therapy | Boundaries of the Soul

Depression : An everyday tale

February 1, 2013 — Dr. Nicholas Jenner

It is an overwhelming fact that depression rates are on the rise in most corners of the globe. Globally, millions of people are living with the misery of the so-called “cancer of mental health” on a daily basis. Some have had their symptoms alleviated by medication, some have sought therapy and there are many others who live with it without getting help. Some are not even aware that they are suffering and some choose not to recognise it, for whatever reason. There are those who have adapted their lives to the extent that they see their depression as a “part” of them, have no trouble talking about it. There are others who feel stigmatized and discriminated against and hide their illness and there are those who live in fear of the consequences of their depression hoping it will not take over their lives. I recently met someone who had been suffering on and off from depression for over thirty-five years. We talked about how this had left an imprint on his life, how it affects him and how he had tried to adapt in order to lead the best life possible. He cut a despondent, resigned figure who had seemingly given up. I asked him if I could write his story….he gladly agreed and here it is :

When did you first realise you were depressed?

I often wondered why my parents were always so miserable. Now I realise that they were depressed too. I guess it would be easy to say that I inherited my depression from them but I know it is not as simple as that. When I look back, it first hit me in my teens. I was an awkward teenager, never with the “in crowd” and consequently got bullied and pushed out. I didn’t dress or act like them which didn’t help. I preferred my own company. Now I realise that I was not doing things because of my depression. I never thought that anything was wrong until I made a mistake at work and started crying when my boss criticised me.

What happened then?

Well, my boss had some previous experience of depression and took me to the GP. I was distraught to have shown such vivid emotion in front of my employer. Luckily he understood, and guided me somewhat. I thought my world was about to end. Depression and mental illness had always been a taboo subject in my family due to my grandmother being “mad” and my parents often criticised and ridiculed others who suffered. My boss took me to the GP and he prescribed antidepressants.

Were you offered other treatment, such as therapy?

No and my parents would not have allowed it. In those days, that meant being “locked up” and that would have brought shame on the family.

What was your experience with medication?

I remember at first, the days full of “zombie-like” feelings, the impression that I was in another dimension but after a while I felt better and the side-effects waned. After that it was a case of remembering to take them. After a year, I decided not to take them anymore and gradually came off them. I don’t regret that at all. I know people who have been taking them for twenty years.

Would you consider yourself still depressed ?

Most definitely. Look, it comes and goes but I am still as miserable as I was as a teenager. I still avoid things that could potentially hurt me psychologically and have really stayed in my comfort zone all my life. I read an article once that stated that some people’s depression never goes away and they should just accept that and adapt their lives accordingly. I can believe that in my case but I am not sure you can accept it or adapt to it…or if you should.

Now the big question…How has being depressed impacted your life?

Well, I would say it’s the little things that have the biggest impact. Waking up in the morning with seemingly nothing to look forward to (or so I think), the difficult interaction with other people. The constant rumination about what other people think of me, regrets and my past. Makes daily life difficult. However, the worst thing is how I think about myself as a weakling, a fragile being who is knocked back by the smallest upset. How I can’t get out of that feeling and it gets worse before it gets better. I haven’t been able to stay in a relationship and that is one of my biggest regrets. I think the worst thing is that I feel society stigmatises depression to the extent that people with it are not seen as “normal”. The health insurance companies treat you like a monster when they hear the word and employers keep you at arm’s length.

How do you see your future?

(laughing) I have a great future behind me !! Look I am resigned to the fact that I will probably suffer from this forever. I know I don’t do much to change that but we are like an old married couple who are together because the alternative is not so rosy. I know that if I am better, new challenges will come and those would be difficult to handle.

What advice would you give to other sufferers?

Well, they probably need to do the opposite to me. I was (and still am) scared of getting better. What would this new world bring? I would have to face things that would scare me to death. I would strongly recommend anyone newly diagnosed to seek help as soon as possible. Join groups, get therapy, medication, anything that can lessen the Impact. To try to survive without help is doomed to fail.

It is not too late for you..why don’t you take your own advice?

This question was never answered. He quickly made his excuses and left. The path out of depression was seemingly too hard to contemplate. Can it really be the case that someone would accept their illness because the alternative is harder to contemplate? I guess this is an issue that people often forget. Getting well can be as difficult as getting sick, brings new challenges and a new world that calls for courage to live in. I didn’t get the chance to thank him for allowing me to talk to him. It must have been painful to go over some of the issues that had been a part of him for years. Who knows? Maybe someday…

Dr. Nicholas Jenner is a Counseling psychologist in private practice working with individuals,couples, groups and companies globally. Online therapy is, in my experience, effective for treating a number of major conditions. Are you having issues that you need to talk through? I have a range of plans that can help you get the help you need. Online Therapy details : Here …… Take advantage of the “online therapy” tester. Try the first three sessions for free. Contact me for more details.

CBT in Action : A Case Study

January 29, 2013 — Dr. Nicholas Jenner

CBT is based on the belief that thoughts, feelings, and behavior are inter-related and impact each other. Since thinking, feelings, and behavior are interconnected, treatment interventions that focus directly on specific thoughts, feelings, or behaviors are expected to impact other thoughts, feelings and behavior. The main goal of CBT is to regulate, modify, augment, or replace problematic thoughts, feelings, and/or actions so that problem behaviors, thoughts, or feelings are interrupted and, ultimately, replaced with more a functional thought-feeling-behavior pattern. One of the best ways to monitor this is with the Daily Mood Sheet. This is used to log feelings, emotions and behavior caused by a triggering event and then gives the client the chance to look at the situation in a more realistic light. Constant logging of these situations will give a firm indication of thought patterns that have lead to dysfunction. They can be used as an integral part of the therapeutic process. More on this HERE.

