Setbacks

Lapses, relapses, and interferences. These are all forms of setbacks that need strategies for handling effectively.
So, this week that's what we're nattering about.

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Transcript

Richard: 0:09

Good day to you all, therapy fans, happy fans, and podcast fans. Welcome to the Therapy Natters podcast. If you're new here, I'm psychotherapist Richard Nicholls, pleased to meet you, and with me as ever in the co host chair is fellow psychotherapist Fiona Biddle. Hello to you, Fiona.

Fiona: 0:28

Hello to you and to everybody. Nice to be here again.

Richard: 0:33

Yes,

Fiona: 0:33

to these recordings as such. It's a nice thing to do, isn't it?

Richard: 0:36

well, I mean, if we weren't doing this, it would be nice just to sit and natter about this sort of stuff anyway,

Fiona: 0:43

Indeed. Yes.

Richard: 0:45

Therapists ought to do that. We need little peer groups where we can sit down and natter about theory. Well it's PD, it's like a personal, um, like a process group. Isn't it? Really? Yeah! We should I wasn't going to say, we should do that. I've got enough to do! I think I'll set up a little local group. I texted a local therapist just to say, are you taking on new clients right now? Because somebody was asking for help and I didn't have the availability. And she said, Oh yeah, happy to take on some new clients. Great to see that you're local. We should meet up. I'm like, yeah, I want to meet everybody. But you can't meet everybody. You can't do all the things.

Fiona: 1:33

Yeah, chatting with other therapists, any therapist listening, it can be quite a lonely profession, because you spend your days one on one with your clients, and only supervision, unless you're careful, unless you do things to meet with others. Absolutely

Richard: 1:50

It's really important.

Fiona: 1:52

One thing that people who aren't therapists might not have actually clicked on is that you can't talk about your work to your partner, or your friends or your family. So, you know, when other people think about people I know, they come home from work and they say, oh god, there was this guy in the meeting today and he was like this and this was awful and I couldn't do that and all these moans and groans that you have, we can't do that because of the confidentiality, so

Richard: 2:21

Dawn doesn't ask me about my day anymore because she knows I'm not going to say anything anyway. It can vary because I've got podcasts to do and there's social media things that I get involved in so she could ask me, I suppose, but every day I say the same, to a degree, the same thing to her. How was your day? She's British, obviously, so she's passive aggressively sarcastic. Thrilling, of course. Okay, whatever. Well, I went to work, didn't it? Oh alright love, whatever. But she's never gonna then say, so how was your day?

Fiona: 2:54

About the most we can say is it was one that was really sad. And then, of course, they want to know why.

Richard: 2:58

Yeah.

Fiona: 2:59

why. So, you know, say, oh God, it was one that was really, really Yeah, but then, that's not much of a story, and

Richard: 3:08

it's not much help, either, to go, Actually, I've had a tough day, hun. Oh, have you? Tell me more. Can't. Ah, dammit.

Fiona: 3:15

It's just not helping to anybody.

Richard: 3:17

No.

Fiona: 3:17

what supervision's for. Actually the peer groups aren't really much better for that because you can't really exchange the data in those either. you can in those situations discuss how you're feeling

Richard: 3:29

And your own therapy, for any therapist listening, I'm hoping that you would see a therapist fairly regularly. Well, it depends on the sort of work we do. I'm not saying every therapist needs to see a therapist all the time to deal with the stuff that clients bring in. But,

Fiona: 3:45

No,

Richard: 3:45

sometimes you might

Fiona: 3:46

It depends on the person and their work, you know, the type of clients they're seeing. It does vary, but having access to therapy is definitely a good thing. Because you never quite know Mm. something's going to affect

Richard: 4:03

Knock you on your back

Fiona: 4:04

Yeah.

Richard: 4:05

Yeah. we need to know how to deal with that sort of thing. And that's the same for non therapists as well. We need to know. How do I deal with these sorts of things? What happens if?

