counselling Archives - Benchmark Psychology

Choosing the Best Digital Mental Health Tools for Patients

Written by Clinical Psychologist Tania McMahon

Digital Mental Health tools and resources are becoming an increasingly important part of our mental health system. They provide effective, evidence-based intervention for patients with mild-to-moderate mental health symptoms, and they can be a fantastic option for patients who experience barriers to accessing face-to-face psychological care (e.g. finances, location, stigma).

However, with a huge selection of digital mental health tools available (e.g. there are an estimated 1400+ mental health apps on the app store), health practitioners face the challenging task of finding and selecting suitable tools for patients on platforms that lack regulation or reliable quality assurance (e.g. the star-rating system on the app store is easily exploited).

A major concern of many practitioners is the quality of the interventions provided by these digital services, as well as concerns about privacy and data security of highly sensitive information. To help address this, the Australian Commission on Safety and Quality in Health Care is undertaking a project to develop national safety and quality standards and a certification framework for digital mental health services. The goal of certification of services is to increase user confidence, increase usage and increase consumer choice in digital mental health services.

With this certification framework still a little while off, the onus is currently on health practitioners and users to individually assess the quality of digital mental health services. While this can feel like an overwhelming task, it doesn’t have to be! Here are a few helpful options, including questions you can ask and steps you can take to help make the right decision:

For Apps – use the Mobile App Rating Scale (MARS)

Researchers at QUT have developed and validated the world’s first known mental health app quality rating tool (the MARS), to provide a multidimensional measure of the quality of each app. The indicators include engagement, functionality, aesthetics, information quality, and app subjective quality.

More information about the MARS (including a free download of the tool) is available here.

For all other services (e.g. websites, online programs)

Is it user-friendly and engaging?
- Is it easy to navigate and use? Is information easy to find?
- Is it engaging and pleasant to use?
- Is the information clearly communicated?
- Will users want to access it enough to get the full benefit?

Is the content clinically safe?
- There should be transparency about who owns the service and what the funding sources are (so that you can identify any conflicts of interest).
- There should be transparency about how the content was developed and by whom (e.g. through university research or a government grant, and what the expertise of the content developers is). Services developed by government-funded bodies and institutions are likely to be the most reliable in terms of content and efficacy. Check out Head to Health for a searchable index of Australian, government-funded digital mental health services.
- There should be some evidence as to the efficacy of the service - ideally a Randomised-Controlled Trial or other evaluative process. However, if not (as RCTs can be difficult to fund), digital adaptations of well-established efficacious treatment interventions (e.g. CBT) can generally be considered effective as long as the treatment is clearly communicated (i.e. something that claims to be online CBT clearly appears to be).
- Are there any treatment elements that could cause harm?
- There should be options for at-risk users to self-identify and seek further help (e.g. a ‘Get Help Now’ button that leads to Crisis Line information).
- If there are health professionals involved in the delivery of the service (e.g. conducting telephone assessments, moderating online forums), do they have appropriate qualifications?

Does it protect privacy and is it secure?
- Is the site secure?
- There should be clear information about how personal data is used and protected.
- The service should have a privacy policy stating that user information is not sold on to third parties.

To get started in your search for helpful digital mental health services, begin here:

Check out the Australian government’s ‘Head to Health’ digital mental health gateway - https://headtohealth.gov.au.
Search for some relevant services and try out one or two for yourself; evaluate them using the questions above (or the MARS, if it is an app).
See if they would be suitable for your clients – if so, great! If not, head back to Head to Health and search for another.

Choosing the Best Digital Mental Health Tools for Patientswebeditor2023-08-21T14:47:38+10:00

Help! My teen has self-harmed. What do I do?

by Karien Hill

Finding out your teen is self-harming can be frightening. You may feel overwhelmed and ill-equipped to handle the situation, fearing you might make it worse. Finding out more about why teens self-harm and how to help them manage their intense emotions can be useful.

Self-harm - The facts:

Self-harm is defined as intentional harming of one’s body without suicidal intent. It is usually done in places not visible to others.
Approximately 12% of young people have engaged in self-harm previously.

Why do young people self-harm?

