Counselling, Psychotherapy and Psychology Blog by Nicholas Rose

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Our latest article has been published in the Chiswick Herald, click here to visit the site or read below.

Here’s how to give yourself a summer mental health and wellbeing check up!
 
Summer can be a great time to take stock. The disruption in our usual routines can remind us that there are different ways to live and this can be enough to help us make some simple but hugely important changes.
 
The summer holiday is for many people the one time when they feel they have earned the right to do what they enjoy. As a result it is a time when many things are enjoyed - some of which maybe vital for well being - but how can you decide what is vital and what is merely pleasure for pleasures sake? 
 
It is a natural tendency for us to let the things that support us fall by the wayside at times when the pressure of everyday life demands sacrifices. I use the word sacrifice intentionally because what I see people doing every day is “sacrificing” something. Firstly because there is a hope that some reward will follow and secondly because a sacrifice is mostly seen and understood as positive thing. Everyone has heard something said like “she sacrificed the best years of her live for  her children and see how they repay her”, or “he worked for them for years, put up with poor pay and now look at how he’s been treated”. It doesn’t change what has happened but it does position the one who has sacrificed as the one to be judged more sympathetically. 
 
In other words I think people can find themselves leading hard lives because they prefer to think of themselves as someone who sacrifices. And then of course people don’t sacrifice overtime for time with their families, don’t sacrifice promotion for staying in a job they are actually enjoying, don’t sacrifice the rush hour commute in favour of a yoga class, don’t sacrifice the hour they spend each day reading bad news for an hour listening to music, reading, walking, making love… A sacrifice seems to be about giving up something we find positive…
 
My point is simply that the judgements and beliefs we hold about the way to approach life will affect the way in which we make decisions and not always for the best! So use the summer holidays to give yourself a mental health and wellbeing check up and heres how. 
 
Think about and write down:
 
1. The things you do during your usual routines that you are pretty certain are unhealthy / unhelpful, the things you would like to change or improve for example, lose weight, drink less, exercise more etc. 
 
2. Your life when you are in your usual routines and without stopping to analyse/censure what comes to mind list the times when you have the most positive feelings/thoughts/bodily sensations.
 
3. When you get the most negative feelings/thoughts/bodily sensations.
 
4. How this compares to when you are on holiday.
 
 
Now:
 
1 Write down the three most significant things that you DO NOT feel compelled by when on holiday. For example “on holiday I do not feel under pressure to get everywhere on time” again do not stop to analyse or censure.
 
2. Again without analysing / censuring, write down what would need to be different for example, “I would need to start working part time”.
 
3. NOW is the time to allow yourself to analyse and censure your reactions to these changes - so list all the reasons why you do not think you can change.
 
This is the point at which you will see all your judgements and belief’s - ask yourself “what of the things I’ve listed here do I actually know, where does this come from and what evidence do I have that this applies to me and my life?”.
 
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Our latest article has been published in the Chiswick herald can be found here. Or please read below:

A couple of common misconceptions about feelings explored….
 
Is it wrong to have bad feelings when people die?
 
At a funeral I went to last year the priest spoke about how loss might bring up sadness, loneliness, depression and shock. The difficulty for me in hearing these feelings listed was that it led me to think that we were being told that only certain feelings are appropriate; ones that suggest we had a relationship with the deceased that was wholly positive? 
 
In reality bereavement can bring up many difficult feelings both about the relationship someone had with a person who has died and the fact that the person has now died, for example, these might include angry, vindictive, hurt, hostile, relieved, excited, numbness etc.  It was only at the wake afterwards people appeared to find themselves able to start to acknowledge the more authentic nature of their relationship with the deceased, for example to be able to say something like “I could get so annoyed with her because she used to be so stubborn” or “I could feel so disappointed because she could be so judgemental”. Even then I found myself wondering about other thoughts and feelings that remain “secret”. For example, people can feel relieved when someone dies but then feel guilty that they have that feeling of relief.  
 
