Interview with Kate Hays, Ph.D.
Kate Hays, Ph.D. graduated from Boston University with a doctoral degree in clinical psychology. Dr. Hays specializes in the area of sport and exercise psychology and has a consulting practice in Toronto, Canada called, The Performing Edge. She works with individual clients, and on occasion, sports teams, integrating clinical psychology practice with the techniques of exercise therapy and performance enhancement. She is president-elect of the American Psychological Association's (APA's) Division 47 of Exercise and Sport Psychology and is a Certified Consultant, Association for the Advancement of Applied Sport Psychology (AAASP). She has also chaired the APA's Board for the Advancement of Psychology in the Public Interest and has served as the Council Representative for the APA.
Dr. Hays presents on various topics related to sport and exercise psychology, including her most recent presentation on "Family Systems and Elite Performers" at the Second Annual Southwest Regional Sport Psychology Conference in Phoenix, Arizona. She edited the book "Integrating Exercise, Sport, Movement, and Mind: Therapeutic Unity (Haworth, 1998) and has written many articles and book chapters on the subject. Dr. Hays recently wrote "Working it Out: Using Exercise in Psychotherapy" (APA, 1999), a very comprehensive and pioneering addition to the field devoted to the wide-ranging therapeutic value of exercise for a variety of psychological disorders.
Dr. Kate Hays can be reached at:
Kate Hays, Ph.D.
The Performing Edge
730 Yonge Street, Suite 226
Toronto, ON M4Y 2B7
CL: Kate, the book that you wrote Working it Out: Using Exercise in Psychotherapy is the most comprehensive and compelling source of information written in the field of sport and exercise psychology about how clinicians can utilize exercise as an effective therapeutic intervention. In your book, you call this type of work exercise therapy. Could you talk about how you specifically use exercise in the therapy process?
KH: Yes. I really start integrating the use of exercise at the beginning of the therapy during the intake session. I ask people a variety of questions about themselves, including questions about their own level of physical activity or exercise, either now or in the past. The beginning work really grounds the therapy by recognizing early on that being physically active may have something to do with how they feel about themselves and how they function. This also opens up the possibilities that exercise may become a method for coping, if it isn't already.
CL: What are the benefits that the patients receive from using this type of therapy intervention?
KH: Well, there are a variety of benefits. There are the very well known and experienced, but still not totally understood, psycho-physiological benefits of being physically active, as well as what is called the "feel better phenomenon." People just end up feeling better when they are physically active.
There is also the more narrow direct effect on particular symptoms that a person may be seeking help with, such as anxiety reduction. There are, perhaps, some changes in people's thought patterns; such as ways of thinking about themselves or thinking about the world. Some people experience increased creativity with exercise or do problem solving in a more systematic way, rather than just sitting at a desk and trying to figure something out. So, there is that mental aspect as well.
Then there is a kind of indirect effect on well-being, which has to do with increased self-esteem, a sense of mastery or capability from having tackled something and accomplished it. Even such things as going out in the middle of winter and being outside for a half-an-hour for a brisk walk or a run when it is cold and snowing, and then coming back in and saying " well I did that." One just feels better about oneself.
CL: So, this is a much more active type of technique that patients can really do for themselves.
KH: Yes. Another benefit, as I think about it, for a number of people, is the social or socialization aspect. A number of people find that going to a gym and having some pals there and just becoming more socially engaged, or even developing a social network, may be an important aspect of feeling better about themselves.
CL: Those all sound like very positive benefits. Are there then any particular types of psychological disorders or particular populations that you find with which exercise works best?
KH: Most of the research that has been conducted in this area has been on depression and on anxiety. There are caveats, there are limits on some of the research, but in general, the research does show that exercise is very helpful with both of these diagnoses.
Exercise is also very helpful for self-esteem issues and some aspects of eating issues. Particularly, for people who are overweight and are interested in losing weight, exercise is from a physical perspective, one of the necessary components. And, psychologically exercise can be tremendously important, too.
CL: Are there certain types of disorders where you think it might actually be negative or harmful to prescribe exercise?
KH: That was one of the interesting things, actually, in doing research for the book, was finding that there are very few diagnostic categories in which exercise was really not an effective intervention.
However, there may be a few warning signs to keep an eye out for with certain patients. People who already tend to be somewhat obsessive/compulsive may need the exercise to be either designed fairly carefully or well thought through. The ways in which the person is using exercise compulsively can potentially become the grounds for talking about their compulsive issues in general.
There are also some aspects of eating disorders in which there may be cause for concern when prescribing exercise to patients. There is some potential with both anorexia and bulimia, in somewhat different ways, for people to distort their use of exercise to serve the problem.
CL: Those sound like valid concerns for clinicians to be aware of when prescribing exercise to particular patients.
