THE PSYCHOTHERAPY FILE
An aid to understanding ourselves better.
In our life what has happened
to us, and the sense we made of this, colours the way we see ourselves and
others. How we see things is for us how things are, and how we go about our
lives seems ‘obvious and right’. Sometimes, however, our familiar ways of
understanding and acting can be the source of our problems. In order to solve
our difficulties we may need to learn to recognise how what we do makes things
worse. We can then work out new ways of thinking and acting to change things
for the better.
These pages are intended to
suggest ways of thinking about what you do; recognising your particular
patterns is the first step in learning to gain more control and happiness in
your life. You should discuss this
questionnaire with your counsellor or therapist.
KEEPING A DIARY OF MOODS AND
BEHAVIOUR
Symptoms, bad moods, unwanted
thoughts or behaviours that come and go can be better understood and controlled
if you learn to notice when they happen and what starts them off.
If you have a particular
symptom or problem of this sort, start keeping a diary. The diary should be
focussed on a particular mood, symptom or behaviour, and should be kept every
day if possible. Try to record this sequence:
1. How you were feeling about
yourself and others and the world before the problem came on.
2. Any external event, or any thought or image in your mind that
was going on when the trouble
started, or what seemed to start it off.
3. Once the trouble started,
what were the thoughts, images or feelings you experienced.
By noticing and writing down
in this way what you do and think at these times, you will learn to recognise
and eventually have more control over how you act and think at the time. It is
often the case that bad feelings like resentment, depression or physical
symptoms are the result of ways of thinking and acting that are unhelpful.
Diary keeping in this way gives you the chance to learn better ways of dealing
with things.
It is helpful to keep a daily
record for 1-2 weeks, then to discuss what you have recorded with your
therapist or counsellor.
It is also a good idea to
write down any dreams you may have, particularly recurring dreams or nightmares
to discuss with your therapist. Any day
dreams or soothing fantasies should also be recorded for discussion.
STARTING TO CHANGE
You may get quite depressed
when you begin to realise how often you stop your life being happier and more
fulfilled. It is important to remember that it’s not being stupid or bad, but
rather that:
a) We do these things because
this is the way we learned to manage best when we were younger,
b) we don‘t have to keep on
doing them now we are learning to recognise them,
c) by changing our behaviour,
we can learn to control not only our own behaviour, but we also change the way
other people behave to us,
d) although it may seem that
others resist the changes we want for ourselves (for example, our parents or
our partners), we often under-estimate them; if we are firm about our right to
change, those who care for us will usually accept the change.
WORKING WITH THE
PSYCHOTHERAPY FILE
Look through the descriptions
on the following pages and highlight or underline the ones that ‘ring a bell’
for you, then rate how far you think they apply to the way you feel. Some will be familiar, others will not. If a description feels familiar but is not
quite right cross out the words that do not apply and write in how things are
for you in your life. Remember there is
no way of doing this badly or of getting it wrong. Bring the File with you and discuss what you
have discovered with your therapist. You
and he/she can work together to work out what your unhelpful patterns are, get
the descriptions as accurate as possible as the first step towards making
helpful changes.
PATTERNS THAT DO NOT WORK, BUT ARE HARD TO BREAK
There are certain ways of
thinking and acting that do not achieve what we want, but which are hard to
change. Read through the lists on the following pages and mark how far you
think they apply to you.
Applies strongly ++ Applies + Does not apply 0
1. TRAPS (vicious circles)
Traps are things we cannot escape from. Certain kinds of thinking
and acting result in a ‘vicious circle’ when, however hard we try, things seem
to get worse instead of better. Trying to deal with feeling bad about
ourselves, we think and act in ways that tend to confirm our badness.
Examples of Traps
1. Fear of hurting other people’s feelings Trap
Feeling that it is wrong to
be angry or aggressive we can be afraid of hurting other people’s feelings so
we don’t express our feelings or needs with the result that we are ignored or
abused which makes us feel angry but confirms feeling that it is wrong to be
angry.
2. Negative thinking Trap
Feeling that we will mess up
tasks, relationships or social situations we can believe that if we try we will
do it badly so when we do try we are ineffective and things go wrong; we often
feel that things went disastrously which confirms the feeling that we will
always mess things up.
