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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 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!
 
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When couples with children come to therapy one of their biggest fears is that any trouble in their relationship might be affecting the children and often guidance is sought about how best to protect them. The bad news is that such fears are well founded, the good news is that there are things that can be done. In this two part article we will talk about how to approach difficult situations, highlight warning signs and suggest ways for handling them constructively.
 
First of all you need to complete a thorough assessment of your relationship to be clear about what the concerns might be - a clear understanding of how you are in your relationship will enable you to think more clearly about the times and situations when things may be problematic and when your children might be affected. 
 
So thinking about your relationship - are you happy with it? Do you always say whats on your mind? Do you feel listened to? Do you feel understood? Do your needs get taken into account? Is your relationship as strong as it has always been? Do you think your partner is happy? Does your partner do the things he or she used to enjoy? Do you laugh together? Do you enjoy your sex life? Do you have lots of happy memories together? Do you look to the future together with a sense of excitement? 
 
If you are starting to identify think about some problem areas try and be as clear as possible about what you have noticed. Avoid conclusions like we are so loving anymore - instead identify behaviour for example we don’t have date nights any more. Once you have identified behaviours, think about when the behaviour change happened. What was happening in your lives at that time, what was the impact of events, what was discussed at the time and were issues resolved? Even if you were happy with the way things were handled, was your partner? Have you ever checked in to see if your partner was happy? Thinking about any unresolved issues, what happens when situations arise that remind either of you of it? How do you handle it? What is the impact of it? What gets said and what does not get said?
 
By now you should have a good idea of the situations, contexts and times where conflict may exist. Even if you feel comfortable with the problem areas identified and think that conflicts are manageable between yourself and your partner you may want to think about whether there is anything to address with your children. So the second stage is to now think about your children.
 
Bringing conflicts to mind what do you think your children would say, think and feel about them? Do you remember anything they said or how they reacted? Did you understand their reaction? Did you explore with them what they wanted from what they said or did? Has their behaviour changed at home, at school or with their friends and how do the changes correspond with changes in your relationship? Has their relationships changed with you, your partner, other family members and relationships?
 
If you are starting to think about times when things were difficult and finding yourself worrying about whether you handled them in the best way then the very first thing to do is to stop that negative train of thought. Instead congratulate yourself for your courage in giving this some thought and look at this as merely a stepping stone to improving things.
 
A relationship without conflict is unlikely to be one where those in the relationship are fully engaged so it can be really helpful to remember that intimacy can come from conflict in as much the same way as through good times! Conflict shows the existence of care and what is important is that it is handled in the most skilful way. The problem for children is that they often only see the negative situations and may start to worry about what might happen or even, in situations where parents have resolved a conflict not know for certain that is the case and suspect that worse is still to come.
 
In our next article we will look specifically at what to do now.
 
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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.