Saying Goodbye

Saying Goodbye

We’ve all been through a time when the world seemed dull and hopeless after experiencing a loss – regardless of whether they’re family, friends or simply an individual of great significance to us. People experience loss in a multitude of ways beyond the passing of a loved one; we grieve at the end of a relationship, a permanent change in appearance, a passing life stage, or simply anything that we can never again regain or revisit. Due to the cyclic nature of life, we deal with grief constantly. Some of them are more gradual and less noticeable like ageing, while others may be more unexpected and sudden like the death of a loved one.

Grief affects us in ways beyond both physical and emotional pain. The five stages of grief modelled by Elisabeth Kübler-Ross concluded that the five major emotions experienced during grief were denial, anger, bargaining, depression and acceptance (Kübler-Ross & Kessler, 2014). This model was based on her work on patients with terminal illnesses, suggesting that these five stages were more applicable to people facing their own existential crises rather than those who were grieving. But in practice, we find that the five stages were also shown in grief clients despite the lack of linearity of graphical evidence. Most of the time these emotions are interwoven with many others, including guilt and fear. Beyond emotional responses, the process of grief also includes natural physical responses like sleeplessness, appetite loss, and a weakened immune system. But with proper coping mechanisms, these responses can be alleviated with time, allowing you to feel more prepared to make peace with it. 

Grief is a personal and subjective process, and coping mechanisms vary amongst people, so there is no norm or timetable to abide by. In most cases, people can process and resume their day-to-day functions after a certain period of time. However, in more severe cases (i.e., the loss of a romantic partner, the loss of a parent, the loss of a grandparent) we find it overwhelming. Especially if such grief was complex or unresolved (for example through sudden life changes, traumatic events, or unresolved issues with the deceased). During Covid-19, these situations were more prevalent than ever before. One of my friends was unable to complete quarantine in time to see his beloved family member in the hospital for the last time. Another one was unable to enter Hong Kong due to Covid-19 restrictions and had missed the last call from his father before he passed in the ICU. 

In sessions, we sometimes find people still struggling with loss even after many years due to the build-up of pain over time in addition to mental challenges stemming from grief, including difficulties in emotion regulation or disassociation. Such challenges can become debilitating as individuals often do not even realise that grief is still affecting them. Clinically, the prevalence of prolonged grief disorder (PGD) was found in approximately 9.8% of bereaved adults in the population. Of the adults suffering from PGD, the symptoms they experienced consisted of intense preoccupation with the deceased, persistent distress, detached or numbed emotion, inability to trust others, and avoidance of the reality of loss (Rosner et al, 2018). 

However, there are many ways to make it easier to cope with grief. If you are currently grieving, there are a multitude of things that may help you navigate this time:

  • Know That You Are Not Alone

Because there was love, there will be pain. Whenever there is a start, there will be an end. As the pain of loss is natural and inevitable, no one can live without going through it. But rather than fearing it, try to remember that it is possible to have an easier relationship with the pain of the loss by allowing ourselves to feel it.

  • Talk About Your Feelings

If you feel that you are struggling with grief, resistance or avoidance will not lift the burden. Instead it may cause unnecessary frustration. Try to express and share your feelings though they are difficult. It will aid your grieving progress. Begin to share these thoughts with your support system, address them in a journal, and find your emotional outlet. 

  • Share Your Memories

Share your memories to alleviate fear of forgetting them. Recalling and sharing the memories with those you surround yourself with can bring you a sense of peace amidst this painful time. The most memorable moment during the funeral of a loved one is the sharing of cherished memories with the people who share our pain. These moments may remind us of the fragility of life and how despite the fact that we are mortal, the love we have is eternal. 

  • Find Ways to Remain Connected With Your Loved One 

You can still connect with those who are no longer with us. I have seen many post-it memos placed along the surface of a tombstone by a wife or a grandchild, each inscribed with a message yearning for their beloved husband or grandfather’s embrace one last time. While others may play songs they used to listen to together, or plant a tree to symbolise their everlasting life. These things serve as a reminder to us that despite our loved one not being physically with us, they are here with us in spirit. 

  • Prioritise Yourself

Everyone grieves at their own pace. To find the best way to heal you have to take care and prioritise yourself. If you feel like crying, cry it out. If you need space, ask for space. It is not selfish nor insensitive to take time for yourself to heal. Please do not be hard on yourself for not being ‘strong enough’ in such circumstances, instead, we learn how to be strong enough through grief. Only through pure transparency with ourselves and our emotions can we make peace with them.

  • Remember That Your Life is Valuable

There are a lot of changes that follow loss, sometimes the change is so drastic that you begin to feel lost in the world. Just as how precious the deceased are to you, your life is just as precious to your family, your friends, and most importantly, your own self. With this mindset you will learn to find purposefulness in continuing on with the future and finding back your sense of self that was lost amidst the grief. 

  • Seek Help When You Need It

If you ever feel overwhelmed in the madness, reaching out to your support system is a wonderful method. You can also read self-help books pertaining to grief, seek help from your religion, your support group, or perhaps by paying a visit to a professional psychotherapist as a source of help for navigating past these mental challenges.

If you are accompanying someone who is grieving, here are some helpful ways you can engage:

  • Keep Them Company

Yes, you just need to stay with them. Remember that they do not need advice or positive talk at the moment, they simply need your presence. Having someone alongside you who is listening with all of their heart is one of the best forms of support. Even if you cannot be there in person, texting or calling them is another viable way of showing support. The feeling of being cared for will aid them through this difficult time.

  • Distractions

Whether it is house renovation, work, or travel planning, it can help people temporarily disconnect from reality and focus on the world around them. Exercise is always a good idea to help them feel uplifted naturally, so asking them for a walk if they are willing to do so is another effective form of distraction. If they do not want to engage in anything physically, providing them with a list of TV show recommendations may help occupy part of their mind.

  • Be of Help

There are a multitude of things you can do to help provide an extent of aid towards a grieving individual. For instance, you can help them with their chores, take their kids to the park, order food for them, etc., Simply by doing this you are offering substantial help and providing time and energy for the individual to deal with the chaos surrounding their loss.

  • Respect, Empathy, and Understanding

There are times when grieving individuals may have some irrational thoughts like bargaining with fate or impulsive, emotion-centred reactions such as blaming the hospital or the doctor. Try to give them space to sort things out and accommodate them with understanding. Everyone heals at their own pace, so your respect is an important buffer for them to feel supported and loved to learn to make peace with their bereavement. 

 “The reality is that you will grieve forever. You will not get over the loss of the loved one; you’ll learn to live with it. You will heal and you will rebuild yourself around the loss you have suffered. You will be whole again but you will never be the same. Nor should you be the same nor would you want to.” – On Grief & Grieving, Kübler-Ross and Kessler

It is a heartbreaking part of the journey. But aren’t we blessed to ever have someone or something that was so hard to let go of in this life?


Kübler-Ross, E., & Kessler, David. (2014). On grief & grieving : finding the meaning of grief through the five stages of loss (Scribner trade pbk. ed.). Scribner.

Rosner, Rita, Rimane, Eline, Vogel, Anna, Rau, Jörn, & Hagl, Maria. (2018). Treating prolonged grief disorder with prolonged grief-specific cognitive behavioral therapy: Study protocol for a randomized controlled trial. Trials19(1), 241–241.

Megan Chang


If you would like to speak with a counsellor about how we can support you, please contact us.

Find out more about Megan here.

Other Articles:

Talking About Eating Disorders

No Bad Parts

No Bad Parts

I really enjoy watching the Disney movie “Inside Out,” and I often recommend the film to my clients. The protagonist of the movie is a little girl named Riley and her emotions – Joy, Sadness, Anger, Disgust, and Fear. These emotional characters help Riley face her daily trials and tribulations. For instance when Anger takes over the console of the mind, Riley starts throwing temper tantrums. Our emotions are similar to having these characters inside us, when different Parts become dominant, different thoughts and beliefs, carried by their perspective Parts, may have control over our behaviours. The modality called the Internal Family Systems (IFS) refers to our inner characters as Parts, which are like family members within us, who interact or argue with each other as our family members sometimes will do in real life.

In the book “No Bad Parts”, Dr. Richard Schwartz, the creator of IFS, talks about how Parts can be divided into the three main categories below:

Exiles: Exiles take on the painful emotions of past traumatic events. They often act like a wounded child, being exiled deep inside our psyche, feeling unloved, worthless, shame, and emptiness. In order to ensure that the Exiles are hidden from our consciousness, the Parts that are called Managers and Firefighters are forced to be generated.

Managers: Managers are protectors who try to control everything in our lives, ensuring that we don’t come in contact with our vulnerable or traumatic experiences, and avoiding emotions that we don’t want to experience again. The Critic is a common type of Manager that only sees mistakes and uses criticism as a means to help, thereby motivating us to attain higher job achievements, greater wealth, and positive affirmations. There are also other types of Managers such as Workaholics, Perfectionists, and the Highly Educated one to name a few, but no matter how hard these managers try, they can never heal their Exiled inner child.

