Sleep and Melatonin by Dr Elizabeth McCardell, M. Couns., PhD

 

January 2025

We are governed by circadian rhythms, which are 24 hour cycles, part of our body’s internal clock. During sleep, the cells in our body undergo healing and replication and our mind works through the experiences and memories of our lives in dreams. Our psyche needs the stimulation of being awake, and being asleep. We need, integrally, a consistent routine for our good health. Our circadian rhythm causes us to sleep and, in the morning, as exposure to light increases, melatonin production stops and body temperature rises, promoting wakefulness. Rhythm is the key. Light and dark, wakefulness and sleep, in harmony and balance giving rise to good bodily and psychological health.

 

Sleep is most likely to be refreshing and restorative when circadian rhythms, the natural cycle of daylight and darkness, and sleep patterns align. Regularity of meal times, exercise, social interaction, and sleep times as well as exposure to sunlight and darkness help maintain our natural circadian rhythms. Sometimes, though, our circadian rhythms are thrown out of kilter: shift work, travel across time zones, social or study habits that lead to irregular bedtimes, illness, stress, bright lights, too much alcohol and other recreational drugs, all contribute to this.

 

Problems with sleep can give rise to insomnia, performance issues (memory problems, difficulty focusing and difficulty performing high precision tasks, emotional and social difficulties, accidents and errors, health problems (obesity, diabetes, heart attacks, high blood pressure, and cancer), and symptoms of low energy and grogginess.

 

A regular schedule for sleep, meals, exercise, exposure to a moderate amount of sunlight  and not too much screen time, etc, helps good sleep. If you are having problems getting to sleep, clinical hypnotherapy (which I do) combined with light therapy (controlled exposure to light, eg going outside in the morning after dawn for an hour or so and then at least 10 to 30 minutes in the afternoon of sunlight is beneficial) and, maybe, melatonin supplements and, if your doctor recommends it, medication. The latter can pose risks and have undesirable side effects.

 

So, melatonin. I’ve been thinking a lot about why melatonin was given to me in ICU when I was seriously ill a few months ago when sleep wasn’t a problem. Melatonin, as we know, is a hormone produced by the pineal gland in the body in response to darkness and regulates day-night/waking-sleeping cycles by chemically causing drowsiness and lowering the body temperature. Melatonin is also implicated in the regulation of mood, learning and memory, immune activity, dreaming, fertility and reproduction. Light decreases melatonin production creating wakefulness, darkness increases melatonin inducing sleep. Sometimes some people do not produce enough melatonin and have insomnia. This is usually and usefully treated with melatonin tablets, drops, patches or gummies. So, why was it given to me in hospital – until I questioned its use and suggested that it really wasn’t necessary for me to take it?

 

I’ve since discovered that it is quite often given to patients during acute illness within a particular age group as it has been discovered that such illness sometimes interrupts the person’s normal circadian rhythm and creates delirium.  Well, this might be true, but to give melatonin to everyone on the basis that sometimes the wakefulness/sleep cycle is interrupted seems a bit of an overkill. At no time was I suffering delirium. Blanket prescriptions cannot include all variables.

 

I often hear from clients that they have been prescribed melatonin and they’ve been using the stuff for years, without much useful result. This supplement is time-limited. The supplement is designed to reset the circadian cycle not to replace it. As a short-term solution to insomnia, it’s useful, but it loses its effectiveness and can contribute to the body not restoring its own circadian rhythm (which is the whole point of taking it in the first place).

 

Melatonin is not innocuous and shouldn’t be used if you operate heavy machinery, nor

taken with alcohol or other sleeping pills as the combined effects may cause breathing problems. Melatonin supplements interact with many medications, including birth control pills, blood pressure medicine, antiseizure medicine, medicine to weaken the immune system, and blood thinners. People who take any of these medicines should speak to their doctor before trying melatonin supplements.

