Kew Pyscho Therapy

Professional
Psychotherapy Course
Karen E. Wells
Copyright
Copyright © 2018 by: Karen E. Wells
Cover and internal design ©2018
All rights reserved. No part of this course may be reproduced in any form or by any electronic or
mechanical means including information storage and retrieval systems – except in the case of
brief quotations in articles or reviews – without the permission in writing from its publisher,
Karen E. Wells
All brand names and product names used in this course are trademarks, registered trademarks, or
trade names of their respective holders. We are not associated with any product or vendor in this
course.
www.kew.solutions
www.kewtraining.com
Table of Contents
Contents
Karen E. Wells............................................................................................................................ 1
Copyright.................................................................................................................................... 2
Table of Contents ........................................................................................................................ 3
Introduction ................................................................................................................................ 5
Module One ................................................................................................................................ 7
What is Psychotherapy? .......................................................................................................... 7

Module One .............................................................................................................................. 12
Self-Assessment Tasks .......................................................................................................... 12

Module Two ............................................................................................................................. 13
The Brain and Hormones ...................................................................................................... 13

Module Two ............................................................................................................................. 28

Module Three ........................................................................................................................... 30
The Conscious and Unconscious Mind .................................................................................. 30

Module Three ........................................................................................................................... 39

Module Four ............................................................................................................................. 41
Memory ................................................................................................................................ 41
Module Four ............................................................................................................................. 46

Module Five ............................................................................................................................. 47
Stress .................................................................................................................................... 47
Module Five ............................................................................................................................. 55

Module Six ............................................................................................................................... 56
Behaviour ............................................................................................................................. 56
Module Six ............................................................................................................................... 65

Module Seven ........................................................................................................................... 66
Affective disorders ................................................................................................................ 66

Module Seven ........................................................................................................................... 76

