Anorexia & Eating Disorders in Children: What Parents and Family can do

When a child in the family develops symptoms of eating disorder (like anorexia nervosa, anorexia bulimia or binge eating disorders), other members in his/her family, in particular the parents may feel overwhelmed by the situation and even helpless.

The ways in which different families deal with the illness vary individually.

As parents or guardians the most immediate thing to do is to get for themselves support from a professional in treating eating disorders, be they doctors /psychiatrists  and/or psychotherapists.

What parents can do

The actual diagnosis and treatment of the physical and psychological aspects of the eating disorder is conducted by doctors. Usually these are done by specialists.

Parents can help the professionals by offering information on the family situation when these questions are posed to them by the diagnostician.  If there is such an interview given, it is best to provide the information as openly and honestly as possible.  This would facilitate un-hindered support for the children.

Once in the care of professionals, it is best for parents to allow the process to take place. 

It is a common reaction for worried parents to want to “take things into their own hands” when they perceive that help is not achieved adequately or quickly enough. Reacting to the child’s treatment in any way, so as to affect the relationship between the child and the professionals treating him/her, or to affect the child’s emotional state can be counter-productive.

If you are a parent of a child who is being treated for eating disorder, and feel uncertain or unpleasantness about the progress of the child’s treatment, do seek a conversation with the professionals in charge, before taking other action to change the treatment process.

Eating disorders arise and develop out of different situations. Sometimes the causes are linked to family dynamics, and other times it is not the case. Regardless of this, there is a tendency for parents and other family members to hold feelings of sadness, anger and guilt, as the result of realizing that a child is suffering from the disorder.

Difficult emotions being felt by parents, when ignored, can make problems worse, rather than better. This is because, when the emotions are pushed aside, they become stress factors that result in actions or behaviors that cause more stress in the family environment. In turn this may snowball into more problems for the child, and his/her other siblings.

It is hence recommended that parents themselves seek some kind of counseling from a psychotherapist, or a self-help group (if such is available).

Having counseling for parents, does not mean that the parents are in any way at fault, or have problems themselves. When parents go for counseling they are supporting the child by helping to provide a stable environment at home for him/her to get better.  

This short article is written with the wish that parents of children suffering from eating disorders take to heart that in order to support the healing of their children, they can do well by taking care of their own emotional state. Having a child diagnosed with eating disorder is, after all, stressful and riddled with questions and judgements of and from the self and others.

It is good to consider this metaphor taken from the aircraft emergency procedures:

“In the event of emergency, put your oxygen mask on first.”

The consequence of not following this aircraft safety advise is the loss of emotional bearings due to hypoxia (lack of oxygen in blood), rendering the person unable to help others, and worse…

In the case of supporting the child with eating disorder, counseling  for the self is the oxygen mask. It helps provide emotional stability in times of stress in the family.

Other Readings

Cottee‐Lane, D., Pistrang, N., & Bryant‐Waugh, R. (2004). Childhood onset anorexia nervosa: The experience of parents. European eating disorders review12(3), 169-177.

Bundesministerium für Arbeit, Soziales, Gesundheit und Konsumentenschutz (2018). Essstörungen: Was Angehörige tun können. Web source from URL:https://www.gesundheit.gv.at/krankheiten/psyche/essstoerungen/was-angehoerige-tun-koennen. Retrieved on 06.2018.

Honey, A., Boughtwood, D., Clarke, S., Halse, C., Kohn, M., & Madden, S. (2007). Support for parents of children with anorexia: what parents want. Eating disorders16(1), 40-51.

Lask, B., & Bryant-Waugh, R. (Eds.). (2000). Anorexia nervosa and related eating disorders in childhood and adolescence. Taylor & Francis.

Crisp, A. H., Harding, B., & McGuinness, B. (1974). Anorexia nervosa. Psychoneurotic characteristics of parents: Relationship to prognosis: A quantitative study. Journal of Psychosomatic Research18(3), 167-173.

Dreams and Dreamwork in Psychotherapy     

The publication On Dreams was written by Freud (1900) after having written his (what was labeled) “book of the century”, Interpretation of Dreams. With these writings,  Freud tries to make his innovative ideas of dream analysis accessible to the wider audience. His was the aim of reaching the “educated and curious minded reader” (Quinodoz, 2013).

Freud prides himself in taking the mystique out of dreams. He says dreams are composed of latent and manifest content. The manifest content, Freud explains, is material that appears in a dream. The latent content is the material that underlie the dream that is hidden within the unconscious. Using his own dreams he analyzed himself on paper. With that Freud brings us on a journey towards his own dream work.