To cope with an intense emotion
To punish themselves if they feel guilty
To try and replace emotional pain with physical pain
To feel ‘something’, ‘anything’ if they feel numb, disconnected or alone
To feel in control
To express they need help

Signs someone may be self-harming:

Wearing long sleeved clothing in warm weather
Isolating themselves and withdrawing
Scratches, cuts, bruises, scars with inconsistent explanations

How is self-harm and a suicide attempt different?

Most young people self-harm as a coping mechanism, rather than to attempt to end their life.
However, people who self-harm are also more likely than the general population to feel suicidal and to attempt suicide.

How do I tell the difference?

Just ask - if you notice your teen is engaging in self-harm, ask them if they have thoughts about suicide. If they are, take them to a GP and psychologist for assessment and support.
Experts agree that asking and talking about suicide does not make someone feel worse or ‘put the idea in their head’ – rather it provides relief.

What to say:

Ask – have they been self-harming, what has been going on, how are they feeling about it, what are they thinking, what have they thought about what they could do.
Then listen – you do not need to give advice or fix anything, unless they ask for it.
Acknowledge their feelings - don’t minimise or tell them not to feel a certain way.
Keep your reactions in check – if you feel scared, shocked, angry or blame yourself – breathe slowly and deeply, relax any tense muscles and get back to listening and acknowledging their feelings. If you react they may be less likely to communicate with you in future. Find other parents to connect with and discuss this and get your own support.
Admit you may react or say something unhelpful. Admit you don’t have the answer. Tell them despite this, you care, you are there, you want to help.

What to do:

Help! My teen has self-harmed. What do I do?webeditor2023-08-21T14:53:15+10:00

Burn Out

by Dr Julieta Castellini

We generally don’t wake up, one day to the next, feeling burnt out. Burn out is a gradual, insidious process. We often miss the somewhat vague warning signs, putting these down to feeling tired or just having “one of those weeks”. It’s often not until we’ve fully hit burn out station, or we have it pointed out to us by partners, family, friends or colleagues, that we recognise how depleted we are.

At a societal level, there is increasing pressure to do more and work harder, both at work and at home. We work harder and do more, and in the end lose touch with what happening for us, how we are feeling and our capacity.

I’ve heard of burn out, but what is it?

Burn out is the cumulative reaction to ongoing life stressors. It tends to occur when the resources we have (such as time and energy) are lost or not enough to meet all the demands we have at hand, or when our inputs don’t result in the output we had hoped for. Some factors that lead to a higher risk of burn out are uncertainty, stressful events, heavy workload and pressure.

Signs or indicators of burn out are:

feeling overwhelmed or unappreciated
cynicism or frustration
emotional exhaustion
avoiding or withdrawing
less commitment to activities, i.e. doing the bare minimum
feeling less satisfied
taking more time off
sense of ineffectiveness or failure
changes in attention or concentration
increased use of alcohol, drugs or TV/social media
changes in sleep or appetite

Many of us will experience some of these signs at one point in time or another, which may be completely unrelated to burn out. However if you are finding that these symptoms are ongoing or you are experiencing several of these, you may be burning out.

What can I do to manage burn out?

If you’ve gotten this far and you’re thinking, “help, I’m burnt out!!”, here are some things you can do to not only address burn out, but also take steps towards preventing it.

Good eating, sleeping and exercise routine. If you can, try to aim for 3 to 5 meals per day, about 8 hours sleep a night and a 10 to 20 minute walk per day
Saying “no” if you do not have capacity. If it’s hard to say “no”, try saying “maybe” and give yourself the time to think about whether you have capacity or not
Give yourself breaks between demands or activities, and have some “quarantined time off “ each week, even if just for an hour
Try to find a balance across the different areas of your life, you are not going to be able to give 100% to each area and that is totally ok
Write out the things that are stressing you out. Make a note of the ones that are urgent or important (i.e. will this matter when I’m 85?) and which ones can be postponed or delegated to others
Reconnect with your passions, the enjoyable activities that fulfil you
Socialise with friends
Use mindfulness based apps (such as Smiling Mind or Headspace) to focus more on the present, the right here and now, rather than the future or the past

If you are finding that your symptoms are significantly impacting on your relationships, work or other life areas, or you would like some support with managing burn out, check in with your GP and you may discuss whether seeing a psychologist could be worthwhile. You might also be able to access a psychologist through your workplace under an Employee Assistance Program.