Case Studies ............................................................................................................................. 77
Foundation Level Psychotherapy .............................................................................................. 79
Final Test .................................................................................................................................. 79
About Karen E. Wells ............................................................................................................... 81
Karen E. Wells.......................................................................................................................... 82
Introduction
Welcome to this professonal course on psychotherapy. This is an in-depth course with self-
assessment tasks at the end of each module so to increase your potential to learn and absorb
course material. There is an exam at the end of the course complete with case-study elements to
ensure your understanding of the course material before you can be awarded certification. This
again is for your own self assessments.
In this course, you will learn what psychotherapy is and the type of people you will be treating.
You’ll gain a thorough understanding of how stress can impact on a psychological and
physiological level. You’ll understand how traumas can impact health and well-being and how
unhealthy behaviours can form as a result. Importantly, you will understand people.
Whether you plan to set up an online therapy business or, to have your own psychotherapy
business where clients attend in person, you’ll be able to help them in a professional capacity.
You’ll understand who your clients are likely to be, and you’ll gain insight into those clients who
are unlikely to seek help or, to continue with sessions. You’ll comprehend the differences
between counselling and psychotherapy.
Importantly, you will be trained to a level where you can start to help clients.
Studying psychotherapy takes time. We encourage you to study regularly and to recap any
aspects which may not be immediately clear. It is of the utmost importance that you learn all
aspects of psychotherapy and utilise your knowledge by gaining practical experience as you do
so. Your knowledge will have an impact on others so there are no short cuts to professional level.
Take your time with this course. You need to have an in-depth understanding of the types of
behavioural problems or issues that may come your way. Some clients will need to talk while
others find it difficult to express themselves. When experiencing psychological issues, it can be
difficult for clients to fully understand their problems - whether anxious, stressed, or, if they have
depression or, even eating disorders. To be able to combat the wide variety of problems that may
present themselves daily, you must feel fully confident in being able to help those individuals.
This means your ability to do so is dependent on your desire to study and to learn this course
material.
Module One
What is Psychotherapy?
Psychotherapy is a successful and popular talking therapy, but it requires strong listening skills
something that many people struggle with. You need to have the ability to draw information
from the client without pressuring them, alienating them or, seemingly, interrogating them.
Clients seek out professional guidance for a wide variety of problems and these psychological
issues are treated through communication. This can take place on a one-to-one level or, in a
group setting. Psychotherapy treatments are time-limited, focused and usually occur just once a
week for a 45- minute session. It is a conversation where you listen and interject where necessary
helping the client to solve their issues through this steady, free-flowing dialogue. Trust therefore
is of the utmost importance.
Why go to psychotherapy?
Some clients will just need to talk. They need to be able to vent their feelings to someone outside
of their close personal circle. But, some issues are also outside of the family or friend’s remit.
They may be biased or have a strong opinion one that contradicts what your client needs. Plus,
they would be unable to take an impartial stance or, to steer the conversation in a professional
way. Psychotherapy is direct, targeted and focused. Talking to a professional helps them to relax
and to trust. They also gain confidence when talking. For many, this is part of the issue, they feel
alone, frightened or unsure. They don’t know why they feel a certain way, they just know that
they do. Their thoughts may be irrational. Just having someone outside of their social circle and
who is listening in a professional capacity can be reassuring. Of course, some clients may have
extreme problems, and these may need to be referred to another specialist so to identify their true
needs or to prescribe treatment.
A psychotherapist does not prescribe medication.
Psychotherapy is time-limited and so, highly focused. You must treat all clients in an attentive
and professional manner. Once they start talking, listen. Make notes. Review your notes with
them to be sure you understand what they are trying to tell you. Some clients will not like you to
make notes during the discussion, although it is best if you can do so. Other clients may not wish
you to record a session but again, it can be useful to do so. Ultimately, you must encourage the
client to talk and to keep the communication airways open.
Psychotherapists helps clients to understand inner conflict, thought processes, negative situations
and behaviours. They write research papers and teach others. They also form bonds with other
psychotherapists and may evaluate papers. No two days may be the same in psychotherapy. You
may hold group counselling sessions for families or for couples. You may hold sessions for
individuals who you think would respond to group sessions.
Psychotherapeutic conversation can only take place when trust has been formed and then, the
process of revelation, and the ability to explore and comprehend the true situation can take place.
It is only in this type of environment that solutions can flourish.
Psychotherapy requires a professional and non-judgmental environment. You must structure
dialogue with clients and be patient and understanding. Ultimately, psychotherapists need to get
to the root of the problem.
You must try to understand a client’s thought processes, feelings and behaviours. You will see
many clients in a state of inner turmoil. You’ll assist them in finding improved ways in which to
live their lives, helping them to manage stress more efficiently, or, being able to resolve issues
more readily. Some clients will have witnessed or been involved with distressing and often,
negative situations and it will have impacted them deeply. You may encounter those clients
contemplating suicide. You may talk to those clients who self-harm or, those who are depressed
through the break-down of a relationship.
There are many procedures that make up psychotherapy and, many schools of thought too.
Successful psychotherapy depends greatly on good communication and, a professional
relationship between both client and therapist. There are therapeutic principles to follow but,
session needs to be structured too. It is not simply a case of determining a solution and fixing it
for the client.
The no-go area
For a successful session and professional relationship, there are boundaries that must not be
crossed. While there may be a temptation to forge a stronger bond by sharing your own
experiences so to help open communication, do not do so. The connection must be completely
professional, and you are not there to share your personal issues. This relationship exists purely
for helping the client.
This is really important.
Confidentiality is paramount. You will be told things that must be kept within your therapy
walls. Clients must be able to be honest without fear of offending others. So, trust is high on the
list of professional must-haves. Within each session, much can be gleaned by monitoring the
client’s body language. Check whether they make eye contact, or if body language is closed-off.
Listen to the tone of the voice too. Much can be gleaned this way and in fact, many clients will
often talk about anything other than the real issue and so, sometimes, detective work is required
during the session. Use open questions to get the client to reveal more about themselves, but, do
so in a way that they do not feel forced.
If you know the client’s specific issues, you can prepare in advance. You can ascertain the types
of questions to ask and be able to lead the session more effectively, or, if you have counselled a
similar session with another client, you may have a unique understanding as to what might help.
However, do not pre-empt a similar outcome. Each client has a unique set of circumstances
which has led them to you and, although a situation may seem similar, the thoughts or
behavioural responses may not be.
Psychotherapy tips:
Listening to your clients with intent is one of the most important aspects of psychotherapy and
you must ensure your mind is clear from any negative thoughts, doubts or feelings before you do
so. Focus only on the client. This may not be easy to do but it is essential.
Confrontation
This may sound an unlikely technique within psychotherapy but, it is a useful one. When you
confront a client, you do not do so in anger but, because they must be prepared to listen and to
consider your viewpoint. This type of situation occurs because you have detected an anomaly in
an earlier conversation. This is purely to express confusion and to gain a better understanding of
them with a view to helping.
Other psychotherapists may use a less direct route leading them back through the questions and
the techniques chosen will be up to you.
Clarification
This is another technique that is designed to gain information from the client. Many clients will
struggle with their communication and be unable to express their deepest fears or, beliefs. When
you use clarification, you make them clarify it first for themselves and by doing so, they work
back through their own problems.
Note: do not make the clients feel as if you are interrogating them.
Module One
Self-Assessment Tasks
Task:
List your understanding of psychotherapy now that you have completed the first module. If you
feel unclear about any aspect, please do go back through the module and make notes. Then, write
a short paragraph clarifying your revised thoughts.
Please note that these self-assessment tasks are to ensure your understanding of the information
within each module. As such, do not submit them for review with Karen E. Wells.
Module Two
The Brain and Hormones
Understanding human nature is a key principle of psychotherapy, so, it’s important to understand
the brain and how it functions. Life is a series of changes and we must adapt to these changes as
best as is possible. In fact, it is this very process in evolution that enabled our ancestors to
survive. Those who did survive were able to pass on the lessons of life to their children and this
passing on of information – both good and bad advice literally transferred across generations.
While there are many physical developments that occurred during the evolutionary stage, the
growth of the human brain has been incredible. These changes have increased our potential to
calculate, plan and remember. It is surely a considerable and perhaps, most amazing type of
progression.
In psychotherapy, you need to understand how the brain works to analyse and help solve any
problems, so let’s look at the components of the brain and the relevant functions.
The brain stem is the oldest part of the brain and the midbrain and higher brain evolved
thereafter. The lower part of the brain deals with rituals, aggressive behaviour and could be
deemed as territorial. The mid brain has the limbic system, and this is responsible for emotions
experienced, sexual instincts along with the senses relating to smell.
The cerebral cortex regulates emotional and cognitive function and, is connected to your
reasoning skills i.e. how you plan, problem-solve or, create. The cerebral cortex forms two thirds
of your brain and it organises the units of the brain. When you need to use your brain so to find a
solution to an issue, it’s the cerebrum that is involved in doing so. Certainly, the cerebrum is vital
to the human condition and we often, mistakenly, just focus on this when we think of the
thinking processes however, the lower and middle parts of the brain are often under-estimated
and yet, without them, you would not be able to survive.
• Brain stem-this has direct responsibility for regulating the physiological state
• Medulla - this has the responsibility for the regulation of heartbeat and the breath
• Pons-this regulates brain activity occurring during sleep
• Reticular formation - this triggers the brain to respond to new stimuli even during hours
of sleep.
• Thalamus - this relays messages between the cerebral cortex and the body’s senses.
• Cerebellum - this has responsibility for movement and balance
• Limbic system - this controls and balances feelings, motives and drive. It also has some
responsibility in respect of memory
• Hippocampus - this is important for long-term memory
• Amygdala - this has a direct role in memory, emotion, aggression and motives
• Hypothalamus - this controls the temperature of the body. It is connected to eating
regulation, drinking and sexual arousal.
• Cerebrum – High levels of feelings and thoughts
• Cerebral hemispheres - connected to thinking, cognitive and emotional function.
• Corpus callosum – links the two hemispheres enabling communication
Left and right brain
You will no doubt have heard people talk about left brain and right brain in respect of processing
styles. The left brain is considered more logical and relates to language. Whereas the right part of
the brain controls visual patterns. The right hemisphere has a direct role when it comes to
negative emotions which includes depression or feelings of anxiety. The left hemisphere relates
to more positive emotions. For those who have an interest in sports psychology, much effort has
been put into utilising the left and right sides of the brain by enabling athletes to utilise both so to
increase performance success. To perform well, the action part needs left brain activity but, if the
individual uses visualisation techniques, they can visualise aspects of the sport using the right
hemisphere to improve their abilities.
Although people talk about the left and right brain being two different parts, they are
interconnected and connect with each other through fibres known as the corpus callosum. The
two parts of the brain also work in a synchronised motion. The left part of the brain controls the
right side of the body and the right part of the brain controls the left.
Frontal lobes
The frontal lobes are located just behind your forehead and in terms of brain evolution, they are
the newest part and execute purposeful behaviour. Therefore, when you make decisions, set
goals and pursue them, it is the frontal lobes that are responsible. Temporal lobes sit behind your
ears and this is an important location because they identify and make sense of information
overheard. The left temporal lobe helps you to understand speech, whereas the right temporal
lobe translates music or sounds for you.
Parietal lobes
The parietal lobes are placed at the top of head and these interpret sensory information gained
from the opposing sides while the left lobe makes sense of the information on the right-hand
side. The right lobe makes sense of information gained on the left-hand side of the body. Your
parietal lobes help you to translate information through touch.
Occipital complex
The occipital lobes located at the back of your head translate visual data. If you have heard of the
expression having eyes in the back of your head, it relates to this. The left occipital lobe has
responsibility for the right visual field in both eyes and the right occipital lobe controls the visual
field on the left. Recent research indicates these two visual systems can work on an independent
level. The first of these systems is known as vision for perception. Simply, this means that you
recognise objects and form a database of knowledge.
The second system is known as vision in action and this enables you to interact with objects or
move about. The two systems are separate. The vision for perception system is located deep
within the cerebrum cortex close to the memory and language areas. Its role is in the
identification of objects rather than spatial awareness.
In direct contrast, the vision for action system is located at the top of the cerebral cortex close to
the motor and touch regions and therefore, the focus is on object orientation. If you have clients
who have somehow damaged their perception system, this means that they will not be able to
recognise an object just by looking at it but, they would be able to reach out, touch it or hold it.
Those who have damage to this action system will understand what the object is but would find
it difficult in locating it.
Plasticity
Our brains are flexible. Far more so than was previously thought. But, more than this, the brain is
adaptive. This is a vital ability should the brain be injured. Equally, if there is a disease or, health
disorder, the flexibility of the brain to rewire itself could mean a big difference to the individual.
When we talk about plasticity, we also call it
neuroplasticity, and this simply means the brain
can rewire itself.
Damaged pathways or functions which have been lost within the brain may be repaired or,
bypassed if the brain can rewire to create new neural networks.
Plasticity also occurs when someone is learning. Consider someone repeatedly making the effort
to learn new techniques, they practice again and again, and repetition helps to connect and
optimise neural connections.
Nervous system
The nervous system contains more than 100-billion nerve cells, and these are important for
relaying messages to and from the brain. The nerve cells known as neurons are specialised cells.
They can send electrical impulses at approximately 250-mph, this is the fastest electrical
impulse.
Within the nervous system, there is the central nervous system (CNS) and the peripheral nervous
system (PMS). The central nervous system is made up of the neurons of the brain and the spinal
cord. The peripheral nervous system has neurons to form nerve fibres and these connect the
central nervous system to the rest of the body. All messages through the central nervous system
are sent to and from the spinal cord. If there is damage to the spinal cord, it can disrupt the ability
for the brain to send or receive messages.
There are three types of neurones:
• Motor neurons
• Sensory neurons
• Interneurons
Motor neurons have the responsibility of directing messages from the central nervous system to
the muscles of the body. Sensory neurons utilise information gained through the senses and
direct them towards the central nervous system. These two neurons rarely have direct
communication with each other and it is the interneurons that act as messengers.
Within each neuron, there is an axon, a dendrite and a soma. The soma has the nucleus of the cell
and supporting it, -the cytoplasm. At the end of the soma, the dendrites are branched fibres that
take messages from other neurons. The information is passed from the dendrites onto one
extended fibre and this is known as the axon. This plays an important role in sending electrical
impulses from the cell body to other cells. This process is called action potentials. The electrical
impulses move along the length until they reach the end – these are swollen structures, rather
bulbous and are known as terminal buttons.
The action potentials cause the release of chemical substances known as neurotransmitters from
each of the buttons. Although there is no direct physical contact between the terminal button and
the next destination (the junction between two nerve cells) known as a synapse. It has long been
deemed that the impulse traverses the gap from the button to the next stage moving to the inner
membrane of the terminal buttons.
The synaptic vesicle then ruptures and the neurotransmitters spill out into the synaptic gap and
attach themselves to the dendrites placed on the other side. We do know now that neurons may
also release neurotransmitters along the whole length of the axon rather than firing exclusively at
the synapse. Surrounding the neurons is something known as white matter and this contains both
axons and ancillary cells. These link both the left and right hemispheres. Neurotransmission
takes place even though there are no dendrites or synapses.
As an electrical impulse travel along the axon cable, the neurotransmitter glutamate travels to the
axon membrane and the content is then released into the brain. It is believed that glutamate
guides the cells within the white matter so to produce myelin (fatty layers around the axons) and
this ensures rapid transmission of these important signals.
Tiny leftover released neurotransmitters can remain for up to a few minutes after the main event
which can lead to chaos.
Complexins are small proteins which serve to premature release of the neurotransmitters. A
breakdown of the process can occur impacting the mechanism, which leads to the rewiring of
neural pathways and promotes synaptic new growth. It is possible that this neurological chaos
could be responsible for disorders such as schizophrenia.
Hormones
The endocrine system plays a very important role in both psychology and psychotherapy. This
system is controlled by the hypothalamus which is in the midsection of the brain and it is this
that produces and secretes hormones into the bloodstream. There are many different functions
involved which includes metabolism, sexual development and of course, mood. It also regulates
alertness.
One of the most well-known hormones is adrenaline and this helps each person to respond to
life-threatening situations when under duress preparing for the fight or flight response. When a
dangerous situation occurs, the heart starts to pound, muscles of the body start to tense, and
people often break out in a cold sweat. This is a very natural response caused through the
endocrine system preparing you for a quick response to a situation that could be highly
dangerous. Even when stress passes, remnants of the stress response can continue to work.
The link between the brain and the body
There is a strong link between the brain and the body and when injury occurs to the brain, it can
change someone’s personality in ways unimaginable. As a prime example, someone who has
experienced damage to the frontal lobes could find it difficult to stop themselves from behaving
inappropriately. Of course, much of what happens within the brain is not a part of conscious
awareness and we could say that the mind, rather than leading us, interprets situations helping us
to identify and develop rationality. This impacts behaviours. But it does not always take physical
damage for the brain to play a key role in how we think feel and act.
Why we are the way we are
There has long been a debate as to why someone would act in a specific way when others act
differently. It could be through genetics or, the lessons of life i.e. experiences. There is still
ongoing work as to how much contribution the genes make as to the people we become but it is
certainly something to keep in mind.
Making sense of life
In NLP, there is a term used which denotes each person’s ability to perceive the world around
them on a unique basis. It’s known as the ‘map of the world’ and in simplistic terms, it means
that no two people’s map of the world will be the same. If we take this further, and five people
all witnessed one event, no matter how diligent they were viewing the situation, their perception
of the situation would be different.
Our perceptions of the world differ from the actual physical reality and so, it’s important to
understand the relationship between your client’s mental world and of course, the physical world
in which they live. We must consider that there could be physical differences between those
witnesses and so, this will understandably affect the data translated such as colour, shape or size.
But our responses to stimuli are very much based by past experiences and so, the signal detection
theory enables us to understand and tell the difference between certain stimuli within the
environment.
Sensory stimulation is not a case of just responding, it is important to be able to make a

