Don’t do it, Mr Collingwood …

I think I first noticed the man because he looked uncannily like a school teacher I’d had a positive relationship with. It didn’t seem to matter how many times I went to the supermarket, the man was always there. I’d say inside my head, ‘Good morning “Mr Collingwood”’ in that distinct rhythm we are all taught to address teachers by as school children.

Sometimes I’d meet ‘Mr Collingwood’ in one of the aisles; on other visits I’d see him, almost hunkered down, in the far corner of the car park, close to the railway line – my favourite parking spot.

When someone looks familiar, I think we signal something to the other person – perhaps we radiate a connection in the unconscious that they respond to.

Over the warm summer months it felt comfortable striking up a non-verbal, nodding acquaintance. When you see someone often enough on a regular route or passage, you begin to notice things about them. What I observed about ‘Mr Collingwood’ was that despite his slender frame he was always eating, but there were only ever two things he consumed: a large baguette pulled straight from the bread rack, cellophane wrapper rolled a little way down as he consumed it; or a family size bag of salt and vinegar chipsticks. Both the baguette and the chipsticks were eaten in a very similar manner – thumbs to the back of the packaging and fingers to the front. He would tilt his head down to a fixed position and then the packaging was raised close to his mouth as the food from within was consumed. It took a few observations before I was certain, but it became clear that bread was eaten inside the supermarket yet the salt and vinegar snacks were only ever eaten outside. In fact, the more often I saw him with the savoury snacks, the more I noticed he ate the sticks in a manner reminiscent of a horse with a nose bag, munching up the hay.

I’m not that certain how many times I actually saw ‘Mr Collingwood’ and I’m not sure how quickly I realised he had mental health issues, but we were exchanging a few words by the time the clocks went back in autumn. We never went beyond an ‘It’s warm today …’, ‘For the time of year …’ type of conversation, but it seemed appropriate, safe, friendly – respectful, even.

Shortly before Christmas, on my journey to the supermarket I was overtaken by a police car. At the roundabout, which is the entry road to the store, I could see, close to my parking spot, another police car. The traffic quickly began to back up at the railway crossing and it was clear that a late middle age man, stripped to the waist, was in major distress in the middle of the track. Those with mental health problems need to be treated sensitively and it is incumbent upon police officers to respond in such a manner. Being the first at a scene like this you’d hope the officers had extensive training in how to calm a situation and deal with the distress. But how can this really be expected of a service that was created for very different purposes? I took a look at the officers. They were young and I’m certain trying to do their best, but watching the scene from the car park it was apparent that every time a uniformed figure approached and shouted out to the half-naked figure, a wave of distress racked the figure’s body. He repeatedly raised his hand then smashed his fists on his body like a man boxing an internal shadow he was trying to rid himself of. I looked around for ‘Mr Collingwood’ and my heart leapt; for a moment I didn’t catch my breath and then a tear pricked my eye. It was poor ‘Mr Collingwood’ who was on the railway line. I pushed myself forward for a few metres and talked to the female officer closest to me.

‘I wonder if I can help?’ I asked.

‘No sir, we have to keep you back this side of the line,’ she replied.

‘I know this man a little; I’m a psychotherapist.’

What the hell am I saying!! This isn’t my line of work anymore. I’ve not worked in a hospital department since 2004.

‘We have called for an appropriate medical professional sir, if you could just stand back please.’ And I watched as three other officers tried to herd ‘Mr Collingwood’ like a farm animal.

I’ve not seen him since at the supermarket; I miss our nods and acknowledgements of the simple things we’ve noticed of the day. I hope you are well ‘Mr Collingwood’, I hope you are well.

All rights reserved © Copyright Duncan E. Stafford 2022. Unauthorized use and/or duplication of this material without express and written permission from the author of this post is strictly prohibited. (This article was originally published in 2019 as part of the Three Men with a Blog project.)

Dying Twice

This year, and for the first time, the anniversary of my father’s death some years ago passed by without me remembering …

It had been a short drive to the nursing home my father had moved to eight days previously. My wife and I had been his primary carers for close to a decade but when, fourteen weeks earlier, he had fallen and broken his hip, his move away from his home and into the healthcare system sparked in him a serious decline. There was also a touch of guilt at the freedoms his move was affording to us.

As we neared the care home, an ambulance on an emergency call passed us. A minute later we drew up behind it and a paramedic vehicle already parked at the home. My wife said to me, ‘It’s for your father.’ I winced; I felt her to be right.

