cognitive behaviour therapy Posts from London Counselling Practice Limited

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Showing posts tagged with: cognitive behaviour therapy

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The following article appeared in the Chiswick Herald on the 1st February.
 
Sometimes people with anxiety start to withdraw and avoid things, people and situations where they experience heightened anxiety. Avoidance is a valid coping mechanism and a tool that can facilitate recovery from trauma but if you or someone you know is gradually withdrawing with no decrease in anxiety then maybe its not the most helpful one!
 
In fact this might be considered as “colluding” with anxiety, and collusion ultimately leads to greater anxiety.
 
Anxiety is a heightened state that is identifiable through a combination of physical, psychological and behavioural experiences. 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.

  

Returning to colluding with anxiety, 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 recognise that the anxiety has a message for us - one that we need to understand and to do this we must adopt a “kindly curiosity” towards the experience of the anxiety.
 
Imagine someone who cannot travel on the Underground, how might you apply the idea of kindly curiosity? Here are a list of questions that might be helpfully worked through.
 
  1. What is the impact on the person of not being able to travel on the Underground? Answers may be practical for example the cost of having to get taxis or more personal for example feeling unhappy with oneself or a combination. 
  2. Has something happened on the Underground? If yes then traumas that have resulted in an unwanted change are something that people take to counselling.
  3. When did this anxiety first appear?
  4. Was there anything else going on in life at the time?
  5. What has been tried to manage or treat the anxiety?
  6. What hasn’t been tried?
  7. Have you looked for information on using the underground, anxiety and how other people cope?
  8. What do you think and feel about what you have found out?
  9. What would you like to do about it?
  10. What might you find supportive / helpful?
  11. Who might you find helpful / supportive?
  12. Is there any reason why you do not try to deal with this or why it is hard to get help?
  13. If a person you cared for was in your situation what would you say to them, or how would you help them?
 
 
In therapy, one of the approaches to overcome an anxiety linked to a specific situation is firstly to talk it through, secondly to talk about information that might be helpful and then thirdly to draw up a plan of action.
 
A plan of action in terms of travelling on the Underground will be tailored to the specific person, based upon what they want to do, what has worked for other people and what the therapist and the person senses to be manageable.
 
For example, the sufferer might first of all watch videos of underground journeys, they might then go to visit an Underground station, then they might take a train just one stop on an overground section before taking longer journeys. They might have a therapist or friend / relative travel with them the first few times, drop them at the station or meet them at the other end. They might take their mobile phone with them and have someone lined up who they can call. They might take a book or listen to music, carry food or water….. As you can see so many options. 
 
The important thing is to be kind, take small steps and listen to what feels manageable. 
 
The Underground is a fairly common example and one that can cause anything from mild to debilitating anxiety. If either yourself or someone you know is struggling with anxiety remember this is a very common problem and it is treatable.
 
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Our latest article was published on page 29 of the Chiswick Herald on the 22nd June, click here or read below:

I’m a therapist because of loneliness.
 
For me, therapy works because the person struggling with something on their own no longer feels on their own! 
 
People come and see me because they are depressed, anxious, having panic attacks, having relationship problems, drinking too much, having problems becoming pregnant, have PTSD, are diagnosed with a mental health disorder, are suicidal, having trouble managing their anger but the baseline is they are coming to see me because they are alone with a struggle. 
 
No longer feeling alone brings a sense of relief and hope. 
 
The change, no matter how subtle brings new energy and makes it possible to express something that has previously been impossible to express. Feeling more relaxed means we can start to see the wood for the trees, be more rational, think about things more clearly, which in turn helps us to feel better.
 
It is only once we can express our difficulties we can start to understand them and once we understand them we have a chance of fixing them.
 
Although loneliness has been much in the news lately, the importance and scale of it is I think,  vastly overlooked. In my experience people find it hard to identify that they are lonely or even if they do feel lonely fail to see the importance of it.
 
When a person finds it hard to make sense of something, be it their thoughts, feelings or how they are experiencing themselves they can get stuck in their internal world. So they will find their thoughts going round in circles, have ever increasing and overwhelming negative feelings, have bodily symptoms - and the more they try to get out of the struggle the worse it gets.
 
This is a really lonely place to find yourself in.
 
When people find they cannot rely on themselves to find a solution they may move towards other behaviours, initially as coping mechanisms, that only act to escalate the problems and isolate them further - drinking, drugs, eating disorders, avoiding friends and family, giving up their hobbies, faith, work. 
 