Fiona: 4:17

Well, there's plenty of other jobs that have the same sort of thing. I was thinking paramedics, firefighters, NHS staff. All sorts of things, and just general everyday. You don't know when you're going to go round the corner and see something that metaphorically knocks you over. Because it can happen. So everybody needs somebody to talk to. When it comes down to it.

Richard: 4:42

But it can be quite vulnerable, opening up, even if you're opening up to your friend. To say, yeah, I'm struggling with something at the minute, and yet it is good to talk. There are exceptions. PTSD, big trauma responses. Probably don't talk about that too much because it might bring back a trauma reaction and you end up feeling just as you did back then and then you're knocked on your back for a month. But for most people, it is good to talk. Whether it's to a stranger on the bench.

Fiona: 5:15

It it's not a panacea. So again, like you were saying about, you know, different people in their different responses, it varies. So the idea of just immediately thinking, oh, I'm feeling such and such and I don't like it, I will talk to somebody about it. That might not be the best thing for you at the time, but it's more likely to be than not. Guess what? It's about awareness.

Richard: 5:40

Who'd have known

Fiona: 5:41

Oof, gosh, yes.

Richard: 5:44

The two themes that tend to crop up most in the therapy room for me with people is awareness and acceptance. Awareness of where you are right now, and an acceptance of who you are right now. I think people make the mistake of thinking that if you accept where you are, that you don't improve. Because, oh, I've just accepted that I'm bad at this, or can't do that, or I'm a piece of crap. I've just accepted it, so I'm never going to change. No, but change doesn't come from pretending that you're not in that place in the first place. If you can accept this is where I am, it's

Fiona: 6:21

people aren't accepting that they are a piece of crap. I hope they're accepting that they feel like that they are because that I would definitely

Richard: 6:31

challenge that, yes.

Fiona: 6:32

acceptance. But you've got to be starting from where you are, which does bring us quite nicely onto today's topic because it's about recognising where you are, isn't it? Which is to talk about setbacks, which sounds like a sort of quite negative thing to talk about. I was thinking about this earlier when I was contemplating today's topic. It sounds negative, setbacks, but it's actually really quite positive in a strange sort of way. Because, as you say, if you're aware that there's a setback going on, or has happened, or you can see potentially happening, if you can have an awareness of it and accept it for what it is, if it is something that's real and not changeable, then you've got a really good chance to do something successful with that setback. In fact, I remember when we used to work with smokers a lot. I expect it was the same for you. Was it the same for you? That quite often people would come back. Six months later, a year later, 18 months later, two years, whatever, and they've started again.

Richard: 7:42

And you'd say, so was there a trigger for this? Was there a cause for this?

Fiona: 7:47

And I'd actually often say, it depends on the person, but I'd say this is actually quite a good thing because you've done that now. You've experienced that setback, that relapse, you've been there, done that, you know not to do that again. It's not always a bad thing to have a setback.

Richard: 8:04

Absolutely. What I used to find in the early days, and I did sort of implement it into the sessions so that people could learn, was that people could get cocky. They've been smoking for 20 years and now they've stopped and they're like, fantastic. I can just turn this on and off. Fantastic. So now I can join some of my friends who have left the pub to go for a quick smoke outside, and I can go and join them. In fact, I can have a quick crafty fag, because I can, I can just turn this on and off. Uh oh, no you can't, because that's not how neurology works, that's not how the brain works. You might have created a new habit of not doing that, but once you light up the neurons for doing it again, your brain goes, are we doing this again, are we? And the next day they just have one or two. Day after that five, day after that twenty. Right back to where I was in a couple of days, yeah. Because your brain does that.

Fiona: 9:02

There's very few people who do it occasionally. It's an all or nothing one. Whereas so many habits, you know, most people for drinking, they're not doing it all day, every day. They're doing it in certain situations.

Richard: 9:17

Yeah.

Fiona: 9:19

But there we go. Let's not talk about that too much. Should we go? Should we talk? Well, we do. We could talk about it for hours, probably. let's talk about setbacks, shall we? The different different types of setback.