As we strode down the corridor of the second floor suite in which my father had taken residency, a member of staff addressed us: ‘Are you here to see Brian?’

‘Yes,’ we both smiled.

There was already a temporal shift occurring – odd, I thought, no one has addressed us in such a way before. A nurse blocked our path to my father’s room: ‘You’re Brian’s relatives?’ Somehow, in a moment, we were all in her office. My wife looked pale: ‘You’d better sit down Mrs Stafford.’ But there was a dreadful tension and confusion in the space. With my psychotherapist’s hat on I honed in on the emotion – there was huge anxiety being broadcast from this experienced nurse. After a few words she left us saying, ‘I’ll just check on your father’s condition.’ It hit my wife and me at the same moment and we rushed along the corridor.

Bundling into my father’s room we saw a paramedic ‘shouting’ at the prone and half naked figure: ‘Come on Brian … stay with us.’ My father’s chest heaved in physical distress as a bag covered his mouth and another medic prepared to shock him. His skin had the waxy hue and paleness I’d seen on my mother as she passed away.

In the small living space that had become my father’s whole world the paraphernalia of modern emergency support was strewn all around. My wife was first to enunciate her horror: ‘What are you doing this for?!’

For several weeks in three separate medical establishments my father, despite his communication difficulties caused by a stroke some years earlier, had made himself understood – he wanted to die. For the long years before he broke his hip my wife and I had cared for my father, it had been difficult to watch his almost daily decline; he had been a proud, principled and independent man, a teacher and an artist. At eighty, long overdue, he become a published poet. Difficult as it was to watch, we respected that this was a man fading out at his own request. And yet here we were, thrust into the most terrible of moments – a man who wanted to die being forced back into a world he no longer had an interest in. Our protestations that my father be allowed to pass away brought yet more tension into the room. The ‘shouting’ stopped, but our fourteen weeks of frustrations at the NHS care system were too much for me and my wife.

In counterpoint we made our cases aloud to the six medics about respect and civilised treatment. But apparently, my father’s DNR (do not resuscitate) wishes had not been recorded in the requisite manner. Procedure and regulation were in the way of care and welfare, and overrode my father’s desires.

For his entire adult life, my father voted for a system that respected people, treated them well; a welfare state, a national health service, free at the point of need – one of the marks of a civilised and mature society. Those entrusted to administer NHS continuing healthcare had already attempted piracy with his rights and, now, these paramedics were clearly having to apply procedure rather than the human care they so obviously wished to dispense.

My father was being denied his wish to die peacefully and with respect. This was a system seeking to revive him so that it might take him back to a hospital he had already refused to be taken to, in order that he could ‘die’ once more, probably on a trolly in a corridor in A&E.

Before all was lost, the senior paramedic took control and through several different stages and conversations that involved myself and my father’s GP the paramedics were allowed to ‘withdraw’. And then the room was quiet and my father once more calm. His beloved radio could be heard in the corner of his room and death once more began to claim his body. Peacefully and with us as comforters for his passage he was able to complete his life, with respect and dignity.

All rights reserved © Copyright Duncan E. Stafford 2022. Unauthorized use and/or duplication of this material without express and written permission from the author of this post is strictly prohibited. (This article was originally published on Three men with a blog in 2018.)

Walking with distress

Moving forward under our own steam on two legs is, in itself, an expressive thing. Look around as you move through the city or the country and you will see people doing it – using their bodies and expressing something about their actions, their direction – the stroller ambling along, the I’m late, I’m late followed by, or bumping into, the smart phone addict head down in a separate world, still checking social media on the way from one meeting to the next. But what’s happening with the inner voice? What past directions and journeys are being played in the inner self?

When I take people for a walk-and-talk session they are curious about how it might work. They are often stuck in life, distressed with it or perhaps bereaved. Inner symbols reveal as you walk: things we pass trigger memories, and the pace and openness of not being trapped within four walls help some very difficult thoughts to make their way out of the unconscious into the conscious realm. And, of course, nature and the environment makes itself very much part of the work. This might make sense as to why therapists so often use tree imagery on their websites. Sometimes a rabbit really is a symbol – vitality and rebirth are never far when you take therapy for a walk …

Read on for some of my free verse triggered by the walking therapy I offer.

Pace: on walking with distress

Walking, walking, walking. Pacing things through. We are in the world right now.

