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Our latest article is published in the Chiswick Herald, please read below or click here.

On The Couch: Is Your Relationship In The Best Of Health?

“In relationships, believing that we understand our partners and that they understand us is the single biggest cause of trouble” says Chiswick based Couples Psychotherapist and Counsellor Nicholas Rose. In this article Nicholas explains how to keep your relationship in the best of health.

Understanding between partners’ comes from a desire for both security and vitally, safety – often closely associated with the idea of loving or being loved. If we feel understood, we are more likely to trust in our partner. Ultimately partners are the people most likely to be relied upon in an emergency and in emergencies nothing is more important than clear communication – it is nothing less than a need born out of a need for survival.

Potentially it all starts from birth – if understanding does not exist between us and our primary carers then we risk death – therefore the first thing a baby does is learn how to communicate with its primary care givers. How this is done depends upon what is learnt in the attempt to gain attention – is it more effective to be noisy or quiet, happy or sad, laugh or cry, well or sick, tidy or messy, dependent or independent, creative or practical - the list is endless. Therefore what we learn in the early days is the closest we come to have an approach to life and relationships that is “hardwired”. Simply put, we are good at doing or being in ways for which we have felt understood.

The implication is we need to challenge our assumption we understand and are understood around the most basic of concepts. For example, love. How love is expressed varies enormously across cultures, communities and families. Just ask your friends how love was shown to them as children and you are likely to get a wide variety of responses from food, fun, talking, not talking, sharing, giving, taking, education, discipline, fairness, holidays the list is endless. 

Another prime example is how people are looked after when sick. In some cultures it is common for everyone to visit sick friends and relatives, in others the patient is cared for by being protected from visitors. Neither is right or wrong but someone who is used to visitors when sick will feel neglected and uncared for if their partner tells everyone to keep away as they need rest!

As adults we acquire the ability to enter into relationships on equal terms. Fundamentally a shared language and status provides us with all we need to build and maintain healthy relationships and understanding. It sounds basic and the principle is, however the skills are something to be learnt and developed. Here are some basic rules:

1 Words like “love” are short cuts – use them at your peril. Instead never assume that the word means the same to you and your partner.

2 It requires commitment from both parties to develop an understanding. (At the extreme, the presence of physical or emotional abuse in a relationship suggests that the commitment does not exist).

3 If you feel hurt by something that your partner does or says then (as long as it is not physically or emotionally abusive) it is likely that your defences and theirs are revealing a conflict of understanding. Do not assume that the intention was to hurt you, instead say how you felt and ask if that was what had been intended. Remember relationships often breakdown due to the conversations that have not been had rather than those that have.

4 Never underestimate the possible impact of change, difficult times and stress. Anything that changes your routines or patterns can bring stress that triggers defences – at difficult times in life you might find it difficult to recognise each other. Look out for bereavements, fertility issues, children arriving and leaving, career changes, health challenges and traumatic events.

5 If you are struggling then do not hesitate to seek professional help. Many couples seek help when it is too late - when there is too much misunderstanding and hurt and not enough energy and commitment left in order to make the changes required.
 
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This article appeared in the Chiswick Herald. Please click here or read below:

Depression - how to think about it and how to recover from it
 
News reports last week covered research showing that 25% of architecture students in the UK are receiving or have received treatment for mental health problems related to their studies. Unusually this study sought to identify the sources of the distress and was able to list a number of factors - importantly all of these were outside of the students control.
 
It is often rightly stated that a stigma exists around depression and other mental health illnesses. However the point that often gets missed is that one of the biggest blocks to sufferers in recovery can be their own attitudes to both mental health and themselves for experiencing mental illness. It is really common for people to feel upset with themselves for struggling and to try and almost bully themselves out of their feelings. Unfortunately this tends to result in sufferers feeling even worse and they can become stuck in a vicious cycle of thoughts and feelings.
 
This research amongst students suggested that financial pressures, workloads, working conditions and sexual and racial discrimination were all serving to damage the mental health of one in four of these students. And as I have written previously, it seems that the mental wellbeing of students and employees in the education sector has been overlooked for some time. So much focus os put on results and processes with little emphasis on wellbeing.
 
