Helping men to help themselves 

Helping men to help themselves

Men2018

It’s been a little while since I blogged about men and therapy. So, at the start of the year, when many people decide to put things in order and turn to psychotherapy and counselling for some clarity about their lives, I thought I’d write something that might help men take a therapeutic step.

It’s a sad fact that, according to the latest 2016 release from the UK Office for National Statistics, men still make up around three-quarters of deaths by suicide and yet are only reported to make up just over one-third of referrals to NHS talking therapies. So, if that sobering statistic makes you think, read on …

Access to therapy isn’t about men vs. women. It’s much more about why, as men, we might find barriers to getting help.

The continued high suicide figures for men by comparison to women suggest there is definitely something going wrong for us men – but taking your life by your own hand is just the start of the male distress story. It’s also true that around three-quarters of adults who choose to ‘go missing’ from home are men, and close to 90 percent of rough sleepers are men. It’s men who are three times more likely to become dependent on alcohol and three times more likely to report frequent drug use. Men also make up two-thirds of drug deaths, 95 per cent of the prison population, and commit more than 85 per cent of violent crimes. Additionally, they are twice as likely as women to be victims of violent crime. Sadly, men have lower access than women to social support networks, and are 50 per cent more likely than women to be detained and compulsorily treated as psychiatric inpatients.

If we look at boys, then we see they perform less well than girls at all levels of education and that close to 80 per cent of children who are excluded permanently from schools are – you guessed it – boys.

While there might be a number of reasons that these gender differences exist, what’s really important to perceive is that, for a large number of men, life is difficult.

When it comes to depression we already know from practitioners’ reports and some academic research that the commonly recognised and described symptoms of depression – being tearful, withdrawn, lacking in motivation and energy – are a more typically female presentation of the issue. Men will actually often express symptoms in an externalized way that we call ‘acting out’. This might be through uncontrolled anger, addictive behaviours that are used as a cover up for the felt distress, or the use of physical aggression. And, of course, if you express your depression in these sorts of ways it tends to compound difficulties in the social world, and will often make family, friends and professional helpers less sympathetic in their response.

Data drawn from population level studies suggest that men who are in psychological distress are more likely than women to choose coping strategies that don’t help them adjust adequately or appropriately to the environment or situation. A popular strategy might be to self-medicate through alcohol, drugs, or porn and/or sexual addictions. Of course, generalised data about gender is just that: general! And so it doesn’t tell us about any one individual. But my experience since joining this profession at the beginning of the 21st century certainly adds up with the data.

This blog hasn’t sought to offer a quick fix or a set of tools to use. What it has done is outline to anyone who reads it that we might need to approach men and their problems in a different way. Men need a space that will reflect their male nature in a positive frame. Sometimes that means that a male therapist can be a good starting point – although it is suggested by some research that as long as the  space takes a ‘male positive’ stance men make better progress. For other men it might be the environment in which they access their therapy that helps them to make progress – for example, men can thrive during online sessions or walk-and-talk sessions where the therapist is alongside them rather than sitting face-to-face.

——–

In my own practice, I see more men than women (excluding couples work) and I offer face-to-face sessions as well as online video-based counselling, psychotherapy and coaching through FaceTime or What’sApp. I also provide single-session therapy and one-off walk-and-talk therapy sessions (on particular days throughout the year) in Cambridge, Bath and Bristol. And, of course, a one-off session can become a gateway to deeper ongoing work …

Statistics for this blog were drawn from sources reporting between 2014 and 2016, including those from the Office for National Statistics.

On beginning to change your life: the first session

blogfirstsessionOn beginning to change your life: the first session

14 February 2017

‘Signing up’ for counselling/psychotherapy can be a big move? It may even turn your life around in ways you hadn’t thought of. So it’s wise to consider a few things before, during and after your initial session.

Many people looking for a therapist do an initial search online. Others look through a directory. And yet others may be given recommendations by friends or a GP. However you ‘find’ a therapist, you may still wish to run the following checks.

