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Our latest article published in the Chiswick Herald and Chiswick Herald Magazine invites readers to write in with their dilemmas. Read the article below:

If you have a question you would like to put to us please write in and we will consider your question and respond to it in the next edition of the Chiswick Herald Magazine. When we publish the question we will not give any of your details - merely print the question and our response. Send us your question by email to mail@nicholas-rose.co.uk or in writing to Nicholas Rose, Nicholas Rose & Associates, The Cove Spa, 300-302 Chiswick High Road, W4 1NP.

Meanwhile, for this edition I’ve pulled together a list of the top questions people ask us about counselling and psychotherapy.

Q. What is the difference between counselling and psychotherapy?

The terms Counselling and Psychotherapy, these are often used interchangeably. However for the purposes of understanding what to expect, counselling is an endeavour that often has a clearer focus than psychotherapy for example a Bereavement or particular crisis. The nature of more clearly de ned concerns tends to result in a limited number of sessions.

Psychotherapy is relevant where there is a sense of struggle without any particular sense of a cause of the concern, often this struggle is something which has been experienced for a considerable period of time. A psychotherapy relationship tends to be of a longer-term nature.

Q. How does counselling or psychotherapy work?

Counselling & psychotherapy with us provides an opportunity to develop a greater understand- ing of your dif culties, to comprehend and clarify what was previously unclear and with this new awareness to identify and implement changes in your life. Crucially we offer a sup- portive relationship until the point at which you feel your dif culties have been addressed.

Q. How many sessions will I need?

It is never possible to say at the start how many sessions will be needed however it is usual to regularly review how your sessions are going and ensure you are nding them helpful.

Q. Will I have to lie on a couch?

The patients of psychoanalysts may well lie on a couch during sessions. But the many thera- pists will arrange the room so you sit in chairs.

Q. How do I choose the right counsellor or psychotherapist?

A great deal of research has and is being under- taken on the subject of Counselling Services, Psychotherapy Services and the different ap- proaches to therapy. It suggests that the most important factor in effective outcomes is the strength of the relationship between the client and the counsellor or psychotherapist. We al- ways suggest you meet a therapist for an initial session and then you can decide whether you feel comfortable, useful questions to ask your- self are: do I feel listened to and understood? Is it easy for me to speak to this person or are there things I am not saying?

Q. If I want a male, female, straight, bisexual or gay therapist is it ok to ask for that?

Of course, the priority is that you feel com- fortable. Having said that if you do not feel comfortable then it can be really helpful to ask yourself why that might be? Is it possible that the way you feel about the therapist is connected to the concerns you are bringing to therapy? If so maybe you have found the right therapist for you after all.

Q. How does couples counselling work?

Couples counsellors aim to provide a warm, supportive and non-judgmental environment, and do not take sides. Couples counsellors do not come to the sessions with an agenda; they are not there to tell you what to do or to manipulate you into staying together. They are there to facilitate you in nding your own way forward; for some couples this will mean nding a more creative and positive future for the relationship, while for others it may mean helping you to accept and manage the end of a relationship.

Q. What is family therapy?

Family therapy enables family members to listen, respect and understand different per- spectives and views, to appreciate each other’s needs and to build on their strengths to make useful changes and nd positive ways forward.

Q. Will I have to talk about my parents?

It is your space to talk about what you choose however a therapist might ask questions if they maybe relevant to the issues you want to explore. Ultimately you decide on what you want to talk about, having said that if you nd there is something that you are not saying it can be really helpful to ask yourself why!

Q. What is Child Psychotherapy?

Child Psychotherapists work with children by building a relationship through talking, play or the use of art materials to help children express themselves and help them to resolve issues concerning them. A space and time is created for them to think about life, to talk about growing up, about what happens at school with friends and about what it is like to be them. A child psychotherapist can also offer a great deal of support for parents and families at times of struggle.

Q. When can a child psychotherapist be help- ful?

If a child is showing signs of distress at home or school or if as a parent/s you are struggling in your relationship with your child. In addition there are a number of particular dif culties which can helpfully be brought to a child psychotherapist including pre and post natal dif culties, birth trauma, aggressive behaviours, ADHD, autism, divorce and separation, adop- tion, bereavement and loss, eating disorders, separation anxiety, selective mutism, obsessive behaviours. self harm.

