Cognitive Therapy Basics

During my work with clients either through Online Mindfulness Therapy Skype sessions or in the office, I find that one of the central problems most people have is that they do not know how to focus inwardly and create a quiet, safe space in which they can engage with their inner emotional suffering. We develop a plethora of secondary reactions of avoidance, resistance or plain resignation. We busy ourselves in activities, anything to avoid facing the inner reality of our anxiety or depression. We talk about our problems, analyze them, and try to fix things through will power and positive thinking, which are all fine in themselves, but only if they come out of a foundation of stillness and inner listening. The problem is that we do not take the time to cultivate this inner relationship, and that’s like trying to fix a problem without knowing all the facts, and that is never a good strategy. We need to learn the art of being still and completely present with the anxiety, depression, traumatic memory or other upset; in short we need to learn the art of listening within. Everyone knows the importance of listening without, to a friend or child needing our attention and support. Well this very same attitude is needed within if we want to bring about healing. This is the prime work of Mindfulness Meditation Therapy: learning to form a relationship based on listening, openness and being completely present with your emotions, and in therapy-teaching sessions, you will be taught how to do this in great detail.

Therapy begins the moment a client establishes a mindfulness-based relationship with his or her emotional reactions, and in fact therapy can almost be defined as the process of cultivating the art of inner listening until it becomes the natural response to suffering. Why is this so important? The attitude of listening and being totally present for our experience has many extraordinary effects, and all of them bring benefit. At the most fundamental level, listening is the process in which we stop reacting and start experiencing. This is what is described as the development of “presence,” and this is one of the chief characteristics of mindfulness: being fully present for whatever you are experiencing, without the interference of thinking or further reacting to what you are experiencing. In fact mindfulness can be described as “engaged-presence.” It is that quality of acute listening and openness to experience coupled by a willingness to engage and face our experience, including the painful and disagreeable thoughts and emotions.

As a therapist, my primary mission is to help my client establish this engaged-presence of mindfulness with his or her suffering. Mindfulness teaches us how to tune in to our core emotions, and as we do that, we create a space around the pain that I call the “therapeutic space of mindfulness.” Reactivity tends to close and contract the mind making it fearful and angry, neither of which helps the healing process. Mindfulness tends to open and expand conscious awareness, and literally makes room in which tight and contracted emotional states can begin to move, unfold and differentiate. In summary: Reactivity inhibits change; mindfulness facilitates change, and this is one of the basic principles of mindfulness psychology.

Mindfulness of our emotions is not the same as acting out the emotion and it is not wallowing in feeling bad. It is the process of literally “sitting” with the emotion: nothing to do, nowhere to go, nothing to fix, just being 100% present with the emotion as an object to observe and investigate with care. This shift in relationship from subjective reactivity, in which we are continually hijacked by our emotions, to an objective relationship, in which we can be with our emotions in a state of inner silence, has an immensely powerful healing effect. It literally creates a space in which the emotion can change from within. So, if you feel overwhelmed by anxiety, fear, worry, guilt or depression, then Mindfulness Meditation Therapy will be of great value to you.

One woman described how she saw herself as being a victim of incessant worrying and anxiety. She had tried several forms of talking therapy, but the anxiety persisted. When I asked her what color the anxiety-emotion was, she seemed puzzled. Apparently, in all her previous therapy sessions no one had asked her to look inside and see what was actually there. Talking about emotions is never as effective as actually looking at them directly. After a couple of sessions of MMT she established an inner mindfulness-based relationship with the anxiety-emotion and immediately noticed that it had a black color and had a hard, tight form. Now, for the first time, she had something tangible to work with, and after several more sessions of simply creating a therapeutic mindfulness space around the black object, it spontaneously began to soften and loosen up, eventually taking on a new color and changing in many other ways. The constricted emotional energy was being released during this process of direct inner experiencing and this led to profound transformation at the core. Out of this change at the core feeling level, her beliefs and thinking also changed and she no longer felt a victim of compulsive worrying. She readily found new solutions and more positive perspectives on things, and all this arose as a consequence of first learning to be present with her worry-thoughts through mindfulness training.

Mindfulness meditation is like “mental massage” in which we bring warmth and healing energy to those hard, reactive places within, and with each gentle touch, suffering begins to respond by healing itself from within. In the Online Mindfulness Therapy Course, I teach clients how to do this “mindfulness massage” so that they can practice the art of inner healing at the core level and learn a totally different way of being with the many challenges of their lives. The problem is seldom in the challenges, disappointments and issues, but almost always in the way that we react to these events. Mindfulness teaches us how to maintain balance and to avoid becoming reactive. We learn to replace reactivity with responsiveness, based on mindfulness rather than blind compulsion. That is the path that heals suffering in our heart and in our relationships. In fact, many of my clients use the mindfulness skills that they learn to heal the compulsive patterns of reactivity and arguing that destroys personal relationships. It all begins by learning the art of true listening based on mindfulness and engaged-presence.

