Combined Wellness intervention


Quick summary: this is a template for a psychotherapy/nutrition combined service which mainly looks at the psychotherapy intervention. A psychotherapist and a nutritionist offer a combined service to assist a client’s mind, body and spirit to work together in achieving optimal health.

A combined intervention to enhance optimal health – psychotherapy and nutrition counseling which help goals that may involve weight loss, an increase in exercise, increasing a person’s consciousness of factors which impede his/her progress, reasonable nutritional improvements, stress reduction (which can include resolution and meaning creation for past and present suffering, life style and/or relational improvements, and relaxation practices such as yoga and mediation), self-awareness, body awareness (learning to listen to the body), a detachments from unhelpful thoughts, and a solution strategy which takes into consideration negative influences that may be out of one’s consciousness.

Continual Coaching – for every stage of the process the health professionals will be working to help you stay motivated and hopeful and will be available to offer you sound recommendations and encouragement.

Supports such as family or friends are welcome – anyone that can support you can attend at no extra charge (we charge by the hour and not by the amount of people) or perhaps a person who wants to engage the process with you – to support and to be supported.


Why are we doing this? As a psychotherapist and nutritionist who have read a great deal of research about wellness and health, we have learned about the many different ways in which the different fields positively influence each other (ex. nutrition is unbelievably helpful for behavioral problems and ADHD symptoms, exercise is perhaps the most effective intervention for depression, and therapy is often needed for people to engage in exercise or to make nutritionally sound choices). By integrating theories within our own fields with theories from complimentary fields we are hoping to create a degree of wellness that could not be achieved using one modality alone… in other words there should be a compounding effect… your health goals will positively influence many other aspects of your life.   


The psychotherapy influence will offer the following interventions

  • A solution focused consultation to create clear, reasonable, and measurable solutions – This involves deconstruction or simplification techniques to create realistic goals. Note: for weight loss goals ‘reasonable’ will be based on what is medically healthy and not what has been socially labeled as optimal (which is often very unhealthy).


  • The nutritionist will help by offering expert nutrition advice which is based on sustainability (she will not have you ‘give up’ your favorite thing – moderation, balance, smart nutritional additions, and eating at optimal intervals is more inline with her philosophy)


  • you will leave with specific goals related to nutrition, exercise, and complimentary wellness practices – after this first stage you may not however have any idea how you are going to accomplish these goals (as many of the concerns or obstacles in your way are outside of your awareness).


‘Precursors of change’ based intervention – used to isolate the areas which will need to be addressed before any change is likely to occur. This intervention will shine some light on why your past efforts were not as successful as you would have liked.

  • This step is intentionally before the strategic plan is created – often the reason that people are not able to meet their goals is that they do not understand or are not yet conscious of what is truly the problem. To be more specific, it is easier to lose weight once you know why you engage in actions that that conflict with your intentions. Basically there is a good reason for everything – there is a good reason why a person does not engage in practices which support health – we will shed some light on these reasons.


  • The following areas will be explored with a psychotherapist: the goal is to help the client to become more conscious of the variables which are impeding progress – the therapist is then trained in addressing each precursor directly… this generally will happen in a future session.


  • Note – at anytime the client might uncover a very important therapeutic issue (such as past trauma or a relationship which needs assistance) the therapist is always available to offer additional individual, family, or couples counseling in such instances).


A sense of necessity – “you will need to honestly believe (not simply because someone told you that you should) that change is needed in order to have the motivation to do so.”

A willingness or readiness to experience anxiety –Change produces anxiety… whether that change is perceived as positive or negative can affect the degree of anxiety, but the fact remains the same… All change creates a degree of Anxiety, and in order to change, you must be willing to accept this anxiety. “change is difficult – you must be willing to experience a degree of discomfort. Often behaviors which are not in the best interest of your health goals are effective to a degree at reducing anxiety – we will come up with alternative way for you to address both anxiety and stress. ”  

Awareness – “You must become aware of all the factors which influence the problem in order to create a successful solution.” (Why do you do what you do?) Awareness can also involve taking personal responsibility… you must be able to honestly identify what you do that gets in the way of your goals.

Confronting the problem – “You must learn to be able to stop the tendency to use rationalization, denial, distraction and other methods which help you to avoid really addressing the concern.” In order to change you must be willing to concentrate on the task at hand.

Effort of will towards change – you must be able to do the work that the solution asks for (this is where you actually do what you plan on doing). It will not help you too much to have a great personal trainer if you don’t follow the exercise routine. Thinking about change is a great first step… effort and engagement in behaviors that will lead to the desired goal is also important.