Talking, listening, watching. Right at the very edge of life. ‘I remember how my father laughed at me as we drove down the hill. I was about to shit my pants and he was laughing, crying with pleasure … at my distress.’

Concrete, gravel, turf, tarmac, the water at our side. ‘If you add the negative moments up and you add the neutral and the positive, you don’t get what you expect.’

Walking, marching, ambling, pausing, listening, watching. ‘The whole marriage is lost.’ Loving and losing, kissing and hating. Steps pass by as seconds rotate in time. [Again] ‘Were more of them good than bad?’

A courting couple in the back of a car cuts like a knife. Pace, control and then, then, there is just loss. ‘An intense toothache. Everyone knows toothache. Through the whole body, the mind, to quiddity.’

Walking, walking, walking, talking, talking, talking, listening, listening, listening. ‘We finally managed to break down the door but he was already dead, squashed against the back of it.’

If we looked over the bridge once, what would happen? Twice? Would a third time make the pain greater or lessen it? ‘Would you jump?’ How much would I remember of my story?

Moving, moving, now always moving. ‘It helps with the pain; it stops that claustrophobic tightness in my head.’ ‘Are these things in your head or are they in your body?’ The sensation of the cradle rocking, the soft, soft murmuring song before I fell asleep.

Pain, pain, pain, stabbing at the pith. Not needing to let go today, not quite rocked, not stepping away just yet. Step, mirror, step, mirror, step, walking, talking, listening, ‘expressing?’.

What does the body say? ‘A question? What does the body say?’ ‘Feel?’ ‘Say!’ ‘Oh look, a rabbit! Lots of them.’ ‘And the body?’ [Slowly] ‘L-o-o-k, t-h-e-r-e-’s a r-a-b-b-i-t-?’ ‘Yes.’ ‘Yes.’

Walking, walking, walking, talking, talking, talking, listening, hearing, feeling, hearing?
‘Yes.’ Feeling? ‘Oh, look, another rabbit!’

***

I highly recommend taking therapy beyond the four walls of the consulting room out into the real world and seeing what happens for you. NB this idea makes many therapists anxious about controlling the situation and the space – but they can get help with that.

All rights reserved © Copyright Duncan E. Stafford 2022. Unauthorized use and/or duplication of this material without express and written permission from the author of this post is strictly prohibited. (This article was originally published in 2019 at part of the Three Men with a Blog project.)

Mother Nature

It’s pretty snug in the back of the café on the high street. Soft fried eggs are being popped by chips on most tables, washed down with builders’ strength teas while unapologetic white bread – spread with margarine – is busy mopping up baked bean sauce.

Across the aisle, to my right, a table of five sit talking – three young women in their mid-twenties, a giant of a man (probably thirty) and an angelic blonde child of about fifteen months who is sat in a high chair with her back towards me.

I’m not quite sure what first draws my attention to the group but I’m suddenly aware of something completely chilling. The woman closest to the child (who appears to be her mother) displays open anger and disgust, for no apparent reason, towards the child, who is finger feeding herself.

I am so tightly aligned with the mother’s eyes that I can’t believe she hasn’t seen me looking directly at their dyad. I’m unsettled. Here in the friendly atmosphere of my favourite greasy spoon, where I have never heard cross words spoken or seen tension displayed. Here in this friendly high street enclave I am deeply disconcerted at some momentary flashed expressions.

And now I’m no longer enjoying the acidic bite of the tinned tomatoes that accompany my eggs, chips and beans. My human ability to read two of the six universal emotions purported by Ekman and Friesen* have seen to that.

Mother is looking blankly at the child. Across the table engaged with her friends and partner she appears inconsistent: sometimes smiling and engaging but then turning to her child with poison and what I see as resentment. Father strokes the child’s head for a moment. Mother, checking to see the others are engaged away from her, flashes more disgust at her child. Mother’s upper lip is raised, the bridge of her nose wrinkles and her cheeks are high.

I think I raise my right hand to my mouth to try to cover the words I’d like to shout across the room. I want to stand up in the back of the café and address my fellow regular patrons. ‘Am I the only one who can see this?’ I’d shout. I want to race across the room and ask what is wrong with this friendship group that they do not challenge this mother, their friend. Why do they not want to protect the Angel from this storm?

I’ve lost my hunger and I am left in a universe of uncertainty. Did my own mother feel these emotions towards me when I was a child?

