All the Rage is a feature film about Dr. John Sarno and others who are pioneering mind body approaches to treating chronic illness.
This film is to be shown in Melbourne at Cinema Nova Carlton on Sunday September 3rd 2017 at 6.30pm. You can listen to local practitioners and find out about local resources.
For bookings contact rosehoey@gmail.com
We are holding a new Learn to use dementia Care Mapping course to be held on November 28-30 in Eltham, Victoria. This course is an introduction to DCM and licenses you to use this powerful tool in your own workplace to improve quality of life for people living with dementia in residential and day care settings.
The cost of the course is $1375 incGST. You will be provided with all materials, lunch and refreshment breaks.
To register contact Bernie McCarthy at bernie@mccarthypsychology.com.au or on 0408 145 819.
The course is provided under license from Bradford University, UK by BMAC Education.
Research as shown that five elements should be present for a psychotherapy to be effective (Weinberger, 1995):
This brief article will examine several modern psychotherapies in light of these elements.
A bit of history. There have always been people to whom we go to talk about our problems. In the modern world they are doctors, psychologists, social workers and other health practitioners.
Modern psychotherapy came out of the work of Sigmund Freud in the late 19th and early 20th centuries. His insights into human behavior helped him develop psychoanalysis. This form of psychotherapy is the first of the many modern forms of therapy that we know today.
Analysis involved his patients (he was a doctor and the medical approach was the only one around at that time) lying on a couch and talking about their problems. He called this type of talking ‘free association’ as the patient talked freely about anything that came into her mind. He maintained that the patient’s talking was in fact directed by unconscious conflicts that were causing the problems she came with. The therapist’s job was to offer interpretations at key moments that brought about changes in the patient’s insight and so led to changes in her life
By making the unconscious conscious, the “talking cure’ helped patients to gain insight into their problems and make changes in their lives.
Psychoanalysis gained a bad reputation for being long and expensive for little improvement. In an attempt to address this, short forms of what is now known as short-term ‘dynamic’ psychotherapy have been developed. ‘Dynamic’ means that the therapy acknowledges there are unconscious forces or dynamics at work in the person’s psyche that create conflicts within him and lead to the problems he presents with in therapy.
The short form that has the best evidence for being effective is Intensive Short-Term Dynamic Psychotherapy or ISTDP. This approach takes a more active stance to the person and does away with the couch in favour of two chairs as is usual in therapy today. Short-term therapy is regarded as less than 40 sessions.
ISTDP is an attachment-based therapy that recognizes that when we engage in relationships with others, old attachment feelings are awakened. We become defensive about the feelings and closeness to others and/or we become anxious and adopt unhealthy patterns of responding to our feelings and the people who come close to us. This causes depression, anxiety, distance in our relationships and problems being productive in work, lack enjoyment and often lack insight into ourselves.
ISTDP and other emotion -focused therapies see it as vital that the client experience emotions in the session in a safe and healing way. There is considerable evidence that the full-experience of emotions gives a more effective result and people have less medication, return to work and have more healthy relationships following such therapy.
Because emotions are physical (in our body) as well as psychological (in our mind) ISTDP focuses on the physical experiencing of feelings so the client can accurately identify and understand his own feelings and not remain depressed or anxious. There is growing interest in these approaches as the body of evidence for effectiveness grows.
ISTDP uses techniques including assisting the person to be aware of her own emotions in her body and mind, and to experience the emotions in the session, including the emotions that the person wants to avoid. This is an active therapy and involves a partnership between therapist and client to achieve the client’s goals.
Many approaches to helping people change through a “talking cure’ have been developed since Freud’s lifetime. The most common approach used today is Cognitive Behavioural Therapy (CBT). This has a solid evidence base but notably recent evidence is not as strong as for early studies.
This approach is based on the idea that most problems occur because of faulty/distorted thinking and habits of acting that no longer work in the person’s life. Examples include thinking styles such as ‘black and white thinking’ or ‘overly negative thinking’. This requires strategies of cognitive restructuring (helping the person to think in more reasonable and balanced ways), response scheduling (adopting regular and scheduled changes) and response prevention (stopping old patterns of behavior that no longer work) among others.
The CBT therapist identifies these thinking styles with the client and provides strategies and homework to reinforce insights and assist them to make the changes to the way they respond to the problem situations in their life.
