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.
Friendship so often appears as a theme in therapy. Sometimes people come for therapy talking about loneliness and isolation specifically in relation to friendship whilst at other times people are experiencing isolation and loneliness, struggling with a concern in life alone, not because of a lack of friendship but because they choose not to talk about worries with their friends. Meanwhile sometimes friends, determined not to lose a friendship come to therapy to try and work through a concern they cannot resolve alone.
If you are struggling, does your experience include not being able to remember things, feeling uncertain, noticing that you have a reduced response to things that ought to feel more painful? Does your experience make sense through the words disconnected, removed or outside of yourself, others or the wider world? Do you think of yourself as though you are or could be a different person or people depending upon the situation or do you experience another presence or presense? Maybe you experience life as if through a haze or mist and or can find yourself somewhere not knowing why you are there or how you got there? And thinking back to before you had this experience were you stressed?
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.
- 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.
- Has something happened on the Underground? If yes then traumas that have resulted in an unwanted change are something that people take to counselling.
- When did this anxiety first appear?
- Was there anything else going on in life at the time?
- What has been tried to manage or treat the anxiety?
- What hasn’t been tried?
- Have you looked for information on using the underground, anxiety and how other people cope?
- What do you think and feel about what you have found out?
- What would you like to do about it?
- What might you find supportive / helpful?
- Who might you find helpful / supportive?
- Is there any reason why you do not try to deal with this or why it is hard to get help?
- 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.
This article appeared in the Chiswick Herald on the 21st December:
Someone upsetting you? Here’s what to do about it.
In this article we will look at getting upset with other people, how we can usefully think about what is happening and what are some of the options available to stop this from happening.
Before getting into the main part of the article it is really important to acknowledge the times when relationship problems are serious and have serious consequences for the health and safety of ourselves and/or others. Some people find almost everyone else difficult and they can find therapy really useful in understanding how their own expectations are causing conflict and find new ways to improve their relationships. And some people are in abusive relationships and they need to get out of them. If you think you might be in an abusive relationship, and abuse can take physical, sexual and emotional forms, there is lots of really helpful information available. For example this page of the NHS website https://www.nhs.uk/live-well/healthy-body/getting-help-for-domestic-violence/. If you are in either of these terrible situations there is a lot of help out there and whilst it might feel hard to take the first step to get help you will be glad you did. Finally, particular in close relationships patterns of destructive and painful behaviour can really put a relationship under strain and often people can find couples therapy helpful. In all these situations the important thing is not to suffer in silence.
Now back to the main part of this article. Most people have difficult relationships with others at some point or another. Sometimes it is something a partner, family member, colleague or friend does that annoys on a regular basis or it might be something that has happened that you are really shocked or stunned by and can’t find a way to deal with it.
Step One - Relax
Relax - this is something that happens to everyone. And it is not all bad - it means your psychological defences, designed to keep you safe, are functioning.
Step Two - Look at this objectively
Sounds easy and it is likely that your hurt feelings will not want you to do this but being able to be objective will enable you to find a way through. Think of an area of your life where you are strongest at being objective - for some people its work, others with their children, for others with authority - identify yours.
Step Three - Own your feelings
In the spirit of being objective it is valuable to remember this fact. Other people do not make us feel bad, we feel bad as a reaction to others - we make ourselves feel bad!
Step Four - Review the facts
Recall exactly what happened and write it down. Then edit what you have written to remove all interpretation and subjective wording. For example a friend is late - you might write:
They are so annoying. They were late as always, they knew how important it was to me, we missed the train and they couldn’t even be bothered to apologise - they said nothing. It is so typical, never take responsibility for anything and doesn’t care about anyones feelings except their own. They ruined my day.
To rewrite this factually:
They were 20 minutes late and we missed the train. I had said not to be late, they said nothing when they arrived. They have been late before. My thoughts were that they don’t care about anyone else’s feelings. My day was ruined and in my thoughts I held them responsible.
Step Five - Review your interpretations and subjective responses.
And question them as follows:
Are they always annoying?
They are always late?
You told them not to be late but how can you know they understood it was important to you - did you use those words?
When people do not apologise does that always mean they do not care? Isn’t there another explanation?
