Saturday, March 2, 2019

Should I take a more CBT approach or ACT approach for my patients with mental health problems?

Let us first explore the some terms related to our "emotional world" and what it means.  This is emotional literacy, and it is very important for us to learn in order to solve emotional problems.  Just like learning numbers and numeracy to solve math problems, we need to learn emotional literacy in order to effectively solve emotional problems.

The human mind has a great ability to fuse, hook into, or buy into a story whether that story may be in a form of a movie, story book, or thoughts in one's head.  So when one is feeling sad, upset, happy, or angry, one may have fusion with a story in one's head.

So how can we change this?

We simple have 2 main options.  One is to change our story.  The other option is to unhook, detach, step back, or defuse from that story.  Traditionally, cognitive behavioural therapy (CBT) is more about understanding the story and helping a person to change that story into a more "positive" or helpful one.  Acceptance Commitment Therapy (ACT), is more about coaching a person to defuse or unhook from that story, and once unhooked, the story will natural has less grip on that person.

There are therapists who consider defusion or unhooking from thoughts a better strategy, and at the same time, I personally believe that thought defusion and thought challenge needs to go hand and hand.  Having said that, I do believe that if one is very fused with one's thoughts, it is much harder to do thought challenge effectively.  That is to say that one has to defuse from thought first in order for thought challenge to be more effective.

At a pragmatic level, if one is very fused with thoughts, I would lean towards a more ACT approach.  If one is already defused or detached from thoughts, I may take a more CBT approach.  I personally think that there is a lot of overlap between these two modalities in any case.

Helpful links and resources from the RACGP

Sunday, June 17, 2018

Self care for Docs: It is super important!

There are 3 main schemas that we see in people:

1sy (Onesie)= “If you don’t love me, like me, or do things my way, I am going to have a fit”. 
2sy= “If you are nice to me, I am going to be nice to you. If you do this for me, I am going to do this for you. It’s fair”.
3sy= “I care about you no matter what. I have unconditional positive regard for you”.

1sy + 1sy= a war
1sy + 2sy= a war
3sy + 1sy/2sy= Better outcome if we can balance the "care of others" with the "self care".

In the business of Doctoring, one needs to be a 2.1sy and above to be more effective. Whenever people are unwell, they often fall into the 1sy schema so if we are 1sy or 2sy, there will be unhappiness. 

In the business of parenting, one also needs to be a 2.1sy and above.

Whenever we fall below the 2.1sy level, maybe it’s time to take a holiday, reflect, and take care of our own needs first before looking after others.

Furthermore, many Doctors are 3sy wannabe. One can’t be a 3sy without good self care. It is not easy of course.

Wednesday, May 16, 2018

Counselling in a nutshell for Registrars

I would like to share some counseling ideas, as I believe that more Registrars can take on more of this work to help their patients better. 

1 Supportive counseling= Validation, acknowledgement, compassion, empathy, reflection, externalize thought and psychoeducation. Great for when people are in crisis and are in a state of vulnerability. Registrars are more than capable of doing this already in my opinion. It is super important in my opinion. This is foundational. 

2 CBT (Cognitive Behavioural Therapy)= We teach people to be more aware of their thoughts, beliefs, and behaviours that lead to negative feelings, AND challenge or change those thoughts, beliefs and behaviours.  It is not easy for many as they are often too “fused” with their thoughts and beliefs. I believe that Registrars are getting some training in this through their training providers. I encourage all of you to build upon that through your career. It will also help you with your own life immensely. It is a bonus!

3 ACT (Acceptance Commitment Therapy)= ACT is more interested in the detachment from those thoughts and beliefs, rather than challenging or changing them through self awareness with values, self compassion, mindfulness, time, maturity, perceiving rather than judging, being present, seeing things through the lens of the here and now rather than the lens of the past (esp trauma and hurts), and taking value based actions. It is not easy but it can be cultivated. 

4 IPT/EFT (Interpersonal Therapy/Emotionally Focussed Therapy)= Interpersonal skills and relational skills training which require all of the above skills plus others.

5 An eclectic approach=all of the above. 

Friday, August 25, 2017

Emotionally Focussed Therapy for couple counselling: Not useful for the exams but maybe useful for your clinically practice!


Introducing EFT trainer

Dr Jenny Fitzgerald is a Clinical Psychologist and a Certified therapist, supervisor and trainer in EFT (International Centre for Excellence in EFT, Ottawa Canada).  Jenny teaches EFT workshops throughout Australia, has presented with Dr Clare Rosoman at two international conference in Nork (2015) and Rome (2017), and provides clinical supervision to couples’ therapists throughout Australia and in Singapore and Malaysia.  She works in private practice in Brisbane and is a part- time senior lecturer in the School of Medicine at the University of Queensland.   


