The very words “mental health” speak volumes to many people and unfortunately not always for positive reasons. They can produce some very negative emotions, including unease, anxiety and even fear - even for people who need help and support for their own mental health.
This stigma means that we don’t always take enough care of our wellbeing or take steps to address mental health problems such as stress, anxiety and depression before they have a significant effect on it.
Mental health is a big problem, with as many as 1 in 4 of us likely to be experiencing a mental health problem in the average year, according to official figures. I’m not convinced that these statistics tell anything approaching the full story though, as so many of us are afraid to admit how we really feel because of the stigma attached to the diagnosis of a mental health issue.
As a psychotherapist, this is something that both confuses and troubles me. Most of us won’t hesitate to seek medical advice or try self help measures if we start to feel physically ill but the same idea is largely alien when it comes to our emotional health.
Fear is undoubtedly one of the reasons why this is the case. For many of us, we worry that other people will think less of us or question us if we let them know that we are struggling to cope, especially with regards to stress at work. The stigma attached to mental health issues unfortunately gives the impression of being inferior, when of course it actually takes a great deal of strength to overcome any mental health condition!
Another factor is the fact that physical problems are more clear cut and easier to understand, both for ourselves and for other people. For example, a heavy cold can significantly affect your ability to think clearly and impact on your energy and inclination to even get out of bed, and the physical symptoms of the cold make it obvious why you feel this way.
If you have the same problems because of depression, it can be a lot harder for people to understand why this is because you don’t have obvious physical symptoms to ‘confirm’ your illness, and this is again where stigma comes into play.
If this is the case however, personally, I think it is important to talk about it; with someone close, with your GP and with professionals who are used to working with common mental health problems. There is no stigma in the therapist's room, and we understand much of what you are going through.
Many of the clients I see in my therapy
room here in Plymouth have a few misconceptions as to what is actually involved
Some are seeking support after being
advised to do so by their doctor but I’m seeing a growing number of clients who
are self-referring for therapy too. This is great to see as it shows that there
is more belief that therapy works.
That doesn’t mean that everyone
necessarily understands what happens in therapy sessions though or why people
come to therapy in the first place.
A great example happened a while back,
during a conversation about the relationship issues that the other person was
experiencing at the time. This person was not a client of mine and did not
appear to know that I work in psychotherapy so they were perhaps a little taken
aback when I suggested that they might think about receiving some counselling
support. In fact, their response to my comment was to ask whether I thought
they may be mad!
To more than a few people, mental
health seems to equate to being mad or insane. The whole concept of ‘madness’
has long been associated with conditions such as bipolar disorder, psychosis
and schizophrenia, (to name just a few) - all of which are on the more severe
end of the mental health spectrum.
As children, many of us knew stories of
people baying at the moon or conducting very loud conversations with themselves
in public. If these tales were true, the people concerned were possibly
suffering from some of the mental health conditions I’ve just mentioned but
were largely dismissed as being ‘mad people’.
There are of course a number of other
mental health conditions that are a lot less extreme in the images and labels
that they conjure up, such as stress, depression and anxiety disorders
(including Generalized Anxiety Disorder and panic disorder). Despite this,
there seems to be a lot of belief that needing therapy means that you are
‘mad’, to some degree at least. Little wonder that there is so much stigma
still surrounding mental health!
I am not a fan of attaching labels to
people and expecting them to act in a certain way as a result. Labels are after
all only a part of who we are as people and so they do not define our behaviour
to the extent that many people believe them to.
It is also true that having been labelled myself in the past, it did help me to have a better understanding of myself and more freedom to express myself as a result, both of which had previously been lacking. This is why my feelings on labels are mixed ones but one thing is certain: I am all for talking about them and the effects they have for clients, to help them to gain a deeper insight into who they are.
This is one of the phrases I hear very often from clients in my therapy room here in Plymouth and I see it as a sign that they would definitely benefit from receiving counselling and/or psychotherapy for the issues they have come to me about.
I am a person centred therapist and am therefore focused on patterns of behaviour that clients have been demonstrating, particularly actions and mistakes that are repeated time and time again and usually with the same end results. Clients will often be at a loss to explain why they continue to do this but regardless of whether their behaviour is learned or adopted, it invariably has significant and often lasting effects for the future.
One very serious example of this is someone who experienced a difficult or abusive relationship with one of their parents can easily fall into this type of relationship with a partner too. This isn’t a conscious or intentional decision by any means but having grown up in this situation, it is arguably all they know and therefore seems comfortable and even normal. That isn’t to say that it doesn’t cause considerable anxiety and sometimes depression, despite it being something of a learned behaviour.
On a less extreme note, if you find yourself with the same relationship issues repeating themselves over and over, it could well be the result of patterns of behaviour that are leading to this outcome.
It isn’t only our relationships that can be affected by repeated behavioural patterns and if you think about your life in general, there are probably lots of situations that are related to this, often without us even recognising that this is the case.
