cognitive behaviour therapy

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. 

Do we really need to talk about our feelings?

How big is your list of 'micro oppressions'?

Nature versus nurture? The ongoing search for understanding.

As psychotherapists our role is to facilitate someone getting to the most helpful understanding of their concerns so that they can make skilful decisions about how to live life. Therapy exists at the point current medical knowledge ends with a view to helping someone live better with “what is”. Sometimes that might mean learning to live with a medical diagnosis and at other times a difficulty for which there is currently no known medical understanding.

Agoraphobia - Counselling and Therapy

In therapy we seek to explore the way in which the sufferer experiences agoraphobia through a detailed exploration, then with a greater understanding comes the possibility for new ways of thinking about and approaching the situations which are connected with the symptoms. Whilst there are tools and techniques available it is often the case that a full understanding enables a sufferer to find their own way of making effective change.

Colluding with your anxiety?

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.

New article - Chiswick Herald

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. 

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 - Is work affecting your mental health?

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?

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?”.

New article - How to make this the best Christmas

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

How to make this Christmas the best ever!

The Christmas holidays are a wonderful opportunity for us to strengthen and improve our relationships and yet for many they can bring stress and anxiety. For some it can be more about surviving than enjoying the Christmas holidays.

The first thing to remember is that people think of Christmas in many different ways and there are often many competing expectations. For example people may use the following words to express their hopes for Christmas, family times, friends, relaxing, having fun, spirituality, charity, reflection, partying, staying in, going out, log fires, wintery walks, time alone, time with others, entertaining, being entertained. Remembering this means that you can be proactive and ask people what they are wanting to get out of Christmas and what they would like to do - you can then decide with those you care about how to ensure everyone can have a good time

Principle one - Examine yourself first

Priority number one is your well being. So it is really important that you know what you want to get out of Christmas. 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 Christmas?

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 Christmas?

What do you not want to happen?

Thinking through how the family is at the moment what do you foresee?

In terms of current challenges what have you tried and what haven’t you tried?

Do you feel supported? Again, if not what have you tried and not tried?

How self critical are you? Yes difficult behaviours in the family may well be coming from the dynamic created by traits that you see as your own shortcomings but be kind to yourself. Don’t make yourself do things because you feel you should - find creative ways to achieve the same aims!

Principle two - Use a constructive and collaborative communication style

Avoid escalation of conflict by simplifying your communication. When you feel that conflict may arise use this four step way of ensuring you express yourself clearly and in a non confrontational way.

1. State the fact/s
2. Share your response to the situation - say how you feel and think (never say you make me feel / think because that will escalate conflict)
3. Explain why this matters to you
4. Share the problem you now have, ideally tell them what you want to do but if you are unsure ask them for their input

For example one of your family arrives late, this means you will be under pressure to get somewhere on time, this is something that you have said is important to you, you feel angry and stressed. It also means that it is unlikely you can fit in both of the things that were planned.

1. I said we would need to leave at 9am but you have arrived at 9.45am
2. I feel upset, angry and under pressure
3. I want to be relaxed and easy going and being late means to me that I am failing but being late also means I end up under pressure 
4. Now that we are 45 minutes I do not think we can do what we had planned, I need help in deciding what to change. Do you have any thoughts?

Principle three - Maintaining boundaries

A constructive and collaborative style of communication does not mean that you now let others decide what happens. Particularly if you are clearly the one with the designated responsibility - for example the cook of the Christmas lunch! 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. 

So you have said your piece and have invited help but it is now for you to decide what you need next. Don’t fall into the trap of expecting others to know what you want and to step in. If it doesn’t feel right then say so - in the best relationships people work together to ensure everyone is happy, it is merely wishful thinking that someone else can know you better than you know yourself. So avoid disappointment this Christmas, take responsibility for your own happiness whilst working with others to help them realise theirs!

Have a wonderful Christmas and a Happy New Year!

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. 

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 - reduce stress and anxiety FAST

Our latest article on reducing anxiety has been published in the Chiswick Herald, please click here or read below:

Reduce stress and anxiety FAST

Below are five things to think about to make you feel calmer:

1. Are you taking things too personally?

We get upset with other people when our expectations are not the same. There is nothing wrong with expectations as long as you recognise them for what they are - our humanly attempt to reduce our anxiety about living. We try to reduce our anxiety by finding meaning and purpose and with this we form personal views based on all our experiences of living. What we have liked and not liked is fed into developing our personal framework of what we think is good and bad - it sets our expectations and our opinions and these become what we believe to be true about life.