Burn Outwebeditor2023-08-21T14:56:49+10:00

Working with: The Existential Crisis

by Tessa Hall

Of the many reasons clients are referred for psychological therapy, anxiety in some form is by far the most common. While treatments like CBT are very effective in helping clients understand and manage their symptoms at a very functional and practical level, sometimes a reflection on the […]

Working with: The Existential Crisiswebeditor2023-08-21T14:58:36+10:00

Helping children (and ourselves) respond to Media coverage of difficult events

by Dr Jasmine Pang

There has been a plethora of difficult news stories to hit our screens recently: from child abuse involving high profile, previously well regarded alleged perpetrators to mass violence resulting in multiple deaths. While the media can help to inform and educate, it can unfortunately […]

Helping children (and ourselves) respond to Media coverage of difficult eventswebeditor2023-08-21T15:00:46+10:00

Using e-Mental Health to Help Our Clients

by Dr Tania McMahon

As part of the Australian Government’s recommended stepped care model of mental healthcare, ‘e-Mental Health’ services (low-intensity online mental health interventions and resources) are becoming a much more important part of our mental health system.

With 1 in 5 Australians experiencing mental health difficulties, low intensity interventions can provide an ideal option for individuals with mild-moderate mental health symptoms where other options (e.g. psychologist referral, medication) might not be suitable. However, e-Mental Health services need not be an either-or choice when compared with face-to-face treatment. In fact, e-Mental Health services can fill multiple roles in the space between an individual seeking help from their GP and accessing treatment with a Psychologist, from initial psychoeducation and increasing acceptability of face-to-face services for first-time help-seekers, to crisis support between appointments, to providing interim support and brief intervention for busy periods where they may be on a waitlist.

Below is a brief guide to the range of e-Mental Health services available (Table 1), as well as an outline of the various roles e-Mental Health can play, and which services are most appropriate.

All listed programs have been developed by credible sources, such as the Australian Government, universities, and national nongovernment organisations.

Table 1. e-Mental Health Service categoriesHere is an outline of some of the ways e-Mental Health can be used to help our clients:

Head to Health (https://headtohealth.gov.au/) Previously ‘mindhealthconnect’, this is the Australian Government’s portal to mental health information and e-Mental Health services. It enables consumers to search for information and receive advice about their mental health needs.
Telephone and Webchat	Telephone and online chat services, most often free and used for crisis support, information-seeking, or brief counselling.	Lifeline Kids Helpline eHeadspace Suicide Callback Service Beyond Blue Support Service
Psychoeducation Websites	Freely accessible websites providing mental health information, and often general tips and strategies for wellbeing.	Beyondblue - www.beyondblue.org.au Black Dog Institute - www.blackdoginstitute.org.au ReachOut - https://au.reachout.com/ Centre for Clinical Interventions - www.cci.health.wa.gov.au
Online programs	Online self-guided courses that are either transdiagnostic (i.e. targeting common core mental health symptoms), or address a specific problem (e.g. Social Anxiety, PTSD). Some programs offer limited guidance from a therapist via phone or email. The majority of programs are free, with a few being low-cost.	Mindspot - https://mindspot.org.au/ Moodgym - https://moodgym.com.au/home This Way Up - https://thiswayup.org.au/ myCompass - https://www.mycompass.org.au/ OnTrack - https://www.ontrack.org.au/ Mental Health Online - https://www.mentalhealthonline.org.au/
Apps	Easy and convenient to use (as they are mobile- or tablet-based). However, due to the number of apps available on the market and the relative ease in creating them (compared to the more comprehensive online programs), many do not have experimental validation. As such, it is important to thoroughly check the content and credentials of any app before referring to it.	BeyondNow Suicide Safety Planning app (developed by Beyondblue) MoodPrism and MoodMission (developed by Monash University) AIMhi Stay Strong App (developed by Menzies School of Health Research for practitioners developing a mental health plan with ATSI clients)

1. As crisis support:

Telephone and webchat services are a great option for clients to contact if they need immediate support out of hours or between appointments with their healthcare professional.
Apps such as the BeyondNow Suicide Safety Planning app can help clients and their healthcare professional create a strong, structured plan for dealing with ongoing crises and distress.

