In this episode, the guest is psychotherapist, Sarah Eames. Sarah has experience with a range of mental health problems, and she’s been working for many years with CBT and compassion focused therapy. She founded Speakeasy Virtual Therapy in September, 2020, as a way for people to continue accessing therapy during the pandemic. Her Instagram handle is speakeasyvirtualtherapy_.
Sarah shares several strategies that you can use for choosing a therapist, for choosing a therapy type, and for helping yourself when you’re dealing with situations that may be difficult or stressful. It’s never too late to start a new practice, to get some help, to do something great for yourself.
We recorded this episode on April 29, 2021.
Contact and follow Sarah on her website and on Instagram.
You can connect with Damianne on the Changes BIG and small website, Facebook, Instagram, Twitter, YouTube. You’re also invited to join the Changes BIG and small Facebook community.
Feel the fear and do it anyway. – Sarah EamesTweet
Timeline of the Chat
Therapy’s hard; it asks a lot of you. – Sarah EamesTweet
- The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma, by Bessel van der Kolk M.D.
- Speakeasy virtual therapy website
- Progressive Muscle Relaxation videos on Instagram
- Download Progressive Muscle Relaxation Script
Good enough is good enough. – Sarah EamesTweet
Transcript of the Episode
Starting Speakeasy Virtual Therapy [01:41]
Sarah Eames: [01:41] Yeah. So it’s funny because I moved back to Ireland the December before the pandemic really took hold. I was living in Cambridge in the UK working over there with the NHS. I’d been working in that job intensely for three years, decided to come home and take a month or two for myself, and then COVID happened. And I ended up staying put in Ireland and I got a job in a mental health service in Dublin. That was going really well and I just kept hearing people talk about their struggles through the pandemic. And then when we couldn’t actually attend sessions and things like that, I’ve been on Instagram myself privately for years and I just thought if there was a resource for people they could dip in and out, be it that they needed an inspirational quote or they want to have, you know, some strategies or skills, that everyone needed something through the pandemic. Something I would have always done historically is if I saw an Instagram page that I thought was useful for mental health resources, I would say to clients, go onto Instagram and see this person; they do really good stuff.
What I’d started to do was compile all of that onto an Instagram page that I had, which then one day I just kind of had a light bulb moment of like, well, why don’t I do this property and give it a name? So I changed the Instagram name to Speakeasy Virtual Therapy. I went on and I said, I’m a psychotherapist if anyone needs any support through the pandemic and just wants to have a chat with me. Straightaway, I started getting a response, naturally because people were struggling. I was surprised though how open people were to the virtual side of us. So then I just took it a step further and went down the private route as well.
So I still work in the mental health service in Dublin, but I also then talk on speakeasy and it’s gone very well, which is good. And then also I’m aware that it’s good because people are struggling, so it’s kind of a double-edged sword.
Damianne President: [03:37] Definitely so many people are struggling right now. I mean, it seems sometimes as if COVID times are and less, endless.
Some people are beginning to see kind of a glimmer out of it.
Sarah Eames: [03:50] Here in Ireland, we just got news today that we are coming out to lockdown officially, I think it’s on the 10th of May, after being in it since pretty much the day after Christmas. So it’s been a very long lockdown for us.
Definitely people have really struggled this lockdown even more so than the first two. And I think there was an element of like, Oh, this is different with the first lockdown. People didn’t really know what to expect from it and although there was a lot of suffering and anxiety, they were more accepting of it. Whereas I think when this lockdown happened and then we heard it was going to go on until May, that really has had such a knock on effect for people’s mental health, because family life, work, life, all that stuff. It’s really damaged people, you know, more so this time around.
Surprises starting Speakeasy [04:35]
Damianne President: [04:35] You mentioned that with starting Speakeasy, you were kind of surprised how open people are and the fact that virtual didn’t seem to be so much of a barrier. What else has surprised you in this journey?
Sarah Eames: [04:46] I think that really was the first thing that really surprised me is people’s willingness to move virtually. I had my own misconceptions about virtual therapy before. I know that sounds strange seeing as how I have a virtual therapy service now. When I was working in Cambridge, if you had said to me, you know, you’re going to be doing all of your sessions online for a year, I would have said, that’s not going to work; that’s not effective, a bit like telephone therapy, which I had worked in before. I found just a little bit of a barrier, but you couldn’t see the people. And I think I hadn’t really accounted for that with the virtual side. And so that was a surprise that people have been so willing and how after the first minute or two even, you know, now chatting to you for the first minute, I’m very aware of myself; I see myself, but then you kind of forget about that as well. So very quickly you kind of switched back into, Oh, this is now a session or this is the environment I’m in.
I’ve been surprised at the impact of it. I’m still getting results with clients. We’re still getting people where they need to be in terms of therapy, regardless of the fact that it’s not face to face. I think that has been the biggest surprise. And then I suppose the other thing is that surprisingly, and not surprisingly, people are coming for therapy during the pandemic. They are taking the time for themselves, and it’s a good surprise.
It is a downtime for a lot of people that are not in work. Maybe their routine has changed so dramatically, but people are prioritizing self care a lot more, which is a good surprise. I would have not necessarily thought that we’d be as good at that as humans as we have been, because we’re also good with being fast, fast, fast.