When we come into conflict with another it is because our “truth” does not agree with their’s. We don’t want to think we might be wrong because that undermines our confidence in how we make sense of our lives, so it is natural to defend our “truth”. When we defend we come into conflict and this often causes more conflict. 

Conflicting positions present us with a challenge so instead of getting angry try to think about conflict situations like this:

“I am right, but only for myself. The other person is also right, but only for themselves. We are in conflict because we are both anxious to be right.”

1. Are you aware of how your time of life is affecting your stress levels?

Because we are so busy living our lives we tend to forget to take stock and think about just how much stress might be coming from our stage in life. Adolescence tends to get most publicity as it is the most easily recognisable - due most likely to its nature of being condensed into just a few short years - but differing pressures are with us throughout live. Relationships, careers, financial security, our health, families, retirements, redundancies, bereavements all bring pressure to what we do everyday. Stages often talked about are coming of age, leaving home, leaving university, 30, 40, 50, 60, empty nests, loss of parents, retirement…..

So if you are stressed and anxious think about the people you love most and think about how they put pressure on themselves and how you wish they would just relax. And now think about where you are in life, what disappointments have you carried from previous times, what impact might these be having today? What are your hopes for the current time and how are you doing with your plans? And what do you want for the future? You might find yourself tempted to start writing lists but maybe you could try to think like this:

“I am right to feel under pressure given everything I want for my life, it is what everyone does. I am anxious just like everyone else”

1. Are you seeking perfection?

Do you describe yourself as a perfectionist? Or do other people see you as a perfectionist? It is natural to want to get things right and as the above questions show anxiety comes from expectations and standards. To be a perfect human though is to make mistakes - if you want to be a perfectionist then don’t strive for perfection. Another way of looking at things is to try and aim for good enough in all things rather than seeking perfection in some areas at the cost of others. You might like to think like this:

“To be perfect requires imperfection, my imperfections make me perfect.”

1. Are you colluding with your anxieties?

Think about all the things that reduce your stress. Think of times when you have felt least stress, places that induce calm, people with whom you feel relaxed, ways in which you can release stress. Excellent you have just completed an exercise in not colluding with anxiety. When you feel stressed or anxious it will affect how you make decisions and not necessarily for the best. Feeling calm and level headed is a good starting point for decision making. So try thinking like this:

“Of course I WANT to think about the things that are stressing me so what I NEED to do is think about all the things that are not stressing me”

1. Are your taking care of yourself?

A great way to turn yourself away from stress is to develop a kind mindset towards self care. DOING taking care of yourself is a great way to reduce from stress and anxiety that arises from THINKING about looking after ourselves. Recent research has shown that just putting one foot in front of another reduces stress, anxiety and depression. So when it comes to exercise, nutrition, finances, relationships, careers, hobbies, spirituality you will feel better just by putting one foot in front of the other. If you are still struggling with your thinking try this:

“To feel better I just need to approach everything with the aim of putting one foot in front of the other.”

We hope you have found this article helpful but if you have been experiencing anxiety for a prolonged period then we advise seeking professional help. In addition, anxiety and stress can also come from underlying health issues so if you are suffering from stress and anxiety symptoms we always advise you check out your health with your GP.

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 - How to make the school holidays the best ever

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

How to make the School Holidays the best ever!

The school holidays are a wonderful opportunity for families to strengthen and improve their relationships and yet for many parents they can bring stress and anxiety. For some parents it can be more about surviving than enjoying the school holidays.

The first thing to remember is that as parents you are in charge and so before anything else take some time to think about how best to manage what can be a massive undertaking in terms of balancing time, logistics, money, competing demands and complex relationships.

Principle one - Look after yourself before looking after others

Priority number one is the well being of the person in charge and yes that is you. So it is really important that you know what you can manage and that you apply your knowledge about what will work best. After all it is you who will have to manage whatever plans are made. Here are a list of questions to help you think about this:-

How are you? 

How’s life for you at the moment?

What is concerning you at the moment?

How do you feel about family life?

What would you like to get out of the summer holidays?

Why do you think you want this - is this what you want or need?

Now take a moment to now think what you NEED from the holidays?

What do you not want to happen?

Thinking through how the family is at the moment what do you foresee?

In terms of current challenges what have you tried and what haven’t you tried?

Do you feel supported? Again, if not what have you tried and not tried?

How self critical are you? Yes difficult behaviours in the family may well be coming from the dynamic created by traits that you see as your own shortcomings but be kind to yourself. Don’t make yourself do things because you feel you should - find creative ways to achieve the same aims!

Principle two - Use a constructive and collaborative communication style

Avoid escalation of conflict by simplifying your communication. When you feel that conflict may arise use this four step way of ensuring you express yourself clearly and in a non confrontational way.

