Kim Barlow-Miles Counselling

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….on Valentine’s Day, my ‘true love’ gave to me…?

April 8th, 2014

On Saturday February 8th I contributed again to a BBC Radio Nottingham Morning Show, hosted by Frances Finn. Our interest was centred on a newspaper report about what women really want from their ‘true love’ on Valentine’s Day, namely, some help around the home, a bit of vacuuming, perhaps……

The principle behind this is that ‘actions speak louder than words’; they show awareness of what is important to the loved one, and care for her needs, ‘easing her burden’ especially if the doer himself does not consider a clean and tidy home to be a priority and may dislike housework.  The action requires effort, unlike simply buying a card and some chocolates or flowers. Doing something like this is the opposite of letting someone down and broken promises. (See Relational Needs , points 4 and 7)

However, a gift can also be immensely meaningful if it is chosen with thoughtfulness and understanding of the loved one’s special interests and taste; even more so if it is unexpected, which possibly, for Valentine’s Day, it might not be….( See Relational Needs, points 5 and 6)

The same applies to a card if it shows evidence of being carefully selected to be just right for the loved one, and especially applicable to their relationship. But without a personally written message of love and validation, it might still seem hollow; positive, specifically targeted words have the power to make us feel unique, worth-full and uplifted, just as negative ones can demoralise and distress. Sadly, we tend to hang on to the latter for longer, and even use them against ourselves. (See Relational Needs, points 2 and 6)

It is natural to seek proof that the positive words are not empty ones, and often this may mean they need to be backed up, for example by actions such as those described above or by physical touch / intimacy. A caress, a kiss, a hug given without being asked, at just the right time, can convey a deep message of love, and togetherness and make the loved one feel secure, desired and special. (See Relational Needs, points 1 and 7)

‘Specialness’ is critical for self-worth and confidence; if we are not truly special to the one we love and believe ourselves to be loved by, it will eventually undermine the relationship. Having ‘quality time’ with the loved one is essential; this provides the opportunity if one is not otherwise readily available to give our undivided attention to the loved one, listening attentively, to the music behind the words, as well as to the words themselves so we can show how important he/she is to us. Again this is the opposite of being self-absorbed, distracted, disinterested and merely paying ‘lip service’ to the principle of Valentine’s Day.  (See Relational Needs, points 2,3 ,4 and 5, 6 and 8 )

The psychotherapy theory supporting these themes can be found an article Attunement and Involvement: therapeutic responses to relational needs, by Richard Erskine (1998),  briefly itemised below. He describes eight aspects of relationship which we seek from cradle to grave with our significant other person, starting with mother. We need:

1.Security, to feel safe

2.Validation, to feel worth-full

3.Reliability, consistency ,dependability

4.Confirmation of our experience, sharing it

5.Self-definition – supporting us to understand who we are, establishing an identity we comprehend.

6.Impact – we make a positive emotional impact on this person, she/he on us.

7.His/her willingness to initiate – not delaying making the first move when we are stuck/blocked

8.The opportunity to express our love

So, in summary, what we most want from our ‘true love’, I would contend, is to feel special by experiencing ‘quality time’ together, which meets the majority of the 8 needs.

Understanding Postnatal Depression

August 4th, 2013

This week, I contributed to a discussion on BBC Radio Nottingham, with Frances Finn, about Postnatal Depression which affects approximately 14% of new mothers, usually about 4-6 weeks after childbirth.

Of course this means that 86% of new mothers will not experience this difficulty. And it is important to emphasise that there is now lots of help and support available if you or someone you know goes through this.

Anyone can develop Postnatal Depression - even the new mother in the spotlight, the Duchess of Cambridge! However, it seems that some factors make it a little more possible, eg a previous history of depression or other mental health diagnosis, eg Bi-Polar Disorder. Also, in my experience, with recent clients, a particularly traumatic birth, eg one in which the mother or child was in a life-threatening situation, may be a factor. It seems possible that a lack of support/isolation may also be relevant issues, which contribute to the new mother feeling overwhelmed with a sense of responsibility and personal inadequacy, which are features of Postnatal Depression. A baby who does not sleep well, particularly if the mother is the sole carer, can lead to her feeling sleep-deprived, which is another potential contributor to this sort of depression. There may be pressure (self-or-other imposed) to breast-feed, which a new mother may find painful or difficult and then feel ‘bad’ if she bottle-feeds. And of course, there are hormonal factors; it seems that sometimes, natural post-birth beneficial hormonal changes simply do not occur, thus making the new mother psychologically vulnerable.