The four-day externship: Fundamentals of EFT is the worldwide starting place for all formal training in EFT for couples.  All participants must be mental health practitioners or in university training toward that end.  The 28 hours of the Externship will provide an understanding of the application of attachment and emotion theories to couples’ distress, outline the steps and stages of the EFT model, help you understand the EFT interventions and three key change events, show you training tapes and give you several opportunities for role play practice with colleagues.  A live consultation with a couple from the community will be conducted if possible.  Reading resources (articles, chapters, manual) will be provided. 

Core skills workshops

After the Externship, interested persons can undertake extra training, Core Skills A (4 days) and Core Skills B (4 days).  See for dates as they become available.

The Core Skills workshops, in small groups of no more than 12, will review all core principles and interventions of EFT.  There will be further application of the EFT model by review of clinical recordings/cases brought by participants, and more viewing of training tapes. Core skills will be practised in role plays. 

    The Australian Centre for Emotionally Focused Couples Th

When:           Friday 6th- Monday 9th  October, 2017

Time:           9.00 a.m. – 5 p.m.

Where:         Hotel Urban, 345 Wickham Terrace, Spring Hill Brisbane
Cost (incl GST):  Early Bird rate:  $995.00 (extended to Sept 7th)  Full fee:  $1250.00  Students: $650.00  (5 places available):  If you join our closed FB group "HealthProXchange", there is a 10% group discount.  Please see details in the relevant post in the close forum or message admin in the closed FB group.


A deposit of $300 is required with registration to secure a place in the workshop. 
The balance of payment is required one week prior to the commencement of the workshop.    See cancellation policy below.

Limited Places:          This workshop is limited to 45 people and a minimum of 15      
                                          places are needed for the workshop to occur. 

Catering:  Fully catered 
Enquiries and registration: Contact Glenys at
EFT Externships and Advanced Core Skills trainings are designed for mental health professionals and trainees only.

Australian Psychological Society (APS)
Please note the APS members can accrue Continuing Professional Development (CPD) hours by participating in CPD activities that they determine to be relevant to their individual professional skills learning plans and goals. These may be self-initiated. CPD activities do not need to be endorsed by the APS.

CANCELLATION POLICY: Requests for refunds must be made in writing at least 14 days prior to the first day of training to qualify for a refund of the balance paid. A $50 administrative fee will apply. For cancellations fewer than fourteen days from commencement, the deposit is not refundable. In the case of medical emergency, registration can be transferred to a subsequent date or alternative city for the relevant workshop.

TRANSFER OF REGISTRATION TO ANOTHER PERSON: registrations are transferable IN FULL to another person on notification. Where a delegate can only attend for part of training, transfer of the remainder of the registration to another person is NOT possible. In the event a course is cancelled due to low registration, refunds will be issued in the full amount paid.

Registration Form

Full Name:

Mailing Address:

Suburb:                                                          State:                                      Post Code      

Telephone contact:                 Mobile:                                     Email address:

Special dietary requirements: (Vegetarian, Gluten Free or Lactose Free)        

Professional Membership/eligibility:

Please indicate if you can agree to the three following statements:
_______I have the educational training, qualifications, and professional credentials to practice as a mental health professional in the area where I live or I am in a formal training program of supervised practice to become a mental health professional. 

_______I agree to keep confidential the personal identifying information of case material shared in the training

_____ I agree not to record any part of the Externship training (other than written notes for my use); neither audio, or audiovisual recordings are allowed to protect confidentiality and respect copyrights.

Registration Type (early bird, student or full)
Early bird                                                                                     $ 995.00               
Student  (5 places available)                                         $ 650.00
Full Fee                                                                                      $1250.00
Clearly mark the amount paid

Please photocopy this form and send your payment to:
Ms Glenys Page
EFT Training Administrator, 14 Goondoola St, Redbank Plains Qld 4301

OR email scanned completed form to and direct electronic payment into Commonwealth Bank (preferred):

BSB 064-012 Account 10205490
Dr Jennifer Fitzgerald
Please ensure that your payment is clearly identified with your family name and EFT.  Please select the option to “Notify someone by email” using the address
AMOUNT PAID:  _____________________       OR   _______________

OR Fax this form to 07 38399131 with payment option of direct debit or credit card
Visa or Master card (please circle)
Card Number________________________________________________________________
Expiry date________________________________Signature______________________________________

Monday, June 26, 2017

How to "let go" emotionally speaking is an important skill for Doctors and Patients alike

One way to accept or to "let it go",  is to explore beliefs and values that you hold "TRUE", which may be preventing you from letting something go.

Examples of some common beliefs and values which impede the "letting go" process:

1 "We shouldn't be wasteful".  This belief can lead to hoarding in the extreme.
2 "Things should be fair".  This can result in much frustration because life is not always fair.
3 "The period of mourning/grief is proportional to the amount of care. Moving on after the death of a loved one shows a lack of care/respect."  This greatly impacts the recovery after prolonged grief.
4 "If someone does something wrong, there should be consequences or punishments.  There should be justice".  This not only hinders forgiveness, but may also encourage spite.

