Tag / Individual counselling

by Therapy place uk

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reports and some academic research that the commonly recognised and described symptoms of depression – being tearful, withdrawn, lacking in motivation and energy – are a more typically female presentation of the issue.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.

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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.

by Therapy place uk

On beginning to change your life: the first session

blogfirstsession‘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.

by Therapy place uk

A mood forecast for the autumn

octoberblogAs the temperature and light levels drop at this time of year, so each day rapidly shortens. Falling leaves unequivocally announce autumn and the inescapable ‘decline’ towards winter. It’s difficult not to be aware of the lack of vitality in nature and the echoes of endings: the end of summer; the end of long days; the end of warmth; and, deeper down, the counterpart that yet another year has slipped through our fingers – and, for many people, an uncomfortable connection with death.

Like the change in leaf colour, the calls to my therapy practice also alter during this season. Certain types of depression become prominent, and relationships seem to suffer even more as couples and families are thrown into closer proximity by the shorter, colder days … not to mention Christmas already becoming a pressure point for many. I note, too, that the two times when existential issues flurry most prominently into my practice are spring (the counterpart to birth) and once autumn beckons (reminding people of the ‘what should have been’ moments of the year).

But it isn’t just a myth that lower light levels bring about a time of increased depression for many millions of people. The ‘winter blues’ (which start in the autumn) has scientific evidence in its support. Seasonal Affective Disorder (often just referred to by its highly appropriate acronym SAD) is thought to occur because of the way our bodies respond to the lack of light available in the short daylight months. Theory around SAD suggests that the light entering our eyes causes changes in hormone production levels in our body, lowering the ‘feel-good’ hormone serotonin and also interfering with our melatonin levels – a hormone that helps determine sleep patterns. And, overall, the low light levels disrupt our circadian cycle – our naturally recurring body rhythms during a 24-hour period. For many people, these changes add up to considerable lethargy and the experience of other connected symptoms of depression.

So far, I’m not really offering much positive about the final part of 2016 stretching into 2017 – especially as I mentioned death earlier (the one unavoidable issue we must all come to grapple with at some point). And while August has the fewest deaths in the UK, January looms at the top of the chart, which equates to an unwelcoming month with more anniversaries of people’s passing – another great trigger for dialogue in the consulting room.

While we can’t avoid death, we can take a leaf (or perhaps an acorn) from a squirrel’s book and prepare for those light-depleted winter days by taking action and planning a few things before the dark takes hold.

For example, think about good, clean eating rather than succumbing to sugary carbohydrates that will add to a feeling of sluggishness, not to mention a few pounds.

Get active before your New Year’s resolutions. According to Dr Andrew McCulloch, the former chief executive of the Mental Health Foundation, ‘There’s convincing evidence that 30 minutes of vigorous exercise three times a week is effective against depression and anecdotal evidence that lighter exercise will have a beneficial effect, too.’* Of course, it follows that exercising outdoors (e.g. brisk walking**) during this period will be useful in helping to expose you to higher levels of light than you would get indoors.

When it comes to that increase in relationship stress, it might be time to book in a relationship MOT session with a therapist, where you can talk in a safe, comfortable, non-confrontational space about any issues troubling you in your life together.

*NHS website

**Walking for health website

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

by Therapy place uk

Just call me …

Blogfind200

“Yes you’re right,” says Jessica, as we begin to talk for the first time about the process of therapy. “The only clues I’ve got,” she says, “are from TV sit coms and films.” We laugh together for a moment and then I begin a fairly routine explanation of what my work role as a therapist is.

First, what I am not. I’m not a psychiatrist. The Royal College of Psychiatrists* describes Psychiatry as a “medical speciality, like general practice, surgery, general medicine or paediatrics. You have to train for 5 years as a doctor and in the UK – like every other medical specialty – do 2 further years of ‘Foundation’ jobs in hospitals before you can start to specialise in psychiatry. It usually takes another 4 years to pass the two professional exams of the Royal College of Psychiatrists, after which you can specialise further.”