Freud and Adler’s Differences


Alfred Adler’s work on dreams is an elaboration of Freud’s.  While here is fundamental agreement of both theories, the main difference is that Adler is very much focused on the individual’s awareness of one’s position in society, and expression of one’s “style of life”, viewing dreams as having a forward-looking, problem solving function. Adler also realizes that the conscious and unconscious are not contradictions to each other, but a unity (Ansbacher & Ansbacher, 1956).

Adler made a point about dream analysis that transcended Freud’s: by acknowledging that even made-up dreams are significant to analysis (p. 359). It implies that the act of talking about dreams alone is fundamentally relevant to the therapy—no matter from where the dream arises. The use of dreams in psychotherapy functions in a manner to facilitate therapeutic process, help patients gain insight and self-awareness, provide clinically relevant and valuable information to therapists and provide a measure of therapeutic change (Eudell-Simmons & Hilsenroth, 2005).

Gestalt Therapy Attitude towards Dream Work in Therapy

How the analysand describes his/her dream is rich in not only the latent content of the dream, but also the latent content of the moment of analysis. Gestalt therapists work on dreams by acknowledging the phenomenon within the client at the moment of analysis.

Enright (1980) recounts a dream work done by Fritz Perls in Los Angeles 1963 (found in the section Memory Gems). After the client recounts his dream, Perls would ask the client to identify himself with elements of that dream, by talking about it in the first person. In an example, an elderly, subdued man had a dream of seeing some friends off on a train. The man worked at first by identifying himself as himself, then as his friends with no effect. As the man identified himself with the train, he felt a bit more energy. Perls then asked the man to “become the station itself”. Enright writes, “At first it seemed as unproductive as the rest. Then, as he said, ‘I’m old-fashioned and a little out of date—I’m not very well cared-for; they’re letting dust and litter accumulate—and people just come and go, use me for what they want, but don’t really notice me,’ he began to cry, and for the next few minutes the current and recent past thrust of his entire life became obvious—what was happening, what he was doing that wasn’t working, and even some possible new things to do.”

Perls, in this example, demonstrates a way of working in the moment. While working with a dream, client and therapist remain in dialogical contact. Nobody gets lost in analysis. The therapist deals with the process of the dream work rather than the content of the dream. Working with process allows a lot of creative freedom; the dream is treated like a work of art, “fruit of the extraordinary creative powers of childhood” from which the patient must be able to experience freely, free of theoretical considerations; so that the person can communicate with and re-create his/herself  (Sichera, 2003. p. 95).

Conclusion

Dreams are useful material for use in understanding the self. If the client brings a dream to the session, and if the dream has significant emotionality attached to it, it is worth spending time on. Recurring dreams are especially interesting, according to Fritz Perls.

The time and setting is also considered before such work is done. There are moments when working on particular dreams lead somewhere important. There are moments when dream work is not appropriate, or when the dream topic is a distraction from current material that is more important for the client.

Working with dreams are tools, but are not ends to itself. The focus lies always on the here-and-now.

Read also:

Dream Analysis

Fritz Perls: Working with Dreams in Gestalt Therapy

Bibliography

Ansbacher, H. L., & Ansbacher, R. R. (1956). The individual psychology of Alfred Adler.

Enright, J. B. (1980). Enlightening gestalt: Waking up from the nightmare. Pro Telos.

Eudell-Simmons, E.M. & Hilsenroth, M. J. (2005). A review of empirical research supporting four conceptual uses of dreams in psychotherapy. Clinical psychology and psychotherapy. 12, 255-269. John Wiley & Sons.

Freud, S. (1900). On dreams, Standard Edition of the Complete Psychological Works of Sigmund Freud. Vol.5. pp. 633-686.

Quinodoz, J. M. (2013). Reading Freud: a chronological exploration of Freud’s writings. Routledge.

Sichera, A. (2003). Therapy as an aesthetic issue: creativity, dreams, and art in Gestalt Therapy. In M. Spagnuolo Lobb & N. Armendt-Lyon (Eds.). Creative License: The art of Gestalt Therapy. NY: Springer.

 

Different Facets of Countertransference

Different feelings brought about by countertransference during a therapy session. Here is a rundown of how countertransference within a therapeutic relationship can manifest itself.

 

Transferences from therapist’s own childhood unfinished business is put onto the client. For example, the client reminds the therapist of his controlling mother.

Reactive feelings arising from therapist’s own narcissism.  Like defiance, being offended, wanting to take revenge, envy, lust, feeling insecure, feeling  inferior or superior, etc.

Complementary countertransference: when the therapist encounters the transference of the client, out of which incites the therapist to behave towards / feel towards the client the way the client’s  caregiver or significant other  would feel.

Identification with client’s significant other (parent, child, spouse, children, boss): in such a way that the therapist cannot empathize with the client.