2. Psychoeducation for first-time or hesitant help-seekers:

Head to Health, the government’s mental health information portal, is a great place to direct clients to in the first instance.
Psychoeducation websites are fantastic tool for providing information about general stress and wellbeing, specific diagnoses (e.g. generalised anxiety, eating disorders), or specific problem areas (e.g. parenting, relationship issues, work stress) to first time help-seekers.
Online programs (particularly the transdiagnostic programs that don’t focus on a specific diagnosis, such as myCompass) are a great option for help-seekers who are hesitant or uncertain about face-to-face mental health intervention.

3. Interim support:

If clients are on a waitlist or aren’t able to access timely support due to situational circumstances, online programs and apps can provide a great option to help them start working on their wellbeing in the meantime (which also means they can hit the ground running when they are able to commence face-to-face intervention).

4. To complement face-to-face treatment:

Online programs and apps can help build on the skills being taught in therapy, such as CBT strategies, mindfulness and positive psychology. Whilst using these resources as a complementary tool can involve a little extra work on the part of the clinician (i.e. to be able to get to know the programs available and find ones that complement their work), it can really help to strengthen and reinforce the work done in session.

Using e-Mental Health to Help Our ClientsTania McMahon2023-08-21T15:02:35+10:00

Parent Self-Care: The Important Flow On Effect

by Dr Alison Bocquee

There is a lot written in social media and print about being a good parent, good enough parent, ‘the best you can be parent’. We hear of the importance of looking after ourselves as parents before or so we can best look after our little people. Anyone who has travelled by aeroplane will have heard the air hostesses instructing parents to put on their own oxygen masks first before attending to their child. It seems counterintuitive, but let’s look at the detail as to why this matters.

Self-care – who takes care of the parent? When the parent is constantly giving to others, do they ever think about how much they are giving of themselves? It’s probably not something that parents ask themselves or even consider often, until they are overwhelmed, feeling exhausted and irritable with their children. Then comes the guilt because they are not being the parent that they ideally want to be.

Let’s put it simply. We cannot give what we haven’t got. So if you, as a parent, are not looking after yourself, not showing yourself the love you show your loved ones, not treat yourself the way you want others to treat you (i.e., with respect), this not only affects you but potentially every member of your family.

Children can be viewed as the barometers of the parent’s functioning. Their behavioural outbursts or emotionality or sensitivity may reflect their parents’ imbalance of ‘all work and looking after the family’ but not themselves. When the parents are balanced (i.e., calm, consistent, non-reactive) there is a much better chance the children will be too. Hence the very important flow on effect of parent self-care.

Self-care includes aspects such as sufficient sleep, regular physical movement, nutrition, rest and relaxation, social connection, and engagement in pleasurable activities. Self-care is giving yourself a break, to recharge, taking time off. Self-care shows you matter. It models to your family the importance of your needs, that each member of the family is important. It reduces stress. Self-care is good for your well-being and that of your family.

Further engagement in each of these aspects of self-care demonstrates and models to your little people important life, coping and self-regulation skills. This is much more powerful than anything you could say or ‘lecture’ your child about. Demonstrating to your child that when you’re frustrated you engage in deep breathing, or when you’re anxious you run a bath, or at the end of the day if you’re tired you go to bed a bit earlier, and so on, are invaluable life lessons.

Self-care doesn’t have to be time intensive. Even engaging in breathing exercises for 2 minutes or watching the clouds, or listening to your preferred music is likely to shift your energy and provide you with a little joy. Getting up a little earlier than your little people to plan or consider your intentions for the day, perhaps whilst you sip a cup of tea, is also important self-care. You’ll likely be more calm, and therefore more intentional in your interactions with your loved ones and less reactive overall.

Our team of highly skilled and professional clinical psychologists are able to compassionately support your journey to being the parent you want to be, that makes your heart sing, a parent who prioritises their own self-care because they acknowledge their own importance and their own needs; and that ultimately flows on to a more contented family. Opening yourself to growth by learning and incorporating skills such as relaxation and mindfulness of thoughts and emotions techniques, means you are prioritising your own wellbeing and that of each member of your family.