Richard: 9:30

Yes please. Tell me all about the different types of setback

Fiona: 9:32

First one is a lapse. lapse can be defined as a brief return to previous thoughts or behaviours. Example, somebody who's adopted a vegetarian lifestyle is tempted by a spaghetti carbonara on a weekend in Rome, which seems perfectly reasonable to me. In fact, I don't know how you would manage to go to Rome and not have a spaghetti carbonara.

Richard: 9:56

Guanciale, pig cheek. Nice.

Fiona: 9:59

Yes But that's the sort of thing, you know, you've made a change. You adopted a new way of being, new behaviour and something happens you slip back to an old behaviour. So, another example would be somebody who's doing a park run. Um, every Saturday. That's when they are, I believe. But one weekend they just really don't feel like it and stay in bed. That's a lapse. The thing with lapses is to recognise that they're perfectly normal and can be used as a learning tool. And see, well, A was that terrible? And in both of those examples, if you have one plate of spaghetti carbonara and miss one park run in a year or something, hardly a big deal. So, it's to not beat yourself up, to say, okay, well that's all right, I'm a human being, I can sometimes do something a little bit different, that's all right.

Richard: 10:56

Yeah, it's about having the right mindset. Because if you have a habit, maybe, of beating yourself up a bit, then when there is that lapse, if you fall into the habit of beating yourself up, I knew I couldn't succeed at this. I knew I'm a waste of space. I'm just back to square one. It's not going to help you. And of course, you're never back to square one. There is no such thing as square one. Apart from when you first start. Because even if you move on to square two, and then square three, and then you feel you're back to square one, you can't be. Because you've got some wisdom and experience that means you're not right at the start anymore. You've got some wisdom, you've got some experience. Yeah, this isn't some weird snakes and ladders game that you're literally back to square one. No, absolutely not.

Fiona: 11:45

Some people do have a tendency, I've seen this particularly for people who are working on losing weight, that they can have a lapse and then, you know, almost use it as an excuse for continuing on with the bad behavior. So let's say somebody's on a program to lose weight and they've decided that they're only going to eat healthy things at the right times for them, the schedule that they have set, and then let's say that that's breakfast, lunch and dinner at the sort of typical times, but then somebody brings in a cake to the office for birthday, as so often happens. So they've eaten cake at 11 in the morning. I'm generalising of course, there seems to be a tendency for people to say, well I've broken it now, so I might as well carry on. So they'll then have a less healthy lunch, and they'll have crisps in the evening, and chocolate, they sort of feel, I've had this lapse now, so I might as well, I've broken it, so I might as well keep it broken.

Richard: 12:46

it makes no sense.

Fiona: 12:47

It's often just for that day. They'll start again tomorrow. And that's not terrible. But it, as you say, it makes no sense. The fact that you've done one thing doesn't mean that you have to do more things.

Richard: 13:01

the metaphor that I often think about when people talk about this is what the, what they would do if they've got a flat tyre and they had to pull over and they had to call a mechanic to come and sort it out because they don't have a spare. Would they then think, well the car's broken down anyway, I might as well just smash up the windscreen. No, that's nonsense. You're not going to do that. The story I tell a lot is how easy it is for somebody to say, well, I've had two biscuits. Pffft. I didn't want to have any biscuits, now I've had two. Might as well have the whole packet then, really, because I've already ruined my diet. No! You haven't ruined your diet! A diet would include the occasional biscuit, maybe even two, maybe even chocolate malted milk with a little cup of tea. It's fine every now and again, but it's not fine to eat the entire packet and then beat yourself up over it, because all you learn is how to hate yourself. That's not what we're trying to help people to learn.

Fiona: 13:58

So, exactly, with lapses, it's about recognising it, accepting it, and learning from it. And if they become too regular, of course, that needs to be looked at. But then the next one is a relapse. So that's a more prolonged return to previous thoughts or behaviours. So an example of that would be somebody who's chosen to leave an abusive relationship but move back in. Or someone who's joined an evening class to improve their IT skills but quits and returns to play with the pub darts team. So those are relapses. They're going back to a previous behaviour in a more prolonged sort of way. Just as with the lapse, it's about thinking it through, looking at the reasons, and, in this instance, probably ascertaining whether the change of behaviour was the right one, because sometimes a relapse will show that the change wasn't the right one. Now, in both of those examples, I've made them specifically that it looks like the change was the right one, but it isn't always.

