for May, 2013

Can a psychologist help you quit smoking?

Posted on May 30, 2013 in Uncategorized - 0 comments - 0

Today- 31st May is World No Tobacco Day, so we’ve interview Dr Stan Steindl about how a Psychologist may help you give the habit up for good!


1.  Generally speaking, how can a Psychologist help a person quit smoking?

Psychologists can sometimes help at three critical stages when a person starts to consider giving up smoking.

First, finding the motivation to quit can be a challenge. A psychologist can help a person to consider what the major motivating factors are for them. Exploring what the person would like to change, why they’d like to change and what makes it important can help create the motivation and willingness to commit to change.

Second, a psychologist can help in the planning and action phase. A discussion around how to make the change, action planning and then confidence building can all help the person take that next step.

Finally, like all behaviour change, relapse is a real consideration. A psychologist can help with relapse prevention, which often involves identifying situations that might trigger relapse and planning ahead to cope better or differently with those situations. Importantly, a person trying to quit smoking has to manage their reaction to any lapses. For example, the Abstinence Violation Effect relates to a person’s feeling of failure and resignation that can come from a lapse, and managing that is an important part of staying on track with quitting.

2.  What are some different approaches to quitting smoking that have proven successful with your clients?

The most successful clients seem to be those who have a combination of a medical managed approach and a behavioural approach. For example, nicotine replacement therapy (NRT) and psychological therapy often work well in combination. The NRT helps the person to gradually reduce the nicotine in their body over several days, and the psychological therapy helps develop coping strategies. A vital contribution of psychological therapy relates to the fact that smoking often provides a function for the person, for example, managing stress. If they try to give up without having an alternative method of managing stress, then the chance of relapse is much greater. A psychologist can help the person identify those functions of smoking and develop alternatives.

3.  What are some common reasons for relapse once a smoker has quit?

People often have their own unique risk factors for relapse, and identifying them early and planning ahead is the key. For some, it is emotional factors such as stress or anxiety, or even boredom. For others it is social situations and pressures, such as living with a partner who smokes. And for others, simple opportunity and access can be a critical factor. I have often heard people say they thought they could ‘just have one’, and this can put people at a major risk of relapse just by itself.

4.  Are there ways to combat a relapse or some self help methods to prevent this from happening?

Effective, evidence-based approaches to combating relapse have been available since the mid-1980s. “Relapse Prevention” is a body of work that covers how people can identify triggers, plan ahead for them, and manage relapses when they occur. More recently, the Relapse Prevention approach has been coupled with mindfulness-based strategies, which are all about dealing with being on autopilot. It seems that being on autopilot and reacting to urges and cravings without thinking is a major risk for relapse, and mindfulness strategies helps the person to be aware of urges and then have the presence of mind to consider what’s important to them and respond accordingly.

5.  Is relapse related to the number of years the person has been smoking? (ie- how bad the addiction is)

The severity of nicotine dependence can influence how difficult it is for a person to quit smoking. This does not necessarily just include how long they have been smoking, but also how much they are smoking and how early in the day they have their first cigarette. No matter how long the person has smoked for, and how much they have smoked, it is never too late to quit.

On the flip-side, and although there is no hard and fast rules about this, often time passing of no smoking after quitting does reduce the risk of relapse. In fact, there does seem to be something about the passing of 9 to 12 months that starts to reduce the risk of relapse significantly.

6.  Is cigarette addition harder to ‘cure’ in those who have drug and alcohol addiction/substance abuse?

Quitting smoking is a difficult task, and it can be made more difficult when other factors are in the mix of a person’s life. Certainly, if a person is misusing alcohol or other drugs, then quitting smoking can be more difficult. Sometimes a person may wish to prioritise what changes they might make first, and this may or may not be smoking. Other factors might include mental health issues, chronic disease issues, and general life stressors. Where a person is facing multiple challenges with quitting, a psychologist may be of particular assistance in helping them cope.

7. What are five things a smoker should consider when they decide they want to quit?

1. What would YOU like to do about your smoking? What is your preference? How would you like your life to be?

2. What are your personal reasons for quitting smoking? How would things be better as a non smoker? How might things be worse if you continue smoking?

3. What makes quitting smoking important for you? How does smoking really fit with who you want to be? Putting aside what others say, what is the clincher for you?

4. If you were to make such a change, how would you go about it? What might work for you? What sorts of things need to be addressed to up your chances of success?

