Changing Addictive Behaviour by Dr Elizabeth McCardell, M. Couns., PhD

 

May 2024

Addictions are gripping but are not necessarily permanent fixtures. We can change our behaviour. We have choices.

 James Prochaska and Carlo Di Clemente, in the 1970s studied the processes of change and came up with what is known as an integrative theory of therapy. This assesses a person’s readiness to act on a new healthier behaviour and provides strategies, or processes of change as well as that person’s decision making capacities. They identified the stages of change in this way:

 Precontemplation (an unreadiness for change) where people are not intending to take action to change and don’t see their behaviour as problematic but may be required to attend therapy to please the courts or families or employers. In this case, exercises in self awareness as well as realizing addictive behaviour is risky to health and relationships. Alcoholism and drug taking, gambling, porn addiction, digital media addiction, etc have dramatically negative consequences on good health, work, and maintaining healthy relationships.   Addiction makes it hard to maintain trust, respect and open communication with others and the life of addicts revolves around obtaining and using the drug of choice. This may lead to neglecting responsibilities or the needs of significant others and burning themselves out.

 

Addiction saturates the brain with dopamine and people become dopamine junkies. Dopamine is less about giving us pleasure per se, rather it motivates us to do things we think will bring pleasure. We experience a hike in dopamine in anticipation of doing something as well as when we do the thing itself, which makes us want to continue doing it. As soon as it’s finished, we experience a comedown or dopamine dip. That’s because the brain operates via a self-regulating process called homeostasis, meaning that for every high, there is a low. Interestingly though, if a person can do something else interesting enough for 12 minutes, the addictive craving subsides.

 

Contemplation (preparing for change) where people are starting to recognize that their behaviour is problematic and are starting to look at the pros and cons of their continued actions. They are also ambivalent about change. On the one hand they may be hoping to change their behaviour, but can also be unwilling to actually take action to make those changes. This is when they are likely to be the most influenced by prompts from others.

 

Preparation (ready for change): here people are intending to act to make changes in their lives and are starting to take small steps towards this. This period typically lasts about  30 days. In this time they are telling friends and family about what they plan to do, which is great because it’s then that support is critical. They are  realizing that the better prepared they are, the more likely they will succeed in life long change.

 

Action: people have made specific overt modifications in their behaviour. This is when they are most receptive to learning techniques for keeping their commitment to change. They are also realizing that they have to avoid certain people and situations that perpetuate the unhealthy behaviours of their old behaviour (for example, not going to the pub and drinking with friends when trying to stay sober). 

 

Maintenance: people are able to sustain these new behaviours for at least six months and are working to prevent relapse. During this phase, it’s recommended that people spend time with others who engage in healthy activities such as exercise particularly during times of stress. Group meetings of former addicts are helpful for many.

 

Completion (termination): people are no longer tempted to return to their old behaviours. If relapses occur, the process of change is likely to be easier than previously.

 

Change is possible. We don’t have to be chained to old behaviours. When we stop doing what we have habitually done, we find ourselves living in the world quite differently. We can obtain pleasure in less destructive ways and we can live life abundantly.

 

Preparing others for a lifetime of change is what counsellors do best. We help people through the first phases of addictive behaviour, for instance, and give them tools for maintaining and strengthening what they have learned and gained. It’s beautiful work.

 

Sunlight and Good Sleep by Dr Elizabeth McCardell, M. Couns., PhD

 

April 2024

Apollo rides his fiery chariot across the sky each day, bringing life-giving light to the earth. In ancient Greek mythology, Apollo was god of medicine and healing as well as of sun and light. Just as he could bring sickness, so he brought cure.

 

We can have too much sunlight and suffer the deleterious effects of that, but we also need sunlight for our fundamental health and well being.

 

Last year I was diagnosed with low vitamin D, all because I wasn’t getting sufficient sunlight. This is surprisingly common in Australia, statistics stating that 1 in 3 people are deficient to some degree. Vitamin D is mostly delivered not through food or supplements, but via the sun.

 

Sunlight is essential for life, whether plant or animal. We humans often forget that we are no different but instead try to live as though daylight doesn’t happen, relying instead on artificial light.

Sunlight has many benefits. Yes, we can have too much of sun’s UV radiation causing skin cancer, cataracts, and so I’ve recently discovered, ultra violet radiation induced immunosuppression of some latent viruses, but some daily exposure to sun helps us. Sunlight triggers the skin to release stores of nitrogen oxides which causes arteries to dilate, lowering blood pressure. Sunlight helps us maintain optimal levels of vitamin D. Vitamin D is necessary for fundamental body processes, such as healthy bones, managing calcium levels, reducing inflammation, and supporting the immune system and glucose metabolism and thus protecting us from type 1 diabetes, multiple sclerosis, and various kinds of cancer.