As psychotherapists, when counselling we so often have patients where part of the struggle is because they have feelings that they think are wrong or inappropriate. That means we often have to deal with the persons feelings about their feelings before we can start to work on the underlying feelings themselves. 
 
So whats the answer? Firstly to accept that when things happen to us then the feelings, the types of feeling and the strength of feelings or even the absence of feeling are a reaction over which we have no control and no matter what we think of them they are all appropriate and justifiable. It is the actions that we take in response to feelings that can be problematic so instead of being concerned about the feelings and trying to control them, pay attention to them instead, question them, try and understand them and then think about what you would like to do.
 
 
Do you ever say (or think) “You are making me feel….”?
 
This is something that I think most people will find themselves saying at some time or other. For example, that person who you have told numerous times not to be late is late and you say to them (or think) “you are always late and you make me feel so annoyed!”. But of course the annoyance is yours and it is most likely because you have again fallen into the trap of expecting a different outcome? After all it is not really a surprise that they were late. So what is the annoyance? I suggest it is annoyance with yourself and because we like to try and get rid of negative feelings as quickly as possible we can mistakenly expect the best way to deal with them is to allocate them on someone else.
 
Because our feelings appear so powerfully to us when someone says or does something that generates a reaction, and because it is also usual for others to quickly think we are the source of their feelings, this basic notion is almost hardwired. However this misconception does not help us, because the way in which we respond to people and situations is a uniquely personal thing based upon a range of factors including our life experiences, expectations and cultural norms to name a few. And the proof? Can you say you never witness different people responding differently when in the same situation? It is a common phenomena that when there is an incident, police witness statements typically contain very different accounts of the same incident. And what about all the times when you have found that your explanation of someones behaviour is different to someone else’s? 
 
The reason why this is so important is that you can change your way of thinking so that you see your feelings as YOUR response to a situation or person. And when you do this you can consider what those feelings are telling you about yourself and how you are living your life. Back to that person that is always late, now you are no longer putting the responsibility for your feelings on them what do YOU want to do about avoiding either the situation or the feelings next time?
 
If you would like to speak to a counsellor for help and advice please don't hesistate to get in touch
 
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Our latest article has been published in the Chiswick Herald, read it here or see below:

How does that make you feel?

I’ve been listening to this Radio 4 series where you hear psychotherapist, Martha, in sessions with patients. The first thing I found myself wanting to do was find out whether it is classed as a drama or a comedy - I was relieved to find that opinion by reviewers appears divided, that it is not seen as pure drama or an attempt to depict therapy in real life. 
 
But ask me how I felt about listening to “How does it make you feel?” and my answer is disappointed and feeling less confident that therapy is being understood and embraced - you find me disheartened. 
 
The title itself set alarm bells ringing for me. I can’t claim to never ask my patients “How does that make you feel?” because sometimes I might, but therapy is not just about getting to people to talk about their feelings. It is a common misconception which does nothing to encourage people to view therapy in a positive light. It’s not the only misconception, others include that people need to talk about their feelings, that men in particular are less likely to talk about them than women and/or it is a British thing not to talk about feelings. The problem with these concepts is that they put across such a simplified view of people and therapy that for anyone struggling, therapy might be seen as nothing more than a placebo.
 
In reality therapy addresses how we make sense and act upon the information given to us by our lived experience - feelings are just one element. Information is also available to us through our thinking, our bodily sensations, our dreams and our interactions with others and the world around us. There is no rule book as to how much importance we should give to each of these components but in therapy we work with our patients to identify how life is being understood and how this understanding is put into action. We then look together at the struggles that have brought them to therapy and look for connections and solutions.
 
So it is not just about feelings. It is also not just about being able to talk about feelings because research indicates that as little as 7 percent of communication is verbal - body language and tone of voice being far greater conveyors of information. It is natural for us to embody how we are and what we want and for us to understand how we do that but also how other people, especially those who are most important to us, is hugely valuable.
 