Damianne President: [06:20] I guess in some sense, there really is no choice if people need help, and so people who may have been cautious or pessimistic before are willing to try something different because that’s the option available.
Sarah Eames: [06:34] That’s it. They’re more willing to try, but I think people are acknowledging that they’re struggling a lot more as well. Whereas before, because we were busy in that rat race of speed, speed, speeds, I was saying to a client only today, we’re so used to go, go go. Now it’s slow, so slow. It’s a shift in speed for us as well. And I think that people are normalizing a little bit hopefully. I’m hearing it anyway that it’s okay to actually say I’m really struggling today. I just hope that when things returned to whatever version of normal they look like for us going forward, that we retain that. I hope that we just continue in that way really to, you know, not mask how we’re feeling so much and that if you need support from a mental health service or from anyone that you still access that, be it virtual or face-to-face, whatever way you’re comfortable with.
Issues that show up [07:27]
Damianne President: [07:27] Are you finding that people are taking the time to notice and address issues that have been around for some time? Or are there new issues that surface in because of COVID. What’s the balance of those.
Sarah Eames: [07:39] That’s such a good question because I think it’s such a mix. Really. I think what it’s done is it’s highlighted for people who had, you know, historic preexisting stresses, worries, distress that maybe now I need to look at this or it’s being compounded by the pandemic. So they were already struggling, then other factors have come into play that they never really saw coming and they kind of hit the wall. But for a lot of people as well, they’ve decided to get in ahead of things. I’ve heard some people who’ve come to therapy with me, for example, are saying, I’m starting to notice I’m getting stressed, Sarah and I want to get in ahead of this because I know that in a few weeks or in a few months, the world’s going to open up and I’m going to be back at work or the kids are going to be doing this or whatever.
So some people are forward planning, which is really, really good. But for some people who would have possibly not identified with the fact that they had anxiety before, coming out of the pandemic seems to be creating a lot of anxiety. They’ve been okay at home. It’s actually been all right but the idea now of going back on a train and commuting to work, how is that going to work? Or if I do get on an airplane or if I do go to that concert or whatever it is, there’s a lot of social anxiety coming up for people. I’m hearing that a lot in sessions and just to return to normal, whatever that is, there’s that anxiety.
Different types of therapy [08:59]
Damianne President: [08:59] A lot of people are familiar with talk therapy. I think that’s probably the kind of therapy that first comes to mind. Maybe some people are also familiar with cognitive behavior therapy, for example, but there are so many different types of therapy. Just before we started talking, I was listening to a podcast and it was talking about IFS, internal family systems, which is by Richard Schwartz. You have expertise in some different modalities as well. Can you tell us about the different approaches that you use in your practice that people might want to look into, if they’re interested in therapy?
Sarah Eames: [09:34] Absolutely. So I normally would say that I’m a little bit integrative, even though I have different modalities. I’m a CBT therapist, which is a Cognitive Behavioral Therapist, which is essentially looking at what you think about and what you do and how that impacts you in your day to day life. Are the things that you do helpful or unhelpful? If I have a thought about something, what does that lead me to do? And we would often look at, you know, the cycles that we move in as a result of that. Are we in a vicious cycle? Is that a helpful place for us to be? Could we be doing things in a different way? So kind of challenging those thoughts and those behaviors.
And then I work with compassion focused therapy, which is the CFT. So a lot of letters. I was explaining this to someone today, which is that it’s almost the opposite of CBT and that CBT is very practical and about challenging your assumptions, your beliefs, trying to give you alternative evidence, and Compassion Focused Therapy is all about feeling. We want to talk about your compassionate side. You’re kind to someone else, like you would treat someone else with respect, so sharing that with yourself. I kind of almost blend the two of those together in a way in sessions, depending on what the client’s needs are.
I also work with EMDR, which is eye movement, desensitization and reprogramming, which is to do with PTSD, really a lot of the time it’s through trauma. We recognize that the body holds the score and that in order for us to move past the trauma, we need to really engage with our body. So through that we actually get you to either use tapping or eye movement. That’s slightly different. Through the pandemic, I haven’t really been using that very much though, because it’s virtual and I find that is a little bit of a barrier for that type of therapy. So I’ve very much been using Cognitive Behavioral Therapy and Compassion Focused Therapy has come in a surprising amount as well.
Damianne President: [11:24] A few years back, I had a therapist and we did Cognitive Behavior Therapy. What I remember from that, what stays with me still, and what I try to practice is some of the mental habits around catastrophizing, and so saying that something it’s the end of the world when really it isn’t and how our words impact our emotions and our behaviors and those cycles.
Even now, when I hear the word should, and I think it’s from that therapy,
Sarah Eames: [11:54] Yes, it’s the rules, the shoulds and the musts.
Damianne President: [11:57] Yeah. I have a tendency to say, Oh, is it really a should here? And that’s something that has kind of stayed with me. So yeah.