Richard: 15:04

Yeah, and the thing is, the brain is a very complicated, squishy, Mostly water. thing in between your ears that isn't really that easy to control because there's so much that goes on that is unconscious. That's what habits are. That's what urges are. I hate to sound reductionist, to reduce everything down to its smallest part, but there's a lot of neurons in the brain that you might have practiced hardwiring in and connecting together and then they're gonna get fired off. It's just what brains do. And there is such a thing called an extinction burst which is worth getting your head around a little bit as well. An extinction burst is what tends to happen in the brain when neurons are moving. When we sleep, our brain begins to prune, prunes away the neurons that it's not been using. And it does this every night, and it's been doing it all your life. It's more prolonged in childhood, it's more advanced. There's a lot of pruning that goes on in the teenage years. That's why teenagers are such an absolute nightmare to be. It's horrible. I wouldn't want to revisit that period in my life because your brain just goes pfff. And it's all because of the pruning, amongst other things. But when you create a new habit and you're creating new neurons, those old neurons, the brain learns, I'm not using these. But before they break the electrical circuit down completely, There's one last ditch attempt to make sure that it's okay to let it go, and it only knows how to make sure by firing it off. And so if you're making a new habit, right at the point where the old habit is gonna die for good, the urge to go back to that old habit is gonna be huge. Because the brain just lights up those neurons. Bit weird, kind of makes some sense, but I wish it didn't do it. Or maybe, maybe it is beneficial to go, look, do you really want to do this? Do you really want to kill off this habit? And it fires it off. So if you've been Cutting out sugar, for example, and you've been doing that for six weeks, and you think, that's it. This, I'm just not interested in sugar anymore. Just the idea of it just, you know, that's, that, bleh. No, that just doesn't feel right in my head, let alone in my mouth. No, no, no, no, no. Right at the point, probably six weeks, four to six weeks, your brain's gonna kick off and go all I want is sugar. All I want is sugar. And if you think that when you then binge a load of doughnuts that you've ruined everything and you're back to square one, you need to know, oh, this feeling, this urge, It's a sign that I am on the cusp of creating a whole new habit and mindset, a whole new life. And if you do give in to those urges and go, oh, you can then understand why. And yeah, that might happen again a couple of weeks later because you recognise it's an extinction burst and go, Nope, let me stop this. Give these doughnuts to somebody else. Let's just go crack on with what

Fiona: 18:21

How do you stop it if you don't give in? Would it not just keep going?

Richard: 18:27

Oh no, because the neurons die. But you need to go to bed and sleep. Then you, well they don't die, they just move off and do something else, it's just efficient. yeah.

Fiona: 18:35

that's the thing. You, you to go to bed and sleep, and kill them. Right.

Richard: 18:41

So it might mean a difficult day or two while the brain is just firing off all those old neurons thinking, are you sure? Are you sure you want to kill me? Are you sure? Are you sure you want this habit to die? So there might be a couple of days of angst and that's when some distractions might be appropriate. That's when you might need to really absorb this fantastic book, or this social experience, or whatever it is.

Fiona: 19:05

Change of scene, get out there, walk Yeah.

Richard: 19:10

yeah, absolutely.

Fiona: 19:11

I think there can also be reasons why people go back because they haven't dealt with the positives that they used to get from the thing that they've given up. So in the examples I just gave, the going back to an abusive relationship, there could be, not necessarily, but there could be, things that they did get from that relationship because rarely are relationships all 100 percent bad. So they could be missing the good bits, whatever they might be. So, that can be acknowledged, recognised, and then work on how to get those things. and the person who takes the course to improve their IT skills and then goes back to play darts at the pub, They could easily be missing the, the friendship and the camaraderie, et cetera, that they get from the pub. I mean, I know that's rather simplistic. But in those sorts of instances, it's to find out how to still get the thing that you're missing, rather than give up the new bit.