We look forward to hearing from you

Nicholas Rose 

 
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The team at Nicholas Rose & Associates has been strengthened with the arrive of Renato Cristini who will take the role of Director with responsibility for the day to day management of the practice.

Renato Cristini, Director

 

Read all posts by Nicholas Rose Posted by: Nicholas Rose on April 25th, 2016 @ 6:03 PM

 
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Our latest article has been published on the Chiswick Herald website. Click here to view or read it below.

Stress that leads to anxiety
 
In the last column I wrote about stress - as prolonged stress can develop into anxiety I thought it might be useful to write about how to recognise anxiety and how it can be treated.
 
Anxiety is a heightened state that is identifiable through a combination of physical, psychological and behavioural symptoms. Anxiety is different to stress in that it is a longer term condition and it is for this very reason that it can be harder to identify and therefore to treat.
 
It is not uncommon for people to be unaware that they suffer from anxiety until they realise that other people do not feel like them and again, being able to identify anxiety can depend upon its cause. Where there has been a significant life event it can be easier to spot than if someone has been anxious since a very early age. Again it is common for people to not recognise anxiety because the way they experience life has never been any different. For people who have this type of anxiety it can be helpful to think about a persons early years and any childhood traumas.
 
And of course anxiety is linked to a wide range of other unpleasant experiences such as panic attacks, agoraphobia, other phobia’s, obsessive compulsive disorder etc. Long term anxiety may also result in clinical depression or other mental health conditions - so once recognised it is really important to start developing ways to manage and hopefully recover from anxiety.
 
Neuroscience is starting to help us understand the impact of anxiety on how the brain functions and to confirm long held views about its nature. It is now being recognised that heightened anxiety can come from the part of the brain called the amygdala. From an evolutionary perspective this area of the brain is tasked with warning us of potential threats and we are starting to understand that whilst this is a very sensitive and fast acting system it is not particularly accurate. Some theorists are suggesting that it is not particularly suited to modern day life because there is so much external stimuli, this area of the brain is constantly activated. As such this is why activities such as mindfulness, yoga, meditation and others that involve reducing external stimuli are becoming increasingly important.
 
Returning to anxiety and how to treat it, a common experience is for sufferers to be anxious about being anxious and this is contrary to how anxiety can be alleviated. This cycle which can only result in an escalation of the anxiety must first be broken. We need to adopt a “kindly curiosity” towards the experience of the anxiety so that it’s particular nature can be understood. There is nothing wrong with anxiety, in might helpfully be seen as a gift that alerts us to something we need to address in our lives. However ultimately, life will only improve if we start to recognise that the anxiety is merely an alert to something and it does not mean we need to be frightened, rather it enables us to question whether we need to be frightened and importantly allows us to decide what action, if any, we need to take.
 
At the primal level the three main psychological responses to an immediate threat are fight, flight and fright and we tend towards adopting a response based not only upon what is most appropriate given the context but what has worked for us in previous situations. For example, the fright response whilst it may have worked for someone who in the past needed to keep very still but it is not going to be helpful if every time you feel anxious you freeze.
 
What this means is we need to start to think about how the information being given to us by our thoughts, feelings and bodily sensations may require us to apply a degree of consideration and reflection to enable us to understand what is going on and as a result take an active role in how we respond. In other words, unless there is an obviously apparent immediate threat then although we may feel impelled to adopt an automatic response what we need to work towards is pausing and taking time to think through how immediate the threat may be and develop an appropriate response.
 
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Our latest article has been published in the Chiswick Herald, click to read it here or read it below:

Stressed by your work or responsibilities? - Younger or older you are not alone!
 
I have been thinking about how many of our clients are routinely impacted on stress that comes from work, either from the pressure of the work itself and or difficult relationships at work. And too much stress can so easily have a significant impact on a persons quality of life. Stress can lead to anxiety and depression that brings with it many symptoms that can prevent people from getting the most out of life.
 
