existential analysis
Philosophy Underpinning Counselling and Psychotherapy
Socrates, an ancient Greek philosopher, is often regarded as the father of Western philosophy and a prominent figure in the history of thought. His teachings and methods have influenced countless thinkers throughout the centuries, and his legacy continues to resonate in various fields, including psychology and psychotherapy.
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.
The lived experience of depression
Do the simplest of tasks feel impossible? Do you often feel overwhelmed, hopeless, and isolated? The lived experience of depression can vary from person to person, but there are some common themes that emerge. One of the most challenging aspects of depression is the feeling of isolation. People with depression often want to withdraw from the world around them and feel disconnected from their friends and family.
Bullying and what to do about it? (Republished from December 2016)
This article was originally published on our blog in 2016 and also appeared in the Chiswick Herald.
Bullying and what to do about it!
Research shows that one in every two people are affected by bullying. It is something that people still find very hard to discuss. Research, information, education in schools, employer advice, safety online, children, adults and the elderly are all areas and people where there is some progress but as our awareness of bullying develops then I think confusion can occur.
Increasingly I think the word can be used incorrectly and it is really important to be clear about whether your or another persons behaviour is bullying. If used incorrectly misunderstandings can be magnified and conflicts made worse, sometimes partners might accuse each other of bullying as it can justify ending a relationship. However it is also essential not to shy away from the word when bullying might be happening.
No good can come from a person being trapped in bullying and to stop a bully is to also give them a chance to change their behaviour.
So the first step is to be able to identify bullying. This sounds obvious but in my work I have found that many people have not realised they are being bullied, it is also common for people not to realise that they are bullying others. Meanwhile I also hear people accuse others of bullying behaviour when on closer examination there is actually something else happening.
Bullying can take many forms but in essence it is deliberately setting out to hurt another person either emotionally or physically. It is often a pattern of repeated behaviour and one that leads to the bullied person feeling differently about themselves and the world. Threatening behaviour, insults, unfair treatment, excluding are all possible manifestations. It is also something that often occurs to certain people because of factors such as how they appear, a disability, sexuality, gender, race or religion. There is always a purpose to bullying - it will be to make the other person feel bad and / or to get them to behave differently or do something that the bully wants.
BullyingUK is a charity that provides information and advice through their website www.bullying.co.uk and it can give you information whether you are experiencing bullying at home, work, school, online or any other context. It is also very good in terms of helping where you might be bullied for a specific reason for example your sexuality. But for the rest of this article I want to help you think about your relationships and whether there are any where bullying might be a concern.
First of all think about your family, friends, colleagues are there any where you can find yourself feeling uncomfortable?
Secondly, identify what is it about your interactions that feel uncomfortable? Is it things that are said to you, is it things you find yourself saying to them? Do you feel irritated, frustrated, nervous or scared? Do you find yourself acting differently around them to how you normally behave? Do you observe that they treat you differently to other people? Has anyone who knows you and spent time with you said anything to you about what they see happening? Are your requests / wishes ignored? Do you feel forced into doing what the other person wants? Does the person approach you even when you have shown no interest in contact with them? Do you think there is an obvious or perceived power imbalance? Do you think the person might find your interactions with them hurtfull or upsetting?
Third, what have you tried to change or stop what is happening? What haven’t you tried and why? Have you tried telling the person that you find their behaviour towards you hurtful? If so did they ignore what you said and continue or increase the hurtful behaviour? Or are you just too frightened to even try? If this is the case then talk this over with someone as the situation needs to change. If you are wondering whether you might have been bullying then can you remember how the other person responded in response to your actions or words. Did they appear calm and relaxed or nervous and scared, what did you then do? Did you continue with your words and actions? Did you ask them if they were ok? Did they do what you wanted even though they had said it was not what they wanted? If you now think that maybe you might have treated them badly you might consider asking them or find someone who you can talk this through with.
Im my experience as a psychotherapist people can feel ashamed if they have been bullied or guilty and afraid if they have been the one bullying, so speaking to someone you don’t know can often be really helpful. It is important to be able to feel able to tell the whole story if you find yourself editing out things you of the other person did then this suggests you are not talking this through with the right person.