So research like this is really important because it shifts focus when someone is struggling. Instead of questions being raised around how the person is coping (or not coping) with the inference being that they are not doing something right, it can be directed at looking and considering the context in which the person finds themselves.
 
We know ourselves through our relationships with others and yet when we are having a hard time, it can be really easy to conclude that it is only us that are finding things hard. I wonder just how surprised but also relieved architecture students were when they read the findings of the research? For many I suspect they will have felt intensely relieved, not that so many others struggle but that they are not alone. And more importantly the cause of their depression and anxiety is not simply themselves.
 
Getting a comprehensive understanding of the issues someone faces and the context in which they live and have come from is crucial in getting to grips with depression. Before anyone can start to recover they need to discover some hope in the potential for them to lead a life without such painful and overwhelming feelings, or as is often the case with depression absence of feeling. And hope comes from the realisation that the depression is only natural given where they find themselves in life, that it is not that they are doing anything wrong but the contrary, that it is only right that given their circumstances they can feel as they do.
 
Being able to make the connections that makes sense of the experience starts a process whereby positive connections can start to be made. Ways in which the sufferer can start to do things differently, take control, build confidence and distance themselves from the illness and increase their sense of connection with the world, others and their ability to find life satisfying and rewarding.
 
Again though, during recovery one of the biggest hurdles can be a persons impatience with their recovery. The desire to get away from the experience of depression can be so powerful that they can be vulnerable to almost addictive behaviours. Exercise can be a good example of this, the physiological feelings and rewards available from exercise can lead to addictive behaviour and ultimately this can act to sabotage recovery.
 
To prevent this it is important to spend time to reflect on whats happening, the changes being experienced and to consider the consequences of decisions moving forwards. It is a common phenomenon that people who appear to be on the point making a full recovery make a decision that can have devastating results. In fact suicide risk can be greatest for people who appear to be in recovery than those in the depth of their depression.
Mental illness is such an unpleasant experience for suffers and their loved ones that it is only natural to try to avoid dwelling on difficult feelings and to want to look forward and focus on the positive however taking time to think about how things are going and how to maintain momentum whilst allowing set backs is crucial.
 
If you or someone you know is suffering from depression then consider seeking help. A counsellor or psychotherapist will have the right skills and experience to help understand the depression, its causes and then provide support through the entire recovery process.
 
Patients often ask me how long it will take, how many sessions will be needed for them to recover. My answer is always a simple one - we know we are finished when we no longer have any concerns that are usefully talked through.
 
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Our latest article has been published in the Chiswick Herald, please click here or read it below.

How to make the School Holidays the best ever!
 
The school holidays are a wonderful opportunity for families to strengthen and improve their relationships and yet for many parents they can bring stress and anxiety. For some parents it can be more about surviving than enjoying the school holidays.
 
The first thing to remember is that as parents you are in charge and so before anything else take some time to think about how best to manage what can be a massive undertaking in terms of balancing time, logistics, money, competing demands and complex relationships.
 
Principle one - Look after yourself before looking after others
 
Priority number one is the well being of the person in charge and yes that is you. So it is really important that you know what you can manage and that you apply your knowledge about what will work best. After all it is you who will have to manage whatever plans are made. Here are a list of questions to help you think about this:-
 
How are you? 
How’s life for you at the moment?
What is concerning you at the moment?
How do you feel about family life?
What would you like to get out of the summer holidays?
Why do you think you want this - is this what you want or need?
Now take a moment to now think what you NEED from the holidays?
What do you not want to happen?
Thinking through how the family is at the moment what do you foresee?
In terms of current challenges what have you tried and what haven’t you tried?
Do you feel supported? Again, if not what have you tried and not tried?
How self critical are you? Yes difficult behaviours in the family may well be coming from the dynamic created by traits that you see as your own shortcomings but be kind to yourself. Don’t make yourself do things because you feel you should - find creative ways to achieve the same aims!
 
Principle two - Use a constructive and collaborative communication style
 
Avoid escalation of conflict by simplifying your communication. When you feel that conflict may arise use this four step way of ensuring you express yourself clearly and in a non confrontational way.
 