Besides face-to-face Mindfulness Psychotherapy sessions, Dr Peter Strong offers the ever-popular Online Psychotherapy and Counseling service, in which he teaches clients specific strategies for working with emotional stress through a combination of email correspondence and Skype sessions. Peter also offers teaching seminars for groups, and companies with an interest in stress management. If you want to learn Mindfulness Meditation, you can do this through email correspondence and Skype. Visit http://www.mindfulnessmeditationtherapy.com

Your email enquiries are welcome.

If you have found this article useful and would like to support the work of Dr Strong and Mindfulness Meditation Therapy, please consider making a donation through PayPal by visiting my website and reading the additional articles on Mindfulness Meditation Therapy. A donation button is located under the articles on Blog/Articles.

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Attachment Facilitating Parenting

 

Arthur Becker-Weidman, Ph.D.

 

Center For Family Development

Many adopted and foster children have had very difficult and painful histories with their first parents. These children have experienced chronic early maltreatment within a caregiving relationship. Such a history can lead to the development of Complex Trauma (Cook et. al., 2003; Cook et. al., 2005), disorders of attachment, and Reactive Attachment Disorder. Children with histories of maltreatment, such as physical and psychological neglect, physical abuse, and sexual abuse, are at risk of developing severe psychiatric problems (Gauthier, Stollak, Messe, & Arnoff, 1996; Malinosky-Rummell & Hansen, 1993). These children are likely to develop Reactive Attachment Disorder (Greenberg, 1999; Lyons-Ruth & Jacobvitz, 1999). Approximately 2% of the population is adopted, and between 50% and 80% of such children have attachment disorder symptoms (Carlson, Cicchetti, Barnett, & Braunwald, 1995; Cicchetti, Cummings, Greenberg, & Marvin, 1990). Many of these children are violent (Robins, 1978) and aggressive (Prino & Peyrot, 1994) and as adults are at risk of developing a variety of psychological problems (Schreiber & Lyddon, 1998) and personality disorders, including antisocial personality disorder (Finzi, Cohen, Sapir, & Weizman, 2000), narcissistic personality disorder, borderline personality disorder, and psychopathic personality disorder (Dozier, Stovall, & Albus, 1999). Therapeutic Parenting is often necessary to help these children heal (Becker-Weidman, A., & Shell, D., 2005/2008). This approach to parenting is often not familiar to most parents and requires a significant amount of work and preparation. Attachment facilitating parenting is grounded in attachment theory and is based on a set of principles that include:



Sensitivity

Responsiveness

Following the child’s lead

The sharing of congruent intersubjective experiences

Creating a sense of safety and security



The effective implementation of these principles requires parents who:

 



Are strongly committed to the child.

Have well developed reflective abilities

Have good insightfulness

Have a relatively secure state of mind with respect to attachment



This type of parenting is consistent with Dyadic Developmental Psychotherapy, which is an evidence-based and effective treatment for children with trauma and attachment disorders (Becker-Weidman & Hughes, 2008). Many foster and adoptive parents find their children’s behaviors strange, frightening, disturbing, and upsetting. They often don’t understand why their child behaves as the child does; “after all, my child is now safe, doesn’t he get it?” It can be difficult to appreciate the depth and pervasiveness of the damage caused by earlier maltreatment.

Therapeutic parenting based on Dyadic Developmental Psychotherapy relies of helping parents understand what is causing the child’s behaviors. Looking deeper in order to understand what is motivating the child. All behavior is adaptive and functional; however sometimes the behaviors that were adaptive in one environment are ill-suited for the new home. If your first parents were neglectful, unreliable, and inconsistent so that you were often hungry and left alone for long periods of time, hoarding food, gorging, and going to “anyone” for help is adaptive. When that child is placed in a foster or adoptive home with caring, responsive, sensitive parents, that same behavior is no longer adaptive. By understanding what is driving the behavior and appreciating the child’s fear, anxieties, shame, and anger, the new parent will be better able to respond to the emotions driving the behavior rather than the surface behavior or symptoms. Unless the underlying emotions are addressed with sensitivity and within a safe, unconditionally loving, and supportive home, the behavior or symptoms are not likely to stop…they may change into other problems, but if the underlying cause remains, then the problems will surface again and again.

Let’s discuss the principles required. These principles are more fully elaborated elsewhere (Becker-Weidman & Shell, 2005; Becker-Weidman, 2007)

SENSITIVITY. Because children with trauma and attachment disorders are often unable to describe their internal states, emotions, or thoughts, it becomes the job of the parent to do this with and for the child so that the child learns to do this. Of course, this is precisely what one does with a newborn, toddler, and child. We often help children manage their internal states by doing that with them. When a baby cries, we pick up the baby, comfort the child, and by so doing, regulate the child’s level of arousal. Over time the infant becomes increasingly proficient at doing this independently. The parent of a foster or adopted child must be sensitive to the internal states of their child so that the parent can respond to the underlying emotions driving behavior.