Article on reducing anxiety
Our article - "Reduce conflict and stress in relationships" published in the Chiswick Herald on the 9th November. Please read below:
Reduce conflict and stress in relationships
Conflict and stress in relationships often come from misunderstandings and poor communication. We cannot expect others to change how they communicate but we can change ourselves and when we find communications of others upsetting then having a better understanding can help.
In this article I’m going to look at how, by paying attention to our thinking and the words we use we can become more relaxed, have less conflict with others and become happier. Initially, I will explain how we have a natural tendency towards the negative, the role of our thinking, how the words we use can make things worse for us and how we can also apply this when we find the communications of others upsetting.
Recognising the difference between interpretation and fact
For example, a friend who you had agreed to let know whether you would or would not be able to make it for coffee, replies saying
“You are late contacting me! Bad behaviour from a friend?”
As you can see the response contains judgements which are negative towards your actions namely, “late” (no date or time had been agreed for confirming) and “Bad” (a subjective interpretation) - with such wording it is likely that you will have had a negative reaction to these words?
Beware - negative interpretations cause escalations in both yourself and others
Your feeling response to these judgements is likely to be negative. What feeling it evokes in you will depend upon your current situation and also how you to tend to respond to negative comments. Importantly your own negative reaction to the judgements may well lead you to negative judgements in return. For example, if you have been really busy and not very well you might feel upset and then your own negative judgement will be to think you are being misunderstood, if you have a history of disappointments, you might feel anger and think they are unfair, if you have had critical parents you might feel anxious or nervous and think you are in trouble?
So likely responses you send in these three scenarios might well be something like:
“You just don’t understand and are not being nice”.
“You are unfair, I know what it is like to feel disappointed and you have no right to feel this way”.
With these first two responses your friend is likely to be respond with further negative judgement and accusation. A third possibility and just as harmful to your friendship would be the following:
“I am sorry, I’ve changed my diary so I can make it”.
In this response you are dismissing yourself and doing what the other person wants just to avoid conflict, ultimately the cost to you of doing this is to have inauthentic relationships that bring you little in return!
Facts, facts , facts
So what can be done?
When you receive something from someone that results in a negative feeling here is what to do:
- Pause - It can be tempting to allow your thinking to take over but this is also unlikely to be helpful as your thoughts will be based upon your negative feelings. Also when you have allowed your thinking to gain momentum you may find it hard to avoid taking action that has negative consequences.
- Take a breath and then ask yourself “what is factual here?”, with this example it can be helpful that having spotted there is little factual content and noting your negative reaction, that the important message from this interaction is that your friend is upset but not able to communicate this to you in a helpful way?
- Now develop a response with the following parts: first - state the facts, two - explain what thoughts it brings up for you. For example:
“I felt upset when I received your message and I do not remember us saying a time by which we would confirm whether or not we would be able to meet. As I felt upset, I am thinking that maybe you are upset that we are not able to meet”?
Such a response is factual, offers a suggestion about what is going on and invites further communication. Unless you are in a friendship with someone who is abusive, in which case their response is likely to contain further judgements and criticisms, it is likely your friend will see that a misunderstanding has occurred. Also if in the future difficult situations arise, this interaction will have helped build trust so that your friends initial response will itself be factual. They might for example say:
“I feel upset because I was looking forward to us meeting and I have not seen as much of you as I would have liked lately”.
And if you now note your reactions to receiving this kind of message, I imagine you feel upset for the other person and rather than defensive and wanting to avoid them, find yourself wanting to reach out and get something new organised?
Reducing anxiety - article in the Chiswick Herald
Our latest article on reducing anxiety was published in the Chiswick Herald on page 31.
View article Or read it below:
Feel happier - reduce stress and anxiety - here’s how!
Stress comes from being under pressure, anxiety comes from prolonged stress, anxiety reduces our happiness - so anything we can do to reduce pressure will have a direct impact on happiness!
In this article I’m going to look at how, by paying attention to our thinking and the words we use to describe things we can become more relaxed, have less conflict with others and become happier. Initially, I will explain how we have a natural tendency towards the negative, the role of our thinking, how the words we use can make things worse for us and then offer an experiment to help you start to make changes. This article will deal with events that we might come across everyday - in the next article we will look at relationships.