Although I studied some developmental psychology during my initial degree, I am also not a psychologist. A Clinical Psychologist (the type of psychologist you are most likely to encounter within an NHS setting) will have gained an undergraduate degree in psychology. Again, according to the Royal College of Psychiatrists, psychologists will have gained “further experience working in relevant healthcare settings[;] clinical psychologists then do 3 years Doctorate clinical training in an approved training scheme at university. During this time they work with patients under supervision from experienced psychologists and study for an academic doctorate as well as their first degree. They complete training placements with adults, children, older adults and people with learning difficulties.”

Historically, psychology has applied experimental approaches to exploring sates of the human mind. My shorthand for people is that psychiatrists are doctors of the mind and psychologists are scientists of the mind.

So back to what a psychotherapist is and isn’t …

“I’m not an analyst.”

“So I’m not going to be lying on a couch answering your questions,” says Jessica. “It’s not a Woody Allen film, then?“

Indeed, in my own twice-weekly analysis that lasted nearly 6 years I never laid down on a couch because even analysts don’t all do that.

“I am a therapist who deals with people’s internal mental and emotional issues and difficulties,” I continue. “Sometimes people are comfortable with me as their counsellor – a word that is derived from one who walks alongside. Other people I work with refer to me as their psychotherapist, from the Greek for ‘soul and healer’. Some think of me as their coach, and others come to me for hypnotherapy.**

“What I will actually do is sit in a chair opposite you and listen, talk and engage with you in a relational manner. In short we will have conversations about you, what course of action you might need to take, often what you have done or experienced in the past, how you see the world and your interactions with it, and where it is you are trying to get to. I work with all the issues a human can have problems with – including things that are really difficult to talk about such as sex, addiction, relationships, anxiety and bereavement. But I’m not a doctor of the mind and I’m not a scientist of the mind. I’m more an interpreter or an artist, helping you to construct your own canvas by pulling things from one place and sitting them somewhere else.”

“I call myself a therapist, but my professional registration*** says I am a counsellor/psychotherapist. You can just call me Duncan.”

* http://www.rcpsych.ac.uk/

** I am fully qualified hypnotherapist and is registered with the General Hypnotherapy Register.

*** I am a fully qualified, registered and accredited BACP (British Association for Counselling and psychotherapy) counsellor/psychotherapist.

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

by Therapy place uk

A stitch in time …

StitchA stitch in time …

29 March 2016

In total, with two different therapists I spent 8-and-a-half-years in therapy. For 5-and-a-half-years I even went twice a week. On the face of it then, therapy was no quick fix. But the main reason I spent so long talking to my kindly octogenarian Jungian analyst was that I had waited too long (22 years to be exact) before I began to face my issues.

When I meet a sizeable proportion of the people coming to my private practice for the first time, they are rather like I was: they come to the space having struggled with their issues for too long. Avoiding issues, as we know, seldom helps them to go away, and when we don’t share difficulties or problems with other people the negatives often become amplified. When issues are within an intimate couple, it’s not uncommon for the partners to struggle together for years, somehow hoping that things will just get better. But in fact the couple usually fall into deeper and more upsetting patterns of behaviours as the partners hang on in there without addressing the underlying problems.

Individuals and couples can live with an overwhelming and prolonged sense of helplessness and sadness. While human beings are quite remarkable in their ability to cope, against the odds, in all sorts of negative scenarios, it is also common for people to enter ‘survival mode’ and this is often accompanied by depressive moods, anxiety, anger and relationship difficulties. As the issues become more widespread and deeply ingrained over time, other issues become amplified and begin to feed back into one another, sometimes leading to a full depressive episode, addictions, anxieties, anger, family and relationship difficulties, and even sexual problems. By this time it can be extremely difficult to decide where one problem begins and another one ends. It’s then common for feelings of being overwhelmed or a prolonged sense of helplessness and sadness to be the presenting issue in therapy. None of this makes it easier to sort your issues out. So, while I don’t have the answer to why we wait so long before seeking help, I hope reading this short blog might make you do something about your needs. Don’t wait; act as quickly as you can.

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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.