RESPONSIVENESS. Once the underlying emotion is identified, the parent must respond to this need or emotion, with sensitivity. By meeting the child’s need (to feel safe, loved, cared about, for food, drink, joy, etc) the child will internalize new and healthier models of relationships and parents.

FOLLOWING THE CHILD’S LEAD. By this I mean that the parent will need to respond to the child and follow the child’s lead in the sense of providing what the child is needing (comfort, affection, support, structure, etc) and at the child’s pace. It is very important to move at the child’s pace to create the necessary sense of safety and security that these children need.

THE SHARING OF CONGRUENT INTERSUBJECTIVE EXPERIENCES. Intersubjectivity refers to shared emotion (also called attunement), share attention, and share intention. You can understand this if you think of playing a board game with your child. When you are playing some game together and enjoying the experience, you are sharing emotions (joy and a sense of competence), sharing attention (focusing on the game), and sharing intention (playing by the rules, both trying to win, having fun, etc.). Or another example, when talking about the death of the child’s loved grandparent, you both may share the same emotions (grief), both are recalling memories of the grandparent (shared intention and attention). It is the sharing of congruent intersubjective experiences, experiences in which all three elements are the shared, that helps the child heal and learn about intimacy and relationships.

CREATING A SENSE OF SAFETY AND SECURITY. Safety comes first. Unless the child is physically, emotionally, and psychologically safe, healing cannot occur. So, it is the job of the parent to create safety and security for the child. This then allows for the exploration of underlying feelings, thoughts, and memories. Without an alliance there can be no secure base. Without a secure base there can be no exploration. Without exploration there can be no integration. Without integration there can be no healing.

 

Unless the child feels safe, exploration is not possible.

So, what sort of parent is needed? We know form extensive research, that one of the best predictors of placement stability is the parent’s commitment to the child (Dozier, Grasso, Lindhiem, & Lewis, 2007). Therefore, building or rebuilding parental commitment is an important first step. Unless there is strong commitment, the child cannot feel safe and, as discussed above, safety is the most important first step in helping a hurt child heal.

Reflective capacity is also vital to placement stability and to the healing of adopted and foster children. The parent must be able to reflect on the child’s underlying emotions, how the past may be re-enacted in the present, and what in the parent’s own past is being triggered by the child. A well developed reflective function is necessary if the parent is to respond to the child in a healthy and healing manner. We all have buttons. The job of the therapeutic parent is to understand one’s buttons so that these can be disconnected so that when pushed, nothing happens.

Insightfulness (Koren-Karie, Oppenheim, Dolev, Sher, & Etzion-Carasso, 2002; Oppenheim, Koren-Karie, & Sagi, 2001; Oppenheim, & Koren-Karie, 2002; Oppenheim, Goldsmith, & Koren-Karie, 2005) is related to reflective capacity.

A parent’s state of mind with respect to attachment is the best predictor of the child’s. (Main, & Cassidy, 1988; Main, & Hesse, 1990). If the parent has a Secure state of mind with respect to attachment, then the adopted or foster child is more likely to develop a healthy and secure pattern of attachment and heal (Steele, Hodges, Kaniuk, Steele, Hillman, & Asquith, 2008). We know that when young children are placed in a foster home, the child will begin to develop a pattern of attachment that is the same as the foster parent’s state of mind with respect to attachment (Dozier, Stovall, Albus, & Bates, 2001). Obviously, in older children, this is a more difficult task. In the general population, about 60% of the adults have a secure state of mind with respect to attachment. For parents who have an insecure state of mind with respect to attachment, they can still learn to parent effectively with help (Becker-Weidman, A., & Shell, D., 2005/2008; Bick & Dozier, 2008).

USEFUL RESOURCES FOR PARENTS

 



Becker-Weidman, A., (2007). Principles of Attachment Parenting. 3-set DVD. Williamsville, NY: Center for Family Development.

Becker-Weidman, A., & Shell, D., (Eds.) (2005/2008) Creating Capacity for Attachment, Oklahoma City, OK: Wood N Barnes/ Williamsville, NY: Center For Family Development.

Golding, K., (2008). Nurturing Attachments. London: Jessica Kingsley.

Hughes, D. (2006) Building the Bonds of Attachment, 2nd edition, Jason Aronson, Lanham, MD. .

Siegel, D., & Hartzell, M., (2003). Parenting from the Inside out. Tarcher.



REFERENCES

Becker-Weidman, A., & Shell, D., (Eds.) (2005, 2008). Creating Capacity for Attachment, Oklahoma City, OK: Wood N Barnes & Williamsville, NY: Center for Family Development.

Becker-Weidman, A., (2007). Principles of Attachment Parenting. 3-set DVD. Williamsville, NY: Center for Family Development.

Becker-Weidman, A., & Hughes, D., (2008) “Dyadic Developmental Psychotherapy: An evidence-based treatment for children with complex trauma and disorders of attachment,” Child & Adolescent Social Work, 13, pp.329-337.