When we experience being under pressure the experience is one that is alerted to us by a combination of our feelings, thoughts and bodily sensations. Neuroscience is showing that our feelings are something over which we have very little control - our bodily sensations and feelings will be triggered in response to a perceived threat or pleasure and then our thoughts will try to make sense of what is happening and if it is a threat, to seek a solution.
Under pressure it is our thinking which often proves to be the weak link.
Thinking happens through our language, thoughts are the assigning of words to our experience and the biggest single problem with our language is how it contains so much scope for subjectivity combined with its tendency to see things as either positive or negative.
Being first and foremost concerned with our survival, negative judgements take precedence. For example, when we have a feeling we see as “good” we do not tend to dwell, analyse and procrastinate because there is nothing to be done, we are not under any possible threat. However when we have a feeling that we see as “bad” we naturally tend towards needing to find out what is “wrong”. The issue here is that we are already looking for something “bad” - we are starting with a bias.
Our experience of living may be made up of equally good and bad feelings but the importance given to the bad means the way we can end up looking at the world will be skewed towards the negative.
In addition, the difficulty of feelings that we experience as bad can mean we do not feel as though we have time to understand whether our judgement is correct. Instead our in built risk assessment systems will urge us to think about the worst scenario, draw upon our previous bad experiences and allow our adrenal systems to kick in and allow physiological action designed to save us.
Our very sensitive but not necessarily accurate systems are great for saving us when we really need it - where our safety is at risk - but it also influences us in low risk everyday situations where we find ourselves reacting to things and making negative judgements. I am not saying we stop judging but we recognise when we do this and how it has the potential to make us unhappy.
Here is an everyday example:
Imagine you are walking down the street - you narrowly miss stepping on some dog faeces. Whilst you are pleased you missed it you remember a previous time when you stepped in some dog “mess” and how annoyed you felt and the extra work involved in cleaning your shoes and the entrance hall carpet at home. The word “mess” combined with the previous memory triggers irritation and you think about how “irresponsible” people can be, that reminds you of how you found a new scratch on your car the previous week, you think “vandalism” and now you feel angry but also a little frightened. In turn that fear then reminds you of what you saw on the news about an increase in muggings in another part of the city. Now you think about how the city is changing and how crime is getting worse, how people are “dangerous” and you now feel unsafe.
Instead imagine this possibility:
Walking down the street you narrowly miss stepping in some dog faeces. Whilst you are pleased you missed it you remember a previous time when you stepped in some dog “mess” and how annoyed you felt and the extra work involved in cleaning your shoes and the entrance hall carpet at home.
NOW at this point - at the time of your initial reaction - try to train yourself to pause. You do this so that you can now look at the reaction and look firstly for words which are not purely descriptive - so ones that contain a subjective / judgement - in this case “mess” and secondly look at how this event today is triggering past negative events.
Now, having fully understood how you are reacting in a way that is amplifying the event and its negative impact on you, recall how you were feeling before this happened, take a second or so to fully experience yourself as you were.
Obviously it is unrealistic to expect yourself to do this every time something generates a negative thought and feeling however if you can start to do this occasionally you will start to understand how set backs, surprises, misunderstandings, disappointments etc end up with much more power than they fully warrant and how that can sabotage your happiness. In our next article we will look at how to apply this to relationships.
Latest article - How to make your family times happy times
Our latest article was published in the Chiswick Herald on the 14th September on page 27, click here to visit the site or read the article below.
How to make your family times happy times
For some people their family feels like the best place in the world whilst for others the worst however for most there are good times and bad times. For everyone though there will be a pattern to peoples behaviours and sometimes those patterns might change for the better!
When relaxed and happy people are able to rub along together with little conflict however individuals in groups often take on particular roles and this can lead to tension between people. When something changes or when stressful situations arise, behaviours may not change to adapt appropriately and / or the defence mechanisms deployed by people may add to conflict.
Staying quiet is an option but one that rarely changes an ongoing problem.
If you want to break patterns of behaviour that cause problems then the first thing to do is to think about your family and the particular roles people take. It is normal for people to assume a “job description” and tensions tend to arise because these job descriptions either overlap or leave holes. For example, you might have four people willing to cook but no one who is willing to clean up afterwards!
Unfortunately, when behaviours remain unchallenged and the resentment starts to build thoughts such as “they are so selfish, so thoughtless, self centred” start to occur and these tend to generate even more difficult feelings.
