvement … it appears 50% of patients respond by the 8th session and 75% are predicted to need at least 14 sessions to experience this degree of relief.”

“Reliable improvement” is a formal way of measuring “appreciable benefit”; it is not however “recovery”.  In the“Handbook of psychotherapy and behavior change” chapter Measuring change in psychotherapy (Ogles 2013) it’s highlighted that two of the “most prominent definitions of clinically significant change include: (1) treated clients make statistically reliable improvements as a result of treatment (improvement), (2) treated clients are empirically indistinguishable from ‘normal’ peers following treatment (recovery).”  The most widely used assessment measure for “improvement” is called the “reliable change index (RCI)”.  The RCI was developed over twenty years ago (Jacobson and Truax 1991) and it compares pre-treatment and post-treatment assessment scores while taking into account the precision of the assessment measure being used. “The change is considered reliable, or unlikely to be the product of measurement error, if the change index (RCI) is greater than 1.96.” (p.155).  If you’ve continued to read this far without developing a headache, it’s probably helpful to underline that “reliable improvement” is the most widely used measure of “appreciable benefit” and Michael Lambert’s comments about “reliable improvement” in the previous paragraph largely refer to the “reliable change index (RCI)”.  Now what about “recovery”?

How many sessions will it take to achieve full recovery?  By “full recovery”, we mean here “indistinguishable from ‘normal’ peers”.  Trying to attain “full recovery” rather than just “reliable improvement” is important for the obvious reasons that we feel better and function better after full recovery than we do after reliable improvement. It’s also important because the chance of relapsing is considerably less after full recovery than it is after reliable improvement – see, for example, Recovery and subsequent recurrence in patients with recurrent major depressive disorder.  Again Michael Lambert’s chapter is an excellent source of evidence-based information and he writes “For patients who begin therapy in the dysfunctional range, 50% can be expected to achieve … recovery after about 20 sessions of psychotherapy.  More than 50 sessions are needed for 75% of patients to meet this criterion.”  Now these are average findings.  Some therapists achieve better results than this and others worse.  Commenting on one of the relevant major studies, Lambert (p.197) writes “Outcome by therapist showed considerable variability, with the most effective therapist’s patients showing rapid and substantial treatment response, while the least effective therapist’s patients showed an average worsening in functioning.”  This variation in therapist helpfulness is such an important issue and I have written extensively about it – for example, in the recent blog postFascinatingly, therapists themselves vary considerably in their effectiveness”.

Unsurprisingly clients also make a big difference to the number of therapy sessions they need to make progress. As in most areas of our lives, commitment and hard work help hugely.  With cognitive & behavioural therapies, encouraging clients to actively work on relevant challenges between therapy sessions adds considerably to effectiveness – see, for example the paper Meta-analysis of homework effects in cognitive and behavioral therapy: A replication and extension. As the paper Homework compliance counts in cognitive-behavioral therapy” shows, committed clients who really tackle these between-session challenges make better progress. You see the same pattern in mindfulness training, with the recent paper The effects of amount of home meditation practice in mindfulness based cognitive therapy on hazard of relapse to depression showing that clients, who work to do the formal daily meditation practice, achieve better results than those who don’t.

Are there some kinds of problem that are likely to need more treatment sessions than others?  Yes!  In general clients who want help with more severe problems will probably need more treatment sessions to achieve recovery.  By more severe, I’m referring to variables like the extent & intensity of symptoms at presentation,  how long the problem has been going on for, and how resistant it has proved to previous attempts at therapy. Relevant too is the overall quality of the client’s life … so it’s not just the severity of the presenting problems that govern speed of response, but also the strengths & resources the client has more generally in other areas of their life.  “Is there any point in getting ‘top-up’ sessions after the main therapy has finished?”  Often this is the case, especially for problems that have gone on longer before therapy was started.  “How would I know if the therapy isn’t working?” and “If the therapy isn’t working, what’s the best thing to do next?”  These are very important questions.  Again I have written extensively about these issues – see the two recent blog posts Routine outcome monitoring can really help therapists clarify where they need to try harder and Practice-based evidence can complement evidence-based practice so very well.

So what are the overall messages?  “If you see a therapist, how many sessions are you likely to need?” is a really relevant question, not least because it’s likely to help having some idea of the size of the journey before embarking on it.  Reiterating Lambert’s review findings, quite a few clients (possibly about 30%), may only need three or so sessions to achieve very worthwhile benefits.  About 50% are likely to have achieved worthwhile benefit after eight sessions and approximately 75% after fourteen.  There is a problem here though.  Aiming for formal “full recovery” makes better sense if possible.  Here we may well need twenty sessions of therapy to help about 50% of clients to full recovery.  To help 75% reach this very desirable goal may well take at least fifty sessions, so for example Arntz & colleagues’ recent successful treatment of clients suffering with diverse personality disorders – Results of a multicenter randomized controlled trial of the clinical effectiveness of schema therapy for personality disorders – involved forty sessions in the first year of treatment and ten in the second. As Richard Layard & David Clark have so cogently argued in their tremendous 2014 book Thrive: the power of evidence-based psychological therapies, there is a compelling case – in terms of both relief of suffering and economic saving – for more major investment in the treatment and prevention of psychological disorders.  Research strongly suggests that, in general, clients are more often under-treated than over-treated. This comment however crucially assumes that worthwhile progress is being made.  It is important to consider careful monitoring of treatment response using well-validated questionnaires to clarify that this is the case.  Lack of response over the first three to six sessions should be a red flag.  Is this therapy practised in this way by this therapist really right for this client?  I have looked here at the “how many sessions?” question and I hope this post will help those involved in therapy be more informed about what is likely to be an adequate dose.

This blog has been reposted from http://goodmedicine.org.uk/stressedtozest/2015/04/if-you-see-therapist-how-many-sessions-are-you-likely-need?utm_source=Main+List&utm_campaign=1291e0d3c2

Until next time, Steve.

We would be delighted if you visit our facebook sites:

www.facebook.com/yourmentalhealthmatters

www.facebook.com/bexhillmindfulnesscentre

Steve Clifford                                                                                                                             Senior Accredited Integrative Psychotherapist.                                                                 Accredited Cognitive Behavioural Psychotherapist.

Image: http://commons.wikimedia.org/wiki/File%3ADepressed.svg