1. Counselling, stress & anxiety management in primary care Frank McDonald Psychologist Consultation & Liaison TTH

2. Aims Improve ability to help people change their approaches to common personal problems, e.g. stress & anxiety. Undertreatment risks more psychopathology Improve ability to help people change their approaches to common personal problems, e.g. stress & anxiety. Undertreatment risks more psychopathology Improve detection & mx of mental illness (shown to co-vary with quality of counselling & interpersonal skills) Improve detection & mx of mental illness (shown to co-vary with quality of counselling & interpersonal skills) Both outcomes begin with active listening (aided by other counselling skills & personal qualities that enhance perceived expertness, attractiveness & trustworthiness) – so primary aim: raise awareness of core counselling skills & interpersonal processes Both outcomes begin with active listening (aided by other counselling skills & personal qualities that enhance perceived expertness, attractiveness & trustworthiness) – so primary aim: raise awareness of core counselling skills & interpersonal processes

3. Objectives Raise awareness of, & confidence in applying, key skills & steps of effective counselling Raise awareness of, & confidence in applying, key skills & steps of effective counselling Describe some ‘action stage’ self- management strategies for stress & anxiety Describe some ‘action stage’ self- management strategies for stress & anxiety Suggest resources Suggest resources

4. Rationale Skill demands on primary care physicians have increased greatly in mental health care Skill demands on primary care physicians have increased greatly in mental health care Locus of psychiatric treatment moving further into community. E.g. 75-90% w. mental health problem seeking help consult G.P. 1 Locus of psychiatric treatment moving further into community. E.g. 75-90% w. mental health problem seeking help consult G.P. 1

5. Rationale While psychopharmacology expanding ++, at same time counselling has become a core medical skill While psychopharmacology expanding ++, at same time counselling has become a core medical skill Of people w. any mental disorder (anxieties most prevalent), 3 in 4 express need for counselling or “talk therapy” = sig. more than number expressing need for medication 2 Of people w. any mental disorder (anxieties most prevalent), 3 in 4 express need for counselling or “talk therapy” = sig. more than number expressing need for medication 2anxieties most prevalentanxieties most prevalent

6. Rationale For many problems, including anxiety disorders, psychological counselling approach works better than drugs, in short & long term 3 For many problems, including anxiety disorders, psychological counselling approach works better than drugs, in short & long term 3 Adverse experiences can impact upon health & well- being. More comprehensively addressed by adding psychological approach & not limiting to bio-medical one Adverse experiences can impact upon health & well- being. More comprehensively addressed by adding psychological approach & not limiting to bio-medical one

7. Rationale Time demands on primary carers are an issue (see ‘Meds easier to get than counselling’) Time demands on primary carers are an issue (see ‘Meds easier to get than counselling’) ‘Meds easier to get than counselling’) ‘Meds easier to get than counselling’) Nevertheless, value of ‘person to person’ skills & principles can impact quickly (usually first 4 minutes) & not require lengthy sessions Nevertheless, value of ‘person to person’ skills & principles can impact quickly (usually first 4 minutes) & not require lengthy sessions Detection rates of mental illness increase significantly if doctors have better interpersonal skills 3b (listed later) Detection rates of mental illness increase significantly if doctors have better interpersonal skills 3b (listed later)later

8. Overview 1. Aims, Objectives & Rationale 2. What is counselling? Definition Definition v. other forms of personal help v. other forms of personal help Types of problems addressed in primary care Types of problems addressed in primary care 3. How to counsel General guidelines (My Idiots’ Guide to Counselling – “How to Counsel”) General guidelines (My Idiots’ Guide to Counselling – “How to Counsel”) Core skills Core skills Blocks to good counselling Blocks to good counselling

9. Overview 4. Counselling stages 1. exploring/clarifying concerns 1. exploring/clarifying concerns 2. deeper understanding of causes 2. deeper understanding of causes 3. change/action stage 3. change/action stage 1. Explore 2. Understand 3. Act

10. Overview 4. Active practice of specific counselling skill of active listening/empathy 5. Principles & strategies of stress & anxiety management 6. Resources

11. What is counselling? Is this counselling? What are some elements of counseling? Boiler-plate a definition from your ideas of its elements

12. What is counselling? Professional relationship to help with personal problems Professional relationship to help with personal problems Relationship differs from both social friendships (less 2-way) & traditional patient-doctor relationships Relationship differs from both social friendships (less 2-way) & traditional patient-doctor relationships Not like usual physician help model - trap for medico’s: to pronounce ‘cure’ after Q. & A.’s of ‘diagnosis’. Counselling is usually less directive Not like usual physician help model - trap for medico’s: to pronounce ‘cure’ after Q. & A.’s of ‘diagnosis’. Counselling is usually less directive