Sarah Eames: [12:05] That’s great because if there’s an element of doubt. If there’s doubt, then you know, we can’t treat it as fact. We always talk about facts and opinions in cognitive behavioral therapy. Is it a fact, or can we challenge that? The one that’s coming up a lot for people at the moment is compare and despair as well, which is where if you compare yourself to something or someone in any way, you’re automatically despairing. I’m hearing people say, well, this person’s managing really well through the pandemic; I should be able to do that. As soon as you’ve put that compare in there, what do you think you’re doing? So that comes up quite a lot at the moment for people. Those unhelpful thinking patterns, I think, are very much at the foundation of all the CBT stuff.
Did you find it useful overall, the type of therapy?
Damianne President: [12:49] I did. I haven’t ever tried talk therapy. That’s not true; I did try talk therapy once, and it was a very interesting experience because I got the sense that the therapist was telling me, Oh, don’t you have friends to talk to about some of these things. It was really odd because I was like, well, I’m coming to you because I want to talk things out. I want to process them without input from my friends necessarily.
What is EMDR Therapy [13:18]
So that was interesting.
I was just telling my sister about EMDR a couple of nights ago and she was like eye movement, so I move my eyes to help myself feel better. I think a lot of people are really confused by EMDR. Can you give us a synopsis about EMDR?
Sarah Eames: [13:38] It’s a bit of a minefield to me too, to be honest, because of the fact that it works. And sometimes we don’t really understand ourselves why it’s working. I remember when I first started and when I got qualified, I’m only qualified in it two years out. I trained over in Cambridge and I was working with it for a year and then the pandemic happened.
I’m not gonna pretend to know every little piece about it because through the pandemic, I haven’t had the opportunity to use it in the same way. What I can tell you about it is that as I was saying there, the body holds the score is a major aspect of it. And what happens is with the eye movement, you’re replicating the deep sleep patterns that happens. When you’re in a deep sleep in that REM sleep, your eyes will do the same movement. That’s actually helping process information from the day when you’re sleeping. It works in the same way for trauma. So that’s why, when someone goes through a trauma, they say like rationally or up here, I completely understand that I am past this that has happened. Whatever that situation was is in the past. Why am I still feeling this way? And it’s because your body hasn’t had time to catch up. So what it does is it connects both mind and body, and it gives the person the full impact. I mean, it’s a very powerful therapy for anyone who’s ever had it or has delivered it.
It’s unlike any other therapy I’ve ever been a part of. It’s powerful is the word that comes to mind for me, because people have physical reactions in these sessions. It’s not just crying. People feel sick, they get sick. People have rashes, because it’s wherever your body is holding it.
I had one client once who had, you know, a situation that had happened where there was physical contact in terms of the trauma and they actually started coming up in a rash on the places where the impact had happened because their body was still going through it. And when you go home and you go to sleep over the course of the sessions, you start to have some strange nightmares sometimes because the trauma’s working its way through. So sometimes with EMDR you feel worse before you feel better and that’s true of all therapy in fairness but sometimes you have to feel a little bit worse before you feel better, but it’s very very much true with EMDR. But it’s very much safe. It’s contained and we move it at a pace that works for the client but it does work. I’ve never had a situation where it hasn’t worked because your own experience, it’s your own body recalling and it has passed. Your body just hasn’t had time to catch up.
So it’s all kind of based around the here and now. That was then; this is now. Let’s update that memory. Let’s update where you are. So if it is that you’ve been in a situation where someone has robbed you and now you see them out. Even if you see them out, like living their lives, in this moment they’re not robbing you. And that’s what we need to communicate to not only our brain, but to our body. And that’s what the processing does. It’s very powerful though. Like it still is, as much as, as we understand it, even as therapists, something you say in the sessions is go with that, go with that. And I sometimes find myself like, okay, go with that, just go with this because it’s working.
Damianne President: [16:44] Yeah, that’s interesting. And you describe it as being for trauma. So then that immediately makes me think, okay, has everybody gone through some sort of trauma? And you also mentioned the book, The Body Keeps The Score a couple of times. I mean, you mentioned the phrase, but is that a book that you recommend as well?
Sarah Eames: [17:02] Yes.
Sarah Eames: [17:02] Excellent. Yes. It’s a really good book and it’s funny. I I did a Reiki course last year just for something to do. I was kind of curious about it and they recommended the book. It’s a completely different thing and they were like, this book is amazing. It’s a really good book but in terms of does it have to be trauma? They say no, but I’ve never worked in it with anyone who hasn’t experienced a single trauma. It’s very effective for individual trauma. So what I mean by that is if you have been in a once off car accident or something that’s happened in a single event, it works really well and quite quickly. For people who have maybe more complex trauma or a series of traumas, It’s not that it doesn’t work, it still works, but it just it’s going to be a little bit more complex, obviously, in terms of trying to tease that out in terms of your body as to what spot.
But in terms of when I was training, they would have said it works really well for low self-esteem, for depression, for anxiety, but because trauma is such a physical impact as you know, there’s so much that your body has to hold on to and process that we just don’t. We just shut down and just go onto the next thing. It’s partially to do with that why it’s so effective.
