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I don’t want to hurt their feelings!

One of the more common reasons clients’ give for not behaving assertively, for not saying something or confronting someone, is that “I don’t want to hurt their feelings”. I think this is very much a cultural thing in New Zealand. Children are often reminded by parents not to do something because it will upset someone else. “So-in-so will be sad (upset, worried, angry)”etc. This trains us to modify our behaviour on the basis of how other people might feel. This has two main drawbacks.

Firstly, and primarily, we should not be responsible for others’ emotional states – just as others should not be responsible for ours. We cannot “make” someone feel bad, others cannot “make” us feel bad. Our emotional reactions, how we feel inside, are the result of how we interpret what happens to us – how we make sense of things, explain or understand them. Our feelings are the result of our “cognitive processing” of the things that happen in our life. That is really important, because it means that we are able to be in control of our emotional states. That is the second drawback – if we believe that our behaviour causes others’ emotional states, we give up control of our own emotional lives.

All of this presumes that our behaviour is appropriate – assertive, reasonable – not aggressive, abusive or unreasonable. So be assured that if you behave appropriately, other people can be responsible for how they feel in response – not you!

Anxiety and Depression

In medical terms, Anxiety and Depression are said to be co-morbid conditions. This means that they often co-exist. In fact they can so commonly accompany one-another in the same person that they can be difficult to tell apart. They are obviously both subjective states with physical and cognitive components. So how are they different? They are actually often quite different. Anxiety is the body’s preparation to deal with something that is perceived as threatening. So cognitively it is experienced as a sense of danger, impending threat, and a desire to escape or avoid. The body prepares to “flee” or “fight”. This involves the body getting ready for action – muscle tension, heart rate increasing, sweating, rapid breathing etc. So the body is actually speeding up. Depression is usually experienced as sadness, and cognitively a sense of hopelessness, or low self worth, a lack of pleasure or interest. The body generally “slows down”, a sense of lethargy, lack of energy, and a desire to withdraw. However because they co-exist, these subjective experiences tend to blur together. Sometimes their symptoms are more similar. For example, Depression can be experienced physically as a sense of agitation. The avoidance associated with Anxiety can lead to a generalised withdrawal. Depression can often be regarded as the body’s attempted solution to prolonged anxiety. If the threat or danger is perceived as being more than the body can cope with, and if it lasts sufficiently long, the body can “shut down” so that it doesn’t have to deal with the threat or danger. Therapy requires that both the Anxiety and Depression are dealt with. Cognitive Behaviour Therapy is an effective therapy for both conditions so they can both usually be addressed at the same time. They do not always co-exist though. Sometimes the Anxiety is a clearly distinct disorder and sometimes Depression is clearly a Mood Disorder with biological or genetic factors involved. Cognitive Behaviour Therapy should still be considered, but medication is also more likely to be prescribed, particularly for Depression.

Do Parenting Groups Work?

Yes, Parenting Groups can work. Any reputable group will impart useful information about parenting and if applied by parents that information will help. However the reasons that parenting groups might not work in a given case are numerous, and they have nothing to do with the quality of the parenting group. Parenting groups work when the primary or only problem is a lack of parenting skill. Unfortunately there are often other problems present that are an obstacle to parents being able to parent effectively. If those problems are not addressed then learning new parenting skills will be of limited benefit because those same obstacles will be present. What are these obstacles? The more common ones follow:

 adult relationship conflict – if there is conflict between the parents in the home, whether that conflict is openly acted out or hidden and not dealt with, the conflict will get in the way of the parents co-operating and parenting effectively together. The same can be said if parents are separated.

 adult mental health or emotional problems – if a parent is depressed, anxious, has anger problems, or has difficulties coping with stress, those problems need to be addressed before parenting should be regarded as the primary problem.

 alcohol and drug abuse – similarly to adult emotional problems, if a parent abuses substances they will be very unlikely to benefit from parenting education.

 attachment difficulties – sometimes the problems with a child’s behaviour cannot be resolved with more effective management. The problems could be due to a relationship problem between the parent and child. That relationship problem might have its origins in the child’s early months of life if the parent was for some reason unable to form a good attachment with the child. That requires different therapy than parenting skills.

 stress –  sometimes the circumstances in which families live are stressful. It could be a lack of social support, financial or employment difficulties, or housing or overcrowding. These more practical problems need resolution before parenting education will help.

 child psychological problems – of particular significance here are the more pervasive developmental problems such as Attention Deficit Hyperactivity Disorder and Autistic Spectrum Disorders. Major Mood or Anxiety problems can also be present in children and need to be addressed rather than a focus just on parenting.

 inadequate motivation – parents enter parenting groups with varying degrees of motivation. Sometimes they do so having been coerced or persuaded or even compelled to attend. Unless parents genuinely want to improve their parenting and make real efforts to put the new ideas into practice, they will be unlikely to benefit from the group.