judgment. When we look at signal detection theory, we must understand that there are many
things that influence us and determine how to make sense of our immediate environment.
We make use of sound waves or light waves and this stimulates the sensory neurons where we
convert the energy into electrochemical signals carried through the nervous system directly to the
brain. This process is known as transduction. The sense organs communicate information to the
brain but in the same way that they tune into what is happening around, they also tune out
stimulation that may not change in intensity. In the main, we focus on sudden or immediate
changes. This could be a sudden movement on the outskirts of our peripheral vision. Certainly, in
days gone by when we had to rely much more on our senses for survival, this would have been
key.
There are many things that stimulate us - hearing sound waves, seeing light waves, feeling any
pressure on our skin, feeling pain, tasting or through scent. These form our main senses and
shape how we see the world.
Photoreceptors within the eyes gather in light and converts physical energy into neural messages.
This is sent via the occipital lobe so to decode or analyse, and this happens in the retina.
The cells in the retina are called rods and cones. Cones operates at their optimal best in bright
light which enables us to discriminate between 5-million different colours. Although, we are
only able to consciously identify a few hundred. Rods are receptor cells. This helps the
individual to see when light is low.
Sound
To understand sound and how we translate it into meaning, imagine a tree falling over and the
sound this would make as the branches and trunk hits the ground. Vibration impacts air
molecules sending them forwards and backwards changing air pressure. The changes that occur
while travelling are called sin waves. The sound waves travel into the ear moving from tissue to
bones and then transform into fluid waves in the core of the inner ear. Think of these as
vibrations which then stimulate tiny hair cells which lead to nerve impulses sending to the
auditory part of the brain. Your brain then starts to analyse these sounds.
Scent
Our ability to smell is perhaps one of our more primitive senses. If we lose the ability to smell,
we also lose the ability to be able to taste. Any odour is simply a chemical molecule which
makes an impact on the membranes within the nose and the receptors translate them to nerve
impulses, relaying them to the olfactory bulb. This is part of the brain that can decode this
information.
The taste receptors can be located on the upper part of your tongue and chemical molecules
dissolved in saliva are sent to the taste centre of the brain.
Touch
Our ability to touch and to feel is extremely important. Certainly, when children have been
deprived of touch, it can impact physical development. Your skin contains nerve-endings, and
these are important to your survival. You notice the sensation of feeling cold or warm or if there
is pressure on your skin.
Pain
Within psychotherapy, we also must understand people’s response to pain. Although we do not
like to experience it, pain alerts us to potential danger and help us to cope with injury. It also aids
the healing process. In other words, pain can become one of our most prized defences. Certainly,
there are other influences on a psychological and social factor that has a direct bearing on how
each individual experiences pain. Each person perceives and translate visual data, and this
includes how it’s communicated to others or even how that person responds to treatment.
Within psychotherapy, understanding someone’s psychological state and how this can intensify
the pain experience is important. Pain is emotionally distressing but, it is also physically
distressing. Certainly, for anyone with upsetting thoughts or, where thoughts are negative,
emotions can be intensified and yes, this may intensify pain.
Introducing the conscious mind
So much happens throughout daily life that it is difficult to retain conscious control over
everything that is occurring. When you pay attention, when you are mindful, you choose to focus
on a specific task and to avoid external distractions. When you do this, it helps you to fade out
any stimuli that is deemed irrelevant. It also helps you to consider the best response to make,
and, enables an active memory of this. The information you choose to focus on, your ability to
focus and to perceive is all important.
Your brain is really organised.
It naturally looks for strategies to make life easier. In other words, it assumes that specific
objects or facts would naturally go together. Think back to when you were a child, when you had
lots of shapes in front of you – squares or, triangles etc. To create order, your brain had to
assume that the square would go into the square hole and the triangle shape into the triangular
hole. Your brain also creates maps.
It uses any changes in texture or colours as a clue and it therefore, defines your world into
specific regions which are deemed meaningful to you. In life, we often instinctively fill in the
gaps so trying to create a bigger picture where one does not exist. If you consider that someone
has behaved badly to you or has let you down in life, you may spend much time trying to
understand why they have done so. Your brain needs a reason. Their behaviour may be
inexplicable or out of character but, your brain must make sense of it. This is quite natural, it can
however, lead to complicated emotional issues.
The brain wants to look for ways to categorise any information, not just in the background, but
the foreground too. It considers textures and colours but again, the same situation will be
categorised very differently on an individual basis. It also tries to add meaning to the data it
receives. All this sensory data of which there is much, can be highly confusing and so your brain
tries to create context. To do so, it draws upon memory, motivation, your personality, social
experiences and even expectations and, will also try to identify and recognise a situation.
Because we rely on our experiences and our memories so much, when we encounter something
out of the usual and this could be false data. Much depends on our perception and how we
translate data, and this is not always in a bad way.
Think about a time when you may have seen someone in a place other than we would expect
them to be. We may not immediately recognise them. They seem out of place i.e. in unordered
sequence. It’s important to understand that your map of the world may be very different from
someone else’s and when you start having clients in for a psychotherapy session, you have to
consider their personal map of the world to make sense as to how they perceive things – whether
correctly or incorrectly.
Module Two
Task:
Explain what is meant by map of the world
Task:
What does the amygdala do?
Task:
List the three types of neurones
Task:
What is the hippocampus?

Task:
How does the brain categorise information?
Module Three
The Conscious and Unconscious Mind
In life, we mainly focus on the core conscious functions. Think of the moment of consciousness
as a search light focusing on a specific area of interest, this could be an object, a person, a place
or an action. Anything outside of this beam of light is not part of consciousness. We draw
sensory data from this and translate the data in a way that makes sense to us. As an analogy,
think about a tall building, a sky scraper with multiple floors. Think of consciousness as being
the top floor. The next floor is the non-conscious floor, followed by the pre-conscious, the
subconscious and the unconscious.
This makes up five levels of the mind.
The non-conscious mind consistently deals with information that is never going to make it into
your memory or into the conscious mind. However, it may be an important function and may
happen automatically.
Your pre-conscious mind takes all the information that you don’t need right at that moment but
files it away in case you need it. You may never be aware of this information which has been
filed neatly for future use. However, sometimes, a trigger occurs which enables you to draw
upon this information without realizing that it was there.
The subconscious mind has information that can be retrieved when you specifically want it. As
an example, hypnosis is extremely good for this because it enables people to recall important or
intricate details. This can lead to some surprising revelations.
The unconscious mind acts as a clearinghouse. This means it shifts through, eradicate or stores
the data as required.
Sleep
Sleep is so important. Few people can function properly if they do not regularly receive six hours
or more at night. Although much research has been carried out regarding sleep and the many
benefits, it was believed that the brain was devoid of activity during this time, but this was
incorrect. The brain actually goes through four stages of sleep.
Stage one is considered the transitional stage. It happens just as you’re starting to become tired
and falling asleep. Your brain waves begin to slow down and enlarge and you experience alpha
waves. As you work naturally through stages 2 to 4, you move into deeper stages of sleep. This
takes you into delta waves which are slow but regular waves. To go through a full cycle, it takes
approximately 90-minutes. Most people have between 4 to 6 cycles of sleep throughout the
night.
The cycles are not repeated in full. Once the first cycle is completed, you start to move
backwards through stages three and then, stage two. Instead of instead of entering the first stage
again, you move into REM sleep which is known as rapid eye movement. A lot happens during
this stage of sleep. Initially, you may experience ten minutes of REM sleep but, as you progress
through the cycles, you may have up to one hour of REM sleep. This is very important. REM
sleep helps to stabilise emotions and to capture, identify and store memories. You also dream
during this stage.
Insomnia
Many people struggle to fall asleep but there are often distinct reasons why sleep is elusive.
• Anxiety or depression
• Unresolved issues
• Exercising too late at night
• Drinking coffee before bed which acts as a stimulant.
• Work shifts which interrupts sleep patterns
• Illness
• Drinking alcohol before going to bed
• Noisy neighbours
Some people have trouble falling asleep and end up clockwatching. Others fall asleep more
readily but wake up in repeated cycles throughout the night. Sleep deprivation can have a very
unhealthy impact on life generally but, emotions are often affected. In other words, you react
badly to certain situations and cannot perceive situations clearly. There is clinical evidence that
confirms sleep deprivation or disruption is present in most psychiatric disorders. So, it’s
important to consider this when you talk to your clients. Erratic behaviour, feelings of depression
or fluctuating moods can all be inter-connected to sleep.
By contrast, there are also disorders which cause excessive daytime sleepiness i.e. a disorder of
the circadian rhythm. This only impacts a very small number of people but, it can take a while to
diagnose this as a disorder because there are many physical ailments which could be the reason
for it occurring. There is also a life-threatening disorder called sleep apnoea. It typically occurs
in older men or those who are overweight. It’s an upper respiratory sleep disorder and it stops
people from breathing while they are asleep.
Blood oxygen levels drop dramatically and so, emergency hormones are secreted into the body
and this causes the person to wake up. They start to breathe normally again. Once they fall back
asleep, they continue this cycle of struggling to breathe due to poor oxygen levels in the blood
and, the hormonal interaction. It can happen multiple times during the night and this is
exhausting to the individual. If treatment is not given, the person could even die during the night.
Dreams
Dreams are often considered to be duel-purpose. The brain terms any disruptive thoughts into
symbols so they can be translated or, dreams may enable people to fulfil desires – all without
having to face social consequences. People who are often stressed may spend additional time in
REM sleep and it may be that dreams and the psyche are interconnected. Dreams enable the
psyche to analyse and work out solutions to issues. Then there are those who are experiencing
transitions in life – getting married, pregnancy or moving to a new area, this can spark off a
dream sequence. Equally, if your client has experienced a traumatic event, it will often manifest
itself within a dream which may be highly disturbing.
Our circadian rhythms vary and yet, for each person, they are consistent. Our biological clock
determines energy levels and our alertness throughout the day. The circadian rhythm is quite
sophisticated and is a series of physiological occurrences that coordinates body temperature,
heart rate, metabolism, hormones and arousal. Research indicates that the internal body clock is
controlled through two genes called CLOCK and BMAL1 and the trigger is an amino acid.
The gene CLOCK works as an enzyme. It adapts the BMAL1 protein within the cell’s DNA and
when it trips the switch, it creates a chain of events on a genetic level. 10-15% of the body’s
genes are regulated by the circadian rhythms however, when the amino acid trigger doesn’t work
multiple disorders could occur - including insomnia, anxiousness, depression, heart disease,
cancer or neurodegenerative degenerative disorders.
Whether we are night owls or early birds, the circadian