Bick, J., & Dozier, M., (2008). Helping Foster Parents Change. In H. Steele & M. Steele (Eds.), Clinical Applications of the Adult Attachment Interview (pp. 452-471). NY: Guilford.

Carlson, V., Cicchetti, D., Barnett, D., & Braunwald, K. (1995). Finding order in disorganization: Lessons from research on maltreated infants’ attachments to their caregivers. In D. Cicchetti & V. Carlson (Eds.), Child maltreatment: Theory and research on the causes and consequences of child abuse and neglect (pp. 135–157). NY: Cambridge University Press.

Cicchetti, D., Cummings, E. M., Greenberg, M. T., & Marvin, R. S. (1990). An organizational perspective on attachment beyond infancy. In M. Greenberg, D. Cicchetti & M. Cummings (Eds.), Attachment in the preschool years (pp. 3–50). Chicago: University of Chicago Press.

Cook, A., Blaustein, M., Spinazolla, J. & van der Kolk, B. (2003) Complex Trauma in Children and Adolescents. White Paper from the National Child Traumatic Stress Network Complex Trauma Task Force. National Center for Child Traumatic Stress, Los Angeles, CA.

Cook, A., Spinazzola, J., Ford, J., Lanktree, C., Blaustein, M., Cloitre, M. et al. (2005) Complex trauma in children and adolescents. Psychiatric Annals, 35, 390–398.

Dozier, M., Stovall, K., Albus, K., & Bates, B. (2001). Attachment for infants in foster care: The role of caregiver state of mind. Child Development, 72, 1467-1477.

Dozier, M., Grasso, D., Lindhiem, O., & Lewis, E., (2007) “The role of caregiver commitment in foster care,” in D. Oppenheim & D. Goldsmith, (Eds.) Attachment Theory in Clinical Work with Children. NY: Guilford.

Dozier, M., Stovall, K. C., & Albus, K. (1999). Attachment and psychopathology in adulthood. In J. Cassidy & P. Shaver (Eds.), Handbook of attachment (pp. 497–519). NY: Guilford Press.

Finzi, R., Cohen, O., Sapir, Y., & Weizman, A. (2000). Attachment styles in maltreated children: A comparative study. Child Development and Human Development, 31, 113–128.

Gauthier, L., Stollak, G., Messe, L., & Arnoff, J. (1996). Recall of childhood neglect and physical abuse as differential predictors of current psychological functioning. Child Abuse and Neglect, 20, 549–559.

Greenberg, M. (1999). Attachment and psychopathology in childhood. In J. Cassidy & P. Shaver (Eds.), Handbook of attachment (pp. 469–496). NY: Guilford Press.

Koren-Karie, N., Oppenheim, D., Dolev S., Sher, E., & Etzion-Carasso, E. (2002). Mothers’ insightfulness regarding their infants’ internal experience: Relations with maternal sensitivity and infant attachment. Developmental Psychology, 38, 534-542.

Lyons-Ruth, K., & Jacobvitz, D. (1999). Attachment disorganization: Unresolved loss, relational violence and lapses in behavioral and attentional strategies. In J. Cassidy & P. Shaver (Eds.), Handbook of attachment (pp. 520–554). NY: Guilford Press.

Main, M., & Cassidy, J. (1988). Categories of response to reunion with the parent at age six: Predictable from infant attachment classifications and stable over a one-month period. Developmental Psychology, 24, 415–426.

Main, M., & Hesse, E. (1990). Parents’ unresolved traumatic experiences are related to infant disorganized attachment status. In M. T. Greenberg, D. Ciccehetti & E. M. Cummings (Eds.), Attachment in the preschool years: Theory, research, and intervention (pp. 161–184). Chicago: University of Chicago Press.

Malinosky-Rummell, R., & Hansen, D. J. (1993). Long-term consequences of childhood physical abuse. Psychological Bulletin, 114, 68–69.

Oppenheim, D., Koren-Karie, N., & Sagi, A. (2001). Mothers’ empathic understanding of their preschoolers’ internal experience: Relations with early attachment. International Journal of Behavioral Development., 25, 16-26.

Oppenheim, D. & Koren-Karie, N. (2002). Mothers’ Insightfulness Regarding their Children’s Internal Worlds: The capacity underlying secure child-mother relationships. Infant Mental Health Journal, 23(6), 593-605.

Oppenheim, D., Goldsmith, D., & Koren-Karie, N. (2005). Maternal Insightfulness and preschoolers’ emotion and behavior problems: Reciprocal influences in a day-treatment program. Infant Mental Health Journal.

Prino, C. T., & Peyrot, M. (1994). The effect of child physical abuse and neglect on aggressive withdrawn, and prosocial behavior. Child Abuse and Neglect, 18, 871–884.

Robins, L. N. (1978). Longitudinal studies: Sturdy childhood predictors of adult antisocial behavior. Psychological Medicine, 8, 611–622.

Schreiber, R., & Lyddon, W. J. (1998). Parental bonding and current psychological functioning among childhood sexual abuse survivors. Journal of Counseling Psychology, 45, 358–362.