1. State the fact/s
2. Say what your response say how you feel and think (never say you make me feel / think because that will escalate conflict)
3. Explain why this matters to you
4. Share the problem you now have and ask them for their input

For example one of your children arrives late, this means you will be under pressure to get somewhere on time, this is something that you have said is important to you, you feel angry and stressed. It also means that it is unlikely you can fit in both of the things that were planned.

1. I said we would need to leave at 9am but you have arrived at 9.45am
2. I feel upset, angry and under pressure
3. I want to be a good parent and being late means to me that I am failing but being late also means I end up under pressure 
4. Now that we are 45 minutes I do not think we can do what we had planned, I need help in deciding what to change. Do you have any thoughts?

Principle three - Maintaining boundaries

A constructive and collaborative style of communication does not mean that you now let others decide what happens. Particularly if you are clearly the one with the designated responsibility. The key concern now is finding a new plan that works for everyone - including you. With the example above you may decide to take out one of the activities that had been planned. Before you do this double check with your motivations to ensure that this is the most practical solution - that the decision is not an outlet for your difficult feelings but an answer to the dilemma you face. The message you want your children to have is that when things go badly in life it is important to take the course of action that best puts things back on track. And if you think some form of punishment is also necessary then that is a different issue and should be handled as such.

So you have said your piece and have invited help but it is now your decision to decide what should happen next. Clarity about who is in charge is ultimately about safety. If any of the children do not like your decision remind them of the fact that you are responsible and that in life it is important that people take their responsibilities seriously. And of course remind them that one day they will be in the position of responsibility and then they will need to be the one making the decision.

New article - Traumatised by the EU referendum?

Our latest article on trauma, anxiety and the EU Referendum has been published today in the Chiswick Herald, please click here or read it below:

Traumatised by the EU referendum?

Last week Mark Carney, the Governor of the Bank of England said that the UK was already suffering from “economic post-traumatic stress disorder” or PTSD. Now in psychology this diagnosis is only applicable to people presenting symptoms once a month has passed since the traumatic event. 

To consider the referendum as a traumatic event may seem exaggerated however it really does depend upon a persons relationship both to it and the perceived threat an unwanted outcome held. In our practice many people have wanted to talk about the EU referendum and the entire range of emotions have been triggered by an event that for many connects to key life concerns such as security, belonging, identity, relationships and hope for the future to name a few. I think many people have found that much of their time has been taken up or influenced by the referendum and if you have too then I think now is a good time to consider how you are coping. 

Specifically, take some time to think about whether you have started to change how you are living on a day to day basis. Has how you experience or spend your days changed? Are you spending more time following the news / social media, are all your relationships as they were before, are you eating and exercising or have you slipped into some bad habits? 

If the answer to any of these is yes then the key is regaining balance. If you are doing things that add to your stress and anxiety levels then either think about reducing the negative activities or add in other positive things to counteract the effects. This is important because if you do not take corrective action then you could end up with a stress or anxiety disorder.

I would however also like to take this opportunity to talk about PTSD as it was the starting point for this article. Having worked with patients diagnosed with this devastating condition for many years, including five years working with survivors of torture for a specialist charity in London, I think there is a growing confusion around trauma and how it impacts on people. I’m not suggesting the referendum will or will not result in cases of PTSD however we know that at times of particular stress and anxiety its also possible for PTSD related to previously untreated traumas to surface. So here is what you need to know about trauma. 

Triggers for trauma are identified as exposure to actual or threatened death, serious injury or sexual violation and the person will have directly experienced the event, witnessed it, learnt of it in relation to a close family member or friend or, have been exposed to the details of the event.

Faced with a traumatic incident it is normal for a persons survival instincts to activate, so “fight, flight or fright” are the primary physiological responses combined with difficult thoughts, feelings and bodily sensations. However it is the symptoms that present following the event which are used to consider whether someone may need treatment.

In the weeks immediately following a traumatic event it would be usual to diagnose an Acute Stress Disorder or ASD. Sufferers with ASD will have the same symptoms as those with PTSD but not everyone who suffers a trauma and ASD will go on to have PTSD. 

The symptoms are grouped into four clusters and include reliving the event (in dreams or through flashbacks), having distressing memories, thoughts or feelings as reminders of the event, then a range of cognitive experiences including memory loss, distorted thinking, wanting isolation and finally “arousal”. So being hyper vigilant, experiencing sleep problems and / or reckless or self destructive behaviour, one example might be use of alcohol.

