london psychotherapist

13 - Feb - 2019

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.

16 - Jan - 2019

When you feel upset with someone

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”

14 - Nov - 2018

Article on reducing anxiety

Our article - "Reduce conflict and stress in relationships" published in the Chiswick Herald on the 9th November. Please read below:

Reduce conflict and stress in relationships

Conflict and stress in relationships often come from misunderstandings and poor communication. We cannot expect others to change how they communicate but we can change ourselves and when we find communications of others upsetting then having a better understanding can help.

In this article I’m going to look at how, by paying attention to our thinking and the words we use we can become more relaxed, have less conflict with others and become happier. Initially, I will explain how we have a natural tendency towards the negative, the role of our thinking, how the words we use can make things worse for us and how we can also apply this when we find the communications of others upsetting.

Recognising the difference between interpretation and fact

For example, a friend who you had agreed to let know whether you would or would not be able to make it for coffee, replies saying 

“You are late contacting me! Bad behaviour from a friend?” 

As you can see the response contains judgements which are negative towards your actions namely, “late” (no date or time had been agreed for confirming) and “Bad” (a subjective interpretation) - with such wording it is likely that you will have had a negative reaction to these words?

Beware - negative interpretations cause escalations in both yourself and others

Your feeling response to these judgements is likely to be negative. What feeling it evokes in you will depend upon your current situation and also how you to tend to respond to negative comments. Importantly your own negative reaction to the judgements may well lead you to negative judgements in return. For example, if you have been really busy and not very well you might feel upset and then your own negative judgement will be to think you are being misunderstood, if you have a history of disappointments, you might feel anger and think they are unfair, if you have had critical parents you might feel anxious or nervous and think you are in trouble?

So likely responses you send in these three scenarios might well be something like:

“You just don’t understand and are not being nice”.

“You are unfair, I know what it is like to feel disappointed and you have no right to feel this way”.

With these first two responses your friend is likely to be respond with further negative judgement and accusation. A third possibility and just as harmful to your friendship would be the following:

“I am sorry, I’ve changed my diary so I can make it”.

In this response you are dismissing yourself and doing what the other person wants just to avoid conflict, ultimately the cost to you of doing this is to have inauthentic relationships that bring you little in return!

Facts, facts , facts

So what can be done?

When you receive something from someone that results in a negative feeling here is what to do:

  1. 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.
  2. 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?
  3. 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?

15 - Oct - 2018

Reducing anxiety - article in the Chiswick Herald

Our latest article on reducing anxiety was published in the Chiswick Herald on page 31. 

View article Or read it below:

Feel happier - reduce stress and anxiety - here’s how!

Stress comes from being under pressure, anxiety comes from prolonged stress, anxiety reduces our happiness - so anything we can do to reduce pressure will have a direct impact on happiness!

In this article I’m going to look at how, by paying attention to our thinking and the words we use to describe things we can become more relaxed, have less conflict with others and become happier. Initially, I will explain how we have a natural tendency towards the negative, the role of our thinking, how the words we use can make things worse for us and then offer an experiment to help you start to make changes. This article will deal with events that we might come across everyday - in the next article we will look at relationships.

When we experience being under pressure the experience is one that is alerted to us by a combination of our feelings, thoughts and bodily sensations. Neuroscience is showing that our feelings are something over which we have very little control - our bodily sensations and feelings will be triggered in response to a perceived threat or pleasure and then our thoughts will try to make sense of what is happening and if it is a threat, to seek a solution.

Under pressure it is our thinking which often proves to be the weak link. 

Thinking happens through our language, thoughts are the assigning of words to our experience and the biggest single problem with our language is how it contains so much scope for subjectivity combined with its tendency to see things as either positive or negative.

Being first and foremost concerned with our survival, negative judgements take precedence. For example, when we have a feeling we see as “good” we do not tend to dwell, analyse and procrastinate because there is nothing to be done, we are not under any possible threat. However when we have a feeling that we see as “bad” we naturally tend towards needing to find out what is “wrong”. The issue here is that we are already looking for something “bad” - we are starting with a bias. 

Our experience of living may be made up of equally good and bad feelings but the importance given to the bad means the way we can end up looking at the world will be skewed towards the negative.

In addition, the difficulty of feelings that we experience as bad can mean we do not feel as though we have time to understand whether our judgement is correct. Instead our in built risk assessment systems will urge us to think about the worst scenario, draw upon our previous bad experiences and allow our adrenal systems to kick in and allow physiological action designed to save us. 

Our very sensitive but not necessarily accurate systems are great for saving us when we really need it - where our safety is at risk - but it also influences us in low risk everyday situations where we find ourselves reacting to things and making negative judgements. I am not saying we stop judging but we recognise when we do this and how it has the potential to make us unhappy.

Here is an everyday example:

Imagine you are walking down the street - you narrowly miss stepping on some dog faeces. Whilst you are pleased you missed it you remember a previous time when you stepped in some dog “mess” and how annoyed you felt and the extra work involved in cleaning your shoes and the entrance hall carpet at home. The word “mess” combined with the previous memory triggers irritation and you think about how “irresponsible” people can be, that reminds you of how you found a new scratch on your car the previous week, you think “vandalism” and now you feel angry but also a little frightened. In turn that fear then reminds you of what you saw on the news about an increase in muggings in another part of the city. Now you think about how the city is changing and how crime is getting worse, how people are “dangerous” and you now feel unsafe. 

Instead imagine this possibility:

Walking down the street you narrowly miss stepping in some dog faeces. Whilst you are pleased you missed it you remember a previous time when you stepped in some dog “mess” and how annoyed you felt and the extra work involved in cleaning your shoes and the entrance hall carpet at home. 

NOW at this point - at the time of your initial reaction - try to train yourself to pause. You do this so that you can now look at the reaction and look firstly for words which are not purely descriptive - so ones that contain a subjective / judgement - in this case “mess” and secondly look at how this event today is triggering past negative events.

Now, having fully understood how you are reacting in a way that is amplifying the event and its negative impact on you, recall how you were feeling before this happened, take a second or so to fully experience yourself as you were.

Obviously it is unrealistic to expect yourself to do this every time something generates a negative thought and feeling however if you can start to do this occasionally you will start to understand how set backs, surprises, misunderstandings, disappointments etc end up with much more power than they fully warrant and how that can sabotage your happiness. In our next article we will look at how to apply this to relationships.

 

17 - Sep - 2018

Latest article - How to make your family times happy times

Our latest article was published in the Chiswick Herald on the 14th September on page 27, click here to visit the site or read the article below.

How to make your family times happy times

For some people their family feels like the best place in the world whilst for others the worst however for most there are good times and bad times. For everyone though there will be a pattern to peoples behaviours and sometimes those patterns might change for the better!

When relaxed and happy people are able to rub along together with little conflict however individuals in groups often take on particular roles and this can lead to tension between people. When something changes or when stressful situations arise, behaviours may not change to adapt appropriately and / or the defence mechanisms deployed by people may add to conflict.