 

 

 

 

 

Knowing and Realizing We Know by Dr Elizabeth McCardell, M. Couns., PhD

 

December 2024

 

It’s interesting that often we know a whole lot more than we realize we know something. Herein lies an important key to effective counselling. Very often the client comes for their first session and effectively tells you – without realizing it – what is missing from their lives and also how they might incorporate that knowledge into everyday experiences. The art of therapy then is to bring to awareness that unawareness. It’s a very subtle thing, and needs to be approached without fanfare. Awareness cannot be forced.

 

A clinical supervisor of mine once described this as like stealing a client’s watch and then returning it to them, gently. We therapists must be very attentive; listen very closely to everything a client says and does. We need to bring awareness in as though this knowledge has arisen from the client own source of knowings (which it has). Their knowledge base is their resource, and in sharing with us, ours as well. Therapy, after all, is a shared conversation, and a very creative one.

 

I have just done a hypnosis with a client of mine. To prepare for this, as I always do, I listened and talked with him about the discoveries and insights he has had during the week. During this first half hour (my sessions are 60 minutes), I discovered not only the main topics that have preoccupied him, but also key elements and strategies for the next half hour, that of the hypnosis itself. I listened, effectively, for the shape and design of his unconscious processes, aiming to bring to consciousness and realization that which is implicit in what he has said.

 

Hypnotherapy is a playful way of approaching the process of realization. The therapist casts aside traditional linguistic order to play with ideas, words and images. The purpose is to stimulate client resources, implicit in the way that person approaches the world. Again, this requires very close attentive listening to them.

 

One exercise, I remember from studying clinical hypnotherapy umpteen years ago in Sydney, was to ask the client to identify their personality and also list all the animals they particularly loved and then to incorporate reference to those animals in the hypnosis session. My client said, they liked meercats. They also said they were a scaredy cat. I played with her words, saying things like “no mere cat, not scared, but a lion.”  The words were already there, as was the intent and direction for therapy.

 

Now, had I said these things directly, the client would well have brushed the words off, instead re-emphasizing her unhappy state of mind. My playful approach may well have been received quite differently, loosening resistance and allowing humour to introduce a deeper understanding and, effectively, releasing the lion within. Lions, after all, are not mere scaredy cats, and are not to be messed with.

 

The shift from unconscious knowing to realization is the start of all knowledge, including the physical. A dancer, or gymnast, already uses their body like everybody else, but have brought particular skills to certain sets of movements. One could say, that skills are realized body knowledge.

 

It’s when knowledge remains unconscious, unrealized, that problems arise. Again, thinking about body knowledge, sometimes pain sets in and learning how to move differently through something like Feldenkreis can release the pain – such is the purpose of realized movement.

 

Psychological pain is similarly created when we keep on doing the things that creates our pain, forgetting our own knowledge that there are other ways of being and feeling. It’s then that the subtle work of psychotherapy comes to its own. Sometimes, doing more than talking about it really helps too. I remember a client years ago who was clinically depressed. I discovered that what she used to do when feeling low was go out dancing. I encouraged her to turn on the radio once a day and just let her body dance. She did, and the next time I saw her, she glowed. Everything changed for her as she realized her inner resources for a good life.

 

 

 

Life Chooses Life by Dr Elizabeth McCardell, M. Couns., PhD

 

November 2024

 See also http://www.nimbingoodtimes.com/archive/pages2024/nov/NGT-1124-24-29.pdf

I’m told that in Mexico when you get to your 70s you are said to have reached the 7^th floor. Very bizarrely, I was recently on the 7^th floor of my third hospital where all the geriatrics were put. I’ve been rather seriously ill with a blood sepsis and near organ failure and the 7^th floor was meant to be a rehabilitation ward, but I was in a room with a woman with dementia and some of the nurses seemed to think I too had dementia (very frustrating!). One asked, after my last shower there where I’d washed my hair in preparation for going home, if I knew how to comb it.  Yes, yes, yes, I said - irritated out of my brain. I wasn’t there because I’d lost my marbles, I was there just because I needed physiotherapy to walk again, without assistance.