Projective IdentificationFeelings of the patient’s childhood experiences which have been split/dissociated, and projected onto the therapist and simultaneously the therapist feels and acts in a way (e.g. sadistic, critical, judgmental… like his father) that leaves the therapist bewildered.

The consequences unrealized countertransference feelings is that the client is robbed of the empathy he/she needs from the therapeutic sessions, which ultimately renders the therapy unprogressive.

The challenging job of the psychotherapist is to be constantly aware of these feelings and the sources of these transference. Self awareness through self therapy, and workshops and supervision are the only and best way to work through these transferences.

 

 

Hoarding Disorder

Definition of hoarding disorder:  the extensive collection of objects followed by difficulty discarding them for aesthetic reasons, or because of an object’s emotional value or consideration of its possible usefulness in the future.

The consequence of hoarding objects is accumulation of objects in living spaces, leading to limited space, poor hygiene and feelings of embarrassment.

Items that people hoard can also be those of abstract nature, like hoarding of digital items. Hoarding becomes a “disorder” when it starts to interfere with relationships and functions of daily life.

Many people with hoarding disorders have tremendous difficulties with relationships. Partners and family members suffer from problems associated with the syndrome like cluttering of the living space. As a result of the behavior, hoarders live lonely lives, and are often suffer depression.

Hoarding is a chronic syndrome, and individuals live with this lifelong. With age, the situation can get worse. Support from others and professional psychological aid, where available, help individuals get on well with their lives despite difficulties.

Check out my Hoarding test here.

Questionnaires to evaluate hoarding disorder

The Saving Inventory-Revised (SI-R) by Frost et.al (2003).

Compulsive Acquisition Scale (CAS) by Frost et.al (2002).

A major contributing factor in hoarding disorder is the need for control over possessions.

Bibliography

Frost, R. O., Steketee, G., & Kyrios, M. (2003). Saving Inventory–Revised (SI-R).

Frost, R. O., Steketee, G., & Williams, L. (2002). Compulsive buying, compulsive hoarding, and obsessive-compulsive disorder. Behavior therapy33(2), 201-214.

Frost RO, Steketee G, Williams L. Compulsive buying, compulsive hoarding, and obsessive-compulsive disorder.

van Bennekom, M. J., Blom, R. M., Vulink, N., & Denys, D. (2015). A case of digital hoarding. BMJ case reports.

Experiences of Grief after a Loss of a Loved Person

What does a person go through when he/she loses a very dear person? This person could be a parent, spouse, child, friend or even pet.  Every person’s experience is unique, because every relationship is unique. In order to understand what people may go through after the death of someone special, here is a questionnaire that I found.

How is the experience of grief described?

This is a set of questions that one can reflect upon when accessing the grief experience.

Since the death of your loved one, how often did you:

      1. Think that you should go see a doctor?
      2. Experience feeling sick?
      3. Experience trembling, shaking, or twitching?
      4. Experience light-headedness, dizziness, or fainting?
      5. Experience nervousness?
      6. Think that people were uncomfortable offering their condolences to you?
      7. Avoid talking about the negative or unpleasant parts of your relationship?
      8. Feel like you just could not make it through another day?
      9. Feel like you would never be able to get over the death?
      10. Feel anger or resentment toward your loved one after the death?
      11. Question why your loved one had to die?
      12. Find you couldn’t stop thinking about how the death occurred?
      13. Think that your loved one’s time to die had not yet come?
      14. Find yourself not accepting the fact that the death happened?
      15. Try to find a good reason for the death?
      16. Feel avoided by friends?
      17. Think that others didn’t want you to talk about the death?
      18. Feel like no one cared to listen to you?
      19. Feel that neighbors and in-laws did not offer enough concern?
      20. Feel like a social outcast?
      21. Think people were gossiping about you or your loved one?
      22. Feel like people were probably wondering about what kind of personal problems you and your loved one had experienced?
      23. Feel like others may have blamed you for the death?
      24. Feel like the death somehow reflected negatively on you or your family?
      25. Feel somehow stigmatized by the death?
      26. Think of times before the death when you could have made your loved one’s life more pleasant?
      27. Wished that you hadn’t said or done certain things during your relationship?
      28. Feel like there was something very important you wanted to make up to your loved one?
      29. Feel like maybe you didn’t care enough about your loved one?
      30. Feel somehow guilty after the death of your loved one?
      31. Feel like your loved one had some kind of complaint against you at the time of the death?
      32. Feel that, had you somehow been a different person, your loved one would not have died?
      33. Feel like you had made your loved one unhappy long before the death?
      34. Feel like you missed an early sign which may have indicated to you that your loved one was not going to be alive much longer?
      35. Feel like problems you and your loved one had together contributed to an untimely death?
      36. Avoid talking about the death of your loved one?
      37. Feel uncomfortable revealing the cause of the death?
      38. Feel embarrassed about the death?
      39. Feel uncomfortable about meeting someone who knew you and your loved one?
      40. Not mention the death to people you met casually?
      41. Feel like your loved one chose to leave you?
      42. Feel deserted by your loved one?
      43. Feel that the death was somehow a deliberate abandonment of you?
      44. Feel that your loved one never considered what the death might do to you?
      45. Sense some feeling that your loved one had rejected you by dying?
      46. Feel like you just didn’t care enough to take better care of yourself?
      47. Find yourself totally preoccupied while you were driving?
      48. Worry that you might harm yourself?
      49. Think of ending your own life?
      50. Intentionally try to hurt yourself?
      51. Wonder about your loved one’s motivation for not living longer?
      52. Feel like your loved one was somehow getting even with you by dying?
      53. Feel that you should have somehow prevented the death?
      54. Tell someone that the cause of death was something different than what it really was?
      55. Feel that the death was a senseless and wasteful loss of life?