Signs of Postnatal Depression include:

  • low mood and irritaability
  • exhaustion/lethargy
  • sense of panic/urge to escape from baby
  • low sense of self-worth/self-belief
  • tearfulness
  • feeling overwhelmed, can’t cope
  • hypervigilance (startle response), difficulty getting to sleep

Help can be provided through midwife/health visitor/mental health nurses and support staff, and of course, through GP. Treatment may include anti-depressants (SSRIs), and talking therapy, usually Cognitive-Behavioural Therapy. In this we collaboratively target the negative automatic thoughts about self, eg inadequacy, worthlessness, failing, and together we challenge the evidence which seems to tell us they are true, proving beyond doubt that they are NOT. We also identify the roots of the panic, and find ways to soothe this, such as breathing regulation, mindfulness ‘meditation’, and developing a more helpful, encouraging internal dialogue. Joining a group of new mothers for mutual support, combatting the isolation - perhaps ‘chosen’ by oneself - also has a therapeutic benefit.

The most important point is that YOU WILL GET THROUGH THIS and any perceived flawed relationship with your baby CAN RECOVER.

From Hero to Zero….?

January 13th, 2013

Last Monday, 7th January 2013, I joined former Notts County footballer, currently Birmingham coach, Michael (Johnno) Johnson, on Mark Dennison’s Morning Show (BBC Radio Nottingham); the topic for discussion was the impact on non-Premier League footballers, of coming to the end of their ’shelf-life’, which is approximately 10years from the age of 20ish-30ish. This followed a report in a magazine about high levels of depression amongst men in this situation. Michael had also observed this phenomenon amongst his peers, and explained that, contrary to popular belief, footballers (apart from Premier League), mostly earn good money for a short time, mainly in that 10year window, after which the contracts dry up, and they find themselves replaced by younger men, and searching for new careers. Those wanting to stay in the world of football have to chase the very few posts available in coaching, managing etc…and there are many more ’surplus’ footballers each year than there are vacancies in those areas.

Suddenly, men who have heard their names cheered by thousands of fans, been in demand for public appearances, autographs etc, are effectively on the Scrapheap!

Unsurprisingly, there can be an impact on confidence, self-worth and consequently personal/family relationships, as income dries up and status changes, from hero to…what now, exactly ? As the former star comes to terms with this, there can be a period of what might be called grieving for a lost identity, which like any bereavement process, will have elements of denial, numbness, anger, fear and sadness; the person may be moody, distant, irritable, lethargic, seeming depressed…..

This is a time of uncertainty. As humans, we have a response to this somewhere on a continuum, ranging from being excited by possible opportunities ahead, to feeling acutely threatened by the unknown. Most of us seem to be towards the threatened end….So it is not really surprising, in this situation, if the ‘ageing’ footballer, starts to show signs of anxiety and tension. 

This time of adjustment could be predicted and planned for - it is after all a fact of footballing life - but all too often, players are so immersed in their familiar lifestyle, in denial about the future, that it comes as a shock.

As a therapist, I have had the opportunity to work with people in the public eye, performers in different fields, sports, film and stage, and the art world. (I have sometimes also worked with partners and other close relatives of sportsmen). The common shared experience is that the ’star’ has a sense of being only as good as the last performance/output. We live in a competitive, judgemental culture. Those in the spotlight are particularly vulnerable to external evaluation. In therapy, of course, we seek to develop a strong internal sense of evaluation, self-acceptance and autonomy/self-agency, an attunement to what feels right for the person, by  the person, so how other people judge us has less power over us.

We can do this by learning to develop and listen to an internal ‘other’ voice; this one is compassionate, warm, wise, strong and encouraging. It does not ‘whitewash’ as in ‘Don’t worry something will turn up’ (eg without you doing anything), nor does it pretend that there is no reason for concerned attention to this reality. But neither is it bullying or negatively critical, putting you down. This is the voice of someone who loves you whilst understanding your strengths, and ‘weaknesses’ - which are aspects of your way of being which may slow your progress in life or limit your happiness.