Angel, who has been so calm and contained for one this young, reaches over her plastic feeding bar and attempts to get to more food. Her father strokes her head gently once more. Mother stretches to the food, breaks off a crust of toast and drives it in the air past her daughter’s eyes to her own mouth, and drops it in. Every gesture aimed at Angel says, ‘I hate you; you disgust me.’

I deploy my inner therapist as my own referee against demonising this young mother.

Thankfully, mother and friends are ahead in their meals and don’t look as though they will sit and talk after they finish. Dad produces hand wipes for mum to clean Angel’shands. The three engage, and Angel is allowed to witness and absorb more of her mother’s bile. Mother’s eyes dart around her friends and partner. She places the first wipe, now dirty, on Angel’s head; it looks like she wants to humiliate Angel, turn her into a rubbish dump. She begins to roughly clean her other hand. Father’s long arm reaches over and removes the wipe from Angel’s head and places it on the table. Mother smiles at her partner in a sarcastically petulant manner, then turns a disgusted face once more towards Angel – dismissing her.

My inner therapist has decided he is watching the acting out of an envious attack from mother to the child who has stolen her lover. It is dangerous, raw and uncomfortable to see. How have I been able to be this voyeur? How have I not been seen watching in plain sight?

Father rises from the table, stoops and picks up Angel from her chair. He holds her lovingly in an embrace and I see, as they twist around, the brightest of faces, a smile and a giggle. Now moments later mother is manoeuvring the empty pushchair through the café. She looks depressed, abandoned, weighted by the world.

The observation is over. I am unsettled: ‘What could I have done?’

I so hope I will not read of a mother and child killed on the nearby railway crossing or of Angel battered and abused, then removed into care.

This breakfast has left me feeling empty; I’ll not forget it for a long time yet.

* Ekman, P. and Friesen, W.V. (1971). Constants across cultures in the face and emotion. Journal of Personality and Social Psychology, 17(2), 124–129.

All rights reserved © Copyright Duncan E. Stafford 2022. Unauthorized use and/or duplication of this material without express and written permission from the author of this post is strictly prohibited. (This article was originally published in 2018)

The Zen of Frank

As a student in the 1980s I had a Critical Analysis teacher who rarely turned up on time for lectures …

In fact, he often didn’t turn up until the very last moments of a session but always managed to hush his students’ chorus of criticism by turning the negative comments back on his accusers. 

In his first term of teaching me, I was as indignant as any other student. But as the months went by I observed his behaviour. With his educational conjuring, this quiet and charismatic man began to gain more and more of my attention. It seemed to me that Frank wasn’t skiving or avoiding teaching; he was watching us individually and as a class – sometimes from a vantage point elsewhere in the college. He enquired of us why it was we wasted the time he was ‘giving us’. Why did we ‘generally loaf around, smoke in doorways or hang out of windows’, especially as there was obviously so much still to learn?

It was the final term of the first year before Frank began to attend as many classes as we, his students, did. Several of us were still some way off working with the set texts our course was supposed to be about. And yet those same classmates were now engaged in infantile battles with Frank over whether he really did know the meaning of every word in the Oxford English Dictionary (from memory, he was never foiled). 

Youth and naivety potentially led us to waste a lot of our time along with projecting onto others the blame for our individual lack of performance.

The last time I saw Frank was, appropriately, a few moments before I left college for the final time. It was a hot summer’s day – the sort many small boys enjoy because of the huge numbers of flying ants building up to their nuptial flight. As I walked through the gates and headed for my motorbike, I caught a glimpse of Frank kneeling on the ground observing insects with more of an amused look of a young boy than a 60 year-old man.

I ambled over to him and we began to converse. A few sentences in, I delighted in telling him that I thought I’d probably learned more from his non-lessons than I had from all my other subjects combined. He smiled, and I continued: ‘And I think I understand what you were trying to do for us. It was all about taking responsibility for our own actions, doing our own work, seeing things how we see them and making use of that knowledge.’

I stopped and smiled back at him. He put out his hand, I accepted it, and we shook with vigour. ‘Keep thinking; keep watching; keep looking,’ he said. He turned away and got back down on his knees to continue his insect observation.

Almost 40 years on from the lessons of Frank, I suppose he will certainly have passed on from this mortal coil. However, his facilitating approach hasn’t. The unconventional methods deployed during those Critical Analysis lessons would be impossible to use in a teaching role this century – and yet from a therapeutic chair they still look deeply valuable. Frank’s style was rooted in creating informed, personal growth. For some of us at least, the approach lay good grounds for the development of complex grey thinking in a world of blacks and whites, but there was much more in it than that. 

