New article - How to make the school holidays the best ever

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.

New article - Traumatised by the EU referendum?

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. 

New article in Chiswick Herald - anger management

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!

New article in Chiswick Herald - Yoga Retreat Review

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”. 

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

New article - thinking philosophically

Our latest article in the Chiswick Herald publishes today and is available online here.

Or read the article below:

Feeling lost? What happens if you think philosophically?

When I first meet people and I ask “How is it that you are here?”  they often tell me they are feeling lost. The experience of feeling lost is one that can be so painful and confusing we naturally tend to look outside of ourselves for help in again finding a way forward. In other words we are no longer finding it possible to approach our situation philosophically.

In my view, our tendency to blame ourselves for having become lost feeds a sense of isolation and loneliness; one which helps prevent us from harnessing our innate abilities to again find our way. And of course any pattern of thinking that encourages us to think negatively will only escalate how bad we feel. We can feel sad about feeling sad, anxious about feeling anxious, confused by our confusion, lost in our lostness; I think you get the point.

To break the cycle we need to do something differently that results in us again feeling hopeful and enables us to again engage with our innate philosophical potential. After all, and to allow us a brief moment of philosophical thinking, to feel lost means that at some point we did not feel lost? And to approach philosophically the point at which this changed is where we will find the information we need to again find our way. But how? Firstly, we need to find a calm disposition and secondly foster a curiosity towards our situation. 

When people come to see me it will become apparent very quickly as to whether meeting with me has the potential to be helpful; whether we can develop a therapeutic relationship. In the first session the single most important factor determining the potential outcome for us is how the person feels in spending that first fifty minutes with me. Do they feel relaxed, are they feeling free to speak openly to me, do they feel heard and understood by me? Is there a glimmer of hope that has surfaced as a result of us meeting? Are my questions or questions that are occurring in them encouraging them to think about things in a new way? The therapeutic relationship is the foundation of healing and often research has shown that for many, a relationship where the person has felt safe, cared for, heard and understood has been what has mattered most. 

And as suggested earlier the second aspect of a philosophical approach is being able to think clearly about our situation. When young, we quickly learn through the use and questioning of the information our senses provide. Our thoughts, feelings and bodily sensations are converted into information that enables us to understand the world when we also ask when? where? who? what? how? and why? And this learning forms the basis of how we make decisions. As we go through life we will automatically respond to situations that we understand as familiar bypassing any great contemplation of our senses or any rigorous questioning.

This all works fine until the situations are in fact not similar enough that an automatic response is the best choice.   Our context may have changed, and/or we may have changed, either way a response that always used to result in a positive outcome is resulting in a negative outcome. We try again and again and that only leads to us feeling worse until we realise we are lost. What we missed at the moment when our choice did not provide the outcome we expected was the need to remember that everything changes. And with change comes the need for us to be prepared to accept that the things we have come to expect as certain may need us to revisit them.

The ease with which we can do this alone depends upon many things but I think that if you are not finding a way to feel calm and that as a result you may not be finding it possible to think clearly then do not punish yourself for feeling this way. Be as kind and compassionate as you would be to the person you care for most in life. After all, surely you would tell them that they deserve help, that it is ok to sometimes need to seek help, that they do not need to feel alone? And once you no longer feel alone and you are again able to access the full potential of your curiosity you will again find your way.

Notes about Nicholas:

Nicholas is registered as a Psychotherapist with the United Kingdom Council for Psychotherapy through the Society of Existential Analysis following a training that applies philosophical enquiry to concerns that are often brought to counsellors and psychotherapists. This particular approach to therapy combines the therapists wish to alleviate the suffering of others with a framework borne from existentialism and phenomenology. 

New Chiswick Herald Article - Send us your dilemmas

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 

New Director Renato Cristini

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.

New article - when stress leads to anxiety

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.

New article - Stressed by your work or responsibilities?

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?

Article - How can we fix our relationship?

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.

A Mindful Festive Season - Part two

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.  