And it is important to remember that therapy is about understanding ourselves AND others. When we improve understanding of ourselves we can be better at understanding others, likewise when we better understand others then that helps our understanding of ourselves. As an aside, and something that probably merits its own article is my view about short term therapy - often thought of as “counselling” (longer term therapy is often thought of as “psychotherapy”) - in short term therapy I think people often start to see themselves in a new and more helpful way in a relatively short period of time however problems can start to appear in their relationships because the therapy finishes before it is integrated across all areas of a persons life. I regularly meet couples where misunderstandings and conflicts have only become more frequent and problematic after one or both partners have been to individual counselling. 
 
Anyway back to my other thoughts about the Radio depiction. I also wasn’t surprised but I was disappointed that this series also seems to promote the misconception about men because three out of the four patients were men! Finally and most crucially I was saddened to think I heard the therapist as being at times tired, irritated and frustrated amongst other feelings with her patients. For me, I view therapy as a collaboration between therapist and client, an agreement to work together, it is a commitment by both of us to undertake a vibrant, energetic, stimulating exploration. It is a project where neither therapist nor patient can know what will occur, but where both agree to try because good things can come when we give something our best efforts and attention. Unfortunately with Martha I was not entirely convinced this was the case, actually I was wondering whether she might benefit from a sabbatical? And I wonder if future productions might possibly capture some of the wonders of the therapeutic endeavour that so many therapists and patients work so passionately to achieve?
 
“How does that make you feel?” Series 8 is currently available on the BBCRadio iPlayer.
 
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Our latest article is being published in the Chiswick Herald newspaper and online here. Or read below:

Mental Health Round Up
 
It has been a very busy few weeks in mental health and it is heartening to see so many people agreeing it is time for mental health concerns to shake off stigma. The charity led by the Duke and Duchess of Cambridge and Prince Harry, Heads Together aims to encourage people to speak out when they are struggling.
 
Of course it is part of our experience of being alive that we have an internal and private world of thoughts and experiences that we do not routinely share with others. So how can we know whether we have a concern which needs attention?
 
At the present time it still seems that only in certain instances can it be accepted that someone might struggle with their mental health; so people who have experienced life changing trauma or those who through a number of factors are diagnosed with a mental health condition. It is also still a harsh reality that only if someone’s “presentation” fit with a recognised “condition” will their struggle be seen as genuine and treatment be provided through health services. Further with all the gaps still existing in the science around mental health we cannot yet be clear about whether existing treatments are in fact effective treatments.  
 
All so called “mental health conditions” (still widely thought of as illnesses) are not identified by the presence of viruses, bacterias, infections, tumours or fractures etc but rather by observed “experiences”.  PTSD, ADHD, Depression, Schizophrenia, Bipolar, Anxiety Disorders, Learning Difficulties etc are all identified through observation and judgement. The authors of the worlds most widely recognised diagnostic publication the DSM (Diagnostic and Statistical Manual of Mental Disorders) have stated that they are concerned that science has not yet been able to validate the categories of conditions it contains. 
 
If you cannot be completely certain about the problem how can you be completely certain about the treatment? And if the treatment is not correct what might the implications be for the patient? For example, in the UK it has been identified that young black men are much more likely than young white men to be diagnosed with schizophrenia and no underlying biological cause has been found. So I think that a system that only treats and recognises “conditions” may be as effective at preventing people seeking and getting help as it is at encouraging treatment.
 
Indeed in response to my article published on the 24th February “What causes mental illness?” where I reviewed a seminar I had attended based upon a book by RD Laing and Aaron Esterson called Sanity, Madness and the Family, the seminar convenor, Anthony Stadlen wrote:
 
“I think the title is a bit misleading, as the whole point of the book, as I try to explain in the seminars, was to question "mental illness" and "schizophrenia", not to ask what "causes" them. The very first sentences of the Preface to the Second Edition were:
 
"There have been many studies of mental illness and the family. This book is not of them, at least in our opinion. But it has been taken to be so by many people." 
 
