• The WHOLE is greater than the sum of its parts.

    Four weeks ago, I was out running and slipped - only a fraction, and injured my back.  I have not been able to work, play, think clearly since.

    This last couple of weeks, I have noticed my mood has slipped, I am definitely feeling overly sensitive,  a little labile, forgetful and to be quite honest, extremely lonely. And I know how ridiculous this sounds since I have  partner who comes home form work every afternoon, two dogs and a cat for company, family and friends to call and visit, work to do....

    But the point is, my life as I knew it is temporarily over, and I'm not coping as well as I thought.  All the things I usually do to de-stress; the routine that keeps the ebb and flow of the household intact;  the ability to be spontaneous about anything; being in pain all the time and not having any power over when that might change; The loss of all these things is doing my head in. To the point where the GP has seen the need to help me cut this off at the pass before it gets any worse.

    I value my GP for this, and I reflect on how fortunate I am to have one who is mental health and wellbeing savvy.  Many people don't, and would have been sent away with nothing more than another prescription.  I, on the other hand, have received the prescription, but also a reminder that I need to build up the credit I have in the domains of my life that aren't as badly affected.  

    It has got me to thinking about the domains of health and wellbeing - the factors that are intrinsic to our social, emotional, physical and psychological wellbeing.  Since it's topical, chronic pain is a good example.  If the "social and emotional fall-out" of an injury isn't managed as carefully as the the injury itself, then the person could easily find themselves hot-footing their way toward a psychological crisis.

    We know that there are key protective factors against mental illness.  The image below lists these domains beautifully.

    It is probably reasonable to say that any psychotherapist - either experienced or in training, along with the researchers would agree that when working with clients, the root cause analysis of their psychological distress is usually as a result of one or two, and possibly even all of these domains being out of balance. That imbalance can be from either an excess or a deficit in the domain and can often result in a domino effect that can impact all the domains in some way, shape or form.  

    A prosaic example might be: A person is made redundant, this clearly impacts on their occupational domain, but it could also cause relationship stress and burden, it might impact socially - loss of colleagues, a sense of purpose.  It could even impact environmentally if the person is forced to move; downsize, change kids from schools etc.

    The nature of our problems when we have them means they are inextricably linked in a complicated chain of events that play out in our lives in weird and wonderful ways. In lots of instances, good mates, supportive families and workplaces, maybe some professional help from a psychotherapist or counsellor; all work together to bring the domains back in to balance, so the person is able to heal and recover from the set-back.

    Sometimes the approach might need to be longer term and the need for more intensive therapeutic intervention could be necessary - issues such as chronic pain and disability are again good examples.  Any treatment plan should factor in all domains of wellbeing and bed these down in the recovery goals.  Therapeutic techniques like Motivational Interviewing enable the psychotherapist to uncover the client's recovery vision.  Such an approach would always be emphasising the positive, and be finding realistic and accessible ways of reaching the positive goals.


    It's this kind of "opposite behaviour" activity that really is the key to helping keep mental ill-health at bay.  Doing the things that we know will make us feel better, even if our mood/circumstances make us reluctant and resistant .

    Any mental health education tells us that the things we like to do, the things we value, become our "protective factors".  Sometimes we know how to do this ourselves, sometimes we need help and assistance building these up. Psychotherapy training, psychology training, counselling courses - they all teach the psychotherapist that treatment of any kind should ideally target not just the areas that need healing, but a focus on strengths-based work as well.    

    This is the resilience building stuff - the actions that shore us up against mental ill-health.

    And after this weekend, having invested in some of those domains, I definitely feel better and possibly the old spine feels a little straighter in to the bargain!




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