Wishing you a mindful Christmas

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

Wishing you all a very mindful Christmas

When I was thinking about what to write for this column I decided to search the internet for “mental health news and Christmas”. The search results displayed many features on how to manage stress over the festive period and I felt discouraged. It seems that Christmas and the New Year are often only really considered for the struggles they bring rather than the potential for reflection, contemplation, love, fun, connection, relaxation and self expression. What did catch my eye though were the many references to Mindfulness and through the website for the Mental Health Foundation I came across an online training course in Mindfulness.

Mindfulness is something I know quite a lot about having started meditating nearly twenty years ago and have always found the more mindful based practices the most helpful. I have also enjoyed retreats and trainings to develop my practice and yet it is at times when I could most benefit from mindfulness that I can so easily end up doing other, arguably less helpful things with my time. And this Christmas is a difficult one for me, it is a year on since the death of someone very important to me and so naturally, as the anniversary comes closer, then I find myself experiencing difficult emotions and thoughts. My body is also showing me that it is a hard time, a cold, tense neck and shoulders muscles a few headaches and occasional sore tummy. So now really is the time for me to be particularly kind to myself and to call upon my mindfulness practice - yet the turbulence I am experiencing also makes this hard to do. I think this explains why this online training has attracted my attention and so I’ve decided that for the next few columns I am going to take the training and then share the experience.

The background information from the provider of this training, a website called www.bemindfulonline.org, states research conducted by Oxford University published in the BMJ (British Medical Journal) reported 58% reductions in anxiety, 57% in depression and 40% in stress; so I feel excited and hopeful thinking about getting started. If you sign up you get free access to a short introductory video from the two Trainers Ed and Tessa. Watching this I find the trainers very reassuring, with what they say resonating easily with my experience of mindfulness. And I find I am really warming to this as an approach to learning, you can take this at your own speed.

Next is a short video introducing a pre-training test. In this Ed explains it will benchmark how you are experiencing and relating to stress to allow for comparison at the end of the course. Taking the test, I recognise the questions that are widely used to form generic tests for stress, anxiety and depression. As I complete the tests I am struck by how the last two weeks have been particularly hard for me and I am again drawn back to thoughts around the events and memories from the run up to my bereavement last year. A further video from Tessa acts to again reassure but also encourage continuing with the course. At this point though the free introductory element comes to an end and a fee of £60 needs to be paid before you can continue. I’m feeling curious so I find it easy to make the payment.

It feels good to be getting properly started and the first exercise is one I’ve done before - they call it mindful eating. What really strikes me is how distracted I am, how hard it is to focus and my awareness of this I find reassuring. I’m already starting to gain a sense of empowerment, I’m thinking I’m on to something that is really going to help me at this time. Pressing the play button again Ed and Tessa now introduce the tasks for week one. Again they are exercises I’ve done before but in hearing what I will be doing I start to feel more relaxed. I’m thinking it is as though I am being allowed to slow down, to go at my own speed. It is a bit like having someone who really really trust ask you what you want to do and then to have them give you reassurance that you really do know best!

So what will I be doing each day for the next week? The tasks are as follows firstly to eat a meal mindfully, secondly choose a daily task for the mindful treatment - mine will be cleaning my teeth and lastly a thirty minute guided mindfulness relaxation. It is going to be a busy time over the next week as I prepare for the Christmas break so I’m going to need a bit of will power. By the next time I write I will be able to tell you how it has been and what exercises were introduced for the second week. In the meantime from all of us here at Nicholas Rose and Associates we wish you all the very best for a mindful and enjoyable Christmas and New Year.

New article in the Chiswick Herald

The latest edition of the Chiswick Herald includes this new article helping with the common concern people often have about how to talk and therefore help a friend or relative who is struggling with mental health concerns. Read it here:

How to talk to someone who is really struggling….

The Mental Health Charity Mind quotes research that 1 in 4 people in the UK will experience a mental health problem each year. So its no wonder that in working as a psychotherapist people often seek my advice when they are concerned about a friend or, family member. In response to this I always ask “Do you believe offering your time and attention will not be helpful - that you won’t be able to think together about a way forward?”