rhythm affects us. These patterns repeat every 24-hours.
When we enter sleep and begin to dream, this is just one type of altered state of consciousness.
We can achieve this through meditation and yoga. Even alcohol can be deemed as an altered
consciousness but with less benefits. It can be beneficial to alter the state of consciousness so to
change or achieve a new level of perspective. This is key within psychotherapy because we all
think and feel differently even if experiencing the same situations.
Some clients may demonstrate avoidance. They don’t want to think about a subject or,
understand it, they want it to go away. You will notice this even if a client has come to you for
help. Avoidance is common and may be relative to a significant trauma or, just an experience
that has had a profound impact on the client. Those who may have taken drugs often do so to
escape from reality.
Learning
Learning is an important part of the whole human experience. Learning is important. We must
consider what we learn, how, and what happens. We also need to understand the power of
association, our experiences and how we interpret stimuli around us. Much of our learning takes
place during childhood and we learn aspects of life from those around us. Many of your clients
will have learned behaviours which are unhealthy during this time.
Many potential clients will demonstrate self-doubts, a lack of confidence or, will feel unworthy.
This is likely to have developed at a young age.
• The child that was not favoured in the same way as others.
• The unwanted child.
• The child that lived when a sibling died
• The child who could not excel at school etc.
Damage of a psychological or emotional level can impact people throughout life. It can also
control their lives. They become bitter, unconfident, angry, selfish or, desperate for love. So, as a
psychotherapist, it is important to understand that learning isn’t just about development and
growth in the traditional sense, but, it impacts emotions, thoughts, feelings and beliefs.
We don’t just learn from books, we learn as we transition through life. So, when you have your
client in front of you, understand that only a small percentage of their behaviours will come from
education itself. We learn through observation. We learn through asking questions and we learn
through experiences.
This is part of the human condition.

When we learn, we gain confidence. We identify with this new knowledge and we make sense of
it. We use our perception, we analyse, we problem-solve, and we utilize. Our thoughts, feelings
and actions affect behavioural changes.
So, there are different types of learning and not all are positive.
Negative classical conditioning
Negative stimuli can create aversive conditioning. Consider this, if you were made to repeat a
certain task over and over again but each time you did so, it created pain in some way, this would
be a very powerful type of learning because there is fear associated with it. In fact, we know that
fear is very difficult as an emotion because it’s so hard to unlearn. Fear may also last a lifetime.
For those clients who have an irrational reaction to something, they may have been the victim of
negative classical conditioning.
Stimulus generalisation
As we progress through life, we form many thousands of associations due to the events that
occur and the situations in which we find ourselves. Of course, not all of these become
classically conditioned events. Not all associations are the same. Let’s imagine you have a client
who has a very real fear of dogs or cats. Perhaps they were bitten or scratched badly when young
and this shock event affected them. Now they are wary or fearful of all dogs and cats. This is
known as stimulus generalisation. This is an instinctive response meaning that we want to avoid
those situations.
Stimulus discrimination
As we become older, people generally become more discriminating. We understand that one
aggressive dog or spiteful cat does not mean that all animals are this way. Therefore, most people
overcome this base fear. With this realisation, the individual is involved in stimulus
discrimination. Through age, aches and experience, we learn that it’s somewhat of a balancing
act between discriminating or responding.
There are however three stimulating qualities which would pertain in classical conditioning and
these include:
• Contrast
• Contingency
• Information
When we talk about contrast, it means we are more likely to notice stimuli such as a certain
scent.
When we talk about contingency, this can be quite powerful. Imagine someone wearing a
perfume each time they are with you. One day, you smell this scent and yet the person is not
there. This brings back many memories and the association is likely to be strong. This
association can last a lifetime.
Information – is where stimuli occurs in a specific situation, it may not be bad but, more data is
needed.
The environment that we are in will undoubtably shape behaviour. We learn to associate strong,
positive and good feelings with certain elements. Or, the opposite. We develop bad feelings
towards others. During childhood, much of this conditioning occurs.
Parents reward their children when they are good or punish them when they are bad. Sometimes
people are rewarded in the wrong way. Let’s say a child constantly shouts for attention and,
eventually, the parents give in and provide attention and so, the child stops shouting. The lesson
here is that the child has learned that shouting or creating a scene gets results.
A client may have been ill-treated or ignored when young. This may not have been deliberate
but, through parents arguing with each other, but whether deliberate or not, the child’s need for
love and attention was pushed to one side. To gain attention, this child may have started
shouting louder and louder. In adult life, they may continue to shout to gain a reaction.
When you work with your clients, you consider all the things that may have led to this point in
their lives. Once you identify a cause, your role may be to help undo certain behaviours. This is
quite difficult. In fact, to unlearn or to detract from certain behaviours, there are two main
choices:
• Punish
• Eradicate the behaviour
• Some techniques used include:
• Relaxation training
• Social skills training
• Systematic desensitization
• Virtual reality exposure
• Aversion therapy
Module Three
Task:
Clarify the types of lessons that are often learned in childhood
Task:
What is meant by dreams having a dual purpose?
Task:
List four reasons as to why people struggle to sleep
Task:
What does the unconscious mind do?
Task:
What is REM?