First, your new therapist should, at minimum, be registered – if not also accredited – with a respected professional organisation such as the BACP or UKCP. (Psychologists should be graduate or chartered members of the BPS.) You should also read their website carefully to check they have the experience of, and feel comfortable working with, your general/specific issues. (This is particularly important in areas like sexual difficulties, as few general psychotherapy/counselling trainings offer enough input in this area.)

You shouldn’t be persuaded that someone is a good therapist because they have a lot of letters after their name. Studies suggest that once core requirements of education and training have been met, the effectiveness of the therapist is not dictated by their qualifications; indeed, research indicates it is the quality of the relationship between you and your therapist that can have a huge positive influence on the outcome of your work together.*

Remember also that, with personal recommendations, what works for one person may not always work for someone else. There is still a ‘goodness of fit’ to consider.

And so, having selected a therapist who you believe will be a good fit for you, the next step is to chat to them – through Skype, email, text or telephone call – and, if it still feels like a good fit – book an initial session.

***

So what can you expect at your first session. If your therapist works for an organisation, your initial session might be quite prescribed. You may have to fill in the organisation’s routine forms and even complete questionnaires or diagnostic tools. However, in a private practice situation, where the therapist works for themselves rather than an organisation, things might be a little more personal and relaxed.

In my own practice, for example, I like people to spend a moment or two getting comfortable on the sofa. It helps me to know how difficult it is for the person to be in the room with me at the start of it all. I often ask people how anxious they feel about coming along for this session – something simple like: ‘On a scale of 1 to 10, where 1 is low and 10 is high, how anxious do you feel right now?’ Perhaps people don’t always tell the truth – a little in the manner that doctors can’t always trust patients to be honest about the number of units of alcohol they drink in a week – but it gets us started. (By the way, the usual ‘anxiety score’ is around 8. Also, people who have had some counselling or psychotherapy before often find it easier to be in the first session with a new therapist.)

Quite often, we might then go on to talk about how odd it is for two strangers to meet in a room, knowing little about each other but being there with the intention of talking about some of the most challenging areas in one of those two people’s lives. I make no secret of the fact there was a time when I, too, needed the help of therapy. I might use that at some point in an initial session if it helps to build a bridge. After all, most of us understand things best when we know something about it – and sometimes going through a process is the best way to find out.

When you’ve said a few things about your issues and discovered that the therapist is a human being, just like you, your anxiety can fall a point or two.

As the session goes on, people begin to sit back on the sofa. They pick up a bottle of water, which I always have available. They might even check out the tissues. In short, they begin to dial into the character of my room, my therapy space. Their breathing deepens and they discover that therapy is just a special kind of conversation. It’s a confidential place where: the therapist won’t have expectations of what you want to do; the phone won’t ring; no one else will ‘break in’. It’s a special conversation because it’s focused on you. That doesn’t mean the therapist has to be silent or a tabular rasa (blank slate) like you see in the movies (although if that’s what you need, then that sort of therapist can still be found).

I see the therapist as someone who: joins you on your journey, facilitating you to find your answers to fulfil your needs; won’t get their story in the way of yours; can help you, from a detached position, to look at things. I also think that therapy is a distinctively creative process that, through working together, forms the unique therapy you need.

The first session normally races by. People often comment they were worried they wouldn’t know how to say things, or even what to say. Yet, somehow, in the end, there wasn’t enough time to cover all the things they wanted to mention.

***

Your first session is over. You are walking away from the place of therapy and are going about you real life again. What can you expect now? You may realise you feel pretty tired, perhaps even exhausted. This is the time to start looking after yourself. Between now and your next session you may spend time thinking about the process. You may even dream some answers or questions. An awful lot of the therapy happens between sessions. Your process has begun … Bon voyage.

 

* See for example: Lambert and Barley (2001) in Psychotherapy: Theory, Research, Practice, Training, Vol 38(4).

 


 

Why not visit my therapy website – therapy-space – where you can contact me or find further information about the therapies I provide for women, men and couples.

 

Where we live: family, home and not making assumptions

bloghomesWhere we live: family, home and not making assumptions

30 November 2016

The situation in which people live is a common subject that comes up in therapy. There are students new to semi-independent living. There are couples going through the pains of divorce without knowing if one or other of them will be able to afford a new house or be able to keep the family home going. There are people who were brought up in care where the idea of family and home itself might be a challenge, even years after the childhood situation has been resolved.

