The study of smoking and smoking cessation continues to be plagued by bad science.  A recent study in the journal  Tobacco Control reported that each smoker costs an American employer $5,800 per year on average.

This does not seem unreasonable until you start to look at how the figure was arrived at. Most of the cost is estimated as lost productivity due to leaving work to go outside and smoke. Then there are the sick days taken by smokers; increased health care costs for the employer, offset by the reduced pension costs due to smokers dying earlier; and lower productivity during working time due to withdrawal symptoms,.

It was this last one that caused me to query these figures. How does a smoker get withdrawal symptoms if they are still smoking? According to the researchers every smoker gets withdrawal symptoms within thirty minutes of putting out their last smoke. Having interviewed thousands of smokers this idea just doesn't stand up to checking. Many people smoke in the morning and then don't smoke all day if they are busy at work: they just forget to smoke. Are we to believe that they are suffering withdrawal symptoms all this time? It doesn't make sense.

Then there is the issue of does smoking more cost the employer more. This is not addressed because the researchers didn't actually speak to any smokers. They read and analysed what other academics had written about smokers. That analysis is how they arrived at the main cost. They did not actually measure how long workers took to go and smoke, they estimated from their reading that smokers would take five fifteen minute breaks during an  eight hour day. It strikes me as astonishing that anyone would create an estimate of work time lost without  measuring how long smokers actually took for their smoke breaks.

And once you start questioning the method, other issues come up. If smokers are to blamed for loss of work time, what about sports players, who lose time at work through injuries, pains, sprains and so on. I am no apologist for smokers, but if you are costing in smoking time, you also need to cost in the benefits of smoking to the smoker. Many smokers use the time to review what they have to done, or to plan the next move, or just calm down from a stressful situation. What about  value of the ideas exchanged between groups of smokers as they congregate socially outside? I am sure that you can come up with your own list of objections.

The flaws in the reported methodology, in my view, make this 'scientific' report unusable. Sadly, too much research into smoking is done by non-smokers speculating about what smokers might be doing and thinking, and not enough is done by studying smokers' behaviour.

A new method has been proposed for treating people who hear voices. Most people who hear voices don't like them;  the voices say terrible things about them; and its gets so bad for some people that they will do anything to turn them off, from abusing alcohol to killing themselves. Occasionally some people hear the voices telling them to hurt other people, but mostly the sufferers just hurt themselves.

The standard treatment has been to try to teach people to ignore the voices, or to prescribe medication that numbs the person so they don't react to the voices. However this approach has had limited success.

The latest technique uses  a computer to let the sufferer create an image of the thing doing the talking, an avatar. The therapist then talks through the avatar remotely, and gets their patient to talk back to the taunts of the avatar. Because they created the avatar, it does not seem so frightening. And then over several weeks, the therapist works with their patient to gradually change the avatar on the  screen, so that they become more comfortable answering back and disputing what the voice is saying. It apparently works quite well.

However, it is reliant on having a fairly sophisticated computer set up, which can be a drawback. Other therapists point out that using dolls or empty chairs works just as well and doesn't need expensive gear.

When I read the report, it struck me that this was something that could be attempted by a hypnotist, with clients at the less severe end of the spectrum. It would not be difficult to get someone to build up an image of their tormentor and to do sort of gestalt technique to get them to answer back. Then over several sessions the image and personality of the voice could be changed to something less disturbing, and gradually accustom the client to become at ease with disputing the messages. Combined with teaching how to relax deeply, I think this would be a valuable way forward for some clients.

I had a client who was trying to lose weight.
It seemed to me that all her problems came from a lack of certainty about what she wanted from life, where she was going. Everything was frustrating because she really didn't know what she wanted to do. She wasn't procrastinating about work, because that was scheduled. It was the unscheduled things she was not doing. She found it very hard to focus on anything and just drifted through the days, not exercising and eating too often.

So I decided to do the BLISS script but I knew that this client would not accept a simple visualization because of her personal beliefs.
So I started with an induction and invented a new script about floating down a river and letting the water peel off all the layers of worry and stress. Then letting the water loosen the excess weight and let it float away.
And then I suggested that as she went deeper down the river she was going back in time to when she had the body she wanted and that firm strong body was still there inside her. I suggested she could feel the muscles trying to come back and getting stronger.
I led her to a pool where she floated in perfect balance, all the things that life had put on her, were now gone. She reported that she was surrounded by a purple bluey colour, nothing but the colour. Everything was going really well. Deep trance and active cooperation: just what I wanted.
I told her there was a door in front of her and behind that door was BLISS. A vision of what she really wanted to get from life, full knowledge of what her life was about.
And then, just as she was about to open the door that would reveal her deepest desires, her cell phone gave out a ring tone that would waken the dead: and she jerked right out of trance.

Damn.