As always when someones is grieving a loss, it takes time to adjust. This is a natural process, and we cannot force the pace. However, we can come to an understanding about what is happening, experience the feedback that this is normal, and start to come to terms with our new NOW. I find that people benefit from reading a short book ‘Who Moved My Cheese?‘ by Dr Spencer Johnson. The ‘cheese’ represents whatever you hold dear in life - and identity is very precious indeed, especially when it has been hard won, that is be becoming successful despite all the odds in a very competitive field.

It helps to learn to challenge the negative thoughts that people faced with this experience typically have eg  ’I'll never be able to survive outside the world I know best’…..’I'm no good at anything else’….’nobody will rate me if I’m not a footballer/actor/sportsman/successful artist, business person etc’.  This is about recognising that we are all more than what we simply do. We are after all, human beings, not human doings. But all too often, shortly after meeting someone new, we go on to ask or tell what we do…This, of course is cultural, societal, and will not change overnight. However, perhaps we might all start the process of a shift in behaviour by our own new, different choice of words to introduce/describe ourselves…a challenge indeed!

As with all our fears, we do best to face them; like the monster under the bed in a child’s nightmare, they tend to look less threatening and more manageable when we do this. Sometimes they even turn out to be non-existent threats! This is not to encourage worrying in advance over something that might go wrong, or never happen; we need to take sensible steps to protect ourselves  - like insurance, a sort of life seat-belt - but not avoid driving through life, nor focus only on the rear-view mirror, otherwise we surely will crash!

There are lots of strategies clients learn in therapy, and elsewhere, to counter anxiety; from breathing regulation, mindfulness meditation/yoga, guided visualisations of a calm, safe place….to more vigorous forms of exercise. The important thing is not to self-distract from the problem or compensate for the anxiety by blanking it out with alcohol, drugs, food, spending or any other soother. That pathway leads to another type of difficulty, addiction.

Before cosmetic surgery…..Let’s talk

June 17th, 2012

Last week we heard about recommendations that people considering elective cosmetic surgery should first have a psychological assessment. On BBC Radio Nottingham’s Morning Show with Mark Dennison, on Tuesday 12th June, we discussed the possible reasons for this.

Most of us have, at some time, wished we looked ‘better’ eg different, in some aspect(s) of our physical selves - face and/or body. When we are feeling at our lowest or most stressed, such thoughts can become more persistent and intrusive, overwhelming even. Some research has suggested that up to 40% of people being treated for anxiety/depression in mental health settings, are also unhappy with their physical appearance and want to change this. Depression and anxiety are usually, fortunately, a temporary mood condition; once people feel back to their ‘normal’ state of mind, although they may still be dissatisfied with some aspects of physical appearance, they tend to view this from a more philosphical perspective and would not usually attempt to alter it surgically.

This is one of the key reasons why a psychological assessment before elective cosmetic surgery is important. All surgery carries risk - things can, and do, go wrong, sometimes. So it makes sense to only undergo it after careful assessment of the pros and cons, rather than impulsively, whilst in the grip of a depressed mind state where we typically feel pessimistic and think negatively about ourselves. Our mood is destined to improve in weeks, or worst case, months, but the changes we have paid to have made to our appearance will be enduring and difficult to reverse/correct if the outcome was not what we hoped for.

Another good reason to have a psychological assessment (i.e via a counsellor, psychotherapist or, indeed, a psychologist) is to identify Body Dysmorphic Disorder (or orientation towards this). BDD is characterised by

- a preoccupation with an imagined defect in appearance. If slight physical anomaly is present, the person’s concern is markedly excessive

-  the preoccupation causes clinically significant distress or impairment in social, occupational, or other important area of functioning.

- the preoccupation is not better accounted for by another mental disorder (eg dissatisfaction with body shape and size in Anorexia Nervosa).      DSM-1V-TR 2000  300.7

Once people experiencing this psychological difficulty start on the road of elective cosmetic surgery, they keep going, never satisfied with the outcome; there is always just one more alteration to be made before they can be happy….In the worst cases, people will be prepared to self-mutilate to try to achieve the desired self-image.  Research has suggested that 6-15% of patients in cosmetic surgery and dermatology settings, could be clinically diagnosed with BDD.