Module Four
Memory
Your brain can store hundreds of trillion pieces of information but even so, memory can play
tricks on you. Think of a time when you met someone in the street and could not remember their
name. Then, there may be those times when you remember something that happened years ago
but forget why you walked into a room. It’s also true to say that we often remember the things
we want to forget and vice versa.
The information that your brain stores is categorised into two specific areas:
• Implicit memory
• Explicit memory
Explicit memory is where you consciously process information striving to retain it and
potentially make a great deal of effort into doing so. Think in respect of studying for an exam.
With implicit memory, unnecessary trivial facts may be stored, and this is unintentional.
There tends to be three reasons as to why people are unable to remember certain facts:
• They may not have fully absorbed the information
• They had the information, but it was lost
• They had the information but is unable to find it
These errors point to failure in the memory system:
• Encoding
• Storage
• Retrieval
If you struggle to remember the name of a work colleague, this is likely to be due to a retrieval
error.
• If you are unable to recall the person’s name, it may be because you did not feel the need
to really get to know them. It is likely to be an encoding issue.
• If your inability to recall your former colleagues name was due to the fact that this person
didn’t fit into your chosen category of colleagues, then the problem is likely to be
storage.
Your sensory memory retains an impression longer than is required and, this gives you time to
register the information.
Working memory has a great deal more stamina than sensory memory. There are limitations as
working memory lasts for a short period of time - approximately 20-seconds. Working memory
sorts through information transferred from long-term memory or from sensory memory. It is
processed into relevant or familiar patterns for recall later. Your working memory also saves
your most recent experiences. However, there are limitations as to storage.
Your long-term memory stores images and words and conceptual data filing them with similar
words or data that is already held in your memory banks. There are two types of long-term
memory:
• Procedural
• Declarative
When something stored in the procedural part, this includes sequences of smaller actions and is
skill-related and this could relate to something as simple as tying up shoelaces. These types of
memories are strong and hardy. Even if you have not used a skill-set for many years, once you
start, your memory quickly returns.
Decorative memory is only involved with the facts. You may need to put in conscious effort.
Within the decorative section of your memory banks, consider there being two rooms – episodic
memory and semantic memory.
All thoughts, feelings and memories that happen to you are stored in the memory room. By
contrast, semantic memory stores concepts and meanings of words.
The brain can be amazingly efficient when it comes to storing information especially with the
long-term memory and this is automatically marked with a timestamp along with the context.
This is for autobiographical information. When it comes to semantic information, there is often
an emotional attachment to it and therefore, you remember it more readily.
We often think of a flagging memory as being age-related, but this depends on the type of
memory recall. When it comes to short-term memory, the ageing process has little impact. It’s
actually the information which has been transferred from short-term and long-term memory
banks that those who are more senior of age tend to have issues with. It’s worth noting here that
those clients who may have problems with recall, it is not a general pattern. By contrast, long-
term memory for events which happened many years ago are typically consistent.
Long-term memory stores information in a very logical manner.
Note that your memories are always under construction and this means your memories may
change over a period of time. Also, experiences in the past, your current views and even
expectations for the future can impact memories too.
We’ve already discussed the importance of sleep and the negative impact of sleep deprivation
but, in a positive way, sleep can improve your brain’s ability to harness information and this
doesn’t mean protecting memories, but it plays a role in how the brain consolidates information
and how it remembers it. Recent research indicates that those people who can achieve enough
sleep between the learning process and, any exams will benefit. It helps the individual to recall
more information than those who did not take time out for sleep.
Events of the day are collated as short-term memories and stored in the hippocampus. This is
then moved to a long-term storage area based in the neocortex and this happens while you are
sleeping. Grey matter covers the hippocampus. While we often think of the importance of sleep
at night, taking a 90-minute siesta also improves the learning process. It enables the information
to be consolidated and stored much more efficiently in the long-term memory banks.
Research also indicates that by taking a nap, this can help avoid interference. This is when a new
task is then followed by a secondary task without sleep taking place in between. As a result, we
now believe that short-term daytime sleep in between bouts of learning is beneficial and enables
less interference.
Module Four
Task:
What can interfere with the learning process?
Task:
List the three memory errors
Module Five
Stress
One of the most problematic aspects of life is stress. Unresolved stress places a huge pressure on
mental health. Stress can increase or decrease depending on the individual’s response to the
situation, however, stress can be highly personal in that it is viewed differently by those
involved. Some people seem to manage their stressors while others struggle, and problems
escalate and compound. When we consider stress, we have to think that it is threatening to us
even if not on a physical level but certainly, emotionally. There will be some concern about
whether we can deal effectively with it.
Stress is not always bad however. We need some stress so to progress and motivate. The stress
response is vital.
Firstly, let’s consider how to respond to stress. This is unique and combines thoughts, feelings
and behaviours as well. Your levels of stress will depend on who you are as a person. This
includes your temperament, self-esteem and whether you have felt supported in life or are
supported currently. Consider this – problems can seem much more significant if you must make
decisions on your own. Shared problems do not usually carry the same risks or responsibilities.
Remember – we have discussed behaviours and how experiences or learned behaviours impact
the people we become. When you turn your mind back to childhood and recall how those around
you may have reacted to stress, you may realise that you are repeating patterns. Our ancestors
would have paid great heed to the stress response because it had the potential to save them from
attack or, to protect them, in modern life, of course, there is less potential for this these days, but
we react to stress anyway. If we do not resolve the cause of the problem, often, the stress
hormones do not dissipate. These days, the challenges of life are different from those faced by
early ancestors and in fact, one of the biggest culprits behind stress to-date is that of change.
Change
Change unsettles people. Even if the changes are positive, a fear of the unknown can create a
ripple effect causing doubts, frustrations or real fears. If you consider moving to a new house
which is one of the biggest stressors, you may worry about whether it will go smoothly or, if the
outcome would be good. Fear of the unknown is certainly a contributing factor to stress.
Pregnancy brings stress, changing jobs bring stress, getting divorced brings stress. Sometimes, it
is the anticipation of change that causes stress and so, you need to be aware of this when helping
your clients. Usually, the expectations of an individual do not normally match reality.
In this day and age, it’s all too easy to feel overwhelmed in life. Your clients may have pressured
jobs and a great deal of responsibility. Equally, a client may be on the opposing end of the scale
and struggling financially while feeling unsatisfied through failing to reach their full potential.
You are likely to see many clients who are subjected to feelings of stress and may even
experience physical manifestations and ill-health as a result.
Tip: Ask clients to write down some notes as to what and how they are feeling. This can form
part of a stress check-up.
Common stress symptoms
• Lack of focus
• Poor memory
• Feeling on edge
• Changes to eating habits
• Mood swings
• Feeling irritable
• Overreacting
• Feeling less motivated
• Drinking more etc.
Stress brings emotional and physical symptoms.
Burnout – where you feel exhausted due to

unresolved stresses is all-too common.
When a series of problems occur one after the other, stress levels can rise substantially. It can be
difficult for your clients to battle against chronic stress and many people succumb to feelings of
burnout. This is something that can be prevented however. When you have clients, who are
feeling very stressed, they need to understand why they feel this way, they need to be able to
identify the various triggers and what they can do to resolve issues. These are the practicalities of
stressors but often the problem because mindset.
Chronically stressed people are often overwhelmed. As stress creates a great deal of mental,
emotional and physical fatigue, it’s often too much effort to battle against these stressors. So,
they continue, adding more and more stress until it compounds and ends in physical and mental
burnout. Simply by talking to someone – to a counsellor or psychotherapist, clients tend to
develop more positive ways of dealing with stressors and start to embark upon a more positive
outlook.
The amygdala is the body’s crisis manager. It surveys the emotions of any situation and
generates an immediate response. The amygdala signals the hypothalamus and prepares your
body for action stimulating the hormones that create and increased heart rate or blood pressure. It
also signals the endocrine system that is involved in the fight or flight syndrome. During this
time, there are at least 15-physiological changes triggered all at once.
Adrenaline is released, and it is this that is responsible for a pounding heart, or for rapid
breathing. The individual also begins to sweat. Of course, once the stress has dissipated, then, the
body returns to normal. This may be acute but is far better than experiencing chronic stress as
this just continues in the body preventing it from returning to normal. If stress continues, the
physical body must work harder, hormones continue to produce adrenaline and the immune
system must battle to protect the body.
Stress may make your clients feel greatly anxious. They may feel motivated to change or feel
pressured by their situation. Memory problems start to occur and overwhelming fatigue sets in.
As such, there is a tendency to turn to alcohol, coffee or smoking so to cope with stress.
Eventually, these chronic levels of stress eradicate more resources than your body can create, and
this leads towards physical illness and emotional stress.
Coping strategies
A healthy lifestyle is of the utmost importance. For your client to start feeling better, it is
important to focus on nutrition, to exercise regularly and to ensure good levels of sleep as this
can all build up tolerance towards stressors. Importantly, learning to respond appropriately to the
stresses of life can make a huge difference between succumbing to burnout or being able to cope.
Coping strategies are not just important – they are essential.
This means that during therapy, individuals work on their stress response, learning how to
identify and eradicate triggers or, consider new ways of combatting stress by learning ways to
start over. Identifying stressors and eradicating them where possible is key. Effective coping
strategies go to the heart of the problem and the focus is on changing what is possible rather than
focusing on what is not. Your clients need to feel a sense of equilibrium in life so to create
foundations of health and well-being.
Generally, there are two types of coping strategies:
• Problem focused
• Emotion focused
Each have strengths and weaknesses.

When you use problem-focused coping methods, there is an emphasis on dealing directly with
the trigger. This means changing the situation so that the stress does not exist or, making sure it
is no longer a problem. This of course, works best when the problem is controllable.
With emotion-focused coping, you look at the response and consider why someone responds in a
certain way. The client can use positive self-talk to change their situation and to boost self-
esteem and confidence levels. Certainly, this type of coping method works best on those
problems where there is little to no control. While it does not eliminate the actual cause of the
stress, by changing the response to the situation, it lessens its impact.
Identifying stress triggers
Some of your clients are likely to feel victimised within life. This may not be deliberate but, they
do not feel empowered. They do not have control over their careers, money or even, health. They
feel as if they are floundering. But, to resolve any issues, it’s important they identify the core
reasons for stress.
Sometimes, your clients will not know why they feel stressed. Perhaps, there are too many
stressors, or, they believe they can handle stress quite well. The reality may be very different of
course. To confuse the issue further, your client may regale the issues as they see them, but,
these may not be the ones that cause the most problems.
The way your clients are likely to think about stressors impact on both an emotional and physical
level. Stress is dangerous. Before your clients can change any situation, they must determine just
how bad the situation is. If left unchecked, they need to consider the consequences and whether
they really do have some control over the situation. Small steps can make a big difference.
Cognitive appraisal
This approach is called cognitive appraisal and it’s a really useful techniques. Clients can create
a coping history where they use cognitive appraisal to identify and evaluate issues and the likely
outcome or consequences. This boosts inner strength and resilience. It helps them to believe in
themselves so that they learn to cope with any issues. Reviewing their track record also provides
them with greater positivity and esteem.
It’s important for each person to understand that the mind and body are linked. Where
psychological stress exists, it also has a negative impact on the physical body too. In fact, those
who suffer from depression are likely to have a weakened immune system, but, when an
individual learns to think more positively, this can be healing, and the body’s immune function
improves.
Every experience in life, every thought and feeling