I often use the sheets with clients as an aid in therapy. They often find it hard to keep the log and especially to look at the situation more realistically but perseverance is the key. Those who do tend to be able to change their thought patterns over time, be able to assess when dysfunctional though patterns have an impact and are able to separate the feelings produced from their general feeling about themselves. One such case is highlighted below. The client concerned found the sheets helpful to recognise where her thought patterns were coming from.

Case Study : Patient Jodie (name changed)
Jodie was a patient of mine from June 2011 to July 2012. She contacted me initially because she “didn’t have a minute of one day when she didn’t feel depressed”. Jodie is an IT professional attached to the US military and was stationed in Germany until just recently. Apart from her depression, she was obese, had various medical problems and was on constant medication. She has given her full consent for a part of our counseling transaction to be included here.

1. Background

Jodie came from humble roots growing up in a military family in the US with two siblings. Her mother was a neurotic who spent most of Jodie’s early life in some form of institution, leaving Jodie’s primary care to her older sister. Her father was a soldier who was often posted abroad, taking the family with him. The parents had strong religious views and were highly influenced by the “fire and brimstone” style of preaching seen in the Bible Belt at that time. For this reason, out of marriage relationships and sex were seen as the devil’s work. During our sessions, Jodie revealed that she, at the age of 42, had never even come close to a sexual experience. All of these factors contributed to Jodie’s view of herself and the world around her causing unhappiness and depression. However, a breakthrough in therapy revealed a complicated relationship between Jodie and her older sister who was apparently jealous of her younger sibling and so behaved in such a way that forced Jodie to feel inferior and subversive. The relationship turned into a love-hate roller coaster that played out over several decades. Jodie’s whole experience of being “molded” by her sister to believe that she was “no good” had created her window of reference on the world and ultimately her depression. One of the side effects of this was a severe lack of assertiveness and in her words “constant cowering down and meekness”

This had affected her in all aspects of her life and none more so than at work where she was one of a few women working in a mostly male environment. The following excerpt from one of our counseling sessions highlights a situation following conflict at work. Jodie highlighted this on her daily sheets and wanted to discuss this. We had been looking at this problem for some time using behavioral experiments and goal setting to help her deal with the situation more effectively.

2. Presenting problem

Jodie had once told me that one of the biggest issues in her life was the lack of assertiveness that she showed whenever she felt conflict was about to happen. While this happened in all aspects of her life, it was especially bad at work where she felt dominated and subversive. We had often linked this back to her experiences growing up and behavioral trials had been unsuccessful for Jodie. She had been filling in daily sheets for some time and had highlighted one situation that had caused her to fall into deep depression afterwards. It had occurred when her boss, just in from the US greeted everyone in the office apart from Jodie. This was later (two weeks) rectified and Jodie realized that is was just an oversight on his part. However, before this happened her mind had come up with many different reasons for this and together with a number of triggers resulted in her believing that he had done it on purpose because he either disliked her or she had done something wrong. She was severely agitated upon arrival and appeared to have been crying.

3.. Final Evaluation

Jodie was in a state that called for a clear head and thought. She is the type of person who had been known to withdraw from others when things got too much for her so I was happy that she appeared for the session. She was unusually agitated and somewhat aggressive and accusatory, something I was not used to from her. This session turned out to be the catalyst for what I consider a successful end to therapy. Jodie in a recent communication with me cited the CBT techniques learnt in our sessions as the major reason for her change in mindset. I would evaluate the session in the following way :

Jodie filled in the sheets even though she couldn’t find a rational response at the time. She later stated that thought the sheets helped her focus on the issue at hand.
I was happy with the way I guided Jodie through the session, setting an atmosphere that facilitated conversation and relaxation.
The use of CBT tools ( sheets, questioning and probing) and a Rogerian style of dealing with the client were present and effective.
I used the good therapeutic relationship between us to give Jodie the basis for expanding on her problem.

The following is a transcript of part of the session :.

Therapist	Client	Evaluation
Please come on in. You look rather like you could do with some tea..would you like some?	Oh, yes please, that is very kind of you.	I was trying to set a relaxed atmosphere. She was in a clear state of anxiety and this was needed to coax her into talking.
You told me on the phone that you have been depressed about something that happened at work. I am sorry you have had a bad week but can you give me some more details?	Well…I am going to quit the damn job and to hell with it!	This was a reaction I was not expecting and through me off guard for a second. My usual prompts for information were usually met with a more open response. I guessed if she was being direct then I can prompt further.
I understand that you have had a bad week but please tell what is going through your mind at the moment.	Well, my damn boss came into the office, said hello to everyone except me and left. What do you think is going through my mind at the moment? If you can’t understand that then I am leaving!	This showed the severity of the problem. This was the first time she had reacted in such a way.
I can see you are very upset but let’s try and see if we can talk through the issue and see if we can find another way of looking at it..would that be ok?	What is there to look at ?..I know what happened but go ahead..we still have 45 minutes.	This was a sign for me that that she was ready to look at the issue from another angle so I decided to bring in one of the CBT tools we had been working with.
Let’s start with your sheet entry..can you tell me what you wrote?	Ok..boss ignored me..emotions..angry, worried, embarrassed. Thoughts…I am going to be fired…how will I support myself..he always give me the cold shoulder..how did that look in front of my colleagues. Rational response..none	This helped to focus the situation on the issue and not the emotion. My aim now was to help her seek evidence to the contrary.
OK..Jodie that was obviously an experience that triggered some reactions..can you remember what we said about triggers a few sessions ago in terms of ABC ?	Yes..and I tried to apply that but it just didn’t work.	I thought it was good to revisit and consolidate part of the ABC model here.
Ok..well I understand you may have been a bit overwhelmed by all of the reaction to the event so let’s try and break down the reactions one by one, ok?	I think that would help. It has been a difficult week.	This was the first sign that Jodie was willing to open up.
Good..take your time with answering and if anything is too much, we can look at it later..is that ok? Let’s look at your first statement…I am going to get fired..do you know this to be 100% true and how do you know this?	Well..it is clear…I am the one to go. Nobody told me this but from his actions, I can tell.	I was trying here to establish links between events and dysfunctional thinking
Interesting..so there is no real evidence that you will be fired?	I told you, damn it..it is clear. Are you calling me stupid?
Of course not…but I just want to look at the comment you just made…nobody has told me this.	It is my impression.	Here was a good chance to introduce signs of evidence to the contrary.
But are there signs that you will be kept on?	Well, I did get a good performance rating and my boss did say I am a valuable member of staff.
So looking at it realistically, could there be another reason he didn’t say hello?	Maybe he just didn’t see me.