Staying quiet is an option but one that rarely changes an ongoing problem.

If you want to break patterns of behaviour that cause problems then the first thing to do is to think about your family and the particular roles people take. It is normal for people to assume a “job description” and tensions tend to arise because these job descriptions either overlap or leave holes. For example, you might have four people willing to cook but no one who is willing to clean up afterwards!

Unfortunately, when behaviours remain unchallenged and the resentment starts to build thoughts such as “they are so selfish, so thoughtless, self centred” start to occur and these tend to generate even more difficult feelings.

Do you think that person really wants to be seen as difficult?

Such patterns are normally formed because things change but habits stay static. It can be really helpful to think that the person with the annoying habit is most likely doing something automatically and doing it because at some point it was what people appreciated.

But now you need accept that the behaviour is simply one that you find difficult and this cannot be changed alone - if it could have been then you would have managed it by now! 

Even if you have been able to see the other persons behaviour as not intentionally difficult it is likely you will find raising this subject difficult. A good initial strategy is to think about how you tend to be under pressure and how others therefore experience you so you can find ways to stay calm. 

Fight, flight or freeze?

Under pressure people with have a tendency to respond in a particular way - this means it can be possible to predict with a degree of accuracy how someone - including ourselves will be when something goes wrong. There is “fight” meaning becoming active. It doesn’t necessarily mean becoming aggressive but if you think of movement it would be a “step towards”. For those who tend towards “flight” a “step backwards” and for those where “freeze” happens think “standing still”.

Once you have identified the response you can think about what this means in handling situations - imagine the situation then think of ways to ensure you both remain calm.

FFTP - Fact, feeling, thought, preference

FFTP is a structure for how to have those difficult discussions! In this method of communication you provide the other person with all the information about what is going on for you in relation to the issue you are finding difficult.

Here is a hypothetical but typical situation. Your brother (Arthur) who is married with three children has, since having the children, started turning up late to family events you organise and when he finally arrives tends to disagree with things arranged in his absence. Today when the family were due to meet for a walk and lunch he arrives an hour late by which time everyone had decided where to eat and ordered drinks. He says he wants to go to a different place as he has heard good things about it. You find yourself feeling annoyed and thinking here we go again. You know that you tend to get angry and that in the past you have ended up shouting so you know it will help if you can stay calm. You’ve been thinking about this and have already planned to ask if you can speak away from the rest of the family, you also know that when you sit down you tend to stay calmer - so you find somewhere you can sit.

You - 

Fact - “We agreed to meet at 1pm and when you didn’t show up on time we decided on this place, looked at the menu and ordered drinks. Now you want us to change what we are doing.”

Feeling - “I am feeling annoyed, hurt and unloved”

Thought - “I am thinking that my time has been wasted, what I want doesn’t matter and not good enough for you - it is hard for me to enjoy our family time with these feelings and thoughts”.

Preference - “Can we find a way to ensure our arrangements work but can I also ask you don’t ask me to change what has been decided.”

Arthur -

“It is always so hard for us to get places on time with the children, something always seems to happen when we are leaving the house. I should allow more time but sometimes I agree to something and then don’t feel I can change my mind. Arriving late today I felt stressed and nervous because you have been angry with me in the past so I am always thinking I have to make up for being late. I think I have spoilt things and I need to find a way to make things OK so I try and suggest something that I think will be better. Now I am thinking that if I arrive late I can just relax knowing that I don’t have to do that - I don’t need to fix anything. But you are right maybe we can change the way we make our arrangements - I would like to know its OK not to agree a time on the spot so I can think about timings?” 

08 - Aug - 2018

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

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

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

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

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

“Avoid playing the blame game.”

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

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

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

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

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

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

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

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

22 - Jul - 2018

Article - Relationship Dilemmas

Our latest article has been published in the Chiswick Herald on page 27, click here or read it below.

 

Relationship dilemmas - what to do when you want different things.

Over the next few months we will be outlining different dilemmas faced in relationships, in this article we will look at what happens when couples want different things.

The struggle for couples to find a way to handle situations when they both want different things is often brought to therapy. Where there is a repeating pattern of a couple not getting what they want resentment tends to build, goodwill is eroded, the relationship becomes a power struggle and the couple grow further and further apart.

There are only two possible outcomes when a couple find they have different wants:

  1. One gets what they want, the other changes position
  2. A compromise is reached

There is often a misunderstanding about “compromise”. Compromise still means that neither will get what they originally wanted however through working together they will find something new they both want.

What this tells us is that being in a relationship means a couple cannot realistically have an expectation they will both get what they want. A healthy relationship is therefore one where both agree that they will do whatever is needed to maintain and develop the relationship. 

This sounds obvious however when a partner starts to struggle instead of the focus being on “what do we need to do?” it tends to go to what each partner needs to do individually. Whilst this is a natural response it is simply not helpful. It is often also something about trust - trust that we can be understood and that we will end up with something helpful. 

Here is a hypothetical but typical situation - J and M have been together for just over ten years, last year M’s father died suddenly. J was in the middle of a redundancy programme at work at the time and although J escaped redundancy the environment has been unpleasant. M’s work have been very supportive but M has increased the amount of overseas travel. Over the last few months arguments have started to do with domestic chores and money, whilst sex has become sporadic and routine. 

Summer is coming and thoughts have turned to the annual holiday. J wants to go somewhere hot and lay on a beach in an all inclusive resort whilst M wants to go on a walking holiday staying in self catering accommodation. 

When they tried to discuss this they argued, it happened much like the other arguments they had been having but this time J picked up a bottle of wine and threw it at the wall. They found they were both shaken by what had happened and came to therapy. We looked closely at what had been said and how argument had developed. What we found was that:

First, they each stated what they wanted and then commented on what the other said they wanted.

Second, they said how the other had hurt them.

Third, they criticised each others behaviour in their conversation so M criticised J’s anger whilst J criticised M’s withdrawing.

So what is wrong with this? Well lets start at the end and work backwards:-

1. In arguments peoples behaviours are the revealing of defence mechanisms. Their activation is actually a sign that the individual is upset and responding - so this needs to be seen as an issue of the relationship - not the individuals. (With the exception of abusive behaviours). So instead of the behaviour it is more helpful to focus and understand the triggers. Ultimately to catch and prevent situations before they require defences.

2. In our relationships we have hurt feelings when our expectations are not met. Whilst is makes apparent sense to blame the other person it is far more helpful to think about how it is we have differing expectations. (Unless we believe the other person is abusive - in which case what are you still doing there?)

3. People often come up with solutions for problems and then are annoyed when others do not agree with the solutions. In relationships, a solution for something affecting both can only be found when both have agreed and understood the problem. 