  1. State the fact/s
  2. Say what your response say how you feel and think (never say you make me feel / think because that will escalate conflict)
  3. Explain why this matters to you
  4. Share the problem you now have and ask them for their input
 
For example one of your children arrives late, this means you will be under pressure to get somewhere on time, this is something that you have said is important to you, you feel angry and stressed. It also means that it is unlikely you can fit in both of the things that were planned.
 
  1. I said we would need to leave at 9am but you have arrived at 9.45am
  2. I feel upset, angry and under pressure
  3. I want to be a good parent and being late means to me that I am failing but being late also means I end up under pressure 
  4. Now that we are 45 minutes I do not think we can do what we had planned, I need help in deciding what to change. Do you have any thoughts?
 
Principle three - Maintaining boundaries
 
A constructive and collaborative style of communication does not mean that you now let others decide what happens. Particularly if you are clearly the one with the designated responsibility. The key concern now is finding a new plan that works for everyone - including you. With the example above you may decide to take out one of the activities that had been planned. Before you do this double check with your motivations to ensure that this is the most practical solution - that the decision is not an outlet for your difficult feelings but an answer to the dilemma you face. The message you want your children to have is that when things go badly in life it is important to take the course of action that best puts things back on track. And if you think some form of punishment is also necessary then that is a different issue and should be handled as such.
 
So you have said your piece and have invited help but it is now your decision to decide what should happen next. Clarity about who is in charge is ultimately about safety. If any of the children do not like your decision remind them of the fact that you are responsible and that in life it is important that people take their responsibilities seriously. And of course remind them that one day they will be in the position of responsibility and then they will need to be the one making the decision.
 
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Our latest article on trauma, anxiety and the EU Referendum has been published today in the Chiswick Herald, please click here or read it below:

Traumatised by the EU referendum?
 
Last week Mark Carney, the Governor of the Bank of England said that the UK was already suffering from “economic post-traumatic stress disorder” or PTSD. Now in psychology this diagnosis is only applicable to people presenting symptoms once a month has passed since the traumatic event. 
 
To consider the referendum as a traumatic event may seem exaggerated however it really does depend upon a persons relationship both to it and the perceived threat an unwanted outcome held. In our practice many people have wanted to talk about the EU referendum and the entire range of emotions have been triggered by an event that for many connects to key life concerns such as security, belonging, identity, relationships and hope for the future to name a few. I think many people have found that much of their time has been taken up or influenced by the referendum and if you have too then I think now is a good time to consider how you are coping. 
 
Specifically, take some time to think about whether you have started to change how you are living on a day to day basis. Has how you experience or spend your days changed? Are you spending more time following the news / social media, are all your relationships as they were before, are you eating and exercising or have you slipped into some bad habits
 
If the answer to any of these is yes then the key is regaining balance. If you are doing things that add to your stress and anxiety levels then either think about reducing the negative activities or add in other positive things to counteract the effects. This is important because if you do not take corrective action then you could end up with a stress or anxiety disorder.
 
I would however also like to take this opportunity to talk about PTSD as it was the starting point for this article. Having worked with patients diagnosed with this devastating condition for many years, including five years working with survivors of torture for a specialist charity in London, I think there is a growing confusion around trauma and how it impacts on people. I’m not suggesting the referendum will or will not result in cases of PTSD however we know that at times of particular stress and anxiety its also possible for PTSD related to previously untreated traumas to surface. So here is what you need to know about trauma. 
 
Triggers for trauma are identified as exposure to actual or threatened death, serious injury or sexual violation and the person will have directly experienced the event, witnessed it, learnt of it in relation to a close family member or friend or, have been exposed to the details of the event.
 
Faced with a traumatic incident it is normal for a persons survival instincts to activate, so “fight, flight or fright” are the primary physiological responses combined with difficult thoughts, feelings and bodily sensations. However it is the symptoms that present following the event which are used to consider whether someone may need treatment.
 
In the weeks immediately following a traumatic event it would be usual to diagnose an Acute Stress Disorder or ASD. Sufferers with ASD will have the same symptoms as those with PTSD but not everyone who suffers a trauma and ASD will go on to have PTSD. 
 
The symptoms are grouped into four clusters and include reliving the event (in dreams or through flashbacks), having distressing memories, thoughts or feelings as reminders of the event, then a range of cognitive experiences including memory loss, distorted thinking, wanting isolation and finally “arousal”. So being hyper vigilant, experiencing sleep problems and / or reckless or self destructive behaviour, one example might be use of alcohol.
 