Online Therapy….A Therapists view…

January 26, 2013 — Dr. Nicholas Jenner

I posted the article below in July last year. It was very much based on my early impressions of adding online therapy to my “normal” way of seeing clients, that is in my practice. Six months have gone by since then and the concept is steadily growing to the point that the split is now 50/50. Which do I prefer?…Hard to say….each method has pros and cons but the overriding factor is that as a therapist I am able to help more people in more ways. That feeling is one that makes everything worthwhile. Have my feelings changed about online therapy? Yes….I have become more adept at using the technology…I have become more skilled at reading between the lines, something that is highly important. Even though video technology is at a stage where it virtually simulates “live” therapy, it is easier for the client to hide feelings if they want to. I have become more accepting of this new way of helping others despite my initial fears and doubts. I have grown accustomed to working outside office hours. All of these factors have contributed to making the experience an exciting one and I look forward to what the future brings……

Online therapy is relatively new and not yet fully accepted by everyone. When you browse articles on this topic, you generally find that the main issues center around privacy concerns, proposed regulation and the usual chatter from psychotherapists stuck in the Freudian era. However, there are some studies, the most recent in Australia, stating that online therapy is proving more and more effective across a wide range of mental health issues including depression…READ HERE. This is exciting news for therapists who have decided to add online therapy to their range of services and one can only believe that the number will increase in years to come. However, in all of the discussion on this topic, one subject is usually overlooked. That is, the new challenges that therapists face in this brave new world. I have been working with online clients for about a year now and I am in a good position to talk about the differences between sitting in front of a computer screen and a “live” client.

The first thing you realise is that the dynamic of the relationship is different. Communication is via video call, email or phone so there is no physical presence in front of you. I often use email as a means of communication between sessions. Clients send me written assignments, journal entries or just their thoughts. This makes the written word and verbal communication extremely important. Unlike face to face therapy, body language and facial gestures play a lesser role, (of course, this can help in a video call). Analysis of mails in particular is very important and looking for signs of automatic thoughts and core beliefs between the lines can be challenging. Often, there is an email exchange with clarification and challenging questioning to find out what is really being said. Often these responses are instant when sent to a smart phone or when the conversation is being held on IM. As a therapist this means, you have to be on top of your game, intensely analysing statements that come very quickly back at you. The wording is also highly important in establishing what is going on under the surface with the client. Looking for clues means going into the very essence of the words used. Often clients when questioned about the use of particular words and phrases can relate these back to a thought that they were have at the time and sometimes they were not even aware of the connection. As clients often come from different cultures, it is essential to have or quickly learn to deal with the nuances in the culture and the language. I have clients from all over the world stemming from the US, Africa, Asia and Europe. All of them see the world through their cultural influences and are all very different.

Secondly, therapists who use video technology to run sessions have to rely on a good connection. Without this, it is an impossible task. Clients who are already troubled find it very traumatic to have the link constantly broken or they have to keep repeating themselves. Even the best encrypted software systems rely on a good internet connection to run video technology. This can make the difference between success and failure with a particular client, especially when working across time zones. This brings in a different point. Anyone who is really serious about online therapy must be prepared to work evenings, weekends and to a time suitable for a client. The beauty of the concept is that you can work with people in other countries. However, this means you can forget 9 to 5. Many, as I do, usually work with the online clients before or after seeing clients in their practice. This can be exhausting if you do not take care of yourself physically and mentally.

It is only a matter of time before online therapy is seen as a viable alternative to face to face therapy. Regulation and establishments offering official training will surely come. Of course, this is the way it should be. However, I hope that it is not regulated to such an extent that it fails to help the very people who most need it. That is clients who are housebound, in rural areas or prefer not to visit a therapist’s office. It is an exciting new world for therapist and client alike. Help is being given to people who would not normally get it but this also brings challenges for everyone involved.

“Put that baby in the fire NOW” ….my wife demanded!!!

January 6, 2013 — Dr. Nicholas Jenner

No…not some black magic ritual but part of a dream I had recently. The dream went as follows : I was carrying a baby that had apparently died and cremation on an open fire was part of a burial ritual in the culture we lived in. The trouble was that I didn’t think the baby was dead, just sleeping or hanging onto life so I refused to carry out the ritual causing my wife to be angry. She then demanded that the ritual took place. I finally agreed but pulled the baby from the fire at the last moment claiming that it was badly burnt but still alive. At this moment, I awoke, distressed and immediately went to my son’s cot, half asleep to check on him. Everything was fine, of course…I hadn’t had a premonition. Thinking about the dream the morning after, I realised the significance of the dream and why it had come at this time. Death in a dream generally means that a part of you is dying, be it a belief, a long-held thought pattern or a habit. I realised that this dream signifies my final recovery from the accident that I had two years ago that left me with various phobias and fears. My wife has been gently encouraging me lately to take that next step (with some resistance). I really feel this dream is a real pointer to upcoming events.