In returning to the EU referendum it is still too early to consider the use of the term PTSD to that event however it is not too early to take stock to ensure you are managing your stress and anxiety. Stress, anxiety and post traumatic stress disorders are types of mental distress and illness where much work has been done to both understand and treat sufferers. Following a time of stress/anxiety/trauma it may well be possible for us to find our way back to a post event way of living but it can also trigger an anxiety / post traumatic stress disorder particularly if there were already other underlying concerns in life or previous untreated trauma. 

New article in Chiswick Herald - Yoga Retreat Review

Here is our latest article from the Chiswick Herald reviewing a Yoga retreat and Yoga approach. Please read below or see it here on the Chiswick Herald site.

Moving from the couch to the yoga mat

Many of my patients are often already practicing or take up “physical” activities such as Pilates, Tai Chi, Qigong or Yoga. Over the years I’ve tried yoga on a number of occasions but not been able to find one that I’ve wanted to continue. So when I heard of a form of yoga where the underlying assumption is about uncovering or more accurately rediscovering the innate expertise we have to live a healthier life, an association I make with therapy - I wanted to explore further. 

Fairlie Gibson teaches this yoga in London but also runs holidays to teach this approach, she told me “the yoga holidays I offer are based upon an approach practiced and shared by Vanda Scaravelli. Vanda didn’t want to give her style a new name but it has become known as Scaravelli inspired yoga. We set the holidays in either beautiful mountainous Andalucia or on the gorgeous turquois coast on Southern Turkey. The aim of these holidays is give the participants, no matter what their experience of yoga, the chance to experience this, as yet, little known approach”.

By way of some background and before I talk more about the potential interplay and complementarity of this yoga to therapy I want to go back in history as I think it provides some basic and helpful context. The word disease has its origins in 14c. coming from Old French desaise and it was an holistic term covering the experience of both physical and emotional distress. It is simply the opposite of ease so the experience of “dis”ease. As medical science has found treatable causes for many sources of distress the word disease has become associated primarily with the physical. With “ill at ease” being used instead of disease but also having the connotation of some minor discomfort. In the same way the word patient has its origin in patience meaning someone that endures pain and suffering.

The importance of all this is recognition that the physical and emotional are in fact inseparable. If you feel “dis-ease” then do see your doctor but remember that when you reach the limits of what current medical science can provide you will need to access your own resources to treat or manage any remaining “dis-ease.”

The relationship I build with patients aims to bring a sense of safety and relaxation as we spend time together. That sense of relaxation or comfort enabling us to look again at how life is being lived and identify misunderstandings, unhelpful thinking, unhelpful habits, automatic responses and physical actions that have become fixed when in reality in any given moment and in any situation a range of options will be available. In short our way of living or being that was helpful in the past may not be the most helpful now.

So now back to the yoga. The experience of many who have trained in yoga is the need to learn new moves, push the body, stretch to the limit in other words to add more instruction and to have to work harder – all at a time when they have been drawn to a physical activity because they want to make life better. Resulting struggles to achieve the pose, remember the sequences, to practice regularly combined with physical injury, negative thoughts and feelings can all lead to the exact opposite of what was hoped. 

Scaravelli is known to have said “if you are kind to your body, it will respond in an incredible way”. My own experience of the yoga was first and foremost one of kindness, creating space, allowing, appreciating and only then to move the body in ways that are known to result in greater flexibility, strength and sense of well being.

Fairlie told me “It’s about coming home to yourself rather than learning something new or put another way, about unlearning and then being with ourselves in a different way”. She continued “We have become so absorbed in the need to achieve. In yoga visuals of practitioners bent double in seemingly impossible stances have resulted in a lot of pressure to achieve whereas it is more about experiencing freedom in the body. The pace of the practice is such that there is great emphasis on creating space and allowing time for the body to find its optimum”. 

As the week progressed I found myself feeling very at ease in positions that felt wonderfully natural only to realize I was actually adopting positions that I would have anticipated requiring a huge amount of effort. I’m not saying it is easy, its not about whether its easy or hard its more about what can happen once you have let go of trying. Fairlie called this “effortless effort.” And I find myself concluding that the space this yoga creates and the freedom it generates to allow for change is indeed very therapeutic. This is a form of yoga I am interesting in continuing to practice. 

Details of upcoming yoga holidays can be found on Fairlie’s website www.freeingthebody.com

New 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 - Stressed by your work or responsibilities?

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

Stressed by your work or responsibilities? - Younger or older you are not alone!

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

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

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

Mind you other research conducted by Monster in 2012 showed that Britons were the most bullied workers in the world. Seven out of ten workers admitted to being bullied by either bosses or colleagues and I suspect the connection here is that although employers do have responsibility we British can find it hard to speak up?

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

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

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

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

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

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.

Did you see?

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