In Cambridge and Bristol (the two cities in which I work) and, indeed, in much of the UK­, being able to afford to buy your own home is a far-off dream for many people. Home is often the fantasy; everything from situation comedy to the big-budget movies and advertising sells the home, the family, in terms of an ideal myth. Think of the Christmas hearth with burning logs, or the burgeoning table with succulent turkey and steaming hot gravy. And now, as we approach Christmas, the pressure really cranks up for the perfect home and the perfect family.

Anyone who has worked with me or read my blog knows that I keep what happens in the therapy space strictly confidential. But in the run-up to Christmas and the unbalancing pressure it can bring to home and family, I’ve asked two men if I might recount a little from recent conversations I’ve had with them for the Therapy Place Blog. They are men who, in the last few weeks, have challenged some of my automatic thinking about Christmas, home and family, and I hope they might make you pause and contemplate for a moment or two before December 25 arrives.

Simon* (54) was brought up in the care system north of Cambridge. He never knew his real parents, as he was placed in care very early in life. Growing up in care was difficult. He found himself in a series of foster placements but he never felt anyone cared for him very much. He reported being quite a naughty child. ‘I probably just wanted someone to notice me,’ he said. ‘A psychologist told me once that it’s better to get negative attention for being naughty [if you can’t get praise for positive actions] than it is to be ignored. I don’t know what it’s like these days, but when I reached my 18th birthday, that was that! I was sent to the hostel and just had to get on with life on my own.’

Through his 20s and 30s Simon was an alcoholic, but when the doctors told him he was going to die from the effects of his consumption he was able to stop permanently. Simon has never known any family, but he reports having friends he can trust.

Until 2002, Dan* (52) was the owner of his own engineering business in Bristol. ‘I grew up in a large family – two brothers, three sisters, me, my mum and dad, and my gran and pops all lived in the same house. It was pretty mad but we mostly got on. I had a lot of freedom, and from my teens I enjoyed recreational drugs. I never really liked to drink so I sort of joined in by letting go by other means. I got through tech college and set up my own business repairing mechanical things that went wrong. For a long time I had it really made when I think back on it.’

Dan pauses. His eyes tear up. ‘I repaired everything from washing machines to motorbikes. It all went wrong though. I lost my daughter, my wife and my house when I started taking heroin. Even my mum and dad refused to help me out. I stole things from them to support my habit, I was an awful person because of drugs.’

Dan has been clean for four and a half years.

‘I actually found it more difficult to give up the prescription meds than the heroin. I’d really like to get back with my family now but I understand why they can’t trust me – at least not just yet.’

So why do Simon and Dan challenge my automatic thinking about Christmas, home and family? I met Simon sitting on the pavement close to St Andrew’s Street, Cambridge; I met Dan on Prince Street Bridge, Bristol. There had been frost the night before I met each of them. Simon has spent 36 years living rough, and Dan has been sleeping out for 18 months. It’s interesting to think who we walk past in our busy lives planning for the illusive ‘perfect’ Christmas.

Joyeux Noël!

*Names and certain details have been altered in order to protect the identity of both men.

Effective solutions for failing relationships

couplesii200-copyEffective solutions for failing relationships

28 September 2016

It is never very comfortable to feel that one is failing at something in life. When it comes to a relationship failing, we can all bring out some pretty special defence systems that keep us away from this recognition: ‘Of course, I’m not perfect, but this really is all his/her fault’; ‘What do you mean we never talk? What were we doing when we went out with Rob and Sue?’; ‘I’m not avoiding you; it’s just that I’ve got to get this work done/answer this message …’;  ‘Oh come on! I’ve not had chance to watch any of my TV programmes this week’; ‘What do you mean I’m always on Facebook [bing … type, type, swipe]?’

If you find yourself in a relationship that is experiencing difficulties, it’s common to feel that you won’t be able to work things out. And if you are feeling that, then the chances are you’ve stopped (or perhaps never did) communicating well. That sense of not mattering in the relationship or the lack of intimacy will very likely have something to do with the couple not being able to properly reach or connect with one another and therefore not talking things through.