Sunlight also supports better sleep and mood and sets people’s circadian rhythms by regulating the levels of serotonin and melatonin. Seratonin is the ‘feel good’ neurotransmitter that modulates our moods, cognition, memory, and learning, apart from other functions. Slow serotonin is associated with depression. Melatonin helps in the regulation of energy and glucose balance. It is also responsible for inducing feelings of sleepiness and a drop in body temperature. When those are out of kilter we suffer.

We are governed by circadian rhythms, which are 24 hour cycles, part of our body’s internal clock. During sleep, the cells in our body undergo healing and replication and our mind works through the experiences and memories of our lives in dreams. Our psyche needs the stimulation of being awake, and being asleep. We need, integrally, a consistent routine for our good health. Our circadian rhythm plus melatonin causes us to sleep and, in the morning, as exposure to light increases, melatonin production stops and body temperature rises, promoting wakefulness. Rhythm is the key. Light and dark, wakefulness and sleep, in harmony and balance giving rise to good bodily and psychological health.

Sleep is most likely to be refreshing and restorative when circadian rhythms, the natural cycle of daylight and darkness, and sleep patterns align.

Regularity of meal times, exercise, social interactions, and sleep times as well as exposure to sunlight and darkness help maintain our natural circadian rhythms. Sometimes, though, our circadian rhythms are thrown out of kilter: shift work, travel across time zones, social or study habits that lead to irregular bedtimes, illness, stress, bright lights, all contribute to this.

Problems with sleep can give rise to insomnia, performance issues (memory problems, difficulty focusing and difficulty performing high precision tasks, emotional and social difficulties, accidents and errors, health problems (obesity, diabetes, heart attacks, high blood pressure, and cancer), and symptoms of low energy and grogginess.

A regular schedule for sleep, meals, exercise, exposure to a moderate amount of sunlight  and not too much screen time, etc, helps good sleep. If you are having problems getting to sleep, clinical hypnotherapy (which I do) combined with light therapy (controlled exposure to light, eg going outside in the morning after dawn for an hour or so and then at least 10 to 30 minutes in the afternoon of sunlight is beneficial) and, maybe, melatonin supplements and, if your doctor recommends it, medication. The latter can pose risks and have undesirable side effects.

Sunlight, in the right amount, can heal us – but we do need to receive it wisely. Not too much, not too little, just right.

 

A Little Reflection by Dr Elizabeth McCardell, M. Couns., PhD

 

March 2024

 

This is my 180th article for the Nimbin Good Times, my 15^th year writing each month. I haven’t missed an issue in all that time, despite sometimes not feeling well; on one occasion being out at sea on cruise to New Zealand, on another, at a training residential, on many occasions having a mountain of other work, sometimes knowing what to write, other times at a loss – yet I keep on keeping on (such is my bull dog nature).

 

I now reflect on those years, beginning with the move from Perth, Western Australia to the opening of my therapeutic practice in Nimbin in March 2009, two days a week in a shared office space above the Oasis Café. I moved my practice to Lismore in the new year of 2010, where I worked in my office space below my house in Kareela Avenue, Lismore Heights. I met many wonderful people through this practice and I continue to work with some of them and hope to work with many more online. What has changed is my return to life in Perth (actually Fremantle), in January 2023. I came back primarily to be near my beloved Indian Ocean, for daily swims and to leave behind Lismore’s ongoing flood problem. The 2022 floods broke my heart but though I am no longer living there, I am with the people in spirit. My little cat, Pusski, now lives with my neighbours who he adopted when I told him I was leaving. I hope the mountain brushtail possum I shared my garden with continues to live contentedly there. I very much enjoyed her chats outside my bedroom window at night and her showings of her little ones through visits to my balcony. And then there were the families of birds I left bowls of water out for to quench their thirst. We had a joyous relationship.

 

I continue to write for this paper because I feel connected with people and place and want to continue to participate in the healing that is going on in the northern rivers. This healing comes in many forms: community communication, markets, crafts and arts and music making, the therapeutic practices of doctors, nurses, chiropractors, osteopaths, acupuncturists, herbalists, naturopaths, psychologists, social workers, counsellors; those that tend clients in hairdressing, massage, and so on. Those that sit and listen to others over cups of tea, those that attend to others’ needs in shops and on the street are all good. Simple, beautiful encounters. Those people not feeling heard can contact me, if they wish. As I say, I’m continuing to see clients online over Messenger, WhatsApp, FaceTime, etc. If you are visiting Fremantle, WA, you and I could work together in person. My details are to be found in the accompanying advertisement.