Thinking accurately and believably

An often heard piece of advice given to people who are feeling depressed or anxious or struggling in some way is to “think positively”. It is not necessarily bad advice and if it’s easy to do then it will probably help. However it is not easy to do. The main reason for this is that our thinking really defines who we are – our opinions, attitudes, beliefs, and our conscious stream of thought are what make us unique. To change them is no easy matter. A more appropriate goal is to “think accurately”. The main problem with “negative thinking” is that it is inaccurate. One of the main tasks in therapy with clients who are depressed or anxious is to help them identify the inaccuracy in their thinking (for example the over-prediction of threat or danger, or the negative evaluation of their own worth). The next step is to change their thinking so that it is accurate, not necessarily positive. In fact it is more important that their thinking is accurate and realistic because their thinking also needs to be believable. There’s no point in helping someone to think in a different manner if they can’t believe it, because they won’t be able to maintain it.

So the goal should be accurate and believable thinking, and if possible, positive thinking, but it shouldn’t be positive at the expense of being accurate and believable.

A Model of Emotional Functioning

Cognitive Behavioural Theory (CBT) has become one of the predominant schools of thought in Clinical Psychology in recent years. One of the major reasons for this is that it is easy to understand – it makes sense quickly. This contrasts it with some schools of thought that are complex, difficult to understand, and sometimes greeted with disbelief by non-believers. The simplicity of CBT leads nicely into a “psycho-educational” approach to therapy. This is an approach that focuses on teaching clients to understand their psychological functioning and to learn skills to manage that functioning more effectively.

 A simple CBT model that I use with clients is the following:

 Situation          ?        Thoughts       +          Physical Feelings       ?        Behaviour

This is a model that can be used to explain how people experience any emotional state. Most commonly, clients will present for counselling with concerns such as depression, anxiety, anger, or grief, but positive emotions such as joy, pride, sexual arousal, or negative ones such as frustration, disappointment, guilt, can also be understood using this model.

The essential elements of the model are:

  •  Emotions can be thought of as a process, not a state. They are made up of different components and they fluctuate in terms of their presence, and the intensity with which they are experienced
  • The process is triggered by “situations” or “stimuli”. These can be external to the person (events that occur, things they see or hear) or internal (memories, thoughts)
  • These “stimuli” trigger thoughts that appraise, evaluate, or attempt in some way to “make sense of” the information coming in through our senses
  • Associated with these thoughts are physical feelings or sensations. These sensations are neither negative nor positive, they are neutral. They are sensations that are associated with physical changes such as muscle tension, breathing rate, blood flow, secretion of bodily fluids. They are perceived by people as positive or negative on the basis of the other information available to the person. For example, anticipatory excitement (positive) and anticipatory anxiety (negative) are associated with the same physical changes in the body but are experienced differently because of the different stimuli and thoughts involved in each
  • When people describe the unpleasantness associated with an emotion, they usually describe a combination of thoughts and physical sensations. The word “anger” for example, can be considered as a label for a particular combination of thoughts and physical feelings.
  • The behaviours that are typically part of an emotional experience can be regarded as the means of coping with, or reacting to, the thoughts and physical feelings. In this way, for example, the avoidance that is typically associated with anxiety is the means of coping with (reducing) the distress associated with the unpleasant physical sensations.

One of the benefits of this model is that it provides four possible avenues to make change – triggering stimuli, thoughts, physical sensations, behaviour. Some of the other entries in my Blog will explore these areas.

Others will think ill of me

I often find myself saying to clients that the most common concern that people who come to see me have is this – “Others will think ill of me”. It is amazing how often people are troubled by this underlying anxiety. It gets in the way of all sorts of relationships functioning better and creates a whole lot of unnecessary stress. I think it’s an appropriate initial comment to make here as well because it is probably one of the major impediments to someone taking the step of consulting with a psychologist – “others will think there’s something wrong with me…I’ll be embarrassed…so-and-so will think I’m weak” etc.

However that anxiety gets in the way of all sorts of other behaviours as well. For example, it’s a major reason for people not behaving assertively, for not telling someone else that their behaviour is a problem, for avoiding conflict, for not speaking in a group, for not making a telephone call, or for not taking any initiative that they would like but are afraid someone else won’t like.

There are several problems with thinking like this:

  • We don’t know what others are thinking; 
  • They most likely are not thinking what we think they are;
  • Even if they are thinking negatively, so what? If their behaviour doesn’t reflect that it needn’t affect us;
  • Even if they do think negatively and do react negatively it’s not our responsibility. As long as we’ve behaved appropriately, they are responsible for how they think, feel and behave.  

Helping clients to change the way they think, to adopt some of these new ideas, is a focus of counselling. It can be very liberating and help clients to change life-long patterns of thinking and behaving that have caused all sorts of distress.