anger management

Working Through Inner Conflicts with Talking Therapy

Lived experiences of inner conflict often generate emotional turmoil, characterised by intense feelings of doubt, anxiety, and tension. The contradictory thoughts and desires within us can create a sense of ambivalence, making it challenging to make decisions or take action.

While inner conflicts can often be distressing, they also present opportunities for personal growth and development. Through introspection, self-reflection, and seeking external support, individuals can work towards resolving these conflicts.

How big is your list of 'micro oppressions'?

New article - Interview with Nicholas in Chiswick Magazine

This month an article appeared in the Chiswick Magazine after Nicholas was interviewed by their Editor Katie Saunders. Please click here to read.

How does that make you feel?

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.

New article - Happy relationship, happy children?

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.

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!