 We demystify what goes on behind the therapy room door. Join us on this voyage of discovery and co-creative conversations. This is The Therapy Show, behind closed doors podcast with Bob Cook and Jackie Jones. Welcome back to The Therapy Show behind closed doors with myself Jackie Jones and the wonderful Mr Bob Cook and this is episode 100 Bob. This is our centenary episode. I know I would look for the champagne and it's gone so I've got a can of coke here. I thought it's really important to celebrate it so have you got anything to drink there? I have I've got a cup of coffee. Congratulations to you Bob. Cheers Bob. Cheers. Congratulations to all the people that have been with us all this time and the new people that have joined and of course the people listening today. I went on the podcast anchor where we publish this and they send it out to everybody to see how many listens we've had and we've had over 22,000 listens. Oh that's amazing and that's just on the podcast that's not including YouTube which you know there's I think there's regularly 250-300 people an episode listening on YouTube so the numbers are really good Bob. That's great and consistent. Yes yes that's the thing consistent. Over a hundred episodes. I know. I know it's amazing really and of course the one we've picked today is I think you said it's about the concept of change in psychotherapy. It is yes the importance of the concept of change in the therapeutic process. It's very important and of course we've got a new king as well. Well we will have. Well we have but the carnation is on the you know sixth I think so if you talk about change I mean King Charles has waited a long time. He has to be third. To actually get his hand on the crown or hands on the crown if you like. Yeah yeah change he actually brings. Yeah change can be really scary for a lot of people. Might be for him. It might be yeah he's going to be completely different because he was allowed to be quite outspoken as a prince but now he's the king he needs to be unbiased and isn't really allowed an opinion is he? No well on some things but he's supposed to be neutral. Yeah so it's a new it's a new era. Yes King Charles. What's the actual name for it? So there's an actual name isn't there for this particular era. It's just like not Caucasian but it's something like that you know like the Victorian age of the Elizabethan age. Yeah this is I read it the other day it was a mouthful but it's a new era. I don't think I've even heard it so I have no idea but yeah it is it's a new era. The world is definitely changing there's a lot of changes going on and some of them well most of them 99.9% of them we don't have any control over. No that's absolutely true. I was two when the Queen you know the Queen before Charles actually came to the throne. Wow. Now I'm seeing another one in. Yeah see I often think that your generation and my generation have seen an awful lot of changes you know inventions new things the internet the microwave the you know the duvet the continental quilt things like lots and lots of changes in my lifetime. Even daytime television when I was a kid television didn't start until like five o'clock at night or whatever. Yeah okay let's talk about therapy. Yes. So I'll be interested in your thoughts about change. I mean you know it's really interesting different approaches to therapy isn't it. But you know whatever different approaches we talk about one of the goals if you like is positive change. Yeah. Eric Bernard originated transaction analysis and as you know contractual theory is a hallmark of transaction analysis. He was always emphasizing the importance of contracts with a positive change. Yeah. So that needs to be specific the change needs to be specific observable behavioral and you wouldn't just have a contract for me and Ringo and for example you'd have a particular specific behavioral observable contract for positive change. So in TA change through contracts is actually central to the therapy. What if a client comes and they don't know what they want to change. We did a podcast we did a podcast didn't we about god I don't know what number this is we're up to 100 so I don't know idea but it was about clients who didn't know what they wanted. Yeah when they come and they just say I want to be happy. Yeah I think it was number 56 or 57 I can't remember we talked for quite a long time about that and many clients do of course come and they don't actually know what they want to change. They have a level of discomfort. Yeah. Usually the motivation for something to happen. It's usually that the discomfort will be taken away somehow but you see I think that in itself is change isn't it. Yeah. Yeah. Yeah. I know TA is very hot on contract specific behavioral observable positive change some sort of change or transformation through the therapy process. I do believe most people who come through our door if not all have some level of motivation. Yeah. Not when coming through that door in the first place or even picking up the phone or writing an email or sending a text or whatever it is maybe a script change in itself. Yes. Yeah. Absolutely. So even though most TA therapists will look for contractual change and anyway in answer to your first question what do people don't know what they want to change. I can tell you as I do which is believe that you know the motivation they're here so there's a motivation somewhere. Yeah. Usually I negotiate with the client if they don't know what they want to change for exploring contract. Yeah. They will explore maybe what brought them here. You know how come they came through the door in the first place what's happening for them in their life. I haven't necessarily contracted for specific change. So exploring is fine for me but out of the exploring if you like we usually settle on some contract for change. Yeah. Yeah. Because you know yes the clients motivated when they come you know like you said to pick