 

Note that I am a psychotherapist/counsellor and a clinical hypnotherapist and both of these modalities work very well online as much as face-to-face in-person sessions.

 

I want to use this article not only to reflect but thank Bob and Sue and all the workers who keep the Nimbin Good Times newspaper running so well. It is one of the very few truly independent newspapers in Australia and as such, one of a tiny minority that tells stuff as it is, without any dubious agenda. We are so very fortunate.

 

 

 

 

 

Feeling Ashamed of Being Successful by Dr Elizabeth McCardell, M. Couns., PhD

 

February 2024

 

I’ve avoided writing about this ever since I started writing articles for this paper nearly fifteen years ago. Why? Because this topic is too close to the bone for me. Yet, I think it’s time. It’s also a pervasive topic for women and, I suspect, many men. Maybe it’s our Australian tall poppy syndrome, maybe it has to do with “the good woman keeps her head down and doesn’t show up to others”, maybe it is indoctrination from our school years where, often, we had to be like everybody else. The thing is, how much are feelings of shame getting in the way of being even more successful? Interesting thought.

 

Since beginning research on this subject two dominate ideas have emerged: 1. Feeling not good enough, and 2. Not wanting to draw attention to oneself. I’ve searched long and hard within myself for confirmation for the first and can honestly say that this is not “the” thing for me but maybe it is true for others, I’m not sure of that.  Since I don’t really know how much of feelings of shame have to do with feelings of unworthiness, I shall concentrate on the second dominant idea of not wanting the attention.

I should note here that there is a difference between guilt and shame. Guilt has a moral dimension, while shame does not. Guilt is concerned with one’s responsibility for a harmful attitude or behaviour. Shame feels different. There is a sense of loss of interior power, a sort of inner collapse. Whereas guilt is likely to motivate either reparative or self-punitive behaviour, shame is likely to motivate either withdrawal or increased efforts in attempts to fit in. 

 

As for me, I’ve never been in any doubt that what I contribute isn’t worthy enough, yet I find it difficult to speak of what I know from my own expertise. It isn’t as though I am spouting fluff nor am I bragging; decades have gone into this knowledge base and when I speak, it’s from that source. Yet I sometimes feel embarrassed when I draw attention to myself; and yet again, in apparent contradiction to that, is an act of self declaration, which I am writing about here. In other words, despite feelings of shame at my success, I still speak up.

 

I don’t have imposter syndrome these days (I used to when I was researching my doctorate) because I know what I know and I know, full well, what I don’t know. I’m not pretending knowledge. Imposter syndrome is very common in the workplace but, actually, most people are doing good work. Few really are incompetent and pretending a knowledge they don’t have. There was a case recently of a paramedic who had cooked up advanced qualifications over a hot computer, but was found out when the certificates were found to have lots of spelling mistakes!  But knowing that so many of us don’t feel confident and yet are doing well, is enough  to drop the imposter syndrome belief.  

So, what of feelings of shame of being successful?  Feelings of shame and embarrassment are social constructs, and as such, can be turned around. When we feel we have been exposed for doing something that is inappropriate in terms of social norms and expectations or inconsistent with gendered role expectations or our social identity we feel uncomfortable, but we can learn to better value the contributions of others and ourselves. Social constructs are fluid and not set in stone. Instead of reacting as though we’ve breached our perceived social status, we could feel pride in what we have achieved. And likewise, pride in what others have achieved. 

 

Feeling pride in one’s work, or any output, is not a dirty shameful thing, and certainly not worthy of excommunication from the community (which experiences of shame can inspire one to feel) despite what some fairly rigid people think. It is a clear acknowledgement that it is a job well done and something to be appreciated for.

 

Condemnation by others simply needs to be ignored, and our authentic expression celebrated.

 

The Implications of Handedness by Dr Elizabeth McCardell, M. Couns., PhD

 

January 2024

 

Leonardo  Da Vinci’s  mid-15^th century notebooks include experiments with writing with both hands at the same time in the same direction, writing in mirror writing, upside down, writing with both hands in different directions, and so on, indicating that he was ambidextrous. For years, it was thought he was left-handed but learned to write with his right hand. Recent studies by the Uffizi Gallery in Florence, Italy, indicate that he was equally proficient with both hands and his drawings and writings indicate this. The drawings and writings showed equal pressure in each stroke and produced in the same style, debunking the other theory that some parts of his work were done by an apprentice.

 

Current studies  on hand dominance are producing a lot of new and interesting insights. I’ve written something about this before, but here I want to elaborate upon the psychological implications of the subject.