Firefighters: Firefighters are a different kind of protector. If the Manager is there to prevent any incentives that can trigger the Exile, the Firefighters mission is to put out the fires at any cost when the Exile’s pain is triggered. The Firefighters will numb or escape painful feelings with more aggressive actions than what the Managers use, such as addictive behaviours with alcohol or drug use, eating disorders, sex, self-harm or even suicide, in extreme cases.

Now let’s pause for a moment and examine our different Parts. I may have a Part that wants to lose weight, while at the same time, I have another Part that tells me I must dine at a buffet. It is also possible when a Part wants to take a good rest, but another Part suddenly tells us not to relax in order to achieve success in our pursuits. I have a client who has several internal Parts and are working very hard every day. For example, when the Hard Working Part is writing a business proposal, Anxiety might interfere by saying, “Are you sure you can meet the deadline? Will the client like this proposal?” Meanwhile the Critic Part also might say, “Why are you so stupid? You can’t do anything well.” When facing the discomfort caused by Anxiety, Play might suggest watching TV, swiping the phone or playing video games. Then Smoking may invite you to enjoy a cigarette, and Binge Eating may start ordering lots of takeout. These Parts appear just to divert attention and escape to face anxiety.

Many psychology modalities try to correct these so-called negative behaviours or thoughts in different ways, but IFS believes that we do not need to push away these emotions or behaviours that might be dragging our lives down, nor is it necessary to beg these Parts to change. Just like the Movie “Inside out”, Joy tries to push Sadness away from Riley’s life, but in the end, she accepts Sadness for who she is, understanding that she serves an important purpose in Riley’s life. Joy is only one element of true happiness, Sadness and other painful emotions make life more meaningful. 

IFS believes that every Part is there with good intentions, and even with extreme, sometimes seemingly unhelpful or destructive actions like Managers and Firefighters, they are doing their best to protect us. Through listening, understanding, and discovering the purpose of each inner Part, we can improve their mutual relationships. When we find our true self (Self) who is caring, curious, empathic, and compassionate, as the leader of the internal family, the healing journey begins. 

​If you would like to speak with a counsellor about how we can support you, please contact us.

Articles by Cecilia:

Coping with Grief at Christmas

Coping with Grief at Christmas

Coping with Grief at Christmas

During the festive season, it is not unusual to feel increased sadness when you are grieving the loss of a loved one. It is during major festivals that people get together and being with family and friends is a part of the celebration. As a result, when you have lost someone, the loss is accentuated during this period.  It is not unusual to feel sad at this time and allowing yourself to feel the grief is a part of the healing process.

Change your Thinking

However you can also engage in other ways to help you cope. By doing this you will be helping yourself, those around you and the family & friends who are trying to help you cope.  It may be difficult for you to celebrate while missing a person you loved dearly. Indeed, you may feel guilty as you believe it is not correct for you to be happy at this time.  However, that may not be the correct way to think: being happy does not mean you miss a person less. Of course you miss them terribly but that does not preclude you from enjoying, for example, a Christmas celebration with other family members or friends. Getting together with family and friends may be the perfect time to remember the good times and to laugh as you recall happy memories of the one you have lost.

Other things to do that might help:

  • Spend some time reflecting on the happy times you had together.
  • Visit a favourite place that you enjoyed going to.
  • Talk about these happy times with other people.
  • Look at photographs and remember the person with love and joy.
  • Write a letter to the person, letting them know how you feel.

Do not Deny What you are Feeling

The main thing is that you do not deny how you are feeling. Just accept the feelings and emotions that may be causing you the increased feelings of sadness. If you need to cry, then cry. If you find yourself laughing then laugh.  Just give yourself permission to grieve the way that suits you best.  Your family and friends will understand and so will the one you mourn. In fact if you could ask them, they would encourage you. Grief is not something that can be set aside to suit the time of year.  It is real and you have to allow yourself to experience it, in whatever way suits you.  If that means you find yourself celebrating with family and friends and enjoying the festive period as you celebrate and remember the great times past, then go for it.  It may also result in you crying at times, then that is acceptable as well. 

Remember, other people will understand the pain you are dealing with and will be there to support you. Don’t turn away – take their helping hand and allow yourself to be a part of the celebration in the way that suits you best.  People that love and care for you will understand and help during this  time of year.

Increasing Effectiveness of Psychotherapy

Increasing Effectiveness of Psychotherapy

How To Increase Effectiveness of Psychotherapy

It is not the easiest of tasks to keep a client in therapy and psychotherapy is no different when it comes to client retention. Barry Duncan PhD and Scott Miller PhD the co-founders of the Institute for the Study of Therapeutic Change have conducted a thorough investigation into how practitioners may be able to increase their effectiveness by recognising and identifying those clients that are not responding to therapy. Using case study examples within a clinical practice they demonstrate the practical application of Outcome-Informed and Client-Directed approaches. Increasing Effectiveness of Psychotherapy

As they mention in their article below most therapists want to help people. If a therapist can be guided how to do that in a practical and long-term way then the chances of patient response and recovery would be increased. As is said at the end of the article:

“Monitoring the outcome and the fit of our services helps us know that when we are good, we are very good, and when we are bad, we can be even better.”

Increasing Effectiveness of Psychotherapy

“When I’m good, I’m very good, but when I’m bad I’m better” –A New Mantra for Psychotherapists by Barry Duncan, PhD and Scott Miller, PhD


At first blush, Mae West’s famous words ‘When I’m good, I’m very good, but when I’m bad I’m better’ hardly seem like a guide for therapists to live by—but, as it turns out, they could be. Research demonstrates consistently that who the therapist is accounts for far more of the variance of change (6 to 9 percent) than the model or technique administered (1 percent). In fact, therapist effectiveness ranges from a paltry 20 percent to an impressive 70 percent. A small group of clinicians—sometimes called ‘supershrinks’—obtain demonstrably superior outcomes in most of their cases, while others fall predictably on the less-exalted sections of the bell-shaped curve. However, most practitioners can join the ranks of supershrinks, or at least increase their therapeutic effectiveness substantially.

Consider Matt, a twenty-something software whiz who was on the road frequently to trouble-shoot customer problems. Matt loved his job but travelling was an ordeal—not because of flying but because of another, far more embarrassing problem. Matt was long past feeling frustrated about standing and standing in public restrooms trying to ‘go.’ What started as a mild discomfort and inconvenience easily solved by repeated restroom visits had progressed to full-blown anxiety attacks, an excruciating pressure, and an intense dread before each trip. Feeling hopeless and demoralized, Matt considered changing jobs but as a last resort decided instead to see a therapist.

Matt liked the therapist and it felt good finally to tell someone about the problem. The therapist worked with Matt to implement relaxation and self-talk strategies. Matt practiced in session and tried to use the ideas on his next trip, but still no ‘go.’ The problem continued to get worse. Now three sessions in, Matt was at significant risk for a negative outcome—either dropping out or continuing in therapy without benefit.

We have all encountered clients unmoved by treatment. Therapists often blame themselves. The overwhelming majority of psychotherapists, as cliched as it sounds, want to be helpful. Many of us answered “I want to help people” on graduate school applications as the reason we chose to be therapists. Often, some well-meaning person dissuaded us from that answer because it didn’t sound sophisticated or appeared too ‘co-dependent.’ Such aspirations, we now believe, are not only noble but can provide just what is needed to improve clinical effectiveness. After all, there is not much financial incentive for doing better therapy—we don’t do this work because we thought we would acquire the lifestyles of the rich and famous.

Unfortunately, the altruistic desire to be helpful sometimes leads us to believe that if we were just smart enough or trained correctly, clients would not remain inured to our best efforts—if we found the Holy Grail, that special model or technique, we could once and for all defeat the psychic dragons that terrorize clients. Amid explanations and remedies aplenty, therapists search courageously for designer explanations and brand-name miracles, but continue to observe that clients drop out, or even worse, continue without benefit.Amid explanations and remedies aplenty, therapists search courageously for designer explanations and brand-name miracles, but continue to observe that clients drop out, or even worse, continue without benefit. Current estimates suggest that nearly 50 percent of our clients drop out and at least one third, and up to two thirds, do not benefit from our usual strategies.

So what can we do to channel our healthy desire to be helpful? If we listen to the lessons of the top performers, the first thing we should do is step outside of our comfort zones and push the limits of our current performance—to identify accurately those clients not responding to our therapeutic business as usual, and address the lack of change in a way that keeps clients engaged in treatment and forges new directions.

To recapture those clients who slip through the cracks, we need to embrace what is known about change: Many studies reveal that the majority of clients experience change in the first six visits—clients reporting little or no change early on tend to show no improvement over the entire course of therapy, or wind up dropping out. Early change, in other words, predicts engagement in therapy and ongoing benefit. This doesn’t mean that a client is ‘cured’ or the problem is totally resolved, but rather that the client has a subjective sense that things are getting better. And second, a mountain of studies have long demonstrated another robust predictor—that reliable, tried-and-true but taken-for-granted old friend—the therapeutic alliance. Clients who highly rate the relationship with their therapist tend to be those clients who stick around in therapy and benefit from it.