Finding the Answers

The questions, answered in the affirmative within the first 2 years of loss of a loved one, reflects the natural response of grief. After a longer period of time, the feelings should subside. If feelings of grief develop into depression, seeking counseling can be a life saver.

Seeking a balance in allowing oneself to grief, and then to slowly move on with living a life without the loved one is an act of taking responsibility for one’s own survival. That is a matter of individual choice, and freedom. Finding resources to survive loss is part of the act of responsibility. A good resource one  can achieve for oneself is to find someone who would listen. This person may be in the form of another family member, friend, counselor, priest or psychotherapist.

Bibliography

Barrett, T. W., & Scott, T. B. (1989). Development of the grief experience questionnaire. Suicide and Life-Threatening Behavior19(2), 201-215.

Psychotherapy for Cardiac Patients?

This article explores the mutual, interactive influence between cardiovascular disease and mental health. The psychological issues present among patients of cardiac health issues are mainly that of anxiety and mood disorders. Often termed “psychocardiology”, this field integrates both medical aspects of cardiology and psychotherapy.

The interactions between the mind and body are pronounced and evident. When we feel anxious, our heart pumps faster and we feel breathless. The interaction between psycho and soma is also complex and multifaceted.

Cardiological and psychiatric disorders are closely interrelated and have a bi-directional relationship. This is what we understand as a psycho-somatic interaction.

Mind and Body Connection in Cardiology

Cardiovascular disease is among the leading cause of morbidity and mortality in the industrialized world.  While psychiatric disorders have a prevalence rate close to 20% of the population, depressive illness  is one of the leading cause of disability worldwide (Murray & Lopez, 1997). 

Put together,  depression and anxiety related to depressoin is identified as a significant risk factor for mortality in patients with coronary heart disease (Barth et. al. 2004).

cardiovascular disease and depression

The article cites a meta-analysis of research papers and have found that depression and anxiety contributes to the mortality of patients of coronary heart disease. Cardiac patients who suffer depression are 2x more likely to die than cardiac patients who do not suffer depression in the 2 years of initial assessment of the disease.

Halaris (2013) highlights links underlying recognized cardiovascular disease and mood disorders. Genetic and epigenetic factors affect how an individual reacts to mental and biological stress. Psychosocial and environmental stressors together with lifestyle choices also determines susceptibility to level of disease states.

Among patients with Congenital Heart Disease, for example, it is found that illness perception of the patient is a significant predictor of  patients’ quality of life, cardiac anxiety and depression one year after the heart intervention (O’Donovan et.al. 2016). It indicates that how the patient see his/her illness and the self in this situation affects his/her health development and quality of life.

Psychological effect of Diagnosis of Heart Defects on Patients

Being diagnosed with heart complications, whether it is congenital heart disorder or coronary heart disease leads to years of continuous physical, psychological and/or social burdens for the patient and family.

Patients with early-recognized congenital heart defect live with the condition throughout life. This is especially so in the case of babies / children diagnosed with congenital heart defect.  The psychological state of these patients is deep rooted becomes embedded in identity.

Encased in the anxiety of other types of patients whose heart disease emerge later in life is the shock/abruptness of the heart failure due to a previously unknown / undetected defect. This further stir associations regarding health in general (loss of former self-identity, increase of insecurities etc.).

Psychotherapy needs of Cardiac Patients in Cardiology

Medical professionals in countries like Austria realize the need for an integrated-method of treatment of cardiac patients. Medical treatment is more focused upon when the symptoms are acute, and with chronic ailments the psychological work take precedence. Many fields of mental sciences work together with the doctors for after-care of the patients.

Psychotherapists, as per the studies cited in this article have un-covered the major psychological issues patients face: Clinical anxiety coupled with depression. These have also been shown to have adverse affect on the health development of the patients.