Damianne President: [18:16] Yeah, as you’re talking, it’s making me think of I lived in India for a couple of years and one evening I was going to visit a friend and this guy came up to me and started propositioning me, just out of the blue. Eventually I said, okay, if you won’t stop, I’m going to scream and everybody will come out. And then he started walking away from me, but then he walked back towards me, grabbed me and then run back away and got on his bike and cycled away. And so I think that many people have, and I mean, I wasn’t hurt. I continued onto my friend. We were going out that evening. Like everything continued. I think I was a bit shocked and had heightened emotion for some time. But then I also noticed that for the next few days, the thing that stayed with me was, Oh, I don’t know what this guy looks like. It could be any of numerous guys on a bike that I see every day and I wouldn’t even know which one it is.
Sarah Eames: [19:19] Yeah. It’s interesting.
Damianne President: [19:21] I haven’t really thought about that when I see people on bikes recently, but then that makes me think…
Sarah Eames: [19:27] As we’re talking now, it’s straightaway bringing you back there. That’s the power of our memory and our bodies, that your body has held on to that in some way. And it doesn’t hang on to every piece of the story. It’ll hang on to the bit that is, we call it the distress spot, the hotspot. When you go through therapy, especially with trauma, there’s that piece around when you break down that scene, what is the hotspot? What is the distressing part? And it’s an image for people. It could be literally when he went to grab you, it could be him getting on the bike. You might have three or four of those and in EMDR, that’s where you do the processing on those hotspots.
Similar to CBT; they’re the parts that we actually start to challenge and create the evidence. So there’s definitely layovers between CBT and EMDR as well that I like, because we’re bringing you back. In CBT, we often talk about the here and now as well, like that was then, and this is now. So there are definitely overlaps. I find sometimes in EMDR I have used CBT strategies and vice versa.
I’ve turned to EMDR in CBT before as well. So that’s why I kind of say, I’m not an integrative therapist but there are ways I kind of merge everything that I’ve been lucky enough to learn over the years.
Choosing a type of therapy and a therapist [20:36]
Damianne President: [20:36] The other thing that I then wonder is how do you decide what kind of therapy to pursue? How do I choose out of all of the options and modalities and integrative therapy? Where would someone start?
Sarah Eames: [20:49] I think that’s a really good point, isn’t it, that there’s so many different types of therapy, sometimes people feel flooded in a way with all the different information out there. Something that we do at Speakeasy is we offer a consultation first of all, for that very reason that when someone comes, the’re coming because they’re struggling with something in some capacity. For some, it’s anxiety; for some, it’s depression, whatever is going on for that person.
I think the first thing that we would always say is that you need to look at what it is you’re hoping to get from the therapy, so not the type of therapy, but what is your own personal goal? Is it more than I want to feel better because that’s a given, but more than that is it that you want to challenge your critical thinking? Is it that you’ve been through a traumatic experience? Have you lost someone; are you grieving. Trying to help you to establish that, and sometimes that’s the therapy in itself. I think if you’re someone who likes to talk and wants to process, talking therapy is a great way to go. It should give you the space depending on who your therapist is to facilitate that to just to give you that space to process.
Counseling is very good for that. CBT is very collaborative and it’s very much about putting you in the driving seat and making you your own therapist, essentially, at some point. You learn coping strategies. It’s not counseling. I love counseling. I’ve had counseling. It’s very effective, but what I find with counseling is that you’re processing, you’re talking and then that’s it. That’s really helpful say in a situation where you have lost someone, when you’ve gone through a break-up and you just want to figure out your own parts. I find for people who’ve separated and things like that, it’s really good because it gives them that time to say, you know, I’m in a pickle here and I just need to feel what I’m feeling. That’s not so great in CBT actually.
Where CBT is very effective is if you are trying to put, I suppose, strategies in place; you want to create a bit of an action plan. You maybe are trying to make a decision on something, or you recognize that you’re in a very unhealthy or negative thinking pattern or behavior. That’s where CBT is very
Sarah Eames: [22:57] effective, so for things like depression, anxiety, panic, trauma, it’s very good.
The Compassion Focused Therapy is very much where if you recognize that you are very hard on yourself, you have a lot of self-doubt, maybe there’s that imposter syndrome coming into play there, compassion focused therapy works really well with that.
If you’ve gone through a single trauma and you are finding it difficult to talk about the experience, but are having a lot of flashbacks or it’s disrupting your sleep, which is often symptoms for people with trauma, EMDR would be a good route to go. But there is so much out there.
I think if you’re uncertain, rather than Googling, because you can end up down the rabbit hole with that, I think the first thing to do is talk to your GP, or if you know of a service. Sometimes it’s to word of mouth, you know, sometimes you hear a friend say, look, I went to this therapist. But in the times that we’re in and everything is virtual and everyone is online, it’s the right time to be doing a bit of research at the same time. So you can find us on Instagram, which again, a year ago, you wouldn’t have done. So yeah, people are more accessible now.
Damianne President: [24:01] For some of my previous therapy sessions, like you said, you could have an initial call with the therapist. And in fact, one of them actually gave like a whole session so I could see what the work between us would be like.