When we are under stress, anxious or worried, sleep is one of the first things to be affected and many complain of broken sleep or the inability to fallasleep. When trauma has occurred in our lives, we are sometimes afraid of sleep, conscious of the nightmares and flashbacks that could follow. However, it is universally recognised that obtaining sleep, and good sleep, is essential for strong physical and mental health. As a therapist, I am very interested in a client’s sleep patterns as they can give a good sign of troubled times (or not). I also believe that what we do when asleep is an equally important source of information, that is the analysis of dreams. The interpretation of dreams in psychology was first pioneered by Freud himself. He believed that dreams are the window to the subconscious. He famously quoted in his work The Interpretation of Dreams (the definitive text was published in 1955), “The interpretation of dreams is the royal road to knowledge of the unconscious activities of the mind” , something that I truly adhere to.

There are people, of course, who believe that dreams hold no particular value and are just a re-run of recent events in our lives, much like when we would watch a film we have shot on a camcorder, that they are just a repository for information received through the senses or are some kind of “white noise”, similar to that hum give off by electrical equipment. On many levels, this could well be true. Our brains need to find an efficient way of filtering and storing valuable information, ready for the next day’s onslaught of even more. We can liken this to spring cleaning in the sense that some things are used and some things stored away for the future. The question is, what happens to the stored information? It is stored in the subconscious just as we store household things away in the attic. When this is added to the existing information present there from the influences. belief systems and experiences gained as we grow older, we have a melting pot of information that goes to making up the vast, murky, mostly uncharted place we call the subconscious. If we see the brain as some form of large computer that is continually fed during waking hours, we could imagine that dreams perform two functions : the correct sorting and processing of information and the presentation of new ideas needed for the dreamer to fully function. To do this. it gets most of its input from our subconscious mind during our sleeping hours as this is the only time that we do not place limitations on our conscious mind, allowing elements of the subconscious to come through. This process is often associated with nightmares but can also be on a more positive note. There have been many recollections of solutions to problems being found while dreaming or in deep sleep.

Nightmares and Flashbacks

When we have a nightmare or flashback to a traumatic event, we are showing a depth of emotion rarely experienced in waking mode. Nightmares are usually associated with our psychological reaction to fight or flight, yet we rarely get to this point and huge relief is felt when we wake and realise that it was not real. Nightmares tend to arise from six sources.

1. Childhood memories of intense emotions associated with loss ( or birth trauma)

2. Childhood fears and anxiety, especially in the case of dysfunctional attachment to parents.

3. PTSD where basic survival is threatened, even when the traumatic event is long past.

4. A fear of the unknown which could have been absorbed as a child. Yet again, the need for basic survival.

5. Serious illness with the natural fear of death.

6. A sense of foreboding of doom to come. This is a concept not fully understood as yet but what seems true is that humans have an innate cognitive ability to predict future events while sleeping.

People who have nightmares are more likely to suffer recurring dreams in the same situation, with the same emotions but participants disguised and often invisible. In these cases, analysis of dreams in therapy is extremely helpful to break habitual responses and change attitudes and anxiety. The analysis of dreams in therapy is not advocated by all therapists and this depends mostly on point of view and personal opinion. I, for one, believe we need to use everything at our disposal to help the client understand and ultimately recover health. Dreams, in my opinion, serve a number of purposes but not least by showing us that we are attempting to achieve a goal that is , at present unattainable, telling us that we need to focus on how we handle emotions such as anger, fear, jealousy or pain or such issues as spirituality and sexuality. Though this is not an exact science and interpretations can be wrong but a simple breakdown of the dream can glean valuable information concerning the conscious and subconscious thought patterns of the dreamer. Initially, the situation or the environment that the dream took place in is significant. A good example is a school: a learning environment. Then the emotions being felt in that situation gives an understanding of the dream framework, just as a theater group sets up a stage for a play. The important part is then to decipher various symbols and sub-plots that occur and the participants involved. We should also realise that a dream can relate to various themes going on in our lives and a simple explanation is often not enough to truly reveal the secrets involved.

Dr. Nicholas Jenner is a Counseling psychologist in private practice working with individuals,couples, groups and companies globally. Online therapy is, in my experience, effective for treating a number of major conditions. Are you having issues that you need to talk through? I have a range of plans that can help you get the help you need. Online Therapy details : Here …… Take advantage of the “online therapy” tester. Try the first three sessions for free. Contact me for more details.

Conditioning can be changed but it takes hard work and awareness.

November 5, 2012 — Dr. Nicholas Jenner

Dr. Nicholas Jenner is a Counseling psychologist in private practice working with individuals, couples, groups and companies. Apart from seeing clients face-to-face, Dr Jenner also runs a thriving online therapy business bringing help to those who are housebound or located in rural locations where therapy is difficult to find. Online Therapy details : Here

A client who has been coming to therapy for quite some time, recently had a revelation where she finally realised that her family had conditioned her as a child to behave in a certain way. Intellectually, she always knew this but emotionally she could not accept it. She cried for the first time in years and has vowed to see this as an opportunity to change her belief systems. In our time together, she has often expressed terms similar to the following:

“My family has always been that way”

“That’s just the way I am”

“Because of my past, I can’t, won’t, will never be able to”.

These statements are often heard when people try to explain, justify or make excuses for their behaviour and attitudes, or the behavior of others. But just how much of our past experience really affects our present? One could never expect children who have been sexually, physically or verbally abused not to have some scars but even many of these have found peace and happiness through a process of closure and forgiveness,being able to love themselves and throwing off the shackles of the past.