Anxiety is an increase in the awareness of psychic or physical sensations to a degree that makes it impossible for the real or imagined danger to be avoided; there is a constant danger signal together with the incapacity for active coping (Waelder, 1960). Relaxation in the tensions of anxiety seeks the experience not of satisfaction but of security (Sullivan, 1953). 

Patients come to psychotherapy with existential anxiety because of their life-death situation.  Illness perception is linked to these feelings. Along with it comes the perception of oneself in relation to a defect. Patients talk about the feeling of being vulnerable, ‘damaged’, ‘weak’.  For adult patients (especially those who are independent in life), these experiences are often concealed from relevant others.  

In therapy, these themes are worked through in the confidentiality and security of the session. The psychotherapist for such patients has to possess the resources to contain the very strong emotions of the clients, approaching the sessions with empathy and patience. Patience is normally understated, but important. Many patients take time to trust the therapeutic process, and may discourage the therapists from helping them. Feelings of hopelessness /helplessness do become projective identification.

“.. the therapist should function as a container of the patients’ anxieties. The fundamental therapeutic task at this stage is the analyst’s containment and interpretation of the patient’s anxiety. To the extent that this process is carried out, if the patient deposits—or rather evacuates — his anxiety and the analyst is able to bear it, a type of relationship is established in which the patient feels the analyst is an object who’s function is to contain him … As this process repeats itself, the patient develops a growing confidence in the relationship and gradually introjects ‘it’. It can be said theoretically, that from the moment there has been sufficient introjection, the patient has (achieves) within him an object where he (from now on) can deposit his anxieties … “

(Etchegoyen, 2005, p. 620).

The therapists who is able to see through the difficulties of the therapeutic sessions eventually builds the sound alliance. He/she is then able to support the client through the worst of feelings (especially that of loss), thus alleviating existential loneliness and isolation that is part of the depression.

Psychotherapy for Parents and Siblings of Children with Congenital Heart Defect

Psychotherapy cannot ignore that alongside a patient is his/her social system. Parents and siblings of child patients bear a big burden. Work with the family on a long term basis helps alleviate chronic stress faced by parents and supports the family. We can take heart from the research mentioned by Re et.al. (2013).

 

 

 

Bibliography

Barth, J., Schumacher, M., & Herrmann-Lingen, C. (2004). Depression as a risk factor for mortality in patients with coronary heart disease: a meta-analysis. Psychosomatic medicine66(6), 802-813.

Etchegoyen, R. H. (2005). The fundamentals of psychoanalytic technique. Karnac Books.

Halaris, A. (2013). Inflammation, heart disease, and depression. Current psychiatry reports15(10), 400.

Murray, C. J., & Lopez, A. D. (1997). Global mortality, disability, and the contribution of risk factors: Global Burden of Disease Study. The lancet349(9063), 1436-1442.

O’Donovan, C. E., Painter, L., Lowe, B., Robinson, H., & Broadbent, E. (2016). The impact of illness perceptions and disease severity on quality of life in congenital heart disease. Cardiology in the Young26(1), 100-109.

Re, J., Dean, S., & Menahem, S. (2013). Infant cardiac surgery: mothers tell their story: a therapeutic experience. World Journal for Pediatric and Congenital Heart Surgery4(3), 278-285.

Humiliation, Shame and Violence

This is a presentation I gave some years ago on the connection on antisocial violent behavior in some men, and how researchers (in this article I feature the work of J. Gilligan) have learnt how these violent behaviors are linked to culturally-adapted values. Such values function as introjects in individuals. The resultant of which is violent and aggressive emotions as consequence of displaced feelings of humiliation and avoidance of shame.

Mass shooting incidents do happen and the perpetrators leave behind chilling messages that point to a root cause, which Gilligan has pointed out.

 

Here are the list of extreme cases of violence in young males. The motives for their actions were later revealed to have mysogynic undertones. Many express their hatred for women.

Working with Shame

  • Empathic understanding of the patient’s experience with shame
  • Assist the client to understand fully this experience.
  • Showing warm understanding, acceptance and respect.
  • To heal shame, the therapist must understand shame. Therapist must understand this in context of the patient.
  • Therapist must be committed to dialogue.

(Yontef, 1996)

  • Hold the client in unconditional positive regard.

Working with Humiliation

Why Humiliation?

Shame is related to humiliation, but they are not the same emotions.