Steele, M., Hodges, J., Kaniuk, J., Steele, H., Hillman, S., & Asquith, K., (2008). Forcasting Outcomes in Previously Maltreated Children. In H. Steele & M. Steele (Eds.), Clinical Applications of the Adult Attachment Interview (pp. 427-452). NY: Guilford.

 



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Contrary to popular belief, Existentialism did not die out along with student riots, free love, and LSD. In fact in recent years it has made a resurgence in, of all places, psychotherapy and coaching. I am an Existential Psychologist practicing in Brighton & London UK, and here I will outline how existential philosophy can form the basis of an increasingly popular approach to helping professions.

Mention the word ‘existential’ and what probably comes to mind is an atmospheric little Parisian cafe along the Left Bank of the Seine, beret-wearing depressives huddled together smoking Gitanes and pontificating about the meaning of life. It’s a stereotype from the sixties associated with the philosophy and the political antics of such notaries as Jean-Paul Sartre and Simone de Beauvoir. What’s less known is that since the late 1980s there has been a resurgence of existentialism in the English-speaking world, most notably within the hotbed of North London psychotherapy society.

This so-called ‘British School’ of Existential Therapy bases its psychology on the philosophies of Martin Heidegger, Jean-Paul Sartre, Soren Kierkegaard, Friedrich Nietzsche, and other continental philosophers. Though each of these philosophers has something unique to say, they all stress individual responsibility, the freedom to choose our lives, and living in full awareness of the unavoidable limits to life, including of course mortality. What we decide to value and believe in life governs our conduct, allowing us to succeed and feel safe in certain ways while also creating difficulties in other areas of life.

Therefore our problems in living originate from conflicts within our outlook on life: For example, the belief “I cannot show any weakness” conflicts with the fact that “I need to be vulnerable in order to have a meaningful relationship”.

From this perspective, many psychological problems arise from our deeper assumptions about life or attempts to ignore the limits of life. Depression, stress, anxiety, despair, are not ‘illnesses’ per se but are all expressions of conflict and inconsistencies in our beliefs about life.

The existential therapist assists the client to actively explore their assumptions, their orientation to life, and to live in greater awareness of the vast range of possibilities open to them. A basic question in existential therapy is ‘why are we not more open to all the experiences life has to offer?’

Existential therapy is much more ‘of the world’ than many other forms of therapy. Like cognitive behavioural therapy, it looks closely at each person’s way of thinking and perceiving, our assumptions and choices. Like psychoanalysis, it looks at our relationships and how these reveal what we’ve made of ourselves. But unlike both of these approaches, existentialism emphasises the unknown in life, the mysteries that exceed all knowledge. For this reason existentialism has often been called the ‘Buddhism of the west’.

Exploring how we limit our own perceptions and the ways that we restrict our own freedom can help us to expand beyond a narrow range of possibilities. Every assumption (for example how we think others see us), every response (for example to crisis or boredom), can be quietly explored. There is meaning in everything.

The way we live everyday life, even the way the client interacts with the therapist in the consulting room can reveal so much. Existential therapists must also, like any human, grapple with how to create meaning in their own lives. In this respect existential therapy accepts that there are no experts on life and that we each must find our own answers to the paradoxes we encounter day to day. Together the therapist and client try to see the big picture, the context within which we act daily. Existential therapy and coaching sessions can take the form of lively dialogue and deep insight.

As well as the resurgence of existential psychotherapy, and the new field of existential coaching, in the past few years existential philosophy has also become the basis for a new approach to legal mediation. Lawyers are being taught existentialism in order to understand the psychological depths of clients involved in legal conflicts. Also, an existential therapy team now works with patients and their families in a large teaching hospital in London. Underpinned by existential philosophy, these practices are able to raise some of the paradoxical questions about human living that current culture, even within the psychology professions, tends to gloss over.



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IMPROVING THE LIVES OF MENTALLY ILL PEOPLE

 - BEYOND MEDICATION

 

Psychiatry is a unique speciality in medicine. It deals with the mind/psyche rather than the physic/body. Psychiatry is also the only branch of medicine that treats conduct and if necessary against the wish of the patient. In our country the mainstay of treatment of mental illness is still with pills/medicine alone, which is based on medical model. Psychiatrist tends to treat mentally ill people physically in the absence of any known physical pathology.

 

All over the world psychiatric services are rendering treatment based on an integrated model which takes care of the mentally ill person as a whole rather than treating the illness with medicine alone. The integrated model of treatment takes into accounts the individual psychological factors and socio-economic circumstances that have an impact on the mental health of mentally ill patients.

 

World Health Organization defines mental health as follows:

 

“Mental health is a state of well being in which the individual realises his/her abilities, can cope with normal life stresses, can work productively and fruitfully and is able to make a contribution to his/her community “

 

Can we restore the mental health as stated above with PILLS alone following the medical model of mental illness?

If we carry on with the medical model of mental health which locates problems solely in the individual then we will continue to ignore critical factors which influence mental health and well being.