Hope for change  –   You must believe that the solution that you collaborated in creating can actually come true – hope is not a wish – hope is truly believing that your expectation in reasonable and attainable.

Social support for change – You will need to have others supporting you in working towards your goal as opposed to people who will only temp you to failure. Our team will be part of your support. People unconsciously and consciously will sabotage your efforts to avoid the discomfort of acknowledging that you are progressing while they are not.

  • Have no fear – it is normal for a person to not be fully aware about their relationships with the above precursors of change and the therapist will help you with this.


Creating the Strategic Plan – The Solution, Strategies and Problem Resolution intervention – the team will help you to isolate solutions and to create additional solutions to any problem or obstacle which is getting in the way of the solutions. The clients will have a plan as to exactly what they will start doing (new behaviors such as starting a daily walk or entering couples counseling etc), what they will stop doing (behaviors that are not helping – such as trendy diets that are simply fostering hopelessness), and what they will continue doing (everyone has at least one activity that already helps the solution – no reason to reinvent the wheel in all areas).

The client will leave with a deeper awareness surrounding both the solution and the concerns which impact the person’s ability to access the solution…  The person will have collaborated with the wellness team in creating an effective strategy that will guide the process.

Stress reduction, body awareness and mindfulness training – this will be an experiential session in which the client will learn to use a variety of different techniques to increase awareness.

  • stress actually impedes a body’s ability to properly regulate digestion – stress is very unhealthy for the body in more ways that I can explain briefly – cortisol (a naturally occurring hormone released in excess during periods of continued stress) impacts mental and physical health in a medically observable way.


  • mindfulness will help you do stop unconsciously or automatically engaging in behaviors which impede the acquisition of your goals – you will also feel happier, be able to notice and engage the world with an increased use of your senses, and you will be more accepting.


  • Body awareness will teach you how to listen to your body to meet your own cognitive, biological and emotional needs. Sometime the body offers more helpful advice then the brain (it is easy to trick the brain – the body is more difficult to trick). The process will also teach you to influence your body in a way that will have positive effects on your emotional disposition.


Cognitive intervention – helping to expose and change the unhelpful thoughts patterns which are getting in the way of progress.

The following questions/themes will be explored:

  • What do you believe about yourself or what did someone else convince you to believe about yourself that is not longer helpful in relation to your goals?


  • When I tell you your solution what thoughts pop up to dissuade you from the motivation needed to achieve your goals?


  • What thoughts do you use to convince yourself that change is not necessary or not worth the energy?


  • What thoughts do you use to maintain a sense of hopelessness?


  • We will then explore why these negative thought patterns are no longer useful. Health and happiness most certainly are possible and I will help you to reclaim your freedom so that you can move smoothly towards your goals…the mind is yours, and it is time for you to take back control.


Narrative interventions – externalize the problem and create a new and helpful set of narratives or stories about your self.


  • You are not the problem you are separate from the problem and the problem is with you. 


  • A set of techniques will be implemented for you to see the problem from a different perspective – often we are so identified with the problem that it is difficult to see the boundary between the problem and our identity.


  • This stage creates freedom – you will gain the freedom to detach from the problem so that you can both better understand the problem and resolve it.


  • This can be a more therapeutically involved stage… by detaching from the problem it is often easier to see who or what it was that encouraged you to take the problem with you.


  • Often what we call the problem was a very intelligent and effective means for you to protect yourself… this will be explored and the problem will be replaced by strengths and resiliency. 


  • We will then deconstruct the solution into something that is very specific, personalized and therefore manageable. This new narrative with solutions and strengths will be incorporated into the story that you live.


Behavioral intervention – how will your new behaviors be rewarded?


  • Behavioral intervention rests on the belief that our actions are very much dictated by the environment – if an action is rewarded then we are more likely to engage in it. Unfortunately many behaviors that get in the way of a client’s goal are very much rewarded by the environment… what can we do to influence your environment so that you are rewarded for behaviors that assist your solution?


  • Unfortunately exercise can hurt initially and it is not instantly rewarding to eat something healthy when you are craving fat and salt. The rewards from exercise and proper nutrition come too far after the desired behavior to be reinforcing. In short, the environment is set up to reward you for disadvantageous actions – eating fast food and sitting on the couch is rewarding in the moment.


  • Another theory behind behavioral intervention has to do with something called conditioning. (Do you remember the story about Pavlov’s dog that was trained to salivate to the sound of a bell?)