The long-running debate about nature vs nurture has never really delivered a clear answer. Are we born with a genetic toolbox given to us by our parents that predetermines our future or do we come into this world as an empty slate, ready to soak up influence from the people and circumstances around us? My opinion is that it is somewhere in the middle meaning that we are influenced by genes and environment as we grow. That said,is it really possible to change this conditioning, if you need to? That is the million dollar question! A client recently said to me that you can only release the past and conditioning if you are aware of its influence. That is very true. Not only awareness but the desire to change has to be there. Some people, of course, could have the awareness but not the desire to change or vice versa. I personally know how difficult it is break with the past, live in the moment and look forward and not back. I come from a background of abuse and neglect, both physically and mentally and it has taken me many years to forgive and find my true self. I know realise that we are all victims of victims but it must stop somewhere and it has with me. Breaking free from your past conditioning is one of the hardest things to do in life but is essential if a fruitful life is to be had in the present.

There are many people who believe that we can change our moods and ultimately our attitudes by changing the way we think. These moods and ultimately depression can be often linked to our early influences. Negative thoughts make these moods worse and can lead to depression and anxiety. Let me make it perfectly clear: we cannot be happy all the time, despite what we read in self-help literature and it is totally unrealistic to think so. What we need is a recognition of the importance of analysing and changing distorted thinking with a view that one is able to see situations from a different viewpoint and not place a negative connotation on everything. Analysing the ‘ vital connections’ between thoughts and emotions is the first step in breaking out of negative thinking. Additionally, thoughts that bring anger, anxiety, guilt and frustration are often unrealistic and distorted even if they seem real at that very moment. The key to stopping this is to become aware of the presence of distortions and how they develop thought patterns. The old adage, we are what we think is certainly relevant here.

Being aware of negative thought distortions is the first step in recognising what thoughts are appropriate, which should be expressed and which should be changed. However, at times anger and irritability when expressed in the right way and in the right place is totally appropriate especially within the context of a loving, honest relationship. Many people have major problems accepting the way they feel and this can lead to further distorted thinking. Ask yourself questions to determine whether feelings should be expressed or changed.

1. How long has the feeling been held? If guilt is still being shown about an event that happened long ago, we have to ask ourselves, what is the purpose of holding it for much longer?

2. Are we willing to learn from the pain of negative experiences and thoughts and see them as part of a growth process?

3. Are we willing to change the way we think about a situation if we accept that our feelings are based on distorted thoughts patterns and then face the situation constructively?

4. Are we able and willing to judge if expressing feelings like anger at any given moment is helpful or hurtful? For example, avoiding conflict in a relationship can lead to feelings of resentment that can damage the relationship.

5. Are feelings shown against something that is completely out of one’s control such as frustration at a traffic jam or the economic situation?

6. Are feelings that are being shown a cover-up for the real problem that is being suppressed?

7. Are feelings of frustration to do with unrealistic views of the world aligned with ‘should’ ‘shouldn’t’ or must thinking?

8. Are feelings to do with unrealistic self-expectations that facilitate perfectionism and ‘ all or nothing’ thinking?

9. Are the feelings attached to a general feeling of hopelessness? Many people who believe they are hopeless will go to great lengths to find the evidence to support the theory.

10. Are the feelings attached to a sense of low self-esteem? People with high self-esteem can take criticism and rejection in a constructive manner. On the other hand, people with low self-esteem see themselves as inferior and display defensiveness and become angry quicker.

Marriage is a funny concept!!

November 2, 2012 — Dr. Nicholas Jenner

This morning I read an article that highlighted the fact that globally, there are more middle-aged people living alone than at any other time since records began and the number is on an upward curve. Some of the people interviewed stated they had never been married and chose a single life, for whatever reason, but the vast majority were alone due to a marriage breaking down. There has always been divorce and separation and it is easy to say that things were better “back in the day” but it does seem that in our modern world, it seems extremely difficult to keep a marriage going. My work as a therapist reflects this in the fact that couples therapy is becoming more and more a part of my daily work and while it is wrong to generalise, there tends to be a red thread that runs very much through the problem areas couples face, especially when children are involved. It can easily lead one to the conclusion that those who choose to live alone know something that has escaped the mind of the rest of us and poses the question…what is marriage in this day and age? What is it that people want from it and why does it so often go horribly wrong?

A good marriage with someone we truly love is generally the fairytale that is sold to us by society, sometimes parents and definitely religion. We are all expected to go on to develop along certain tried and trusted paths which includes marriage. Many are totally unprepared (especially if they marry young) for the immense amount of hard work that goes into keeping the thing going…almost the same amount of effort that is needed to keep a business afloat and running viably. The shock that comes when two suddenly become one means that life will never be the same again. As official divorce rates suggest, over 50% of these unions fail to make it. Many marriages are broken through financial pressure or infidelity or one or both partners wanting something new but many never get to this stage and stay together even though little seems to keep them tied to each other. These marriages seem to be the ultimate in convenience, two people afraid of making the changes that need to be made and resigned to living in a loveless union “for the sake of the kids” or some other excuse. These are usually the type of couples who end up on my couch and I make it extremely clear early on that my job is not to keep them together under any circumstances but to help them get to a point where they can make a decision to either improve the marriage or potentially end it.

Many of the same problems exist in marriages of most of the couples I see and many of them are unaware that such negative habits have crept into their marriage. Some have spoken openly with each other for the first time in a long time when they come for the first session leading to a huge amount of surprise from both partners about some of the statements made. While we can all think of potential problems that can wreck a marriage…the common spectrum is not so wide, in my experience.

Taking a partner for granted : This is probably the number one reason why marriages fall flat. The marriage becomes routine, stale and lacks any kind of excitement. Thinking that your partner will always be there leads to a notion that nothing has to be done to make that happen…complacency on one side, resentment on the other. This is usually never spoken about for fear of “rocking the boat”. It is clear that sometimes the parallel lines that hold partners together get blurred when such events as children arriving happen but some couples have difficulty finding each other again.

