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Our latest article has been published in the Chiswick Herald click here or read below:

Make sure depression does not destroy your relationship 

In my work with couples it often comes to light, that at some point in the past, one of the couple has struggled with depression. Through therapy couples often come to realise that the way they responded at the time harmed their relationship. In this article I explain what often happens and what to do.

Depression often occurs after something has happened in a person's life that has been difficult to cope with. The struggle can be very tiring, resulting in low confidence and a circle of behaviour that only serves to lead to more unhappiness. 

It can have a terrible impact on how someone experiences their life on a day to day basis, symptoms often include a felt sense of low desire to undertake daily activities including work, socialising, exercise etc. It can have a debilitating effect and often be a very confusing experience for the sufferer and their friends and relatives. It can also have a significant impact upon partners and can often lead to the breakdown of relationships.

So what goes wrong? In our relationships we generally expect that partners support each other during difficult times and illness. So far so good! However the difficulty tends to come from failing to support partners in a way that recognises the needs of a healthy relationship.

All too often, the person struggling will most likely be experienced by their partner as withdrawing and this creates a dilemma. On the one hand the partner will be upset to see the person they care about struggling and want to help them, whilst at the same time they are also likely to be struggling themselves with negative feelings about how the relationship with their partner has changed.

To be upset ourselves when our partners are struggling can be difficult as judging thoughts can come to mind like indulgent, selfish, uncaring. We prefer to think that when things go wrong for someone we care about we will drop everything and put the other person first and that they will do the same for us. Whilst this expresses just how important our partners are for us it introduces a mindset that leads to thinking about “them and me” and not about “us”. So at a time when we both most need our relationship to be working well we tend to put it on hold, relegate it, not give it priority.

Quite simply if you are affected by the fact your partner is struggling then you need to look at it as information telling you that your relationship is struggling. If someone is unhappy in a relationship then it is an unhappy relationship and no matter how tempting it is to try and hide this fact from a partner who is struggling, ultimately that partner will not thank you for this further down the line.

So what is it that happens that causes the relationship harm? Usually the partner not struggling puts their needs to one side, they might miss their “old partner”, but they give them space, or their sex life but don’t want to impose, or being able to talk about their own problems. Unfortunately the denial of needs tends to have a habit of impacting upon us in ways we do not expect. 

Of course the struggling partner will be finding it hard to carry on as though nothing is happening but if that partner also loses the benefit to their sense of self that comes from being able to make their partner happy, then thats just another thing to add to their probably ever increasing list of failures. They might not even realise this so it is up to the supporting partner to remind them!

Unfortunately patterns get put in place whereby the supporting partner also withdraws and changes their behaviour with the result the way the relationship works is changed to such an extent that a time comes when neither recognise it any more. The relationship can be experienced as lifeless, dead, lonely. 

Couples can often avoid this for years, particularly if they have children, busy jobs, other interests etc but ultimately they become to realise that their relationship is no longer there for them.

Main points - 

  • Think about your relationship - it is not helpful to think just about your partner and yourself separately. 
  • Take a step back and think together about what you can do so that you can both feel as though you remain committed to each other
  • Even if your relationship is in a good place at the moment talk about this now - if trouble comes along you will have an agreed strategy in place and this will make it much easier to have the conversations that will help.
  • If you or your partner is depressed share this article with them and think about seeking couples / relationship / marriage counselling.
 
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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 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 in the Chiswick Herald written by Child Psychotherapist Juliet Lyons on the international aspects of her work can be read here. Or please see below:

International aspects of my work

As an 18-year-old, I worked as a nanny in Italy. It was my first taste of child-care. I learnt how to care for a 1-year-old while being welcomed into this Italian family - Mother, Father, Grandmother and Grandfather. There was a sharing of languages - English and Italian nursery rhymes; nappy changing practice; foods for a one-year-old (variations on tiny pasta cooked in stock or ‘brodo’ with parmesan, of course). I learnt that learning another language can be a gateway into understanding and partaking in a culture, and to be really satisfied in our exchanges, we not only seek to understand, but partake. At the time, I had a very significant dream: I could talk across languages, transitioning in each sentence between several different languages to produce an extraordinary type of poetry. The dream has stayed with me ever since as does my experience as an English nanny in Italy. 

In some senses, this dream has come to fruition: over the past 7 years, working in Chiswick as a Child Psychotherapist, I have been struck by the number of international clients and how enriching this is to the work. My clients come from areas as diverse as Argentina, Russia, Bulgaria, the Ivory Coast, South Africa, Brazil, Italy, Sweden, US, China, Rumania, France, Germany, (the list goes on) as well as the UK. Occasionally, I even work with a translator. This cultural mix makes for very interesting and varied exchanges. They are multi-layered and complex in the interchange of attitudes and beliefs around caring for each other, parenting, and the forming of identities. 

It is not surprising then that in my consulting room, I have noticed recent political events have had an enormous impact. Following the American elections, I had an influx of young American, female clients who were experiencing enormous amounts of anxiety. Children in my consulting room seem highly aware of politics and environmental issues, particularly those who originate from outside the UK. There is a lot of uncertainty and anxiety in families that come from abroad about their future and where they will live in the near future.

People who come to this country do so for many reasons. Often to do with their work, sometimes for the hope of a better quality of life for themselves and their families. Some have married a UK resident; others have married someone from their own or a different country and culture. They often face enormous losses of friendships, family, and the familiarity of their culture and language. Sometimes they take tremendous risks to move and often feel very vulnerable in such a move. I have been deeply moved by parents that have sacrificed so much to come to the UK, at times to enable their already vulnerable child or children to have opportunities in schooling, therapies and medical care that is just not available in their home countries. 