 

Let us look into the following vignette.

 

Mrs.Suba is 44, married with four children. Her husband is an auto driver. She is warm, intelligent and caring homemaker living in a joint/extended family and coped well with life until ten years ago when she suffered with the first episode of depression following her first childbirth. Since then she had several admissions to psychiatric hospital. Her treatment consisted mainly of medication. She has been prescribed twenty different drugs and has been taking at least one or two of them since 10 yrs.

During her recent admission psychotherapy (talking therapy/ counselling) was offered to Suba to try and understand the background to and reasons for her depression. The psychiatrist who has been treating her for many years was not happy about this idea and agreed to it reluctantly. Suba also had mixed feeling about starting psychotherapy as she knew little about it and her family had been told that her depression is due to recurrent illness. But she gave a go. For the first time she opened up and talked about her feelings and the thoughts and incidences that precipitated depression. In the following sessions the psychotherapist continued to trace the roots of her depression. Therapist also looked into her childhood for the origin of her coping styles. Suba was able to work through and come to an acceptance of her past and ventilated the painful pent up feelings, which were inside her. Her feelings were not just dismissed or labelled. They were acknowledged and validated.

Suba slowly gained insight about the maladaptive thoughts and coping skills and started to make changes in her life with the support of the ongoing therapy.

As she was living in a joint family, her interaction with other members of the family was actually maintaining her depression in a way. She became aware of these and developed her interpersonal skills and worked towards bringing about changes in her family too.

She became a stronger person who could cope well with the normal life stresses and did not let them precipitate another episode of depression.

The psychotherapy gave us a way of understanding Suba’s depression as part of her whole person by understanding all her past and present experiences and relationships, rather than just as an unpleasant mental illness.

 

 Merely managing mental illness by containing the symptoms with medication is not the real recovery. It needs a change on a whole-person level with the help of combined effort through integrated model.

 

In a busy outpatient consultation, it is easier for psychiatrist to fall back on something they did know about i.e. medical-style treatment consisting of psychiatric assessment, diagnosis, biological investigations, medication and hospitalisation which ignores seeing the patient as a PERSON but only as an isolated phenomenon. This leaves the patient in the same situation and prevents from striving for change because the psychiatrist has defined the problem in such a way that the patient is prevented from realising that change is necessary. Moreover the psychiatrist is pushed to repeat the same because of the success in treating the previous episodes of illness with medication and make them reluctant to try psychotherapy.

 

The underlying message is that treating patients with PILLS/MEDICATION alone may be appropriate for any sort of physical illness but not for mental ill. Treating mentally ill person with medicines alone based of medical model is like treating the diseased tree with medicinal sprays and ignoring to strengthen the roots.

 



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Individuals seek therapy for a variety of reasons. Usually, they are seeking help for a personal issue. Some patients go into psychotherapy expecting to have their issues resolved right away. In order to see the full benefits of talking therapy a patient must attend sessions for quite some time. Psychotherapy seeks to help a patient understand the causes of their problems by identifying the triggers behind negative thought patterns or destructive behaviors. The full benefits of psychotherapy can only be seen in the long term.

Of course, simply attending psychotherapy sessions is not enough. Patients must actively engage with their treatment program and find a therapist that works personally for them. A patient should be able to completely trust his or her therapist; without this trust, it can be difficult for a patient to make progress. If a patient has a good relationship with a therapist, over time, there should be marked improvement in several areas of life.

Individuals who have spent some time in therapy find that their personal lives improve. Psychotherapy does not just help individuals deal with their own personal issues, it also helps patients develop strategies for when they interact with others. Patients learn that they cannot control others; they can only control themselves. Learning the best ways to maintain self-control and diffuse a problematic situation takes many sessions.

Therapy can help patients better their professional lives as well. The conflict resolution techniques they will learn will help them deal with co-workers as well as friends, and family. Therapy can also help individuals determine what they truly out of life. Once a person understands what they truly want, they will be able to determine a career that is meaningful for them. Then at work they will feel engaged enough to perform well, gain advancement, and find fulfillment.

If a patient is suffering from any form of addiction, therapy can help that person get and stay clean. Addiction sufferers have stated that quitting is not the hard part. Anyone can put down alcohol or drugs for a few minutes. Staying clean is the most difficult part of the recovery process. Regular sessions with a psychotherapist keep former addicts on track. They will have someone to talk to about problems they face during the ongoing recovery process. A short period of therapy will not provide an addiction sufferer with the support they need to make a full recovery.



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NYC therapy is therapy that is used to help people and it is derived from the social science called psychology. It is a practical science that is used to help understand the world around us and how it affects the human being in his environment.

Psychology contains issues that concern everyone and can be very diverse. One end of the spectrum is mental illness while the other end includes many social questions. Generally, NYC therapy deals with the stress that affects people in their every day lives.

It may also deal with sleep cycles and their difficulties for many people, improving mental skills like memory and how a person learns. One thing that we can be clear on is that psychology deals with issues that affect the development of human beings from the cradle to the grave and in time may proceed past that. It also investigates body processes and how they effect emotion.