I think this whole question is really important because the gaps in scientific understanding can mean only one thing - we need to look to ourselves and how we experience our lives and decide whether we need to make changes. So back to the question I posed at the start of this article - “How can we know if we have a mental health struggle that needs attention?” Firstly, if people who you are close to say they are worried about you or have noticed that you do not seem to be your old self then take some time to think about their feedback, ask them to give more detail and if you are unsure whether they might have a point then go and see someone to talk things through with. Secondly, if you wonder whether you are struggling then again go and see someone and talk things through. Be as kind and careful with yourself as you would your best friend!
 
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Our latest article has been published in the Chiswick herald please click here or read below.

Latest advances in treatment of anxiety and depression coming out of the USA
 
I have just returned from the annual Anxiety and Depression Association of America’s annual conference. The Association is a huge organisation that aims to improve patient care by promoting the implementation of evidence-based treatments and best practices. The focus of this years conference was “wellness” and aimed to present the latest research findings coming from neuroscience and treatment. 
 
I have for some time been interested in what neuroscience is able to tell us about how the brain appears to work differently when there are particular concerns such as anxiety and depression. For example, studies have shown that the practice of mindfulness appears to have a direct impact upon brain activity and the reduction of anxiety. And it is becoming ever clearer that “disorders” occur when there is some disturbance or interruption between the alarm raising part of the brain - (the amygdala) and the processing or thinking area - (the prefrontal cortex). But we still do not know whether the disruption is in the connection from the amygdala to the prefrontal cortex or from the prefrontal cortex to the amygdala; or a combination of the two. It also seems as though opinion is leaning towards the view that such disturbances occur following some kind of “trauma”, either event driven or biological. However this cannot be definitely stated.
 
In the therapy profession the behavioural community do tend to be more interested in research than practitioners in the other disciplines and so cognitive behaviour therapies or “CBT” have a bigger base of research evidence. As a result service provision organisations like the NHS tend to lean towards offering these services as they are easier to justify from a financial resources perspective and offer monitoring opportunities. Of course the absence of research from other types of therapy proves very little except that those practitioners do not see a need for research. 
 
But research on outcomes from therapy generally conclude that the single most significant factor determining a positive outcome is not the therapeutic model or approach but the quality of the relationship between the patient and the therapist. The major issue here is that researching “relationships” and monitoring them is far more complex than therapeutic tools and techniques and so the focus is unlikely to change any time soon. 
 
My experience tells me that what people need more than anything else is to meet with someone who they feel cares for them and is passionate about wanting to understand their particular concerns. Such an experience is helpful because the person won’t feel the need to justify themselves and can instead think clearly with another person about their situation and what they can do about it. But I also find that people make sense of their situations in different ways, some people are analytical, some clear about their feelings and others like to think through things. When someone is struggling it is likely that they may need to adjust the emphasis they put of the way in which they make sense or not of their problems. Sometimes people ask for CBT and then want to spend their time speaking about their past, whilst others may say they want to talk about how they feel but spend their time looking for solutions. So what does this mean for anyone wanting to seek help with their psychological well being? 
 
  1. Keep in mind that all mental health conditions have been developed by grouping experiences and are not like physical health conditions that can be diagnosed like viruses, infections or fractures.
  2. We still don’t know whether conditions are nature or nurture or both
  3. The expectation of trauma can be misleading and sufferers can fear that their condition must exist because something has happened to them that they have no hope of coping with
  4. Chose a therapist with whom you feel comfortable - someone with whom you find it easy to speak openly with.
  5. Remember you are in charge and give feedback to your therapist to ensure you get the best possible outcome.
 