Next we need to measure those known predictors in a systematic way with reliable and valid instruments. So instead of regarding the first few therapy sessions as a ‘warm-up’ period or a chance to try out the latest technique, we engage the client in helping us judge whether therapy is providing benefit. Obtaining feedback on standardized measures about success or failure during those initial meetings provides invaluable information about the match between ourselves, our approach, and the client—enabling us to know when we are bad, so we can be even better. The only way we can improve our outcomes is to know, very early on, when the client is not benefiting—we need something akin to an early warning signal.

Using standardized measures to monitor outcome may make your skin crawl and bring to mind torture devices like the Rorschach or MMPI. But the forms for these measures are not used to pass judgment, diagnose or unravel the mysteries of the human psyche. Rather, these measures invite clients into the inner circle of mental health and substance abuse services—they involve clients collaboratively in monitoring progress toward their goals and the fit of the services they are receiving, and amplify their voices in any decisions about their care.

The Outcome Rating Scale (ORS)

You might also think that the last thing you need is to add more paperwork to your practice. But finding out who is and isn’t responding to therapy need not be cumbersome. In fact, it only takes a minute. Dissatisfied with the complexity, length, and user- unfriendliness of existing outcome measures, we developed the Outcome Rating Scale (ORS) as a brief clinical alternative. The ORS (child measures also available) and all the measures discussed here are available for free download at The ORS assesses three dimensions:

  • Personal or symptomatic distress (measuring individual well-being)
  • Interpersonal well-being (measuring how well the client is getting along in intimate relationships)
  • Social role (measuring satisfaction with work/school and relationships outside of the home)

Changes in these three areas are considered widely to be valid indicators of successful outcome. The ORS simply translates these three areas and an overall rating into a visual analog format of four 10-cm lines, with instructions to place a mark on each line with low estimates to the left and high to the right. The four 10-cm lines add to a total score of 40. The score is simply the summation of the marks made by the client to the nearest millimeter on each of the four lines, measured by a centimeter ruler or available template. A score of 25, the clinical cutoff, differentiates those who are experiencing enough distress to be in a helping relationship from those who are not. Because of its simplicity, ORS feedback is available immediately for use at the time the service is delivered. Rated at an eighth-grade reading level, the ORS is understood easily and clients have little difficulty connecting it their day-to-day lived experience.

Matt completed the ORS before each session. He entered therapy with a score of 18, about average for those attending outpatient settings, but continued to hover at that score. At the third session, when the ORS reflected no change, it was not front-page news to Matt. But a different process ensued. In the same spirit of collaboration as the assessment process, Matt and his therapist brainstormed ideas, a free-for-all of unedited speculations and suggestions of alternatives, from changing nothing about the therapy to taking medication to shifting treatment approaches. During this open exchange Matt intimated that he was beginning to feel angry about the whole thing—real angry. The therapist noticed that when Matt worked himself up to a good anger—about how his problem interfered with his work and added a huge hassle in any extended situation away from his own bathroom—that he became quite animated, a stark contrast to the passively resigned person that had characterized their previous sessions. One of them, which one remains a mystery, mentioned the words ‘pissed off’ and both broke into a raucous laughter. Subsequently, the therapist suggested that instead of responding with hopelessness when the problem occurred, that Matt work himself up to a good anger—about how this problem made his life miserable. Matt added (he was a rock-and-roll buff) that he could also sing the Tom Petty song “Won’t Back Down” during his tirade at the toilet. Matt allowed himself, when standing in front of the urinal to become incensed—downright ‘pissed off,’ and amused. And he started to go.

This process, the delightful creative energy that emerges from the wonderful interpersonal event we call therapy, could have happened to any therapist working with Matt. The difference is that the use of the outcome measure spotlighted the lack of change and made it impossible to ignore. The ORS brought the risk of a negative outcome front and center and allowed the therapist to enact the second characteristic of supershrinks, to be exceptionally alert to the risk of dropout and treatment failure. In the past, we might have continued with the same treatment for several more sessions, unaware of its ineffectiveness or believing (hoping, even praying) that our usual strategies would eventually take hold, but the reliable outcome data pushed us to explore different treatment options by the end of the third visit.

Pushing the limits of one’s performance requires monitoring the fit of your service with the client’s expectations about the alliance. The ongoing assessment of the alliance enables therapists to identify and correct areas of weakness in the delivery of services before they exert a negative effect on outcome.

The Session Rating Scale (SRS)

Research shows repeatedly that clients’ ratings of the alliance are far more predictive of improvement than the type of intervention or the therapist’s ratings of the alliance. Recognizing these much-replicated findings, we developed the Session Rating Scale (SRS) as a brief clinical alternative to longer research-based alliance measures to encourage routine conversations with clients about the alliance. The SRS also contains four items. First, a relationship scale rates the meeting on a continuum from “I did not feel heard, understood, and respected” to “I felt heard, understood, and respected.” Second is a goals and topics scale that rates the conversation on a continuum from “We did not work on or talk about what I wanted to work on or talk about” to “We worked on or talked about what I wanted to work on or talk about.” Third is an approach or method scale (an indication of a match with the client’s theory of change) requiring the client to rate the meeting on a continuum from “The approach is not a good fit for me” to “The approach is a good fit for me.” Finally, the fourth scale looks at how the client perceives the encounter in total along the continuum: “There was something missing in the session today” to “Overall, today’s session was right for me.”

The SRS simply translates what is known about the alliance into four visual analog scales, with instructions to place a mark on a line with negative responses depicted on the left and positive responses indicated on the right. The SRS allows alliance feedback in real time so that problems may be addressed. Like the ORS, the instrument takes less than a minute to administer and score. The SRS is scored similarly to the ORS, by adding the total of the client’s marks on the four 10-cm lines. The total score falls into three categories:

  • SRS score between 0–34 reflects a poor alliance,
  • SRS Score between 35–38 reflects a fair alliance,
  • SRS Score between 39–40 reflects a good alliance.

The SRS allows the implementation of the final lesson of the supershrinks—seek, obtain, and maintain more consumer engagement. Clients drop out of therapy for two reasons: one is that therapy is not helping (hence monitoring outcome) and the other is alliance problems—they are not engaged or turned on by the process. The most direct way to improve your effectiveness is simply to keep people engaged in therapy.

An alliance problem that occurs frequently emerges when client’s goals do not fit our own sensibilities about what they need. This may be particularly true if clients carry certain diagnoses or problem scenarios. Consider 19-year-old Sarah, who lived in a group home and received social security disability for mental illness. Sarah was referred for counselling because others were concerned that she was socially withdrawn. Everyone was also worried about Sarah’s health because she was overweight and spent much of her time watching TV and eating snack foods.

In therapy Sarah agreed that she was lonely, but expressed a desire to be a Miami Heat cheerleader. Perhaps understandably, that goal was not taken seriously. After all, Sarah had never been a cheerleader, was ‘schizophrenic,’ and was not exactly in the best of shape. So no one listened, or even knew why Sarah had such an interesting goal. And the work with Sarah floundered. She spoke rarely and gave minimal answers to questions. In short, Sarah was not engaged and was at risk for dropout or a negative outcome.

The therapist routinely gave Sarah the SRS and she had reported that everything was going swimmingly, although the goals scale was an 8.7 out of 10, instead of a 9 or above out of 10 like the rest.

Sometimes it takes a bit more work to create the conditions that allow clients to be forthright with us, to develop a culture of feedback in the room. The power disparity combined with any socioeconomic, ethnic, or racial differences make it difficult to tell authority figures that they are on the wrong track. Think about the last time you told your doctor that he or she was not performing well. Clients, however, will let us know subtly on alliance measures far before they will confront us directly.

At the end of the third session, the therapist and Sarah reviewed her responses on the SRS. Did she truly feel understood? Was the therapy focused on her goals? Did the approach make sense to her? Such reviews are helpful in fine-tuning the therapy or addressing problems in the therapeutic relationship that have been missed or gone unreported. Sarah, when asked the question about goals, all the while avoiding eye contact and nearly whispering, repeated her desire to be a Miami Heat cheerleader.

The therapist looked at the SRS and the lights came on. The slight difference on the goals scale told the tale. When the therapist finally asked Sarah about her goal, she told the story of growing up watching Miami Heat basketball with her dad who delighted in Sarah’s performance of the cheers. Sarah sparkled when she talked of her father, who passed away several years previously, and the therapist noted that it was the most he had ever heard her speak. He took this experience to heart and often asked Sarah about her father. The therapist also put the brakes on his efforts to get Sarah to socialize or exercise (his goals), and instead leaned more toward Sarah’s interest in cheerleading. Sarah watched cheerleading contests regularly on ESPN and enjoyed sharing her expertise. She also knew a lot about basketball.

Sarah’s SRS score improved on the goal scale and her ORS score increased dramatically. After a while, Sarah organized a cheerleading squad for her agency’s basketball team who played local civic organizations to raise money for the group home. Sarah’s involvement with the team ultimately addressed the referral concerns about her social withdrawal and lack of activity. The SRS helps us take clients and their engagement more seriously, like the supershrinks do. Walking the path cut by client goals often reveals alternative routes that would have never been discovered otherwise.