So back to J and M. The “problem” was that they were both exhausted and upset with how the relationship was going and they recognised that their exhaustion was preventing them from being as flexible as they had been in the past. They had both been worried for themselves and each other and realised they had been trying to go on as normal and that included the holiday planning. They both agreed that the solution was they needed a holiday to relax / recuperate and when asked to think about each other they accurately identified they tended to have different ways of relaxing and recuperating (“expectations”). It had never occurred to them that holidaying apart might be feasible, fleeting thoughts had been dismissed because part of being on holiday was usually about enjoying time together. But this was not usual and so unusual solutions were valid. They agreed that for this holiday they would take separate holidays but they would also plan an extended weekend away together for a month later.

27 - Jun - 2018

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. 

13 - Jun - 2018

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.

29 - Apr - 2018

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

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

 

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

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

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

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

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

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

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

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

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

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

11 - Apr - 2018

Nicholas at Sky News to talk about relationship sabbaticals

Nicholas appeared on SkyNews this morning to contribute to a discussion about the recent and growing phenomena "relationship sabbaticals". A clip of the interview will be available soon.

27 - Jan - 2018

New article - Make sure depression does not destroy your relationship

This article was published in the Chiswick Herald on the 19th Janaury, click here to read it our their website or see below:

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

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

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

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

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

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

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

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

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

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

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

Main points - 

  1. Think about your relationship - it is not helpful to think just about your partner and yourself separately.  
  2. Take a step back and think together about what you can do so that you can both feel as though you remain committed to each other
  3. Even if your relationship is in a good place at the moment talk about this now - if trouble comes along you will have an agreed strategy in place and this will make it much easier to have the conversations that will help.
  4. If you or your partner is depressed share this article with them and think about seeking couples / relationship / marriage counselling.
27 - Jan - 2018

New Article - Keep your children safe and well in their use of the internet - part one

The first part of this article appeared in the Chiswick Herald on the 5th Janaury, read it on page 21 here, or read below:

Do you struggle to talk to your children about their use of the internet and their safety and wellbeing? Are you tempted to stop your children using the internet altogether? Are you unclear yourself on what is appropriate internet use? Do you fear that talking to your children will only serve to drive them to hide their use of the internet from you?

Over the next couple of articles I will endeavour to provide some useful information on current thinking. However I will also offer some guidance on how to prepare and raise potentially difficult conversations about the use of the internet with your children.

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

In the news this week has been the work by the National Crime Agency to protect children using live streaming platforms, work that resulted in 192 arrests and the safeguarding of 245 children. However National Police Chiefs' Council Lead for Child Protection, Chief Constable Simon Bailey, said: 

“We will keep working together to do this, adapting our approach so that nowhere online is safe for people out to groom children or view them being abused. But we also need help. We need internet companies to help us stop access to sexual abuse images and videos and prevent abuse happening on their platforms.We need parents and carers to talk to their children about healthy relationships and staying safe online.”

A new animation has been developed and released to show how offenders try to build relationships online with young people and guidance for both parents and children on the risks posed by live streaming is available on the “Thinkuknow” website.

The website is helpful in providing information on warning signs to look out for, actions to take and how to access further support and information. As they point out, the best way to address these issues is to be able to have “Calm and open conversations” however they also recognise that you might find trying to talk about safety overwhelming and that you might yourself struggle with difficult feelings. 

They provide really great information on how as a parent you need to act and also what you might expect to experience yourself and how to manage that. I think this is really valuable reading if you are at all hesitant in starting a conversation because it is possible that your hesitancy is indicating that you do not yet feel fully equipped. 

The only criticism I have of the information is that it is presented as a resource to be used if you find out your child has been abused, I would argue that it is really very good reading in terms of how to prepare for any potentially difficult conversation with your children. Why? Because as parents it is so easy to feel under pressure and carry expectations about how you should know what is right and wrong and know what to do. 

It is natural to feel this way and it is also natural for your children to feel nervous about not getting things right, upsetting their parents or have unrealistic expectations about what you know and can help with. The important thing is to be aware of this and think these things through in anticipation of starting any conversations.

In the next article I will write about what is needed from you as parents in talking to your children about the potentially difficult subject of their internet / social media use.

06 - Dec - 2017

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?

28 - Sep - 2017

Article - Make sure depression does not destroy your relationship

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

Make sure depression does not destroy your relationship 

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

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

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

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

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

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

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

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

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

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

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

Main points - 

  • Think about your relationship - it is not helpful to think just about your partner and yourself separately. 
  • Take a step back and think together about what you can do so that you can both feel as though you remain committed to each other
  • Even if your relationship is in a good place at the moment talk about this now - if trouble comes along you will have an agreed strategy in place and this will make it much easier to have the conversations that will help.
  • If you or your partner is depressed share this article with them and think about seeking couples / relationship / marriage counselling.
07 - Aug - 2017

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?”.

24 - May - 2017

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

12 - May - 2017

How does that make you feel?

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

How does that make you feel?

I’ve been listening to this Radio 4 series where you hear psychotherapist, Martha, in sessions with patients. The first thing I found myself wanting to do was find out whether it is classed as a drama or a comedy - I was relieved to find that opinion by reviewers appears divided, that it is not seen as pure drama or an attempt to depict therapy in real life. 

But ask me how I felt about listening to “How does it make you feel?” and my answer is disappointed and feeling less confident that therapy is being understood and embraced - you find me disheartened. 

The title itself set alarm bells ringing for me. I can’t claim to never ask my patients “How does that make you feel?” because sometimes I might, but therapy is not just about getting to people to talk about their feelings. It is a common misconception which does nothing to encourage people to view therapy in a positive light. It’s not the only misconception, others include that people need to talk about their feelings, that men in particular are less likely to talk about them than women and/or it is a British thing not to talk about feelings. The problem with these concepts is that they put across such a simplified view of people and therapy that for anyone struggling, therapy might be seen as nothing more than a placebo.

In reality therapy addresses how we make sense and act upon the information given to us by our lived experience - feelings are just one element. Information is also available to us through our thinking, our bodily sensations, our dreams and our interactions with others and the world around us. There is no rule book as to how much importance we should give to each of these components but in therapy we work with our patients to identify how life is being understood and how this understanding is put into action. We then look together at the struggles that have brought them to therapy and look for connections and solutions.

So it is not just about feelings. It is also not just about being able to talk about feelings because research indicates that as little as 7 percent of communication is verbal - body language and tone of voice being far greater conveyors of information. It is natural for us to embody how we are and what we want and for us to understand how we do that but also how other people, especially those who are most important to us, is hugely valuable.

 

And it is important to remember that therapy is about understanding ourselves AND others. When we improve understanding of ourselves we can be better at understanding others, likewise when we better understand others then that helps our understanding of ourselves. As an aside, and something that probably merits its own article is my view about short term therapy - often thought of as “counselling” (longer term therapy is often thought of as “psychotherapy”) - in short term therapy I think people often start to see themselves in a new and more helpful way in a relatively short period of time however problems can start to appear in their relationships because the therapy finishes before it is integrated across all areas of a persons life. I regularly meet couples where misunderstandings and conflicts have only become more frequent and problematic after one or both partners have been to individual counselling. 