Do they really never take responsibility for anything? How can you be certain? Also how can you be certain they do not care about anyone else’s feelings? If so how do they manage in life?
If they don’t manage in life then why are you taking this personally when you could have anticipated this happening?
You think they ruined your day - does that mean you were powerless to salvage your day - how come?
Step Six - Decide what to do.
By now three things will have happened:
- You will feel calmer - you are taking back control of the situation and your feelings
- You will be starting to think about what happened differently
- You may now want to just forget about what happened or maybe you will want to talk to the person about what happened
- When you replay things in your mind you might now find that the other person was even upset that you were upset - so maybe they are feeling bad too now?
Step Seven - If you decide to talk to them
If you decide you would like to speak to the person then use this simple framework:
State the facts - “you were late and I had asked you not to be so we missed our train and I did not enjoy the rest of the day”
Say how you felt - “I felt angry and upset”
Say what thoughts you had - “I was thinking it means you do not care about me and I remembered when you were late before”
Say what you would like - “I would like you to be on time in future”
Our article - "Reduce conflict and stress in relationships" published in the Chiswick Herald on the 9th November. Please read below:
Reduce conflict and stress in relationships
Conflict and stress in relationships often come from misunderstandings and poor communication. We cannot expect others to change how they communicate but we can change ourselves and when we find communications of others upsetting then having a better understanding can help.
In this article I’m going to look at how, by paying attention to our thinking and the words we use we can become more relaxed, have less conflict with others and become happier. Initially, I will explain how we have a natural tendency towards the negative, the role of our thinking, how the words we use can make things worse for us and how we can also apply this when we find the communications of others upsetting.
Recognising the difference between interpretation and fact
For example, a friend who you had agreed to let know whether you would or would not be able to make it for coffee, replies saying
“You are late contacting me! Bad behaviour from a friend?”
As you can see the response contains judgements which are negative towards your actions namely, “late” (no date or time had been agreed for confirming) and “Bad” (a subjective interpretation) - with such wording it is likely that you will have had a negative reaction to these words?
Beware - negative interpretations cause escalations in both yourself and others
Your feeling response to these judgements is likely to be negative. What feeling it evokes in you will depend upon your current situation and also how you to tend to respond to negative comments. Importantly your own negative reaction to the judgements may well lead you to negative judgements in return. For example, if you have been really busy and not very well you might feel upset and then your own negative judgement will be to think you are being misunderstood, if you have a history of disappointments, you might feel anger and think they are unfair, if you have had critical parents you might feel anxious or nervous and think you are in trouble?
So likely responses you send in these three scenarios might well be something like:
“You just don’t understand and are not being nice”.
“You are unfair, I know what it is like to feel disappointed and you have no right to feel this way”.
With these first two responses your friend is likely to be respond with further negative judgement and accusation. A third possibility and just as harmful to your friendship would be the following:
“I am sorry, I’ve changed my diary so I can make it”.
In this response you are dismissing yourself and doing what the other person wants just to avoid conflict, ultimately the cost to you of doing this is to have inauthentic relationships that bring you little in return!
Facts, facts , facts
So what can be done?
When you receive something from someone that results in a negative feeling here is what to do:
- Pause - It can be tempting to allow your thinking to take over but this is also unlikely to be helpful as your thoughts will be based upon your negative feelings. Also when you have allowed your thinking to gain momentum you may find it hard to avoid taking action that has negative consequences.
- Take a breath and then ask yourself “what is factual here?”, with this example it can be helpful that having spotted there is little factual content and noting your negative reaction, that the important message from this interaction is that your friend is upset but not able to communicate this to you in a helpful way?
- Now develop a response with the following parts: first - state the facts, two - explain what thoughts it brings up for you. For example:
“I felt upset when I received your message and I do not remember us saying a time by which we would confirm whether or not we would be able to meet. As I felt upset, I am thinking that maybe you are upset that we are not able to meet”?
Such a response is factual, offers a suggestion about what is going on and invites further communication. Unless you are in a friendship with someone who is abusive, in which case their response is likely to contain further judgements and criticisms, it is likely your friend will see that a misunderstanding has occurred. Also if in the future difficult situations arise, this interaction will have helped build trust so that your friends initial response will itself be factual. They might for example say:
“I feel upset because I was looking forward to us meeting and I have not seen as much of you as I would have liked lately”.