5. What will you do? What is going to be your next step?

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Having your heart in the right place

Posted on May 19, 2013 in Uncategorized - 1 comment - 0

 Motivational Interviewing and Compassion

By Dr Stan Steindl

I recently presented at the International Symposium on Motivational Interviewing (ISMI) in Melbourne on the topic of Motivational Interviewing (MI) and Compassion.

As many will know, MI is a communication style in which clinicians can explore with clients the client’s own motivations for change, helping the client to articulate to themselves what they’d like to change, why, what makes it important to them and how they might go about it. Ultimately, MI helps the client to resolve feelings of ambivalence about change and make a commitment to what actions they will take next.

The presentation at ISMI was all about the role of the clinician’s compassion in all of this. As Miller and Rollnick (2012) have written in their core text on the topic, “To be compassionate is to actively promote the other’s welfare, to give priority to the other’s needs.” (p. 20).

Why Add Compassion?

The MI Spirit, previously comprised of collaboration, evocation and respect or autonomy support, was thought to not completely differentiate what the MI practitioner might be doing from, say, the approach of a salesperson.

A salesperson might work in partnership with their customer, might evoke the customer’s own arguments for buying, and can ultimately accept that the person will make the choice whether to buy or not. In fact, people in sales are often very astute at discerning those customers who are unlikely to buy and moving on to the next potential customer.

Not that there’s anything necessarily wrong with that. It’s just that MI is different…perhaps more. MI is essentially all about the promotion of the other’s welfare, setting aside ourselves, and setting aside creating any benefit for ourselves.

As Miller and Rollnick (2012) pointed out, the MI practitioner endeavours to have their “heart in the right place”. (p. 20).

What Is Compassion?

While I, like many clinicians, have long pondered compassion and its role in the clinical work I do, its recent formal inclusion in the spirit of MI has brought the topic into sharp focus for me. So what is compassion? It seems to me that it is made up of a variety of aspects, and so, just to name a few:

•   Kindness – “Be kind, for everyone you meet is fighting a harder battle.” – Plato

•   Acceptance – “A truly compassionate attitude toward others does not change even if they behave negatively or hurt you.” – Dalai Lama

•   Equality – “Compassion is not a relationship between the healer and the wounded. It’s a relationship between equals. Only when we know our own darkness well can we be present with the darkness of others. Compassion becomes real when we recognize our shared humanity.” – Pema Chödrön

•   Action – “Compassion is a verb.” – Thich Nhat Han

I also asked my mother, a GP of 40 years. Despite being put on the spot at her Mother’s Day dinner recently, she said, “Compassion is a feeling of understanding, and of sorrow, for the difficulties somebody else is experiencing…and trying to do something about it.” And I think this highlights the two key components of compassion. There is a feeling component in which we feel for, and with, the other person. And there is an action component, where we do something about it.

A Definition of Sorts

While I am no expert on the topic of compassion, I thought I would put out there a definition of sorts for others to consider and elaborate upon.

Compassion is the capacity to see clearly into the nature of another’s life…their values and strengths, dilemmas and challenges, as well as their suffering. It is a recognition that one is both separate from, and not separate from, that suffering, given the shared experience of being a part of humanity. It is being fully present to the whole story, including all aspects that might influence what the other person goes on to do. It is an aspiration towards transforming that suffering, and active efforts to do so, while at the same time not being attached directly to the outcome of that transformation.

Strong Back; Soft Front

We are not eggs! Eggs have a hard shell, protecting an inner softness and vulnerability, but the hard shell is fragile and brittle and breaks easily under too much pressure. The characteristics of a compassionate person is the opposite, involving a strong back and a soft front.

The strong back is about the emotional strength, courage and wisdom to be with a person and their suffering. It is about being able to see clearly the whole person, and with both conviction and humility provide support.

The soft front is about love, the kind of “non-possessive love” that Carl Rogers spoke about. It is about approaching the other person with kindness and care, acceptance and open-heartedness, and calmness and patience. It is treating the other person with respect and being able to empathise, demonstrating an understanding of what they might be thinking or feeling.

And compassion has enemies. Judgement is an enemy of compassion. Negative judgement of course, but also sometimes positive judgement, which can still put the clinician into a position of superiority. Feelings of pity or fear can also undermine compassion, or moral outrage at the person or their behavioural choices. Also arrogance or thinking that we know best…these and other characteristics are like white ants eating away at the core of our compassion.

Cultivating Compassion

With a growing sense of what compassion is, then we consider how to cultivate compassion. Cultivating compassion includes feeling empathy and concern for others, and it goes beyond this. Steps can be taken to foster the strong back to be present with another person and their suffering, as well as the the soft front of acceptance and positive regard. Further, personal commitments to take compassionate action can be developed and solidified. And clinicians can develop the resilience to prevent ‘compassion fatigue’.

