Choosing the right therapist

Seeking help from a psychotherapist and counsellor is an important step towards improving your mental health and we understand how difficult this might be when you are not feeling your best. It can be daunting, overwhelming and confusing to navigate through the abundance of options available but there are key factors to consider when choosing the right therapist for you.

Relationships - think you understand each other?

The anxiety of knowledge and what to do about it

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?” 

Latest article - relationship dilemmas, when you or your partner wants change

Our latest article has been published on page 27 of the Chiswick Herald. Click here to visit the site or read below.

Relationship dilemmas - what to do when you want something to change

One of the concerns couples often bring to therapy is the conflict that arises when a partner wants something to change in the relationship. Maybe its something to do with lifestyle, socialising, money, sex - whatever the issue many couples struggle to integrate change.

A major reason is that before the need for change becomes clear there is often a period of growing dissatisfaction. During this period couples often start to argue and both end up taking polar positions on the issue, often the issue itself becomes overshadowed by a power struggle.

“Avoid playing the blame game.”

It can be difficult for the dissatisfied partner to talk because they can feel awkward or guilty asking for change or maybe the conflict has become so difficult they fear raising the subject? And for the other partner they may also actively avoid the issue, nervous that they might not want to make the change or that the change is the start of other changes for which they are not yet ready.

A very common situation is where something that was merely slightly irritating in the early stages of a relationship appears to grow in importance. We all tend to be on our best behaviour in a new relationship, not wanting to be difficult but also having a significant amount of goodwill. As our relationships settle down our desire for our relationship to be one we experience as supportive and relaxing means that things we find irritating can start to damage our relationship.

“It can be helpful to see this as a sign of a maturing relationship”.

Here is a hypothetical but typical situation - M & T have been together for two years. M has been increasingly annoyed about the amount of time T spends with children from a previous relationship. Things came to a head recently when there was a confusion about dates, there was a wedding for one of M’s friends on the same day as T’s youngest was graduating from University. They argued about it, M revealed that this was the latest in a long list of upsetting times, T was angry that M should be upset. The issue was not resolved, M went to the wedding and T went to the graduation - they both felt hurt and something between them shifted. After a few more arguments and with growing sense of unhappiness they came to therapy.

Through therapy the first thing we did was de-escalate the conflict. Both M & T could see that disappointing though it was to have struggled with this issue it was a relatively common problem. They were also able to discuss how having this issue had led to them “catastrophising” in other words they had starting to wonder if the relationship had been a bad one from the start. Such thinking had badly affected the relationship so by speaking about this they were able to see that the growing conflict was merely a symptom of a need to improve their communications.

In the second stage of therapy M & T learnt how to speak about things when they were upset or importantly sensed that each other might be upset about something. M spoke about how sometimes it had felt difficult to say how it felt in a situation and had seen something in T’s reaction that meant the possibility of conversation had closed down. Meanwhile T spoke about how it was difficult to see M upset, had spotted the upset but had been fearful that they would end up arguing. 

Following this M was now able to tell T that the worst thing about this was not that it prevented them finding a solution but that it raised a fear that T was not interested and that they could not communicate. Meanwhile T was able to say that M often appeared really angry and spoke in an aggressive way that meant it had to be M’s way. So they could easily see how they shared the fear that neither was interested in communicating but only getting their own way.

They were now able to see how the misunderstandings had occurred, they were relieved to hear that they both actually wanted the same thing - to be able to talk about things. When encouraged to make an agreement between them to deal with this going forwards M asked T to check out whether they needed to speak when such situations arose in future, meanwhile T stated clearly a desire to hear from M in those situations.

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 - Keep your children safe and well in their use of the internet

Our latest article was published on Friday 27th April in the Chiswick Herald. Click here to visit the Chiswick Herald Online or read below:

Keep your children safe and well in their use of the internet - part three

My previous editorials have focussed on safety and how to speak to your children if you are concerned about how they keep themselves safe but also if you have any concerns because of they way you see them using the internet. Today I thought it would be useful to consider appropriate use of the internet to contribute to the wellbeing of your children.

In June this year new studies provided evidence that moderate use of the internet and social media does actually benefit children and young people. Suggesting that use of social media helps build resilience and develop social skills thus having a positive impact on mental wellbeing. So it looks as though the usual thinking about moderation in all things does also apply to the new digital age too.

More than a third of 15 year olds in the UK are understood to be classed as “extreme internet users” sending over six hours a day online and 95 percent are using social media. Extreme users are more likely to report being bullied online and research by the NSPCC identified that 80 percent of children felt unsafe using social media to some degree.

In all cases research suggests that parents need to be supported in helping children use the internet appropriately but there appears to be very little guidance out there on how to do that. Most focus is still on safety rather than wellbeing. 

Current thinking concludes it is unlikely that one size will fit all and that the appropriate use of the internet will depend upon a range of factors. You might like to think about your child’s age, interests, social networks and particular needs. 