  • We have all been heavily conditioned in this country to engage in behaviors which are not advantageous for our health. Why do companies run commercial and other marketing campaigns with supermodels eating fast food? – so that you are conditioned to associate sexuality and beauty with eating fast food – sound impossible? Billions of dollars are spent every year doing this – they wouldn’t pay for this marketing strategy if it didn’t work.


  • The unfortunate truth is that the majority of money being made by people with advanced educations in psychology is in the field of marketing… every cognitive/behavioral technique I will be using to help you attain your health goals is already being used to promote unhealthy behavior.


  • If fast food chains can condition you do associate French fries with friendship, intelligence, music, sexuality etc… then we can use the very same strategies to condition positive behaviors.


  • Food should never be used as the reward… and verbal rewards are more effective then people think.


  • How can we enlist your supports to reward you after you engage in a positive behavior?


  • The reward must be acquired after engaging in the positive behavior and it would be ideal if you were variably rewarded (you never know when the reward will happen) immediately after completing a behavior – rewarding only the end product or the goal (such as the five pounds lost) is less effective as you are not influencing the behavior which manifested the goal. Completed goals should be rewarded in addition – behaviors are perhaps more important to reward.


Social assistance and social influence

  • How can we surround you with positive influences? Studies have found that people who are able to maintain health goals typically are surrounded by likeminded individuals.


  • People tend to ‘cluster’ around similarities – this seems obvious if you think about the subject from a political or religious perspective – it is also true regarding beliefs and behaviors surrounding health.


  • Joining a group of people with similar health goals will be unbelievably helpful to your success. They will not only support you … they will model the behaviors that you are trying to engage in – this is another way in which we learn – observation.


  • This intervention will be even more successful if you can do the combined service with someone – family members or friends (remember that there is a therapeutic component so the support person might also be called upon to support some of the emotional concerns which are affecting your obstacles to attaining health).


Continued therapy

The above plan might very well be all that is needed for some individuals… others will find that they have more to explore in the safe and supportive therapy setting.

the above interventions might shed some light on other issues that need to be addresses for health and happiness reasons – some people will be able to meet their health goals, but will need a bit more help with attaining a satisfaction in other areas such as in their relationships, in their jobs, or in their sense of purpose and overall wellbeing.

William Hambleton Bishop is a practicing therapist in Steamboat Springs Colorado.

Motivation to Exercise – why it is hard and how to make it easier


Quick summary – Psychotherapists are not allowed to prescribe exercise for liability reasons though many of us have an understanding of neurology and the connection between physical and mental health… the research is both abundant and specific (as with most fields we are required to tell you to consult with a doctor to ensure that you are healthy enough to exercise). Much of what pharmacology (taking medication – such as anti –anxiety pills) does is to reproduce the release of neurotransmitters (think of them like chemical signals in the brain which affect or ‘turn on or off’ your thoughts, emotions, your hormone levels and ultimately your behaviors). Neurotransmitters associated with reducing depression, anxiety and stress are often released naturally during experiences such as exercise. Exercise has been studied to reduce stress, sleep problems, anxiety and depression while increasing euphoria, hope, sexual drive and neurogenesis (basically the creation, maintenance, and enhancement of neurons which are the functioning ‘parts’ of you brain.) The association between exercise and the resulting benefits does not happen naturally for reasons that I will explain – you must create the associations yourself. 

With all these benefits (many of which can come from nowhere else)… why is it so hard to exercise? 

  • Delayed gratification and pain – Unfortunately you need to overcome a bit of difficulty (around 30 minutes of exercise) before you get the benefits.
    • Conditioning (behavioral psychology) – we tend to pair stimuli together to create learned associations. ‘That feels good – I like that…’
      • With exercise it has been suggested that the delay in time between the initiation of exercise and the positive benefits of exercise inhibits our ability to connect exercise with the resulting benefits… and we probably pair exercise with the initial feelings – pain, inconvenience, etc


  • Fatigue, lethargy, apathy, and other symptoms of depression– a lack of exercise can be associated with certain depressive symptoms, which can make you less motivated to initiate the exercise you need to reduce those symptoms. (note: symptoms of depression means that you have one or more symptoms of depression without necessarily have a diagnosable case of depression – most of us have depressive symptoms relatively regularly)
    • There is no substitute for exercise if you have stress levels that are too high – stress has a physical effect on the brain. Exercise is the leading component in repairing a stress cycle (an over-active state used to respond to danger in which you almost always feel as though you are in the ‘fight or flight’ mode).
    • Hopelessness is a symptom of depression which would make any motivation to heal through exercise seem futile or useless.
    • Apathy is another symptom in which you believe that you don’t care – so why would you even bother trying to be more healthy – “what difference does it make.”
    • Lethargy – doing nothing physically exertive can have sedative effects – which makes you temporarily feel better if you are suffering from stress or anxiety… as with alcohol and other sedatives the effects are temporary and often cause other concerns. 