Providing feedback to clinicians on the clients’ experience of the alliance and progress has been shown to result in significant improvements in both client retention and outcome. We found that clients of therapists who opted out of completing the SRS were twice as likely to drop out and three times more likely to have a negative outcome.We found that clients of therapists who opted out of completing the SRS were twice as likely to drop out and three times more likely to have a negative outcome. In the same study of over 6000 clients, effectiveness rates doubled. As incredible as the results appear, they are consistent with findings from other researchers.

In a 2003 meta-analysis of three studies, Michael Lambert, a pioneer of using client feedback, reported that those helping relationships at risk for a negative outcome which received formal feedback were, at the conclusion of therapy, better off than 65 percent of those without information regarding progress. Think about this for a minute. Even if you are one of the most effective therapists, for every cycle of 10 clients you see, three will go home without benefit. Over the course of a year, for a therapist with a full caseload, this amounts to a lot of unhappy clients. This research shows that you can recover a substantial portion of those who don’t benefit by first identifying who they are, keeping them engaged, and tailoring your services accordingly.

The Nuts and Bolts

Collecting data on standardized measures and using what we call ‘practice-based evidence’ can improve your effectiveness substantially. “Wait a minute,” you say, “this sounds a lot like research!” Given the legionary schism between research and practice, sometimes getting therapists to do the measures is indeed a tall order because it does sound a lot like the ‘R’ word.

A story illustrates the sentiments that many practitioners feel about research. Two researchers were attending an annual conference. Although enjoying the proceedings, they decided to find some diversion to combat the tedium of sitting all day and absorbing vast amounts of information. They settled on a hot air balloon ride and were quite enjoying themselves until a mysterious fog rolled in. Hopelessly lost, they drifted for hours until a clearing in the fog appeared finally and they saw a man standing in an open field. Joyfully, they yelled down at the man, “Where are we?” The man looked at them, and then down at the ground, before turning a full 360 degrees to survey his surroundings. Finally, after scratching his beard and what seemed to be several moments of facial contortions reflecting deep concentration, the man looked up and said, “You are above my farm.”

The first researcher looked at the second researcher and said, “That man is a researcher—he is a scientist!” To which the second researcher replied, “Are you crazy, man? He is a simple farmer!” “No,” answered the first researcher emphatically, “that man is a researcher and there are three facts that support my assertion: First, what he said was absolutely 100% accurate; second, he addressed our question systematically through an examination of all of the empirical evidence at his disposal, and then deliberated carefully on the data before delivering his conclusion; and finally, the third reason I know he is a researcher is that what he told us is absolutely useless to our predicament.”

But unlike much of what is passed off as research, the systematic collection of outcome data in your practice is not worthless to your predicament. It allows you the luxury of being useful to clients who would otherwise not be helped. And it helps you to get out of the way of those clients you are not helping, and connecting them to more likely opportunities for change.

First, collaboration with clients to monitor outcome and fit actually starts before formal therapy. This means that they are informed when scheduling the first contact about the nature of the partnership and the creation of a ‘culture of feedback’ in which their voice is essential.

“I want to help you reach your goals. I have found it important to monitor progress from meeting to meeting using two very short forms. Your ongoing feedback will tell us if we are on track, or need to change something about our approach, or include other resources or referrals to help you get what you want. I want to know this sooner rather than later, because if I am not the person for you, I want to move you on quickly and not be an obstacle to you getting what you want. Is that something you can help me with?”

We have never had anyone tell us that keeping track of progress is a bad idea. There are five steps to using practice based evidence to improve your effectiveness.

Step One: Introducing the ORS in the First Session

The ORS is administered prior to each meeting and the SRS toward the end. In the first meeting, the culture of feedback is continually reinforced. It is important to avoid technical jargon, and instead explain the purpose of the measures and their rationale in a natural commonsense way. Just make it part of a relaxed and ordinary way of having conversations and working. The specific words are not important—there is no protocol that must be followed. This is a clinical tool! Your interest in the client’s desired outcome speaks volumes about your commitment to the client and the quality of service you provide.

“Remember our earlier conversation? During the course of our work together, I will be giving you two very short forms that ask how you think things are going and whether you think things are on track. To make the most of our time together and get the best outcome, it is important to make sure we are on the same page with one another about how you are doing, how we are doing, and where we are going. We will be using your answers to keep us on track. Will that be okay with you?”

Step Two: Incorporating the ORS in the first session

The ORS pinpoints where the client is and allows a comparison for later sessions. Incorporating the ORS entails simply bringing the client’s initial and subsequent results into the conversation for discussion, clarification and problem solving. The client’s initial score on the ORS is either above or below the clinical cutoff. You need only to mention the client scores as it relates to the cutoff. Keep in mind that the use of the measures is 100-percent transparent. There is nothing that they tell you that you cannot share with the client. It is their interpretation that ultimately counts.

“From your ORS it looks like you’re experiencing some real problems.” Or: “From your score, it looks like you’re feeling okay.” “What brings you here today?” Or: “Your total score is 15—that’s pretty low. A score under 25 indicates people who are in enough distress to seek help. Things must be pretty tough for you. Does that fit your experience? What’s going on?”

“The way this ORS works is that scores under 25 indicate that things are hard for you now or you are hurting enough to bring you to see me. Your score on the individual scale indicates that you are really having a hard time. Would you like to tell me about it?”

Or if the ORS is above 25: “Generally when people score above 25, it is an indication that things are going pretty well for them. Does that fit your experience? It would be really helpful for me to get an understanding of what it is that brought you here now.”

Because the ORS has face validity, clients usually mark the scale the lowest that represents the reason they are seeking therapy, and often connect that reason to the mark they’ve made without prompting from the therapist. For example, Matt marked the Individual scale the lowest with the Social scale coming in a close second. As he was describing his problem in public restrooms, he pointed to the ORS and explained that this problem accounted for his mark. Other times, the therapist needs to clarify the connection between the client’s descriptions of the reasons for services and the client’s scores. The ORS makes no sense unless it is connected to the described experience of the client’s life. This is a critical point because clinician and client must know what the mark on the line represents to the client and what will need to happen for the client to both realize a change and indicate that change on the ORS.

At some point in the meeting, the therapist needs only to pick up on the client’s comments and connect them to the ORS:

“Oh, okay, it sounds like dealing with the loss of your brother (or relationship with wife, sister’s drinking, or anxiety attacks, etc.) is an important part of what we are doing here. Does the distress from that situation account for your mark here on the individual (or other) scale on the ORS? Okay, so what do you think will need to happen for that mark to move just one centimeter to the right?”

The ORS, by design, is a general outcome instrument and provides no specific content other than the three domains. The ORS offers only a bare skeleton to which clients must add the flesh and blood of their experiences, into which they breathe life with their ideas and perceptions. At the moment in which clients connect the marks on the ORS with the situations that are distressing, the ORS becomes a meaningful measure of their progress and potent clinical tool.

Step Three: Introducing the SRS

The SRS, like the ORS, is best presented in a relaxed way that is integrated seamlessly into your typical way of working. The use of the SRS continues the culture of client privilege and feedback, and opens space for the client’s voice about the alliance. The SRS is given at the end of the meeting, but leaving enough time to discuss the client’s responses.

“Let’s take a minute and have you fill out the form that asks for your opinion about our work together. It’s like taking the temperature of our relationship today. Are we too hot or too cold? Do I need to adjust the thermostat? This information helps me stay on track. The ultimate purpose of using these forms is to make every possible effort to make our work together beneficial. Is that okay with you?”

Step Four: Incorporating the SRS

Because the SRS is easy to score and interpret, you can do a quick visual check and integrate it into the conversation. If the SRS looks good (score more than 9 cm on any scale), you need only comment on that fact and invite any other comments or suggestions. If the client marks any scales lower than 9 cm, you should definitely follow up. Clients tend to score all alliance measures highly, so the practitioner should address any hint of a problem. Anything less than a total score of 36 might signal a concern, and therefore it is prudent to invite clients to comment. Keep in mind that a high rating is a good thing, but it doesn’t tell you very much. Always thank the client for the feedback and continue to encourage their open feedback. Remember that unless you convey you really want it, you are unlikely to get it.

And know for sure that there is no ‘bad news’ on these forms. Your appreciation of any negative feedback is a powerful alliance builder. In fact, alliances that start off negatively but result in your flexibility to client input tend to be very predictive of a positive outcome. When you are bad, you are even better! In general, a score:

  • that is poor and remains poor predicts a negative outcome,
  • that is good and remains good predicts a positive outcome,
  • that is poor or fair and improves predicts a positive outcome even more,
  • that is good and decreases is predictive of a negative outcome.

The SRS allows the opportunity to fix any alliance problems that are developing and shows that you do more than give lip service to honoring the client’s perspectives.

“Let me just take a look at this SRS—it’s like a thermometer that takes the temperature of our meeting here today. Great, looks like we are on the same page, that we are talking about what you think is important and you believe today’s meeting was right for you. Please let me know if I get off track, because letting me know would be the biggest favor you could do for me.”

“Let me quickly look at this other form here that lets me know how you think we are doing. Okay, seems like I am missing the boat here. Thanks very much for your honesty and giving me a chance to address what I can do differently. Was there something else I should have asked you about or should have done to make this meeting work better for you? What was missing here?”