If your child could do with help in particular areas then the internet will be able to offer advice, support and even tools. It is most likely that the most effective approach is to actively talk to your children about how they use the internet and look for how it can support them. Focussing purely on time spent online is going to be too limited.

To understand the uses that lead your child to experience positive outcomes and affirmation to their self esteem and seek to strengthen and support this use is likely to be more effective than focussing on usage where it either appears to be causing distress or at best appears to have little benefit.

Rather than any single solution, it appears that children benefit most when parents use a combination of approaches including modelling positive behaviour, using a collaborative approach to setting limits on usage, keeping up to date on developments and technologies around security and online safety and showing curiosity and a willingness to support positive behaviours. 

Technology can be something that parents can think they are ill equipped to deal with, especially when children can be more up to date and often more proficient in handling technology. However what parents do have more knowledge about is the importance of balance - you can therefore support your child in the same way as you would for any other issue - food, friendship, health. You don’t have to know about the technology - just about how best to find a healthy balance.

Article - Make sure depression does not destroy your relationship

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

Make sure depression does not destroy your relationship 

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

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

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

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

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

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

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

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

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

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

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

Main points - 

• Think about your relationship - it is not helpful to think just about your partner and yourself separately. 
• Take a step back and think together about what you can do so that you can both feel as though you remain committed to each other
• Even if your relationship is in a good place at the moment talk about this now - if trouble comes along you will have an agreed strategy in place and this will make it much easier to have the conversations that will help.
• If you or your partner is depressed share this article with them and think about seeking couples / relationship / marriage counselling.

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.

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 - 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?

1. Boring as it might be do the research and read up on what best practice is for protecting yourself online.
2. 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.
3. 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 - Is your relationship in the best of health?

Our latest article is published in the Chiswick Herald, please read below or click here.

On The Couch: Is Your Relationship In The Best Of Health?

“In relationships, believing that we understand our partners and that they understand us is the single biggest cause of trouble” says Chiswick based Couples Psychotherapist and Counsellor Nicholas Rose. In this article Nicholas explains how to keep your relationship in the best of health.

Understanding between partners’ comes from a desire for both security and vitally, safety – often closely associated with the idea of loving or being loved. If we feel understood, we are more likely to trust in our partner. Ultimately partners are the people most likely to be relied upon in an emergency and in emergencies nothing is more important than clear communication – it is nothing less than a need born out of a need for survival.

Potentially it all starts from birth – if understanding does not exist between us and our primary carers then we risk death – therefore the first thing a baby does is learn how to communicate with its primary care givers. How this is done depends upon what is learnt in the attempt to gain attention – is it more effective to be noisy or quiet, happy or sad, laugh or cry, well or sick, tidy or messy, dependent or independent, creative or practical - the list is endless. Therefore what we learn in the early days is the closest we come to have an approach to life and relationships that is “hardwired”. Simply put, we are good at doing or being in ways for which we have felt understood.

The implication is we need to challenge our assumption we understand and are understood around the most basic of concepts. For example, love. How love is expressed varies enormously across cultures, communities and families. Just ask your friends how love was shown to them as children and you are likely to get a wide variety of responses from food, fun, talking, not talking, sharing, giving, taking, education, discipline, fairness, holidays the list is endless. 

Another prime example is how people are looked after when sick. In some cultures it is common for everyone to visit sick friends and relatives, in others the patient is cared for by being protected from visitors. Neither is right or wrong but someone who is used to visitors when sick will feel neglected and uncared for if their partner tells everyone to keep away as they need rest!

As adults we acquire the ability to enter into relationships on equal terms. Fundamentally a shared language and status provides us with all we need to build and maintain healthy relationships and understanding. It sounds basic and the principle is, however the skills are something to be learnt and developed. Here are some basic rules:

1 Words like “love” are short cuts – use them at your peril. Instead never assume that the word means the same to you and your partner.

2 It requires commitment from both parties to develop an understanding. (At the extreme, the presence of physical or emotional abuse in a relationship suggests that the commitment does not exist).

3 If you feel hurt by something that your partner does or says then (as long as it is not physically or emotionally abusive) it is likely that your defences and theirs are revealing a conflict of understanding. Do not assume that the intention was to hurt you, instead say how you felt and ask if that was what had been intended. Remember relationships often breakdown due to the conversations that have not been had rather than those that have.

4 Never underestimate the possible impact of change, difficult times and stress. Anything that changes your routines or patterns can bring stress that triggers defences – at difficult times in life you might find it difficult to recognise each other. Look out for bereavements, fertility issues, children arriving and leaving, career changes, health challenges and traumatic events.

5 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 in order to make the changes required.

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 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 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.

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.

Counselling and psychotherapy for adolescents, adults, couples and families in West London

We are a full service counselling and psychotherapy practice based in Chiswick, West London, able to offer male and female therapists for adolescents, adults, couples and families. To access our services you can make a direct referral or request referral to us from your GP or private healthcare provider. We offer a confidential and professional service with flexibility around availability without the expereince of waiting lists.