Do you think that person really wants to be seen as difficult?
Such patterns are normally formed because things change but habits stay static. It can be really helpful to think that the person with the annoying habit is most likely doing something automatically and doing it because at some point it was what people appreciated.
But now you need accept that the behaviour is simply one that you find difficult and this cannot be changed alone - if it could have been then you would have managed it by now!
Even if you have been able to see the other persons behaviour as not intentionally difficult it is likely you will find raising this subject difficult. A good initial strategy is to think about how you tend to be under pressure and how others therefore experience you so you can find ways to stay calm.
Fight, flight or freeze?
Under pressure people with have a tendency to respond in a particular way - this means it can be possible to predict with a degree of accuracy how someone - including ourselves will be when something goes wrong. There is “fight” meaning becoming active. It doesn’t necessarily mean becoming aggressive but if you think of movement it would be a “step towards”. For those who tend towards “flight” a “step backwards” and for those where “freeze” happens think “standing still”.
Once you have identified the response you can think about what this means in handling situations - imagine the situation then think of ways to ensure you both remain calm.
FFTP - Fact, feeling, thought, preference
FFTP is a structure for how to have those difficult discussions! In this method of communication you provide the other person with all the information about what is going on for you in relation to the issue you are finding difficult.
Here is a hypothetical but typical situation. Your brother (Arthur) who is married with three children has, since having the children, started turning up late to family events you organise and when he finally arrives tends to disagree with things arranged in his absence. Today when the family were due to meet for a walk and lunch he arrives an hour late by which time everyone had decided where to eat and ordered drinks. He says he wants to go to a different place as he has heard good things about it. You find yourself feeling annoyed and thinking here we go again. You know that you tend to get angry and that in the past you have ended up shouting so you know it will help if you can stay calm. You’ve been thinking about this and have already planned to ask if you can speak away from the rest of the family, you also know that when you sit down you tend to stay calmer - so you find somewhere you can sit.
You -
Fact - “We agreed to meet at 1pm and when you didn’t show up on time we decided on this place, looked at the menu and ordered drinks. Now you want us to change what we are doing.”
Feeling - “I am feeling annoyed, hurt and unloved”
Thought - “I am thinking that my time has been wasted, what I want doesn’t matter and not good enough for you - it is hard for me to enjoy our family time with these feelings and thoughts”.
Preference - “Can we find a way to ensure our arrangements work but can I also ask you don’t ask me to change what has been decided.”
Arthur -
“It is always so hard for us to get places on time with the children, something always seems to happen when we are leaving the house. I should allow more time but sometimes I agree to something and then don’t feel I can change my mind. Arriving late today I felt stressed and nervous because you have been angry with me in the past so I am always thinking I have to make up for being late. I think I have spoilt things and I need to find a way to make things OK so I try and suggest something that I think will be better. Now I am thinking that if I arrive late I can just relax knowing that I don’t have to do that - I don’t need to fix anything. But you are right maybe we can change the way we make our arrangements - I would like to know its OK not to agree a time on the spot so I can think about timings?”
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.
New article - Give yourself a summer mental health and wellbeing check up!
Our latest article has been published in the Chiswick Herald, click here to visit the site or read below.
Here’s how to give yourself a summer mental health and wellbeing check up!
Summer can be a great time to take stock. The disruption in our usual routines can remind us that there are different ways to live and this can be enough to help us make some simple but hugely important changes.
The summer holiday is for many people the one time when they feel they have earned the right to do what they enjoy. As a result it is a time when many things are enjoyed - some of which maybe vital for well being - but how can you decide what is vital and what is merely pleasure for pleasures sake?
It is a natural tendency for us to let the things that support us fall by the wayside at times when the pressure of everyday life demands sacrifices. I use the word sacrifice intentionally because what I see people doing every day is “sacrificing” something. Firstly because there is a hope that some reward will follow and secondly because a sacrifice is mostly seen and understood as positive thing. Everyone has heard something said like “she sacrificed the best years of her live for her children and see how they repay her”, or “he worked for them for years, put up with poor pay and now look at how he’s been treated”. It doesn’t change what has happened but it does position the one who has sacrificed as the one to be judged more sympathetically.
