Sunday, July 8, 2012

CBT for the GP

Welcome to our first segment of CBT for the GP.  Although, you will not require to do CBT (Cognitive Behavioural Therapy) in the OSCE exam, having some CBT knowledge will at least give you an appreciation of what counselling is and what type of patients will benefit from a referral to a Counsellor, Psychologist, or a GP with an interest in counselling.

So what happens when you refer a patient for counselling?

Well, this is my take on it......

Counselling encompasses many techniques and strategies including CBT, Mindfulness, Acceptance Commitment Therapy (ACT),  Dialectical Behavioural Therapy (DBT), Schema Therapy, Interpersonal Therapy, Relationship Counselling, Parenting Training etc, but if you look at the bigger picture, it all comes down to this.

Counselling helps people to accept that life is challenging and full of twists and turns.  Everyone has a story.  The trick to life is to embrace that and learn how to "play the game of life" so to speak.  If the game is too easy, then it loses substance, meaning and purpose.  If it is too difficult, then it can get too overwhelming.  So the key is to upskill so that your level of competence can match the level of difficulty.  So what are the skills required to play the game of life.  I divide these skills into 3 categories.

  1. The first is CENTERING.  Just like riding a bike or surfing, centering is very important if not the most important.  So what is centering.  Think of a elite sport person during a game.  Usually, they are very "centred" even when they are losing.  Think of the contestants in a gameshow like Masterchef.  Usually, the one who is more calm, composed and centred, are the one who usually going to outperform the others.  Although centering is very important, most of us do not invest the time on practising this skill through mindfulness, exercise, yoga, pilates, spending time with nature or some form of meditative practice.  I guess in some ways, these skills are not "intellectual" enough for our society.  Centering is about being wise and not about being smart.  Food for thought here.....
  2. The second category is life skills to FIX things.  These include relationship skills, social skills, parenting skills, conflict resolution skills, financial skills, study skills, cognitive skills, mood regulation skills, self reflective skills and self knowing, and skills on how to live a life that is congruent with one's core values, and the list goes on.  These are of course, extremely important as well.  If you do not have these skills, it can often destabilize you and throw you off centre.  In my opinion, our current society tends to value these skills more than any other skills. 
  3. The last set of skills is simple but yet so difficult for most of us to learn, and that is, ACCEPTANCE. Acceptance is about letting go and total surrender.  This is not easy because most of us have been conditioned that letting go means giving up, and giving up means losing, and losing of course means failing.  Think of an exam with ten questions.  What happens when the first question is extremely difficult.  What do you do?  Do you just dwell on that or do you just let go for now?  As you can see from this example, sometimes letting go, is one of the most powerful thing that you can do.
Most of us go through life with only one predominant set of skills and that is "to Fix" and even then, it's not complete.  As you can see, how can you thrive in life when you have an incomplete set of tools.  So in a nutshell, counselling is about helping people learn how to be more centered, learn to fix the things they can fix, and then let go "for now" of  the things that they cannot.

It is that simple.  However, simple things are not necessarily easy, but not easy, does not mean impossible.

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