Here is one that I’m sure the vast majority of us can relate to! We are all probably guilty of automatically telling people that the gift they bought us was “lovely” (even if it really was anything but!) and in reality, it only emerges from the depths of the wardrobe in preparation for the next encounter with them. This is seen as the polite thing to do so it’s very much a learned and repeated behaviour.
Going back to the title question of this post, my response to clients is very simple. You may well feel that “this” will always happen to you and there is no way to stop this but the important thing to realise is that it does not need to be this way.
Just as we learn certain patterns of behaviour, we can also unlearn them too. This requires an understanding of what causes the behaviour, which can then be used to inform our choices and ultimately take a different path to the one that has become the “norm”.
This is one of the most rewarding parts of my job as a therapist, to help clients, through the process of counselling, to choose alternative behaviours and change their life for the better so that they no longer have to bemoan their “lot” in life.
Why is that we’re often so focused on the idea of instant change in our lives?
This is something I see very often with clients and it’s a source of much frustration for them.
One of my clients was disappointed that they were not making the changes we had discussed in their initial assessment and was quite upfront about this. Given that they had come to therapy partly as a result of their anger issues (which had been a fairly big problem in their life), you probably won’t be surprised to know that this frustration also revealed a touch of anger that change wasn’t as forthcoming as they had hoped. I must admit to being more than a little bemused at their reaction as this was only our third session in total (and our second session working on the things that had been highlighted in the initial assessment).
Another client had some frustrations in their relationship, namely with a partner who worked away from home and a lack of meaningful connection between the two of them when they were together. Rather than spending quality time together, the client’s partner was frequently sidetracked by emails and social media and would think nothing of responding to notifications straight away - often due to a sense of obligation because the other party were apparently expecting an immediate reply.
The latter scenario is just one example of the way that the instant communications culture has changed our lives. It’s certainly a far cry from my youth and the days of shared telephone lines. In a world where so many of us are glued to mobile screens, the youngsters of today would no doubt be amazed (and horrified!) at the idea of having to wait for the phone line to become free before making a call!
Technology has come a long way since those days. It’s quicker, more powerful and keeps us connected in ways we could only previously imagine. This can be a good thing as it lets us stay in touch with and check in with loved ones if there is an emergency, for example. It can also be true that these advances in technology have also raised our expectations. Do we now expect everything to be as quick and easy, even therapy?
To some degree, the therapy industry may have had some hand in this. Cutbacks have limited the number of sessions the average client can receive through public mental health services, often so more clients can be seen. Limited resources are one of the main driving forces for this but it begs the question of whether this ultimately encourages clients to believe that they will be “better” by the end of these few sessions. And with life moving at such a fast pace around us, does this also feed into the idea that change needs to happen at the same speed?
My personal opinion is that this shouldn’t be the case. As a therapist, I’m very much focused on looking for patterns in how my clients behave and think and this is often learned from a relatively early age. As we get older, we may need to relearn what we thought we knew and this can take some time, even more so when it comes to putting it into action.
Clients almost always want to know when they can expect to see change(s) - so much so that it’s something I address when I agree contracts with clients. It’s definitely not a question that can be answered easily and it will be different from client to client.
As a therapist, I can’t make any kind of promises or guarantees to clients other than the fact that I will provide an opportunity for them to talk things through. For many clients, this can be the only chance they get to do this without worrying about the expectation life often places on us to just go with the flow.
“I don’t want to slag off my parents …”
This is something a client said to me in a recent therapy session and it got me thinking about our relationship with our parents and the ways that this can shape our lives.
For every client that tells me something along these lines, there are of course many others who are very keen to talk about their parents and as is often the case, to blame them for various things. Often they will want to use a session to get things off their chest; as a therapeutic tool, if you will. Sometimes this is very much needed and is an opportunity to channel some of the hurt and anger about their childhood, particularly where there has been dominance or abuse (physical, emotional and sexual). Whatever the situation, as a therapist I’m there to help the client to facilitate the release of emotions and not to pass any judgement on what is said.
It’s often useful to think about my own childhood to help my clients with this. Like all children, I needed to feel loved, supported and encouraged but also to be given the chance to get things wrong and be reassured if this happened. Looking back I now realise that this wasn’t always the reality. My parents probably had the best intentions but with no one to show them how it “should” be done, they did what they thought was right and there were times when they made wrong choices or didn’t quite know how to react in certain situations.
When we’re young, we tend not to pay much attention to the things our parents get wrong and as children, we often aren’t even aware of them. Many of us held our parents in very high esteem when growing up, often to the point of putting them on a pedestal, and don’t realise that they aren’t automatically blessed with knowing how to be a perfect parent. This doesn’t make a lot of difference though; we are ultimately human and feel emotions such as hurt, disappointment and anger if our needs and expectations aren’t met.