Anyway back to my other thoughts about the Radio depiction. I also wasn’t surprised but I was disappointed that this series also seems to promote the misconception about men because three out of the four patients were men! Finally and most crucially I was saddened to think I heard the therapist as being at times tired, irritated and frustrated amongst other feelings with her patients. For me, I view therapy as a collaboration between therapist and client, an agreement to work together, it is a commitment by both of us to undertake a vibrant, energetic, stimulating exploration. It is a project where neither therapist nor patient can know what will occur, but where both agree to try because good things can come when we give something our best efforts and attention. Unfortunately with Martha I was not entirely convinced this was the case, actually I was wondering whether she might benefit from a sabbatical? And I wonder if future productions might possibly capture some of the wonders of the therapeutic endeavour that so many therapists and patients work so passionately to achieve?

“How does that make you feel?” Series 8 is currently available on the BBCRadio iPlayer.

27 - Apr - 2017

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!

19 - Apr - 2017

New article - Latest advances in treatment of anxiety and depression coming out of the USA

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

Latest advances in treatment of anxiety and depression coming out of the USA

I have just returned from the annual Anxiety and Depression Association of America’s annual conference. The Association is a huge organisation that aims to improve patient care by promoting the implementation of evidence-based treatments and best practices. The focus of this years conference was “wellness” and aimed to present the latest research findings coming from neuroscience and treatment. 

I have for some time been interested in what neuroscience is able to tell us about how the brain appears to work differently when there are particular concerns such as anxiety and depression. For example, studies have shown that the practice of mindfulness appears to have a direct impact upon brain activity and the reduction of anxiety. And it is becoming ever clearer that “disorders” occur when there is some disturbance or interruption between the alarm raising part of the brain - (the amygdala) and the processing or thinking area - (the prefrontal cortex). But we still do not know whether the disruption is in the connection from the amygdala to the prefrontal cortex or from the prefrontal cortex to the amygdala; or a combination of the two. It also seems as though opinion is leaning towards the view that such disturbances occur following some kind of “trauma”, either event driven or biological. However this cannot be definitely stated.

In the therapy profession the behavioural community do tend to be more interested in research than practitioners in the other disciplines and so cognitive behaviour therapies or “CBT” have a bigger base of research evidence. As a result service provision organisations like the NHS tend to lean towards offering these services as they are easier to justify from a financial resources perspective and offer monitoring opportunities. Of course the absence of research from other types of therapy proves very little except that those practitioners do not see a need for research. 

But research on outcomes from therapy generally conclude that the single most significant factor determining a positive outcome is not the therapeutic model or approach but the quality of the relationship between the patient and the therapist. The major issue here is that researching “relationships” and monitoring them is far more complex than therapeutic tools and techniques and so the focus is unlikely to change any time soon. 

My experience tells me that what people need more than anything else is to meet with someone who they feel cares for them and is passionate about wanting to understand their particular concerns. Such an experience is helpful because the person won’t feel the need to justify themselves and can instead think clearly with another person about their situation and what they can do about it. But I also find that people make sense of their situations in different ways, some people are analytical, some clear about their feelings and others like to think through things. When someone is struggling it is likely that they may need to adjust the emphasis they put of the way in which they make sense or not of their problems. Sometimes people ask for CBT and then want to spend their time speaking about their past, whilst others may say they want to talk about how they feel but spend their time looking for solutions. So what does this mean for anyone wanting to seek help with their psychological well being? 

  1. Keep in mind that all mental health conditions have been developed by grouping experiences and are not like physical health conditions that can be diagnosed like viruses, infections or fractures.
  2. We still don’t know whether conditions are nature or nurture or both
  3. The expectation of trauma can be misleading and sufferers can fear that their condition must exist because something has happened to them that they have no hope of coping with
  4. Chose a therapist with whom you feel comfortable - someone with whom you find it easy to speak openly with.
  5. Remember you are in charge and give feedback to your therapist to ensure you get the best possible outcome.
21 - Mar - 2017

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.

21 - Mar - 2017

Article by Juliet Lyons, Child Psychotherapist

Our latest article in the Chiswick Herald written by Child Psychotherapist Juliet Lyons on the international aspects of her work can be read here. Or please see below:

International aspects of my work

As an 18-year-old, I worked as a nanny in Italy. It was my first taste of child-care. I learnt how to care for a 1-year-old while being welcomed into this Italian family - Mother, Father, Grandmother and Grandfather. There was a sharing of languages - English and Italian nursery rhymes; nappy changing practice; foods for a one-year-old (variations on tiny pasta cooked in stock or ‘brodo’ with parmesan, of course). I learnt that learning another language can be a gateway into understanding and partaking in a culture, and to be really satisfied in our exchanges, we not only seek to understand, but partake. At the time, I had a very significant dream: I could talk across languages, transitioning in each sentence between several different languages to produce an extraordinary type of poetry. The dream has stayed with me ever since as does my experience as an English nanny in Italy. 

In some senses, this dream has come to fruition: over the past 7 years, working in Chiswick as a Child Psychotherapist, I have been struck by the number of international clients and how enriching this is to the work. My clients come from areas as diverse as Argentina, Russia, Bulgaria, the Ivory Coast, South Africa, Brazil, Italy, Sweden, US, China, Rumania, France, Germany, (the list goes on) as well as the UK. Occasionally, I even work with a translator. This cultural mix makes for very interesting and varied exchanges. They are multi-layered and complex in the interchange of attitudes and beliefs around caring for each other, parenting, and the forming of identities. 

It is not surprising then that in my consulting room, I have noticed recent political events have had an enormous impact. Following the American elections, I had an influx of young American, female clients who were experiencing enormous amounts of anxiety. Children in my consulting room seem highly aware of politics and environmental issues, particularly those who originate from outside the UK. There is a lot of uncertainty and anxiety in families that come from abroad about their future and where they will live in the near future.

People who come to this country do so for many reasons. Often to do with their work, sometimes for the hope of a better quality of life for themselves and their families. Some have married a UK resident; others have married someone from their own or a different country and culture. They often face enormous losses of friendships, family, and the familiarity of their culture and language. Sometimes they take tremendous risks to move and often feel very vulnerable in such a move. I have been deeply moved by parents that have sacrificed so much to come to the UK, at times to enable their already vulnerable child or children to have opportunities in schooling, therapies and medical care that is just not available in their home countries. 

Attitudes to parenting vary. What is accepted as normal parenting in one country, is seen as abusive in the UK. For instance, hitting your child is still accepted in many countries. Parents can find themselves in the hands of Social Services, learning about the dangers of hitting a child, and learning of more humane ways of setting boundaries and having a different type of relationship with their child. In such cases, the child can see the UK as a protective force, a caring and kind country. But equally, it can be hard for them to carry the burden of knowing that their country of origin did not protect them in this way. It is a complex situation to come to terms with. But these children are initiated into the extremes of cultural diversity that few experience in such stark ways, and often become deeply sophisticated in their understanding of difference. Some families, very sadly, have experienced abuse here in the UK. When people put their trust into a system and an individual in the system abuses the trust and vulnerability of a child and family, it is very difficult to come to terms with. The pain can be shared and born, but it is always there. 