The Emotional Bank Account : A marriage needs to be worked on similar to the effort needed to run a business. The idea of the emotional bank account was one that I read while reading works from Stephen Covey. He suggested that if you continually withdraw from the bank account without depositing, then bankruptcy will follow. The concept is great…put as much into the marriage as you expect to take out. Something that is often out of balance.

Assumptions, Assumptions! : We as humans have never mastered the art of mind-reading but the practice is alive and well in a lot of marriages. Assuming what a partner is thinking or how they are likely to react without evidence is a very common problem. The subsequent behavior that follows is always based on a false impression. As I said earlier, many couples are surprised when they find out that these impressions and assumptions are wrong.

Competition..win. lose, lose win : There are those couples around who tend to be in competition with each other continually for the honor of being right. That clearly means that someone in their eyes has to be wrong. They keep going until this happens …pushing and probing until effective communication is impossible in the race to see who gets the finish line first. On the other hand, there are couples where one is dominant and the other is the proverbial “doormat” giving in to keep the peace. The idea of win-win here is a concept that is alien for these couples.

Selfishness : There needs to be fairness in the distribution of work and responsibility within the relationship. This willingness to extend oneself also pertains to meeting emotional needs. Placing one’s desires consistently ahead of a partner’s emotional needs and responding only when it is a matter of convenience, demand or negotiations leaves a spouse feeling unloved.

Leading separate lives.: Relationships also suffer when couples don’t mesh their lives through shared activities, recreational companionship or spending enough time together. Living too independently from each other takes away connection and joy from the relationship. Couples need to function as a team when it comes to parenting, managing a household, sharing finances, and relating to relatives. They need to consult with each other about important decisions and coordinate their schedules. Time needs to be set aside to enjoy conversation, adventures, common interests, vacations and fun. Time spent together should be anticipated with pleasure. Without this component, couples drift apart and have little in common.

Dishonesty, laziness and other character defects : Basic trust and respect underlie love and form the basis of relationships. Lies, deceit, disloyalty, secret habits, or emotional dishonesty about thoughts or feelings destroy trust and respect. Spouses who willingly do not take or follow through with their personal responsibilities unfairly shift those burdens to their partner. Marriage is a partnership between equals, not a parent/child relationship.

It is a known fact that most couples who have “good” marriages just know how to deal with marital problems effectively, and they make an effort to keep their relationship alive. All of the problems mentioned above can be solved leading even the most sceptical and “difficult” of cases to a revival of what brought them together in the first place. It is often as simple as that…more time, more understanding, more communication, more focus. Two willing partners will manage this and more.

Punishment is not Discipline (Part 2) Considerations

October 9, 2012 — Dr. Nicholas Jenner

When my daughter who is now 24 started crawling, we attended as a couple some parenting classes. This was supplemented by visits from the seminar leader to consolidate the theory in practice. We thought at the time..why not? We are young, this is our first child and we thought we could surely learn something. As we were talking, my daughter crawled over towards a plant and reached for one of the leaves. The seminar leader jumped into action, putting herself between plant and child and yelling “no” at the top of her voice, scaring the daylights out of everyone in the room. I quickly picked my crying daughter up and asked what would be the next stage when she inevitably tried again to touch the leaf. “oh..smack her on the hand”. At this point, she was quickly escorted from the house, never to be seen again. Applying positive discipline would have meant a different result but more on that later.

From my last post, you will know that positive discipline must take place in a loving, respectful, kind but firm learning atmosphere. This teaches children what they can do not telling them constantly what they can’t do. There are some prerequisites for this. Firstly the house should be childproof meaning that anything that is dangerous or you do not want destroyed should be out of reach. This allows for healthy, safe exploration. Essential also is that the parents make time for the measures and bring endless amounts of patience along with it. Parents will need to repeat steps over and over again and need time and patience for this. Parents also need to clue themselves up on developmental phases and what is appropriate behavior for children of a certain age. Consider this: two children same age, different personalities. Which one would you say will grow up with more self-esteem?

Child A often sits alone, reading and playing quietly needing no input from parents. He is the classic “seen and not heard” child. The parents are proud because unlike their friend’s child, he doesn’t need disciplining or punishment. They can watch TV without being disturbed and when they have people over for dinner they can put him in his room and never hear a sound. The school has recently contacted them with the comment that he finds change difficult and is often disruptive when asked to do something new. The parents cannot believe this! Child B loves to explore the large family room that the family sits in. He has his toys in a specific place but is allowed to explore freely with intervention from his parents when needed. He never has to worry that his parents will shout and become angry and really enjoys the final game before bed in which he has to choose which color box to put his toys in. He loves it when his father says “which one this time..red or green for the cars?”. The parents are content that he is happy but have received a comment from their friends that their house is always so untidy.

The most important factor in the implementation of positive discipline is trust and the basis of this can be grounded from birth onwards. The first months and years of a child’s life teaches him about the world and the people in it. Children who are happy and healthy and have been given boundaries are more likely to grow up balanced than a child who has suffered abuse or neglect or has parents with limited parenting skills. Parents must respond to a baby’s cues from the get-go, especially for this is where trust and security is given or taken away. One of the first parenting skills for parents to learn is how to respond to the many signs that a baby will give about his preferences. He will surely cry when hungry, needs changing or is sick. It is important that he receives attention for these things as these are his needs. As parents become more experienced they will learn that they must care for a baby’s basic needs but it is extremely harmful to give into to all wants. The result being strong dependence on the parent. Children learn more when they are confident that their needs are met and parents can allow them to gain self-esteem by self-soothing. Babies who have parents who give appropriate time and attention to them during this early bonding phase usually go on to develop healthier relationships with others. This early phase with babies is crucial if positive discipline is to be effective. Touch, voice and making time for play is essential. Even though, we as adults like to make noises towards babies that we think they respond to, it is important for brain development that they hear their parent’s voices in normal speech, through reading, commenting and singing. Many experts believe that using a running commentary when going about daily activities with the baby is extremely useful. All of these things set the foundation for effective positive discipline as the child gets older. In my next post, I will be looking at positive discipline methods in specific situations.

