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Call to Action – would welcome your comments

In the words of a very brave father, who deserves to be heard:

“Do Something about it. Make the changes Now.”

http://news.sky.com/story/shortage-of-mental-health-beds-for-young-people-10515728

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Am I mentally ill or expecting too much of myself?

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This post is partly inspired by the ever increasing prescription of medications for depression and anxiety. It is also informed by clients who have been told, perhaps by friends or family, that they must be mentally unwell, given the symptoms they present with (fatigue, worry, low mood, tearfulness, etc.). This can be daunting for individuals who have perhaps watched relatives endure mental health problems, and naturally fear that they may be heading down a slippery slope.

I am not suggesting that changes in mood be dismissed; it is important to inform your GP if you are struggling with fluctuating mood that has gone on for some time with no obvious trigger. Anxiety and low mood often come to the fore when we find ourselves under pressure or faced with uncertainty. In some cases, we may be able to problem-solve issues resulting in an improvement in mood but this requires some detective work in the first instance to identify contributing factors.

Often, individuals are carrying enormous burdens that they have become accustomed to and therefore do not make the link between their responsibilities to others and their deteriorating mood. Exhaustion can have a profound effect on physical and emotional well-being and does not necessarily suggest an underlying mental health problem. In some cases medication can ease periods of extreme anxiety and low motivation but solving the cause of this exhaustion is the only real path to recovery.

I would advise people struggling with low mood to ask themselves if they are stretching themselves too thin, giving to the detriment of receiving, and asking of themselves what they would not ask of others. It can be tough to challenge our norms, especially if we have become accustomed to being the ‘strong’ one who never says no for fear of letting others down. However, the results could be surprising. When we reduce our desire to take on the world we may come to find that others have been dis-empowered by our input and can now start to develop their own coping mechanisms, freeing up more time to look after yourself.

Resilience

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How I wish I could capture and distill the dignity and spirit of clients facing daily battles with mental health problems. It is quite extraordinary how the human spirit to survive and flourish can remain in the face of fear, anxiety and despair.

There is a great deal of research into factors affecting resilience; some point to positive role models, and others to character traits. In my experience, it remains a mystery.

I have met individuals who have endured multiple traumatic events, face obsessive rituals that dominate their days, and struggle with unimaginable inner torment. And yet, these individuals continue to seek answers and solutions to their unwelcome afflictions. It is a credit to them as individuals and a testament to the human determination to survive.

I believe it is near impossible for those who have never experienced a loss of reality or an event that defies belief, to imagine what life might look life in the aftermath of this: darker, more fragile, unjust? And yet, there are survivors, those who have been there and back again.

There is a theory, loosely based on the common dictum: ‘What doesn’t kill us…only makes us stronger’. It is called Post Traumatic Growth Theory. This theory suggests that it is not only possible to successfully treat symptoms associated with trauma but to growpersonally as a result of this. I am not entirely bowled over by this assumption given the perhaps overly positive spin it suggests. However, I would very much like to believe that the human spirit can accommodate significant blows and remain resolute in the face of an uncertain future where appropriate support is provided.

I can testify to what I have seen in my practice; a desire to find meaning where at first there seems none. This need for meaning aligns itself with the metaphor of the brain as an information processing system. If it is possible to locate trauma and injustice within some form of an extended world view, then what occurs to us over our lifetime, good or bad, might have some chance of being appropriately accommodated, along with all the other experiences and memories that we so efficiently store away.

Following successful treatment for post-traumatic stress disorder, I have often observed a shift in clients’ perspectives towards the self, others and the world. Where once there was no self-compassion to be found, kindness might evolve. Where there was no purpose, a desire to support others can emerge. Perhaps it is integral to the human mind to find meaning in the face of adversity.

Whatever may be the key to resilience, it must not be overlooked by the symptoms associated with poor mental health. To do so would be a huge disservice to those who have suffered and survived.

What is it to be traumatized?

 

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Clients often report feeling fraudulent entering therapy, stating that they had a happy childhood and no significant traumas in their life to date. In their mind, it is they who are fully responsible for their ongoing depression or anxiety. We tend to think of traumatic events as those extremes we hear about in the media: rape, assault, terrorism etc. In reality, the link between trauma and a traumatized brain is less clear cut.

Life is littered with uncertainties and perceived threats, to our lives, self-esteem and confidence. In the face of such threats, some of us are simply unequipped to deal with the psychological fall out – through no fault of our own. To assume full responsibility for how we react to these events, is inaccurate and disregards all that we now know about the brain. Brain imaging has revealed our limitations as human beings to differentiate between perceived and real danger. As a result, it may be more accurate to attribute some responsibility to our innate physiology.

I prefer to use the word ‘traumatized’ in therapy rather than labeling specific events as the moment trauma occurred. This allows clients to identify behaviors, emotions and thoughts that may indicate a ‘traumatized brain’. Put simply, a traumatized mind is a ‘confused or disorganized’ mind, involuntarily firing on all cylinders and largely out-with our control due to our evolution.