Another common approach is Interpersonal Psychotherapy. This is most often used for treatment of depression. This approach understands the problems people have as caused by changes in social roles and the way these changes have affected interpersonal relationships. It is these changes in relationships that cause depression. This therapy has a ‘here and now’ focus. It is not focused on the past but on how the person is functioning in the present.
There are many new types of psychotherapy that are proving popular. These include Mindfulness-based therapy, Acceptance and Commitment Therapy (ACT), and some approaches based in the positive psychology movement.
Mindfulness is an ancient technique that is practiced by Buddhists and has become very well known in the west in the past 60 years. It involves being attentive to your current experience, remaining present to yourself, your activity or inactivity and your surroundings. By being attentive and noticing yourself you become aware of the truth of yourself, your desires, feelings and urges. This enables you to make choices that are more grounded in what is actually happening in your life rather than from your thoughts alone, which may or may not be a good indicator of what is good for you.
Meditation is the most common form of mindfulness and is taught by many practitioners today, some more reputable than others. Used as a technique within many types of psychotherapy it is an effective way to assist the client to be aware of her own internal experience, particularly of her own feelings.
Acceptance and Commitment Therapy (ACT) is also proving popular among therapists. The aim of ACT is to enable the client to accept what is out of her personal control, and commit to action that improves her life. This approach is focused and can be applied to many life problems including depression and anxiety.
ACT uses techniques common to many psychotherapies. These include assisting the client to be present and identify his experience, and of course mindfulness, with or without meditation.
So when you are choosing a therapy, ask yourself:
Do your own research. This is a brief survey that should lead you to the Internet for more information and to ask others who have been to a therapist. Keep in mind though that their experience will not be your experience. The dynamic between therapist and client is always unique to each person. So your friend’s experience may not be yours. That said, if it ticks the five elements and you can answer the questions above, you should at least avoid harmful experiences at the hands of charlatans who may promise you that you will get better if they slap a couple of salmon together over you and chant ‘Om’.
Disclaimer: Bernie McCarthy practices ISTDP.
This brief clip shows Dr Patricia Coughlin PhD speaking about the importance of emotional experience.
Living with a serious mental illness affects not only the person with the condition but everyone in the family. Mental illness can take many forms.
The most common are anxiety conditions such as panic, phobias and generalised anxiety; depression, schizophrenia, bipolar disorder, eating disorders, and obsessive-compulsive disorder.
A person with a mental health condition is likely to experience considerable tension and distress in their lives and this can affect those around them. Apart from this their behaviour towards others in the family and to those outside the family can often cause concern and strong feelings in those closest to them. This can be in the form of anger, fear, grief or confusion, particularly if the behaviour is aggressive, repetitive or unusual.
You may find you are grieving for the person that you once knew and now cannot see in the person they have become. This grief may need time and patience to understand as you come to grips with the changes in the person’s life and trajectory. The dreams you had for them may no longer be possible and this may take some time to adjust to.
However, it is important to remember that most mental health conditions are in the form of ‘episodes’. This means that they are not necessarily permanent or the changes enduring. People recover from mental illness and often learn a great deal about themselves in the process. This can help to become more insightful and informed and often better people to live with as a result.
If the person is your child or your sibling
It is important to have open communication in the family when a member has a mental illness.
Talking with each other about the problems other family members are having can relieve a sense of isolation that can arise if everyone stays silent and doesn’t talk about what is happening to the family. By sharing it you can work together to support and encourage each other and prevent further problems occurring in other family members.
It is common for those caring for someone with a mental health condition to experience anxiety and depression themselves. So looking after yourself with time away or just getting outside the house to walk around the backyard can be essential to maintaining your own mental health. Keep up a balanced life as much as possible with breaks, changes of scene or setting, or connecting with friends via phone or skype or email. This can relive the isolation and ‘cabin fever’ that can occur.
Always keep reminding yourself that the person themselves is still there and relate as normally as possible with them so they can keep up the bond with you as much as possible. Avoid speaking to them as if they are a patient or sick. Normal communication is very important in helping them to find their way back to you when times are difficult for them.
Be clear about what is acceptable or OK behaviour in your family home and make sure everyone is on the same page so that acceptable behaviour is affirmed by all members. For example, it may not be OK to swear or use a loud voice or be aggressive so that others feel afraid.
