What to expect when you are referred to a psychologist

You take the morning off work and head to your GP, with the plan on telling then you have been struggling with feeling stressed, not sleeping well, or feeling low or flat. Perhaps you are often feeling angry, or beginning to feel like you don’t want to live like this anymore. When you see your GP, they ask you some questions and assess how things are going. You fill out a short questionnaire about how you have been feeling, and then your GP says it…

I would like to refer you to a psychologist.

Your GP completes some paperwork, generally including a Mental Health Treatment Plan and a referral to the psychologist (or Mental Health Social Worker/Occupational Therapist), and tell you to contact the psychologist to make an appointment. Alternately the psychologist may contact you when they receive the referral.

You will usually organise an initial appointment on the phone, and the psychologist or their receptionist will let you know if you need to complete any paperwork and should let you know any terms, such as the clinician’s details, cancellation notice periods, session fees and rebate information. You can request a copy of all this information in writing. You may need to wait a while for an appointment, depending on the clinician’s wait list time. You can often request an earlier appointment if it comes up sooner, and you can make yourself available at short notice.

Then your first appointment comes around

Try to arrive 10-15 minutes early to complete any paperwork, and allow yourself to catch your breath and get comfortable in the surroundings. You might want to jot down any concerns you have if you are worried you might forget them. Your clinician will come and greet you, and you will go with them to their consult room. The initial appointment is often mostly for gathering information about your difficulties and any relevant history, as well as completing some basic assessments and creating a treatment plan. Your clinician will usually share this information with you at the end of the first appointment, including their recommendations about what happens next. Once the appointment is over, you pay for the session (or sign a bulk bill form if it’s a bulk-billing clinician - we don’t offer this at HMC) and book in future appointments. Often future appointments are fortnightly, but sometimes they are a little more frequent or spaced out further.

Congratulations!

It's now time to give yourself a little bit of space to process that you have done it! You have commenced treatment and taken the first step toward optimising your life. Now you have a safe person in your team, that will help you work toward becoming the best version of yourself.

Olivia Boer is a Clinical Psychologist and Director of Healthy Mind Centre Launceston, a private allied health practice in Launceston, Tasmania. 

So, you think you can breathe?

Most people could benefit from slowing down and relaxing a bit more. We get caught up in our busy lives, rushing around, and all of a sudden it's the end of the day. Then it's the end of the week. And before we know it, another year has passed. 

How many times over the past year did you purposely slow down and relax?

Really slow down, I mean. Stop, breathe, connect with the moment. Focus on calming down any physiological stress or tension in your body. Maybe you had a massage a few months ago, and there WAS that week off over Christmas. But, actually, that week was mostly spent running back and forth between various relatives and trying to manage overtired and overstimulated children. And while you were having that massage you were actually planning your partner's birthday present for next week and what you had to get done at work that afternoon. Hmmm. 

The problem is often our attitude. I'm not saying we don't believe relaxing is important. But... how often do you prioritise rushing over relaxing? Our attitude and judgements make this really hard. We often don't truly believe that it needs to come first, or that other things or other people can generally wait. Instead, we rush all day and then at the end of the day we flop on the couch and scroll through facebook for the rest of the evening. Yes, when sitting down are bodies are slowing down. Technically. But this doesn't really give our minds an opportunity to slow down too. 

This is where breathing comes in. 

By purposefully and intentionally stopping to prioritise relaxation (such as breathing practice), we are changing our behaviours. Changing our behaviours can help us to develop new habits, spend more time doing what is meaningful and brings vitality to our lives, and help us to challenge some of those unhelpful attitudes and judgements. Breathing helps us focus, and calms down our physiological stress response. 

But I've been breathing my whole life, I hear you say. 