Of course, it’s not always easy to see where we are going wrong with our communications. It’s likely that many surface issues will be getting in the way of us finding our voices with one another. Even serious matters such as affairs and addictions can be the secondary issue – the disease symptoms rather than the cause of the illness, so as to speak. Once you realise that difficulties can so often arise from a hunger for real communication and understanding from a life-partner, then effective counselling or therapy can begin to change your joint life.

In my couples counselling and therapy practice I find it’s good to start by checking out what views people actually hold of the relationship they are in. Too often, as I mentioned in my blog ‘A stitch in time …’, people wait until very late in the day before taking action. In relationship therapy and counselling it’s as if one partner has already given up on the relationship. This sort of secret needs to be brought out into the open. Therapy attempts to help partners view the relationship in an objective way – importantly, stopping ‘blame conversations’ and attempting to replace them with a process that involves both partners making an enquiry into how they jointly and individually got to where they currently are. This style of working develops the narrative ­– the story of the relationship to the current point in time. If there are contextual situations lurking in the background – for example, loss in the family or money worries – it helps to see that these are factors that can be negatively influential on the immediate situation the couple find themselves operating from.

It is important to understand that couples therapy isn’t just a mental process. When fully engaged with, couples work is also about behaviour change and emotional understanding. Dysfunctional behavioural issues (such as addictions, anger and especially any perceived or actual physical threats) all need to be examined in terms of what damage they do to trust, intimacy and the ability to communicate. Emotional avoidance tends to lead to fears about expressing the inner dialogue. Depending on how we were brought up, our attachment patterns can lead us to acting out our attachment story in adult life within our close relationships – sometimes with very negative consequences. (Read ‘On being ignored, forgotten or abandoned’ for more detail.)

Your first session of couples counselling or therapy might not result in booking date nights, having meaningful sex with the person you are attending with, finding yourself buying them little gifts, writing love notes or perhaps simply having great fun with them. However, with an effective couples therapy approach, at the right point in your couple difficulties, you should be able to discover just what you need as you move along the therapy road together.

——————-

Why not visit my therapy website – Therapy Place Couples – where you can contact me or find further information about the therapies I provide for women, men and couples.

Men: porn, relationships and the respectful gaze?

Curveblogsmall31 October 2015

As part of my wide-ranging work as a therapist, I engage in conversations with men who have issues with pornography and sexual addictions. The work can be short and contained or it can take a considerable period of time but, in whatever way it progresses, the issue of ‘how to look’ and ‘what will be seen’ at some point becomes a central issue for conversation.

Gay and heterosexual men alike have to confront how pornography and sexual addictions have affected their looking-and-seeing process. In my practice, there appears a difference in the way these two groups of men confront their burden. The female form is used differently in art and the media from that of the male body. Male couples are often able to pull together through conversation about what looking-and-seeing means and how it functions for the individual – and the couple. Conversely, heterosexual couples frequently fracture during a simple stroll along a high street or as they sit in a restaurant, where every passing female form becomes an unknowable challenge.

In a free, thoughtful and open society, thankfully it is an impossibility not to have the option of looking at and seeing the human form. But what is it that a respectful, heterosexual male (even one previously challenged by negativities created by porn and sexual addiction) looks at and sees when in the presence of the female form? The question leads men to search not down a single agenda track but to open their horizons, and one of my starters for this process is often with something like a poem. Rick Belden captures something in his poem, looking for the perfect curve.

looking for the perfect curve

my eyes
go where they want to go
and they’re always looking
for the perfect curve.

my mind
knows what it wants to know
and it wants knowledge
of the perfect curve.

what is it about the female form
more perfect
than the quiet moon in the sky
or the gentle bend of a river
or the soft contours of waves
rhythmically caressing a beach.

without it
my life is all
straight lines and right angles
and every sentence ends in a period
never a question mark to be found.

the mere sight of it
lights my heart and lightens my day
it nourishes me
and reconnects me with the pure cosmic joy
of being a man.

perhaps only a fool is driven
by that which he cannot have
I’m an old fool now
getting older all the time
and most of the curves I see these days
are many miles
and many years
out of my reach
but my eyes still go
where they want to go
and my mind still knows
what it wants to know
and I’m still looking
for the perfect curve.*

The first two stanzas often create the acknowledging head nod; the third brings breath in – as comfort is acknowledged; the fourth raises a smile or chuckle; the fifth results in a sigh, and the sixth, in equal measures, clasped hands or a bowed head.
And as we come back to conversation, we look at each other and smile – now, just two men sitting in a room. We perhaps understand in the others’ psyche ‘the perfect curve’ – a heterogeneous proliferation of one man, getting the other.