3. Anxious thinking Trap
Anxious that we won’t be able
to cope with tasks, relationships or social situations we worry that we will
mess things up and we anxiously worry about getting things right resulting in
panicking, stress and exhaustion. This
makes us feel more anxious about things.
4. Trying to please trap
Feeling uncertain about
ourselves and wanting to be liked we try to please others by doing what they
seem to want with the result that they take advantage of us. We can feel angry and used but also as if we
have failed to please which confirms our uncertainty about ourselves.
5. Can’t say “No” Trap
Feeling that it is impossible
to say “No” to others leads to feeling out of control in relationships. To feel more in control we avoid others by
hiding away or letting them down with the result that they get angry and can
reject us. We then feel guilty which
confirms that we shouldn’t say “No” to others
6. Avoiding upset Trap
Feeling anxious and believing
that we mustn’t upset or displease others we avoid upset by doing what they
seem to want, anxiously trying to please them.
As a result others don’t get upset, we feel relieved but trapped in not
upsetting others.
7. Social isolation trap
Feeling that others may find
us stupid or boring we lack confidence in social situations and feel anxious,
so we don’t approach others or respond when others approach us with the result
that others may see us as unfriendly and go away which confirms feeling that we
are stupid or boring.
8. Worthlessness Trap
Feeling that we can’t ever
get what we want or have what we need, it can feel that if we try to get needs
met we will be punished, rejected or abandoned; sometimes it feels as if we
have be born cursed. We give up trying
and feel hopeless and helpless and can even feel suicidal as if everything is
impossible.
9. Self-punishment Trap
Feeling bad, weak or guilty,
we can feel agitated or upset and feel as if we must punish ourselves. We can hurt or harm ourselves in different
ways which can make the feelings of badness or guilt go away briefly but only
confirms that we are bad and should be punished.
2. DILEMMAS (False choices and narrow options)
We often act as we do, even when we are not completely happy with
it, because the only other ways we can imagine, seem as bad or even worse.
Sometimes we assume connections that are not necessarily the case – as in “If I
do ‘x’ then ‘y’ will follow”. These false choices can be described as either/or
or if/then dilemmas. We often don’t realise that we see things like this, but
we act as if these were the only possible choices. Do you act as if any of the
following false choices rule your life? Recognising them is the first step to
changing them.
Examples of Dilemmas
1. Upset feelings dilemma
When I feel upset either I bottle up my feelings, others
don’t notice that I’m upset and so ignore me or take advantage of me or abuse
me or I express my feelings, sometimes explosively, and others feel hurt,
attacked, overwhelmed or threatened and respond by attacking me or rejecting
me.
2. Deprivation Dilemma
When I feel needy either I
spoil myself, take what I want or get what I need and then feel guilty or
greedy as if depriving others and then feel cross with myself, bad and
frustrated or I deny myself things and don’t ask for what I want or need and
feel modest and self-righteous, as if giving to others and then feel as if I am
punishing myself.
3. Perfectionism Dilemma
Feeling inadequate or not
good enough either I try to be perfect, which is impossible and very stressful
and leaves me feeling an exhausted angry failure or I just let things slide and
feel guilty for not trying and feel like an angry and dissatisfied failure.
4. Dealing with demands and
criticism Dilemma
Feeling bullied or criticised
either I gloomily submit to demands and feel trapped and crushed, miserable and
hopeless or I passively resist demands, put things off, drag my feet and feel
anxious but still get criticised and bullied.
5. Sabotage or rebellion
Dilemma
Feeling bullied or criticised
either I secretly resist demands and sabotage what is demanded of me
but end up attacked and bullied or I actively rebel against demands and attack
others and destroy things and feel hopeless and end up feeling trapped and
punished, a hollow victory.
6. Responsibility Dilemma
Feeling over-responsible
either I look after others, take charge, meet their expectations of help and
feel needed but also taken advantage of and can feel angry and trapped (even
though I’m in control) or I don’t look after others, don’t take charge, others
don’t expect me to do things for them and I feel unwanted, rejected or without
a role and can feel lonely, anxious and out of control.