It’s a natural response because once someone starts to focus inwardly they have already discounted, not thought about or had experiences which have led them to believe that they cannot be helped. 
 
But what is help?
 
The important thing about seeing a therapist is that you are meeting with someone who you do not know and who does not know you. This means that the problems you might experience in trying to talk to friends and family do not exist - you can feel more relaxed and speak freely, your conversations will be confidential, you do not have to worry about the therapists feelings, do not have to worry that they might not cope with you being upset, might change their opinion of you, be sure that they are there because they are focussed on helping you and as you are the client you are in control. 
 
One of the common problems people experience about sharing their struggles is a worry that somehow control might be taken away from them - with a therapist that is not the case.
 
Crucially though finding the right therapist for you is essential. Research consistently shows that the single most important factor in finding therapy helpful is the quality of the relationship someone has with their therapist. 
 
It is true that we go through years of training, undertake our own therapy, have experience in talking about things often not talked about in everyday life, so we might have some new way of looking at things, be able to share a wisdom but to know if you have found the right therapist I suggest you ask yourself “Do I feel lonely now I have my therapist to talk to?” If the answer is no, or not so much then I think you have found the therapist who is right for you. 

 
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Our latest article published in the Chiswick Herald on the 1st December on page 21, to read it click here. Otherwise the article is detailed below:

 
Is work affecting your mental health?

 I have been thinking about how many of our clients are routinely impacted on stress that comes from work, either from the pressure of the work itself and or difficult relationships at work. And too much stress can so easily have a significant impact on a persons quality of life. Stress can lead to anxiety and depression that brings with it many symptoms that can prevent people from getting the most out of life.

 And did you know that employers should be thinking about whether your work is well designed, organised and managed? Employers in the UK have a legal duty of care to protect the health, safety and welfare of all employees and yet according to research conducted by the mental health charity Mind in 2013, work was given as the most stressful factor by 34% of respondents saying they found their work life either very or quite stressful. Other research quoted by the Health and Safety Executive also shows that workers in the public service industries tend to have higher incidences of stress.

 It can of course be difficult to attribute stress to just one source and yet if you find yourself saying that work is stressful, or if you notice that someone else tends to exhibit signs of stress in relation to work then it can be helpful to keep in mind that there are ways to manage and reduce stress. It is also helpful to remember that if you are stressed at work then your employer has a responsibility too.

 Bullying continues to attract much attention in the media for example, if you are struggling at work whilst it might be your first thought to think about how you are failing that might mean you fail to recognise that you are the victim of bullying. Instead of focusing on what you are doing wrong take a step back and think about the environment and context in which you find yourself. Examples of bullying can include overbearing supervision, constant criticism, exclusion and maybe you are working an a culture where this is routine but it doesn’t mean you have to put up with this. 

 But it is not just adults in the workplace who are suffering from stress. It seems this is an increasingly recognised problem for children too. In August 2015 The Guardian reported that English children are among the unhappiest in the world and again there seems to be a significant link with bullying. Head Teachers have been calling for improved mental health care and yet for some time now the news has been full of articles on how much stress teachers say they are experiencing.

 Marybeth Mendenhall, our Senior Associate and a Systemic Psychotherapist told me “The dynamics within organisations can usefully be likened to those that occur in families -  dysfunctional organisations are like dysfunctional families. For the members belonging to the group harmful behaviours may easily become so familiar that it is only when a new member joins or an outsider gets to see and experience being part of the group that the harmful dynamics can be identified”. 

 

Ia Tollstam, our Consultant Supervisor for business services told me “many medium and large organisations have services in place to help managers think about stress and employees deal with stress. Access to counselling is commonplace in many organisations but not so much for those that are smaller”. She added “there is so much an organisation can do to support its staff and the value of a workforce who feel looked after is something the most successful employers understand.”

 

As Marybeth says “Just like with a family, members can really help each other out when trouble strikes and good communications and strong relationships can build resilience that minimises the impact of difficult times or events.” 

 

In talking to my colleagues about stress at work and in families I have found myself thinking about how more and more of our work is with children and adolescents. It seems that stress is affecting everyone? Stressed parents equals stressed children, stressed managers a stressed workforce and stressed teachers stressed pupils so to end I guess I am thinking about just how useful it can be to think about the different roles you have in life - parent, manager, partner, friend, colleague, teacher - when you think of that role can you recognise stress and if so what impact might that be having on those who count on you?
 
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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?”.
 
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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