At this particular point in time, when the UK is reconsidering its relationship with Europe and the rest of the world, it seems more important than ever to consider the psychological aspects of being native and being a foreigner. Above all, what I observe and learn from my international clients is around how they navigate the space between dependence and independence, and how they retain or lose their sense of cultural identity.

How we form our identity is relevant to this discussion. According to theories, based on observations of infants, babies and children, identity is formed in relationship. We take in how others view us and see us, how they understand us, and how they interact with us. It is a complex dance of interactions that are forever being built in our minds and held in our bodies. On each building block, the next identity forming interaction is possible. It is the interactions around the care of ourselves that seem to form our resilience and identities most strongly. 

What is significant in this dance is that where we are understood and feel ‘got’, we can accept closeness. Where we are misunderstood, and in particular our vulnerability is misunderstood, trust cannot be built and we therefore tend to break bonds, move away from closeness. Empathy is what allows us to reach each other, to hear each other to feel touched by one another. When one is vulnerable, fragile, unformed, forming, emerging, discovering, awakening, then the softness, safeness and attunement of empathetic responses will find their way into our very being and become part of us. If we are responded to without empathy, with misattunement, with harshness, with a lack of understanding about our vulnerability, then we will shut out the relationship, with long-term and ongoing consequences for us and others. Of course, we will constantly make mistakes as parents, but what is key is that we can repair the ruptures – change our ways, recognize it if we get it very wrong, work with others to find different ways. 

This process introduces the individual in a timely and careful way to their capacities to be an individual within a group. To retain a sense of individuality that, when under attack, can find itself again, and therefore is secure enough. This individual will therefore be likely to tolerate difference. This, in part, is what makes us able to have an interest in another without too much fear of losing our identities. When we meet another, a stranger, we are always taking a risk. But it is the capacity to be uncertain, unsure and how we manage this that is key. If we are too frightened, we might wish to either merge (to deny difference) or to project our fears and make the other more frightening than they are. Managing the tension between a child wanting to explore and keeping them safe is a key principle of parenting. Psychotherapist Nicholas Rose advocates ‘the importance for us to equip ourselves with communication tools so we can feel safe and secure in engaging with others whilst also knowing how to deal with abuse and dysfunction.’ This is inevitably complicated if we are communicating across languages and cultures.

At Nicholas Rose and Associates, we have a culturally diverse team. Psychotherapist Adriana Amorim says, ‘I think that working with diversity is at the core of what we do as counsellors and that having a better understanding of the mechanisms of diversity through personal experience of migration helps me to work more efficiently and in tune with clients' predicaments.’ For me, learning from clients from all over the world, I find that children and parents want to retain something of their original identities and yet, they want to be themselves at the end of the day. And who they are and are becoming can hold many cultural identities. For me, to be able to partake in and support this complex process of identity building, is a privilege.

 

17 - Dec - 2016

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!

07 - Dec - 2016

New article - Bullying and what to do about it?

Our latest article on bullying in the Chiswick Herald can be read here. Or below:

Bullying and what to do about it!

Research shows that one in every two people are affected by bullying. It is something that people still find very hard to discuss. Research, information, education in schools, employer advice, safety online, children, adults and the elderly are all areas and people where there is some progress but as our awareness of bullying develops then I think confusion can occur. 

Increasingly I think the word can be used incorrectly and it is really important to be clear about whether your or another persons behaviour is bullying. If used incorrectly misunderstandings can be magnified and conflicts made worse, sometimes partners might accuse each other of bullying as it can justify ending a relationship. However it is also essential not to shy away from the word when bullying might be happening.

No good can come from a person being trapped in bullying and to stop a bully is to also give them a chance to change their behaviour.

So the first step is to be able to identify bullying. This sounds obvious but in my work I have found that many people have not realised they are being bullied, it is also common for people not to realise that they are bullying others. Meanwhile I also hear people accuse others of bullying behaviour when on closer examination there is actually something else happening.

Bullying can take many forms but in essence it is deliberately setting out to hurt another person either emotionally or physically. It is often a pattern of repeated behaviour and one that leads to the bullied person feeling differently about themselves and the world. Threatening behaviour, insults, unfair treatment, excluding are all possible manifestations. It is also something that often occurs to certain people because of factors such as how they appear, a disability, sexuality, gender, race or religion. There is always a purpose to bullying - it will be to make the other person feel bad and / or to get them to behave differently or do something that the bully wants.

BullyingUK is a charity that provides information and advice through their website www.bullying.co.uk and it can give you information whether you are experiencing bullying at home, work, school, online or any other context. It is also very good in terms of helping where you might be bullied for a specific reason for example your sexuality. But for the rest of this article I want to help you think about your relationships and whether there are any where bullying might be a concern.

First of all think about your family, friends, colleagues are there any where you can find yourself feeling uncomfortable? 

Secondly, identify what is it about your interactions that feel uncomfortable? Is it things that are said to you, is it things you find yourself saying to them? Do you feel irritated, frustrated, nervous or scared? Do you find yourself acting differently around them to how you normally behave? Do you observe that they treat you differently to other people? Has anyone who knows you and spent time with you said anything to you about what they see happening? Are your requests / wishes ignored? Do you feel forced into doing what the other person wants? Does the person approach you even when you have shown no interest in contact with them? Do you think there is an obvious or perceived power imbalance? Do you think the person might find your interactions with them hurtfull or upsetting?

Third, what have you tried to change or stop what is happening? What haven’t you tried and why? Have you tried telling the person that you find their behaviour towards you hurtful? If so did they ignore what you said and continue or increase the hurtful behaviour? Or are you just too frightened to even try? If this is the case then talk this over with someone as the situation needs to change. If you are wondering whether you might have been bullying then can you remember how the other person responded in response to your actions or words. Did they appear calm and relaxed or nervous and scared, what did you then do? Did you continue with your words and actions? Did you ask them if they were ok? Did they do what you wanted even though they had said it was not what they wanted? If you now think that maybe you might have treated them badly you might consider asking them or find someone who you can talk this through with.

Im my experience as a psychotherapist people can feel ashamed if they have been bullied or guilty and afraid if they have been the one bullying, so speaking to someone you don’t know can often be really helpful. It is important to be able to feel able to tell the whole story if you find yourself editing out things you of the other person did then this suggests you are not talking this through with the right person.

23 - Nov - 2016

New article - Happy relationship, happy children?

 

When couples with children come to therapy one of their biggest fears is that any trouble in their relationship might be affecting the children and often guidance is sought about how best to protect them. The bad news is that such fears are well founded, the good news is that there are things that can be done. In this two part article we will talk about how to approach difficult situations, highlight warning signs and suggest ways for handling them constructively.

