Kate Joseph, Counsellor @ UCL

Hi Kate, welcome to the podcast. You specialize in cognitive behavioral therapy, mindfulness, and compassion and focused therapy. Could you just describe to us what that entails and what it's like?

They're all different forms of therapy. The first one that was developed was called cognitive behavioral therapy, CBT, and very simply, it's a sort of short, short to medium term therapy that works more or less in the here and now, thinking about people's cognitions, which is basically a posh way— word for thoughts, and people's feelings and people's behaviors. And the idea is that when people are feeling bad or anxious, it's hard just to feel better. So the, the way in is to work on people's thoughts, which might be negative thoughts about themselves or the future, and on their behaviors. Um, so if they're not going out or are very fearful of doing things, then that, that will affect their, how they feel. So CBT works on thoughts and behaviors. And then mindfulness and, and compassion-focused therapy, what's sometimes called third wave CBT, third wave cognitive behavioral therapy, cuz the, the, the basic or simple form of CBT doesn't work for everyone. So mindfulness is about slowing down. And focusing on the breath and sort of paying attention to feelings. And there's lots of different ways of doing that. And compassion-focused therapy is also about slowing down but learning how to become more compassionate to yourself and others. So they can all be used together.

Yeah, I mean, that's a really comprehensive overview. But I guess before we get into the tools, before we get into maybe some advice you're going to give all of our listeners, maybe a bit about yourself. What, how, how maybe How have you got to the situation you are? What do you do? And, um, yeah, like, why do you love it?

If you do. Well, um, so, uh, how did I get into it? I mean, I trained in the NHS, which is quite a broad training as a clinical psychologist where you get to sort of work with lots of different kinds of people, but got a bit disheartened by the sort of system and the very, very long waiting lists. That people were facing. And so I managed to— yeah, I got into working in universities, and I think it's a great job because it's sort of— students are also really diverse, sort of international. You get PhD students who are a bit older, but it's really rewarding, yeah, to work with, with that group. And the waiting lists aren't as bad as well.

So, um, and why do you think counseling as a career is so important, and why would you recommend anyone to go into it?

Well, I think, you know, it's definitely not for everyone, but I think, you know, we don't, we don't as a society talk enough about our feelings. In the past, there has been more of a stigma, and I think things are improving a lot. But for many people, depending on their background, they have just haven't had that experience. So to come and sort of have that opportunity to talk to someone privately, confidentially, can be really important and in some cases life-changing.

Yeah, definitely.

It feels a privilege to do it.

It's incredible. So yeah, I guess that's a brief overview of your career and maybe how you got there and maybe your motivations. And we, we can scatter them in throughout the episode too. But I guess in terms of maybe the benefits then for maybe students listening to this podcast, what are maybe some benefits of using mental wellbeing aids like those described, and maybe others too.

What are the benefits for students, uh, of coming to counselling?

Yeah, coming to counselling.

And what are the different forms of counselling that there are? Like, so you could be in a crisis, or you could be in a good place and go to it. Like, what are the different types of services that UCL provides?

Well, the great thing about the service at UCL is it doesn't sort of— there's no cutoff, or no, no people who, who can't come because they— or you're too fine, or that's too small a problem. We think that, you know, anyone can benefit from from talking, whether that's about, you know, just what they might want to do in the future and maximizing their potential, to the other end where people are really, really, really struggling with mental health problems. I suppose there, there are some people for whom we feel the problems aren't suitable for very short-term service, and we would refer them, you know, elsewhere. So, um, so those are the kind of people who come.

Um, what are some of the sort of the people that are striving for success or maybe having bad thoughts? What are some of the most common problems that you've encountered with students?

I think mood fluctuations are really, really common, whether that's depression or mood going sort of up and down. So there's that side, and then, you know, anxiety and stress is, is really natural, I think, you know, living in London You know, exams, jobs, cost of living crisis, all of these factors can lead us to feel stressed. And then I suppose there's the more sort of social side of things with people falling out with friends, breakups, feeling isolated, lonely. So there's sort of more social problems which people want to talk about.

Yeah, and for people that might not know much about what therapy is, Is it somewhere that they come to get advice or is it somewhere they just come to speak about their problems?

Good question. I think it can be, it can be either and it can be both. There are people who really, really want guidance and advice and they, they kind of want coping strategies and set really clear goals for their sessions. If they want to, you know, work on panic attacks or exam stress or something quite focused. But then there are those people who don't have any clear goals and sort of more just want to talk, explore feelings. Um, and so there's no, no clear endpoint, but it's more the process of talking. Um, and there's different forms of therapy that are more suitable for different, you know, presentations, different people. Yeah.