And if you now note your reactions to receiving this kind of message, I imagine you feel upset for the other person and rather than defensive and wanting to avoid them, find yourself wanting to reach out and get something new organised?
Our latest article on reducing anxiety was published in the Chiswick Herald on page 31.
View article Or read it below:
Feel happier - reduce stress and anxiety - here’s how!
Stress comes from being under pressure, anxiety comes from prolonged stress, anxiety reduces our happiness - so anything we can do to reduce pressure will have a direct impact on happiness!
In this article I’m going to look at how, by paying attention to our thinking and the words we use to describe things we can become more relaxed, have less conflict with others and become happier. Initially, I will explain how we have a natural tendency towards the negative, the role of our thinking, how the words we use can make things worse for us and then offer an experiment to help you start to make changes. This article will deal with events that we might come across everyday - in the next article we will look at relationships.
When we experience being under pressure the experience is one that is alerted to us by a combination of our feelings, thoughts and bodily sensations. Neuroscience is showing that our feelings are something over which we have very little control - our bodily sensations and feelings will be triggered in response to a perceived threat or pleasure and then our thoughts will try to make sense of what is happening and if it is a threat, to seek a solution.
Under pressure it is our thinking which often proves to be the weak link.
Thinking happens through our language, thoughts are the assigning of words to our experience and the biggest single problem with our language is how it contains so much scope for subjectivity combined with its tendency to see things as either positive or negative.
Being first and foremost concerned with our survival, negative judgements take precedence. For example, when we have a feeling we see as “good” we do not tend to dwell, analyse and procrastinate because there is nothing to be done, we are not under any possible threat. However when we have a feeling that we see as “bad” we naturally tend towards needing to find out what is “wrong”. The issue here is that we are already looking for something “bad” - we are starting with a bias.
Our experience of living may be made up of equally good and bad feelings but the importance given to the bad means the way we can end up looking at the world will be skewed towards the negative.
In addition, the difficulty of feelings that we experience as bad can mean we do not feel as though we have time to understand whether our judgement is correct. Instead our in built risk assessment systems will urge us to think about the worst scenario, draw upon our previous bad experiences and allow our adrenal systems to kick in and allow physiological action designed to save us.
Our very sensitive but not necessarily accurate systems are great for saving us when we really need it - where our safety is at risk - but it also influences us in low risk everyday situations where we find ourselves reacting to things and making negative judgements. I am not saying we stop judging but we recognise when we do this and how it has the potential to make us unhappy.
Here is an everyday example:
Imagine you are walking down the street - you narrowly miss stepping on some dog faeces. Whilst you are pleased you missed it you remember a previous time when you stepped in some dog “mess” and how annoyed you felt and the extra work involved in cleaning your shoes and the entrance hall carpet at home. The word “mess” combined with the previous memory triggers irritation and you think about how “irresponsible” people can be, that reminds you of how you found a new scratch on your car the previous week, you think “vandalism” and now you feel angry but also a little frightened. In turn that fear then reminds you of what you saw on the news about an increase in muggings in another part of the city. Now you think about how the city is changing and how crime is getting worse, how people are “dangerous” and you now feel unsafe.
Instead imagine this possibility:
Walking down the street you narrowly miss stepping in some dog faeces. Whilst you are pleased you missed it you remember a previous time when you stepped in some dog “mess” and how annoyed you felt and the extra work involved in cleaning your shoes and the entrance hall carpet at home.
NOW at this point - at the time of your initial reaction - try to train yourself to pause. You do this so that you can now look at the reaction and look firstly for words which are not purely descriptive - so ones that contain a subjective / judgement - in this case “mess” and secondly look at how this event today is triggering past negative events.
Now, having fully understood how you are reacting in a way that is amplifying the event and its negative impact on you, recall how you were feeling before this happened, take a second or so to fully experience yourself as you were.
Obviously it is unrealistic to expect yourself to do this every time something generates a negative thought and feeling however if you can start to do this occasionally you will start to understand how set backs, surprises, misunderstandings, disappointments etc end up with much more power than they fully warrant and how that can sabotage your happiness. In our next article we will look at how to apply this to relationships.