In other words I think people can find themselves leading hard lives because they prefer to think of themselves as someone who sacrifices. And then of course people don’t sacrifice overtime for time with their families, don’t sacrifice promotion for staying in a job they are actually enjoying, don’t sacrifice the rush hour commute in favour of a yoga class, don’t sacrifice the hour they spend each day reading bad news for an hour listening to music, reading, walking, making love… A sacrifice seems to be about giving up something we find positive…
My point is simply that the judgements and beliefs we hold about the way to approach life will affect the way in which we make decisions and not always for the best! So use the summer holidays to give yourself a mental health and wellbeing check up and heres how.
Think about and write down:
1. The things you do during your usual routines that you are pretty certain are unhealthy / unhelpful, the things you would like to change or improve for example, lose weight, drink less, exercise more etc.
2. Your life when you are in your usual routines and without stopping to analyse/censure what comes to mind list the times when you have the most positive feelings/thoughts/bodily sensations.
3. When you get the most negative feelings/thoughts/bodily sensations.
4. How this compares to when you are on holiday.
Now:
1 Write down the three most significant things that you DO NOT feel compelled by when on holiday. For example “on holiday I do not feel under pressure to get everywhere on time” again do not stop to analyse or censure.
2. Again without analysing / censuring, write down what would need to be different for example, “I would need to start working part time”.
3. NOW is the time to allow yourself to analyse and censure your reactions to these changes - so list all the reasons why you do not think you can change.
This is the point at which you will see all your judgements and belief’s - ask yourself “what of the things I’ve listed here do I actually know, where does this come from and what evidence do I have that this applies to me and my life?”.
A couple of common misconceptions about feelings explored….
Our latest article has been published in the Chiswick herald can be found here. Or please read below:
A couple of common misconceptions about feelings explored….
Is it wrong to have bad feelings when people die?
At a funeral I went to last year the priest spoke about how loss might bring up sadness, loneliness, depression and shock. The difficulty for me in hearing these feelings listed was that it led me to think that we were being told that only certain feelings are appropriate; ones that suggest we had a relationship with the deceased that was wholly positive?
In reality bereavement can bring up many difficult feelings both about the relationship someone had with a person who has died and the fact that the person has now died, for example, these might include angry, vindictive, hurt, hostile, relieved, excited, numbness etc. It was only at the wake afterwards people appeared to find themselves able to start to acknowledge the more authentic nature of their relationship with the deceased, for example to be able to say something like “I could get so annoyed with her because she used to be so stubborn” or “I could feel so disappointed because she could be so judgemental”. Even then I found myself wondering about other thoughts and feelings that remain “secret”. For example, people can feel relieved when someone dies but then feel guilty that they have that feeling of relief.
As psychotherapists, when counselling we so often have patients where part of the struggle is because they have feelings that they think are wrong or inappropriate. That means we often have to deal with the persons feelings about their feelings before we can start to work on the underlying feelings themselves.
So whats the answer? Firstly to accept that when things happen to us then the feelings, the types of feeling and the strength of feelings or even the absence of feeling are a reaction over which we have no control and no matter what we think of them they are all appropriate and justifiable. It is the actions that we take in response to feelings that can be problematic so instead of being concerned about the feelings and trying to control them, pay attention to them instead, question them, try and understand them and then think about what you would like to do.
Do you ever say (or think) “You are making me feel….”?
This is something that I think most people will find themselves saying at some time or other. For example, that person who you have told numerous times not to be late is late and you say to them (or think) “you are always late and you make me feel so annoyed!”. But of course the annoyance is yours and it is most likely because you have again fallen into the trap of expecting a different outcome? After all it is not really a surprise that they were late. So what is the annoyance? I suggest it is annoyance with yourself and because we like to try and get rid of negative feelings as quickly as possible we can mistakenly expect the best way to deal with them is to allocate them on someone else.
Because our feelings appear so powerfully to us when someone says or does something that generates a reaction, and because it is also usual for others to quickly think we are the source of their feelings, this basic notion is almost hardwired. However this misconception does not help us, because the way in which we respond to people and situations is a uniquely personal thing based upon a range of factors including our life experiences, expectations and cultural norms to name a few. And the proof? Can you say you never witness different people responding differently when in the same situation? It is a common phenomena that when there is an incident, police witness statements typically contain very different accounts of the same incident. And what about all the times when you have found that your explanation of someones behaviour is different to someone else’s?