Graceful acceptance of any problems and responding with flexibility usually turns things around. Again, clients reporting alliance problems that are addressed are far more likely to achieve a successful outcome—up to seven times more likely! Negative scores on the SRS, therefore, are good news and should be celebrated. Practitioners who elicit negative feedback tend to be those with the best effectiveness rates. Think about it—it makes sense that if clients are comfortable enough with you to express that something isn’t right, then you are doing something very right in creating the conditions for therapeutic change.

Step Five: Checking for change in subsequent sessions

With the feedback culture set, the business of practice-based evidence can begin, with the client’s view of progress and fit really influencing what happens. Each subsequent meeting compares the current ORS with the previous one and looks for any changes. The ORS can be made available in the waiting room or via electronic software (ASIST) and web systems ( Many clients will complete the ORS (some will even plot their scores on provided graphs) and greet the therapist already discussing the implications. Using a scale that is simple to score and interpret increases client engagement in the evaluation of the services. Anything that increases participation is likely to have a beneficial impact on outcome.

The therapist discusses if there is an improvement (an increase in score), a slide (a decrease in score), or no change at all. The scores are used to engage the client in a discussion about progress, and more importantly, what should be done differently if there isn’t any.

“Your marks on the personal well-being and overall lines really moved—about 4 cm to the right each! Your total increased by 8 points to 29 points. That’s quite a jump! What happened? How did you pull that off? Where do you think we should go from here?”

If no change has occurred, the scores invite an even more important conversation.

“Okay, so things haven’t changed since the last time we talked. How do you make sense of that? Should we be doing something different here, or should we continue on course steady as we go? If we are going to stay on the same track, how long should we go before getting worried? When will we know when to say ‘when?’ “

The idea is to involve the client in monitoring progress and the decision about what to do next. The discussion prompted by the ORS is repeated in all meetings, but later ones gain increasing significance and warrant additional action. We call these later interactions either checkpoint conversations or last-chance discussions. In a typical outpatient setting, checkpoint conversations are conducted usually at the third meeting and last-chance discussions are initiated in the sixth session. This is simply saying that based on over 300,000 administrations of the measures, by the third encounter most clients who do receive benefit from services usually show some benefit on the ORS; and if change is not noted by meeting three, then the client is at a risk for a negative outcome. Ditto for session six except that everything just mentioned has an exclamation mark. Different settings could have different checkpoints and last-chance numbers. Determining these highlighted points of conversation requires only that you collect the data. The calculations are simple and directions can be found in our book, The Heroic Client. Establishing these two points helps evaluate whether a client needs a referral or other change based on a typical successful client in your specific setting. The same thing can be accomplished more precisely by available software or web-based systems that calculate the expected trajectory or pattern of change based on our data base of ORS administrations. These programs compare a graph of the client’s session-by-session ORS results to the expected amount of change for clients in the data base with the same intake score, serving as a catalyst for conversation about the next step in therapy.

If change has not occurred by the checkpoint conversation, the therapist responds by going through the SRS item by item. Alliance problems are a significant contributor to a lack of progress. Sometimes it is useful to say something like, “It doesn’t seem like we are getting anywhere. Let me go over the items on this SRS to make sure you are getting exactly what you are looking for from me and our time together.” Going through the SRS and eliciting client responses in detail can help the practitioner and client get a better sense of what may not be working. Sarah, the woman who aspired to be a Miami Heat cheerleader, exemplifies this process.

Next, a lack of progress at this stage may indicate that the therapist needs to try something different. This can take as many forms as there are clients: inviting others from the client’s support system, using a team or another professional, a different approach; referring to another therapist, religious advisor, or self-help group—whatever seems to be of value to the client. Any ideas that surface are then implemented, and progress is monitored via the ORS. Matt and the idea of encouraging his anger illustrate this kind of discussion.

The Importance of Referrals – Psychotherapy

If the therapist and client have implemented different possibilities and the client is still without benefit, it is time for the last-chance discussion. As the name implies, there is some urgency for something different because most clients who benefit have already achieved change by this point, and the client is at significant risk for a negative conclusion. A metaphor we like is that of the therapist and client driving into a vast desert and running on empty, when a sign appears on the road that says ‘last chance for gas.’ The metaphor depicts the necessity of stopping and discussing the implications of continuing without the client reaching a desired change.

This is the time for a frank discussion about referral and other available resources. If the therapist has created a feedback culture from the beginning, then this conversation will not be a surprise to the client. There is rarely justification for continuing work with clients who have not achieved change in a period typical for the majority of clients seen by a particular practitioner or setting.

Why? Because research shows no correlation between a therapy with a poor outcome and the likelihood of success in the next encounter. Although we’ve found that talking about a lack of progress turns most cases around, we are not always able to find a helpful alternative.

Where in the past we might have felt like failures when we weren’t being effective with a client, we now view such times as opportunities to stop being an impediment to the client and their change process.Where in the past we might have felt like failures when we weren’t being effective with a client, we now view such times as opportunities to stop being an impediment to the client and their change process. Now our work is successful when the client achieves change and when, in the absence of change, we get out of their way. We reiterate our commitment to help them achieve the outcome they desire, whether by us or by someone else. When we discuss the lack of progress with clients, we stress that failure says nothing about them personally or their potential for change. Some clients terminate and others ask for a referral to another therapist or treatment setting. If the client chooses, we will meet with her or him in a supportive fashion until other arrangements are made. Rarely do we continue with clients whose ORS scores show little or no improvement by the sixth or seventh visit.

Ending with clients who are not making progress does not mean that all therapy should be brief. On the contrary, our research and the findings of virtually every study of change in therapy over the last 40 years provide substantial evidence that more therapy is better than less therapy for those clients who make progress early in treatmentfindings of virtually every study of change in therapy over the last 40 years provide substantial evidence that more therapy is better than less therapy for those clients who make progress early in treatment and are interested in continuing. When little or no improvement is forth coming, however, this same data indicates that therapy should, indeed, be as brief as possible. Over time, we have learned that explaining our way of working and our beliefs about therapy outcomes to clients avoids problems if therapy is unsuccessful and needs to be terminated.

Barry Duncan writes: But it can be hard to believe that stopping a great relationship is the right thing to do.

Alina sought services because she was devastated and felt like everything important to her had been savagely ripped apart—because it had. She worked her whole life for but one goal, to earn a scholarship to a prestigious Ivy-league university. She was captain of the volleyball team, commanded the first position on the debating team, and was valedictorian of her class. Alina was the pride of her Guatemalan community—proof positive of the possibilities her parents always envisioned in the land of opportunity. Alina was awarded a full ride in minority studies at Yale University. But this Hollywood caliber story hit a glitch. Attending her first semester away from home and the insulated environment in which she excelled, Alina began hearing voices.

She told a therapist at the university counseling center and before she knew it she was whisked away to a psychiatric unit and given antipsychotic medications. Despondent about the implications of this turn of events, Alina threw herself down a stairwell, prompting her parents to bring her home. Alina returned home in utter confusion, still hearing voices, and with a belief that she was an unequivocal failure to herself, her family, and everyone else in her tightly knit community whose aspirations rode on her shoulders.

Serendipity landed Alina in my office. I was the twentieth therapist the family called and the first who agreed to see Alina without medication. Alina’s parents were committed to honor her preference to not take medication. We were made for each other and hit it off famously. I loved this kid. I admired her intelligence and spunk in standing up to psychiatric discourse and the broken record of medication. I couldn’t wait to be useful to Alina and get her back on track. When I administered the ORS, Alina scored a 4, the lowest score I’d ever had.

We discussed her total demoralization and how her episodes of hearing voices and confusion led to the events that took everything she had always dreamed of from her—the life she had worked so hard to prepare for. I did what I usually did that is helpful—I listened, I commiserated, I validated, and I worked hard to recruit Alina’s resilience to begin anew. But nothing happened.

By session three, Alina remained unchanged in the face of my best efforts. Therapy was going nowhere and I knew it because the ORS makes it hard to ignore—that score of 4 was a rude reminder of just how badly things were going.

At the checkpoint session, I went over the SRS with her, and unlike many clients, Alina was specific about what was missing and revealed that she wanted me to be more active, so I was. She wanted ideas about what to do about the voices, so I provided them—thought stopping, guided imagery, content analysis. But, no change ensued and she was increasingly at risk for a negative outcome. Alina told me she had read about hypnosis on the internet and thought that might help. Since I had been around in the ’80s and couldn’t escape that time without hypnosis training, I approached Alina from a couple of different hypnotic angles—offering both embedded suggestions as well as stories intended to build her immunity to the voices. She responded with deep trances and gave high ratings on the SRS. But the ORS remained a paltry 4.

At the last-chance conversation, I brought up the topic of referral but we settled instead on a consult from a team (led by Jacqueline Sparks). Alina, again, responded well, and seemed more engaged than I had noticed with me—she rated the session the highest possible on the SRS. The team addressed topics I hadn’t, including differentiation from her family, as well as gender and ethnic issues. Alina and I pursued the ideas from the team for a couple more sessions. But her ORS score was still a 4.