First of all you need to complete a thorough assessment of your relationship to be clear about what the concerns might be - a clear understanding of how you are in your relationship will enable you to think more clearly about the times and situations when things may be problematic and when your children might be affected. 

So thinking about your relationship - are you happy with it? Do you always say whats on your mind? Do you feel listened to? Do you feel understood? Do your needs get taken into account? Is your relationship as strong as it has always been? Do you think your partner is happy? Does your partner do the things he or she used to enjoy? Do you laugh together? Do you enjoy your sex life? Do you have lots of happy memories together? Do you look to the future together with a sense of excitement? 

If you are starting to identify think about some problem areas try and be as clear as possible about what you have noticed. Avoid conclusions like we are so loving anymore - instead identify behaviour for example we don’t have date nights any more. Once you have identified behaviours, think about when the behaviour change happened. What was happening in your lives at that time, what was the impact of events, what was discussed at the time and were issues resolved? Even if you were happy with the way things were handled, was your partner? Have you ever checked in to see if your partner was happy? Thinking about any unresolved issues, what happens when situations arise that remind either of you of it? How do you handle it? What is the impact of it? What gets said and what does not get said?

By now you should have a good idea of the situations, contexts and times where conflict may exist. Even if you feel comfortable with the problem areas identified and think that conflicts are manageable between yourself and your partner you may want to think about whether there is anything to address with your children. So the second stage is to now think about your children.

Bringing conflicts to mind what do you think your children would say, think and feel about them? Do you remember anything they said or how they reacted? Did you understand their reaction? Did you explore with them what they wanted from what they said or did? Has their behaviour changed at home, at school or with their friends and how do the changes correspond with changes in your relationship? Has their relationships changed with you, your partner, other family members and relationships?

If you are starting to think about times when things were difficult and finding yourself worrying about whether you handled them in the best way then the very first thing to do is to stop that negative train of thought. Instead congratulate yourself for your courage in giving this some thought and look at this as merely a stepping stone to improving things.

A relationship without conflict is unlikely to be one where those in the relationship are fully engaged so it can be really helpful to remember that intimacy can come from conflict in as much the same way as through good times! Conflict shows the existence of care and what is important is that it is handled in the most skilful way. The problem for children is that they often only see the negative situations and may start to worry about what might happen or even, in situations where parents have resolved a conflict not know for certain that is the case and suspect that worse is still to come.

In our next article we will look specifically at what to do now.

26 - Oct - 2016

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. 

01 - Oct - 2016

New article - Is your relationship in the best of health?

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

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

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

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

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

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

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

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

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

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

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

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

5 If you are struggling then do not hesitate to seek professional help. Many couples seek help when it is too late - when there is too much misunderstanding and hurt and not enough energy and commitment left in order to make the changes required.

28 - Sep - 2016

New article - Depression how to think about it and how to recover from it

This article appeared in the Chiswick Herald. Please click here or read below:

Depression - how to think about it and how to recover from it

News reports last week covered research showing that 25% of architecture students in the UK are receiving or have received treatment for mental health problems related to their studies. Unusually this study sought to identify the sources of the distress and was able to list a number of factors - importantly all of these were outside of the students control.

It is often rightly stated that a stigma exists around depression and other mental health illnesses. However the point that often gets missed is that one of the biggest blocks to sufferers in recovery can be their own attitudes to both mental health and themselves for experiencing mental illness. It is really common for people to feel upset with themselves for struggling and to try and almost bully themselves out of their feelings. Unfortunately this tends to result in sufferers feeling even worse and they can become stuck in a vicious cycle of thoughts and feelings.

This research amongst students suggested that financial pressures, workloads, working conditions and sexual and racial discrimination were all serving to damage the mental health of one in four of these students. And as I have written previously, it seems that the mental wellbeing of students and employees in the education sector has been overlooked for some time. So much focus os put on results and processes with little emphasis on wellbeing.

So research like this is really important because it shifts focus when someone is struggling. Instead of questions being raised around how the person is coping (or not coping) with the inference being that they are not doing something right, it can be directed at looking and considering the context in which the person finds themselves.

We know ourselves through our relationships with others and yet when we are having a hard time, it can be really easy to conclude that it is only us that are finding things hard. I wonder just how surprised but also relieved architecture students were when they read the findings of the research? For many I suspect they will have felt intensely relieved, not that so many others struggle but that they are not alone. And more importantly the cause of their depression and anxiety is not simply themselves.

Getting a comprehensive understanding of the issues someone faces and the context in which they live and have come from is crucial in getting to grips with depression. Before anyone can start to recover they need to discover some hope in the potential for them to lead a life without such painful and overwhelming feelings, or as is often the case with depression absence of feeling. And hope comes from the realisation that the depression is only natural given where they find themselves in life, that it is not that they are doing anything wrong but the contrary, that it is only right that given their circumstances they can feel as they do.

Being able to make the connections that makes sense of the experience starts a process whereby positive connections can start to be made. Ways in which the sufferer can start to do things differently, take control, build confidence and distance themselves from the illness and increase their sense of connection with the world, others and their ability to find life satisfying and rewarding.

Again though, during recovery one of the biggest hurdles can be a persons impatience with their recovery. The desire to get away from the experience of depression can be so powerful that they can be vulnerable to almost addictive behaviours. Exercise can be a good example of this, the physiological feelings and rewards available from exercise can lead to addictive behaviour and ultimately this can act to sabotage recovery.

To prevent this it is important to spend time to reflect on whats happening, the changes being experienced and to consider the consequences of decisions moving forwards. It is a common phenomenon that people who appear to be on the point making a full recovery make a decision that can have devastating results. In fact suicide risk can be greatest for people who appear to be in recovery than those in the depth of their depression.

Mental illness is such an unpleasant experience for suffers and their loved ones that it is only natural to try to avoid dwelling on difficult feelings and to want to look forward and focus on the positive however taking time to think about how things are going and how to maintain momentum whilst allowing set backs is crucial.

If you or someone you know is suffering from depression then consider seeking help. A counsellor or psychotherapist will have the right skills and experience to help understand the depression, its causes and then provide support through the entire recovery process.

Patients often ask me how long it will take, how many sessions will be needed for them to recover. My answer is always a simple one - we know we are finished when we no longer have any concerns that are usefully talked through.

27 - Jul - 2016

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.

11 - Jul - 2016

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. 

01 - Jul - 2016

New article in Chiswick Herald - anger management

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

Anger - are you an angry person?

 

“Anger management” is a very popular therapy search term and it is something patients often bring to therapy. Anger is a very healthy and normal feeling but what is often missed is that anger is generated from other underlying feelings; so people may easily be avoided because they are viewed as angry because the hurt or upset that lies underneath is not recognised. 