An example of this would understand the reason why the environment may affect the neurotransmitters in the brain, bringing on some mental illnesses which often change our behavior.

New York City is renowned around the world for its culture, movies, fashion, economics and art. Although it is flexible and diverse; change is not a new concept in this city. It can also be conservative and traditional. If something new comes in the way of treating people with therapy, you would not be wrong in suggesting that the idea was first used in NYC therapy.

NYC therapy offers traditional therapies that have been designed to meet the social changes that have taken place over time. NYC therapy is the first place to offer people who have a busy schedule therapy on the run. Instead of having to go to a psychologist’s office, your psychologist will meet with you on the way to where you are going.

You might wind up meeting in central park because it is on the way to where you need to be. The people who are able to get this kind of therapy are the largest percent of the population. Children, friends, family and work combined with a busy life style bring on stresses that if not dealt with tend to manifest themselves.

NYC therapy can help individuals get back on track and reconnect with their lives so that they are relatively peaceful rather then in constant turmoil. NYC therapy also helps people with many other problems such as depression, anxiety, panic disorders, eating disorders, personality disorders and pain that is chronic and often coupled with chronic fatigue commonly referred to as somatic complaints, post traumatic stress disorders and obsessive compulsive disorders.

You will find the most common NYC therapy to be much the same as therapy that is practiced anywhere else. Cognitive behavior therapy assists people in recognizing negative thoughts and maladaptive beliefs. This is a type of insight therapy because its emphasis is on recognizing the problems you have so you can change them.

Psychoanalytic therapies that were originally developed by Freud, explains personality and what motivates the behavior that is usually unconscious. Systemic and family therapies focus on the problem and how it affects the whole which is the family.

Other types of NYC therapy include cognitive analytic, humanistic therapy in which the therapist is trained to be empathetic and supportive, so that their clients feel safe and know that their problems and who they are, are understood and respected.

Group analysis, art therapy and expressive arts that help a client deepen self expression, body-oriented psychotherapy that helps the client to understand that we can heal and transform ourselves from the painful memories of the past. Therapy that helps a person understand the past and the personal issues that come from past relationships so that the present can bring healing is Psychodynamic psychotherapy.

NYC therapy is easily obtainable through many different areas. People looking for therapy can find information and referrals through their family doctor. They can also find therapy through the mental health community, hospitals both public and private, community health centers, universities and some businesses.

Private NYC therapists give quality therapy because of their long standing practice and knowledge that they have obtained, not only through their education, but through their experience as well. Types of therapy and where to get the therapy you are looking for can be found on websites that show people where to go and how the therapy works.

Many of the online sights give you maps of the area in which to define your search parameters to make your search that much easier. NYC therapists do their best to help you succeed in the changes you wish to make in your life, or to correct and change life issues that are stopping you from enjoying life to the fullest of your ability.

NYC therapists work with their clients in a friendly relaxed manner that is responsible, ethical and empathetic.



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When you really look closely at anxiety, depression, fear, anger or stress, you will almost always find recurring patterns of negative thoughts, traumatic memories and habitual emotional reactions. They are our tormentors, the pesky biting insects that annoy us throughout the day. They ambush our consciousness, pull us down and cause stress and emotional suffering. They come uninvited, cause havoc, and we wish that they would go away. If only we could control them, we would certainly have a better chance of controlling our mental state. So how do we do this? The practice of mindfulness and mindfulness meditation can provide a path forward.

The first step of mindfulness practice, and one that can make all the difference, is to fully and completely understand that YOU ARE NOT YOUR THOUGHTS. Thoughts, emotions, in fact any mental content that arises are simply products of conditioning; YOU are much more than this. It is like the ocean and the fish that swim in the ocean. The ocean is not the same as the fish that live in it, and cannot be equated with the contents. The essence of the ocean is as the space that contains these things, not its contents. The same applies to the mind. The essence of the mind is as a container of experience, the ground in which mental objects, thoughts, emotions, beliefs, perceptions and memories can exist. When you realize this, that you are so much more than your thoughts and emotions, then you are well on the way to gaining your freedom and independence from the pesky flies that cause so much stress and suffering. At the end of the day you have a simple choice to make: Do you want to be the ocean in all its vastness and glory, or do you want to be a fish, flapping around in a state of agitation and fear? Learning to be the ocean is a wise choice, and this is something that can be achieved through the practice of mindfulness.

The trick is to learn to see mental objects as just that, objects, not you, that arise, do their dance and then pass away. Anxiety arises, and what is our usual response? We are ambushed by the emotion and we become the emotion. We become an anxiety-fish! Fear arises and we are seduced into becoming afraid, a fear-fish. Anger arises and we become angry-fish. No choice, no freedom, lots of suffering.