If it is possible you may need to gently and firmly remind the person of what is OK and not OK, always remembering to do it in a way that lets them know they are loved and accepted but that it is their actions that are not OK. Letting the person know they are loved and valued regardless, is a vital part of remaining connected with the person who is unwell. Sometimes this has to be said quite explicitly, more than you might in everyday life with someone who is mentally well.
If the person is your partner
The person with the mental illness may be your partner, so communication about everyday things that usually don’t cause a lot of tension, may become muddled easily and arguments and emotional explosions can occur. If this has happened or is likely, you may need to be the party who takes responsibility for being clear in your communication so that you can help them to be as clear as possible about the everyday difficulties and issues that healthy couples experience.
Every couple experiences differences of opinion or points of view that can erupt into problems out of proportion to the real problem. In this case it is helpful to be calm and clear yourself. Know what pushes your own buttons and work out a plan for dealing with this moment in yourself so you do not explode and add to the emotional discharge.
Having a partner with mental illness may require you to do extra things, take more time or be ready to step in to make situations OK when they feel overwhelmed. As above you will need to keep a balance in your life if your role has become that of carer as well as partner. What do you need in your life to remain healthy in your own mind and heart? It might be keeping up a healthy diet, a hobby, maintaining friendships, regular exercise, or doing something together that is outside your routine. You may need to talk this through with someone you trust to get some ideas.
Be vigilant about domestic abuse (verbal, physical, sexual, emotional and financial) and be ready to care for your own interests by making yourself safe if that is necessary. If you have children and their parent is the person with the mental illness you may need to spend time explaining or debriefing with them about their experience or understanding of what has happened or just explaining the condition in ways that make sense to the growing minds. Often children do not need a great deal of information or very complex information. Rather they need honesty and clarity in small bites that satisfy their need to understand. They will come back later when they need more information.
Stigma
The way mental illness is viewed in society has improved a lot in recent decades. However, there is still some stigma or prejudice against people with a serious mental illness. You may be concerned about letting people know that your relative or friend has mental illness. Choose wisely to share information with people you trust and whose judgment is not going to be prejudiced but is more likely to be helpful and supportive.
When people ask, you may need to work out a way of explaining the situation in a manner that is faithful to the person you love and helps the other person to understand.
Get help from professionals
There are many organisations available now to help with information, ideas and practical support. Examples include beyondblue, and Mental Illness Fellowship, which provide education and information for carergivers, and for people with mental illness.
You are not alone and you will benefit from joining in education and support groups so that you can gain from the experience and wisdom of those who have gone before you.
I once had a client who said when I asked what feelings he felt, “I don’t seem to have feelings”. This dismayed him and his eyes began to fill up. Slowly it dawned on him that he did indeed have feelings and that he experienced them so rarely that he thought he had no feelings at all. This was normal for him.
On the other hand I have also had clients who seem to have so much feeling that they come in weeping or angry and have difficulty talking without exploding in tears or rage. Usually it is tears as we are not all that comfortable to express rage in front of others.
Feelings are an important dimension of being human and they are present in all of us. If we are biologically human we have feelings. I am sometimes asked, “But if I have feelings, tell me what they are because I can’t feel them?” Examples of feelings include love, sadness, anger, rage, gratitude, guilt, grief, and anxiety.
How we experience our feelings can vary from person to person. In some households you may find that there is so much feeling expressed that it seems chaotic and out of control, even unpredictable. This brings us to a distinction. There is a difference between EXPRESSING and EXPERIENCING.
Expressing is when we do or say something with our feelings, i.e., Cry when we are sad, or hit or shout when we are angry. This becomes aggression. Anger is the feeling and aggression is the action or words. Experiencing on the other hand is when we have the physical experience of the feeling inside our bodies, without expressing it.
To help understand feelings better here we can identify three parts to a feeling. There is the COGNITIVE label or thought that goes with a feeling, i.e., we know we are angry and recognise it.
The second part is the physical experience of the feeling in our body. This is slightly different for each feeling. Sadness, feels heavy, comes into our chests and causes us to fill up with tears and crying so our nose runs and we have tears. Anger on the other hand is hot and it rises from our stomachs into our chest and up our spine into our shoulders and arms, We form fists and clench. We feel stronger and breather faster in readiness for action.