 

Treatment can start when someone has started to wonder whether they have a problem with anger. This sounds obvious but in my experience this is not always so simple. Whilst people think they know what anger looks like - probably more than many other emotions - the reality is that anger can be hidden in a number of ways, examples being by silence and withdrawal or passive aggressive behaviour.  Meanwhile some people can appear to be angry when actually they are more excited or desperate to be understood. I work with my dog in the room and she is an excellent barometer for identifying anger. Many times she has behaved in such a way as to alert me to anger when it has not been obvious to me.

 

Treatment can helpfully be seen as having a two pronged focus - the first is to work on identifying anger and putting in place strategies for de-escalating the anger, the second is to look at the feelings which lead to anger; so its about treatment and prevention.

 

So lets look first at identifying anger. Anger can make itself known through a number of physical, emotional and behavioural signs. Physically you might have an increased heart rate, start to sweat, have stomach pain or a headache, clench your jaw, shake or feel dizzy whilst emotionally it is common to feel a number of emotions for example like running away, wanting to strike out, anxious, guilty. Behaviourally, things that are common are things like pacing, being sarcastic, speaking loudly, doing things that you know are not healthy but you find change how you feel for example drinking, smoking or taking drugs. 

 

Another key way to know if you struggle with anger is to think about your interactions with other people. Does anyone ever make any comments about your behaviour? Do you come away from situations with others where the outcome has left a conflict outstanding? Ask your friends and family whether they experience you as being angry?

 

If you have come to the conclusion that you do have a problem with anger then its time to put in place some strategies to deal with it. Neuroscience is showing that a part of the brain called the amygdala is responsible for triggering our emotions and this trigger happens anything up to six seconds before the rational / thinking part of the brain steps in. This means you can be angry before you know why - so if you are now better able to identify feeling angry you can now manage it. One very useful tool is to count to 10 - it sounds like just one of those things people often say but given the neuroscience, what you are in fact doing is allowing the thinking part of your brain to catch up! Another very useful tool, and something to do at the same time is to focus on breathing slowly. Combine the two and count each breath - use 1001, 1002, 1003 etc.

 

With these tools in place it will now be possible to start to look at understanding the situations and feelings that are generating your anger. Take time to reflect on the times when you became angry. Exactly when did it happen, where were you, who were you with, how did you act, why did you react and what were the thoughts and feelings in the moments before your became angry? You will also find it useful to start keeping a diary so that you can start to identify patterns. 

 

What you may find is that you get angry in certain circumstances - in other words you have ended up with an automatic response and this needs to be challenged as it is no longer useful. Lets take a very simple example just for illustration, imagine you realise you always get angry when you hold open a door for someone and they do not say thank you and you think “that person has no respect, why did I bother?”. Ask yourself what are the other reasons why they might not have said thank you? If nothing comes easily to mind think about a time when you didn’t say thank you - what was happening for you? Once you have found one possible alternative others are likely to follow. Secondly, ask yourself what makes you hold open doors for others and the thoughts and feeling that surface when you challenge yourself to stop doing it? In my experience people often realise that they are reacting to an assumption and an interpretation that may well be unfounded and secondly they are more upset with themselves for having expectations than what actually happened.

 

In finishing though it is really important to be kind to yourself, if you struggle with anger and  the thought of attempting what I’ve written here brings up difficult feelings, maybe even anger then consider talking to someone. And of course if your anger is already at levels where you are putting your safety or the safety of others, (which of course is one and the same thing), then don’t hesitate to seek help, anger can be managed!

17 - Jun - 2016

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”. 

Fairlie Gibson - Scaravelli Inspired Yoga

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

26 - May - 2016

New article - thinking philosophically

Our latest article in the Chiswick Herald publishes today and is available online here.

Or read the article below:

 

Feeling lost? What happens if you think philosophically?

When I first meet people and I ask “How is it that you are here?”  they often tell me they are feeling lost. The experience of feeling lost is one that can be so painful and confusing we naturally tend to look outside of ourselves for help in again finding a way forward. In other words we are no longer finding it possible to approach our situation philosophically.

In my view, our tendency to blame ourselves for having become lost feeds a sense of isolation and loneliness; one which helps prevent us from harnessing our innate abilities to again find our way. And of course any pattern of thinking that encourages us to think negatively will only escalate how bad we feel. We can feel sad about feeling sad, anxious about feeling anxious, confused by our confusion, lost in our lostness; I think you get the point.

To break the cycle we need to do something differently that results in us again feeling hopeful and enables us to again engage with our innate philosophical potential. After all, and to allow us a brief moment of philosophical thinking, to feel lost means that at some point we did not feel lost? And to approach philosophically the point at which this changed is where we will find the information we need to again find our way. But how? Firstly, we need to find a calm disposition and secondly foster a curiosity towards our situation. 

When people come to see me it will become apparent very quickly as to whether meeting with me has the potential to be helpful; whether we can develop a therapeutic relationship. In the first session the single most important factor determining the potential outcome for us is how the person feels in spending that first fifty minutes with me. Do they feel relaxed, are they feeling free to speak openly to me, do they feel heard and understood by me? Is there a glimmer of hope that has surfaced as a result of us meeting? Are my questions or questions that are occurring in them encouraging them to think about things in a new way? The therapeutic relationship is the foundation of healing and often research has shown that for many, a relationship where the person has felt safe, cared for, heard and understood has been what has mattered most. 

And as suggested earlier the second aspect of a philosophical approach is being able to think clearly about our situation. When young, we quickly learn through the use and questioning of the information our senses provide. Our thoughts, feelings and bodily sensations are converted into information that enables us to understand the world when we also ask when? where? who? what? how? and why? And this learning forms the basis of how we make decisions. As we go through life we will automatically respond to situations that we understand as familiar bypassing any great contemplation of our senses or any rigorous questioning.

This all works fine until the situations are in fact not similar enough that an automatic response is the best choice.   Our context may have changed, and/or we may have changed, either way a response that always used to result in a positive outcome is resulting in a negative outcome. We try again and again and that only leads to us feeling worse until we realise we are lost. What we missed at the moment when our choice did not provide the outcome we expected was the need to remember that everything changes. And with change comes the need for us to be prepared to accept that the things we have come to expect as certain may need us to revisit them.

The ease with which we can do this alone depends upon many things but I think that if you are not finding a way to feel calm and that as a result you may not be finding it possible to think clearly then do not punish yourself for feeling this way. Be as kind and compassionate as you would be to the person you care for most in life. After all, surely you would tell them that they deserve help, that it is ok to sometimes need to seek help, that they do not need to feel alone? And once you no longer feel alone and you are again able to access the full potential of your curiosity you will again find your way.

Notes about Nicholas:

Nicholas is registered as a Psychotherapist with the United Kingdom Council for Psychotherapy through the Society of Existential Analysis following a training that applies philosophical enquiry to concerns that are often brought to counsellors and psychotherapists. This particular approach to therapy combines the therapists wish to alleviate the suffering of others with a framework borne from existentialism and phenomenology. 

22 - May - 2016

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 

01 - Apr - 2016

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.

06 - Jan - 2016

A Mindful Festive Season - Part two

This article is the second in a series by Nicholas reviewing an online Mindfulness Training he started just prior to Christmas.....