The phrase “you can choose your friends but not your family” is very true for many of us and it is often only in later life that we choose how much contact (if indeed, any at all) we have with family. Compare this with friends, who we may choose to keep in our lives despite a few bad points or drop completely if they treat us questionably. We will often put up with a lot more from family than friends.
This means coping with their choices and the effects this may have, which can lead to conflicting emotions. We may love them and feel loyal to them on the one hand while also feeling resentment and perhaps even suspicion at the same time.
How we cope with this can vary a lot but my role as a therapist is not to offer an opinion on a client’s parents or to judge them in any way. Rather, I look to help clients to understand their relationship with their parents and as far as possible, encourage an acceptance of what has gone before. In this way, clients can begin to recognise who they really are and why they behave in certain ways - often due to things that happened when they were children.
Doing this can be difficult, not least because of a sense of loyalty to family. As difficult and disloyal as it may seem to talk about your parents and their effects on your life, it can be a key part of being able to see them in a different light or if necessary, get closure on the relationship. Either way, it’s not necessarily about slagging off or blaming but understanding the ways our parents have shaped who we are today.
This is a question I thought a lot about before starting this blog, largely because I wasn’t sure what I would actually talk about!
The obvious thing would be to tell you about the clients I’m working with but client confidentiality forbids me from going into any great detail about this. Couldn’t I talk a little about my work and keep things suitably vague, you say? Ok, I could do this but it’s sometimes all too easy to say more than intended and I find it much safer to say nothing at all!
There’s also the prospect of being obliged to give my opinion on things through a blog. After all, blogs were originally intended as an online diary, although they have evolved a lot since then. The idea of offering my opinions isn’t one that seems all that comfortable, especially if it involves judging other people. How do I even start to think about giving my opinion on others without a good idea (or any idea!) of who they really are, what their current situation is, what may have happened to them in the past and their journey to this point, for example?
And then there’s the somewhat alien concept of talking about myself. During sessions, the focus is very much on the client. My job of course is to ask the right questions and guide in the right direction but we certainly don’t talk about me! Clients will invariably ask about my life but my typical response to this is that we’re here to discuss their situation, not mine, and to steer the conversation back to them. As a private person who is much more comfortable on the other side of the camera as the photo taker and not the subject, I find that this suits me very well indeed.
As a therapist I have the opportunity to build relationships with my clients without any deep and meaningful talk of myself, which is why the thought of writing blogs is more than a little daunting.
Mixed in with this is fear, not just of exposing myself and my thoughts to the wider world but also relating back to my youth. I have dyslexia, although it wasn’t officially recognised as such back in my school days or for 20 odd years after that. You can probably imagine the constant fear of being known as an idiot or dunce due to my difficulties with spelling and this stayed with me until the opportunity to return to education came along in my early 30’s. This was truly life changing and introduced me a world in which I could finally realise my true potential, which deep down I had always known about but never dared to believe it would come to anything.
Part of this was the result of my own experiences of counselling, which helped me to see where I wanted to go in life and to unlock the previously hidden parts of myself that would enable me to do this.
Some of you will go on a similar journey through counselling, albeit with different hopes and goals for the future, and are no doubt wondering if I am the right person to support you through it all.
Committing to this isn’t always easy but in my experiences as both a therapist and a client, I truly believe that it is worth any of the pain or stress it may cause. None of that will necessarily be obvious until you take the first steps on the journey (however tentative these may be!) and that is often the hardest part. You too may need to put aside some reservations and fears as I have in starting this blog but in doing so we can reveal things about ourselves we never thought possible!
What we communicate with others, can be a hugely complex and yet extremely important necessity, particularly in ‘relationship’. I have put apostrophes around that word because I am talking about all relationships we have with others, rather than just our intimate relationships with partners. Sometimes, in my work as a counsellor and psychotherapist, I think we often use this word incorrectly and forget its true meaning.
If we consider that a relationship is “the way in which two or more people are connected, or the state of being connected”, then that is the purpose of this article, as it seems from my work, that many people, even those in intimate relationships with another, can feel alone and isolated, and find me and many of my colleagues for these and similar reasons. The basis of this concept was first presented by one of those colleagues, and I hope that these thoughts will do his initial suggestion justice.
Imagine a square box, divided into four. For those that can’t, there is a diagram below. Then imagine this as a representation of self. Someone once said, “we are what we do”, suggesting that the way in which we behave, sums us up as a person. Several psychologists have suggested, using this idea, that in order to change, we should start with our behaviour. Although there is some evidence to support this notion, and there are various therapies that use this idea to motivate change, I disagree with this concept that our behaviour defines us.
I believe that we are so much more than just our behaviours. In my representation of self below, I have outlined several other, just as important, traits to consider. We are not only our behaviours, but our thoughts, our values and beliefs, and our emotions. It is all of these that define who we are, and the interactions between them all that make us unique. And it is only in our oversight of two of these, that can leave us lonely and isolated. Allow me to explain what I mean.