In terms of maybe those, that sort of diversity of, um, therapy approaches, is there maybe mindset that you'd recommend to approach therapy with in order to get the best out of it?

Sure. I think it's, uh, the best mindset is just to be open-minded, open to the possibility that it might feel difficult. So there's a little sort of phrase, it's, it's not always about feeling better. It's not necessarily about feeling better, but about getting better at feeling, which might be difficult. So, and, and to give it a bit of a chance. So if, you know, someone's not quite sure after their first session, it may be about, you know, giving it a couple of goes to sort of get into it, trust the person they're talking to. So I think it's, yeah, just about being open to give it a try and having no major expectations. It's not really a quick fix.

Yeah. And obviously society at the moment, obviously getting a lot better, but maybe some of that apprehensiveness comes from maybe some social stigmas around seeking help, which are still unfortunately deeply ingrained in society. Do you still find that that is a problem? And what are some ways that maybe we can promote, um, speaking out?

Yeah, I think, you know, I think like you say, it is improving, but it is still— there is still a bit of a block, um, you know, in, in certain cultures more than others. And how, how can we address that? I suppose it's about the more people who actually go to counseling or therapy to sort of share, you know, You wouldn't, you wouldn't be sort of embarrassed about saying you were going to the dentist. And then it's about, you know, universities and workplaces really promoting and encouraging people to go and having an open conversation, I suppose.

Yeah, if we could go through some sort of situations that I've experienced, maybe other students have experienced, and maybe look for some advice. One of the big things is that you go from school, which is quite, and you're living with your parents, which is quite a sheltered lifestyle. And then suddenly you're in this new place with new people and this newfound independence. You know, nights out increase, drinking increases, different social pressures. What's some advice to that initial adaptation? Like, you know, getting used to this new independence and new feelings.

Yeah, I think you're right. It's really not easy. Although, you know, it's lots of new opportunities. I suppose it's about Expecting that there'll be a range of different feelings when you start out at university, and it may be exciting and fun at times, but sort of being open to the possibility that it might be stressful, or there might be times when you're lonely or feel quite overwhelmed by all the new things that you need to do, like cooking and budgeting and, you know, things that which sort of many freshers aren't used to doing. So I suppose it's about, you know, there's this idea that university is the best days of your life, and be open to the fact that it's a bit of— it could be a bit of a roller coaster as well, and to talking to people if you are finding it hard, you know. And that could be the Counselling Service, or it could be a friend at home, could be a family member, or it could even be your personal tutor, you know. It's not only counseling, but you know, just sort of talking, sharing.

So essentially the importance of managing expectations and reaching out if you're feeling you're not managing them well.

I think so, yeah, I think that, that's, uh, that summarizes it really well, yeah.

And if we sort of move to the other side of university, and we're about to graduate ourselves, and there's going to be a lot of people about to graduate, and one of the scariest things about that is that if you don't have it all sorted, which a lot of people don't, you can get a lot of feelings of confusion and feeling lost and you know, just generally like not feeling great about their future. And how would you recommend sort of setting goals to sort of get rid of that feeling or just generally navigating them?

I think that is really, really hard because I guess you've been in education your whole life so that the next step has always been, you know, fairly sort of obvious for you—GCSEs and A-levels. And even if you took a gap year, it's uni. And then now the world is wide open. So I guess it is about, again, managing expectations that that is kind of quite scary. It could be quite overwhelming. I guess there's practical routes about going to the Career Service and, you know, getting different ideas that are doing internships and things like that. But then on the emotional side, I suppose it's about trying not to compare yourself too much. There will be those people who have secured jobs, but actually, you know, it's not a race. Everyone's on their own path. And trying to kind of stick to your path, even if you're not quite sure where it's gonna go. And that even if you don't find the ideal job or the right career straight away, that can still be really interesting experience. So I didn't say, but you know, I kind of, I did a PhD and then I went into a different job, which was speech therapy or a different, and that was a sort of windy road and I found that wasn't for me.

Yeah, so you don't have to know the direction you're going necessarily, but you know, it's important to make sure you're on some kind of path and doing your best to stick to it.

Yeah, yeah, sort of choose one path and see how it goes because you can't predict how you're gonna feel at 25, or, you know.

And I'm sort of curious about maybe— prevention might be the wrong word— but you know, if you don't have the means or don't want to actually go speak to a counsellor, one thing that's really important is, is your friends, maybe your partner. And I was wondering, how do you think as students, as people, we can be sort of de facto counselors, better, you know, and better friends? What should we be doing to help out?