impacts the physical self.
You may find that some of your clients demonstrate physical illnesses but, feel frustrated as no
diagnosis can be made. This is known as somatic symptoms disorder and it occurs when the
body starts to express what the mind cannot. There is also somatization disorder, and this is when
your client has a long list of vague and unverifiable medical issues.
This could be anything from heart palpitations, feeling sick and dizzy or headaches.
While it’s important for clients to talk to a doctor about these potential issues, often, there will be
an underlying psychological condition i.e. depression. Keeping a record of when these symptoms
begin, often start to show regular patterns such as headaches and this occurs through stress.
Tip: Use relaxation techniques to help calm the client
Progressive muscle relaxation techniques can really benefit a client who is suffering from stress.
Muscular tension is often incredibly high, and they may not even realise that their bodies are so
tense. Ask your client to close their eyes and to try to relax while you talk them through tensing
and releasing individual muscles of the body. Work from the feet, all the way up the spine, to the
neck and shoulders. They should relax the jaw and their facial expressions too. Teaching them to
respond to this technique means they can practice at home and gain many benefits from doing so.
You should start to see a difference in subsequent sessions.
Module Five
Task:
What is stress?
Task:
How do thoughts impact the body on a physical level?
Task:
What is somatic systems disorder?
Module Six
Behaviour
Clients will come to you with a variety of issues. Some may simply feel out of sorts. They know
that something is wrong, and experience low moods or even depression. This may not be the
norm and so, they are worried that something is seriously wrong. Others feel angry or, confused
and uncertain as to what they can do to make life better. Equally, you may find some clients have
started to recognise the connection from their younger years to problems that they are
experiencing now.
Fluctuating moods can create great concern and, your client may be concerned that they are
acting differently. They feel irritable, irrational or out of control. Anxiety may also impact life on
a daily basis. Many people feel this way at times, so it is not always a cause for concern unless it
escalates.
Life can spiral out of control and, your client’s reaction to stressors is important. It’s not
uncommon for clients to experience strange thoughts or feelings and probably few people
haven’t wondered if they were thinking in the right way on occasion. Of course, it’s difficult to
determine exactly what is abnormal.
Difficult moods and emotions may be a natural part of life at times, but, when deep bouts of
sadness or depression become a regular part of life, something must be done. If these dark
emotions are far from fleeting, the client will need support. Depression can be debilitating if it
occurs and, it’s also important to identify markers associated with changes in mental health.
Some clients will express concerns at their inability to function well during these times.
So, within your psychotherapy practice, you must determine the crossroads at which your
client’s behaviour has crossed to a point of potential illness. This is known as psychological
diagnosis. To make this diagnosis, your client must have experienced problems for an extended
period of time. It is vital that you determine that low feelings or irrational behaviour is not just a
short-term or temporary state of being. There may be external factors involved – grief, stress, job
loss etc. These factors may directly impact their coping mechanisms. Ascertaining the
reason/trigger is vital.
If your client displays signs of clinical depression – feeling seriously low of mood for a
minimum time frame of 2-weeks, then, they should also seek a medical diagnosis. You can refer
them to their doctor. If you suspect a personality disorder, the timeframe for diagnosis is much
longer. The minimum period would be two years. We strongly suggest that you recommend your
clients to see their doctor for a medical diagnosis and for any prescribed medication where
necessary.
Each client will have their own set of issues. They will also respond to those issues differently.
You must consider the client’s experiences, thoughts, feelings and beliefs. Ultimately, the
problems that are affecting your client may be enough to impact daily life in a negative manner.
There may be sleep issues or, even substance abuse.
Evaluation of a client’s behaviour relates to the following criteria:
• Maladaptive
• Unpredictable
• Unconventional
• Distressing
• Irrational
If two or more of these topics are present, this should alert you to look more closely at the
symptoms being expressed.
Maladaptive
This is where your client is unable to adapt to everyday life. They may seem rebellious about
society or specific goals. Their actions could counteract their own health and well-being. There
may be problems at work or at home and their sense of unhappiness may even lead to social
isolation.
Unpredictable
Your client may have unpredictable behaviour and seem to lose control of life, perhaps
displaying aggressive behaviour for no real reason.
Unconventional
Unconventional is not used often in diagnosis unless your client is eccentric in nature but, even
then, the term does not always apply. Unconventional relates to morally unacceptable or
undesirable behaviour.
Distressing
This is where your client suffers from severe distress on a personal level or, experiences intense
or negative emotions.
Irrational
This client may act in ways that are seemingly unimaginable to others. Irrational behaviour may
be extreme or unwarranted i.e. the person who weighs only 6-stone but believes they are obese.
Think about clients who may be suffering from anorexia nervosa or, bulimia.
Mental health issues
Mental health conditions are still difficult to clarify or diagnose and even in this day and age,
there is still some stigma associated with them. Irrational and unpredictable behaviours cause
great anxiety, fear and concern in others. Sometimes, it is as simple as not knowing what to say
or how to behave to this person.
Although research into the brain and the mind continues, we do know that thoughts and beliefs
impact actions in often extreme ways. Psychological problems can be attributed to nervous
system disorders or to a disorder of the brain. Even the smallest change in brain tissue or to the
chemical messengers can greatly influence mental health. We do know that where there is a
tumour in the brain, this can create many changes in that person’s behaviour.
Fortunately, today, we do have a little more understanding when it comes to mental illness
especially when you consider that historically, those people who demonstrate mental health
issues would have spent much of their lives in an asylum. Nowadays, modern medicine has made
a tremendous difference.
It’s always important to consider the person and as such, we don’t just look at physical or mental
health, but must look at social factors too. We need to consider the person in all ways. Therefore,
psychotherapy sessions explore the person’s life so to comprehend a potential trigger, even one
which is seemingly innocuous. Parental styles, personal experiences, inner conflicts or traumas
experienced all play a part. Environmental factors can also make a difference when it comes to
emotional or mental health. As regards treatment, some therapists focus on the client’s actions
or, on their relationships with others. This would no doubt lead them towards conflict in the
client’s life and to examine these carefully.
Those who specialise more in behavioural treatments would focus on environmental conditions.
This is because environmental conditions can trigger or reinforce problematic behaviours. Those
therapists who utilise cognitive therapy will be more likely to focus on the individual’s
perspective, on irrational thinking, or, whether everyday problem-solving skills are functioning
fully. Ultimately, all of these are areas should be considered in relation to the impact on that
client’s life. Sometimes, the smallest of issues can have the biggest impact.
We must also understand that while genetics may play a role in some conditions, many cases
occur where the client’s life goes out of control and it is only then that mental health issues
begin. This could be a simple as losing a job because it impacts their ability to function normally.
If their job was their whole life and of the utmost importance, this could make them lose their
confidence, others may lose respect in them and they would no longer feel empowered. Equally,
a distressing or traumatic event such as divorce could trigger psychological concerns. But
equally, there could be biological reasons including faulty neurotransmitters.
There are many different categories to consider including:

Anxiety disorders
When anxiety disorders are present, the common factor is fear or a deep sense of anxiousness
which manifests as the main symptom. This includes panic disorders or even social anxiety
disorders.
Depressive disorders
Clients who have premenstrual dysphoric disorder, disruptive mood dysregulation disorders or
major depression would fall into this category.
Somatic symptom and related disorders
In this category, there may be physical symptoms expressed including pain disorder or
hypochondriasis where they worry excessively about serious health conditions.
Substance related and addictive disorders
Within this category, we place health concerns caused by taking excessive alcohol or drugs.
Equally, compulsive behaviours would fit into this category i.e. a gambling disorder or having
substance dependence.
Dissociative disorders
Within this category, you will find this disassociated identity disorder, or de-realisation
disorders.
Schizophrenia spectrum
Within this category, you will find disorders whereby there is a loss of contact with reality. It
may be that the client suffers from delusions, or experiences hallucinations. This includes
schizophrenia and delusional disorder.
Sexual disorders
Clients may have problems functioning sexually and this includes women who find sex painful
or, male clients who struggle to perform.
Gender dysphoria
This is where a client expresses deep and consistent desire to be a member of the opposite sex.
You may notice clients become extremely distressed when trying to balance physical needs with
psychological ones.
Eating disorders
These include an unhealthy association with food whether through binge eating or, developing a
disorder such as anorexia nervosa.
Sleep disorders
Some clients may have difficulty falling asleep or, just have disrupted sleep patterns regularly.
Others may experience deeply-upsetting nightmares. Insomnia and narcolepsy are examples of
sleep disorders within this category.
Disruptive impulse control or conduct disorders
Clients whose actions fall into this category, may self-harm or, try to hurt others. Certainly, they
will have impulsive behaviours. This includes oppositional defiant disorder or even pathological
gambling.
Neurodevelopmental disorders
Neurodevelopmental disorders include those conditions which are diagnosed initially during
infancy or childhood. Some diagnosis may have been made during the adolescence stage. This
includes autism spectrum disorder, intellectual development disorder or, those conditions that
affect communication.
Personality disorders
Typically, long-term disorders. They focus on the maladaptive traits within their personalities.
This includes antisocial personality disorder or even narcissistic personality disorder.
Neurocognitive disorders
Within this category there may be mild or even severe conditions that affect memory. This also
relates to a lack of cognitive function at times. Alzheimer’s disease falls into this category but,
impairment can easily occur through an injury to the head. A stroke would also fit be labelled
here.
Bipolar and related disorders
Within this category, you will have clients who demonstrate serious mood swings. They may
have fluctuating energy levels too. This includes bipolar and some forms of depression.
Obsessive compulsive or related disorders
This includes OCD along with hoarding behaviours or body dysmorphic disorder.
Traumatic and stress-related disorders