Often I hear the problems appear so big and complicated there is a sense of not being able to help and people can be feeling fearful that anything they might try to do and say could make things worse. It is natural to experience such a response because it is likely the person you are concerned about is thinking and feeling this way too. At this point many people become nervous that they are not equipped to help, particularly if words come up like suicidal, crazy, murderous, out of control, psychopathic or any of a whole range powerful words or the many psychiatric terms that are becoming so widely used nowadays. So it can be useful to recognise that actually you are already developing a good understanding of what is happening for them and that this means you are already able to help. 

These thoughts and feelings are most likely coming from a place of isolation, loneliness and desperation and the most effective way to start dealing with things is not to panic but to see if you have understood correctly. Do this by asking something like “I am wondering whether you are thinking the problems are too big and complicated, things can only get worse and you are feeling isolated, lonely and desperate?”

In doing this you will already be helping with the feelings of isolation and loneliness and your willingness to ask questions will already be challenging the feeling of desperation. Now start to consider whether either of you might be struggling to talk freely. One of the most frequently given reasons people give for choosing to talk to a therapist is they don’t need to worry about what impact sharing their problems will have on either the other person or that relationship. So if you think that the conversation isn’t flowing freely then ask. You can then both think about whether there is someone else who it would be easier to talk to. 

If you both decide to carry on talking then the next thing is to ask for as much information as possible. If suicide has been raised ask about it - “you have been thinking about suicide? what have you been thinking of doing? what has stopped you?” It is likely that the conversation will move onto the underlying problems but if not then maybe this is the time to talk to them about taking more immediate action. Again, Mind’s website suggests what action to take. 

Assuming you both feel it’s proving helpful to talk then you can think through together the basis of the concerns. Consider questions like what is going on? What if anything has changed? Why might the concern have become apparent now? What has been tried to sort things out? Whats different that means you are not coping like in the past? Is this a completely new experience, if not what happened last time? What options have been considered and why have they been ruled out? What would you like to do if you could do anything you wanted? Ultimately to help them think through what to do to start to make their situation better.

Remember although you are asking questions it is not for you to answer them. You might have opinions or think your own experiences are relevant - it can be helpful to share these but ask whether they want to hear them. Opinions can be really helpful if you know the person well enough however remember answers are only really answers when we find them for ourselves - to give or be given an answer is rarely the answer! The most important opinions and experiences are the persons own. 

If after having talked things through the other person is still really distressed ask what they would like to do now and what they want from you? If you are concerned tell them what you would like to do, if suicide has been talked about ask if they are still feeling suicidal. If it’s a yes then again talk about the options for getting more help. If at the end you are left feeling nervous about whether they will be alright then think about what you need. You might find it helpful to talk this through with someone.

If you have any questions about this or to book an appointment, please contact us on 020 8996 9551 or send an email to info@nicholas-rose.co.uk and we will get back to you.

How to improve your relationship, published in the Chiswick Herald - Part Two

To read our latest column on couples counselling including a guide to a specific therapeutic approach called Emotionally Focussed Therapy (EFT) used by our Senior Associate, Marybeth Mendenhall please click here. Or read it here:

TITLE: How to improve or even save your relationship - part two

In this editions' column, and following a number of reader’s letters we are writing more about therapy for relationships. It seems to me that there is a great deal of interest in relationship therapy at the moment, just last week I met with a TV production company interested in covering couples going through the therapy process. 

Time and again I hear of people who feel reluctant to go for couples therapy because they have heard often going for therapy results in relationships ending. I’m not saying this is not a common outcome but from my experience it is often because couples turn to therapy as a last resort, when too much has happened, they feel too tired to find the energy for the changes that need making and, when they no longer remember just how good the relationship can be when it did work well. 

I asked our Senior Associate, Marybeth Mendenhall, a Family and Relationship Psychotherapist, to give an overview of a model she uses in her work with relationships. Marybeth writes “Couples distress is the single most common reason for seeking therapy.  It undermines relationships and family functioning and can often lead to feelings of despair, depression, loneliness and anxiety.  