And did you know that employers should be thinking about whether your work is well designed, organised and managed? Employers in the UK have a legal duty of care to protect the health, safety and welfare of all employees and yet according to research conducted by the mental health charity Mind in 2013, work was given as the most stressful factor by 34% of respondents saying they found their work life either very or quite stressful. Other research quoted by the Health and Safety Executive also shows that workers in the public service industries tend to have higher incidences of stress.
 
It can of course be difficult to attribute stress to just one source and yet if you find yourself saying that work is stressful, or if you notice that someone else tends to exhibit signs of stress in relation to work then it can be helpful to keep in mind that there are ways to manage and reduce stress. It is also helpful to remember that if you are stressed at work then your employer has a responsibility too.
 
Mind you other research conducted by Monster in 2012 showed that Britons were the most bullied workers in the world. Seven out of ten workers admitted to being bullied by either bosses or colleagues and I suspect the connection here is that although employers do have responsibility we British can find it hard to speak up?
 
But it is not just adults in the workplace who are suffering from stress. It seems this is an increasingly recognised problem for children too. In August 2015 The Guardian reported that English children are among the unhappiest in the world and again there seems to be a significant link with bullying. This month Head Teachers have been calling for improved mental health care and yet for some time now the news has been full of articles on how much stress teachers say they are experiencing.
 
Marybeth Mendenhall, our Senior Associate and a Systemic Psychotherapist told me “The dynamics within organisations can usefully be likened to those that occur in families -  dysfunctional organisations are like dysfunctional families. For the members belonging to the group harmful behaviours may easily become so familiar that it is only when a new member joins or an outsider gets to see and experience being part of the group that the harmful dynamics can be identified”. 
 
Ia Tollstam, our Consultant Supervisor for business services told me “many medium and large organisations have services in place to help managers think about stress and employees deal with stress. Access to counselling is commonplace in many organisations but not so much for those that are smaller”. She added “there is so much an organisation can do to support its staff and the value of a workforce who feels looked after is something the most successful employers understand.”
 
As Marybeth says “Just like with a family, members can really help each other out when trouble strikes and good communications and strong relationships can build resilience that minimises the impact of difficult times or events.” 
 
In talking to my colleagues about stress at work and in families I have found myself thinking about how more and more of our work is with children and adolescents. It seems that stress is affecting everyone? Stressed parents equals stressed children, stressed managers a stressed workforce and stressed teachers stressed pupils so to end I guess I am thinking about just how useful it can be to think about the different roles you have in life - parent, manager, partner, friend, colleague, teacher - when you think of that role can you recognise stress and if so what impact might that be having on those who count on you?
 
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Our latest article has been published in the Chiswick Herald, please click here. Or read it below:

This is probably one of the most frequently asked questions and of course there is no one single easy answer.. or is there? 

Well what I can say is that there is a state of trust and a quality of communication that I think is definitely needed in order to restore or heal a damaged relationship and I can explain more about that. 

Meanwhile my experience is that whilst the therapeutic process can facilitate change the route will depend upon an endless amount of variables. If you have not had any experience of therapy before it can be a very challenging experience and ultimately you will need to start to consider and behave differently with your partner.

And because it will be up to the two of you to be different with each other you will need to have the desire and the energy to make the changes that will be required. You will also need courage. I think the hardest thing about therapy and making any significant change in life is that it requires us to let go of ways of thinking and behaving which are familiar to us, have served us well in the past in other situations and ultimately we need to start doing things differently - something that we naturally think of as risky and frightening.

We have to accept change all the time, every day and in every way because change happens and there is nothing we can do about it except try and manage ourselves so that we can cope and continue to live a positive life. Then of course there is our potential for changing things - all the choices we make every day that change the course of our lives. Ultimately we may have a limit as to how much change we can endure before our quality of life starts to feel threatened or affected.

Coming back to our relationships, when we start to feel threatened it is natural to start analysing the situation to try and understand what is going wrong. We might accept that there are things we could do better and we might make some changes but then it is quite normal for us to turn our attention to what the other person is doing wrong. Here are where the misunderstandings start to occur, conflict arises, escalates and the quality of the relationship starts to become eroded. You are no longer a team, no longer each others main supporters but instead they become just another person in life that needs managing or even another battle that needs fighting.