In returning to the EU referendum it is still too early to consider the use of the term PTSD to that event however it is not too early to take stock to ensure you are managing your stress and anxiety. Stress, anxiety and post traumatic stress disorders are types of mental distress and illness where much work has been done to both understand and treat sufferers. Following a time of stress/anxiety/trauma it may well be possible for us to find our way back to a post event way of living but it can also trigger an anxiety / post traumatic stress disorder particularly if there were already other underlying concerns in life or previous untreated trauma. 
 
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Our latest article on anger management has been published in the Chiswick Herald, please click here or read the full article below:

Anger - are you an angry person?
 
“Anger management” is a very popular therapy search term and it is something patients often bring to therapy. Anger is a very healthy and normal feeling but what is often missed is that anger is generated from other underlying feelings; so people may easily be avoided because they are viewed as angry because the hurt or upset that lies underneath is not recognised. 
 
Treatment can start when someone has started to wonder whether they have a problem with anger. This sounds obvious but in my experience this is not always so simple. Whilst people think they know what anger looks like - probably more than many other emotions - the reality is that anger can be hidden in a number of ways, examples being by silence and withdrawal or passive aggressive behaviour.  Meanwhile some people can appear to be angry when actually they are more excited or desperate to be understood. I work with my dog in the room and she is an excellent barometer for identifying anger. Many times she has behaved in such a way as to alert me to anger when it has not been obvious to me.
 
Treatment can helpfully be seen as having a two pronged focus - the first is to work on identifying anger and putting in place strategies for de-escalating the anger, the second is to look at the feelings which lead to anger; so its about treatment and prevention.
 
So lets look first at identifying anger. Anger can make itself known through a number of physical, emotional and behavioural signs. Physically you might have an increased heart rate, start to sweat, have stomach pain or a headache, clench your jaw, shake or feel dizzy whilst emotionally it is common to feel a number of emotions for example like running away, wanting to strike out, anxious, guilty. Behaviourally, things that are common are things like pacing, being sarcastic, speaking loudly, doing things that you know are not healthy but you find change how you feel for example drinking, smoking or taking drugs. 
 
Another key way to know if you struggle with anger is to think about your interactions with other people. Does anyone ever make any comments about your behaviour? Do you come away from situations with others where the outcome has left a conflict outstanding? Ask your friends and family whether they experience you as being angry?
 
If you have come to the conclusion that you do have a problem with anger then its time to put in place some strategies to deal with it. Neuroscience is showing that a part of the brain called the amygdala is responsible for triggering our emotions and this trigger happens anything up to six seconds before the rational / thinking part of the brain steps in. This means you can be angry before you know why - so if you are now better able to identify feeling angry you can now manage it. One very useful tool is to count to 10 - it sounds like just one of those things people often say but given the neuroscience, what you are in fact doing is allowing the thinking part of your brain to catch up! Another very useful tool, and something to do at the same time is to focus on breathing slowly. Combine the two and count each breath - use 1001, 1002, 1003 etc.
 
With these tools in place it will now be possible to start to look at understanding the situations and feelings that are generating your anger. Take time to reflect on the times when you became angry. Exactly when did it happen, where were you, who were you with, how did you act, why did you react and what were the thoughts and feelings in the moments before your became angry? You will also find it useful to start keeping a diary so that you can start to identify patterns. 
 
What you may find is that you get angry in certain circumstances - in other words you have ended up with an automatic response and this needs to be challenged as it is no longer useful. Lets take a very simple example just for illustration, imagine you realise you always get angry when you hold open a door for someone and they do not say thank you and you think “that person has no respect, why did I bother?”. Ask yourself what are the other reasons why they might not have said thank you? If nothing comes easily to mind think about a time when you didn’t say thank you - what was happening for you? Once you have found one possible alternative others are likely to follow. Secondly, ask yourself what makes you hold open doors for others and the thoughts and feeling that surface when you challenge yourself to stop doing it? In my experience people often realise that they are reacting to an assumption and an interpretation that may well be unfounded and secondly they are more upset with themselves for having expectations than what actually happened.
 