Sarah Eames: [24:15] That’s it. I think it’s such a key part of therapy is your therapist, the therapeutic relationship. Even myself, I’ve had three therapists over the years. I didn’t actually have a bad experience with any of them, but at different points where they would have met me, I might’ve had different needs. So it’s finding what your client needs, but also just, maybe it’s not the right fit therapy wise or therapists wise. Not to bash any therapists, but sometimes it’s just not a good fit. It’s a little bit like, you know, I say wearing a pair of shoes, it has to be a good fit because you’re going to talk to this person about the deepest, darkest parts of your experience, your saddest moments and those stressful moments. You don’t want to feel judged. You don’t want to feel that they’re rushing you through something or that they’re ill-equipped to do that you need. You know, very quickly I think with a therapist. And that’s why we offer the consultation as well in our service, because we want you to make sure that I’m a good fit for you, or, you know, that the type of therapy that you’re being offered is going to be right for you. And we don’t want you to have to pay for that. So it’s between 30, 45 minutes a consultation. It’s either with myself or my colleague and we essentially just want to get a sense of where you’re at. So we just ask, what is the problem you’re experiencing at the moment? Is there anything you’re doing already that’s helpful or not so helpful.
The feedback we get all the time is that they find that consultation really helpful because if they weren’t thinking in the way of goal setting, now they are, or it just helps them to connect some dots. A few clients have said, like, I didn’t actually really realize that that was connected to this, only when I was talking to the consultation. At that stage, then we would make our recommendation as to whether, you know, CBT is a good fit. Some people have had it before. Some people have no idea what CBT is when they come to us. So it’s just about finding what the client needs and making sure that that’s what we’re delivering.
Damianne President: [26:06] I’ve had a variety of therapists. Depending on what the issue is, sometimes I’ll look for a therapist that specializes in that issue.
Sarah Eames: [26:14] Yeah.
Damianne President: [26:15] and I’ve had very mixed results in terms of the relationship that I’ve been able to build with the therapist. And I think for me, part of it is trust in myself to know what is the right time to persist with the relationship or to decide, okay, this is not working and I’m prioritizing my health, my self care, the reason I’m here.
So for example, my very first therapist, we had a very good relationship until I was trying to make a decision about something, and she gave me advice that was very contradictory to my values and, values that I had shared with her. And so I felt a bit betrayed in that moment, and then that really hurt the relationship between us.
Red flags when working with a therapist [27:04]
So is that ever possible for somebody to actually be hurt from a therapy session? Are there warning signs people need to look for?
Sarah Eames: [27:15] Yes, I think there are some red flags with a therapist or the therapeutic relationship. It might start out okay and as you say that, you know, you get to a point in therapy where you feel the therapist should have a sense of who you are, your values, your beliefs and if they’re persistent and they’re pushing you in a direction that you have a reaction to that, it’s about exploring that. I think you have to feel comfortable to talk, to talk to your therapist about that. Communication is very important, but if you’re at a point where you don’t even feel you can communicate that to your therapist, there’s possibly a reason for that. It’s the therapist’s job to make you feel safe. But if you’re not someone who’s used to being assertive or you’re afraid of confrontation let’s say, how would you go about that then when you feel hurt by your therapist and let down by your therapist in some way.
I think recognizing the difference between that and when actually the therapist might know to push you that little bit, because maybe they can see that you’re just about to get to where you need to be, but you’ll only be able to figure that out by having that communication with the therapist.
I think the red flag that I would say to look out for is when you get to that point, if it does happen that you’re finding your values are leading you one direction, the therapist is trying to advise you to go another way with things, if your instinct and your gut instinct is not that you don’t want to talk about it because there’s anxiety there but actually you feel like I can’t talk to my therapist about this, they’re not listening to me, or they’re not going to take this onboard, that is a problem. You need to have it’s trust; it’s that understanding and respect.
It comes back to trust. You have to trust that your therapist knows what they’re doing, and if you don’t believe that, there’s a problem. Or if you feel that the therapist, despite what you’re trying to say to them, isn’t listening, that’s also the crucial part. But sometimes it is just by opening that up. It’s happened with me with clients where they’ve said, Sarah, I don’t like where you’re taking me with this. I’ll explain my rationale at that point and say, well, look sometimes with anxiety, you have to feel a bit worse because therapy isn’t easy, and I think there’s a misconception that therapy is just talking.
I have someone who has a phobia at the moment, and I’m asking that person to do things that are difficult. They’re doing it. They’re really engaging with it, but I can see the anxiety when I ask them to do the things. They’re really good and they’re pushing through because they know that there’s a reason, that there’s going to be results from that. But in order to kind of feel better, they have to feel a little bit worse. But if you don’t trust your therapist, that client trusts me enough to go with me on that. And I’m able to explain the rationale and so they have needed some reassurance along the way in that sense. Because they know me, they know that the trust is there and I listened to their concerns, we’re okay in that way. But I think you always know in your gut, don’t you, if there’s something not quite lining up for you. But more than that, if you can’t articulate that to your therapist in some way or form, you don’t feel completely comfortable to do that.