Anxiety is different again. In anxiety we have a sense of something coming from above and pushing down, raised heart rate in palpitations, dry mouth, shakes, tight chest causing sighing, increased need to go to the toilet to pee, and muscle tension in various body areas. Anxiety can also go to our gastro-intestinal tract, causing pain, nausea and bloating. If anxiety becomes chronic the muscles can become stuck in a tense state causing significant pain. Third, anxiety can affect our senses so we have temporary visual problems, hearing difficulty, or a sense of feeling drifty or in some cases blank out altogether for brief periods, leaving us with no memory for parts of conversations. Other words for anxiety include stress and tension.
The third part of a feeling is the IMPULSE. This is an urge we have to act in a way that releases the rising energy generated by the physical and cognitive parts of the feeling. This may be the impulse to cry, to hit, to shout, to hug, to walk up close to someone you love, look them in the eyes and tell them you love them.
When a feeling is experienced it is all internal, not communicated to others and is not expressed. All feelings can be experienced without expressing them.
When a feeling is expressed it is discharged or exploded out and others can see it or hear it in the actions that we have the urge to do or words we want to say.
An example is anger. This is the feeling. It is internal to the person and is experienced as heat rising like a volcano. As described above it causes a rising sense of strength and the impulse is to strike out, to grab, to throttle or to kick. We rarely give expression to this impulse so most of the time people around us are safe. However, some people have trouble containing the impulse to act and they express the feeling in aggressive or even violent actions, i.e., road rage.
Some households have a lot of expressed emotion flying around. They shout at each other, swearing and calling each other names when they feel anger toward each other. These are rarely emotionally safe places to grow up. Children form defensive shells around themselves, learn how to handle feelings and intimacy from watching their parents and other adults and do the same themselves. They are often punished for it by the very parents they are modelling.
Couples can sometimes engage in expressing feelings to each other and this can be destructive if it is done in the heat of the feeling and without respectful concern for the emotional safety of the other person.
Expressing feelings is not as healthy for us as experiencing the feelings, knowing what they are and understanding the meaning of the feeling for us. This is all internal and only then does it lead to external actions toward other such as raising a concern, sharing thoughts and having a discussion together to reach an understanding of an issue that concerns you both.
For example, people will say to me, “But what do I do with it once I experience it?” The answer is understand it. If a couple are angry with each other and discharge their anger by shouting and calling each other names, swearing at each other or making statements about their past behaviour in anger or rage, the feeling is expressed but is this helpful? Not likely. The most likely result is that there is increased distance between the people and they do not communicate easily. There is silence and hurt. This can create loneliness and isolation.
The other alternative may be if both parties notice they feel angry, experience it internally, understand why they feel angry, understand the importance that the other person’s actions or words have had for them and only then once the feeling is understood, they engage with the other person to share their thoughts and that they have felt angry.
This is much more emotionally safe for each person. Words are not said in anger and people are not hurt intentionally because the love we have for the person is also felt alongside the anger. It is true that we can experience more than one emotion at a time. I have had clients say to me, “If I get angry that means I don’t love them anymore.” We can feel angry at the people we love most in the world.
Experiencing feelings first is more emotionally safe, better for relationships and better for us individually than expressing emotion without the experience.
See what feelings you can recognize in yourself. Monitor your own inner emotional life more closely by noticing what changes in your body when you have interactions with others. How do you feel when you are waiting for your partner to come home? Love? Anger? Sadness? Joy? Gratitude? All of the above? Nothing?
Expressing or discharging emotions does not communicate feelings and create understanding. Rather it pushes people away and creates hurt and loneliness.
Experiencing feelings enables us to create intimacy and closeness with others that is respectful, safe, and enjoyable. It also enables us to be productive in our work because our energy is available for creativity and effort. Finally it enables us to experience pleasure and enjoyment in our lives.
I was at a funeral last year and it struck me that it is acceptable to cry at a funeral if you were close to the person because the person was important to you. But if the person was not particularly close and you still feel like crying you may find yourself thinking that it is not OK because you were not close enough to them to justify feeling so overwhelmed and sad.
I am interested in the fact that we put such restrictions on when and how much we can feel sad. Only if we are close enough, only if the loss was big enough to justify it etc.