In finishing though it is really important to be kind to yourself, if you struggle with anger and  the thought of attempting what I’ve written here brings up difficult feelings, maybe even anger then consider talking to someone. And of course if your anger is already at levels where you are putting your safety or the safety of others, (which of course is one and the same thing), then don’t hesitate to seek help, anger can be managed!
 
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Here is our latest article from the Chiswick Herald reviewing a Yoga retreat and Yoga approach. Please read below or see it here on the Chiswick Herald site.

Moving from the couch to the yoga mat

Many of my patients are often already practicing or take up “physical” activities such as Pilates, Tai Chi, Qigong or Yoga. Over the years I’ve tried yoga on a number of occasions but not been able to find one that I’ve wanted to continue. So when I heard of a form of yoga where the underlying assumption is about uncovering or more accurately rediscovering the innate expertise we have to live a healthier life, an association I make with therapy - I wanted to explore further. 

Fairlie Gibson teaches this yoga in London but also runs holidays to teach this approach, she told me “the yoga holidays I offer are based upon an approach practiced and shared by Vanda Scaravelli. Vanda didn’t want to give her style a new name but it has become known as Scaravelli inspired yoga. We set the holidays in either beautiful mountainous Andalucia or on the gorgeous turquois coast on Southern Turkey. The aim of these holidays is give the participants, no matter what their experience of yoga, the chance to experience this, as yet, little known approach”.

By way of some background and before I talk more about the potential interplay and complementarity of this yoga to therapy I want to go back in history as I think it provides some basic and helpful context. The word disease has its origins in 14c. coming from Old French desaise and it was an holistic term covering the experience of both physical and emotional distress. It is simply the opposite of ease so the experience of “dis”ease. As medical science has found treatable causes for many sources of distress the word disease has become associated primarily with the physical. With “ill at ease” being used instead of disease but also having the connotation of some minor discomfort. In the same way the word patient has its origin in patience meaning someone that endures pain and suffering.

The importance of all this is recognition that the physical and emotional are in fact inseparable. If you feel “dis-ease” then do see your doctor but remember that when you reach the limits of what current medical science can provide you will need to access your own resources to treat or manage any remaining “dis-ease.”

The relationship I build with patients aims to bring a sense of safety and relaxation as we spend time together. That sense of relaxation or comfort enabling us to look again at how life is being lived and identify misunderstandings, unhelpful thinking, unhelpful habits, automatic responses and physical actions that have become fixed when in reality in any given moment and in any situation a range of options will be available. In short our way of living or being that was helpful in the past may not be the most helpful now.

So now back to the yoga. The experience of many who have trained in yoga is the need to learn new moves, push the body, stretch to the limit in other words to add more instruction and to have to work harder – all at a time when they have been drawn to a physical activity because they want to make life better. Resulting struggles to achieve the pose, remember the sequences, to practice regularly combined with physical injury, negative thoughts and feelings can all lead to the exact opposite of what was hoped. 

Scaravelli is known to have said “if you are kind to your body, it will respond in an incredible way”. My own experience of the yoga was first and foremost one of kindness, creating space, allowing, appreciating and only then to move the body in ways that are known to result in greater flexibility, strength and sense of well being.

Fairlie told me “It’s about coming home to yourself rather than learning something new or put another way, about unlearning and then being with ourselves in a different way”. She continued “We have become so absorbed in the need to achieve. In yoga visuals of practitioners bent double in seemingly impossible stances have resulted in a lot of pressure to achieve whereas it is more about experiencing freedom in the body. The pace of the practice is such that there is great emphasis on creating space and allowing time for the body to find its optimum”. 

Fairlie Gibson - Scaravelli Inspired Yoga

As the week progressed I found myself feeling very at ease in positions that felt wonderfully natural only to realize I was actually adopting positions that I would have anticipated requiring a huge amount of effort. I’m not saying it is easy, its not about whether its easy or hard its more about what can happen once you have let go of trying. Fairlie called this “effortless effort.” And I find myself concluding that the space this yoga creates and the freedom it generates to allow for change is indeed very therapeutic. This is a form of yoga I am interesting in continuing to practice. 

Details of upcoming yoga holidays can be found on Fairlie’s website www.freeingthebody.com