The problems with undergoing cosmetic surgery in these circumstances are obvious: the chances of satisfaction with the outcome are low (expectations will often be unrealistic). The effect of real or imagined ‘failure’ of the cosmetic surgery (one of the risks), is likely to be devastating. And the person is spending money to live in the future, rather than in the present - things will always be better after this, or that, piece of cosmetic correction has been carried out.

Similarly, it is possible to become addicted to improving personal appearance. Like any addiction, it can only be satisfied by yet one more hit, which needs to increase in intensity. In the case of cosmetic surgery, this would start with a relatively minor ‘improvement’ and graduate to larger-scale interventions.  The addiction process often starts through a person feeling that something is not Ok about life; typically, through therapy, this might be identified as a missing relational need. Erskine (1998) proposed 8 key relational needs which we seek from cradle to grave in our significant relationships. (eg security, the need for validation, to express love, make an impact on the other person, etc…). It makes sense to address this deficit with a talking therapy which will work towards reconciliation of this and self-acceptance without surgery…..

Women have traditionally been more interested in pursuing cosmetic surgery than men; however, there is growing media and peer pressure on men to look ‘fitter’ and more virile. This sometimes draws them towards surgery, but more often tempts them to take supplements, typically steroid-type, and often in combination with circuit/weights training at the gym.  This can quickly become addictive, and has its own risks. Again, following the trend slavishly, succumbing to external pressure, are indicators that the person’s sense of self-worth/acceptance and confidence are not as robust as he might wish.

If depression/anxiety or tendencies to addictive personality or BDD are found during psychological assessment, alternatives to cosmetic surgery can be offered. Typically this would be through a talking therapy programme, often Cognitive Behavioural Therapy which would aim to challenge the negative thinking about self-image, perfectionism etc. Other therapies might seek to uncover suppressed/subconscious deficits in relational needs The object of most talking therapies is for the person to become more self-aware and more self-accepting and compassionate to self. As the French say ‘il faut se faire a son visage’ = we have to learn to like the way we are.

Why Now?……falling out on holiday

April 18th, 2012

Last Thursday 12th April, I once again joined Frances Finn on the Morning Show on BBC Radio Nottingham. We were in Easter holiday mood, discussing why people have arguments and upsets with their nearest and dearest (or perhaps bestest of friends) whilst sharing what should be ‘quality time’ together.

Clients tell me that this often happens to them….and it has certainly happened to me!

There appear to be some common reasons:

1. A holiday, especially, away or far, far away is a change from normal routine. Part of being human is to regard change as potential threat, or loss ….even a change for the better means letting go of something known and familiar. And our default setting for threat is the stress response, ie fight or flight/freeze. So even as we let our imagine roam over mind pictures of sun, sea, sand, fun and relaxation, it is possible that we can also be having suppressed anxious stressful thoughts ‘yes but what if…..I miss my flight, the weather is bad, the room/villa is awful, the children play up on the journey etc’ . If you are an habitual worrier, this will be familiar ground, perhaps something that others have criticised you for, saying ’stop worrying it will be fine…’ Unfortunately this is likely to have the opposite effect, as you may then think you have to take all the responsibility for thinking about the details, putting problems right etc.  We usually have to find items to take with us, and remember to take particular things with us; interestingly, the part of the brain associated with memory is also a part affected by stress, which, of course makes it harder to remember! This can set the scene for tension between people before the journey begins and the holiday starts…….making mistakes more likely and a blame-game to begin.

2. We mostly work hard for our holidays and may count down to them, treating them as a reward and consequently loading them with expectations: ‘at last some down-time/time for each other/it will be great!’. Even if a staycation is planned there may be a plan to ‘have fun days out/ do lots of things we never get time to do’. There can be a sense of ‘must make the most to this…’ Our mind-picture may represent our own unique concept of blissful perfection.  All too often, unfortunately, life gets in the way: someone gets sick, loses/breaks something, the weather turns for the worse, neighbours are a nightmare, money doesn’t stretch the way it should…and the reality does not match the dream. Disappointment ( a combination of frustration and sadness) makes us tetchy/ over-sensitive, rows brew up and rain down on our holiday….  