Punishment is not Discipline (Part 1)

October 2, 2012 — Dr. Nicholas Jenner

The first weeks of a baby’s life can be gruelling and tiring for the new parents. Some parents can be completely overwhelmed with this new life that is suddenly thrust upon them. During these early phases, mistakes can be made that can have an effect in the years to come. Experts often cite the first three years in a child’s life as a very important if not the most important phase , a time when the behavior and attitudes show by the parents and other caregivers set a blueprint for adult life.

Just to put this into perspective..Alfred Adler , a Viennese psychiatrist believed that we are all born “hardwired” to seek connection with others. Adler felt strongly that this basic human need to belong, connect and find worth is influenced by our early experiences and consequently the early decisions we make about ourselves, others and the world around us. Recent research tells us that those children who enjoy this “connection” to their family, school and community are less likely to misbehave as children and underachieve as adults. Adler’s work is seen as the forerunner of the Positive Discipline “movement”.

Positive discipline is a process of teaching children how to behave appropriately and respects the rights of the individual child, the group, and the adult. It is different to punishment. Punishment tells children what they should not do; positive discipline tells children what they should do. Punishment teaches fear; positive discipline teaches self-esteem.

This is the key to understanding the difference between punishment and discipline because there is a big difference. How many times have you seen parents yelling, screaming, smacking and dragging their little one along the street in the name of “discipline”? How many times have you heard parents using threats, warnings and lectures to gain compliance in the name of “discipline”. All of these punishments create bad behavior and not only that..they lack respect, create considerable doubt in the child’s mind and lead to guilt and shame. They also have long-term effects. Some may be thinking at this point that I am advocating some kind of permissiveness and saying that children should be able to do as they please…nothing could be further from the truth. Permissiveness does not create a learning atmosphere nor does it create important skills needed later. Positive discipline on the other hand, coaches, guides, teaches and invites the child to make healthy choices by being part of the solution, not the problem. Children do not learn when they spend most of their time being threatened, scared or angry and in defensive mode. To some parents, this seems like compliance or rebellion but is purely a reaction and a need to regain the “connection”. In the child’s mind, this misbehavior works because it regains the parent’s attention…even though it is negative attention. Cheryl Erwin, MD wrote in her famous book, The First Three Years, that punishment is “likely to produce the Four R’s…Resentment, Rebellion, Revenge and Retreat”…enough said.

In my next post, I will look at ways of implementing positive discipline.

My personal top five : Self-Help books

September 20, 2012 — Dr. Nicholas Jenner

I have always been an avid reader and especially of self-help books. I find the positive message they portray encouraging for my work and I often recommend them on to my clients. Even though, I have read many over the years, there are a few that I always go back to and are constant companions. Here is a list of my personal favorites :

Number 1 : The Seven Habits of Highly Effective People by Stephen Covey

I could have chosen one of Covey’s many other titles but this is for me a ground-breaker. There is nothing original about Covey’s message and he packs established ideas in his own wrapping but manages to come up with a structure, that if followed, can lead to effective change. This is the key to Covey’s work. It is not just advice, it is a whole system, a way of living, looking at the world and interacting with others. It is delivered in a very simple, easy to imagine style and can be adapted for work and interaction with families and loved ones. It comes from deep understanding and from the willingness to believe and seek the good in everyone and everything. It is a source to start with the man in the mirror and then to go on to build a better world.

Number 2 : The Road Less Travelled by Scott M Peck

Peck was not loved by everyone. His direct writing style brings across the impression that he arrogantly went through life not being able to practice what he wrote about. Despite this, this title is often referred to as “the self-help book that self-help authors read”. It has its weak points, such as Peck’s musings about religion and grace but when he talks about discipline, parent’s responsibilities and the effect of bad parenting styles on children’s development, one can easily identify where he is coming from. The Road Less Traveled is the one book that made M. Scott Peck a household name. The book-divided into sections-has the premise of defining what makes a fulfilled human being. Most of the book is based on what Peck has experienced in life and as a psychiatrist and he passes this knowledge on with great effect.

Number 3 : The Feeling Good Handbook by David Burns

As a CBT therapist, I can appreciate most of this book. It distinguishes itself from the others due to its interactive nature. There are self assessment exercises galore and the reader has a chance to practice various behavioral experiments. The one downside is the rather large section on medication which is badly outdated. Having said this, this book is for those who choose to treat their depression, anxiety or panic attacks without the aid of therapy. This excellent how-to manual leads people who are depressed on a journey of understanding and self-discovery. Beginning with an easy to read and understand overview of the cognitive theory of what causes people to become depressed, it goes on to discuss the multitude of methods and techniques used to help treat depression. This book is on my bookshelf for good reason. It is not only a good read once, but you can pick it up time and time again to reference and refer to items which you may have forgotten.