Richard: 20:15

Yeah, because if you take away something that you enjoy, that could lead to something unhappy. If you're making a change, and that original behaviour gave you something positive,

Fiona: 20:28

Which

Richard: 20:28

how did that make you feel?

Fiona: 20:30

do, because

Richard: 20:31

Most of them do. Yeah, of course. Why were they doing it if they didn't, you know?

Fiona: 20:34

mean some some don't, you know. I mean, nail biting is a typical one. And very often that's a habit that is giving nothing now. It did when they started. Anxiety relief usually, um, or tension stress relief. But now it doesn't. So that's an easy one to get rid of because it doesn't have a positive element. But most things that people do have some level of positivity within them, as you say otherwise you're only doing it at that unconscious level and when the unconscious mind realises that it's doing something for no reason whatsoever, it tends to find it quite easy to stop doing it. So the next type of setback, um, this is an interference. So something that happens to you or an external factor that prevents progress. So it could be an illness, could be something out of your control, it could be short term, so having a stomach upset means you miss an important meeting, so you've got a set back from that. It could be longer term, needing to care for somebody for a few months. It could be really long term, so a major life change. With interferences, the, again stating the obvious, it's my job, the key is to be able to keep a sense of proportion and adapt in the best way possible. So, recognising where you are, going back to your awareness and acceptance, but maybe taking a sort of overarching view and seeing the big picture

Richard: 22:03

Mm hmm.

Fiona: 22:04

and how that's going to be. And we can use the pandemic as an example. An interference that we all shared, global experience pretty much. I remember at the beginning, do you remember this, at the beginning of 2020, we were all talking about having 20 20 vision and using our 20 20 vision to set goals and look ahead and be clear about wanted to achieve and all of this stuff. And very quickly, our 20 20 vision, fell away.

Richard: 22:34

We had a setback for sure.

Fiona: 22:36

And, you know, everybody had setbacks in different ways. Different experiences for everybody, of course. For some people it was absolutely catastrophic. For other people, it wasn't. But everybody was affected. And, one of the things with I mean, I was just talking about sort of taking that overarching view, looking at the big picture. When you're in these things, quite often, you don't know how long it's going to last.

Richard: 23:03

Mm.

Fiona: 23:04

And with that pandemic, nobody knew how long it was going to last.

Richard: 23:09

Mm.

Fiona: 23:10

And if you think back to that time, it was, it was quite weird, wasn't it? I remember the very first lockdown, it was, well, it's going to be three weeks? it going to be three weeks? Can it really be three weeks? And then it's six weeks, and then, and it's, when, when is this going to end? Are we going to be like this forever? So, not knowing, and If you think back to, well, any sort of conflict, the, Second World War, just use that as an example. If you're living through that, you didn't know it was ending in 1945. You didn't know that.

Richard: 23:46

That's true.

Fiona: 23:47

And now we've got the Ukraine conflict going on at the time of recording, it's still going on, probably still will be for a while, we don't know. So there's that uncertainty with so many interferences. Now, if your interference is that you've got a cold You know that next week you're going to be fine. If your interference is that somebody's called you in to help them because they've broken their leg, well you know that it's going to be a few weeks or something. So sometimes you know, sometimes you don't, but building that awareness and thinking things through very clearly can help you.

Richard: 24:24

And do bear in mind that if you ever do say to yourself, I can't handle this much more. If there is a big setback, I can't handle this much more. I bet there were times you said that in the past and you could. People said it during that first lockdown. I can't handle this anymore. Three weeks in, can't handle this anymore. And a month later, they'd handled it. Well, we don't, we can't see into the future to see that we are going to handle it. We just don't like where we are right now and I don't want to have to do this again. But actually you can handle it. Doesn't mean it's easy. But actually we can handle a lot more than we think because we just, you just did.

Fiona: 25:07

I cannot control everything but I can manage anything.