3. Another source of stress and subsequent aggression, is our 24/7 exposure to the people we love; for most of us this is a change from normal life. Generally, with work and domestic routines we do not actually spend such a concentrated period with our loved ones or friends. This can be really testing of our relationships - just how much can we tolerate/forgive as individuals pursue their own idea of the perfect holiday in a way that does not synchronise with our own?  If it is a staycation, at least this is happening in familiar surroundings where we feel relatively comfortable (although there might be a suppressed - or voiced - sense of it being unfair that ‘everyone else is going away, but not us’). But when we are adjusting to a different environment in addition to being in each other’s company all the time, the smallest, most apparently trivial issue can trigger individual sensitivities…..‘why do you always have to (do/say/be like) that..?’  We might say that this situation is like being put under a microscope. Unsurprisingly, most of of would fail this sort of examination in some way, as no-one is perfect 24/7.

4. Of course, it might well be that we are not starting our holiday with all issues resolved between us; this is often called ‘unfinished business’, and includes things that have been left unsaid, but not ‘un-thought’, or the elephant in the room that never gets discussed; or perhaps problems which one or other person is unwilling/unable to address. These may seem to disappear into the depths of everyday life for most of the time, but they are lurking below the waterline, ready to wreck the peace. What better time for them to surface than when there is an already stressful or disappointing situation and unavoidable exposure to each other. 

5. Holidays also provide a unique opportunity in a busy everyday life to take time out and reflect; this can provoke challenging questions such as ‘is this it?…is this what my life is going to be like now for always?…is this all I am going to have to look forward to?…. etc..’  Whilst it can be helpful to develop our self-awareness, tune in to our inner voice and reflect on ourselves, our choices and decisions, we may sometimes risk over-thinking, and over-analysing.  This pathway can lead to maladaptive rumination and/or obsessive self-criticism rather than towards inner peace and self-acceptance.  Before we then shut out or snap at our nearest and dearest, we might do well to consider the prayer of St Francis …’for the serenity to accept what we cannot change, the courage to change what we can and the wisdom to know the difference’.  And it might be helpful, of course, to take this to therapy.

6. A further source of falling out, is the disinhibition and other consequences of increased levels of alcohol consumption. Again an attitude of ‘got to make the most of this’ especially in ‘all-inclusive’ holiday situations, may prevail. Rows may stem from one person not wanting to drink as much, upset by the amount consumed by other family members -perhaps due to health worries, cost or embarrassment etc. Or it could simply be the ‘in vino veritas’ issue, where people say what they really think to each other…and regret it when it is too late.

7. Sometimes, the falling out may be triggered by one person’s own insecurities - a kind of personal unfinished business. For example, if someone’s self-esteem is wobbly, perhaps due to poor self-image, he/she is likely to be super-aware of attention being paid (apparently or actually) by their partner, to other people at the holiday location. This might lead to sulky withdrawl or overt accusation, responded to possibly, by reassurance, or, potentially by frustration and denial. It typically never gets completely resolved until the person first deals with their own issues, perhaps through therapy, and then can take a more grounded look at whether the relationship works for them.

HELPFUL STRATEGIES

- identify your own and others’ triggers of stress - then you can offer yourself maximum choice about responding.

- take responsibility for your own emotional stuff/unfinished business - try to say ‘I feel …when you…’ rather than ‘you make me…when you..’  Seek mutual agreement to formally shelve particular ongoing topics

- compare and contrast your mind-pictures of this holiday with those of your nearest and dearest - prepare to make adjustments and compromises in advance

-moderate your expectations - even a perfect holiday will have some elements which could have been better, and even the worse holiday will have a few pluses

- agree and commit to regulate alcohol consumption - you will remember more about the holiday and feel better for it!

- learn to recognise and challenge negative thinking - eg catastrophising, seeing only the negative in the situation and missing the positive, mind-reading, condemning the whole picture on the strength of one small negative detail, emotional reasoning (a thought not a fact), generalising negatively etc/

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