Post-traumatic stress disorder was initially classified as being an integral part of an anxiety
disorder however, it is now linked with acute stress disorder, adjustment disorders or reactive
attachment disorders.
Note: These categories are just guidelines.
As a psychotherapist, you must work with your clients determining ways in which their lives can
be improved by changing thought patterns, actions or behaviours. Importantly, you must
understand the root of the problem which may take some time to identify especially if the issues
occurred during childhood. You must explain how and why these occurrences can affect your
client and how, with greater understanding, they can make positive, informed decisions about
their lives. Sometimes, it is a case of changing their perceptions and learning new ways to see the
world and adapting behaviours to fit.
Tip: Behavioural trial
This is where you teach the client the appropriate responses to situations which need to be
learned. This happens through discussion and practice. In time, this becomes a new behaviour.
Modelling can also be used to reinforce behaviours.
Module Six
Task:
How do you evaluate a client’s behaviour using the criteria listed in this module?
Task:
Can genetics play a role in psychological issues?
Module Seven
Affective disorders
Psychotherapy and designated treatments for client health is such an in-depth subject and so, it’s
important to understand the basics of client conditions so that you can then start building
practical experiences while studying case histories. Certainly, having time spent working
alongside a qualified psychotherapist (where possible) is extremely useful but is not always
possible. So, you can utilise case studies so to help to build up experience in listening,
identifying and then, helping others. This is a vital part of the learning process prior to starting
out on your new career.
Within psychotherapy, learning is ongoing.
Ultimately, you need to feel as confident as possible when it comes to treating your clients as
you are likely to encounter many varied issues. We have talked about many potential conditions
and stress-related psychological and physiological issues but, we must discuss affective
disorders.
This is a group of illnesses where the main symptom expressed is a combination of mood or
anxiety or even depression. It’s important to identify and comprehend the differences between
bad moods, feelings of sadness or major depression. It’s also important to understand conditions
such as bipolar disorder along with cylothymia and to consider the four anxiety disorders.
From a clinical perspective, depression would not be an initial diagnosis if you have a client who
is feeling unusually down but for a short period of time. They may say they are depressed but
this does not mean they have clinical depression. Unfortunately, the word depression is often
used incorrectly. People say that they are depressed when really, they are feeling low in mood
this may be because of environmental factors. Someone who has lost their job, or, is having
relationship difficulties may well feel anxious, sad or, worried. Again, this does not equate to
clinical depression as this is life-changing, consuming by nature, and lasts for several months or
more. If untreated, it can be dangerous.
Depression
When someone is clinically depressed, it can seem to be a considerable effort to even get out of
bed in the morning. They have little drive or desire to do anything. There is no motivation or
even hope. They cannot see a way forward. In fact, it may feel as if they are treading water as
they cannot achieve anything. Often, depressed people feel deeply sad and may spend much time
crying. Sometimes, this is triggered by the smallest of things and yet, they cannot seem to stop
the tears. At other times, they want to cry but can’t. It takes too much energy. Depression
impacts people from all ethnic and social and economic backgrounds. It can happen gradually or
can happen in an instant. It is serious, dangerous and completely debilitating.
Symptoms of depression include:
• Loss of libido
• Feeling very sad
• Loss of interest in hobbies or activities
• Feeling restless
• Feeling as if life is slowing down
• Significant changes in appetite
• Thinking about dying or, having suicidal thoughts
• Fatigue
• Feeling worthless
• Feeling guilty
• Changes to sleep patterns-sleeping more or sleeping less
• Difficulty concentrating
• Difficulty making decisions
• Memory loss
If the client specifies that they are suffering from depression, determine how long they have felt
this way. For any diagnosis to be made, depression should have been present for a minimum of
two weeks and, through discussion, you are likely to see that it will have caused your client some
emotional distress during this time. It is true that depression often occurs within family groups,
but this is not necessarily so. Often, there will be no indication of any family history but,
environmental factors and genetics can play a significant role.
Although research indicates depression may be inherited, simply, it means that some people just
have a greater vulnerability to depression than others. Family history does not guarantee
depression in life. Some clients may worry about this. Long-term research has discovered that
those with a genetic predisposition for depression also have an 80% chance of experiencing
depression where three or more negative events occur in a short period i.e. one year. This seems
to increase the sense of vulnerability experienced and means that normal coping strategies are
under pressure.
There will be some clients whose genes may protect them to a degree from specific mood
disorders. Genes will also play a significant role in how we all respond to difficult events which
can be traumatic in nature.
There is a stress hormone called CRH (corticotropin releasing hormone) and this regulates
messages through the cells of the brain and improves memory. It may also increase anxiousness
and suppress appetite. It is secreted via the paraventricular nucleus of the hypothalamus and has
several functions. It acts as the driver of the stress hormone system. This is called the
hypothalamic-pituitary-adrenal axis. It promotes the release of adrenocorticotropic hormone
from the pituitary gland. It is this hormone that is responsible for the release of cortisol from the
adrenal glands.
Where trauma or, difficulties occur in childhood, it may make this system overactive leading to
depression later on in life. This means that both psychological and physical events can cause
feelings of depression. Certainly, depression can lead to a circle of issues that are interconnected
on a physical and psychological level.
Dysthymia
There is also a disorder called dysthymia and this causes mild to moderate levels of depression.
It can often last up to 2-years. The impact is like clinical depression – hopelessness and fatigue
but, also sleep patterns can be impacted. Appetite is likely to be affected too. Although it’s a
milder form of depression, the impact is still devastating. It can start at any age but, appears to
impact women more than men. The actual cause is unknown, but it may be through altered
serotonin levels. There are of course, other issues such as severe stress, medical problems or
personality disorders.
Postpartum depression
It is quite natural or common for pregnant women and new mothers to experience fluctuating
moods including to feel tearful or, even irritable for a few weeks after giving birth. But,
postpartum depression impacts so many women and the symptoms can occur at any time
throughout the first year following birth. The symptoms are extreme, sleeplessness, deep
sadness, feeling tearful, hopeless and anxiety is rife. These emotional fluctuations can be
devastating.
There should be much joy at this time of a woman’s life however, a lack of joy and low mood,
can emphasise the difficulties being experienced, and guilt is often felt too. Some women will
feel resentful, angry with themselves and self-esteem will also suffer. Bonding with the baby
often takes much longer.
The exact course of postpartum depression is unclear. There may be a variety of factors at play
including:
• Hormonal issues
• Genetic susceptibility
• Stress
• Lack of sleep
Some women are more at risk due to less than adequate social support. Young mothers on a low
income or, who already have a history of depression can increase the risk.
Bipolar
Bipolar disorder affects approximately 1% of the population in every country throughout the
world. Both men and women can develop bipolar and this disorder causes extreme highs and
lows. Those people who have entered the depressive stage of bipolar disorder will appear to be
clinically depressed. By contrast, the extreme highs can make the individual feel amazing and
they are filled with energy and inspired. These highs are short-lived and then, mood plummets.
Symptoms include:
• Inability to sit still

• Struggling to concentrate
• Rapid/racing thoughts
• Speech may be disconnected
• Paranoia
• Subject to impulsive behaviour
• Easily excitable or irritable
• Remaining awake for days
There is a strong genetic influence with bipolar. Approximately 50% of those clients who have
this disorder will have at least one parent who suffers from depression. If any parent has bipolar,
the child has ¼ chance of developing depressive symptoms. When both parents have bipolar
disorder, the risk increases between 50% and 75%.
Cyclothymia
The condition – cyclothymia has similar symptoms to bipolar disorder i.e. fluctuating moods
swings including mania and, depression is likely too. But they never fully experience an extreme
manic episode. Equally, when they move into the depression stage, they never fully reach the
same levels of clinical depression. Mild symptoms can respond to psychotherapy treatments but
where there are severe mood problems, medication is usually prescribed.
Mood disorders during childhood
Mood disorders often develop during childhood and, more commonly, those who are in the
adolescent stage. Mood disorders can easily mimic each other – for both adults and children.
There are approximately 2000 teenagers who take their own lives annually and many will make
strong, negative comments such as: I wish I was dead.
These types of statements can cause a great deal of concern and, they must be taken seriously.
This is because younger children cannot always articulate how they are feeling. Mood disorders
or suicidal thoughts can manifest as behavioural problems. For those who survive, depression or,
mood disorders can be present into adult life.
Certainly, puberty is a risky stage, and this is because changes occur within the brain. We often
think that teenagers are just moody and that it is due to the adolescent changes. When you see
teenagers, who become isolated and shut themselves away for periods of time, it is possible that
they are suffering from clinical depression.
Within psychotherapy, there is a type of treatment known as Cognitive Behavioural Therapy