A traumatized mind is separate from the traumatic event. We are not born with the skills to self-soothe in the face of danger (perceived or real). We may seek them out in infancy but there is no guarantee these needs will be met through our environment. We have to learn these skills, to enable our brain to successfully access the parasympathetic nervous system, which essentially sends in the ‘para’-troupers in times of stress to calm the flames of anxiety and fear.

We learn key nurturing skills in early childhood, largely from care givers. Given that care givers are only human, and may well be inexperienced at managing their own emotions, we may find ourselves vulnerable to developing self-compassion. This is not to say our parents or peers are to blame for our underdeveloped brains rather that it is in no way our own fault as individuals for getting trapped in a traumatized mindset.

The good news is, no matter how traumatized our brains may be, brain imaging has shown that these key nurturing skills can be learnt at any age with the help of psycho-education and/or appropriate psychotherapy. Schema Therapy, Cognitive Behavioural Therapy, Psychoanalysis and Mindfulness all offer ways to calm the traumatized mind and gain essential self-regulatory skills.

It might be useful to consider the mindset that is engaged in the face of danger for you personally? Remember, our brains may be limited by insufficient development, but they are also extremely flexible, allowing new neural pathways to develop and arming us with more efficient and effective skills. A traumatic event can never be eradicated from our memories but we can significantly re-wire how our brains relate to these memories.

Recovering from Trauma

I wrote a while back about the impact of shame and how often this can lie at the root of psychological distress. Here’s a few more pointers on how shame can be tackled with compassion focused therapy.

Shame often disguises itself in more easily identifiable emotions, including, anger, disgust, anxiety, and depression. When shame is unresolved it can lie dormant for a long time. Typical behaviours that we might find ourselves caught up in are, self harming and aggression (attack), submissiveness to other’s demands (submit), and withdrawal from others (hide).

Shame is a normal human emotion, essential for the survival of social evolution, however, if left to eat away at us, it will often raise its ugly head again and again when we are feeling vulnerable or stressed. The power of shame is such that it can feel like a knife in the back, knocking our confidence and sense of direction and self worth. We can feel shamed socially, leaving us vulnerable and highly alert to other people’s judgments, and shamed internally, where we become our own worst and punitive critic, irrelevant of other people’s comments.

The good news is, no matter when or where our sense of shame comes from, the shameful mindset has been learned and therefore, we have the opportunity to learn a new mindset, one based on compassion.

The compassionate mindset involves first looking at the root cause, usually a situation or comment from others in the past, that first sowed the seeds of shame. This is followed by skills based training in Mindfulness, a meditative technique, which opens the door to a new way of interacting with our emotions, behaviours and thoughts. In a nutshell, Mindfulness increases self awareness of the shameful mindset, promotes self healing, and nurtures our ability to develop kindness, compassion, and a non-judgmental stance towards ourselves.

A great book for anyone struggling with shame and looking for an alternative path to freedom is The Compassionate Mind Approach to Recovering from Trauma by Deborah Lee.

Warning signs and relapse prevention

Exercise and adopting a generally healthy lifestyle are often key factors credited with helping to sustain good mental health. Naturally, most people who are coming to the end of psychological therapy are keen to maintain their improved health; what is not so commonly cited is the benefit of knowing your own particular warning signs.

Recovering alcoholics are all too aware of the triggers that can pose a threat to maintaining a sober lifestyle. Willpower can be helpful in some cases, but faced with a Christmas party or a sudden life crisis, the recovered alcoholic can find themselves once again staring their demons in the eye. Even our thoughts can blind us in times of stress and worry, the idea that we can be ‘cured’ for life is misleading. It would be wise to keep in the back of our minds that we all have our vulnerabilities and though they may not haunt us in our day-to-day lives any more, they have shown themselves to be extremely powerful and deserve a degree of respect and caution as we move forward.
Any therapist worth their salt, will dedicate sufficient time towards the end of therapy for the client to explore their own ‘warning signs’: essentially emotional, physical and behavioural signs that might indicate a step towards that slippery slope. Maintaining good mental health is just that; a maintenance job, that in itself can prove rewarding as a reminder of how well one we are doing.

The less conspicuous warning signs can often be difficult to spot in order to swiftly nip them in the bud. These include sleep disturbance following a period of relative stability, weight gain or loss, physical aches and pains and even a period of elated mood that is not common to the individual despite all the positive feelings that come with it.

Relapse prevention is often best supported by checking in from time to time with a trusted clinician for a mental MOT. The simple act of keeping a diary with a view to reviewing day-to-day observations that might be impacting on our mood can also be extremely useful.

As someone who struggles with mental health issues, I am all too aware of the importance of keeping an eye on any signs that have in the past snowballed and led to a drop in self-esteem and a fear of relapse. In no way do I live my life under the microscope of these fears, scrutinizing my every move, rather, I take each day for what it brings with an awareness that just as life can be unpredictable so too can my moods. I own my vulnerabilities as well as my strengths and this alone makes me feel all the more confident moving forward.