7. Self-sufficiency Dilemma
Feeling that I should be
self-sufficient or that I shouldn’t want or need anything, if I reach out for
what I want and get it I feel childish, guilty and undeserving as if I
shouldn’t want things, that I should contain myself; on the other hand if I
don’t reach out or don’t get what I want I can feel angry and deprived (as well
as saintly) and that I should have the things that I want or need and that I
should be more assertive.
8. Anxious control Dilemma
Feeling anxious about what
may happen I try to keep things, feelings, plans in perfect order, pay
obsessive attention to details in order to keep in control but feel exhausted
and overwhelmed by the endless tasks and so feel like letting go and giving up;
on the other hand If I let things go and get into a mess by avoiding or
ignoring things then the brief relief is followed by feeling anxious and
panicky about the mess and I feel an urgent need to get back into control.
9. Not knowing how to be in
relationships Dilemma
Feeling unsure how to act
towards others either I stick up for myself too much, don’t join in or take my
turn and find that others reject me or don’t like me which leaves me feeling
confused and unhappy or I give in and do too much to try to please others and
get taken advantage of and end up feeling angry or hurt.
10. Approval vs feelings
Dilemma
I want to express my feelings
but also need approval from others so mostly I feel I have to bottle up my
feelings in order to be approved of or accepted; so I don’t cry or be angry or
tender or playful with the result that I am accepted or approved of but feel
frustrated and cut off; on the other hand when I express my feelings, be myself
or do what I want or need, it can feel as if I am being childish or rebellious
and angry with the result that I am often rejected or disapproved of and feel
my feelings and needs are unrecognised.
11. Approval vs
independence Dilemma
I want to be independent but
also need approval from others so mostly I feel I have to do what they want to
be approved of or accepted; I have to submit and can’t be myself or do what I
want; I feel accepted but at the same time frustrated and miserable; on the
other hand when I do what I want and be myself it feels as if I am being
rebellious and angry and am often rejected or unrecognised, disapproved of and
unacceptable to others.
12. If involved then
smothered Dilemma
It is as if when I get
involved with or too close to others I can feel smothered, engulfed or taken
over by them and then feel suffocated, trapped and desperate; so I keep distant
and feel safe with
breathing space and room to
move but can also feel lonely and miserable.
13. If involved then abused
Dilemma
I fear that if I get involved
with others I will be abused so when I get involved I can easily feel taken
advantage of or used and feel angry or miserable or I don’t get involved and
feel safe but then feel lonely and miserable.
14. If involved then
admiring Dilemma
I feel that I need a lot of
attention and seek others who I can admire or who will admire me which feels
good; often this does not last and then I don’t admire them in fact I often
feel contempt towards them or find that they are contemptuous and rejecting of
me which can leave me feeling bad or worthless.
15. If involved then
perfectly caring Dilemma
I feel that I need a lot of
care; I seek someone I can care deeply about and who will give me perfect care;
this feels good until they fail to care perfectly and I then feel they don’t
care anymore and so I don’t care for them anymore; I can feel angry and reject them
and can feel abused and rejected by them too; this leaves me feeling bad, angry
and worthless.
16. Clinging Dilemma
I have a strong need to
depend on others and seek someone whom I can depend on and cling to; when I
depend on someone either I have to give in and be dominated and controlled in
order not to be abandoned or they have to give in and be dominated by me to
make sure they don’t abandon me.
17. Trust Dilemma
I have a strong need to trust
others and look for someone I can trust completely; when I trust someone I feel
safe and relaxed until they show themselves to be unreliable and then I can’t
trust them anymore; I can then feel suspicious, jealous or paranoid and feel
betrayed and murderously angry.
18. Controlling others
Dilemma
I have a strong need to
control others to feel OK; I get them to give in or submit to my control which
feels good until they rebel or fail to do what I want; then I feel angry and
can become bullying or violent to assert my dominance; they end up as an
obedient slave or crushed victim; often I then lose interest and abandon them.
3. SNAGS (Subtle Negative
Aspects of Goals)
Snags are what is happening when we say “I want to have a better
life, or I want to change my behaviour but……”. Sometimes this comes from how
we or our families thought about us when we were young; such as ‘she was always
the good child’, or ‘in our family we never…’. Sometimes the snags come from the important
people in our lives not wanting us to change, or not able to cope with what our
changing means to them. Often the resistance is more indirect, as when a
parent, husband or wife becomes ill or depressed when we begin to get better.