I walked out of there determined to get back into the swing of life and work as quickly as possible, and I’m getting there. I’ve resumed seeing clients online. Please email me on dr_mccardell@yahoo.com for further information.

 One of the medical doctors asked me at the second of the hospitals if, in the case of near death, would I want to be resuscitated. I had to think; to weigh up questions of the meaning of life; to consider what matters most to me as a living person. This is, after all, an existential question that we all must face sooner or later. I replied, after some thought, “Life chooses life.” And so it is. I guess that if I was closer to death, I may have chosen death, but I have an abundance of life, more to live, to give, to celebrate.

 Being a patient in hospital is a strange disjointed thing, a Dali-esque  thing. You are treated as both object and subject, at once. There I was using a bed pan and – at the same time – being measured up for a pressure sore prevention cushion by an occupational therapist. There I was wrapped only in a towel sitting in a wheelchair after a shower and wheeled out into the hallway filled with medical students and no-one noticing anything. Exposed, and yet, not. There I was trying to engage a young doctor in conversation (because befriending people is what I do, and doing so changes the dynamic rather wonderfully between us) while she painfully inserted a cannula into a vein on my wrist. The illness, itself, was felt subjectively, but objectified at the same time: a timely reminder that, as a dear mentor puts it, we are not our bodies. Bodies change, age, decay, but our spirit lives on, just as buoyantly as ever. And we can learn to watch all this happening. For life chooses life, even as if it feels like an energy beyond our selves (which it is).

 Learning the art of mindfulness, of witnessing without interpreting according to our problem stories (our neuroses), is the art that I try to encourage in my clients and which I tried to practice in the near month of illness and hospital experiences. I can’t say that I succeeded all the time. My tendencies towards impatience flared up pretty often, but – even these – I attempted to witness without excuses. All this isn’t easy, but I believe, it’s worth it for the sake of equanimity, as well as fairness towards other people.

 

The practice of lucid dreaming is a helpful start to the art of mindful witnessing. We don’t have to get caught up in our habitual ways of responding, but can choose how to resolve our issues. The dreamscapes of our mind are not predetermined and we can wake from them consciously. I think consciousness is life’s purpose, that, and love/compassion.

 

One of my greatest regrets is that I was unable to contact all my clients while hospitalized because my new phone had lost a number of contacts. To these people, I’m deeply sorry. I hope that those who were affected have found another therapist, or perhaps would like to contact me again. I do not like leaving people unsupported.

 

 

Discovering the Resources We Possess by Dr Elizabeth McCardell, M. Couns., PhD

 

August 2024.

 

“Every person has more resources than they realise”, as Milton Erickson put it. Erickson was a founder of modern hypnotherapy, an American psychiatrist whose greatest skills were his capacity to observe and listen very closely to his clients and utilize their inherent resources. 

 

In such close listening and observing he learned much more about the whole person than his medical diagnostic training may have produced, and he acted on it. His methods were quite eccentric. Sometimes someone would come to his Phoenix, Arizona house with a particular problem but who was so preoccupied with the issue that they didn’t actually listen to what Erickson had to say, so he had them climb a high peak outside the city and then come back for their session. Then, the real work could happen. Another client came to study Erickson’s methods (and he came preoccupied with his own self importance), so Erickson had him work in the garden, which was cacti and stones and not much else. When we are preoccupied, we neglect paying attention to very ordinary things so encouraging the doing of the ordinary is very valuable. Climbing a mountain or talking about ordinary things,  puts clients back in their bodies and makes them attend to the here and now and thereby reconnect with the resources that they’d forgotten about.

 

I’m less about extremes, but I will talk about ordinary things – interspersed with the problem that the client came to work out – to reassert a groundedness and to help the person not get stuck in the murkiness of the issue that has preoccupied them.