* looking for the perfect curve Copyright © 2013 by Rick Belden. The work is licensed under a Creative Commons Attribution- NonCommercial-NoDerivs 3.0 Unported License. Visit http://www.rickbelden.com

——————-

Why not visit my therapy website – therapy-space – where you can contact me or find further information about the therapies I provide for women, men and couples.

Finding a good therapist

Blogfind2002 June 2015

I remember reading Canadian educationalist Allen Tough’s pioneering thoughts in the area of self-directed growth in adults and being inspired at the way most adult learning occurred in informal settings and ways. You could say that adults learn on a need-to-know basis. When you need to get a new car you read magazines, check the Internet, ask around your friends and family for their views, and if you are lucky enough to know a professional in the area you are ‘researching’ then you tend to ask them.

I’m tempted to say that the above pretty much all holds true for finding a therapist as well. But if I think back 20 years or so when I needed therapeutic help myself, I can all too easily remember how difficult it was to talk to people about such issues. Back in the early 90s society was still too wary of therapeutic help. It was also the pre-Internet world when counsellors and psychotherapists were more difficult to find. So, should you just rely on the Internet? Is it good enough to simply look someone up on a website and then hand over your emotional wellbeing to them?

If I were looking for a therapist today here’s what would be on my checklist before I started any sessions with them:
Are they registered and accredited by a respected professional organisation such as the BACP, UKCP or BPS?
Will they talk to you on the phone, by Skype or email before you book a session?
Are they experienced in working with the issues you want to work with? (This is particularly important in areas like sexual difficulties, as few general trainings offer enough input in this area.)
Is the therapist used to working with people in short-, medium- and/or long-term encounters? This might be very helpful in matching your needs with the therapist’s skill set.
Has your prospective therapist had their own therapy? (It might seem odd but not all models of therapy require therapists to undertake their own therapy, while some will simply have done the minimum required by a training course. I’d find it odd to have therapy with someone who hadn’t been in the chair themselves.)

Above all, don’t be persuaded that someone is a good therapist because they have a lot of letters after their name. Studies show that once core requirements of education and training have been met, the effectiveness of the therapist is not dictated by their qualifications.

To my mind, all therapists should be looking to make a good match to the people they are going to work with. Again, studies support the view that it is the quality of the relationship that really helps therapy work. So, it follows that I always offer a no-obligation initial session.

Finally, go with your gut feeling and, if it doesn’t feel right in the room, shop around.

Suicide rates: can you get the men in your life talking?

BlogSuicide

Suicide rates: can you get the men in your life talking?

22 April 2015

Seven years ago I wrote on the men’s page for Therapy-space Cambridge that ‘thankfully, (with the exception of 2008) in the UK male suicide rates have been falling since 1998’. However, the latest figures released in 2015 by the Office for National Statistics make for sobering reading, given it reports that the number of suicides in the UK has once again risen and the rate for males is the highest it has been for 14 years.

Since I wrote that previous men’s page, male suicide rates have increased significantly, while female rates have stayed relatively constant and have remained lower than those for men.

Looking at past statistics shows that rates for male suicide in 1981 stood at 63% of the total UK rate, but in 2013 the figure had risen to 78%. The increase in the male figure has been a steady one by comparison to female rates.

If you are a male, aged between 30 and 74 but particularly if you are between 45 and 59, then it’s time to start talking because suicide rates in your age group are the highest in the UK. If you are the partner of a man who is depressed, now would be a good time to get him to realise that there’s no stigma in asking for help. Whether it’s talking online or on the telephone to the Samaritans, visiting the family GP or booking a session with a therapist (face to face or via Skype), let’s get men talking: it might just save a life.