up the phone to make the appointment to arrive on time and all those sort of things but they've got to be prepared to take action as well and to do something different and that can be a big thing for some clients. They want to change but they don't necessarily want to do anything different. Well I think there's a difference between inter-psychic change or internal change. Yeah. Internal change. Yeah. Yeah. Quite often we are aware of the changes that maybe are occurring with our clients and the second thing I know I've said the statement a thousand maybe two thousand times through my career change is a process not an event and it always starts with internal change. Yeah. And then from the internal change comes the external change. It's always that way around. Yeah. So in therapy we change in the internal then. Like the thoughts because to me everything starts with a thought and awareness of of needing to change. Well it doesn't with me. I understand where you're coming from but I think if we're talking about the internal world I think we're talking about not just thoughts or feelings maybe you know spiritual change spiritual change maybe. Yeah. Even. Yeah. Maybe thoughts and feelings are the major two. But the spiritual change and feelings and everything do they not all start with a thought and being conscious of where we are now and where we want to be with it. Well now you're into deep areas you see. I think we have lots of unawareness processes if you like which doesn't necessarily demand thinking. Wow. That's a new one on me Bob. In other words I think you have an energetic change. You see thoughts are energy. Yeah. Yeah. Feelings are energy. Yeah. So it doesn't have to start with the thinking could start with the feeling. Okay. You can have you could have feeling if you're talking about energetic processes it could have or one way of thinking is that in a cycle is that the the energetic process if you like is a feeling and the thought comes after that doesn't necessarily mean the thought comes first and the feeling comes afterwards. Okay. People can have you know yourself you can offer and well perhaps you don't perhaps you're going to you're going to disagree with me which is fine as well. But I'll be odd if you might not be odd actually you might not think it's odd. But many times I've had a feeling and I haven't the idea. What the feelings about because I've been thinking about the feelings feelings just happened like a pressure cooker suddenly it's happened. Suddenly I feel sad for some reason or I feel depressed for some reason or I feel emotional for some reason and I haven't been thinking about I was sad. I just felt sad. Yeah. Yeah. And maybe it's not always a conscious thought. Yeah. Yeah. Well you know do you think differently then? Well yeah I think so. There's a lot of thinking going on Bob. It's like I used to I've got a lot better now but I used to have a fee of flying didn't like flying and I can remember I was going I had to go to Tesco to buy some toiletries deodorants and things like that to go on the flight you know you always buy new stuff new toothbrush when you're going away and I got anxious going to Tesco's buying things for the flight. But for me that was connected to the flight because I knew I needed those before I went on the flight so I wasn't thinking about the flight but it was connected to the flight in some way if that makes sense. Well I think you're saying the flight was a trigger or something that was happening internally. Quite possibly but you know I wasn't having a conscious thought about the fact the flight that made me feel anxious. I was going to buy something that was relevant to flying I don't know but yeah it's kind of like my brain connects up the dots that aren't necessarily needed connecting up a lot of the time. So for you everything starts with thinking. Yeah even if I'm not aware that I'm having a thought. So so there are many approaches that would have different ways of thinking about that. Yeah. Yeah. Emotions rather feelings. Yeah. It's awful. Yeah but I am a very thinking person it's what I do. So there for you with clients I suspect you'll be after a specific change around thinking. Yeah an awareness around with thoughts yeah yeah. And nothing itself is a change isn't it? Absolutely yeah. Followed by behavioural action. Yeah yeah and I like the fact that you were talking about you know internal change and external change you know there are two different ones we can we can present and look like we're making a change we can get up and go to the gym and do all of those do you know what I mean that there is is a external change but whether there's an internal change as well we can't see that yeah. And of course with clients and you'll have this experience I'm sure not necessarily not necessarily do they know what's going on internally because they're so disconnected to different parts of the self. So they could be they could feel things and be disconnected from their thinking for example. Yeah yeah. So they feel things but they don't necessarily think what they're feeling. Yeah yeah because it's different for everybody. Yeah and I do believe that most people usually in Derby are disconnected to some levels. Yeah I went to Derby for the first time. I knew there's huge disconnect between you know maybe what was happening at a thinking level and what was happening at a feeling level and part of the therapy was perhaps a big part of the beginning of the therapy anyway was to help me have some sort of connection between the two parts of what I was thinking and what I was feeling. Yeah. Sometimes I didn't know what I was thinking at all. I had a feeling but I couldn't connect with the thought. Yeah. So I think as the more often disturbed we are the more fragmented we are. Yeah is this what you would refer to as being split off? Yes. Parts of us being split off yeah yeah. We disown part of ourselves. Yeah. Split off