Now, Kate, in your book, you not only address the uses of prescribing exercise to patients as an effective intervention to alleviate a host of emotional symptoms, but you also talk about actually doing exercise with some of your patients as part of the therapy, which I can imagine might cause some clinicians to raise their eyebrows. So, I'm curious, first of all, what are some of the advantages or disadvantages you have found in using this technique with patients?
KH: Some of the advantages certainly go back to some of the benefits of doing exercise. But I think potentially this is an area that really has not been explored very systematically. It has come up in various moments and it has been briefly popularized, but there really is not very much information and certainly no experimental research information about it. All of that aside, my own experience with clients and exercising during therapy is that when the exercise becomes the setting for doing the psychotherapy, it lends a greater depth of focus in which people are sometimes more disclosing. It provides a parallel process like riding in a car together where the integration of moving and talking seems to allow for a greater openness.
CL: So, exercising with the patient may actually free him/her up to express more and possibly get in touch with underlying issues more easily?
KH: Yes. And one of the challenges is that the therapist may experience that same increased openness. A therapist will then really need to do increased self-monitoring about his or her own process. Therefore, the biggest concern probably in doing exercise with a patient is about what this change in setting and mode means to the client. What is the meaning of this to the client? How does the client understand this change in mode? What are they looking for from it? And, obviously, what is the therapist looking for from it?
CL: Those all sound like very good questions to keep in mind if a therapist is thinking of exercising with his/her patients.
Another area of concern I was wondering about, is how do you work with patients suffering from depression, lethargy, or fatigue about issues integral with exercise, such as motivation or discipline? Is it best not to prod them too much, or are there ways of overcoming that inertia?
KH: I think not prodding is a great idea. I really see this issue as occurring within the framework of the Stages of Change Model. The vast majority of people really don't have physical activity very high up on their radar screen. Even just bringing up the topic of exercise really helps to increase people's awareness of the importance of taking care of themselves physically. Therefore, a very important goal initially is to help increase their awareness, and support them in getting more information about exercise.
I think that this is especially important since a lot of people are not even aware of the mental health benefits of physical activity; so, even just giving them that information is really intriguing. I can think of a specific client I was working with who was moderately depressed and did begin walking, somewhat reluctantly. She had owned a treadmill for some years and finally started using it. I suggested that she rate her mood from one to ten and write down the number, both before she started walking on the treadmill and when she was finished. She was really quite stunned at the change in her mood. She had absolutely no sense that that would be true. When she saw the difference in her mood recorded in black and white, it served as a very important motivator to her. So, it seems that if you present exercising as an experiment and have the person discover from inside their own body all of the emotional and psychological benefits, rather than just hearing the therapist say, "this will make you feel better", that it can serve as an effective motivator even to those who are reluctant to exercise.
CL: Well, Kate, so far we have been discussing how exercise can be integrated into psychotherapy. But, could you talk a little about the work that you do utilizing sport psychology performance enhancement techniques?
KH: Sure. Sport psychology really tends to focus more on the mental aspect of physical activity; the ways in which the mind can affect the body as compared with the exercise psychology focus on the body affecting the mind. This is the work that is typically thought of in sport psychology; the mental training performance enhancement aspect of changing one's thoughts in a positive direction to improve one's physical performance. In sport psychology, there are a couple of different things that I do. I work with individuals and, at times, teams on performance enhancement techniques so that they can perform their sport optimally.
An example of this would be visualizing an exceptional tennis swing and really working on the details of that from a mental perspective. Then, it involves actually going out on the tennis court and being able to do the swing with considerably more grace or greater speed or whatever the particular elements are. That is a very narrow kind of example.
CL: So, how someone is actually thinking of that tennis swing can translate into really doing it the way he/she had imagined?
KH: Well, within the limits of physical capacity and practice.
CL: So, someone who is a novice tennis player cannot suddenly become Martina Navratilova!! (grin)
CL: Performance enhancement sounds like something we could all use.
KH: That is really a very important point. In fact, there are a lot of ways in which one can focus on performance more generically. In my own practice, I have really been working quite a bit with performing artists as well as athletes, and using some of these techniques with them in regard to their performance. These performing artists include musicians, actors, and dancers.
CL: Since performance enhancement techniques seem to apply then to a variety of skills, can they be helpful to the business world as well?
KH: I have done a bit of this work in the business world. I know there are other colleagues who do quite a lot of work in that area, translating some of the performance enhancement skills from sport psychology to work with business people.
CL: And within the business world, would performance enhancement techniques be to help with leadership abilities primarily?
KH: Yes, and with focus, team issues, and a sense of competence.