This flies in the face of the fact that sadness is just that. Sadness. It is the normal and natural feeling we have when we feel loss of something valuable to us, perhaps loved. There may be many reasons we feel sadness come up in us at a funeral of someone we were not particularly close to. It may be that it touches off memories of someone we were close to in the past. Or it may be that we saw someone else crying and that was enough to trigger our own sadness. Or it may be that we are feeling loss in some other area of our lives, other than loss of someone by death, i.e., loss of a job or moving to a new town and feeling sad about losing the old town. Having an argument with your spouse can make you feel sad about the distance it creates so you find yourself crying.
It is important here to distinguish between reasons we cry. We cry because we are sad. But we also cry because we feel overwhelmed by strong feeling such as anger and so we discharge it by crying it out, as if the tears wash the feeling away. It can seem like a relief afterward but this relief is due to the fact that we were becoming anxious/tense about the feeling becoming so intense. We felt overwhelmed and so cried to get rid of it. This is not as healthy as the tears from sadness.
Sadness does not have a calendar to it so as with all feelings, it doesn’t know that the death was a long time ago. It just knows that you feel sad right now.
You do not need to have a good reason to feel sad. Your psyche knows you feel sad so you will feel sad and then once the sadness has been felt in its entirety you will find the insight comes that helps you understand what it was about.
Emotions do not have reasons. The reasons come afterward to help us make sense of the feeling.
So sadness is a valuable emotion. It tells us how much we have valued something or someone we have now lost. This is important in loving relationships that we can know how much we have loved those we lose in death. Sadness tells us how much we love.
Gratitude is an old fashioned word that we don’t hear much in everyday conversation these days. Yet, it is the oil that greases the wheels of human relationships and makes us able to get on with each other so much more smoothly than we do without it.
Gratitude is simply thankfulness. I have noticed in some relationships people do not express gratitude for anything others do, but accept the kindness or thoughtfulness of others as if it is just a given, something to take for granted, that is always there. Some even seem to expect kindness and thoughtfulness and become annoyed when it is not readily available, but do not express gratitude for it when it is offered.
Being thankful is a way of recognising that what someone has done for us has been noticed and we are better for it. It recognises that the other person is important and offers them this recognition as a way to say, “I see what you do for me”. In effect this is like saying, “I see you and I value you”.
Close relationships are built on a capacity to accept another person in your life and allow them to affect you emotionally and psychologically.
Gratitude is a way to recognise that the other person has done something that has a beneficial effect on us, and we welcome this closeness. We welcome them into our lives.
Expressing gratitude for what others do for us is also a recognition that we are not islands, self-sufficient to ourselves, but need others and rely on others for much in our lives. These acts of gratitude may be for simple acts such as that someone has cooked a meal for us, or offered to drive us somewhere, or folded our clothes for us, or asked us if we would like a cup of tea/coffee.
Being grateful is a way of recognising the other person’s thoughtfulness, valuing it and letting them know that you understand you are better off because of them.
Often in long-term relationships it can easily slip into an acceptance that the other person in the relationship does what they will do and will continue doing what they do, and that we don’t have to keep thanking them for it. However, this can lead to the kindness, thoughtfulness and generosity of others becoming invisible and not being valued by either party. The solution is gratitude.
The type of gratitude I have in mind is regular small thanks for regular small things. Each time someone does something for you thank them for it. Thanks for making breakfast. Thanks for taking the bins out. Thanks for listening to me rant on. Thanks for tea. Thanks for doing that for me.
Thanks for reading.
We are often afraid of our anger, that feeling anger means we should be guilty. But what have you done by feeling it? Nothing. Feeling is not doing.
We frequently get feeling and acting mixed up as though feeling angry means we have been aggressive. Let’s get a few things straight. Anger is a feeling and aggression is an action or words. One is interior (anger), and the other is exterior (aggression).
The feelings we have are a normal part of being a human being. They are a physiological response we have to experience and so are an integral part of relating with other people, the world around us and our own inner experience.
Take for example, the sadness we have when we lose a person we love in death. This is a normal reaction and not something pathological. We grieve because we have lost someone we loved. The grief is an indicator of the depth of love in us for that person. In this way sadness is to be welcomed because as painful as it is, it is never the last word. Love is.