fragmented. Yeah. And the job of therapy is to help the clients be in touch with different parts of themselves, to take ownership of different parts of themselves and integration as the cure. Yeah even the parts of ourselves that we don't necessarily like. Well more that's actually more the case actually. Yeah. The darker sides are usually the parts of the sides we've cut off. Yeah. So almost by definition we'll go to the darker sides of our internal processes. I believe anyway. Yeah. I mean I think the straightforward part is the parts that we like actually because we we tend to take ownership of the parts of the self that we like. So for example yeah if you like being a humus person then yeah you probably can take ownership of the fact you can express humour. It's the darker sides I think that we have difficulty in taking ownership of. Yeah understandably but we all have them and it's about being honest and truthful with ourselves which is quite difficult a lot of the time and to accept like you said those parts of us. And of course the therapy that is most favoured by the National Health Service in the UK is cognitive behavioural thinking. Because cognitive behavioural therapy starts with you know all about thoughts. If we can change our thinking that will lead to a change in our behaviour. Yeah. Change in our behaviour especially positive behaviour is what it's about for CBT therapists. Yeah. Yeah and again though it's awareness for me. If we're aware of our unhelpful thinking at times or that negative self-talk but often it's it's there but when we don't hear it we react to it and you know all those sorts of things but we're not consciously aware of the negative self-talk that we have running in the background pretty much all the time. It's like just me. No you're correct you're correct that most people I believe are unaware because it's become because it's become like a habit. Yeah. A habit has gone down in our levels of awareness. Yeah. So you can say to clients well I experience you being very hard on yourself and they might say yes I'm a very I know I'm very hard on myself because friends say I'm hard on myself but then are they aware then of all the negative diatom that they say every day of that you know they wake up when they go to bed probably not but they do know at some level they're hard on themselves but the question is do they know they're hard themselves because friends have told them they're hard on themselves or do they know they're hard themselves because they can actually take ownership they've been hard on themselves. Yeah. I think they're two different things. Yeah absolutely. Yeah. So you're right I think awareness is the first place. Yeah and you know so how do we create an environment in the therapy room for change what do we as therapists need to do? Well I think the first place is to provide what you do all the time I do all the time which is to provide an environment where the person feels safe enough and secure enough to be able to just be whatever. Yeah. So that's the first step isn't it? Yeah. The second step is I think which is taught in any counselling courses or any any psychotherapy courses from the word dot is to help the client be aware of our non-judgmental stance in other words but we're not going to judge them negatively. Yeah. Yeah. That will help them feel much safer and much more secure. So I think we have to provide an environment we have to come from a non-judgmental stance and I think we need a lot of patience to help a person tell their story become aware perhaps of the different parts themselves that weren't aware of but I think the starting point is a safe secure environment and the therapist coming from a non-judgmental stance. Yeah. Yeah and when we do make a change often we have to let something go and you know when we're integrating and I'm talking personally now I learned you know things about myself that I didn't necessarily like so I was letting go of one part of my personality if you will in order to pick up something else so it's kind of like part of who I was needed to go you know the performing personality and the surviving personality you know the one that I was projecting out wasn't necessarily the authentic me but in order to let that go that that was quite a big thing. Yeah I think you're correct and therefore loss is a big part of change isn't it? Yeah yeah yeah and understanding that and giving the client time to come to terms with that. Yeah come to terms with the loss of what was in the in the service of being able to be different. Yeah which is a bit strange really because if we're making change the positive things so that you know we're a better person and our life script is you know working in our favour rather than against us and everything you think it'd be really easy to let part of ourselves go but it's not because it's our identity so we've associated with for you know 40 50 years whatever it is and to suddenly not be that person anymore it can make us quite anxious. Oh I think it inevitably makes ourselves anxious and it's a process never an event. Yeah yeah it needs to be so that we can you know one of the things I say to clients a lot of the time is you know we don't need to go full gusto into this it's okay to stop and tread water for a while and to just kind of like when we go into a dark room you need to allow your eyes time to adjust so we need to adjust to a new way of being when we are making a change and that's okay. Yeah and I think there's always a cost to change. Yeah because cost is loss. Yeah there's always a cost to change and as I said the biggest cost I think is loss. Yeah I can remember when I started my training you know the me who I was training with said that you know there's a certain percentage of people when they go through psychotherapy training that end up you know splitting up from the partners because they realise how different they actually are and when when they start to change