In other cases we seem to ‘arrange’ to avoid pleasure or success,
or if they come, we have to pay in some way, by depression, or by spoiling
things. Often this is because, as children, we came to feel guilty if things
went well for us, or felt that we were envied for good luck or success.
Sometimes we have come to feel responsible, unreasonably, for things that went
wrong in the family, although we may not be aware that this is so. It is
helpful to learn to recognise how this sort of pattern is stopping you getting
on with your life, for only then can you learn to accept your right to a better
life and begin to claim it.
Do you recognise that you
feel limited in your life:
1. For fear of the response
of others: for example I must sabotage success (1) as if it deprives others,
(2) as if others may envy me or (3) as if there are not enough good things to
go around.
2. By something inside
yourself: for example I must sabotage good things as if I don’t deserve them.
Snags – Examples:
1. Wanting to change Snag:
I feel that I want to change
the way I am; I make plans to behave differently but I don’t carry them through
or sabotage or spoil my plans because I feel that others will be upset or
deprived or that deep down I feel I don’t deserve good things; this can leave
me feeling frustrated and miserable.
2. Wanting a better life
Snag:
I want to have a better life;
I reach out for what I want but I can’t go through with getting things or
sabotage or spoil things because I feel it will deprive others and I would feel
guilty, or that others would be envious and nasty to me, or deep down it goes
against my identity, against who I believe I am; again leaving me feeling
frustrated and miserable.
3. Not moving on Snag:
I want to move on in my life
and leave the past behind; I think about changing things but I don’t carry
through the changes or sabotage or spoil my plans because I feel others are to
blame for my troubles and they must first apologies or keep on paying for what
they have done; this leaves me feeling angry and trapped, like a righteous
victim.
4. DIFFICULT AND UNSTABLE STATES OF MIND.
Some people find it difficult to keep control over their behaviour
and experience because things feel very difficult and different at times.
Indicate which, if any of the following apply to you:
1. How I feel about myself and others can be unstable; I can
switch from one state of mind to a completely different one.
2. Some states may be accompanied by intense, extreme and
uncontrollable emotions.
3. Others states by emotional blankness, feeling unreal or feeling
muddled.
4. Some states are accompanied by feeling intensely guilty or
angry with myself, wanting to hurt myself.
5. Or by feeling that others can’t be trusted, are going to let me
down, or hurt me.
6. Or by being unreasonably angry or hurtful to others.
7. Sometimes the only way to cope with some confusing feelings is
to blank them off and feel emotionally distant from others.
5. DIFFERENT STATES
Everybody experiences changes in how they feel about themselves
and the world. But for some people these changes are extreme, sometimes sudden
and confusing. In such cases there are often a number of states which recur,
and learning to recognise then and shifts between them can be very helpful.
Below are a number of descriptions of such states. Identify those which you
experience by ringing the number. You can delete or add words to the
descriptions, and there is space to add any not listed.
- Zombie. Cut off from feelings, cut off from others,
disconnected. - Feeling bad but soldiering on, coping.
- Out of control rage.
- Extra special. Looking down on others.
- In control of self, of life, of other people.
- Cheated by life, by others. Untrusting.
- Provoking, teasing, seducing, winding up others.
- Clinging, fearing abandonment.
- Frenetically active. Too busy to think or feel.
- Agitated, confused, anxious.
- Feeling perfectly cared for, blissfully close to
another. - Misunderstood, rejected, abandoned.
- Contemptuously dismissive of myself.
- Vulnerable, needy, passively helpless, waiting for
rescue. - Envious, wanting to harm others, put them down or pull
them down. - Protective, respecting of myself, of others.
- Hurting myself, hurting others.
- Resentfully submitting to demands.
- Hurt, humiliated by others.
- Secure in myself, able to be close to others.
- Intensely critical of self, of others.
- Frightened of others.
Note:
The Psychotherapy file was first put
together by Dr Anthony Ryle the originator of Cognitive Analytic Therapy –
CAT. This version was adapted by Mark
Dunn. The file may be reproduced but not
altered and Dr Anthony Ryle is to be given due credit as author on
reproductions.2004