 

We all have more resources than we realize, and attending to ordinary everyday stuff is part of that. Erickson used this knowledge to regain muscle strength and mobility after spending a year in an iron lung after contracting polio at age 17. He began to explore autohypnosis and concentrating on the body memories of the muscular activity in his own body. He learned to

tweak and stretch his muscles and to regain control of parts of his body, to the point where he was eventually able to talk and use his arms. Then he trained his body by embarking and completing a thousand-mile canoe trip. Extraordinary man! On his return he attended the University of Wisconsin-Madison, graduating in both psychology and medicine and then in psychiatry. All these experiences helped in his work with clients and students. Most particularly, though, they focussed attention to the people around him; enabling him to notice not just what they said, but how they said it, and what their bodily expressions had to add to their presence.

 

Unfortunately polio comes back to bite you. The virus that affects the nerves and the spinal cord and may affect the breath and can lead to paralysis, doesn’t go away, but returns later on in life. In his late 40s Erickson got post-polio syndrome and became too weak to walk, even with sticks, and so was bound to using a wheelchair.  But this article is less about Erickson and more to do with listening and observing and utilizing all the resources we all have.

 

He didn’t just listen to what the clients said they wanted, but observed them to identify what they needed.  This is not to say that Erickson always got it right. There are several cases that he missed the boat entirely, but this is not unusual for any therapist. We are  fallible. Nevertheless, what he taught us about listening, observing and utilizing the resources and strengths each client brings to a session is invaluable. We need to move beyond a self or medical defined diagnosis (eg the person who comes saying they have clinical depression) to understanding how ordinary resources can be drawn upon to grow beyond their problem story. The art, of course, is to say this in an acceptable way to the client, so that they  do not simply reject the therapeutic session. Exploring the subtleties of generally overlooked resources can be the way forward to untangling presenting problems in a safe and acceptable way. Listening, observing and witnessing person is critical and doing good work from that point onwards.

 

 

 

 

 

 

Passings by Dr Elizabeth McCardell, M. Couns., PhD

 

July 2024

 

I swim in the sea practically daily – yes, even in winter – and I get to watch the rhythm of the waves, the surge, the fluctuations of swell, in preparation for entering the water. After all I don’t want to get rolled over by entering in the middle of crashing waves. I watch and wait, and then enter. There are good moments, and not so good ones.

 

Everything is in process, nothing happens in any other way. We live, we die and although we can look back at our life and decide to discern stages, while we are living everything is in process. Such a realization is quite liberating.

 

Over my lifetime, quite a number of friends, and family have died. These are people I have cherished. These are those I have learned much from; learned how to be empathic, generous, loving, as they were to me. Some I was pre-warned of their coming death, through dreams and careful observation of skin tone, lightness of being, and the like. A cello teacher and friend had stomach cancer and was dying from it, but on the last day of me seeing him alive, he sat down and played the cello finally free of his old desire for correctness. He played like a glorious angel and in that moment I saw love in all its playful joy.

 

When my cellist friend died, I remembered (and remember still) his liberated and liberating music making. There was no grief, per se, just a profound sense that death is not dark and miserable; it can be joyful.

 

I used to volunteer at a palliative care unit here in Perth in the late 90s and there I witnessed several passings. One woman called me in to be with her. She wanted me to give her reiki. Now it turned out that I didn’t know what reiki actually was but I knew it was a healing. I knew I didn’t have a choice, I had to conjure up something or other healingwise, and so I did. In this process, I laid my hands not on her body itself, but hovering above. I could feel a strong energetic pull and “saw” a golden light emanating from this woman, and that’s what I entered into. That night she died, peacefully.

 

Life is process. Like wave over wave of lives, intermingling, coming apart, we meet and depart. Death can come after a long life, like my father who died nearly 101, and suddenly, in a crib. It comes in utero, it comes at birth, it comes crossing the road, it comes after a long protracted illness,  it comes in war, in murder, in suicide, it comes …. It’s inevitable.