Often when we have lost someone in death there is also anger toward the loved person. So we feel sadness and anger and love, all mixed in or one after the other in close succession. This can be confusing and cause guilt in us as if we are being unfaithful to the person by being angry with them. We feel what we feel – no judgment. It just is. if you feel angry about them leaving you in death or for any other reason then that is what you feel. Once you feel it deeply enough you can get to the bottom of why you feel angry. Just give yourself enough time to feel all of it without loading it up with judgments.
Keep it simple. Feelings are OK because they are a natural process we experience as much as breathing is a natural process. Feelings are like our emotional skin to the world.
If we let feelings be themselves, feelings will come and go. I often hear people say (as a justification for not crying) “If I start I won’t stop”. This is not sadness talking, it is anxiety. Anxiety that you will be out of control if you let yourself feel sad. So we avoid it. This has the makings of depression if we sit on our feelings and won’t let them be felt.
This brings me to my last point. Experiencing is not expressing. This is the difference between anger and aggression. Anger is an experience, and aggression is an expression of the angry feeling. I am encouraging you to experience rather than express your anger or whatever other feelings you have
Notice in yourself how you relate with your own feelings. How much anxiety do you have about experiencing (not expressing) your feelings? Give yourself close attention so you notice the physical experiences that make up your feelings. This means practicing self-monitoring, or self-observation. If you don’t do it naturally, you may have to learn to do it by practicing is regularly, daily and just notice your inner sensations. What do I feel right now?
Take
Are you dragging yourself round and saying to yourself, What is wrong with me? Pull it together!”.
As Christmas comes around we can think we have to feel the ’joy of the season’ if the advertising is to be believed. However, some of us do not feel joyful or even neutral. In fact we can feel blue and down in our mood and for no apparent reason.
Since beyondblue made depression better known in our community more people have a better understanding that feeling down or blue or low in your mood for extended periods is not the normal way we should.
Depression is much more common today than it was in the community 50 years ago. Even though we are more likely to talk about it today than we did 50 years ago, more people are experiencing signs of depression.
Depression is often misunderstood so let’s be clear about what it is and what it is not. A diagnosis of depression will be made if mood is low for at least two weeks, if your self-esteem is low, you are extra critical of yourself, you feel unreasonably guilty, you have feelings of being worthless, you have no energy and feel lethargic, your appetite has increased or decreased, you can’t concentrate, your sleep is poor, you have trouble getting to sleep, you wake repeatedly, and/or you wake early, you have lost weight without intending to, or you find yourself thinking about suicide.
If you more than one of these signs you should contact your GP to speak about it. Perhaps a friend may have spoken to you about changes they have noticed in you. Depression is often not recognized by ourselves but can be noticed by others around us.
Depression is not sadness. Feeling sad is a normal part of life. Depression is not normal.
Feeling like this can be very unpleasant and sometimes painful to feel so low in your mood. It is best to go to your GP and have them ask you a series of questions to establish what the possible causes may be and how life is for you right now.
It is important to remember that sometimes depression happens for no particular reason. There may be an interaction between the events in our life and the personal history or our biology that causes a change in the chemical levels that shape how we feel about ourselves, our life, future and others.
Treatment is often a combination of medication and psychotherapy. For mild depression psychotherapy alone may be sufficient to relieve the low mood and other signs.
However, when depression becomes more severe it is important to use the tools at hand that have proven effective. The evidence suggests that medication plus psychotherapy is the most effective way to treat symptoms of low mood and other signs of depression and to ensure that you do not have further problems in the future. This is called relapse prevention.
There are some strategies that can be useful for all of us in preventing depression. First, pay attention to yourself – do not neglect yourself. Be aware of your mood. How do you feel right now? Most of us do not have a clue and so become alarmed when we notice we are feeling low.
Second, exercise regularly. Exercise has been shown to have a beneficial effect on mood. Several times a week go out of your house and walk at a pace that makes your heart go a little faster. Some say “walk like you’re late”. For 20 minutes three times a week. Check it with your doctor before you walk if you have medical conditions that concern you.
Third, socialize. Have at least one conversation, however brief, each day. This keeps you connected to others. If you don’t feel like doing it, make yourself do it. Form the habit. Do it every day for six weeks and it will become a habit.
These are anti-depressive habits to support your wellbeing.