Parent Self-Care: The Important Flow On EffectEllie Raymond2023-08-21T15:04:39+10:00

Freeing Ourselves From Avoidance

By Dr Jasmine Pang

As human beings, we are encoded to survive by avoiding things that are likely to cause us pain, which we have learnt in the past to induce pain or which is stressful or unpleasant: be it that giant spider sitting on the clothing line, that shoulder pain that has been ongoing for a while, or an article that you have promised to write for your upcoming practice newsletter.

In the initial phases, avoidance can work very well. By just using the part of the clothes line that the spider has not occupied, by not thinking about the article I need to write or by working around my sore shoulder, I can pretend that everything is ok and continue on my merry way. We work around it. The problem is that things very seldom remain the same. My resident clothesline spider decides to expand his territory and take up more and more of my clothesline, my shoulder pain worsens to a point that I cannot reach up beyond my shoulder and my practice manager starts sending me “reminder emails” that I cannot avoid anymore. Whilst some avoidance can be a very successful strategy to keep us safe from stressful situations, unpleasant experiences or threats, it can also become counter productive

So what have I learnt about avoidance?

1. Avoidance can be helpful when threats are real. If that spider on the clothesline turns out to really be that gastly dangerous “it’ll kill a grown man within an hour” species that Australia seems prone to having, avoiding it is probably a good idea. We can never totally avoid all the things that we want to avoid. It is seldom that avoidance makes things go away. The spider is still on the line, my shoulder still hurts and the looming newsletter article deadline is still there.

2. Avoidance feeds fear and is an all consuming voracious creature. The more we avoid the greater the problem often becomes. This is particularly so with anxiety. The more anxious I feel, the more I avoid. The more I avoid, the more anxiety I feel. As time goes by, our world becomes smaller and smaller and we feel more and more trapped.

3. Avoidance prevents us from learning that something different can happen or that what we were so fearful of is not as bad as we expected it to be. It prevents us from really experimenting and checking it out, to determine if something is really a threat or not.

What have I learnt to do about it?

1. Acknowledge the problem. We cannot do anything about a problem until we acknowledge it. For me, it was acknowledging that I had a problem in my shoulder (and in all likelihood had torn a ligament), that I was frightened of that spider and that the thought of having to sit down and write an article brought back traumatic memories of writing my thesis.

2. Start small. Be it writing notes on what you’d like to include in the article, finding out about physiotherapists or reading up about whether your resident spider is indeed as dangerous as you imagined it to be. Keep pushing yourself to be at the edge of your comfort zone. Don’t try to aim for the big wins. Small sustainable goals are more likely to get you there. Remember the tortoise and the hare.

3. Get support and help. Having someone to walk you through the journey can be invaluable. It helps give you perspective, keeps you accountable and gives you someone to whine to at the end of the day. This is particularly so if you have been avoiding a situation because of traumatic experiences. Until you stop avoiding, it will continue to intrude in your life and limit you. It might be uncomfortable but keep practicing and trying. Eventually it becomes the new normal.

To quote loosely from Vivian Greene, perhaps life is not about trying to avoid the storms but learning how to dance in the rain. Now excuse me whilst I get a broom to try to relocate my eight-legged friend for the fifth time before I head out for my physiotherapy appointment.

Freeing Ourselves From AvoidanceEllie Raymond2023-08-21T15:05:33+10:00

When Cracks Appear – Referring Couples for Relationship Therapy

By Dr Jennifer Wilson

Positive, supportive relationships can help us withstand many of the expected or unexpected challenges life might throw at us. At times of stress, knowing there is at least one special other to turn to, who we can trust to hear and respond to us, strengthens our capacity to cope. Conversely, when that need for support at a critical time is not met, we can feel profoundly hurt by those we rely on for care
and comfort. At these times, instead of pulling together to face life’s difficulties, partners can become disconnected and even hostile with each other.

This is where a trained couples therapist can help. As health professionals, you are likely to be caring for patients who are going through just the kinds of difficult life events that can place strain on relationships. Here are a few tips on how you can encourage your patients to seek help for their relationship.