(CBT) and this, along with prescribed medication can be extremely effective to assist in
combatting major depression. In fact, the statistics are encouraging with up to 90% of people
finding CBT useful. CBT is all about the cognitive aspects of behaviour and so, it can help those
with depression fight against common self-defeating thoughts.
Medication is of the utmost importance if depression is severe. Encourage your clients to go back
to their doctors and to request medication. Often, they will be prescribed selective serotonin
reuptake inhibitors (SSI’s) and these include Prozac or Paxil. Unfortunately, they may cause
negative side-effects. Then, there are the tricyclic antidepressants, but these can take longer to
start working, it is also possible for a client to take too many of these leading to the risk of
overdose and side-effects can be more extreme. Where bipolar disorder is diagnosed, mood
stabilisers are often prescribed.
Anxiousness
There will be many clients who feel anxious. If anxiety is increasing and they have felt this way
for more than six-months, they may be suffering from generalised anxiety disorder (GAD).
Sometimes, it focuses on specific worries or problems, or, there may be unfounded fears. Other
clients may live in fear constantly. They dread every moment of the day, sure that something bad
is going to happen.
This causes great emotional discomfort. GAD may impact sleep patterns which of course will
increase their anxiety levels the next day. They may be tense and easily startled. Unsurprisingly,
those with GAD often state that they feel continuously tired or exhausted.
Panic attacks
Those who have a panic disorder will experience deep bouts of anxiety and these will often occur
when least expected. On a physiological level, blood pressure rises, the client’s heart will start to
pound, their mouth will be dry, and they may even believe that they are going to die. These bouts
of anxiety can last for 10-minutes or much longer. They are consistently regular but can occur at
any time.
Once the person has experienced several of these bouts, it is unsurprising that they worry about
when the next bout is going to occur. Common coping strategies is to avoid going places where
these attacks may have occurred but sadly, this can lead to a serious condition called
agoraphobia.
Agoraphobia
Agoraphobia often starts after random panic attacks are experienced. This can quickly escalate,
and the client may start to question when it will happen. Gradually, the client does not want to
leave the house as this is the only place where they feel safe. Often, there is a strong sense of
embarrassment associated with anxiety attacks whereas in the home, there is privacy at least.
Obsessive compulsive disorders
Many people suffer from mild versions of this condition. Consider a time when you may have
left the house and suddenly cannot remember if you turned off the cooker. The anxiety can be so
strong for some that they would have to go back and check the house or, would worry all day
listening out for the sound of the fire brigade. This can lead to negative, self-repeating patterns of
behaviour, leading toward OCD.
There are other disorders which include:
Phobias - these are potentially the easiest to deal with

Separation anxiety disorder – this is where a young child struggles to be separated from their
parents.

Module Seven
Task:
What is agoraphobia?
Task:
Explain your understanding of anxiety
Case Studies
Congratulations on reaching the final part of this course. By now, you will have a strong
understanding of psychotherapy and how you will be able to help future clients. Importantly, you
will have a good understanding as to how thoughts and feelings can create faulty perceptions,
negative behaviours or, sometimes, lead to serious mental health issues.
No two people are the same, even if they are suffering from a similar health condition. In
psychotherapy, we look at how the brain works, we understand if there is likely to be brain
trauma, problems with brain chemistry, or, if unhealthy behaviours may have been learned which
can have a negative impact on life. Some clients will be suffering from stress, others from
traumas and it will be your role to help identify the root cause of their problems. There is no
greater gift to give someone than listening and then, guiding them. Your clients may feel lonely,
isolated or, desperate for help. The relief at knowing you are there in a professional capacity to
advise can make a big difference.
To consolidate your learning in a practical sense, we would like you to complete two case
studies, and these must be handed in with your final exam. Do not rush. You have two months in
which to prepare the following case studies on:
1. The implications of stress
2. Negative thought patterns
To create your case studies, you must find a friend or family member who may demonstrate
these patterns of behaviour. For case study one – consider how stress impacts them and their
stress response. Talk to them about their stressors and how they could make changes and discuss
their feelings. Identify root causes and log this. Please do not add the person’s name to the case
study, merely list as case study 1 – stress and case study
For, negative thought patterns, you need to find someone whose thoughts can work against them
rather than for them. Perhaps, it is someone who is not reaching their full-potential due to low
self-esteem or confidence levels. Consider any triggers for negative thoughts, or, why these
patterns may have developed. Add case study 2 – negative thought patterns.
Please create in-depth studies on your findings and whether you have been able to ascertain the
initial cause of the issues. You will learn so much from discussing stress or thought patterns with
your chosen people and this will help you to reach out and help those who are in desperate need
for your support.
Professional Psychotherapy
Final Test
This final test is very important so please take your time to work through the questions
systematically. If you are unsure of any answers, please spend time working through the relevant
modules again as this will help to reinforce the knowledge you have gained. Please allow at least
two months from the start of this course before completing this test. You must achieve a pass rate
of 80% or higher to gain your professional certificate. You must also add two case studies when
submitting.
1. Write down your understanding of psychotherapy and your plans for using this course
material going forward.
2. State the negative implications of stress.
3. What is the oldest part of the brain?
4. Which system is in the mid-brain?
5. What is the medulla responsible for?
6. What does the limbic system govern?
7. What does REM stand for?
8. List the two types of long-term memory
9. State your understanding of the left and right brain hemispheres
10. What percentage of the world’s population is affected by bipolar disorder?
11. What factors may increase the potential for post-partum disorder?
12. Define the amygdala and its role
13. The hypothalamus controls which system of the body?
14. What is meant by map of the world?
15. List the function of the parietal lobes.
16. Case study 1 – the negative implications of stress
17. Case study -2 – negative thought patterns
About Karen E. Wells
Karen E Wells
Karen is an established therapist & tutor with many year’s experience of
successfully helping thousands of clients and students to move forward in
life.
Karen works extensively with renowned Spiritual Healers Mike
Robinson & Jo Le-Rose and brings elements of their exclusive teachings &
healing into the world of Hypnotherapy & Regression to offer unique
sessions & courses not found anywhere else in the world. It is through
these teachings with Mike & Jo that Karen developed the pioneering work
of Parallel Quantum Lives (PQL)
She has also been a member of The Newton Institute training team in
California & Europe. (Journey of Souls, Destiny of Souls) and in 2006 Karen
established The KEW Training Academy Ltd, which offers Classroom &
Online training courses.
Karen is the author of 2 best selling books:
Past Life Regression; Exploring The Past to Heal The Present
& Hypnotherapy; A Simple Solution in a Complex World.
With Karen’s extensive experience, skills & knowledge she has faced,
healed & cleared many of her own issues so you can rest assured you are in
safe hands.
If you are ready to begin or continue to take your inner journey, Contact
Karen.

Professional
Psychotherapy Course
Karen E. Wells

Kew Pyscho Therapy

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Table of Contents ........................................................................................................................ 3

Module One ................................................................................................................................ 7

What is Psychotherapy? .......................................................................................................... 7

Self-Assessment Tasks .......................................................................................................... 12

The Brain and Hormones ...................................................................................................... 13

Self-Assessment Tasks .......................................................................................................... 28

The Conscious and Unconscious Mind .................................................................................. 30

Self-Assessment Tasks .......................................................................................................... 39

Self-Assessment Tasks .......................................................................................................... 46

Self-Assessment Tasks .......................................................................................................... 55

Self-Assessment Tasks .......................................................................................................... 65

Affective disorders ................................................................................................................ 66

Self-Assessment Tasks .......................................................................................................... 76

Foundation Level Psychotherapy .............................................................................................. 79

Final Test .................................................................................................................................. 79

About Karen E. Wells ............................................................................................................... 81

A psychotherapist does not prescribe medication.

This is really important.

The link between the brain and the body

Why we are the way we are

Making sense of life

Sensory stimulation is not a case of just responding, it is important to be able to make a

Introducing the conscious mind

Your brain is really organised.

Explain what is meant by map of the world

What does the amygdala do?

List the three types of neurones

What is the hippocampus?

How does the brain categorise information?

This makes up five levels of the mind.

Whether we are night owls or early birds, the circadian

This is part of the human condition.

Negative classical conditioning

• Some techniques used include:

Clarify the types of lessons that are often learned in childhood

What is meant by dreams having a dual purpose?

List four reasons as to why people struggle to sleep

What does the unconscious mind do?

These errors point to failure in the memory system:

Long-term memory stores information in a very logical manner.

What can interfere with the learning process?

List the three memory errors

Common stress symptoms

Stress brings emotional and physical symptoms.

Burnout – where you feel exhausted due to

Coping strategies are not just important – they are essential.

Generally, there are two types of coping strategies:

Each have strengths and weaknesses.

Identifying stress triggers

Every experience in life, every thought and feeling

Tip: Use relaxation techniques to help calm the client

How do thoughts impact the body on a physical level?

What is somatic systems disorder?

Mental health issues

There are many different categories to consider including:

Somatic symptom and related disorders

Substance related and addictive disorders

Disruptive impulse control or conduct disorders

Bipolar and related disorders

Obsessive compulsive or related disorders

Traumatic and stress-related disorders

Note: These categories are just guidelines.

Tip: Behavioural trial