The Phenomenological difference between Shame and Humiliation

  • Humiliation relates to distinct “self and other” interactions, and to distinct levels of self-definition.
  • Humiliation is done by one person to another purely for own selfish purpose.
  • Humiliation implies an activity occuring between oneself and another person.
  • “Humiliated” is a feeling of position of oneself in relation to another or others. It is also an interpersonal interaction.
  • Humiliation is the feeling of an act of being put into a powerless, debased position by another who at a point in time posesses greater power than oneself.
  • Humiliation can involve anger over one’s lowered status.  (Gilbert & Andrews, 1998)

References

Anderson, E. (1994) The Code of the Streets. The Atlantic Monthly 5 81-94

Cohen, Vandello, Rantilla (1998) The sacred and the social . Cultures of honor and violence. In P Gilbert, B Andrews (Eds.) Shame: Interpersonal Behavior, Psychopathology, and Culture pp.261.

Gilbert, P. E., & Andrews, B. E. (1998). Shame: Interpersonal behavior, psychopathology, and culture. Oxford University Press.

Gilligan, J. (2001) Preventing Violence. London: Thames & Hudson.

GILLIGAN, J.. (2003). Shame, Guilt, and Violence. Social Research, 70(4), 1149–1180. Retrieved from http://www.jstor.org/stable/40971965

Herbert, B. & Gilligan, J. (2014) Bob Herbert’s Op-Ed. TV: Dr James Gilligan on our Culture of Violence. Youtube Video. https://www.youtube.com/watch?v=IozZsuCfiZo

Retzinger, S. M., 1995 Identifying shame and anger in discourse. American Behavioural scientist 38(8) 1104-1113.

Yontef, G. (1996) Shame and guilt in Gestalt Therapy. In R. Lee & G. Wheeler (Eds) The Voice of Shame. San Francisco: 390. pp. 370-371.

The Neuroscience of Language Explains How and Why Psychotherapy Cures

Drawing much inspiration from a lecture given by Sapolsky (2011), an expert in the neuro- and biological field, I would like to discuss the use of language, or — more accurately put– communication, as a cure for psychological pain.

The profession of Psychotherapy, at its formation, was termed the “talking cure” (Freud & Breuer, 1895).  This literally means talk as a means of relieving one of symptoms or psychical and often also somatic nature. What the term “talking” does not describe is the “listening” from the other person. In psychotherapy it is the talking to someone who is actively listening that cures. Read also: The Psychotherapeutic Alliance.

Language is in verbal and non-verbal communication

Talking and listening is communication. When we think of communication, we think of dialogue, and language. Language, according to Sapolsky is more than speaking or writing verbally. Neuroscience has indicated, especially through studying the neurobiology of sign language learning of completely deaf individuals, that whether it is verbal or non-verbal, the communication process is the same. This means that language is not merely a motoric process (i.e. about moving lips and tongue), but rather a cognitive process.

Language is unique to humans

Human communication has universal qualities. All forms of human languages have semanticity, embedded clauses, all human language can “talk about things”, can talk strategy. There is arbitrariness of language, in which words are not tied to meaning. People are able to tell lies, and say one thing and mean/feel another. Language is also invented and re-invented. Human children have innate ability to coin phrases and say things they have never heard before (N. Chompsky).

Unlike animals that have specific vocals for specific emotions, human language is not tied to specific emotions. This explains why in therapy we notice a quality of communication in which there is a “content-affect split”.

Non-verbal aspect of language

We do not communicate with words alone, there is also verbal tone, sounds, body movement, hand gestures, facial expression. Gestalt therapists look out for these during therapy as well, since the non-verbal language reveal often much of the emotional content of the communication. Certainly emailing does not allow for non-verbal communication. Perhaps that is why many of us feel more secure communication over messenger apps to even talking on the phone.

Neuro-centers of the brain that affect language

Ninety percent of humans process verbal language in the left hemisphere of the brain. The other (right) hemisphere, process the non-verbal and emotional content of the communication. The Broca’s area is connected to the motoric nature of language production. The Wernicke’s center is responsible for language comprehensibility. The connection between these two centers connect the two functions.

Through studies of biological brain disfunction due to disease, degeneration or injury, scientists have managed to identify which part of the brain is utilized for which function. Through neuro-imaging, we know that in tourettes syndrome, for example, where the sufferer curses uncontrollably, the limbic system is hyperactive. The limbic system is not known to be responsible for emotions and not language production, but language is connected to the formation of emotions.

Many have also proven that singing is a way for people who suffer damage to the Broca’s area (and hence have problems talking). Singing activates the right hemisphere and emotional centers of the brain.

Hence the phenomenon of the talking cure; an emotional weight off the shoulders when on talks emotionally to someone who is willing to listen.  One can also see how verbal language is only a part of communication. Clients who have problems with speech (in particular in Alzheimers patients) respond to communication with music.

 

 

References:

Freud, S., & Breuer, J. (1895). Studies on Hysteria. SE 2.

When to Engage the Services of a Psychotherapist

When is it a good time to decide to get psychotherapy? What has to happen before someone actually needs psychotherapy? Does seeing a therapist mean that I am sick / crazy?