Mm, that's a good question. I suppose it's something— there's a sort of term called active listening, which is really sort of slowing down and tuning into what that person is saying and not maybe not jumping in too soon to give advice or say, you know, how you found something. Cause sometimes they just might wanna vent. They might not necessarily want, oh, do this, do that. Mm-hmm. So yeah, I guess checking out with your friend what, what they want on how you can best support them, whether that's, you know, just going for a walk or, or helping them with the next steps. So really, I suppose, yeah, tuning into what, what they would need. Yeah.

And I guess maybe another scenario in terms of, well, somewhere like UCL, a highly competitive environment, many people join as freshers, or even now, they may be with this, uh, expectation upon themselves that they are— so they maybe came from school where they were one of the smartest there, and obviously such an environment like this may— you feel a bit more like a small fish in a big, big pond, which is obviously a very difficult feeling. How would you— what advice would you give to navigate such a feeling that may be completely alien to a lot of us?

Yeah, I think that's, that's a hard one and does affect quite a lot of people, that sort of small fish in a big pond situation. I don't know if there's anything very obvious that kind of solves it, but I suppose it's about just normalising that, that, that, that, that is really sort of understandable if they were like the best in their class and then suddenly, you know, they're very much in the middle and, and trying to get away, as I was saying before, from this comparing comparing yourself too much because it's sort of, you know, once you're all on the same course, you've all done really well to get on, and it's probably, it's generally not that helpful to have that sort of rank mentality where we, that tends to lead to people feeling bad. And to sort of, you know, focus on your own interests and, you know, if you're feeling really struggling, get academic support. Truck. Yeah, trying not to, to beat yourself up or compare yourself to people doing better.

Yeah, on a sort of personal level, for me, I think something that I've struggled with like throughout my life and I've got way, way better at since I've sort of learned why it is and what it is, that is the side of sort of maybe intrusive thoughts and just thinking unhealthy thoughts. And I just maybe am an overthinker, actually, but I've sort of learned that thinking is really important, you know. What you deal with is, is all about thoughts and, you know, making sure you're thinking the right things. And one thing that helps for me is like just active thinking. So like, you know, going on, on walks, going on runs, being in the gym, just being out and about and having those thoughts in a healthy environment. What are some other things that might help, you know, dictate your thoughts in a healthy way?

Yeah, I think thoughts are so central, aren't they? And it's, it's hard not to think certain thoughts if they're on our mind. I think we can get into a danger of fighting with our thoughts or trying to push them away. I agree that, you know, being active can be really, really helpful for many people. Mind and body are not separate, you know, so sort of getting out, moving can be really helpful. I suppose mindfulness meditation is another way of developing a different relationship with our thoughts so that if intrusive thoughts do come in, we learn to gently bat them away and they might come back. And it's, it's about gently batting them away if we, if we're recognizing that thoughts aren't helpful, saying, oh, that's just my worry thought, or that's just my comparing myself thought. So that's another, another good one. And, you know, as we, as we've said, talking can often put things into perspective. Another one that for people who aren't quite ready to come to counseling or who don't have many people to talk to is journaling. Something about getting your thoughts out of your mind onto the paper that can be really sort of cathartic for some people. Yeah.

Obviously one of the key trends in the last sort of 15 years has been the rise of social media, and which is obviously something that contributes greatly to this comparing yourself attitude that you speak of that many of us have. How have you, in your experience, obviously you've been within the field for a while, how would you feel that mental health maybe problems have changed, if they have, due to social media?

Yeah, it's really interesting. I mean, I think sometimes people have a tendency to put too much responsibility or blame on, on social media, but I would also say that it can exacerbate people's negative feelings. And it's been quite interesting, so I've been at UCL over 10 years and things have changed even in that time with, you know, like things like Instagram weren't really around when I started in 2012. And the people who aren't feeling good, that is looking at those kind of sites is a real opportunity to compare yourself with people who may be looking or, or seeming to do better. So, you know, one of the things I, I discuss with people sometimes is about, you know, distancing themselves by, you know, checking, checking social media less often, or even coming off some sites, uh, or setting some kind of limit on their phone for social media. And, um, that generally helps because I think we, we have these phones, but we, we kind of— they're designed to be very addictive. Sometimes we're not that good, and myself included, not that good at managing that thing that has become an alarm clock that's right all the time. Things I say is, you know, kind of get a normal alarm clock and don't have it right by your bed.