The reason why this is so important is that you can change your way of thinking so that you see your feelings as YOUR response to a situation or person. And when you do this you can consider what those feelings are telling you about yourself and how you are living your life. Back to that person that is always late, now you are no longer putting the responsibility for your feelings on them what do YOU want to do about avoiding either the situation or the feelings next time?
If you would like to speak to a counsellor for help and advice please don't hesistate to get in touch.
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.
Mental Health Round Up
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!
New article - Latest advances in treatment of anxiety and depression coming out of the USA
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?
- 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.
- We still don’t know whether conditions are nature or nurture or both
- 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
- Chose a therapist with whom you feel comfortable - someone with whom you find it easy to speak openly with.
- Remember you are in charge and give feedback to your therapist to ensure you get the best possible outcome.
New article - Keeping yourself and your family safe online
Our latest article has been published in the Chiswick Herald, click here to visit the site or read below:
Keeping yourself and your family safe in a world of online communication
It is becoming clear that whilst the legal landscape is changing to try and keep up with the online communication revolution, ultimately our safety is dependant upon our own abilities to decide on the most skilful way to use new technology.
In this article Nicholas Rose suggests some information sources that provide valuable information about safe use of the internet and social media but also suggests how to most skilfully use them.
The wonder and the horror of online communication is its scale, immediacy and permanence. There is such a vast world of people and issues available online that we can engage with instantly however any mistakes are recorded and once information is out it can be impossible to retrieve it. What we do and say has consequences and so we have to develop skills and experience to ensure that we minimise the risks of being misunderstood and maximise our understanding of the things and the people with whom we engage.
It is obvious that new technology is providing new ways for criminals to steal, abuse and violate and an excellent website giving detailed information on security and safety is www.getsafeonline.org however here I want to look at how we can judge what is going to be the most skilful use of technology for us individually. And when I say skilful I mean how we ensure it is harnessed for positive benefit, enabling us to engage with subjects and people who can enrich our lives and how to avoid those that might be to our detriment.
So when I am talking about safety it is not just about physical, financial and psychological safety its about protecting our full potential. If you are parents then again there is lots of great information, even by age range on the above website but your children will still benefit from you teaching them how to be skilful in their use!
We live in a world where lives can be ruined by a seemingly simple mistake and so often we hear people being accused of “poor judgement” and this can have a devastating impact on someones life. Ultimately it is poor judgement that leads to us making mistakes, of course mistakes can happen but given the power of social media and technology what can we do to avoid them as much as possible?
- Boring as it might be do the research and read up on what best practice is for protecting yourself online.
- Think about your strengths and weaknesses in life - finances, relationships, health, parenting and then think about the benefits social media and technology can offer but also identify areas where you might be more vulnerable.
- Think about the experience of communicating and engaging with information and people and how this varies across situations and media.
- So what is it like for you to be with family, friends, colleagues in face to face situations - how does it vary and why?
- What is your preferred way of communicating in different situations and with different people and why? Face to face, telephone, text, facetime/skype, email, social media….
- So with whom and in what situations do you feel most at ease and in which do you feel least at ease?
- Can you now identify the people and situations in which you may struggle to communicate and those where you will find it easiest?
In guidance I have read it often says to notice how you feel and think in response to content or communications to see if they bring up any negative feelings or thoughts. The intention here is to encourage people to listen to the very good warning systems that we have but can so often dismiss. However, I also suggest looking out for very positive feelings or thoughts - whether we are nervous or excited such feelings can influence our actions and awareness of these feelings can be used as a signal that we may benefit from exercising some caution. Look out for your reactions both positive and negative and when you are aware of them consider the following:
Think about how you are feeling and ask yourself whether those feelings appear logical given the context. If you have no feelings or very strong feelings either positive or negative then try and take a step back before offering any information or entering into any further communication; try asking yourself:
- In what way is this material / content / communication triggering these feelings - what assumptions am I making and what are the other possibilities?
- What do I want to do or say now and what might the consequences be?
- If I put myself in the other persons place how might they interpret what I do or say right now and what might result?
- What am I wanting from this situation and what if I don’t get what I want?
- Am I feeling under any pressure here and what is the source of this?