If you sometimes wonder why you feel the way you do, then creating a daily journal is a good way to learn about yourself. Writing a journal diary will let you keep track of your emotional reactions to life's problems as they happen.  Writing your thoughts down lets you deal with issues as they arise. But the main advantage is that it gives you a time to reflect. Self reflection is the key to changing how you feel and how you cope. Physically writing things out forces you to focus on what is important. The suggestions below will help you to get the most from your writing exercise.



Getting started

Buy a hardbound lined-paper book. It doesn't really matter what size it is but most people like to have a large format to reflect its importance. Other people like to have a small intimate diary so that they can carry it with them and write in it in private moments. Habitual diarists buy a different color each year.

Some people like to write it online, a bit like private blog. This will work if you are a good typist, but if you are not your thoughts will outpace your typing speed and you will find that by the time you have typed the first thought, the second thought has gone. It might be better to stick to writing on paper.



When to Journal

Writing can be done every day or only when you feel you need to express yourself. They are both good. Most people like to set aside a fixed time of day, such as before getting ready for bed. Other people wait until they feel in the mood. Or you can just read over your journal from time to time and something will engage with your emotions and you can write your reaction to that. It really doesn't matter if there are gaps of days or even months between entries. There is no right or wrong way to do it.



What to Journal

You can write your journal as a series of daily observations for nobody in particular. Or you can write them as emails to yourself. Or you can write open questions without answers. Like 'why do I always feel inadequate when I visit my Dad?' Leave the question, and then some time in the future, when you re-read that question, you will be in a different frame of mind, and you might get an insight into it. Or some people think of a question to write down each night, and then use that as their starting point for writing the next entry. For example your question could be 'If I really thought about it, what could I accomplish tomorrow?' or 'What am I going to do different tomorrow?'.

Some people prefer to take a structured approach to their journal. They start with the same questions every day, for example 'What three good thing happened to me today?', 'How could I have handled some situation better today', 'What did I do really well today?' and so on. Looking back on your successes is a great antidote to depression.

Another method is to read something that you can reflect on, a religious or philosophical work perhaps, a poem or a biography, and find some sentence, some phrase that speaks to your heart. Allow that to guide what you write. Copy out the sentence, and then explain to yourself why it spoke to you.

Or you can choose not write anything at all. You can draw a picture that expresses how you feel right now. Or you can cut out articles from the newspaper that mean something special to you, or glue in a ticket or a bit or wool that that has a some special meaning that you can't express. Or you can use a mixture of all of these.

Some journallers like to turn their thoughts into affirmations, to use something from what they have written to plan how they will improve something tomorrow.



Getting into the mood

To use the journal effectively you need to be able to connect to your own emotional energy centers when you write. You need to find a quiet spot where you can be undisturbed for ten to twenty minutes. Then close your eyes, and focus on your breathing. Just notice your breathing, and on each breath out allow your muscles to relax. Continue breathing quietly and then let your mind drift over the events of the day. Let your mind wander where it will, and get in touch with your feelings. When you get a feeling, any kind of feeling, just notice it and acknowledge it. then start describing to yourself what that feeling is like, what it reminds you of, how it affects you, what you want to have happen. This will only take a few minutes. Then you are ready to start writing your journal.



Writing it out

When you feel the need to express something about your thoughts and emotions, just start writing. Just start. Do not worry about grammar or spelling or correct sentences, just let your thoughts flow and focus on getting them down before they vanish. Tell yourself that you can always go back and rewrite it if you need to. It is private to you and not going to get graded so you can use whatever form suits you best. You can use words and pictures and abbreviations and shorthand and lists or leave gaps or anything else you want. No one is going to judge what you right, or criticize it, and you can down your most private thoughts without shame.

Each thought will lead to more thoughts and go off in the most unexpected directions. Don't worry about it. Just keep writing. If your thoughts are racing away from you, just make little notes and pictures and then use these to remind you of what you need to write about.

While you are writing, even though you are not aware of it, your mind is working, examining each word, thinking about each phrase, and finding other examples that are themselves reminders and set off another mental search.

When you think you are done, read over what you have written. That will likely spark off more thoughts and just follow that wherever it leads.



Advantages

Journaling is simple but very effective.

The act of writing is therapeutic. By describing a situation you are forced to really notice all aspects of it. Journaling gives you a non-threatening way of identifying your feelings about the situation. Journalling gives you the space and time to reflect.

Reading back in your journal can help you put things into perspective. Keeping a journal will remind you that things always get better, and can help to identify patterns in how you feel. Going over an old journal will remind you how you have changed, how things that used to be an issue just don't figure in your life anymore. Reading over your journals will give you a unique sense of who you are.

Be honest with yourself. Make a pledge that your journal will only be read by you. That way your unconscious mind will feel free to let you express your deepest desires. Putting your thoughts down on paper can be liberating. Your journal doesn't talk back. If you want to you can scream and shout in your journal, get back at the person who humiliated you, vent your anger or your frustration. Externalizing how you feel helps to manage those feelings. Many therapists ask their client to keep a journal precisely because it does help 'get it off your chest'.