Our latest article was published in the Chiswick Herald on the 14th September on page 27, click here to visit the site or read the article below.
How to make your family times happy times
For some people their family feels like the best place in the world whilst for others the worst however for most there are good times and bad times. For everyone though there will be a pattern to peoples behaviours and sometimes those patterns might change for the better!
When relaxed and happy people are able to rub along together with little conflict however individuals in groups often take on particular roles and this can lead to tension between people. When something changes or when stressful situations arise, behaviours may not change to adapt appropriately and / or the defence mechanisms deployed by people may add to conflict.
Staying quiet is an option but one that rarely changes an ongoing problem.
If you want to break patterns of behaviour that cause problems then the first thing to do is to think about your family and the particular roles people take. It is normal for people to assume a “job description” and tensions tend to arise because these job descriptions either overlap or leave holes. For example, you might have four people willing to cook but no one who is willing to clean up afterwards!
Unfortunately, when behaviours remain unchallenged and the resentment starts to build thoughts such as “they are so selfish, so thoughtless, self centred” start to occur and these tend to generate even more difficult feelings.
Do you think that person really wants to be seen as difficult?
Such patterns are normally formed because things change but habits stay static. It can be really helpful to think that the person with the annoying habit is most likely doing something automatically and doing it because at some point it was what people appreciated.
But now you need accept that the behaviour is simply one that you find difficult and this cannot be changed alone - if it could have been then you would have managed it by now!
Even if you have been able to see the other persons behaviour as not intentionally difficult it is likely you will find raising this subject difficult. A good initial strategy is to think about how you tend to be under pressure and how others therefore experience you so you can find ways to stay calm.
Fight, flight or freeze?
Under pressure people with have a tendency to respond in a particular way - this means it can be possible to predict with a degree of accuracy how someone - including ourselves will be when something goes wrong. There is “fight” meaning becoming active. It doesn’t necessarily mean becoming aggressive but if you think of movement it would be a “step towards”. For those who tend towards “flight” a “step backwards” and for those where “freeze” happens think “standing still”.
Once you have identified the response you can think about what this means in handling situations - imagine the situation then think of ways to ensure you both remain calm.
FFTP - Fact, feeling, thought, preference
FFTP is a structure for how to have those difficult discussions! In this method of communication you provide the other person with all the information about what is going on for you in relation to the issue you are finding difficult.
Here is a hypothetical but typical situation. Your brother (Arthur) who is married with three children has, since having the children, started turning up late to family events you organise and when he finally arrives tends to disagree with things arranged in his absence. Today when the family were due to meet for a walk and lunch he arrives an hour late by which time everyone had decided where to eat and ordered drinks. He says he wants to go to a different place as he has heard good things about it. You find yourself feeling annoyed and thinking here we go again. You know that you tend to get angry and that in the past you have ended up shouting so you know it will help if you can stay calm. You’ve been thinking about this and have already planned to ask if you can speak away from the rest of the family, you also know that when you sit down you tend to stay calmer - so you find somewhere you can sit.
Fact - “We agreed to meet at 1pm and when you didn’t show up on time we decided on this place, looked at the menu and ordered drinks. Now you want us to change what we are doing.”
Feeling - “I am feeling annoyed, hurt and unloved”
Thought - “I am thinking that my time has been wasted, what I want doesn’t matter and not good enough for you - it is hard for me to enjoy our family time with these feelings and thoughts”.
Preference - “Can we find a way to ensure our arrangements work but can I also ask you don’t ask me to change what has been decided.”
“It is always so hard for us to get places on time with the children, something always seems to happen when we are leaving the house. I should allow more time but sometimes I agree to something and then don’t feel I can change my mind. Arriving late today I felt stressed and nervous because you have been angry with me in the past so I am always thinking I have to make up for being late. I think I have spoilt things and I need to find a way to make things OK so I try and suggest something that I think will be better. Now I am thinking that if I arrive late I can just relax knowing that I don’t have to do that - I don’t need to fix anything. But you are right maybe we can change the way we make our arrangements - I would like to know its OK not to agree a time on the spot so I can think about timings?”