- Thinking about past situations are any similar - do I have a pattern of behaviour that can be unhelpful and is this an opportunity to change it?
If as a result of this reflection you are left with any sense of doubt or dilemma then think about taking a step back to give yourself more time. Consider doing something else and going back to it later or ask someone else for their views.
New article - Depression how to think about it and how to recover from it
This article appeared in the Chiswick Herald. Please click here or read below:
Depression - how to think about it and how to recover from it
News reports last week covered research showing that 25% of architecture students in the UK are receiving or have received treatment for mental health problems related to their studies. Unusually this study sought to identify the sources of the distress and was able to list a number of factors - importantly all of these were outside of the students control.
It is often rightly stated that a stigma exists around depression and other mental health illnesses. However the point that often gets missed is that one of the biggest blocks to sufferers in recovery can be their own attitudes to both mental health and themselves for experiencing mental illness. It is really common for people to feel upset with themselves for struggling and to try and almost bully themselves out of their feelings. Unfortunately this tends to result in sufferers feeling even worse and they can become stuck in a vicious cycle of thoughts and feelings.
This research amongst students suggested that financial pressures, workloads, working conditions and sexual and racial discrimination were all serving to damage the mental health of one in four of these students. And as I have written previously, it seems that the mental wellbeing of students and employees in the education sector has been overlooked for some time. So much focus os put on results and processes with little emphasis on wellbeing.
So research like this is really important because it shifts focus when someone is struggling. Instead of questions being raised around how the person is coping (or not coping) with the inference being that they are not doing something right, it can be directed at looking and considering the context in which the person finds themselves.
We know ourselves through our relationships with others and yet when we are having a hard time, it can be really easy to conclude that it is only us that are finding things hard. I wonder just how surprised but also relieved architecture students were when they read the findings of the research? For many I suspect they will have felt intensely relieved, not that so many others struggle but that they are not alone. And more importantly the cause of their depression and anxiety is not simply themselves.
Getting a comprehensive understanding of the issues someone faces and the context in which they live and have come from is crucial in getting to grips with depression. Before anyone can start to recover they need to discover some hope in the potential for them to lead a life without such painful and overwhelming feelings, or as is often the case with depression absence of feeling. And hope comes from the realisation that the depression is only natural given where they find themselves in life, that it is not that they are doing anything wrong but the contrary, that it is only right that given their circumstances they can feel as they do.
Being able to make the connections that makes sense of the experience starts a process whereby positive connections can start to be made. Ways in which the sufferer can start to do things differently, take control, build confidence and distance themselves from the illness and increase their sense of connection with the world, others and their ability to find life satisfying and rewarding.
Again though, during recovery one of the biggest hurdles can be a persons impatience with their recovery. The desire to get away from the experience of depression can be so powerful that they can be vulnerable to almost addictive behaviours. Exercise can be a good example of this, the physiological feelings and rewards available from exercise can lead to addictive behaviour and ultimately this can act to sabotage recovery.
To prevent this it is important to spend time to reflect on whats happening, the changes being experienced and to consider the consequences of decisions moving forwards. It is a common phenomenon that people who appear to be on the point making a full recovery make a decision that can have devastating results. In fact suicide risk can be greatest for people who appear to be in recovery than those in the depth of their depression.
Mental illness is such an unpleasant experience for suffers and their loved ones that it is only natural to try to avoid dwelling on difficult feelings and to want to look forward and focus on the positive however taking time to think about how things are going and how to maintain momentum whilst allowing set backs is crucial.
If you or someone you know is suffering from depression then consider seeking help. A counsellor or psychotherapist will have the right skills and experience to help understand the depression, its causes and then provide support through the entire recovery process.
Patients often ask me how long it will take, how many sessions will be needed for them to recover. My answer is always a simple one - we know we are finished when we no longer have any concerns that are usefully talked through.
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.
- State the fact/s
- Say what your response say how you feel and think (never say you make me feel / think because that will escalate conflict)
- Explain why this matters to you
- 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.
- I said we would need to leave at 9am but you have arrived at 9.45am
- I feel upset, angry and under pressure
- 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
- 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 - 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.
Nicholas Rose
Nicholas Rose is a psychotherapist registered with the UKCP working with adults both individually and their relationships.