Now what? We were in session nine, well beyond how clients typically change in my practice. After collecting data for several years, I know that 75 percent of clients who benefit from their work with me show it by the third session; a full 98 per cent of my clients who benefit do it by the sixth session. So is it right that I continue with Alina? Is it even ethical?

Despite our mutual admiration society, it wasn’t right to continue. A good relationship in the absence of benefit is a good definition of dependence. So I shared my concern that her dream would be in jeopardy if she continued seeing me. I emphasized that the lack of change had nothing to do with either of us, that we had both tried our best, and for whatever reason, it just wasn’t the right mix for change. We discussed the possibility that Alina see someone else. If you watch the video, you would be struck, as many are, by the decided lack of fun Alina and I have during this discussion.

Finally, after what seemed like an eternity, including Alina’s assertion that she wanted to keep seeing me, we started to talk about who she might see. She mentioned she liked someone from the team, and began seeing our colleague Jacqueline Sparks.

By session four, Alina had an ORS score of 19 and enrolled to take a class at a local university. Moreover, she continued those changes and re-enrolled at Yale the following year with her scholarship intact! When I wrote a required recommendation letter for the Dean, I administered the ORS to Alina and she scored a 29. By my getting out of her way and allowing her and myself to ‘fail successfully,’ Alina was given another opportunity to get her life back on track—and she did. Alina and Jacqueline, for reasons that escape us even after pouring over the video, just had the right chemistry for change.

This was a watershed client for me. Although I believed in practice-based evidence, especially how it puts clients center stage and pushes me to do something different when clients don’t benefit, I always struggled with those clients who did not benefit, but who wanted to continue with me nevertheless. This was more difficult when I really liked the client and had become personally invested in them benefiting. Alina awakened me to the pitfalls of such situations and showed a true value-added dimension to monitoring outcome—namely the ability to fail successfully with our clients. Alina was the kind of client I would have seen forever. I cared deeply about her and believed that surely I could figure out something eventually.

But such is the thinking that makes ‘chronic’ clients—an inattention to the iatrogenic effects of the continuation of therapy in the absence of benefit. Therapists, no matter how competent or trained or experienced, cannot be effective with everyone, and other relational fits may work out better for the client. Although some clients want to continue in the absence of change, far more do not want to continue when given a graceful way to exit. The ORS allows us to ask ourselves the hard questions when clients are not, by their own ratings, seeing benefit from services. The benefits of increased effectiveness of my work, and feeling better about the clients that I am not helping, have allowed me to leave any squeamishness about forms far behind.

Practice-based evidence will not help you with the clients you are already effective with; rather, it will help you with those who are not benefiting by enabling an open discussion of other options and, in the absence of change, the ability to honorably end and move the client on to a more productive relationship. The basic principle behind this way of working is that our day-to-day clinical actions are guided by reliable, valid feedback about the factors that account for how people change in therapy. These factors are the client’s engagement and view of the therapeutic relationship, and—the gold standard—the client’s report of whether change occurs. Monitoring the outcome and the fit of our services helps us know that when we are good, we are very good, and when we are bad, we can be even better.


Psychotherapy Net

Psychotherapy in Australia.

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Thinking is an Addiction

Thinking is an Addiction

Why Thinking is an Addiction?

Thinking is an Addiction and during Psychotherapy not thinking gives away the best clues to what is wrong. If you have ever tried to give up an addiction it would not have taken you long to appreciate that addictions are hard to overcome.  In this short video Eckhart Tolle discusses the phenomena of excessive thinking and he says quite clearly that thinking is an addiction.  A thinking addiction is a lot harder to break than smoking or drinking according to Tolle.  One of the reasons he believes this is so; thinking is part of our pseudo self. As a result many of us do not want to let go of our thoughts. During a Psychotherapy Session it is often when the client goes blank and stops thinking that the truth emerges through their unconscious or unthinking actions and words.  Thinking is an Addiction-Psychotherapy

Being in the present moment is one way to prevent the thinking addiction and Tolle discusses other ways you can stop those excessive thoughts. A short but very informative video presentation by Eckhart Tolle.

How to break the habit of excessive thinking?

What Bullying Does

What Bullying Does

If you wonder why you allow yourself to be bullied as an adult have a look at this video of a child describing when she was bullied on the school bus.  If a child is not supported when he or she is bullied it can have devastating consequences.  The effects of the bullying are not good at the time of the event but their effects may be felt for years afterwards. This is a very poignant video that shows the lack of support that was given to a little girl from the Principal, Bus Driver and Law Enforcement Officer, These people are looked up to by all children and so their lack of help would have been all the more devastating for this child. They did not support this little girl as they discredited her words and  they make no attempt to stop the bullying.  The fact that the officer almost called her a liar by saying ‘the bus driver would not do that’ further undermines her confidence and trust.   This a very sad thing for an eight year old to go through and unless the emotional trauma is dealt with appropriately as she grows up she will forever be affected and wounded by this event. What Bullying Does

This wound will cause her all sorts of problems in her life.  Bullying can eventually lead to depression and fear, it has to be addressed and stopped at the source.  Thank goodness the mother supported her child and no doubt that will be a comfort to the little girl. Indeed, I wonder how the mum  continued to video as she must have been feeling absolutely awful. However it is great that the mum decided to do something about the bullying and the little brother, well he was quite amazing. This video of the 8-year-old girl’s giving her heartbreaking account of being bullied went viral, garnering more than 22,000 views in just a 24-hour period which demonstrates how interested people are in the subject of bullying.

We are all subjected to bullying at different levels. It can happen when shopping, walking down the street, at work and often at home.  Bullying can manifest in every avenue of life.

However, bullies can only exist if there is someone to bully and the type of person that gets bullied  tends to lack assertiveness and at an unconscious level seems to radiate fear. So when a person allows him or herself to be bullied, s/he must have some long-term fearful memory within their psyche. This memory is very fearful and as a result it does not allow them to stand up to the bully. Or, when they try to, it only takes a breath of wind for them to crumble.

If you find yourself crumbling when you try and stand up to being bullied remember this little girl and how unjust you think her treatment has been.  Then reflect on your own life and appreciate as an adult you have the tools to correct any childhood bullying you have experienced, You do that by not crumbling, instead you appreciate you are a grown-up. You re more than capable of standing up for yourself – you have a voice that will be heard. If necessary you can give back as good as you got – a bit like the little brother seems to have done.

Good luck and if you have any inspiring stories to tell – post them to our Facebook Kumara Healing Connections community and help other adults overcome their fear of bullying.

The Power of Silence

The Power of Silence

The Power of Silence

Modern humans have lost touch with their inner ‘true self’ says Steve Taylor Ph.D  a lecturer in psychology at Leed University, UK. In his article below, Steve says that: “Silence and stillness are a means to recovering happiness and contentment. In the modern world silence has practically ceased to exist.” which few of us can deny when we reflect on our daily busyness.  The Power of Silence

The human race has stamped its authority over the planet Earth not just by covering its surface with concrete and destroying its plant and animal life, but also by burying the natural sounds of the Earth beneath a cacophony of man-made noise. We live our lives against the background of this cacophony, with the jagged mechanical sounds of urban-industrial society continually assaulting our ears: the roar of trucks, aeroplanes and trains, the clanging and thudding of machinery, the noise of building and renovating, the chatter of radios and TVs in other people’s cars and houses, and pop music blaring from every conceivable place.

But nothing, of course, has done more to obliterate silence than the car. In the modern world it’s very difficult to go anywhere where there’s no possibility of being disturbed by the sound of passing cars, and the only chance that city or town dwellers get to experience something of the quietness which existed everywhere in the pre-car world is sometimes on Sundays, when the mad rushing to and fro of modern life slows down. This quietness seems so foreign now that it seems difficult to believe that a hundred years ago and before it was everywhere all the time. Back then this quietness would even have filled the busiest city centres, which would have probably had a noise level equivalent to that of a modern small village.

There’s also more noise than ever before inside our houses. It’s unusual to go into a house nowadays where there isn’t at least one television set chattering away somewhere, even if the residents aren’t actually watching it, and other forms of home entertainment compete against TV to produce the most noise: radios, CD players, computer and video games etc. In fact the only sound which is largely absent from people’s houses nowadays is the voices of their occupants actually talking to one another.

Living in the midst of all this noise is bound to have a bad effect on us. All man-made noise is fundamentally disturbing. We find the sound of birds singing or of wind rushing through trees pleasing, but mechanical noise always jars and grates. And since we live our lives against a background of mechanical noise it follows that there’s always an undercurrent of agitation inside us, produced by the noise. This noise is certainly one of the reasons why modern life is so stressful as well. In modern life our senses are bombarded with massive amounts of external stimuli. Our fields of vision are always crowded with different (and constantly shifting) things, and our ears are bombarded with a bewildering variety of sounds — all of which clamour for our attention. Our senses have to absorb and process all this material, which takes up a lot of energy, and means that we’re liable to become drained of energy or ‘run down’ easily.

We can get out of this state by removing ourselves from all external stimuli and letting our energy-batteries naturally recharge themselves i.e., by relaxing. But there’s so much external stimuli around in the modern world and people are so unaccustomed to the absence of it that we may never be able relax properly, which could mean living in a permanently ‘run down’ state.