 

About 90 percent of people are right handed, while the remaining 10 percent are either left handed or with some degree of ambidextrousness, though only about 1 percent are truly ambidextrous.

What is happening in the brain? The examination of those who have had surgery to fix their epilepsy that involved having their brains surgically split, has shown that the two halves of the brain are responsible for different tasks. The left side controls language and the right emotional and nonverbal functions. When a person has a right-hand preference, the brain’s left hemisphere is dominant. Left-brain dominant people tend to be better at analytical thinking, while right-brain dominant are more ‘big picture’ thinkers.  In mixed-handedness, one side of the brain has no clear dominance over the other.  Ambidextrous people are using both sides of their brains about equally. Herein lies some difficulties that may arise for the ambidextrous. These issues that can be corrected with training.

An article published in a neuroscience journal in 2023, identified an association between dyslexia and ‘mixed-handedness.’ In the study context, ‘mixed handedness’ referred to both ambidexterity (no hand preference for a task) and inconsistent hand use (using different hands across different activities.) A strong link was found between dyslexia and mixed-handedness, and also, interestingly enough, ADHD (attention-deficit/hyperactivity disorder). Which hand to use, and how? What to do next? A symmetrical brain thinks differently. In typical brains, language is rooted in the left hemisphere and neural networks that control attention are anchored in the right hemisphere, but brains without a dominant hemisphere operate in other ways. Maybe our education system just isn’t geared to these differences.

Hand dominance is inherited, though the old practice of making left handed children write with their right hand often leads to ambidextrousness, or left-right confusion.  La sinestra, from which comes our English word “sinister”, literally means “left” and being left handed was an indication of being associated with the devil (according to some misguided people).

Being ambidextrous is useful. A  friend of mine once worked in casinos and she was able to be  much more efficient way than her right or left handed counterparts. I first came to know her when she was a university student of mine. I noticed then that she seemed to have a certain linguistic blindness to particular words. When she became a friend, I continued, and continue, to proofread her creative writing and notice that the problem continues. I only recently discovered that she is ambidextrous.

Now, I am also ambidextrous, but I am not dyslexic. I’ve been mulling about this and conclude that because I was introduced to playing musical instruments at a very young age, I was able to develop my dual-handedness, without too much confusion. I do retain a bit of left-right confusion when opening jars, as do others with ambidextrousness, but the clue to ironing out incipient problems is getting the person to engage the hands in related but different tasks at once. I encourage others to explore this. Maybe taking up an instrument, or experimenting – as Da Vinci did – with writing/drawing with both hands at once could be the clue to strengthening one’s attention and linguistic skills , and thus avoiding psychological issues associated with a symmetrical brain. 

 

 

Psychotherapy, uncertain art, uncertain science by Dr Elizabeth McCardell, M. Couns., PhD

 

December 2023

 

     I used to be an occasionally good university teacher before changing careers to practicing psychotherapy full time. This was over in Perth, Western Australia. We had a syllabus to follow, lectures and tutorials to run and they followed a pretty standard course. For about 14 or so years or so, since then, I’ve worked solely as a psychotherapist. There are similarities to teaching – we want the best for those under our care – but the way we go about it is very different. As psychotherapists, we observe and guide the other person(s), and we participate in their lives, aiming to bring forth insights, understanding, different ways of doing things, as well as strengthening their sense that only they are the authors of their lives.

 

     Psychotherapy is art and science: fumbling, uncertain, creative, experimental; it’s a growing body of psycho-social-spiritual knowledge, it’s an understanding of the dynamics between people; it’s sometimes methodical, ordered, and follows a clear beginning, middle and end; it’s helped by therapist self-awareness (which is very important) and depends on just seeing what is effective and what isn’t, it unfolds, it explores, and it’s not a journey that finishes with the last therapeutic session. It’s part of a life time of self-discovery. Those coming to therapy or counselling or whatever you call it should not expect clear cut outcomes all the time; it’s not an anti-inflammatory pill for the mind, despite what some might tell you. A course of treatment is a dubious way of talking about what is a much more subtle and impactful process. Here is a therapeutic conversation that has goals along the way, but they are reached via improvisation, intuition, acute listening and trial and error.  That is the best therapy, as I and several others see it. Yes, we can strictly follow the protocols of psychotherapeutic schools and models and rituals, but when we do so, we cease to actually listen to what our client is saying in her words, her body, indeed her whole demeanor. When we get caught up in saying the ‘right thing’ we have stopped listening to what is. I fear I have missed quite a number of people as I’ve observed and participated in their therapeutic journeys, by doing exactly this.  For that, I sorry.