CL: It seems that utilizing performance enhancement techniques can open up more opportunities then to mental health professionals. Considering that, let's talk about what your professional background is in terms of your training and education so that it becomes clearer how you have been able to blend together these two fields of psychology and sport and exercise sciences.
KH: Well, where I came from and where I am now are two quite different things. I went to Boston University where I was in the clinical psychology department. My training was a classical clinical psychology background. The focus there was psychoanalytic and my training was as a child clinical psychologist in a very traditional kind of a role.
I moved out of that area fairly rapidly because I was very involved with the beginning of the community mental health movement, as well as issues around prevention. Also, I discovered that I was more comfortable at a theoretical level with a cognitive-behavioral orientation, and I was more comfortable working with adults. So, what I am doing now is almost entirely different, on probably a number of different dimensions, from my initial training.
CL: The professional path you have taken is probably very comforting to many clinicians because it demonstrates how one can continue to grow and develop in the field of psychology, even if one's roots started out very differently. So, now that we understand your background in psychology, can you comment on what your personal and professional background was in sport and exercise?
KH: Sure. Personally, I was actually quite sedentary until my mid 30s when I started to run and fell in love with it. From there I really began to pay attention, in fact, to changes in my own thought processes in response to physical activity. That is what really headed me towards an interest in sport psychology.
Then, professionally what happened, was that well past my doctoral degree and having a well established clinical practice, I really began just reading everything that I could and catching up on the field of sport psychology; a field which I had known absolutely nothing about. There is a very long and large literature on this subject, which pulls from the fields of sports medicine, physical education, and psychology. This information is something that is very important for psychologists and other medical professionals to be aware of. A person should not plunge into it and think that just because they like X team or that they think they know what a particular athlete should do, that they can just immediately pick up and provide performance enhancement skills.
CL: So, it sounds important that somebody be familiar with the whole culture of sport.
KH: The culture of sport, and then again, the very extensive research literature that exists in a field that is related, but not the same as psychology. The path that I followed is not the path that I would encourage others to follow. At this point, there are many more training programs available for people and more systematic ways of going about learning.
CL: So, what kind of a professional track would you recommend to those who are interested in becoming a sport and exercise psychologist?
KH: There is some very interesting and useful information available, actually, through the American Psychological Association's (APA's) Division of Exercise and Sport Psychology. There are a couple of pamphlets that are available directly, or on the web, for people who are considering a career in sport and exercise psychology. It is important for people to think about what they want to be doing at some point in the future and then either head into psychology with a concentration in sport psychology or to head more towards sport sciences with a focus in psychology.
There are just barely beginning to be doctoral programs that have this dual focus. There are some master's programs that do, however. For people who are already trained, there are some postdoctoral programs that are just starting a couple of training opportunities. There is a very interesting book that is a directory of programs in sport psychology that has been developed by the Association for the Advancement of Applied Sport Psychology (AAASP), which is another way that people can really get information.
Basically, until very recently, this has been essentially two different fields where each individual needs to figure out, at their particular location or university, how to go about designing a program that will work for them. This can mean a tremendous amount of initiative on the part of the student, which is not a bad thing. It may be that at this point in time, it is a little bit easier to find programs that have been designed, rather than trying to create a specific program in sport psychology.
CL: So, if somebody at this point, let's say, has a doctoral degree in clinical psychology or has some sort of degree in exercise physiology and wants to blend the two, it sounds like there are various different paths that they can take to get there, but you really do need to put the effort into learning as much as you can about both fields. Is that what you would say?
CL: And, are there any kinds of particular training experiences or certifications that you think a person should have if they want to go into this field?
KH: At this point, the only real guideline, if you will, that exists in sport psychology is something that is called a Certified Consultant, Association for the Advancement of Applied Sport Psychology. This certification recognizes that an individual has followed prescribed course work and supervised experience in sport psychology. APA's Division of Exercise and Sport Psychology, is also, currently considering whether it would be useful to develop a proficiency in sport psychology because, again, the field is just so wide open and amorphous.
What that means in terms of consumers and education is that pretty much anybody within the bounds of ethics is capable of providing these kinds of services. And there is a fair amount of hype out there that is available that is not necessarily backed up by solid work.
CL: So, it sounds as if consumers really need to be somewhat cautious when wanting to hire someone as a consultant in that area by doing some legwork about the person's background and how knowledgeable they are in sport psychology.
CL: That is certainly important information for people to know. Are there any other comments or pieces of information that you think might be helpful or interesting to people learning more about this field?
KH: I would like to add that because this is such a developing field, which is coming from at least the two disciplines, it is very exciting for people to become involved. So, I would encourage people to really engage in knowing more about sport psychology, whether people are doing their own research or understanding the information that is already available.
CL: Thank you, Kate, for your time and for offering so much invaluable information about the exciting field of sport and exercise psychology!