through the training and the therapy process you know that there's a strain on the relationship because they're not changing alongside you. Yeah I don't know they're searching for those statistics but that's correct. Yeah. Hopefully people who really love and care for people will stay with them. Yeah yeah but it's a big thing about communication. Oh absolutely and I think it's quite high the statistics I think you're correct it's a big thing. Yeah change. Hopefully the people who care for them will stay with them. Yeah which I suppose you know for the clients if they're making a change relationships change alongside it. All the time. Yeah very interesting. Yeah it's very interesting that's why it's important I think for people to be aware of the cost of change. It's not straightforward at all. No and we can't unlearn the things that we learn in therapy but once we become aware then we can't kind of go back to where we were in the first place. That's why contracts I think are always a process never an event as I said earlier and I think some contracts may take six months some might take six years. Yeah. Because they need to be fully integrated. Yeah. Now the more disturbed a person is the more fragmented they are and then the more fragmented they are the more ownership of different parts of the self needs to happen and that all takes time. Yeah yeah because I think you know sometimes in the the therapy room I've seen a client appear to be making changes but the reality is it's kind of like their child trying to please you by making out like they're making a change if that makes sense but it's not it's not really a change it's not authentic it's it's them adapting to what they think they should be doing. Yeah and I think that's a big part of the therapy process. Quite often people do go down that road you just talked about they adapt to what they think you want them to be like or whatever it is. Yeah to get it right to do the right thing yeah. Yeah and I think that's an important important thing for the therapist to look out for and to have adult to adult discussions if possible. Yeah. With the client around all this and what they've changed and what they've done. Yeah. So this adaptation is talk through if it's there. Yeah. Yeah yeah because you know like you said earlier on you know having a safe space where they can you know practice that change out and you know learn about themselves in a safe environment without fear of judgment or whatever before they go out into the big wide world. Yes and then the question is is there always change in the psychotherapy room you know in other words do clients always change and maybe one thought processes are they always going to change for the better. I mean that's the definition usually of the contract a positive contract that there will be change for the better but is that always the case. It's an interesting question. Not quite so sure. I think I hope I hope it's that way. Yeah the people around them might not always think it is I know for me I was a people pleaser I still am to a certain extent but not as much as what I used to be and when I changed that the people around me didn't necessarily like it because I wasn't pleasing them all the time I was putting myself further up my priority list which wasn't what I used to do so they didn't think it was a positive change. I do think though usually in psychotherapy you know a person will change in some ways. Yeah it's about achieving a contract. Other disciplines which doesn't have contractual theory at the hub of it will also have a hub of it if you like transformational change. Yeah so they can look at how changes occurred. So I think for effective psychotherapy it is important that we look at how a person's changed or hasn't. Yeah yeah and I think it's good for the client to notice that you know what I mean to recap over the contracts every so often and see you know how they are now compared to how they were when they came in because when it is gradual when it is a process I don't think we often realise how far we actually have come down the road. That's right and as a therapist one thing I always did religiously was to celebrate changes. Yeah yeah. No that's not as easy as it sounds because a lot of clients were brought up that it was the wrong thing to do if you like to celebrate positive change and for clients to take ownership of you know of positive change was something I embedded in my therapy. Yeah I like that because yeah it is you know blowing your own trumpet or you know being big-edded or things like that it's not you know it's not the dumb thing a lot of the time we're not encouraged to do that as kids or when we're growing up. No so the therapist needs to advocate a different way of being. Yeah yeah and again model it you know what I mean it's it's part of the process. Yeah I like that I like I like celebrating I always I always celebrate the wins that's what I call them. Yeah so change should be part I think of effective therapy. Yeah. Even though it may take a long time. Yeah and to notice when change does occur you know in the therapy process if the client is doing something that's you know kind of unusual or not normally done to notice that and feed it back to them. Yeah I think that's a big one. Yeah I have our clients that are very amiable and very agreeable and everything and the one time where they kind of disagree or say something I will point it out to them so you know I did that for you that's that's really you know a change for you. Yeah I enjoyed that both thank you. You're welcome. So what we're going to be talking about next time is working with the isolated client. That's a big topic. It is yeah quite a difficult topic as well. Okay until next time Bob thank you. You've been listening to The Therapy Show behind closed doors podcast. We hope you enjoyed the show. Don't forget to subscribe and leave us a review. We'll be back next week with another episode.