Nobody has to ask these questions when one is physically ill. One goes directly to the general practitioner, because it is clear to one that his/her body is not feeling as good as it normally does. Psychological health is slightly different, the degree of suffering is not so clear, and often we feel “it is not necessary” or “I can get through this” and/or “it is to much of a luxury” to get psychotherapy. Oftentimes ignored emotional challenges (which can be unpacked in psychotherapy) lead to debilitating mental suffering in later life.

 

Certainly this article come from within a psychotherapist’s blog. It is however the intention of the author to shed light on the “hows”, “whys” and “what for” in seeking psychotherapeutic treatment. As a psychotherapist having worked also in psychiatric wards in hospitals, I’m also a witness to how mental health of an individual today is vulnerable to life-changing situations.

Individuals who attend therapy when they can still work and function in their daily lives have better prognosis than those who are at already a point where their psychological state does not allow them to live independently of others or medication.

When is appropriate time to seek psychotherapy?

Imagine these rather normal scenarios:

Scenario 1: Your child is not sleeping well, and has frequent nightmares. In the day he is agitated and has problem paying attention. This is stressful for you, because you are at a loss in managing his fits of anxiety, crying at night, etc. You are thinking of seeing the pediatrician/child psychiatrist but he/she is a doctor, and you are aware of the side effects of prescription drugs on children.

Scenario 2: You lost a parent 2 years ago and most of your family members and yourself have mourned your loss and have moved on. Your youngest sister, 15, is lately very depressed and has stopped going to work or socializing. You believe that she has not got over the loss of the parent.

Scenario 3: You are aware that you are using the computer / smartphone / tablet constantly. It is difficult for you to get yourself away from the LCD screen. When you’re in social events and have to turn off your phone, you feel annoyed and want to leave the place. You have feelings of guilt/shame about this.

Scenario 4: You are a successful career person. Lately you have not slept for more than 4 hours on average per night. You’re mentally exhausted, but every night you lay in bed, and your mind is racing with thoughts. You are considering taking sleeping medication.

Scenario 5: You are a college student and have recently moved out of your family home. Lately you have been feeling panic attacks in the night.

Scenario 6: Your child has been diagnosed with an illness that requires complicated medical treatment. You are worried sick. You have other children.

Scenario 7: You witnessed something traumatic (real or fiction or imagined). 6 months later, you still get nightmares and/or flashbacks.

Scenario 8: Your teenager is withdrawing from the family and his/her grades, which used to be good, are falling.  You notice him/her losing excessive weight. You need someone to talk to.

Scenario 9: You are suffering pain in part(s) of your body, and the many doctors you have consulted confirm that they could find no physical clues to the causes. Doctors tell you it could be psychosomatic.

Scenario 10: Your marriage is breaking up, and you are worried that the children will be affected by the split. You want to get a divorce and you want the process to be done cordially, so that the children are spared the emotional turmoil involved in the conflict.

In all these scenarios, the services of a qualified psychotherapist can be a life-saver. These problems are not uncommon, and they happen to anyone living in this internet age we are in today. It is not to say that the internet per se has anything to do with it, but these are the kinds of problems familiar to people around the world.

What Happens in Psychotherapy?

A psychotherapist is a professional trained to be a person-in-contact with you and/or your child. As human beings we get embroiled in our daily life, unawares of the underlying emotions that drive us. These un-felt, emotions are what some of us would describe as the unconscious.

The therapist’s work is to study this aspect of your character.  He/she does this by asking you questions about yourself, and checks with you at each step how you feel about certain things. The therapists also gives you feedback on your blind spots about your mannerisms, incongruences in your dialogue with him/her (for example if you contradict yourself or if your words  contradict your body language, etc). The therapists holds a dialogue with you in this way and in so doing, you discover things about yourself you were not previously aware of. You also gain insights into the the situations you found yourself “stuck” in.

Above all, psychotherapists work under the rule of strict confidentiality.

Difference between psychotherapists and counselors

Psychotherapists, more so than counselors, work with your unconscious.  We are interested in what drives and motivates you, and what is causing the stress responses in your lives. Psychotherapists that work with couples and families treat the individuals as part of a system. It is the unconscious forces in each member of the family that create the family dynamics. Psychotherapists believe that it is only by going deep into the emotions can we really uproot the inner conflicts behind the stress, sleeplessness, psychosomatic pain and problems that we face in our daily lives.

Most psychotherapists, unlike counselors, do not give advise (at least they try not to). Rather, the therapist will sit with you during these hours and provide you just enough support and as much support as you need to find your own resources. This way, we do not heal you, we help you make your own reparations.