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Our latest article on reducing anxiety has been published in the Chiswick Herald, please click here or read below:

Reduce stress and anxiety FAST
 
Below are five things to think about to make you feel calmer:
 
  1. Are you taking things too personally?
 
We get upset with other people when our expectations are not the same. There is nothing wrong with expectations as long as you recognise them for what they are - our humanly attempt to reduce our anxiety about living. We try to reduce our anxiety by finding meaning and purpose and with this we form personal views based on all our experiences of living. What we have liked and not liked is fed into developing our personal framework of what we think is good and bad - it sets our expectations and our opinions and these become what we believe to be true about life.
 
When we come into conflict with another it is because our “truth” does not agree with their’s. We don’t want to think we might be wrong because that undermines our confidence in how we make sense of our lives, so it is natural to defend our “truth”. When we defend we come into conflict and this often causes more conflict. 
 
Conflicting positions present us with a challenge so instead of getting angry try to think about conflict situations like this:
 
“I am right, but only for myself. The other person is also right, but only for themselves. We are in conflict because we are both anxious to be right.”
 
  1. Are you aware of how your time of life is affecting your stress levels?
 
Because we are so busy living our lives we tend to forget to take stock and think about just how much stress might be coming from our stage in life. Adolescence tends to get most publicity as it is the most easily recognisable - due most likely to its nature of being condensed into just a few short years - but differing pressures are with us throughout live. Relationships, careers, financial security, our health, families, retirements, redundancies, bereavements all bring pressure to what we do everyday. Stages often talked about are coming of age, leaving home, leaving university, 30, 40, 50, 60, empty nests, loss of parents, retirement…..
 
So if you are stressed and anxious think about the people you love most and think about how they put pressure on themselves and how you wish they would just relax. And now think about where you are in life, what disappointments have you carried from previous times, what impact might these be having today? What are your hopes for the current time and how are you doing with your plans? And what do you want for the future? You might find yourself tempted to start writing lists but maybe you could try to think like this:
 
“I am right to feel under pressure given everything I want for my life, it is what everyone does. I am anxious just like everyone else”
 
  1. Are you seeking perfection?
 
Do you describe yourself as a perfectionist? Or do other people see you as a perfectionist? It is natural to want to get things right and as the above questions show anxiety comes from expectations and standards. To be a perfect human though is to make mistakes - if you want to be a perfectionist then don’t strive for perfection. Another way of looking at things is to try and aim for good enough in all things rather than seeking perfection in some areas at the cost of others. You might like to think like this:
 
“To be perfect requires imperfection, my imperfections make me perfect.”
 
  1. Are you colluding with your anxieties?
 
Think about all the things that reduce your stress. Think of times when you have felt least stress, places that induce calm, people with whom you feel relaxed, ways in which you can release stress. Excellent you have just completed an exercise in not colluding with anxiety. When you feel stressed or anxious it will affect how you make decisions and not necessarily for the best. Feeling calm and level headed is a good starting point for decision making. So try thinking like this:
 
“Of course I WANT to think about the things that are stressing me so what I NEED to do is think about all the things that are not stressing me”
 
  1. Are your taking care of yourself?
 
A great way to turn yourself away from stress is to develop a kind mindset towards self care. DOING taking care of yourself is a great way to reduce from stress and anxiety that arises from THINKING about looking after ourselves. Recent research has shown that just putting one foot in front of another reduces stress, anxiety and depression. So when it comes to exercise, nutrition, finances, relationships, careers, hobbies, spirituality you will feel better just by putting one foot in front of the other. If you are still struggling with your thinking try this:
 
“To feel better I just need to approach everything with the aim of putting one foot in front of the other.”
 
 
 
We hope you have found this article helpful but if you have been experiencing anxiety for a prolonged period then we advise seeking professional help. In addition, anxiety and stress can also come from underlying health issues so if you are suffering from stress and anxiety symptoms we always advise you check out your health with your GP.