Well, of course. But automatic, everyday breathing isn't the same as intentional, focused breathing. What's worse is when our everyday breathing becomes stressed, shallow, and a little too fast. Diaphragmatic (or slow, deep, "belly") breathing can help us undo this, by using our lungs to their full potential. See, when we are stressed we can hyperventilate, or "over-breathe". This results in an imbalance between our oxygen and carbon dioxide levels in our body. By breathing too quickly, we get a sharp drop in our carbon dioxide levels. This causes our blood vessels to constrict, chest pain or heart palpitations, dizziness, and a sensation of not getting enough air (amongst other things). Although this isn't dangerous, it is uncomfortable and if you are prone to anxiety, can lead you to misinterpret what is happening in your body as something really bad, leading to higher stress and over-breathing even more! Hello, panic attack! Slowing down your breaths, and using your full lungs to breathe deeply assists us to re-balance our carbon dioxide and oxygen levels. Doing this intentionally, with an attitude that relaxation is essential and is worth prioritising over other less-essential parts of our lives, can help us start to slow down and relax. 

How do we breathe this way, then?

First, find a quiet place where you are unlikely to be interrupted for 10 minutes. A comfy place such as your bed or favourite chair works well. If all else fails, head to the toilet if that's the only place you won't be bothered. If you have young children, pick your time when someone else is around to help out, or when they are taking a nap. Or when Paw Patrol is on. Whatever works. Put on some slow, relaxing music or nature sounds. 

Start by breathing normally, about 3 seconds in - brief pause - 3 seconds out - brief pause. Gradually extend this to a four second cycle, and keep extending as far as it feels comfortable. Let your belly relax and extend. This is not the time for sucking your tummy in. Let your shoulders hang. Expel all the air from your lungs and allow them to refill. As you breathe in, imagine you are taking a huge whiff of something delicious. Freshly baked chocolate-chip cookies or the like. Breathe in a big lungful and allow your belly to expand. Pause, and breathe out like you are blowing on a spoonful of piping hot chicken soup. Enough to cool it, but not enough to splatter it everywhere. Chocolate-chip cookies - pause - chicken soup - pause. Chocolate-chip cookies - pause - chicken soup - pause. Focus your mind on the sensation and experience of breathing, and when you choose to finish, reflect on what it feels like in your body and what it was like to purposefully stop and prioritise your mental well-being. 

Try it. I'd love to hear how you go. 

Olivia Boer is a Clinical Psychologist and Director of Healthy Mind Centre Launceston, a private allied health practice in Launceston, Tasmania. 

The importance of being "present"

We often fail to recognise the impact our thoughts have on our emotional well-being. It's pretty easy to recognise when you are feeling a negative emotion, after all, it feels bad. We feel tense, irritable, stressed-out. Sometimes, we recognise our behaviours that are associated with these feelings. We withdraw, stomp around, or pace the hallways. But what about our thoughts?

Actually, it all starts with our thoughts...

Wait, what? Our thoughts come first? Well, yes, according to CBT, or Cognitive Behaviour Therapy theory. This idea suggests that it's our interpretations of situations that lead to a particular feeling and set of actions. Helpful, realistic, coping-oriented thoughts or interpretations lead to helpful, realistic, coping-oriented feelings and behaviours. And vice versa. Extreme, unhelpful thoughts, that overestimate how bad something is or how likely it is the bad thing is going to happen (or overestimate how bad something was that actually happened), lead to extreme feelings, and extreme behaviours. But what does this have to do with being present?

Being "present" means being in the here and now.

Having our attention focused on our experience right in this moment. Connecting with what is actually happening right here, right now. It's a concept called "Mindfulness", and it's making it's way into many therapy rooms across the globe. But why is is helpful to be mindful? Well, think about when we are having those stressed thoughts. The ones about last week, or yesterday, or this afternoon, or next year. When we spend time up in our heads, time-travelling with our thoughts, it takes us away from what is right in front of us. The important things. The things that bring meaning, richness, and connection to our lives. Our children. Our gardens. What is on our dinner plate. Well, these things bring richness to my life. Whatever brings richness to your lives is what you might want to spend some more time engaging with. 

So, how does one be present?

Well, there are lots of ways actually. But a good place to start is to think about your five senses. Sight, hearing, touch, taste and smell. Your senses tell you about this exact moment. What you hear is occurring right now. Not yesterday. Not tomorrow. This very moment. Same for the other senses. I like to show my clients an activity called the 5,4,3,2,1 game, to help them start to connect with their present experience (and disconnect from their time-travelling stressed thoughts). It involves noticing 5 things you can see, 4 things you can hear, 3 things you can touch, 2 things you can smell, and 1 thing you can taste. You CAN mix up the order, but I find this version works well.