Can first-hand experience of a mental health problem help therapists to better help their clients?

Now that’s an interesting one. I would have to say, on balance, yes and no.

I myself have experienced episodes of depression and anxiety and I have also bared witness to family members struggling with addiction, psychosis and schizoid affective disorder. So you would think, on balance, that I would have a good head start as a psychotherapist working with clients who report very similar symptoms.

It is true that my personal experiences have had a significant bearing on my choice of current profession; however, with experience, I can see some of the pitfalls of ‘over identification’. Is it always possible to remain subjective when the client seems to be telling ‘your story’? Can one always retain professional distance if this is the case?

In my experience to date, I have paid particular attention to these obstacles and have discussed such transference issues at length with my supervisor. I guess this is not a challenge specific to therapists as it appears to be human nature to identify and empathize with others. It does however require self-reflection as it is not the norm for therapists to self-disclose whilst working with a client who will be quite unaware of the subtle identification process that might be going on.

I would also like to note how my own struggles with mental health have, I believe, benefitted my professional development as a psychotherapist. I have discovered that theory and formulation does not necessarily equate with desired outcomes, i.e. improved mental health and wellbeing. When I have attempted to stick rather rigidly to particular ‘models’ of therapeutic intervention, I have often hit a brick wall. I have essentially lost touch with the client and my own subjectivity in my attempt to remain the objective scientist. To counteract this effect, I now approach every client with a blank sheet, essentially encouraging myself to be mindful of everything that is happening within the room so as to respond authentically and holding theory, skills and my own subjective reality on an equal level.

Finally, I would like to thank all my clients to date for giving me greater insight into my own inner world. It is often assumed that given my training I must be super adept at managing my own life’s worries and problems. I do my utmost to ‘practice what I preach’ but at the end of the day, I am human and I’m glad to be able to identify with others’ difficulties. Without this personal insight I really don’t know how I would be able to do my job!

Mindfulness as a powerful adjunct to cognitive behavioural therapy

Presently there is a lot of talk about the practice of Mindfulness in the media as one of the ‘new’ forms of treatment for depression and anxiety. Ironically, mindfulness as a form of meditative practice is in fact as old as the hills. It is only recently, that evidence-based studies have brought to the fore the powerful effects this practice can have in reducing some of life’s most difficult problems – rumination and worry.

I have been using mindfulness techniques myself for about 6 months and I for one can testify to the beneficial effects they have had on reducing my own inner world. It is important to note here that I am not implying that I no longer find myself caught up in worries and pessimistic thoughts. In fact, I think I have become even more aware of how often my mind tends to lead me down this old familiar path of negativity. The effect  of practicing mindfulness has led me down a completely different path, one where I am able to relatively quickly spot these thoughts as they float into my consciousness and then take a decidedly different course of action. In the past I would only become aware of such intrusions after having acted on them in some way, whether it be to try and ignore them or to act in a way that would suggest that such negative thoughts were truths rather than thoughts or opinions.  Now I am not only able to spot them as they arise, I am happy to let them be, safe in the knowledge that they are just that – thoughts.

The practice of mindfulness appears in theory to be a very simple meditative act but the truth is it is a difficult and sometimes elusive skill to acquire. I have started to introduce mindfulness into my private clinical practice with great effect. Those who fully apply themselves to regular (daily) practice do appear to reap the benefits associated with a grater sense of self and greater ability to let unhelpful thoughts pass by without engaging or trying to escape.

As a cognitive behavioural therapist, there can be a tendency to stick with the evidence-based route, helping clients to challenge negative and unhelpful thoughts. Having incorporated mindfulness into my practice, I now recognise that this approach is not a one-size fits all solution to the problem of depression and anxiety. We cannot ever truly eradicate free thought, which in itself can be a great tool and without which we would lead much less richer lives. We can however, choose to cultivate that part of ourselves that is innately human; the ability to observe our own thoughts. Coupled with a non-judgmental acceptance of our inner ‘chatter’, we might just find ourselves on the path to better mental health and greater contentment despite the ever more chaotic and frantic world we find ourselves in.

Family & Addict Recovery Engagement Academy

This is a fantastic opportunity for individuals struggling to deal with alcohol and substance abuse. I have first hand experience of engaging with the academy through the Pierpoint organisation.

Many local authorities do not have a clear and comprehensive rehabilitation programme available to those who need it most. Pierpoint uses the model of a therapeutic community and offers individuals and their families a lifeline when all other routes may have been exhausted or ineffective.

I could go on but I would recommend you check out the links below if only for a breath of fresh air with regards to progressive treatment for addictions in the UK.

http://www.pierpoint.co.uk

Intensive Home Treatment Plans in Scotland

http://www.bbc.co.uk/news/uk-scotland-23084517

The link above takes you to an audio file hosted by BBC News – I’m very interested to see how these home treatment plans progress. Any comments?