Attitudes to parenting vary. What is accepted as normal parenting in one country, is seen as abusive in the UK. For instance, hitting your child is still accepted in many countries. Parents can find themselves in the hands of Social Services, learning about the dangers of hitting a child, and learning of more humane ways of setting boundaries and having a different type of relationship with their child. In such cases, the child can see the UK as a protective force, a caring and kind country. But equally, it can be hard for them to carry the burden of knowing that their country of origin did not protect them in this way. It is a complex situation to come to terms with. But these children are initiated into the extremes of cultural diversity that few experience in such stark ways, and often become deeply sophisticated in their understanding of difference. Some families, very sadly, have experienced abuse here in the UK. When people put their trust into a system and an individual in the system abuses the trust and vulnerability of a child and family, it is very difficult to come to terms with. The pain can be shared and born, but it is always there. 

At this particular point in time, when the UK is reconsidering its relationship with Europe and the rest of the world, it seems more important than ever to consider the psychological aspects of being native and being a foreigner. Above all, what I observe and learn from my international clients is around how they navigate the space between dependence and independence, and how they retain or lose their sense of cultural identity.

How we form our identity is relevant to this discussion. According to theories, based on observations of infants, babies and children, identity is formed in relationship. We take in how others view us and see us, how they understand us, and how they interact with us. It is a complex dance of interactions that are forever being built in our minds and held in our bodies. On each building block, the next identity forming interaction is possible. It is the interactions around the care of ourselves that seem to form our resilience and identities most strongly. 

What is significant in this dance is that where we are understood and feel ‘got’, we can accept closeness. Where we are misunderstood, and in particular our vulnerability is misunderstood, trust cannot be built and we therefore tend to break bonds, move away from closeness. Empathy is what allows us to reach each other, to hear each other to feel touched by one another. When one is vulnerable, fragile, unformed, forming, emerging, discovering, awakening, then the softness, safeness and attunement of empathetic responses will find their way into our very being and become part of us. If we are responded to without empathy, with misattunement, with harshness, with a lack of understanding about our vulnerability, then we will shut out the relationship, with long-term and ongoing consequences for us and others. Of course, we will constantly make mistakes as parents, but what is key is that we can repair the ruptures – change our ways, recognize it if we get it very wrong, work with others to find different ways. 

This process introduces the individual in a timely and careful way to their capacities to be an individual within a group. To retain a sense of individuality that, when under attack, can find itself again, and therefore is secure enough. This individual will therefore be likely to tolerate difference. This, in part, is what makes us able to have an interest in another without too much fear of losing our identities. When we meet another, a stranger, we are always taking a risk. But it is the capacity to be uncertain, unsure and how we manage this that is key. If we are too frightened, we might wish to either merge (to deny difference) or to project our fears and make the other more frightening than they are. Managing the tension between a child wanting to explore and keeping them safe is a key principle of parenting. Psychotherapist Nicholas Rose advocates ‘the importance for us to equip ourselves with communication tools so we can feel safe and secure in engaging with others whilst also knowing how to deal with abuse and dysfunction.’ This is inevitably complicated if we are communicating across languages and cultures.

At Nicholas Rose and Associates, we have a culturally diverse team. Psychotherapist Adriana Amorim says, ‘I think that working with diversity is at the core of what we do as counsellors and that having a better understanding of the mechanisms of diversity through personal experience of migration helps me to work more efficiently and in tune with clients' predicaments.’ For me, learning from clients from all over the world, I find that children and parents want to retain something of their original identities and yet, they want to be themselves at the end of the day. And who they are and are becoming can hold many cultural identities. For me, to be able to partake in and support this complex process of identity building, is a privilege.

 
 
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Our latest article has been published in the Chiswick Herald, please click here or read below:

How to make this Christmas the best ever!
 
The Christmas holidays are a wonderful opportunity for us to strengthen and improve our relationships and yet for many they can bring stress and anxiety. For some it can be more about surviving than enjoying the Christmas holidays.
 
The first thing to remember is that people think of Christmas in many different ways and there are often many competing expectations. For example people may use the following words to express their hopes for Christmas, family times, friends, relaxing, having fun, spirituality, charity, reflection, partying, staying in, going out, log fires, wintery walks, time alone, time with others, entertaining, being entertained. Remembering this means that you can be proactive and ask people what they are wanting to get out of Christmas and what they would like to do - you can then decide with those you care about how to ensure everyone can have a good time
 
Principle one - Examine yourself first
 
Priority number one is your well being. So it is really important that you know what you want to get out of Christmas. 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 Christmas?
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 Christmas?
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. Share your response to the situation - 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, ideally tell them what you want to do but if you are unsure ask them for their input
 
For example one of your family 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 relaxed and easy going 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 - for example the cook of the Christmas lunch! 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. 
 
So you have said your piece and have invited help but it is now for you to decide what you need next. Don’t fall into the trap of expecting others to know what you want and to step in. If it doesn’t feel right then say so - in the best relationships people work together to ensure everyone is happy, it is merely wishful thinking that someone else can know you better than you know yourself. So avoid disappointment this Christmas, take responsibility for your own happiness whilst working with others to help them realise theirs!
 
Have a wonderful Christmas and a Happy New Year!