Once aware, we can challenge these beliefs (CBT Cognitive Behaviour Therapy) or defuse from it, through validation and acknowledgement (ACT Acceptance Commitment Therapy).  You cannot "TRY" to let go in my opinion, because letting go is, in essence, "NOT trying".  So "letting go" is more about "unlocking" a belief through deeper understanding and validation rather then "doing".  Ironically, many people say, "Yes, I am trying to let it go but I can't!"

Mindfulness practice will help one to be less judging and more "perceiving".   It is this perceiving state of mind, that letting go, or acceptance becomes easier.

Once we realise that these are just beliefs and values that make us feel a certain way, we can then change them, or defuse from them, fostering a different relationship with them.  It is no longer as fixed or as detrimental, as we initially thought.

Some examples:

"We shouldn't be wasteful" can be acknowledged that it is good to be like this in some situations but in the case of a child who has not finished his oily chips and you are full, it is not very helpful for you to eat those oily chips just because you feel that it is wasteful.

"Things should be fair"
This may be changed to ... "It would be nice if life is fair, but the reality is that it is not.  Life is not fair and it is what it IS.  I can only do my part to make it as fair as possible.  Change what I can and let go of the things I cannot."

"The period of mourning/grief is proportional to the amount of care. Moving on after the death of a loved one shows a lack of care/respect."
This can be changed to... "My loved one would not want me to be in so much pain, and would like me to move forward and live the best life that I can.  He/she would probably like me to honour him/her in this way".

"If someone does something wrong, there should be consequences or punishments.  There should be justice"
This may be changed to ... "Letting go is important for me to reserve my energy for more important things in my life right now.  I forgive them, for me, for my health and wellbeing, and for the important people in my life. Human beings are not perfect and they will have to learn from natural consequences.  I don't have to be the judge or jury in their life".

We have all been conditioned to fix, rather than to let go, so these skill are not always easy to foster.  However, it is not impossible.

Sunday, June 25, 2017

My thoughts on the types of mental health problems we see in General Practice

I think a lot of mental health issues we see in the General Practice setting is an adjustment problem with depressed mood or anxious mood of "some sorts" and taking a benzodiazepine, seroquel or an SSRI might "numb" the emotion but it does not necessarily equip our patients with skills to increase awareness, solve the problem or in many instances, to let it go and find "sustainable acceptance".  When I ask patients what aspect of their life is not meeting up with their expectation, the answer will generally highlight to me the "adjustment" issue.  Often it will have a relational flavour to it or some sort of a "loss"... e.g. lack of intimacy with partner, conflict, kids are sick, someone is sick, conflict with parents, conflict with friends, loss of a loved one, loss of a job, conflict with boss or colleague etc etc ... Often acknowledgement and validation will go a long way and once that "relationship and safe connection" is more established, helping them to defuse from that and let go of the things they cannot change and change the things they can, will do a world of good. Not easy of course for many....

It will take time along with a lot of compassion!

Saturday, June 24, 2017

This will not be in the exam but it might be useful for self care. Emotional literacy and emotional processing

Emotional literacy and emotional processing: 

Do you know the difference between avoidance, "putting up with it" and acceptance?
Do you know the difference between being assertive vs aggressive?

If you have fully accepted something, you will be at peace with it.  You would feel happy with it.  If you are "putting up with it", there is a sense of resentment there.  So on the surface, acceptance and "putting up with it" may look the same but internally, the feeling is different.

With regards to assertiveness vs aggressiveness, assertiveness has no blame and less judgment.  Aggressiveness has blame and judgment as its undertone. Often people will find these 2 states difficult to differentiate and cultivate.

Emotional literacy is also important for emotional processing.  In schools, we teach our children numeracy to help them solve complex mathematical equations.  We also teach them literacy in order to solve communication issues.  The question is, do we put enough emphasis on teaching them emotional literacy to help them solve emotional problems?  I don't think we do and in my opinion, this needs to change for us to cultivate a more emotionally well generation.

Poor emotional processing, "blocking it out" or suppressing your emotions can lead to a lot of frustration

So how does one process one's emotion?  This is my take on it.....

1 Name the emotion
2 Step back and "detach" or "defuse" from the emotion and ask "Why do I have this emotion?"
"What is it trying to tell me?"  
"What external factors are there that made me feel this way and can I change that?"  and if not....
"What values and beliefs do I have that make me react this way and can I change that?"
3 Then try the "tame" the emotion with fact checking, reasoning and challenging it or "defuse from it", and focus on actions that are congruent with one's values.

Not easy of course but this certainly can be learnt and cultivated in everyday life.

Tuesday, June 20, 2017

A message of self care for Doctors.....

A simple reminder for Doctors....

Life can be stressful.  Looking after other people can be stressful.  Self care is important. If one looks at the BioPsychoSocial model of "wellness", one will realise that to be well, one has to be physically well(bio), emotionally well(psycho) and well in your relationships and financially well(social).
From experience, the "relationship" component is often forgotten or it is simply "too hard". Take time to reflect on your relationships, learn more about it and most importantly, look after it!
The 75yr Harvard longitudinal study on relationships say it all.... Good relationships are good for you!

Take care of it!

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