Emotionally Focused Therapy for Couples (EFT) is a structured approach to couples therapy that sees adult needs for safety, security and emotional closeness at the core of  loving and meaningful relationships.  EFT has been acknowledged as one of the most researched, empirically validated approaches to working with couples.  

Distress usually occurs in couples when feelings of safety and security are threatened, and then we find ourselves getting into arguments or negative interactional patterns, which repeat themselves over and over again.   Using this approach we focus on helping partners restructure the emotional responses that maintain their negative interaction patterns.  Through a series of steps the therapist leads the couple away from conflict deadlock into new bonding interactions.  

When couples argue over issues, the origins of these arguments are some form of protest from one partner about not feeling connected, not trusting, or not feeling safe or secure with the other partner.  When those we are attached to are not available, or are not responding to our needs to feel close or supported we feel distressed.  We may become anxious or fearful, numb or distant.

Those behaviours can become habitual or rigid modes of reacting to our partners.  Sometimes these behaviours feel toxic, and they take on a life of their own as they cycle into destructive interactions that cause much pain, injury and despair.  When a relationship is in trouble we tend to start a habitual ‘dance’ which Sue Johnson, the founder of EFT for Couples, calls the Demon Dialogues;  one person might start criticising and complaining and the other gets angry and starts defending.  This demon dialogue takes on a life of its own as it gains momentum, and very soon we see the other person as the enemy. In couples therapy we focus on these patterns and work on changing negative interaction cycles in a non-judgemental environment.

EFT helps partners begin to identify where their misunderstandings are and how their negative dance affects the other. In a relatively short time, couples begin to recognise and eventually express their needs for love, support, protection and comfort that are often hidden or disguised.

Once feelings of connection are re-established, you will be better able to manage conflict and the painful or difficult feelings that will inevitably arise from time to time in your relationship.  Furthermore, without so much defensiveness, each of you will be able to send clearer messages and will be better able to hear the other’s perspective, collaborate, problem solve and compromise. In short, you’ll be more of a team, which is the secret of a long -lived, successful partnership”.

In our next column I will be writing about how to help someone you care about when they are struggling.

If you have any questions about this or to book an appointment, please contact us on 020 8996 9551 or send an email to info@nicholas-rose.co.uk and we will get back to you.

How to improve your relationship, published in the Chiswick Herald

Our latest column in the Chiswick Herald talks about relationships, click here. Or read it here:

How to improve or even save your relationship

Believing that we understand our partners and that they should understand us is the biggest source of trouble. It is what comes up again and again in my work with couples. The problem is that it sounds really obvious but its actually far more complex. Even the strongest and longest of relationships can struggle and once a relationship starts to have unresolved issues then intimacy and connection can be affected.

External factors are often very influential in difficulties arising, bereavements, work stress, redundancies, children arriving and leaving, health challenges and traumatic events can result in a couple feeling like they are working against each other rather than pulling together.

I asked my Senior Associate, Marybeth Mendenhall, a Family Therapist with a great deal of experience in working with families, couples, adolescents and individuals to talk to me about what she finds in her work. “During times of stress our sense of safety is challenged, and this triggers coping mechanisms that are built on our assumptions of the best ways to stay safe. Assumptions are based upon unique life experiences and therefore potentially reveal huge differences between partners”.

For my part I think about this in how we share many of the same needs for example, family harmony, to be a good partner, or parent and yet our strategies will be very different. I remember being at a conference where we were asked to say how love was shown in our families. I was amazed by the range of responses including time, holidays, education, family events, food, travel, working together, fun, looking after the older family members, being given the opportunity to go away, being encouraged to try new things… the list went on. I still think about that when people say they don’t feel loved - it sounds simple but actually there is so much to understand. And time and again couples struggle because they just cannot understand why their partners are behaving in a certain way when they would behave completely differently in the same situation.

“Couples often struggle to reach a full understanding around a point of conflict because they do not feel heard by the other. A major part of my work is to help couples develop listening and conflict resolution skills.” states Marybeth.

Marybeth and I put our heads together and came up with some core guiding principles:

1 Words like “love” are short cuts – when talking to each other ask what they mean when they say that.

2 Learn how to improve your communication skills. For example, if you feel hurt by something that your partner do not assume that the intention was to hurt you, instead say how you felt and ask if that was what had been intended.