This lack of quietness has also meant is that people are no longer used to silence, and have even, as a result, become afraid of it. Along with inactivity, silence has become something which most people are determined to avoid at all costs, and which, when they are confronted with it, unnerves them. People have become so used to the frantic pace and the ceaseless activity of modern life that they feel uneasy when they’re left at a loose end with nothing to occupy their attention even for a few moments, and they feel equally uneasy when the noise they live their lives against the background of subsides. Why else is it that they need to have their radios and televisions chattering away in the background even when they’re not paying attention to them?

In other words, in the modern world silence has become an enemy. And this is a terrible shame, because in reality silence is one of our greatest friends, and can if it’s allowed to reveal itself to us have a powerfully beneficial effect on us.

Inner Noise

It’s not just the noise outside us which causes us problems, though, but also the noise inside us.

In the same way that the natural quietness and stillness of the world around us is always covered over with man-made noise, the natural quietness of our minds is constantly disturbed by the chattering of our ego-selves. This chattering fills our minds from the moment we wake up in the morning till the moment we go to sleep at night an endless stream of daydreams, memories, deliberations, worries, plans etc. which we have no control over and which even continues (in the form of dreams) when we fall asleep. This ‘inner noise’ has as many bad effects as the mechanical noise outside us. It actually creates problems in our lives, when we mull over tiny inconveniences or uncertainties which seem to become important just because we’re giving so much attention to them, and when we imagine all kinds of possible scenarios about future events instead of just taking them as they come. It means that we don’t live in the present, because we’re always either planning for and anticipating the future or remembering the past, “wandering about in times that do not belong to us and never thinking of the one that does” as Blaise Pascal wrote. And this constant inner chattering also means that we can never give our full attention to our surroundings and to the activities of our lives. Our attention is always partly taken up by the thoughts in our minds, so that wherever we are and whatever we’re doing we’re never completely there.

It’s probably possible to say that there’s also more of this ‘inner noise’ inside human beings than there’s ever been before. The hectic pace and the constant activity of our lives, the massive amount of external stimuli we’re bombarded with, and the barrage of information which the mass media sends our way, have made our minds more restless and active. We’ve got to juggle dozens of different problems and concerns in our minds just to get by from day to day, and every new thing we see or every new piece of information which is sent our way is potentially the beginning of a whole new train of thought to occupy our minds.

The True Self

Ultimately, the most serious consequence of both this inner chattering and the noise and activity of the modern world is that they separate us from our true selves.

Our ‘true self’ might be called the ground, or the essence, of our beings. It’s the pure consciousness inside us, the consciousness-in-itself which remains when we’re not actually conscious of anything. It’s what remains when our the activity of our senses and the activity of our minds cease. The sense-impressions we absorb from the world and the thoughts which run through our minds are like the images on a cinema screen, but our ‘true self’ is the cinema screen itself, which is still there even when there aren’t any images being projected on to it.

Experiencing this ‘consciousness-in-itself’ can have a massively therapeutic effect. It brings a sense of being firmly rooted in ourselves, of being truly who we are. We also have a sense of being truly where we are, realising that before we were only half-present, and everything we see around us seems intensely real and alive, as if our perceptions have become much more acute. But above all, we experience a profound sense of inner peace and natural happiness. As the Hindu and Buddhist traditions have always held, the nature of consciousness-in-itself (which means the consciousness inside us and the consciousness which pervades the whole universe) is bliss. Getting into contact with the pure consciousness inside us enables us, therefore, to experience this bliss. Indeed, it could be said that it’s only when we do this that we can experience true happiness. Usually what we think of as happiness is hedonistic or ego-based that is, based around pressing instinctive ‘pleasure buttons’ or around receiving attention and praise from others and increasing our self-esteem. But the kind of deep and rich happiness we experience when we’re in touch with the ground or essence of our beings is a natural, spiritual happiness, which doesn’t depend on anything external, and doesn’t vanish as soon as the thing which produced it is taken away. It’s a happiness which comes from experiencing the divine inside us and also the divine inside everything else, since the pure consciousness inside us is the same pure consciousness inside everything else, and the pure consciousness of the universe itself.

Making Contact with the True Self

Whether we’re in touch with this ‘true self’ or not depends on how much external stimuli our senses are taking in from the world around us, and on how much activity there is going on in our minds.

If there is a lot of noise, movement and activity taking place around us then we can’t help but give our attention to it; and in the same way, when there is a lot of ‘inner noise’ taking place we have to give our attention to that too. And when our attention is completely absorbed in this way either by external stimuli on their own, such as when we watch TV; by ‘inner noise’ on its own, such as when we daydream; or by both of them at the same time it’s impossible for us to be in contact with our ‘true self’ to any degree, in the same way that it’s impossible to see a cinema screen in itself when it’s full of dancing images. Being in contact with our ‘true self’ is a state of attentionless-ness, when our minds are completely empty.

What we have to do if we want to get into contact with this part of ourselves is, therefore, to withdraw our attention from these things. And this is, of course, what we do when we meditate: first of all, we remove ourselves from external stimuli, by sitting in a quiet room and closing our eyes. And then there’s only ‘inner noise’ standing between us and consciousness-in-itself, which we try to quieten by concentrating on a mantra or on our breathing. If we manage to stop the inner noise (and therefore stop our attention being absorbed in it) pure consciousness immerses us and we become our true selves.

And this brings us back to the most serious problem caused by the massive amount of external stimuli (including noise) which our senses are bombarded with in the modern world, and by the intensified ‘inner noise’ which modern life generates. It’s not just a question of completely closing yourself off to external stimuli and shutting down ‘inner noise’, so that you can experience a state of total immersion in pure consciousness. It’s possible to have a foot in both camps, so to speak; to live a normal life in the world, being exposed to external stimuli and experiencing inner noise, and at the same time still be rooted in your real self. That is, it’s possible to be partially immersed in consciousness-in-itself, and for your attention to be partially absorbed by external stimuli and inner talk. But this can only happen when there is just a moderate degree of both of the latter.

It would probably have been quite easy for our ancestors to live in this way, because they weren’t exposed to a great deal of external stimuli and because their lives were relatively slow-paced and stress-free, which would have meant that their attention needn’t have been completely absorbed by external stimuli and inner talk. Perhaps this even partly explains why native peoples seem to possess a natural contentment which modern city dwellers have lost because their more sedate lives mean that they’re able to be in touch with the ground of their being as they go about their lives, and that they can therefore continually experience something of the bliss of which is the nature of consciousness-in-itself.

For us, however, this has become very difficult. There’s always so much noise and activity both inside and outside us that our attention is always completely absorbed, so that we can’t be in contact with our real selves. We spend all our time living outside ourselves, lost in the external world of activity and stimuli or in the inner world of our own thoughts. We’re like a person who plans to go away for a few days but finds so much to occupy them in the place they go to that they never go home again, and never again experience the peace and contentment which lie there. This is certainly one of the reasons why so many people nowadays seem to live in a state of dissatisfaction — because they’ve lost touch with the natural happiness inside them. That natural happiness has been buried underneath a storm of external stimuli and what Meister Eckhart called ‘the storm of inward thought’.

As a result of this it’s essential for us, in the modern world, to go out of our way to cultivate silence ourselves. Circumstances may oblige us to live in cities, and our jobs may be stressful and demanding, but we’re still free to remove ourselves from external stimuli and to try to quieten our minds by meditating, going out into the countryside, or just by sitting quietly in our rooms. We don’t have to fill our free time with attention-absorbing distractions like TV and computer games, which take us even further away from ourselves. We should do the opposite: stop our attention being absorbed like this so that we can find ourselves again.

We need silence and stillness to become our true selves and to be truly happy. ‘Be still,’ said Jesus, ‘and know that I am God.’ But he might have added, ‘and know that you are God.’

What is the Real Meaning of Negative and Positive

What is the Real Meaning of Negative and Positive

Understanding the Positive and Negative in Life

We often look destruction as negative, we blind ourselves to the opportunities that a fresh start present us. we are so focused on what has been lost, we blind ourselves to the opportunities that a fresh start presents us. To start with let’s look at a bush fire; it is hard to comprehend, but one of the greatest things that can occur for a forest is a fire. Bush fires act to decompose dead organic matter, clear space for new growth and in some plant life it is essential for the seeds of the organism to spread. Of course viable plant life is destroyed, but without the bush fire and the new growth that ensues, the forest would eventually perish. The real meaning of negative and positive goes beyond its literal meaning.


On the second of September 1666 a fire occurred in London, this was no bushfire, this was a fire that devastated the city displacing 88% of the cities inhabitants, destroying 85% of the cities buildings and ultimately changed the course of England’s history. Was this a good thing? No. Did good things happen as a result? Yes.

The Great Fire of London, whilst being a completely negative event had positive outcomes. London at the time had just suffered the Great Plague of London (not a fantastic time for the city) killing 69, 000 people. Many historians believe that if it wasn’t for the fire wiping out the majority of rats and fleas that were carrying the virus the plague would not have ended at this time. Also had the fire not wiped out many of the slums, London would not have been rebuilt in an orderly fashion able to sustain the vast metropolis it has become today.