Damianne President: [30:12] In a previous interview, the guest said that she had a barrier between herself and the therapist. And then at some point she thought to herself, what might happen if I actually participated in this therapy fully and stopped putting up so much resistance. And then that was really necessary before she could make any progress, because she was talking about how she had all these limits to what she would talk about, what was allowed. And so I think that foundation of trust and knowing that you and your therapist are both aligned with your progress, with your goal and identifying what that goal is, is very helpful.
Sarah Eames: [30:55] Absolutely. And I think, yeah, establishing that goal is very important as well in the beginning. And as you say, you know, but the barrier as well, that that can exist, I think sometimes the greatest learning you have in therapy is through actually the therapy session itself. So like if someone is saying, you know, well, you know, I struggled with this or with confrontation, and then they’re in a situation where they have to talk to the therapist about something, there’s exposure happening within the session, without maybe being fully aware. If the therapist is doing their job and is helping you and you trust them, you’re going to actually start to speak up within a session, which in turn is the reason you’re in therapy as well. So it’s helping you and it’s helping to facilitate that.
I always think it’s quite interesting when someone comes to me and says, I have no confidence and I can’t speak about this. And then there’s the turning point where, you know, maybe there’s something I say and they go, Sarah, that didn’t sit well with me. Or can I just ask you why you asked me that? I kind of say, do you realize what you just did. It’s a good learning within the session and no therapist is perfect. No therapist does things right all the time. I think at the moment as well, therapists are going through the pandemic as well.
So, you know, I think not letting people off the hook essentially, but just be aware that we’re all human and the best way to move to something is to talk through it. So opening it up and you have to have that trust with your therapist to do that.
Therapy versus counselling [32:15]
Damianne President: [32:15] A few minutes ago you mentioned that therapy is not the same as counseling. And I think maybe some people might put them as being the same thing, actually. Can you highlight what’s the difference between those two?
Sarah Eames: [32:30] This came really as a topic when I lived in the UK. So they would have talked about therapy was talking therapy and talking therapy in the UK was all around the IAAPT services, which is very much about CBT based, numbers driven, effective therapy. They’re looking at, you know, how you’re doing, how you get there, and it’s about the outcomes essentially with clients and how the progress has been. With counseling, it’s more comes from a space of giving time for processing, which is just the complete opposite. So that comes from my background there just in case I was confusing anyone with that.
It is very much when I talk about therapy in that sense, I’m talking about the IAAPT services, which are brilliant in lots of ways. I’ve learned so much from my time there, whereas counseling would be let’s take time now, let’s process; you don’t want to rush someone through a grieving process. You can’t be like, come on next session, you know, whereas in IAAPT, it was very much like that.
Damianne President: [33:27] And what are you saying, IAAPT Services?
Sarah Eames: [33:30] IAAPT, which are the integrative and counseling and therapeutic talk and services. They’re not called that anymore. They’re the psychological wellbeing services now in the NHS; they’re the services for therapy that is skilled over in the UK.
Tips for making progress with therapy [33:45]
Damianne President: [33:45] In cognitive behavior therapy and in other types of therapies, people learn strategies that they can apply outside of therapy time as well. Now therapy might happen on a weekly basis, it might be bi-weekly. There are many different timeframes in which people can go through therapy. How can people support themselves for progress between sessions?
Sarah Eames: [34:09] Yeah. So with CBT in particular you’ll probably be aware of this as well that, you know, we ask clients to, I’m always cautious not to say the word homework, but I hear myself about to say it so we give them homework. That’s not to put anyone off. I generally will refer to it as activities or practice. We have different words that we use. It’s funny just that word homework comes up and people respond negatively.
Essentially what we’re doing is we say you have therapy, as you say, either weekly or every other week, whatever frequency you have it, but it’s only for an hour. So there’s only so much that can get done. The learning, the real learning, the real insight, the real progress gets made outside of sessions. The way to do that is to, I suppose, identify that. We will often get people to either journal, log things, work through different techniques. So sometimes it can be testing a theory. So again, talking about that particular client who was a phobia, they’re going off and testing different experiments over the week. They have to go off and try doing things in a certain way because their head, their anxiety is giving them all these predictions. Well, I bet when you go to do this, you’re going to …. and that person’s going to….
And so what we do is we write that down and say, right, that’s your prediction. Now go do it and see what happens. So then they have to go, and that’s true of a lot of social anxiety as well, because we’re so self focused with social anxiety, we don’t sometimes see that maybe other people aren’t focusing on us the way that we are focusing on ourselves. And the only way to really figure that out is to go and do it, feel the fear and do it anyway is what I say. But yet to maintain that progress, I think writing is the best way personally.
Something I do myself between any therapy sessions that I have is I always have a goal going into my session. I’ll write down what I want to get out of that session, be it that, you know, I really want to talk about something that’s happened in my week, or maybe I need to work on some relaxation or some self-care, whatever it is. And then I have my session and then I always finish the session and straight away I write down anything that’s in my head, just for a few minutes. It could be insights that I’ve made with the therapist in that session. It could be a question that I’ve come away going, wait, was that about? Or it might just be how I’m feeling, like that was a really good session or I’m drained after that session.