It is really important to accept that you must first cast aside the notion that either one of you is to blame. The problems exist because your relationship exists. Who you are with each other creates a unique and complex phenomenon where the only possible solution is a team effort aimed at understanding what you create together and what needs to change for the relationship to adequately contain the two of you.

In order to achieve this you will first need to achieve the state of trust and quality of communication I mentioned earlier. And what is this? Well you need to accept that there are two truths in your relationship - yours and your partners. You are both right but because the relationship is not working for either on or both of you then you are also both wrong. You need to approach each other with a kindly curiosity to understand the foundations of each others truths and work together to find approaches that can bring you both happiness.

When you think back to the start of your relationship you will have been nervous and careful with each other but over time it is likely you will have lost patience. Accepted situations that you find painful and retreated into a position of trying to accept things that are just not acceptable. Harbouring resentments and putting up with things that make you unhappy. If either of you is unhappy then you are in an unhappy relationship.

In therapy we help you to return to that state of kindly curiosity - one where what hurts can be spoken and understood and where a way forward can be considered.

 
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This article is the second in a series by Nicholas reviewing an online Mindfulness Training he started just prior to Christmas.....
 
I hope you had a peaceful, relaxing and enjoyable Christmas? 
 
For my part a quiet Christmas with close friends and family has been a healing experience after three successive festive seasons with various painful, stressful situations and losses. Periods of calm, gentle relaxation with others who have been easy company, has been nurturing, restorative and facilitated a general sense of well being. 
 
Alongside this and the absence of any new difficulties, has also been the Online Mindfulness Training I’ve been doing as introduced in the last column published in the paper on the 17th December or available here online: http://chiswickherald.co.uk/on-the-couch-with-nicholas-rose-p4693-261.htm. The training itself is provided by www.bemindfulonline.org.
 
Overall, both have given me an experience of a period of time whereby the noticeable absence of worries again suggests to me just how much previously experienced day to day stress and anxiety maybe coming from nothing other than self made pressures. Of course it is natural to react to difficult situations by taking action and making lists of things to do, however a list of things will only bring additional pressure and a resulting bodily response that adds to the already heightened experience caused by existing difficulties.
 
As is always the case when I spend time practicing and learning more about Mindfulness I find something new and helpful that makes the time spent both easier and more rewarding. As I start week three of the training it is during a meditation I notice throbbing in my head, it is something I’ve noticed many times before. Previously I’ve tried doing what I’ve been taught, namely paying it attention but the outcome has been for me to feel somewhat nauseous and it has led me to feel reluctant at times to practice. However this time, right at the moment when the nausea is starting to appear the facilitator, Ed, says something like “if you notice any unpleasant thoughts, feelings or bodily sensations you can try paying them attention or you might find it helpful to return your focus to your breathing". This I do and the pain and nausea disappears. Todays learning was a piece of “unlearning” - I had been holding an assumption that there was only one way to deal with difficult experiences during mediation but now these few words have released me from something that was certainly unhelpful.
 
And I am finding Ed and Tessa, the facilitators, to be perfect companions to the training. In the middle of the second week just at the point I noticed thoughts around how the training was not enough I received an email inviting me to a mid week video. It was as though they knew exactly how I would be thinking and feeling at this stage and hearing them talk about the successes and challenges of the exercises as I had also experienced of them was just what I needed. I was left feeling reassured that I was in fact on course, not alone in my experience of suddenly doubting whether the training was useful and not failing.
 
This week I read two articles published on washingtonpost.com about Mindfulness, one from Neuroscientists again talking about how after eight weeks of practicing, changes to the brain can be seen in areas that they believe are helpful and healthy, meanwhile another article warns that Mindfulness is being “mindlessly” taken up by everyone when for some people it might not be helpful - in fact it might be unhelpful.
 
Mindfulness helps me to identify where stress and anxiety is leading me to do more than I need to, whether that is working, cleaning, eating, drinking, exercising, resting or like this week, paying attention to difficult experiences during a meditation. In other words it helps me to keep things in perspective and this is what I believe is most helpful. As a psychotherapist I’ve learnt and experienced many different approaches to gaining perspective but when I think of things that I have found helpful I would say that both therapy and mindfulness as it is taught and practiced today have been the most useful.
 
I’m still working through the Online Training so I will let you know in the next column what I think as I reach the end.