Difference between psychotherapists and psychiatrists

Most Psychotherapists, unlike psychiatrists, spend more time being with you and we do not provide psycho-pharmaceutical drugs. If you are depressed, we provide do not encourage you to reach for an antidepressant (sometimes we send clients to the psychiatrist, when the client’s symptoms are severe). If you are on medication, we would ask you how it is working for you. Some clients come to us because they want to wean themselves off the drugs. This is because many psycho-pharmaceuticals are dangerous if you suddenly stop taking them.

Gestalt therapists, for example, works as your person in contact, who would guide you through your inner conflicts (which we know can feel desperate), and walk you through the experiences till you see the light again. Usually we expect to go through with you some painful experiences, thoughts and memories. We believe that it is through understanding these anxiety-causing experiences that you can find long-term peace to live again. Taking medicine alone robs you of this chance to overcome your depression in this way.

Difference between psychotherapists and psychologists

Unlike clinical psychologists, psychotherapists view the client as an individual person, builds a transpersonal relationship with you, and do not commonly see diagnosis as a main part of their work. This means that we do not see you as “a depressed patient”. We regard you as a person in relation to us who is in a mental / spiritual / emotional / social / relational situation that needs to be understood. Psychotherapists delve into the unconscious inner conflicts, looking at childhood experience and past traumatic events /illnesses that may be the cause of present afflictions. He/she sees the client as an individual with a special challenging life situation, with a unique family background, with a unique vulnerability. Most psychotherapists are trained to contain your vulnerability.

How do Psychotherapists do this?

Most licensed psychotherapists from Austria & Germany ( I can only speak for this part of the world since I am trained there) are rigorously trained for the profession. The training takes more than 6 years to complete. We are trained academically in psychology, psychopharmacology, sociology, gerontology, child and youth psychiatry, psychotherapy research, cultural anthropology, philosophy, neuroscience, ethics, sexuality and diagnostics. Over and above the academic studies we complete hundreds of hours of individual psychotherapy and group psychotherapy ourselves. We also work at least a thousand hours in psychosocial and hospital institution as interns.

How do you shop for a psychotherapist?

Use the internet and check their credentials. Psychotherapists who do not have credentials little accountability. Since you are engaging someone who is going to work with your mental suffering, it is only advisable to engage someone who is trained in a reputable institute.

Call the therapist and ask for a first interview. During this interview ask questions and you’ll have a feel if this person can help you. After a few sessions, check again.

Recommendations from friends/and other professionals do help. The best is to try the therapist out.

Characteristics of therapist to look out for:

  • does he/she answer your questions transparently?
  • do you get the impression that your concerns are being addressed?
  • do you get the impression that he/she is authentic in what he/she says?
  • do you get the impression that he/she is curious about you?

Most important thing to remember is that the therapist is a professional to serve you. In your first interview with him/her you should get impression that the therapist is more interested in knowing about you than about him/her telling you about him/herself.

 

 

 

Psychotherapy is about Uncovering Truths of the Self

It is said that the truth will set you free. In psychotherapy patients liberate from the psychological stressors in their lives through uncovering the truths about themselves.

This might sound counterintuitive if we believe that we know everything about ourselves or that we are in total control of the decisions we make. The field of psychology has proven empirically that this is not the case, and psychoanalysis has provided theories about how this is so.

Put briefly, the human person is an integral part of his/her society and culture through which our  psychological processes are influenced.

Knowing the truth is coming to terms with this realization. That we become depressed, anxious, angry… etc because we have lost the sense of our of needs. In so doing we turn them into symptoms, so that we do not have to face these needs.

An example would be that of a woman who is depressed and no longer able to enjoy simple things in life. Through therapy she uncovers the truth that her going into depression is a means for her to not face up to an inner rage, for it was safer to lock oneself into a state of depression than to attack another person, especially an abusive childhood caregiver.  Realizing the truth of her rage, she is able to talk about it and understand it. In Gestalt therapy, the client is encouraged to express this rage through art, speaking, acting out, writing… etc. When the underlying issue is set free, the depressive symptoms lose their foundation as well.

Therapy in this way is done with the patient being in control of his/her progress. Therapists in general do not advice, coerce or make analysis to tell the clients what the truth is. Clients find this out through dialogue with the therapist. The client has the agency to his/her own truths and healing.

When patients are asked retrospectively what they gained from a period of psychotherapy, their answers frequently feature an increase in their sense of agency: “I learned to trust my feelings and live my life with less guilt,” or “I got better at setting limits on people who were taking advantage of my tendency to comply,” or “I learned to say what I feel and let others know what I want,” or “I resolved the ambivalence that had been paralyzing me,” or “I overcame my addiction” are typical comments (McWilliams 1990 p. 16).

Bibliography

McWilliams, N. (1999). Psychoanalytic case formulation. Guilford Press.