 

Elisabeth Kubler-Ross, the psychiatrist,  was instrumental in changing how much of the world viewed death and introduced to us how the grieving process might proceed. Most of us are familiar with the stage theory of this process, but few realize that Kubler-Ross didn’t originally develop these stages to explain what people go through when they lose a loved one. She actually developed them to describe what patients go through as they come to terms with their terminal illness. The stages: denial, anger, bargaining, depression, and acceptance were only later applied to grieving friends and families who seemed to go through a similar process after the loss of their loved ones.

 

It's unfortunate that the stage theory of grief has so much traction, because – in some quarters – not adhering to these stages is seen as pathological.

 

Grief at the loss of a loved one can follow any course. Life, with all its richness of emotions, is process. A thanatologist friend and counselling colleague of mine uses the sign of infinite to illustrate this process. We can feel sad, happy, depressed, whatever, whenever. We are not bound to any stage theory at all. Feelings of loss, and I feel them sometimes very strongly, can take us up and surge through us, to another place, and that’s alright. Feelings of stuckness are more problematic, but that too can pass. This is when  talking about it with a trusted person is all that is required.

 

 

Sound Knowledge Makes for Good Therapy by Dr Elizabeth McCardell, M. Couns., PhD

 

June 2024

 

The other evening I did a Mental Health Professionals Network online discussion group event with other hypnotherapists talking about using hypnotherapy for the treatment of chronic pain and phobias. It was nice being in a group of fellow practitioners talking about things I'm passionate about.

 

One thing that I couldn't swallow was the uncritical way a couple of the therapists described their use, and training, in Neuro Linguistic Programming (NLP), to the exclusion of other more fundamental studies of human behaviour and, more critically, psychopathologies. You can't treat the habitual use of tobacco or any other substance or behaviour - you can't really understand the psychology behind addictive behaviour at all - just by studying our communication styles (the basis of NLP). You really do have to have made concerted study of the human body-mind beyond what you can achieve in a maximum of 15 days. In 15 days, according to the training websites for NLP, you can get certification as a Master Practitione. And that's all a few of the participants in the MHPN hypnosis group had in the way of other training, apart from hypnotherapy.

 

I tear my hair out. I used to teach a unit in Advanced Personality Disorders to Psychology students at Murdoch University, Perth. The human psyche is complex. I also note that I did my Honours dissertation in the area of psycholinguistics prior to researching and writing my PhD in the philosophy of human transactions and interactions.  I know how communication works, and I know much of how the mind works and I am still learning. Why do I mention this? It's to illustrate that the 15 years or so of concerted study in the areas with which we are concerned: treating humans with human problems didn't happen in 15 days.

 

It worries me that practitioners of NLP who have not been trained in anything else, and other inadequately trained therapists are garnering lots of money with such a flimsy understanding of what they're dealing with.  Neuro Linguistic Programming sounds good, to be sure. It sounds scientific, neurological; it’s got “programming” in its title; must be good. This ain’t necessarily so. No studies, apart from lived experience accounts, have shown it’s an evidence based therapeutic strategy. Of course, lived experience accounts matter, but – and we have to caste a critical eye over this – how much positive outcomes are of a placebo effect? After all, paying a substantial amount of money and time encourages us to think a therapy is working. And maybe it does work for some people. The philosophical basis of NLP, though, is debateable, as I shall describe.

 

Now, to be perfectly transparent, some aspects of NLP are useful and are used, anyway, in most other therapeutic modalities. What the founders (Grindler, the linguist, and Bandler in the 1970s)) of NLP did was, they believed, at least, to distil and systematize the therapeutic approaches of other client oriented therapies (those of Virgina Satir, Milton Erickson and Fritz Perls). It employs anchoring, belief changing, reframing, visualization and visual-kinesthetic dissociation where the client is asked to relive the trauma in a dissociated state (the latter of which could be dangerous in the wrong hands). They also state as a fundamental, that the map is not the territory (which it is true, it isn't). What Grindler and Bandler and their followers failed and fail to realize that while we can study the therapeutic styles of the masters, we cannot decide that success lies with imitating them. Milton Erickson, whose hypnotherapeutic work was legendary, pointed this out to Grindler and Bandler, but his wisdom fell on deaf ears. Erickson’s work really could not be pinned down and his style differed from person to person. Jung, after all, said decades previously, that there are as many therapies as there are people. We are all different and the therapist must work accordingly.