The Center for Compassion and Altruism Research and Education (CCARE) at Stanford University ( has been developing and researching practices for cultivating compassion by combining our knowledge of neuroscience, psychological science and spirituality. The Compassion Cultivation Training (CCT) incorporates:

•   mindfulness practices such as breathing, imagery and loving-kindness meditations,

•   colleagial discussion, reflection and communication, and

•   real-world homework practicing compassionate thought, feeling and action.

Practicing Compassion Through Meditation

“I don’t like that man. I must get to know him better.” – Abraham Lincoln

I invite you to close your eyes.

Think of someone you are currently working with. Perhaps someone with whom the work has been challenging.

Develop a picture of that person in your mind. Feel the presence of that person in your life, in this room.

Now consider and say to yourself:

“This person is just like me. Just like me, they have a history…they were a child once, too. And just like me, this person has had ups and downs in their life. Just like me, this person has had goals and dreams. Just like me, they have strengths and qualities…fears and vulnerabilities…they have had successes and they have made mistakes.”

Good Practice of MI

It seems to me now, that with compassion being formally added to the spirit of MI, good practice will include taking active steps to cultivate compassion.

First, the importance of cultivating compassion for ourselves, for self-compassion is itself a key ingredient in being able to feel compassion for others.

Second, cultivating compassion for our colleagues, all of whom come from the same well-intended place and are facing the same challenges as we are.

And finally, cultivating compassion for our clients, and significantly the client we are just about to see, who comes offering us the privilege of being with them while they consider their own question of change.



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Juggling Act- The Working Mother

Posted on May 11, 2013 in Uncategorized - 0 comments - 0

Today it seems that parents and particularly mothers are expected to be super heroes, their superpower is multi-tasking. The question is what is a working motherʼs kryptonite and how do we sustain the juggling act?

The decision to go back to work after having a baby can be a difficult one for many


women, provoking a complex web of emotions, from liberation and pleasure to guilt and anxiety.

Psychologist, Mother and Psychology Consultants Director, Kathryn Smith comments on her professional and personal experience.

“I frequently see women who carry some guilt over leaving their child to return to the workplace. Women who commonly have difficulty adjusting are those who thought they would stay home full time and are unable to do so due to financial reasons.

Leaving your child in the care of a stranger is certainly an anxiety provoking process and it’s important to be confident in the care you have chosen” said Kathryn.

Kathryn stresses the importance of knowing your boundaries when returning to work after having a child. She says you need to remind yourself that life has changed and therefore your level of commitment to work needs to be different.

Registered Psychologist, Kylie Layton is a mother of one and pregnant with her second child. She has recently joined the team at Brisbane based practice, Psychology Consultants and finds the juggling act challenging but rewarding.

She outlines below three helpful ways to get the most of out working whilst raising children.

“The first is to spend some time exploring and evaluating your priorities and how best to achieve them”

It is important to have this discussion with your partner to agree on your priorities and how to achieve them. Look at where things can be sacrificed or altered in order for you to maintain your personal values, goals, and aims as a mother and as an individual. Then regularly re-evaluate your aims and your situation to see if things are working for you. Each mother is different and it isimportant that decisions are made based on what is important for each individual; there is absolutely no ʻone size fits allʼ when it comes to parenting and return to work decisions. Ignore unwanted advice and opinions; the best emotional balance will come from planning your life around your own individual values and needs.

The second important step is to ask for help. In the first instance from your partner (if you have one), get into the habit of actively making requests for help and assistance and letting them know when you are struggling to cope.

Take up offers or make requests of friends and family when you need it. Explore parenting books for fresh ideas and new options for dealing with things and have open discussions with your childʼs alternate carers to ensure you feel confident and comfortable with your childʼs care.

Thirdly invest in some “you” time. Even a small amount each week will allow you to function better and to build a store of reserves on which you can call when needed. You need to have energy reserves in the bank to draw on it at work and home.

The pressure put on mothers in this generation is far greater than previous generations. Now women are expected to maintain their careers whilst raising a family. There is also a much greater emphasis on the emotional and developmental needs of a child and whether you are fulfilling this as a parent.

Kylie concludes with some sound advice on the juggling act; “Establish clear priorities and values and give yourself permission to do some things well-enough rather than perfectly. This will go a long way in alleviating the stress of juggling two demanding jobs.”

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