At Benchmark Psychology, we have psychologists trained in Emotionally Focused Therapy (EFT) for Couples. According to recent studies, 90% of couples who see a well-trained Emotionally Focused Therapist experience improvement, and 70% report full repair of their relationship. Unfortunately, many couples are reluctant to seek therapy because of a range of fears and misconceptions, and
couples therapy is often seen as a last resort before breaking up.

Here are some common concerns couples have about therapy -

1. The therapist will take sides.
We are trained to recognise and understand how both partners contribute to their pattern of disconnection and distress, and to assist partners to understand the painful emotions that underlie their partners’
attempts to reach them.

2. The therapist will tell us we should break up.
The decision about whether to continue in a relationship always belongs to the couple. The role of an EFT therapist is to help couples understand how their relationship has gone wrong, and to guide them, for as long as they are willing to try, in how to repair it.

3. We are too far gone; the situation is hopeless.
Even longstanding problems can be resolved or improved with EFT. The intensity of distress does not indicate the relationship cannot be improved.

4. Talking about our problems will make things worse.
Many couples have experienced that their own attempts to talk about their problems have made things worse, so this concern is understandable! However, an EFT Therapist is trained to create a safe space where problems can be discussed productively. In many cases, the therapist will be able to help partners see each other’s struggles in new ways that open the door to healing and reconciliation.

5. Couples therapy is a waste of time and does not work.
EFT has years of research demonstrating its effectiveness in helping couples improve their relationships, and follow-up studies show these improvements are long lasting. EFT is one of a handful of couple therapies designated as empirically supported by the American Psychological Association (APA).

6. We (or he or she) need individual therapy first.
A growing body of evidence suggests that successful couple therapy can reduce an individual’s symptoms of depression, anxiety, posttraumatic stress and other psychological disorders. At the very least, a stronger, more supportive relationship will reduce the suffering both partners experience when one is struggling with a psychological disorder. Couple therapy may not be the only treatment needed when a partner has significant psychological symptoms can help partners to join hands in working together on the challenges they are facing individually.

Adapted from Ruth Jampol, PhD, Licensed Psychologist Certified EFT Therapist,
Supervisor-in-Training Board of Directors, Philadelphia Center for EFT

When Cracks Appear – Referring Couples for Relationship TherapyEllie Raymond2023-08-21T15:10:05+10:00

3 Ways To Tell If Your Child Might Have Social Anxiety

Written by By Dr Cate Hearn

Shy or Self-Conscious

Compared to other children their own age, socially anxious children appear shyer and more self-conscious. They may:

Find it hard to talk to other children

Find it hard to make new friends

Feel left out or awkward, or worry they’ll embarrass themselves

Have less well developed social skills than children their own age

Dislike being the centre of attention

Worry a lot about their appearance

Worry that their friends don’t really like them

Be quiet in large social situations

Speak softly to those they don’t know well

Avoidance

Socially anxious children fear and avoid a range of social situations. They may:

Avoid new social situations

Make excuses not to go, by saying, “I’m just a homebody”, “I don’t feel like going”, “I don’t like parties”

Dread sports days or swimming carnivals

Dislike giving orals or talks in class

Be too anxious to raise their hand/answer questions in class

Play alone often

Tummy pains, headaches

Anxiety and worry can manifest in physical symptoms, and socially anxious children may:

Report pains in the stomach, headaches, nausea or sore/aching arms/legs especially before school or social events

Become withdrawn or irritable before social events or before school

Won't they just grow out of it?

Research shows that a great many children with social anxiety do not just ‘grow out’ of it.

Left untreated, social anxiety can persist and cause significant interference in children’s lives. Child friendly cognitive behaviour therapy for social anxiety can help children overcome social anxiety.

At Benchmark Psychology, we have a number of therapists who can provide child friendly therapy to socially anxious children. Ask for Dr Cate Hearn (who’s PhD thesis was in child and adolescent social anxiety), Dr Alison Bocquee, Dr Kylee Forrest, Dr Jasmine Pang or Dr Leona Chun.

3 Ways To Tell If Your Child Might Have Social AnxietyEllie Raymond2023-08-21T15:11:48+10:00

12 Next