Number 4 : Strong at Broken Places : Linda T Sandford

Not officially a self-help book but inspirational nonetheless. I came across Linda T Sanford’s Strong in Broken Places some years ago and while many would say there is nothing revolutionary about the content, it struck a chord with me due to its simplicity and ability to potentially help anyone who has been through the hell of child abuse, whether it be of a sexual, physical or emotional nature. One part of the book highlights the research done into the case studies that were used and how this progressed onto the theories created by Sanford. Linda T Sanford studied twenty survivors of child abuse as the basis for her book. They were chosen after sending a “request for volunteers“to over one hundred psychologists using specific criteria as a prerequisite. The survivors were finally chosen to give as much of a cross-section as possible of demographics as well as type of abuse suffered. Her aim was to attempt to dispel commonly held theories and prejudices about abuse victims in that they find it hard to stop the abuse jumping generations and they will be a drain on society’s resources by becoming criminals, drop-outs or abusers themselves. She states many times in her research that most of the twenty survivors had nothing in common with this stereotype and had gone on to become successful parents and business people. A must-read for anyone who has experienced abuse as a child and wishes to understand the consequences.

Number 5 : The Mindful Way through Depression by Jon Kabat-Zinn, et.al

For anyone suffering from depression, the ability to stay focussed on the present is a helpful tool. Mindfulness gives sufferers this opportunity. The authors show us how futile our attempts to “think our way out of” or “work through” depression and anxiety, usually are. The book is an attempt to apply Eastern meditative practices to our stressful Western world. It shows the reader how to cope with the mental habits that lead to despair, rumination and self-blame. The accompanying CD contains various guided meditations and regular practice with these is essential for anyone looking to regain a sense of hope and well-being. Even successful treatments for depression too often stop short of providing you with a way to protect yourself from falling back into the downward spiral. With The Mindful Way Through Depression, you will develop the tools you need to understand the core mental habits and patterns that lead to depression—and learn a proven method for creating genuine change that lasts a lifetime.

The role of loss in depression.

September 11, 2012 — Dr. Nicholas Jenner

Life is such that we never get all that we want and this is probably just as well. When we taste some amount of success, we are usually rightly elated for a short time. However,part of this is that we have also to get used to loss when things go against us. Whether it is the loss of a job, the end of a relationship or a missed target at work, the way we deal with loss is critical and can soon lead to depression if not dealt with properly. When one of the events mentioned occurs, then of course, we are down or sad for a while but this should be a fleeting experience. However, if it lasts longer than a few days, it could lead to depression and can be worse if depression is already present. The depressed individual will then view himself in a negative, distorted manner even more. It leads to experiences being misconstrued and made more negative than normal. The roots of depression are usually found in childhood and experiences of loss at this time, leaving the depressed individual over-sensitized in adulthood.

Aaron Beck defined what constitutes a loss as highly individual and unpredictable but stated that most were interpreted and responded to in similar ways ( Beck,AT, Cognitive Therapy of Depression).:

1. The individual believes he has failed to reach a goal or objective and has lost something valuable. ( Break-up, being made redundant)

2. He sees little value in setting future goals or engaging in positive or constructive activities and sees his future as bleak.

3. He sees himself as a loser, useless, worthless, inept or untalented.

4. This leads to a destructive vicious circle where

Negative thinking leads to negative feelings which leads to lack of motivation

Each of the above reinforce each other and keep the individual stuck in a seemingly never-ending spiral. During this cycle, individuals engage in a variety of self-defeating thinking patterns. For example, reduced self-esteem, comparing oneself negatively to others, blame themselves for failing in areas where they expected to succeed and magnifying this and increased pessimism. When this goes too far, thoughts of suicide can prevail and a certain percentage will carry this through.

If help is sought, there is much that can be done to combat depression in therapy. A therapist will try ( along with the client) to identify three distinct levels of the depressive episode. Firstly, observable symptoms such as sadness, loss of motivation or apathy then the disturbed underlying motivations, for example, withdrawal from social circles and then dysfunctional cognitions like life is pointless and hopeless. CBT therapists especially employ various methods to challenge these maladaptive assumptions such as visualising success, setting small goals and rewards and finding alternative explanations for dysfunctional responses. Important also is the logging of daily moods and successes as a homework assignment.

Depression : The symptoms

Although it is often classed as ‘mental illness’, clinical depression often has as many physical symptoms as mental. The feelings or emotions that are depression symptoms actually begin to cause the physical effects. How this happens is a vital part of understanding depression and the symptoms that come with it. If you are depressed at the moment some of the following symptoms may sound familiar:

You feel miserable and sad.
You feel exhausted a lot of the time with no energy.
You feel as if even the smallest tasks are sometimes impossible.
You seldom enjoy the things that you used to enjoy – you may be off sex or food or may ‘comfort eat’ to excess.
You feel very anxious sometimes.
You don’t want to see people or are scared to be left alone. Social activity may feel hard or impossible.
You find it difficult to think clearly.
You feel like a failure and/or feel guilty a lot of the time.
You feel a burden to others.
You sometimes feel that life isn’t worth living.
You can see no future. There is a loss of hope. You feel all you’ve ever done is make mistakes and that’s all that you ever will do.
You feel irritable or angry more than usual.
You feel you have no confidence.
You spend a lot of time thinking about what has gone wrong, what will go wrong or what is wrong about yourself as a person.
You may also feel guilty sometimes about being critical of others (or even thinking critically about them).
You feel that life is unfair.
You have difficulty sleeping or wake up very early in the morning and can’t sleep again. You seem to dream all night long and sometimes have disturbing dreams.
You feel that life has/is ‘passing you by.’
You may have physical aches and pains which appear to have no physical cause, such as back pain.

It’s this wealth of depression symptoms, and the broad scope that confuses many people as to what depression actually is. Explanations rarely cover all the symptoms, and everybody’s experience is different.

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Depression : An everyday tale

CBT in Action : A Case Study

Online Therapy….A Therapists view…

“Put that baby in the fire NOW” ….my wife demanded!!!

Conditioning can be changed but it takes hard work and awareness.

Marriage is a funny concept!!

Punishment is not Discipline (Part 2) Considerations

Punishment is not Discipline (Part 1)

My personal top five : Self-Help books

The role of loss in depression.

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