Some sessions you come away from, and you feel a bit uncomfortable about what’s going on and other sessions you feel really positive. And some you’re just like, I need my bed now after that. So I like to keep a little bit of a log of that and sometimes I go back and there’s learning in that for me as well, even aside from anything else, just the reflective piece. So that’s something I encourage all my clients to do as well for that reason, because I just started doing that.
Especially in CBT, you’ll generally get something to do between sessions. We always find in therapy as therapists, as well, that tests the level of engagement with the client. So if the client comes and you given them an activity diary after the first session or a questionnaire to fill out, if they fill that out ahead of the second session, you know that they’re really engaged with the process. If they come up with an excuse or they are anxious about it, there’s learning in that, like sometimes they’ll come and say, I didn’t do it and you kind of explore why. There’s anxiety there. So even there’s learning in that.
So I think the activities, the coping strategies that we give between sessions allow for progress, cause the learning happens out in the real world in your life. You’re coming because of things that are happening in your life, not because of what’s happening and the therapy session.
Damianne President: [37:32] So there’s not much opportunity to practice truly in the therapy session. It’s too controlled.
Sarah Eames: [37:38] Yeah. Only to a point. I would always say if it’s an experiment or something we would within means do it within the therapy session first; do it in a safe environment or do a version of it or test out a bit of the theory or like role-playing, that’s a good example will be something that we will talk about it, you know, we’ll say, all right, let’s practice this role-play. I’ll be you, you be the person or you be yourself and I’ll be the person. Tell me what they’d say. And we get the person to a point where they’re comfortable enough with that. I wouldn’t send someone straight away to do something like that cause either they’ll be crippled with anxiety and then they’ll doubt themselves and lose trust in the process. Or they’ll go do it and they haven’t prepared enough and then there’s a problem.
Being part of a supportive community [38:20]
Damianne President: [38:20] How can we support people who are in therapy as friends or as family members? And we may or may not know when people around us are in therapy, but what can we look out for and how can we be good friends and good family members?
Sarah Eames: [38:37] It’s true. I read something recently, which is excellent, which is on weaponizing therapy. It’s not something that people do too much of hopefully, but that idea that, you know, you’d say, well, you should have therapy, or I hope you’re having therapy for that. It’s almost like it’s a backhanded insult or a backhanded compliment. It’s like, you’re saying one thing but you really mean in another. And so I think where possible avoid that. If you see that someone is struggling in your life, they might already be having therapy and sometimes you do feel worse when you’re having the therapy before you feel better.
So sometimes people actually are in therapy. So say they’re going because they’re grieving for someone and all of a sudden they’re more emotional, it could be because they’ve now opened that up, you know, with a therapist. So,I think always being sensitive to, we don’t fully know what is going on for anyone, you know, even within our own lives.
It’s a very personal thing, therapy. Some people don’t want to ever disclose that they’ve gone to therapy. Other people are very open about it like, I am very open about it, but that’s not everyone. There’s people who aren’t ready to talk about why they’re in therapy, you know, it opens up questions. But if you are aware that someone in your life is having therapy or is contemplating it even, I think being as supportive as you can. There’s a boundary there; let the person bring to you what they want and just letting them know that you’re there to talk if ever they need it, you know, being supportive, being an ear for them, because there is a difference between being a friend or being a therapist as well.
Damianne President: [40:00] So accept that we’re not therapists.
Sarah Eames: [40:02] Yeah, you are not the therapist, so you don’t have to have the answers as well. And not that the therapist will always have all the answers, but sometimes as friends and family, we feel hopeless or we really want to help the person and all of our worry is there. You don’t need to be the fixer; you’re not there to do that. Be with the person where they are, just let them know you’re there for them and support them. Ask them what they need and if you can help them with that, great. But you may not be able to help and how do you be okay with that? It is tough.
Misconceptions about therapy [40:30]
Damianne President: [40:30] What do you wish more people knew about therapy?
Sarah Eames: [40:34] What do I wish, that’s a good question. I wish, I think, that people knew that it is worthwhile because I think there’s still that stigma there, as much as we like to think that it’s not. I think therapy is brilliant; I’m biased but I thought therapy was brilliant before I became a therapist.
It’s hard. Like I think sometimes there the thing that was going around as well that therapy is cool. That’s nonsense as well. Therapy’s hard; it asks a lot of you. People who go to therapy are incredibly brave because they’re facing whatever is going on for them. They’re looking in that mirror. So I think you get out of therapy what you put into it.
Personally I love therapy. I think it’s great because we could create that space for you in your week, your month that’s for you, that you don’t get otherwise. No matter how much our family, our friends, our partners, whatever supports us, and they might give themselves to you, they’re not impartial. They’re going to bring a level of emotion or push or opinion into it that a therapist doesn’t because they have that distance and they have that clarity that maybe family don’t have because they love you and they’re concerned and all of that. A therapist can separate that and say, okay, I see why your family are saying that, but maybe…. So I think it’s really helpful therapy. Therapy is hard but good. It’s worth it.
Damianne President: [41:56] A few minutes ago, you also said meet people where they are and the topic of the season is self acceptance. In several interviews, when I ask people, okay, what has helped them with self acceptance or what has hindered them with self acceptance, they talk about their community and they environment and how that impacts their sense of self acceptance.