13. What is counselling? Rather than just informing or giving specific advice, counsellors serve as skilled listeners (“the best counsellors are dumb”) Rather than just informing or giving specific advice, counsellors serve as skilled listeners (“the best counsellors are dumb”) Help person Help person explore feelings, thoughts, experiences explore feelings, thoughts, experiences see things more objectively - can help person deal with problems more calmly / less anxiously see things more objectively - can help person deal with problems more calmly / less anxiously clarify issues, generate options - based on shared understanding of issues - so person can solve problems on their own & clarify issues, generate options - based on shared understanding of issues - so person can solve problems on their own & make own decisions from available choices, so more self- sufficient (not dependent on counsellor) make own decisions from available choices, so more self- sufficient (not dependent on counsellor)

14. What kind of problems are appropriate for counselling? Whatever troubles the person Whatever troubles the person Common concerns include: Common concerns include: depression depression grief & loss grief & loss self-esteem self-esteem anxiety anxiety un/employment stressors un/employment stressors romantic relationships romantic relationships family family alcohol or other drugs alcohol or other drugs sex sex academic problems academic problems diet & body image diet & body image shyness, loneliness, identity shyness, loneliness, identity ‘media stress’ (major disasters, crime, war, environmental degradation) ‘media stress’ (major disasters, crime, war, environmental degradation) changes to relationships & lifestyle after illness or disability changes to relationships & lifestyle after illness or disability Cartoon copyright: Michael Leunig / Penguin Books Australia

15. How to Counsel Discuss handouts – 1.‘How to Counsel’.‘How to Counsel’ 2.‘Building a Therapeutic Relationship’.‘Building a Therapeutic Relationship’

16. How to Counsel Core skills Specific characteristics & skills of effective counsellors Good non-verbal skills Good non-verbal skills Observation skills – e.g. picking up on patients’ communication before they speak Observation skills Personal characteristics – 7 communication skills common to successful counselling (& close relationships) Personal characteristics

17. How to Counsel 7 Communication Skills for a Successful Counselling Relationship 7 1. Empathy 2. Respect 3. Concreteness 4. Genuineness 5. Self-disclosure 6. Challenging 7. Immediacy

18. How to Counsel Blocks to good communication & counselling Blocks to good communication & counselling

19. Stages of Counselling Discuss handout – ‘ Stages of Counselling’ ‘ Stages of Counselling’ 1. Explore 2. Understand 3. Act

20. Practice exercise Empathy discrimination class exercise 6 Empathy discrimination class exercise

21. Stress & Anxiety Management Untreated stress problems can become anxiety disorders & in turn depression Untreated stress problems can become anxiety disorders & in turn depression Stress Management (Manual & pamphlet web links) - Main Principles & Strategies Main Principles & Strategies - Instant Stress ManagementInstant Stress Management Overview of Behaviour Therapy & Cognitive- Behaviour Therapy for Common Conditions Overview of Behaviour Therapy & Cognitive- Behaviour Therapy for Common Conditions

22. Counselling, Stress & Anxiety Management Resources www.fmcdonald.com Panic Attacks! Managing Worry Stress Management – Awareness and Coping (Manual) Instant Stress Management (Patient pamphlet) Sleeping Better Behaviour Therapy & CBT for Psychiatric Registrars http://stress.about.com Stress management & counselling in primary care www.mja.com.au/public/mentalhealt h/articles/turner/turner.html or counselling and stress management emja.pdf www.mja.com.au/public/mentalhealt h/articles/turner/turner.html counselling and stress management emja.pdf

23. Counselling, Stress & Anxiety Management Resources CRUfAD Clinical Research Unit for Anxiety & DepressionClinical Research Unit for Anxiety & Depression Beyond Blue http://www.beyondblue.org.au/ http://www.beyondblue.org.au/ eMJA article on quality Australian websites for depression http://www.mja.com.au/public/is sues/176_10_200502/gri10081_ fm.html#elementId-1189689 or http://www.mja.com.au/public/is sues/176_10_200502/gri10081_ fm.pdf http://www.mja.com.au/public/is sues/176_10_200502/gri10081_ fm.html#elementId-1189689 http://www.mja.com.au/public/is sues/176_10_200502/gri10081_ fm.pdf the MoodGym. ANU’s free online training in CBT for depression site http://moodgym.anu.edu.au/ http://moodgym.anu.edu.au/

24. Counselling, Stress & Anxiety Management Resources References & other resources References & other resources