 

That's the beauty of being a therapist - and a well trained one: we understand human processes, we've studied when things go wrong and what do with the person to heal them, and we listen to each person's uniqueness and work with that, work with them.

 

It's a beautiful work, a study of which never ends.

 

 

 

 

 

 

 

 

 

 

 

Changing Addictive Behaviour by Dr Elizabeth McCardell, M. Couns., PhD

 

May 2024

Addictions are gripping but are not necessarily permanent fixtures. We can change our behaviour. We have choices.

 James Prochaska and Carlo Di Clemente, in the 1970s studied the processes of change and came up with what is known as an integrative theory of therapy. This assesses a person’s readiness to act on a new healthier behaviour and provides strategies, or processes of change as well as that person’s decision making capacities. They identified the stages of change in this way:

 Precontemplation (an unreadiness for change) where people are not intending to take action to change and don’t see their behaviour as problematic but may be required to attend therapy to please the courts or families or employers. In this case, exercises in self awareness as well as realizing addictive behaviour is risky to health and relationships. Alcoholism and drug taking, gambling, porn addiction, digital media addiction, etc have dramatically negative consequences on good health, work, and maintaining healthy relationships.   Addiction makes it hard to maintain trust, respect and open communication with others and the life of addicts revolves around obtaining and using the drug of choice. This may lead to neglecting responsibilities or the needs of significant others and burning themselves out.

 

Addiction saturates the brain with dopamine and people become dopamine junkies. Dopamine is less about giving us pleasure per se, rather it motivates us to do things we think will bring pleasure. We experience a hike in dopamine in anticipation of doing something as well as when we do the thing itself, which makes us want to continue doing it. As soon as it’s finished, we experience a comedown or dopamine dip. That’s because the brain operates via a self-regulating process called homeostasis, meaning that for every high, there is a low. Interestingly though, if a person can do something else interesting enough for 12 minutes, the addictive craving subsides.

 

Contemplation (preparing for change) where people are starting to recognize that their behaviour is problematic and are starting to look at the pros and cons of their continued actions. They are also ambivalent about change. On the one hand they may be hoping to change their behaviour, but can also be unwilling to actually take action to make those changes. This is when they are likely to be the most influenced by prompts from others.

 

Preparation (ready for change): here people are intending to act to make changes in their lives and are starting to take small steps towards this. This period typically lasts about  30 days. In this time they are telling friends and family about what they plan to do, which is great because it’s then that support is critical. They are  realizing that the better prepared they are, the more likely they will succeed in life long change.

 

Action: people have made specific overt modifications in their behaviour. This is when they are most receptive to learning techniques for keeping their commitment to change. They are also realizing that they have to avoid certain people and situations that perpetuate the unhealthy behaviours of their old behaviour (for example, not going to the pub and drinking with friends when trying to stay sober). 

 

Maintenance: people are able to sustain these new behaviours for at least six months and are working to prevent relapse. During this phase, it’s recommended that people spend time with others who engage in healthy activities such as exercise particularly during times of stress. Group meetings of former addicts are helpful for many.

 

Completion (termination): people are no longer tempted to return to their old behaviours. If relapses occur, the process of change is likely to be easier than previously.

 

Change is possible. We don’t have to be chained to old behaviours. When we stop doing what we have habitually done, we find ourselves living in the world quite differently. We can obtain pleasure in less destructive ways and we can live life abundantly.

 

Preparing others for a lifetime of change is what counsellors do best. We help people through the first phases of addictive behaviour, for instance, and give them tools for maintaining and strengthening what they have learned and gained. It’s beautiful work.