3 Never underestimate the possible impact of change, difficult times and stress.

3 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 to make the changes required.

In the next edition Marybeth will write in more detail about the techniques she uses in working with couples.

If you have any questions about this or to book an appointment, please contact us on 020 8996 9551 or send an email to info@nicholas-rose.co.uk and we will get back to you.

Introducing a new column in the Chiswick Herald

We are pleased to announce that we will be writing a regular column in the Chiswick Herald. We would like to hear from anyone who has a question they would like to see answered in the column.

Contact us

Get in touch by calling 020 8996 9551 or send an email to info@nicholas-rose.co.uk

How do I find the right therapist?

Research consistently shows that the single most important factor for a positive outcome from counselling / psychotherapy / therapy is the quality of the relationship between the client and therapist.

Nicholas Rose says "When searching for a therapist do not be afraid to ask questions and do not censure any thoughts or feelings you have about whether you want a male or female therapist, someone older or younger, someone with similar life experience, straight or gay, particular ethnicity, religion, language, how much you want to pay, how often you want to meet - whatever it might be that is important to you." He continues "The most important thing is that you feel relaxed and supported by your therapist then you will be able to talk about things that really matter, things that you might not have spoken about previously and that are crucial to you being able to identify, understand your struggles and then if you chose - change."

There are many therapeutic approaches but they sit within three basic underpinning asumptions - the humanistic focuses on the importance of positive relational experience, the analytic that looks to review information about a persons life often historical but also considering the present and future and then the behavioural that looks at thoughts and feelings and seeks to identify those that might be unhelpful and replace them with ones that are more supportive. Says Nicholas "it all depends upon what we believe and want, some people are relational, some analytical and some behavioural - again its about finding a therapist where you feel connected, understood, affirmed and who can then help bring new insights." 

Nicholas Rose & Associates offers a team of qualified and experienced therapists - as a practice we are able to offer you a choice of therapists and therapies. 

Contact Us

If you have any questions about any of our therapies or therapists, please contact us on 020 8996 9551 or email info@nicholas-rose.co.uk and we will get back to you.

New book on Existential Therapy published by Ernesto Spinelli

Professor Ernesto Spinelli's new book "Practising Existential Therapy, The Relational World, Second Edition" has just been published and is excellent. It is both eloquent and accessible, clearly illustrating the basic ethical underpinning of this therapeutic approach whilst providing a thought provoking framework for existential practice.   

Thinking about therapy?

Spring brings new energy and with it the possibility for new opportunities - it is a great time for starting therapy.

Did you see?

Nicholas recently appeared on episode 3 of the latest series of "My Naked Secret" offering cognitive based therapy to "Sam". Screened on the Discovery Channel, the series seeks to help people who have issues with their bodies that they feel are ruining their lives.

Join our team?

We are interested in finding counsellors and psychotherapists to join our team who are acccredited with the BACP and/or registered with the UKCP and have at least two years experience of working in private practice. Please contact Nicholas to discuss the opportunities further.

Office relocation

From the 1st April we will be relocating a short distance to The Chiswick Health and Wellness Spa, 300-302 Chiswick High Road, London, W4 1NP.

Saturday services for couples and relationships

We have recently extended our couples counselling service to include Saturdays. For relationship counselling, marriage counselling and couples counselling services please contact us to enquire further.

Couples Counselling London

Couples Counselling can be a positive experience at any stage of a relationship, as relationships pass through various stages new challenges and possibilities arise where counselling can facilitate growth, change and alleviate conflict. Very often, it is helpful when one or both of you are feeling misunderstood or isolated, or when you identify negative and destructive patterns.

If you are based in West London and feel that you could benefit from couples counselling then Nicholas Rose and his expert team are here to help you through any issues that you may be having

Please also remember we run evening sessions, and sessions via Skype, telephone and email. For further information please feel free to contact us.

Off peak reduced fee service

We are pleased to announce the introduction of a number of reduced fees for services during off peak times. For full details click here.