Friday, 8 November 2013

Second visit with Psychologist - Sensate Focus and Thought Recording

Another long day, about six hours of travel time for a two hour psychologist appointment. A very productive appointment though! Learnt some new techniques that I’d like to share with you guys, mainly to do with the homework I was assigned.

The first thing I’d like to mention, is last time I was assigned homework for this appointment that I forgot to write about: A Cognitive Hierarchy of Fears.

I’m no psychologist, and so I’ll do my best to describe it, but do some research of your own and if you think it may be a beneficial tool I would recommend consulting a psychologist to help you build one or look over yours and help you with the steps after the hierarchy being written.

When I was building my hierarchy, I thought of all the situations that scare me to do with my pain (self stimulation, foreplay, sexual intercourse with penetration, kissing, cuddling, etc.). Once I thought of all the situations that cause me anxiety (any level anxiety/fear from a little bit to a lot), I put them in order of least fearful to most fearful and finally give them a fear score out of 100 (ex. Sexual Intercourse - 85/100). When working with a psychologist after making your hierarchy, he/she will help to decrease the anxiety associated with those situations, and each psychologist will have his/her own methods of going about this. What I have heard of some psychologists doing is teaching their client relaxation techniques (deep breathing, muscle relaxation, changing thought processes, etc.) and once the client is comfortable with the technique(s), the psychologist will describe a lower anxiety situation from the hierarchy to the client, the client is to imagine this situation as it’s being described, and use the relaxation skills to decrease the body’s natural reactions to anxious situations. You might be thinking “but how is that going to help my real life pain?” Surprisingly, research has shown that once you can remained relaxed while imagining all these situations, and your anxiety level in these situations has decreased to a low score (out of 100), that the skills will transfer to the real life situations as will your anxiety levels to the situations. The brain is powerful, but easily tricked! When you imagine a stressful situation (or any situation really), your body will act as if you are truly, physically in the situation, and so practicing while imagining can be equally as effective as practicing in as real life situation!

My psychologist and I did not work on this today, but she noticed in my previous homework that I have a bit of fear to any physical touch that may or may not lead to any sexual activities, so she suggested an interesting exercise for my partner and I to try: Sensate Focus.

Apparently there are five stages to sensate focus, she only described to me the first stage. The first stage involves taking a half hour with your partner, and exploring with touch anywhere except the genitalia and the breasts. For fifteen minutes each, one partner will touch the other all over his/her body – light touch, deep touch, one finger tracing, full hand massage, etc. As the partner is touching different parts of the body (for 30-60 seconds each body part touched), the receiving partner is to “go inside his/her own body” and practice deep breathing and thinking about how the touch feels (where do I feel this? It is tingling. It is ticklish. It is soft. Etc.). There is no talking between partners during the process, except that the partner receiving the touches should say ratings out loud as to how the touches feel (example: 2/10; 9/10; 5/10, etc.). Any rating above zero is a good rating, if there in any touch that is painful or too unenjoyable, “stop” must be said, and the partner just moves on to another area of the body. 1’s, 2’s and 3’s should not discourage the partner touching from the area he/she is touching, in fact he/she should continue touching that area for the thirty to sixty seconds, because as the partner receiving touch relaxes and is deep breathing, the feeling of the touch may change. After fifteen minutes lf touching one partner, the two should switch roles (no feedback or discussion while switching). After both individuals have had fifteen minutes of touch, then you can offer each other feedback. This is a beneficial exercise for many reasons: couples get to learn where their partners enjoy being touch and what kind of touch is pleasurable; if either partner had a fear of touch, he/she will begin to habituated and maybe start to uncover some non-sexual pleasurable touches; it allows each partner to practice relaxation techniques and a new way of thinking about touch, a more curious thought process about how the touch feels, where it affects your body, etc. The last important thing to remember is that this is not meant to be sexual, and that the couple should refrain from any sexual interaction during the exercise and for at least an hour afterwards.

Some resources to learn more on senate focus:

-          Link to Great PDF

My second homework assignment was to start a thought record.  In this thought record, I’m to write down any thoughts I have about my diagnosis or pain, the date I have this thought, if I experience pain during the thought or prior to the thought I need to rate the pain out of 10, the situation that provoked the pain and/or the thought and if my thoughts follow any thinking errors.

Thinking errors are different ways of thinking that have been identified of thought processes that people experience when they experience chronic pain, depression, anxiety and other disorders that affect the way we think. Here are some examples:

-          All or none thinking: you see only two categories in a situation, everything is black or white, no grey areas. You might use language like “always, every or never” and something feels like it is either completely good or completely bad.

-          Fortune telling: predicting that negative things are going to occur. An example might be “I’ll never get better.”

-          Catastrophizing: thinking that the worst is going to happen (kind of like fortune telling, but to the extreme).

-          Discounting the Positive: ignoring positive aspects or somehow altering them to seem negative.

-          Emotional Reasoning: because you feel emotionally something is true, you ignore any evidence discounting it and follow your emotions. Example: “I wouldn’t feel so hopeless if it wasn’t so.”

-          Labeling: labeling yourself or others. Example: “I’m a (sexual) failure.”

-          Mental Filter: paying attention to negative details instead of the whole situation.

-          Mind Reading: believing you know what others are thinking and not thinking of alternative possibilities. OR you assume that others should know what you’re thinking.

-          Overgeneralization: making the assumption that a negative situation will occur forever and repeatedly. Example: “I will never have pain free sex.”

-          “Should” and “Must” Statements: you know how you want yourself and others to act and are upset when the expectations are not met. Example: “I should be able to enjoy sex.”

-          Maladaptive Thoughts: thoughts that may be true, but do not help to dwell on. Example: “I’m feeling a lot of pain” or “It’s not fair.”

-          Minimizing: refusing to five yourself credit for any positive feedback received.

Nobody will experience all of these thought errors, but maybe a few of them. There are ways of rethinking these, and writing them down makes it that much easier to see them and say, “That definitely is fortune telling, I could think this instead.”

Here are some good resources to learn more about thinking errors and thought recording:

-          Cognitive Thinking Errors

-          PDF of Thinking Errors

-         More Thought Recording Sheets

My last homework assignment was to start tracking my pain and interventions. At the end of every day I need to write down if I had physiotherapy that day, if I experienced pain that day, what my stress level was that day and if I used any interventions that day. Hopefully this will help us to start pin pointing aspects that might affect my pain!

This was a long trip, but it was productive, I’ll be returning in three and a half weeks to the psychologist. Here’s money spent:

Money spent today on psychologist: $300.00

Travel Expenses today: $165.00

Total expenses today: $465.00

Total Psychologist fees up until today (not including travel expenses): $450.00

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