Yeah, I think a problem for me that comes from social media and just, I mean, I'm sure it's always existed, but this idea of like body dysmorphia, which I think even might get worse when you're at university when you know, you're sort of in a more dating capacity, you're meeting more people, and you're maybe feeling more judged or more pressured to look a certain way. And, you know, social media might give that to you. Once you actually have that sort of condition of body dysmorphia, what are some sort of tools to get out of that, you know, out of that feeling? Wow. Well, body dysmorphia—

if people have sort of clinically diagnosed body dysmorphia, that's kind of a pretty, pretty difficult sort of problem to be getting over, you know, with, with some simple advice. So I'd say for that, you know, go to your GP and get specialist help if you think you've got sort of body dysmorphic disorder. For people who are kind of, you know, very kind of concerned about their appearance and, you know, I, I would say, you know, that it might be about like distancing oneself from, from checking too often and realizing that there's only so much we can do to change our appearance. We're all, we're all different. And it's, it's, uh, it's probably, you know, not helpful to be comparing ourselves to the physical ideal all the time. And often these, these people's photos are quite airbrushed and they're not even real anyway. I would say, you know, social media, there can be some really positive benefits as well. Yeah. People connecting with other people and, and talking about problems and feeling part of a community. And, you know, it's, it's definitely not all bad. Just to say. No, definitely.

And, uh, yeah, as mentioned before, I mean, a lot of problems we have are because we compare ourselves to one another, and social media, other factors have exacerbated that, and going to university. But maybe what are some advice you can give to love oneself and to be happy with yourself, and maybe even practical tips in terms of reinforcing that?

I mean, I'd probably, um, move more towards sort of trying to accept oneself and, and support oneself rather than necessarily— don't think we can always love ourselves. It's complex. And, you know, sometimes I might be frustrated with myself or a bit disappointed with myself, and maybe that's okay. But probably the, the best thing I would say is to sort of— if you can try to treat yourself like you treat a good friend, that's probably a good way forward. And often that's a quick sort of shortcut because you can think about in any situation, what would I say to my friends? And often we have kind of a really good instinct, you know, and, you know, that allows for us being a bit frustrated with a friend or annoyed with a friend. And, you know, I suppose it's a bit more realistic than wanting to love ourselves or to be happy all the time. Because again, I think in this, this world that we all live in, Maybe that's kind of— that's unrealistic, can get us, can get us into problems if we're expecting to be happy.

A question we like to ask all our guests, their idea of success and their personal idea of it, their personal definition of it. And I'd like to know for a start what yours is, but then also like what the word success means to you and how we should actually, you know, healthily look at that word. You know, I think for some people it's like a— it's quite an intimidating word, like I need to achieve success, and people find it hard to work out and, you know, maybe hard to actually attain because they put such unrealistic definitions of it. So maybe your own definition of success and advice on setting the right definition. Hmm.

Um, my definition might be something quite broad because I think everyone's different. Um, success would be something about finding meaning in life. So that, you know, that, that could be having a job that you find meaningful or just meaningful relationships. It, it's not, it doesn't sort of mean that you have to go down any kind of path or earn a certain amount. But I think once people find some kind of meaning, that, that will lead to sort of contentment. Uh, and it doesn't mean that you can't strive for more. But it's, um, okay.

I want to thank you so much for coming on today, and I think everything you've said has been amazing. And me personally, I, I've used the UCL Counselling Service and I can't say how good it's been for me. And, you know, I, I didn't even, you know, use it in a time of crisis, but, you know, I feel like maybe I should have done at times in my life. But now I've been using it when I'm doing well, you know, it's always a reason why you should look for it. How do students actually go about getting involved with university counselling? Where should they look? How should they actually get started with it?

So it's, it's really easy. You just have to look on the UCL webpage of Students Psychological and Counselling Service, which is under Students Support and Wellbeing. So you can just sort of Google that, and then you— students can refer themselves directly to us on a registration form. Which, you know, asks quite a few questions so we can get an idea of what's going on. And then depending on, you know, the demand, there might be a bit of a wait and then they get to meet with one of our team for an initial consultation. So that's basically, it's just register online.

Well, yeah. Well, Kate, that's been an amazing conversation and obviously a little bit different episode for a lot of our audience, but I think in terms of value, and relevance to students, like world-class and unbeatable, really, your insight. So thank you so much for your time, and thank you so much for asking and allowing us to pick your brain on these issues. It's been really insightful for both of us and hopefully for everyone else too. So yeah, without further ado, I hope everyone enjoyed, and yeah, we'll see you next in the next episode.