Try it now. And next time you are eating dinner, or in the shower, or going for a walk. And notice whether that experience added richness and meaning to your life. Then recognise that now, you have the ability to be present and connected with the here and now. There are heaps of other ways to add richness and meaning to your life. Reach out to your therapist to find out more. 

Olivia Boer is a Clinical Psychologist and Director of Healthy Mind Centre Launceston, a private psychology practice in Launceston, Tasmania. 

Your bucket is overflowing...

So, you have worked out you are stressed, tried some basic strategies, and are now keeping track of your stress levels (if you haven't done this, go back and have a look at our last two blog posts here). But how do you put it all together?

One nice, neat analogy is the stress bucket. Essentially, most people have a bit of stress (or SUDS of 3/10). This can be thought of as a bucket 3/10th full. When your bucket is just under a third full, then you have just over two thirds left of capacity before your emotional bucket overflows. Now, not everyone starts at the same place. People who have very little stress, or great resilience, start off with a little less. People who have a lot going on, or lots of things topping up their bucket, start off with a bit more. Or a lot more.

If you are starting out with a bucket half-full (wow, that sounds optimistic hey!) or two thirds full of stress, then you have less coping capacity to deal with stressful things that happen. If you have a large amount of stressful things happening, and your resilience is low, you might find yourself sitting at 95%. Then, all it takes is one more (sometimes small) thing and whoosh, your bucket overflows. 

Now for some people an overflowing bucket looks like bursting into tears, or yelling at your children, or saying out loud that statement you have fantasised screaming at your boss. Or maybe it's getting into bed, turning over to face the wall and pulling the covers up. And for those who are struggling the most, thinking that there is no way out and our bucket will be like this forever. Or that the bucket can't be emptied. 

You CAN get your bucket levels down. Sometimes it's by reducing the amount of stress coming into your bucket (life), sometimes it's getting more effective at letting it out. Mostly it's a combination of both. But often we aren't sure how to do this on our own, and that's where someone like a psychologist, counsellor, or your GP can help you move into a less-stressed and healthier head space. 

Olivia Boer is a Clinical Psychologist and Director of Healthy Mind Centre Launceston, a private psychology practice in Launceston, Tasmania. 

How much stress do you have in your life?

Stress can impact most, if not all areas of our lives. Every day. In fact, even things that we typically see as good, such as a new relationship or doing something exciting, add stress to our lives. 

No one has no stress (unless we are unconscious, and even then our brains and bodies can experience stress - nightmares, anyone?). Additionally, stress is a very individual and often internal experience. Other people might not know how stressed we are just by looking at us.

One helpful way to measure how stressed you are is using a Subjective Units of Distress Scale (SUDS). Using SUDS allows us to compare our stress levels across events, and at different times of the day. It's a technique psychologists and other counsellors often use, so we can accurately understand someone's internal experience. A SUDS scale can be 0-100 or 0-10. I prefer 0-10 for simplicity (and because I work with a lot of children, not all who can easily count to 100!). Generally, 0 = no distress (comatose) and 10 = extreme distress.

So, back to no one has no stress. Average, everyday stress levels for the average, everyday person could be about 3/10. Enough so they look before they cross the road and make a bit of an effort in life. Netflix and Chill is around 2/10. At about 5/10, you are noticing signs of stress in your emotions and body, but you can still do the things you need to do. At around 7/10, your level of functioning begins to become impaired - you can no longer concentrate as well as you would like to, and it's getting tricky not to high-tail it out of there or scream at someone. By 9/10, you are on the verge of losing control. And 10/10, well, you've lost it. 

Try getting into the habit of checking in with yourself regularly (or your partner or children) at different times and working out what your number is at any given time. It's a very useful strategy as it can guide what you do next, as well as help predict the times you are likely to be more vulnerable in the future. Keeping note in a diary or on your phone is a great idea too. Have a chat to your psychologist for more guidance - we can help you work out what next.