Supporting each other with self-acceptance [42:20]
With your expertise, how can we support each other with self acceptance?
Sarah Eames: [42:27] I think self-acceptance is what we all strive for really. I think recognizing that everyone’s doing their best is one thing. People are trying to find their own level of acceptance with themselves. When I say meeting people where they are, it’s about acknowledging that as well. It’s about identifying where you are and where you want to go and what can we be doing to support each other in that way so that we are recognizing that none of us are perfect, but also identifying what we are doing. So what are you doing in your day to day? If there’s someone in your life who, you know, is struggling with that, that you can say to them, well look what you are doing in your day.
Something we talk about in therapy is the positive qualities diary or an activity diary, but the things you have done, as opposed to the things you haven’t done. This is very much a CBT approach is that when you go back and you have those negative thoughts of, I didn’t do anything, I’m not good enough, you now actually have an evidence log. Cause we’re now getting you to focus on what you are doing versus what you’re not. You are doing things in your day, but because you have all this doubt and all this negative thoughts, and self-talk, it’s getting in the way of that. So we’re hopefully trying to reshift the focus a little bit there. That’s something that we can all be learning from together, individually, in families, in work environments, in communities. It’s about recognizing what you are doing. People are, for the most part, doing their best with whatever they have at that time.
Self Acceptance in Therapy [43:56]
Damianne President: [43:56] Does the topic of self-acceptance come up in therapy?
Sarah Eames: [44:00] Yes, it does quite a lot. Sometimes with perfectionism or, you know, people who have really high standards. Sometimes it’s about accepting well, how did we get you down from that because the higher you try to climb the further you’re going to fall, and then recognizing that sometimes good enough is good enough. That’s something that I kind of say a lot in therapy. It’s like maybe good enough is good enough. And you see people squirming in their chairs and you’re like, how do we get you to a place that, that will be okay?
When will you be good enough? When will you be the best in the class or the best at this and the best at that? You’re never going to get there if you’re constantly moving the goalpost. So we need to establish where that will be. So that’d be something that really does come up in therapy around your beliefs and helping you to recognize what you’re already doing, perhaps, and that maybe you’re disqualifying stuff that you’ve already been doing along the way.
Damianne President: [44:51] If somebody’s listening and they have a few minutes right now, what’s something that they can do? Do you have an invitation or a challenge of something that they can do in a few minutes, let’s say five minutes, 10 minutes, that would be helpful for their mental health?
Sarah Eames: [45:06] Absolutely. So it’s actually a highlight on the Instagram page as well. It’s called progressive muscle relaxation. I swear by it. It’s where you tense muscles in your body so you lift your shoulders up towards your ears, hold for six seconds, and then roll it out. That releases any tension that you’re holding in your shoulders.
If you go through the whole body, essentially it takes two minutes, max, if you do it quickly. You can also stretch that out for an hour. That’s what I like about it. And essentially what you’re doing is you’re communicating with your body that, okay, you’re tense. Let’s relax you. It sounds very simplistic, but actually when we’re stressed, the adrenaline that hits our body is responding to tension. So what we do is we tense and then we relax, we’re showing the body you can relax so relax. Drop your shoulders, take that deep breath. Breathing, it sounds so simple but when we’re stressed, we forget to breathe or we hyperventilate, we shallow breathe. Stop, take a breath, lift your shoulders up towards your ears, drop them and go about your day.
If you do nothing else and do that, that’ll start to have a physical impact for you.
Damianne President: [46:14] I found myself wondering the other day, does everybody else also hold tension in their shoulders or in their back or do other people hold it in different places. I remember when I used to go to physio therapy, after I had a shoulder injury, she kept saying, drop your shoulders, drop your shoulders. And so, I we do have a tendency to carry tension.
Sarah Eames: [46:38] Yeah, we just kind of hunch up. I actually notice this in one of my shoulders in particular, which is really strange. It’s not actually both. I definitely hold it in my shoulders, but when I do that, I really feel it in one shoulder, so it’s obviously the way I sit as well. And especially in COVID times, we’re sitting a lot more, we’re not moving around to the way that we were.
But yeah, I find that to be a really effective thing because it’s a practical thing that we can do. It’s excellent before bed because you’re relaxing your whole body and it’s been shown to help sleep and the quality of sleep. It’s really effective for people who struggle with panic disorder as well.
So if you have panic attacks, the first thing that we would say is we need to talk about the physical symptoms and how we’re going to reduce those. And I would always implement the progressive muscle relaxation there as well. I have it as a highlight on the Instagram page. If you want to work through us, or if you want to email us, I have a script that I can send you if you want to work through it.
Damianne President: [47:28] Yeah, that would be great. I’ll follow up with you on that. And I can include it in the show notes as well.
Fast Five [47:33]
When will you be good enough?You’re never going to get there if you’re constantly moving the goalpost. – Sarah EamesTweet
Ask yourself what you can do and when you can do it and how can you go about doing it? Do what you can do. – Sarah EamesTweet
- Theme music by Rafael Krux. Inspiration on freepd.com. License: CC0
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