These days, when Frank crosses my mind during a session I can be pretty certain that the work of growth is deeply in play – the focus in those moments will so often have turned towards becoming truly, richly, deeply the person they were looking to become before everything else got in their way. Frank didn’t appear to care for the ego of attribution of knowledge, only that you learn and find the things you need for your journey. But once in a while I like to mention his name, to tell others of a great teacher who has stayed with me – as relevant in therapy as he was in the arts. 

(This article was originally published on Three Men With a Blog.)

All rights reserved © Copyright Duncan E. Stafford 2022. Unauthorized use and/or duplication of this material without express and written permission from the author of this post is strictly prohibited.

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.

There’s something about anxiety right now (2017)

stressBoth the West and the UK as a nation have had a difficult couple of years – from terror attacks in major European cities that many of us know well, to the Brexit vote and result, quickly followed by the political fall-out and Trump’s control of the USA. Just when we thought it couldn’t get worse, terror came back to the streets of the United Kingdom in the middle of yet more political uncertainty during the 2017 general election. Then, most recently, we witnessed the unprecedented loss of life in the Grenfell Tower horror.

For most of us, these events are stories we digest through the various forms of news and political and social media coverage – something happening in the outside world, well away from us. But these events have been quite triggering for people with worked-through and unworked-through trauma in their life stories.

At my own practice, contacts from people experiencing anxieties appear to have risen dramatically since the June 2016 Brexit vote; 2017’s events have done nothing to quell this near tide.*

Anxiety can be an extremely difficult and life-restricting thing to experience or have to live with. The professions of psychiatry, psychology and psychotherapy have created many working models of anxiety and many labels with which to subdivide or associate types of anxiety. Social Anxiety, Panic Disorders, Obsessive-Compulsive Disorder (OCD), Post-traumatic Stress Disorder (PTSD), Acute Stress Disorder and Generalised Anxiety Disorder form the kaleidoscope of disorders humans feel when anxiety gets overplayed and out of hand. And yet, anxiety is a natural thing to experience. Indeed it is the body’s response to danger. You can think of it like a monitor or alarm that is set to be triggered if you are put in the position of feeling threatened, under pressure or when you are facing a stressful situation.

In small amounts, anxiety is often a very good thing and in some situations it can even be the thing that saves your life. However, get too much of it happening inside a human being for too long a duration, and it can cause problems with pretty much any area of your life. At that point, we start to think of it not as a friend that can help us to feel alert, motivated and push us into action, but as a disorder that can control and even ruin our life.

If you find that you have – in addition to the primary anxiety symptoms of irrational and excessive fear or worry – other common emotional symptoms such as feelings of dread or apprehension, vigilance for danger signs, expectation of the worst, difficulty with concentration, feeling irritable or tense and jumpy, or that you experience mind fade (where your thoughts just go blank), then it might be time to think about taking steps to talk through your anxiety issues with a professional or, at the least, take some positive actions which might include things like mindfulness practice or regular exercise. And, if you don’t feel like being confined to a room to work through your issues with a therapist, then you might want to consider taking your anxiety to an outside environment with some walk and talk therapy – such as the type I offer within my Cambridge or Bristol practice.**

* There has been a reported five-fold increase in traffic to the Mental Health Foundation’s online anxiety page since July last year (Therapy Today Magazine May 2017)

** Walk and talk therapy will be the subject of a future post on this blog site.

The right to choose more than black and white

ThinkingBlog

Recently, I had a long and exhilarating conversation with a male colleague who had sought to challenge some black and white (binary thinking) by making a particular job application. We spoke the day after his application had been turned down on the grounds of occupational requirement – this is a circumstance where it is lawful to be treated differently due to your sex.*

One of the reasons it became such a meaningful conversation is that the failed application appeared to raise so much detail about the way humans get locked into simplistic or binary thinking. Take, for instance, the complex sociopolitical situation the UK has become embroiled in since Brexit first reared its head. You don’t have to look too hard to have seen numerous examples from both the ‘in’ and ‘out’ camps of over-simplification and binary thinking. Such debates perhaps underline that the world is a complex place but that our actual ability to cope with these complexities is limited. Maybe it’s best to see that, in seeking simple solutions, we largely ignore or hide the complexities.

After my conversation with my colleague I was left to consider something I have lived with the whole of my psychotherapeutic career – the fact that women who you might expect to want to work with another women often choose to come and work with a man instead.