 

     One thing I need to say with regards to  not listening properly to a client is that it forces me to sit with my own discomfort, to tolerate uncertainty and the hoard of ghosts of self doubt, but to also aim to be more present, more sensitive, next time. Erving Yalom says of this that such is a prerequisite for the profession. Ours is a somewhat wobbly profession. We try to steer an even course through uncertain waters, while knowing that this goes against much of  the common perception of what we do. That idea is that what we do follows predictable, measurable pathways but very often it doesn’t work that way, and that’s ok. The outcomes may be quite different from what could’ve expected at the outset.

 

     Though I speak of such things, I also know that the journey we travel together isn’t without a safety net, well, actually a few safety nets.  Psychotherapists have been trained (in my case, university trained at a post-graduate level), we have experience, we are monitored by a colleague or colleagues in supervision, we participate in ongoing professional and personal development, we are bound by a rubric of ethics, we are insured, we abide by the laws surrounding our practice and, basically, we just care what happens to our clients.

 

     Ours is a caring profession. We guide, we accompany, we share, but we do so from a fairly objective position. If we did it any other way, both of us would be lost. But in participating with the client in a deeply human way, we allow them, and us, to be changed at the very heart of the therapeutic encounter. This is a rich, wonderful collaboration where both client and therapist are nourished in a journey that  reintroduces  the client to the authorship of their own lives, and that’s good to be part of.

 

 

 

 

Holding the Therapeutic Space by Dr Elizabeth McCardell, M. Couns., PhD

 

November 2023

In recent times I’ve been thinking a lot about the space we therapists hold with clients. It is a tangible tension that we have; you can feel it when it’s there and when it slides by. Usually, I’ve found, the tension is lost when our connection is impaired in some way, as when I’ve missed the mark and assumed an understanding when there wasn’t one, or I’ve got impatient and have stopped careful listening: it’s about focussed listening, and much much more.

 

Freud spoke of what a therapist needs is an “even hovering consciousness,” a consciousness not subject to the extremes ordinarily elicited in the human encounter. Buber says the psychotherapist needs a detached presence. This is a skill I use all the time with clients, and quite often in other places as well. Recently, I had to hold the space in a legal case. I was both looker on and supporter of a friend. I was listening and watching what was going on, not speaking, just being there; essentially holding the space. I took into my awareness the body language of the others, the questions asked, the feeling expressions, and so on. It was intense, and very interesting.

 

As therapists we need to occupy the space holding us together and, paradoxically separating us. We need to be consciously aware of what is arising in the client, and taking note of the things arising in our own and their unconscious. If we are overly conscious, we fail to be aware of the nether world that surrounds us. If we are paying too much attention to the unconscious, we are missing the mark of here and now consciousness. Both need to be present.

 

We hold polarities of rationality and feelings, ensuring that neither dominates. We must be able to enter into the client’s world and feel the world from the client’s perspective, and we need to hold all that according to our own developed science based, art and craft skill set.  Psychotherapy isn’t an easy job; it isn’t us just sitting back and listening. It is a mix and meld of things.

 

Richard Hycner sees the profession as essentially paradoxical. Paradox as a descriptor of psychotherapy is exactly right. What we do is elicit – and hold – the tension of polarities. There is the paradox in the tension between the subjective and objective. We must be both deeply personally present in the subjective experience of the client, and maintain an objectivity. The balance of these is absolutely critical. We have to acquire, and keep on acquiring scientific theoretical knowledge about individual and interpersonal behaviours, yet none of this can be separated from our own self awareness. If our knowledge base is to keep on growing without the presence of our own self awareness then we’ve missed the boat, and cannot work effectively with anyone. A subjective awareness and an objective one must be masterfully blended. To achieve this, most of us know that to do the work of psychotherapy with others, we must also work on ourselves in therapy and receive good clinical supervision throughout our career.

 

A good therapist has to be practical and also have a philosophical bent. She needs to recognize practicalities, and think beyond those to the greater human drama. Mental wellness isn’t just an individual matter, it’s sociological and political as well. Pathology and health is  affected by income, poverty, ideology, drug use, belief systems, sleep patterns, work requirements, education, etc etc. We have to be aware of the life story of our clients, as well as our presumptions. All these matter.

 

What we also need to realize is that life is ambiguous, and our work itself is ambiguous. It is always unfinished, there is always something more to be discovered. Working with clients and receiving therapy is only limited by choice, time, and certainly money, but the beauty of it is that it can be picked up and continued for as little or as long as both decide to do it. While we live, we have the opportunity to live better and feel better living. Therapy helps.