Richard: 25:10

One day at a time. Hmm. There's a reason why the AA use that phrase. One day at a time. One day at a time. Because, yeah, you can do one day. Like running a marathon. That seems ridiculous. Yeah, it is. Takes a lot of training. But if you think, I'm just going to go and practice running a marathon. No, you run one kilometre at a time. One mile at a time.

Fiona: 25:36

then when you finally get to it, it's one step at a time. But you've got to have put in all the steps to get to the point where you can do one step at a time. I was talking to Ellie actually about this the other day because she's doing a marathon and I heard somebody say that if you can do 10k you can do a marathon.

Richard: 25:55

Yeah, because the amount of effort it takes to run a 10k is huge, so if you can do that, all, all you've got to do, I know that sounds easy, is just maintain that feeling of, this is hard, this is hard, you've just got to maintain that

Fiona: 26:11

So, the final type of setback that we are talking about here is what I've defined as a wobble. where you're doubting your choices or behaviours. Now, we've talked about that a little bit in terms of the relapses as to whether the choices or behaviours are actually the right ones for you. But a wobble can be, more subtle than that, sort of, It's not going so well, it's not going exactly the way that you planned for it to go. So, you need to then, go back to a planning phase and go back to looking at why you set the goal. Why you chose these particular behaviours in order to meet that goal and see whether they still fit with what you're wanting to achieve. Because a goal setting process, It's unlikely to be exactly right first time. You're likely to have to go back and tweak things here and there.

Richard: 27:08

But your why doesn't change. Know your why. Why did I decide to

Fiona: 27:16

Your why might adapt. It might hopefully grow.

Richard: 27:22

Grow.

Fiona: 27:23

you might, find that some of the whys aren't as applicable. I was listening to somebody yesterday who said one of the reasons they weren't doing something was they because they feared being judged and then when they'd realized that they realized that there was in this particular instance no chance of them being judged so they could let that why go because it was from somewhere else. So whys can adapt but keep a hold of your why if it's the right why.

Richard: 27:54

Yeah.

Fiona: 27:56

was just thinking about other things that people might do where you would never expect it to be right in the first place and I was just thinking if you were a chef opening a new restaurant with a new theme You wouldn't expect to just put together a menu with all new recipes and to just say Well I'm going to make this new thing with fish and cauliflower, and it's going to be perfect first time you'd be trying it out and testing and adding this and taking that away, and

Richard: 28:25

Yes.

Fiona: 28:26

All sorts of ways of thinking and then that doesn't combine very well with these options on the menu because there isn't anybody for, who's vegetarian those sorts of things. It takes work, adaptation to

Richard: 28:37

To hone

Fiona: 28:38

To hone it. And it's the same for most things with most goals that we're setting.

Richard: 28:44

Mmm. Yeah. Absolutely for personal development. Yeah. Hone it. Hey, shall we leave them for another week, Fiona?

Fiona: 28:51

Let's do that.

Richard: 28:52

Because we've probably nattered long enough on this subject. We will be back next week, as always, with a similar theme, potentially? Can't remember what we're talking about next week.

Fiona: 29:07

inner voices next week, so yes, be, could, yes, because inner voices could easily be causing setbacks, so yes, but they can also be good things.

Richard: 29:17

We'll be back next week talking about that then. If you need anything, you know where to find us. Like I often say, our contact details are splattered all in the description of the episode. You can whatsapp us, you can message us through the website, you can text us, there's a link there in the show notes, and you can sign up for our Evolve to Thrive program if you fancy and get a bit more about this and why we're talking about it. The early bird discount is still on. Yeah, sign up! You can potentially change your life, which will be quite sweet, and we're happy to hold your hand on the way.

Fiona: 29:49

We don't know that the early bird discount is on because somebody could be listening to this in 2036.

Richard: 29:54

Yeah, apologies about that. We might have increased the price by then, but, at current time of recording

Fiona: 29:59

At time of launch, it will still be there

Richard: 30:01

Yes So sign up for our Evolve to Thrive program. You know you want to. Have a super week. See you next time. Bye everybody.