Simple and binary thinking might lead you to imagine that a woman who has lived in a coercive or abusive relationship with a man would only want to work with a woman. Similarly, if you are female and have been raped by a man, then it might be expected that you would only work with a woman. However, as we have already discussed, the reality is that the real world is more complex. While it might be that many women feel far more comfortable working with a female therapist, some women make different choices. Some women – especially those who have also suffered at the hands of other women – actually need to work with a male therapist. It might be that to work in a safe, secure space with a trained, registered and accredited male therapist can offer certain women the opportunity to begin to work towards trusting men again.

On numerous occasions during my career, I am glad to have been prepared and able to offer to be a trusted man in the repair work women have undertaken. I just wish that all therapeutic and support organisations would consider getting their palettes out, mix the black and white, and do some ‘grey’ thinking by offering the opportunity for women who need it their choice of gender for their recovery.

*https://www.equalityhumanrights.com/en/advice-and-guidance/sex-discrimination

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.

Blue Monday, acceptance and the ‘good enough’ New Year’s Resolution.

bluemonday

This year, Blue Monday* – reportedly the most depressing day of the year – occurs on 16 January. But for a moment, I’m not thinking about why, for so many people, things might get so rotten early in the year. In fact, I’m thinking back to a workshop I ran for therapists who came a from wide variety of theoretical backgrounds, and the theoretical approach I’m particularly reminded of as I write this blog is Winnicott’s ‘good enough mother’.**

Beyond the technical details of theory, there is something almost magical about the simple phrase ‘good enough mother’ – especially if seen as a contrast to the idea of the ‘perfect mother’. I often find the same sort of clarity when I examine the word ‘acceptance’, because both the idea of ‘good enough’ and ‘acceptance’ offer us the chance of freedom or liberation from expectation.

As Blue Monday approaches, imagine how quickly you could realign some of the simple hurdles you have already erected in 2017 if you begin to use the ideas of being ‘good enough’ or ‘acceptance’ rather than seeking unobtainable standards.

Reportedly, more than 30 per cent of people will have broken their New Year’s resolutions by the end of the second week of January. So, I wonder how useful the concepts of ‘good enough’ or ‘acceptance’ might be in helping people to continue with the positive changes commonly set around 1 January each year.

Imagine your resolution is to run regularly. At a packed party on 31 December you announced enthusiastically and publically at the stroke of midnight that you’d run a marathon before the end of 2017. On 14 January, as you put on your running shoes and realise how dark and cold it is outside, you notice your determination and enthusiasm shrinking. Despite wanting to save face, you throw in the towel and return to your sofa – crisps and beer in hand. At some point later, you beat yourself up for being weak-willed or lacking commitment.

But what if you take the option to reframe? Drawing from the ‘good enough’ idea, how would it be if you simply decide that enjoying a bit of running could be good enough? In the following days and weeks, you might discover that 1 kilometre turns into 2km, then 5km, then 10km. It turns out that you can accept where you find yourself right here and now and allow your ability to grow naturally, rather than demand of yourself that you adhere to the unrealistic goal you first chose.

Similarly, if you set yourself the task of losing weight – a popular New Year’s resolution – then be realistic. Don’t set your goal at a huge weight loss in an impossible period of time. At least at first, just try to lose something each week – which is actually going to be ‘good enough’ until you have firmly built the habit. If you focus on the small, the sizeable will quickly grow from it. You will then have a much better chance of embedding the change in your life long term; it will become achievable and, therefore, much more likely to improve, rather than knock, your self-esteem.

As you begin to succeed, come from your continued acceptance of the here-and-now ‘good enough’ perspective. This will undoubtedly create chances for you to grow more, but without that demanding self-expectation.

Let me wish you a happy, ‘accepting’ and ‘good enough’ 2017!

*The concept of Blue Monday, the point at which we are supposedly at our most melancholy, was first proposed by psychologist Dr Cliff Arnall as part of a 2005 press release from holiday company Sky Travel. It is claimed that the date was calculated using the equation: [W+(D-d)]xTQ/MxNA – W is weather, D is debt, d monthly salary, T time since Christmas, Q time since failure of attempt to give something up, M low motivational level and NA the need to take action. See: http://www.independent.co.uk/news/science/blue-monday-the-science-behind-the-most-miserable-day-of-the-year-a6816926.html

**Donald Winnicott (1896–1971), a British paediatrician and child psychoanalyst, was the original proposer of the ‘good enough mother’.


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.