So now to tie this all together, destruction is bad, but we cannot blind ourselves to the good that can come out of it. We have all experienced a metaphorical fire in our life. This could come in the form of a loss of job, end of relationship or any devastating event where you lose a part of your identity. These events are horrible, there is no other way to describe them, but they are also instruments of great change.

As humans we are inclined to remain where things are comfortable, we hate veering from the norm. Sometimes it takes a drastic event for you to make necessary changes in your life. Life cannot improve without change, without risking elements of your current life to try something new. When a fire burns down a forest beautiful trees are lost, but a new forest grows. This new forest may not have so many beautiful trees, or it may have more beautiful trees, or it may have no beautiful trees and a thousand stunning flowers! The point is no matter what, there will be things in the forest to love, things you did not even realise existed until they are forced before you.

In life losing a job is hard, but there will be things in your new job you love, or you may hate your new job and try a hundred different jobs until you find something you love. Whether it takes months or years after a ‘fire’ burns through your life, a new life will grow. Mourn what you have lost, but look forward to the opportunities that are now open to you, and look with optimism on the new course of your life.

Taking something that is Negative and making it into a Positive will transform the way you live your life. Embrace happiness by being optimistic and full of hope – the first day of the rest of your life starts – NOW.

How To Reduce Stress Level By Deep Breathing

How To Reduce Stress Level By Deep Breathing

How to reduce stress level by deep breathing

Good health is not just about having a fit and toned physical body.  Good health is also about having a sound and calm mental or emotional body.  But despite the improvements in diet and working conditions the mental health of the inhabitants of 1st world countries continues its statistical decline. We may not be as physically unwell as we used to be but mentally we are not in the best of health. The decline in the health of the populations in ‘rich countries’ is due to statistics showing that people suffering from stress and mental illness is on the rise. In the USA mental health issues are one of the most common health disorders. It does not matter if you are 5 years old or 50+ years old – mental health issues, including stress is taking its toll. In this article deep breathing & stress levels you will be given some very simple tips on how to reduce stress level by deep breathing and how to keep them down. Deep Breathing & Stress Levels

Deep Breathing & Stress Levels

There have been many discussions about how to reduce stress level by deep breathing but one of the easiest and most efficient ways of reducing your stress is using the breath and learning to breathe correctly.  So read on and take a deep breath, you are about to reduce your Stress Levels through a couple of very simple meditation breathing techniques. De

It is the way you breathe, doing the meditation techniques, that will bring about a significant improvement in your health.  The shallow ‘chest breathing’ that most people do will be replaced by a deeper form of breathing. Indeed shallow breathing is not the best way to breathe during meditation or at any time. From a purely physical perspective this shallow breathing does not bring an adequate supply of oxygen into the body.

The type of breathing that is a good method to learn is a called deep or belly breathing. This type of breathing brings the air all the way into the lungs and as a result you achieve better health benefits with every breath. You go beyond just breathing to the chest, which is shallow breathing, but you take the breath down to the abdomen.

As mentioned before, the deeper breathing during meditation is great at bringing more oxygen into your physical body thus helping you become more vitalised and refreshed. Your lungs get a good work-out and the fresh oxygen moves throughout your physical body, helping your blood and all your organs. It is no wonder that a simple deep breath can be referred to as the wonderful breath of life.

How to reduce stress level by deep breathing. When you meditate you are encouraged to do this deeper breathing. This will help you gain even better results from your meditation practise. Meditation is not just about stilling or slowing the mind and having one pointed focus. Meditation is also about bringing better health and vitality back into your physical body. Although it is good to still the mind and make an attempt to stop the constant chatter, it is also essential to fill the body with life giving vitality through this deep breathing. How to reduce stress level by deep breathing.  Deep Breathing & Stress Levels

In more advanced spiritual teachings it is believed that through this deeper breathing you are feeding the body with pranic energy or prana. Prana is the life force that is in the air all around. It is the giver of life and is the the 3rd principle of the 7 principles that make up the composition of every human being.

When you breathe correctly you help your body, mind and soul.

There are many benefits of meditation but one of the main benefits is the reduction of stress. As you learn how to take a deep breath and reduce your stress levels you are shifting your mental and emotional energy bodies and reducing your overall anxiety and worry.

Detailed below are some breathing techniques to help you use the deep breath techniques.

If you practise doing them in meditation there is a good chance that eventually you will be able to use them when you are not meditating and just getting on with daily life. This will be a great help when your stress levels are sky-rocketing because of some problem at work or at home.

Choose the method below that best suits you and use it daily.
If you do this you will not fail to notice the physical or emotional improvements in your life

Technique 1: How Deep Breathing Reduce Stress Level

The focus of this breathing technique is to take full deep breaths.
It’s not hard to do but you may require a little practise before it flows easily.

The trick is to breathe all the way down to the abdomen, getting as much fresh air as possible into your lungs.
This type of breathing will immediately make you feel less tense.


Sit comfortably with your back straight.
Put your right hand on your chest and your left hand on your stomach.
Exhale fully through the mouth.
Breathe in through your nose.
Be aware of your left hand as you feel your stomach expand.
Your chest may move a little but not too much.
Exhale through your mouth.
Really push the air out.
You may contract your abdominal muscles which will help dispel more air.

When you are ready repeat for 2 breaths.
Gradually built on the number of ‘breath-sets’ that you do.
But only do the breathing sets to the limit of your comfort zone.
Do not force the issue, start with one set and then build it up gradually.

You can also do this lying down if you prefer.

Technique 2: Counted Breath for Stress Relief

The counting of the breath is a very simple meditation
You can do this meditation sitting or lying down.
But it is very important that you breathe deeply and count the breath all the way down to the abdomen.
It is all about learning to take a deep breath so the deeper breathing is your normal way of breathing.


Be aware of your normal gentle breathing.
Exhale fully.
Then as your breathe in silently and slowly count: 1-2-3
Then hold the breath again slowly counting: 1-2-3
Then breathe out and slowly count: 1-2-3

Repeat the process 3 times.

Then relax your breathing.
Become aware again of your normal gentle breathing.

When you are ready
Exhale fully
And repeat

Do this for as long as you can.
Even just doing one round of the counted breath will make a difference.

Use the method that best suits you and you may find that you change your mind a few time. That doesn’t matter as long as you try and make one of these breathing techniques a part of your daily practice.

Thanks for reading.

Anne Frank: How To Live Life to the Fullest

Anne Frank: How To Live Life to the Fullest

Anne Frank-Live Your Life

Anne Frank-Live Your Life. This article will focus on a particular event, the diary entry of one little girl on the first of August 1944. This was the last diary entry of the fourteen-year-old Anne Frank. It details in a few words the trauma that she went through as she and her family had to hide in an attic to escape German persecution during the second world war. However it also clearly reflects the good and bad that Anne felt herself to be and her struggle to try and be the person she wanted to be and to live the life she wanted to live. Three days later, Anne and her family were arrested and sent to a Nazi concentration camp, where Anne would later die on March 15, 1945, aged fifteen.

I get cross, then sad, and finally end up turning my heart inside out, the bad part on the outside and the good part on the inside, and keep trying to find a way to become what I’d like to be and what I could be if . . . if only there were no other people in the world.            – Anne Frank

This statement perfectly captures the internal struggle that occurs when external pressures cause a change in your identity. Because, when the actions of others dictate what you do and how you act it, can cause a profound effect on your emotions. Anne was living in a world where there was so much hate directed at her and all the people she loved. How could she look at herself as being ‘good’ with all the other people in the world telling her that she is not.

Obviously Anne lived in a terrible time, and a young Jewish living in Europe during the holocaust is very different than any of our own circumstances, yet as with everything in life, there are lessons to be learnt.

  • How would you be if there was no one else in the world?
  • What makes your identity?

Whilst our environment influences us all, you must strive to discover who you are irrespective of those exogenous factors. There is a time and a place to fit into a social hierarchy and follow social norms, but mindlessly conforming to the world around you will ultimately mean you are unfulfilled with the person you become.

Another interesting aspect of this quote is the thought of ‘turning your heart inside out’. Anne discusses the anger she feels towards the world causing her to hide her good qualities and display her ‘bad part’, this is something which we all face daily. For example when someone is rude to you in the checkout, and as a result you are short with your ‘innocent’ kids on the way home, that demonstrates the influence of others has a huge effect on how you think and feel. Anne was facing enormous hardship and she can feel herself becoming this negative hateful person.

In your life, you must not let others control your emotions. To the best of your ability, live the life that you want to live. Hopefully, unlike Anne Frank your life is not threatened nor are you confined. Although no one can be positive all the time and sometimes you will feel sad & miserable do realise that you are the only person who is in control of your emotions. You can remain sad or you can pick yourself up and move on.

Try and be conscious of who you are, live the way you would live were there no other people in the world influencing your behavior. And especially be thankful for what you have. Whenever this feels hard to do, allow yourself to briefly think of young Anne, and how her life was cut short before she could find her place in the world.

You have your whole life ahead of you and you have the ability and the power to discover the real you.

Start searching and be joyful with what you discover.