Although your journals are private, you never know, they could turn into treasured heirlooms for your grandchildren's children.



Using it to set goals

Your journal does not have to be about now, or just looking back. You can set aside the back of the journal for long term goals. And then check on them from time to time. For example write down the answers to :

What I want to achieve in the next twelve months?

What I want my life to be like in ten years time?

What things about myself am I most proud of?

What are my greatest strengths?

What weaknesses can I work on to eliminate?

What is holding me back right now?



It can be interesting to write the same list out every year and notice how they answers change year to year.



Special types

Gratitude Journals

You set aside part of your journal to record all the good things that happen every day, all the ways that you are blessed, all the random kindnesses of strangers. This will build in to a life affirming collection.

Ideas Journals

As you write in your journal your unconscious mind is working hard, and you will find that you come up with ideas and insights and new ways of doing things. As they occur to you, jot them down in a special section. Don't worry about how good they are or if you have the resources to do them. Just note them down and go back to your journalling. Later on you can revisit the section. It will build up into a resource of ideas that might spark other ideas.

Project Journals

If you are working on some unique project, like changing your job, or getting a house, you can create a separate section that has to do with that project. Put down ideas, resources, name and addresses, web sites - anything and everything whenever something occurs to you about it. It will build up over time to a useful reference and resource.

Commonplace books

These were very popular in Victorian times. A commonplace book is simply a book where you paste in printed texts you come across that you want to keep. These often include poems, obituaries, paragraphs from novels, pages from religious manuals - whatever interests you, or that you feel might be of some use to you in years to come. It is more than a scrap book, it is usually for things of more than fleeting interest.

It is quite normal for clients to cry. In fact I regard it as a help to diagnosis and a sign that the emotions must be near the surface and gives a potential feeling to target for regression therapy.

However a recent academic article has looked into the issue of therapists crying.  When I started out in this business I was as damaged as any of my clients and I frequently heard stuff that echoed my own upbringing. I could listen to it quite dispassionately, and I think the closeness to my own experience helped my understand more. Listening was no problem. Following a script of mostly direct suggestion was no problem either. But when it came to designing a metaphor to suit their situation, the closer it was to my own issues the more it resonated with me, and I found myself getting emotional along with the client.

I was quite startled by this at first, but I later realised that it was doing me good: and it if was doing me good then it was probably doing good for the client as well. Then I deliberately started designing metaphors that would cause me to cry, because that way I knew they were good powerful metaphors, and by listening to my own emotions I got better at designing them.

As I got more experienced I realized that in order to get into the client's mind, I first had to imagine what they were feeling in my mind, and the metaphors were what I thought might work for me. And then as I said the metphor I had to imagine the images in my mind, and of course my mind was being affected by them at the same time as the client's mind was being affected. This set up a feedback loop that I thought greatly increased the depth of empathy between us.

As I progressed, by fixing other people's problems in this way, I fixed more and more of own problems. I no longer feel that same raw emotion to the same extent. But I think that I do in fact come close to tears with more clients, rather than fewer. Healing myself has let me open up to more empathy with other people and I feel the sadness of an abusive childhood probably more keenly than I ever did years ago.

The article says that more than half of therapists reporting tearing up in the last four weeks, and I think that this about right. Only one percent of therapists thought that they had disadvantaged their clients by showing emotion. In my case I only get emotional while delivering the words, and so the client does not see me, since they have their eyes closed by that point. But I often remark to them that they were not the only ones crying during that session, and I think that the client appreciates sincere emotional contact.

The British Psychological Society has issued a statement saying that in their opinion it is time to re-assess the medical model of mental health. This model has been the leading way of thinking about how to deal with mental health issues for more than sixty years. What they are saying is that it is time to question the validity and usefulness of the idea that all mental problems can be treated by drugs, and that every mental or behavioural problem is now automatically assumed to need some pharmaceutical treatment.

It is very brave of BPS to come out with this statement. There will huge opposition to this idea. There is no coincidence in its timing: it comes shortly before the American Psychiatry Association is about to issue the latest update of the DSM-5, the Diagnostic and Statistical Manual of Mental Disorders. This has been accused of inventing illnesses so that they can then be treated. In the US, insurers will only pay for treatment if it is classified in the DSM. If it is not there, then it cannot be treated under health care plans. It is also accused of leading to uneccessary diagnoses: caregivers note symptoms, and then search the DSM until they find something that matches, and the patient is thereafter labelled with that disorder, whether they have it or not. It is also not incidental that the DSM is the major source of income for the APA, so they can be expected to respond robustly to any challenge to their model of treatment. The pharmaceutical companies are unlikely to be pleased either.

It will be interesting to watch what develops.