Alcohol and Comfort foods – both alcohol and comfort food can temporarily appear to assist with depression, anxiety and stress – unfortunately they might harm in the long run more than they help. 

  • Both make you less motivated to do exercise.
    • If you are full, hungover or drunk you are probably less likely to want to exercise.
  • It is more difficult and can take more energy to exercise a body which is impacted by over consumption of these substances.
    • This likely increases you association between pain and exercise.
    • To sedate the pain of depression, stress and anxiety without exercise you would need to indulge in comfort food and alcohol to a degree that could create a body that was more difficult to exercise.

Sexuality – other mammals in the animal kingdom are encouraged to maintain physical health for reproductive reasons. 

  • Hormones and neurotransmitters (those signal chemicals in the brain) are connected, which means that the neurological benefits of exercise also affect your hormones – which affect you sex drive.
  • Exercise and been shown to effect you libido (your sexual drive).
    • Perhaps some humans experience a reduced enough amount of exercise to impact the natural drives of mammalian sexuality.
  • It appears that sexuality can be a huge motivator for people to exercise as some people connect exercise with meeting sexual desires.
    • This form of motivation seems to be especially evident in reality TV show actors. 

Survival – other mammals in the animal kingdom associate physical health with survival. 

  • If an animal does not have health they could be chased down and eaten – many humans don’t tend to face such a concern
  • If a human does not maintain health they risk suffering from disease or body failure. 
    • Again the time line between not exercising and the onset of disease is too long for us to make a meaningful connection automatically.


Solution for the Day… 

You as a human have a developed enough mind to create your own associations, connections, and beliefs… which influence your behavior. 

  • Why do you associate ‘murder’ with ‘bad’ or ‘charity’ with ‘good’? – You and society made those connections…. people have beliefs even though they have had no relationship with the subjects.
  • Why would anyone have a retirement fund? There are no immediate benefits – you have to condition yourself to believe that it is beneficial.
  • Why would you have a tornado shelter? What is the immediate benefit – how can you know that it even is beneficial? You told yourself it was.
  • Why would you ever try in school if you didn’t like school and you would have rather been off playing in the woods? You created an association between doing your schoolwork and meeting your dreams – you can do the same with exercise.
    • There is a huge social component here – it is easier to make association when society at large is all in agreement (we are a social species).

You can make your own association between exercise and the resulting benefits– increased libido, feelings of euphoria, reduced mental and physical health risks etc. 

  • I have created an association between hopelessness and apathy (the depressive symptoms I experience more often than others) and exercise.
    • If I start to have thoughts such as “there is nothing that I would be happy doing right now… I just don’t seem to care.” I will go exercise – for myself there is a 100% connection – those thoughts go away 100% of the time following exercise.
      • I remind myself of this truth to create a motivating belief system.
  • I associate exercise with my passion for the mountains – every time I am out in nature I thank myself for the exercising that I did which allowed me to access nature with such ease – this creates a connection.
  • I exercise a lot with my dog – she is immediately happy – so I create an association between exercise and creating joy in my good little friend.
  • The mental, relational and physical benefits of sexuality are remarkable (perhaps a future blog will cover this.)
    • You can create or recreate an association in this context. 

The truth is this – We are a social species and much of our reality is created by collective agreement – or perception of reality is neither correct or incorrect – we simply all agreed that our beliefs, customs, rituals etc. were either correct or incorrect…  

  • When we collectively agreed that the world was flat we all behaved as though the world was flat.
  • When we all collectively believed that cigarettes were not bad for you – we behaved as though they were not bad for you.

You are a social being – join with groups of people who associate exercise with positive benefits and you will increase your ability to make such beneficial associations. 

  • There is no one on the planet that I am closer to than my wife – our agreed upon belief concerning the benefits of exercise makes it infinitely easier for me to engage in and to motivate to exercise.
  • Groups work.
    • Groups work for everything from trauma recovery to substance abuse treatment to weight loss to spirituality etc. 

Make life easier on yourself – get with a group of people that have positive and motivating beliefs associated with exercise and let the collective help train your mind to engage in the healthy activity known as exercise. 




William Hambleton Bishop is a practicing therapist in Steamboat Springs Colorado.