I hope you had a peaceful, relaxing and enjoyable Christmas? 

For my part a quiet Christmas with close friends and family has been a healing experience after three successive festive seasons with various painful, stressful situations and losses. Periods of calm, gentle relaxation with others who have been easy company, has been nurturing, restorative and facilitated a general sense of well being. 

Alongside this and the absence of any new difficulties, has also been the Online Mindfulness Training I’ve been doing as introduced in the last column published in the paper on the 17th December or available here online: http://chiswickherald.co.uk/on-the-couch-with-nicholas-rose-p4693-261.htm. The training itself is provided by www.bemindfulonline.org.

Overall, both have given me an experience of a period of time whereby the noticeable absence of worries again suggests to me just how much previously experienced day to day stress and anxiety maybe coming from nothing other than self made pressures. Of course it is natural to react to difficult situations by taking action and making lists of things to do, however a list of things will only bring additional pressure and a resulting bodily response that adds to the already heightened experience caused by existing difficulties.

As is always the case when I spend time practicing and learning more about Mindfulness I find something new and helpful that makes the time spent both easier and more rewarding. As I start week three of the training it is during a meditation I notice throbbing in my head, it is something I’ve noticed many times before. Previously I’ve tried doing what I’ve been taught, namely paying it attention but the outcome has been for me to feel somewhat nauseous and it has led me to feel reluctant at times to practice. However this time, right at the moment when the nausea is starting to appear the facilitator, Ed, says something like “if you notice any unpleasant thoughts, feelings or bodily sensations you can try paying them attention or you might find it helpful to return your focus to your breathing". This I do and the pain and nausea disappears. Todays learning was a piece of “unlearning” - I had been holding an assumption that there was only one way to deal with difficult experiences during mediation but now these few words have released me from something that was certainly unhelpful.

And I am finding Ed and Tessa, the facilitators, to be perfect companions to the training. In the middle of the second week just at the point I noticed thoughts around how the training was not enough I received an email inviting me to a mid week video. It was as though they knew exactly how I would be thinking and feeling at this stage and hearing them talk about the successes and challenges of the exercises as I had also experienced of them was just what I needed. I was left feeling reassured that I was in fact on course, not alone in my experience of suddenly doubting whether the training was useful and not failing.

This week I read two articles published on washingtonpost.com about Mindfulness, one from Neuroscientists again talking about how after eight weeks of practicing, changes to the brain can be seen in areas that they believe are helpful and healthy, meanwhile another article warns that Mindfulness is being “mindlessly” taken up by everyone when for some people it might not be helpful - in fact it might be unhelpful.

Mindfulness helps me to identify where stress and anxiety is leading me to do more than I need to, whether that is working, cleaning, eating, drinking, exercising, resting or like this week, paying attention to difficult experiences during a meditation. In other words it helps me to keep things in perspective and this is what I believe is most helpful. As a psychotherapist I’ve learnt and experienced many different approaches to gaining perspective but when I think of things that I have found helpful I would say that both therapy and mindfulness as it is taught and practiced today have been the most useful.

I’m still working through the Online Training so I will let you know in the next column what I think as I reach the end.  

19 - Dec - 2015

Wishing you a mindful Christmas

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

Wishing you all a very mindful Christmas

 
 

When I was thinking about what to write for this column I decided to search the internet for “mental health news and Christmas”. The search results displayed many features on how to manage stress over the festive period and I felt discouraged. It seems that Christmas and the New Year are often only really considered for the struggles they bring rather than the potential for reflection, contemplation, love, fun, connection, relaxation and self expression. What did catch my eye though were the many references to Mindfulness and through the website for the Mental Health Foundation I came across an online training course in Mindfulness.

Mindfulness is something I know quite a lot about having started meditating nearly twenty years ago and have always found the more mindful based practices the most helpful. I have also enjoyed retreats and trainings to develop my practice and yet it is at times when I could most benefit from mindfulness that I can so easily end up doing other, arguably less helpful things with my time. And this Christmas is a difficult one for me, it is a year on since the death of someone very important to me and so naturally, as the anniversary comes closer, then I find myself experiencing difficult emotions and thoughts. My body is also showing me that it is a hard time, a cold, tense neck and shoulders muscles a few headaches and occasional sore tummy. So now really is the time for me to be particularly kind to myself and to call upon my mindfulness practice - yet the turbulence I am experiencing also makes this hard to do. I think this explains why this online training has attracted my attention and so I’ve decided that for the next few columns I am going to take the training and then share the experience.

The background information from the provider of this training, a website called www.bemindfulonline.org, states research conducted by Oxford University published in the BMJ (British Medical Journal) reported 58% reductions in anxiety, 57% in depression and 40% in stress; so I feel excited and hopeful thinking about getting started. If you sign up you get free access to a short introductory video from the two Trainers Ed and Tessa. Watching this I find the trainers very reassuring, with what they say resonating easily with my experience of mindfulness. And I find I am really warming to this as an approach to learning, you can take this at your own speed.

Next is a short video introducing a pre-training test. In this Ed explains it will benchmark how you are experiencing and relating to stress to allow for comparison at the end of the course. Taking the test, I recognise the questions that are widely used to form generic tests for stress, anxiety and depression. As I complete the tests I am struck by how the last two weeks have been particularly hard for me and I am again drawn back to thoughts around the events and memories from the run up to my bereavement last year. A further video from Tessa acts to again reassure but also encourage continuing with the course. At this point though the free introductory element comes to an end and a fee of £60 needs to be paid before you can continue. I’m feeling curious so I find it easy to make the payment.

It feels good to be getting properly started and the first exercise is one I’ve done before - they call it mindful eating. What really strikes me is how distracted I am, how hard it is to focus and my awareness of this I find reassuring. I’m already starting to gain a sense of empowerment, I’m thinking I’m on to something that is really going to help me at this time. Pressing the play button again Ed and Tessa now introduce the tasks for week one. Again they are exercises I’ve done before but in hearing what I will be doing I start to feel more relaxed. I’m thinking it is as though I am being allowed to slow down, to go at my own speed. It is a bit like having someone who really really trust ask you what you want to do and then to have them give you reassurance that you really do know best!

So what will I be doing each day for the next week? The tasks are as follows firstly to eat a meal mindfully, secondly choose a daily task for the mindful treatment - mine will be cleaning my teeth and lastly a thirty minute guided mindfulness relaxation. It is going to be a busy time over the next week as I prepare for the Christmas break so I’m going to need a bit of will power. By the next time I write I will be able to tell you how it has been and what exercises were introduced for the second week. In the meantime from all of us here at Nicholas Rose and Associates we wish you all the very best for a mindful and enjoyable Christmas and New Year.

04 - Dec - 2015

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.

06 - Nov - 2013

Off peak reduced fee service

We are pleased to announce the introduction of a number of reduced fees for services during off peak times. For full details click here.

07 - Mar - 2013

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

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