With the practice of mindfulness, we begin to get wise, and become more engaged with what is going on in our minds. Mindfulness helps us tune in to this cycle of habitual emotional reactivity. Instead of blindly accepting our impulses to become anxious, to become afraid, to become fish, we learn to actively engage with these reactions. When anxiety thoughts arise, we respond with, “I see you, anxious thought. I welcome you, I will make a space for you to do your dance, I will listen to you with care and attention…but I will NOT become you.” You can learn to mindfully greet each emotion, each negative thought, as a visitor who has come to stay for a while, just like visitors in your home. Invite them in, offer them tea and sit with them for a while. You may not like your visitors, but you know the importance of being kind, courteous and hospitable.

You cannot get rid of your negative emotions, your depression and fear by force, which is our usual reaction. We don’t want to feel our anger or fear; we want to fix them so they won’t bother us. But, here’s the thing. You can’t. Why not? Because you created them. Its like asking a wolf to guard the farmer’s chickens. A system that is broken cannot fix itself.

What is needed is something altogether more creative, and this is the second step of the practice of mindfulness: Actively turn towards your suffering and work on creating a safe relationship with your fish. When you are mindful, you are by definition not being reactive. The effect of this is to create a space around the emotion. The more mindful you are, the greater the space. The more space there is, the more freedom. Freedom from what? Freedom from the grip of the negative emotion, thought or belief. There is a Zen proverb: What is the best way to control a mad bull? Answer: Place it in a very large field. If there is plenty of space, then the mad bull, or your anxiety, hurt, trauma or depression cannot harm you. Also, what is equally important is that the mad bull can’t hurt itself. This is very important, because both of you need the space in which to heal.

Mindfulness creates therapeutic space in which emotional knots can move, unwind, unfold, soften and become workable. And, what is most remarkable, if you create lots of space around your suffering, the suffering has a chance to transform and heal itself. Its not what you do that matters so much as creating this transformational therapeutic space and allowing emotions to change themselves from the inside out.

In my work as a psychotherapist, I never cease to be amazed at how effective mindfulness can be when used correctly. The moment when a client stops running away and turns towards his or her suffering with kindness, full attention and engaged presence, things start to change in a beneficial direction. The healing comes from the quality of the relationship that we have with our pain. It’s not about trying to fix things, trying to replace negative thoughts with positive thoughts – it’s all about presence. With this quality of listening, based on genuine openness and gentleness, the relationship of mindfulness, solutions appear quite naturally.

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Peter Strong, PhD is a scientist and Buddhist Psychotherapist, based in Boulder, Colorado, who specializes in the study of mindfulness and its application in Mindfulness Psychotherapy. He uses Mindfulness-based Psychotherapy in combination with NLP to help individuals overcome the root causes of anxiety, depression, phobias, grief and post-traumatic stress (PTSD). He also teaches mindfulness techniques to couples to help them overcome habitual patterns of reactivity and interpersonal conflict.

Besides face-to-face therapy sessions, he also offers the ever-popular Online Psychotherapy and Counseling service, in which he teaches clients specific strategies for working with emotional stress through a combination of email correspondence and Skype sessions. Peter also offers teaching seminars to groups, and companies with an interest in stress management. If you want to learn Mindfulness Meditation, we can do that through email correspondence and Skype. Visit http://www.mindfulnessmeditationtherapy.com

Email enquiries welcome.

If you have found this article useful and would like to support the work of Dr Strong and Mindfulness Meditation Therapy, please consider making a donation by PayPal by visiting my website. Donation button located under Blog/Articles.



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If you want to get an idea of what psychotherapy s all about, watch an episode of the television series The Sopranos. Tony Soprano is a mafia don in New Jersey who is in talk therapy with Dr. Jennifer Melfi. He has panic attacks, loses consciousness, and has slipped into a depression. All of this seems irrational to him, but he can’t help it. He has some hidden agenda lying just outside his awareness that is controlling his feelings and behavior. He doesn’t believe in therapy at the start, convinced he cannot talk about himself and that it won’t help anyway. He resists, evading Dr. Melfi’s questions, withdrawing, and even walking out. But eventually he is intrigued.

Aspects of his unconscious experience expressed in his dreams and in the triggers of his panic attacks come together. For Tony, ducks and their babies stir up a deep-seated dread having to do with his tortured relationship with his malevolent mother. He begins to have some conscious awareness of what is really bothering him in his depths. And he begins to feel better. This is what psychotherapy is about – an exploration of one’s internal world, conscious and unconscious, played out in the relationship between the patient and the therapist, designed to alleviate pain and suffering.

Psychotherapy is a conversation, a two-person enterprise in which both participants contribute to an evolving relationship. The therapist’s task is to create a safe atmosphere in which the patient can open up and express feelings he may have repressed his entire life. She analyzes his defenses against these feelings – his joking, forgetting, intellectualizing, rationalizing, denying, avoiding, and withdrawing into silence. And she offers ways of understanding his experience, leading him toward self-awareness.

The patient’s task is to open up as much as possible, say whatever comes to mind, note whether the therapist’s attempts to understand him click at a gut level, and tell her the reactions he has to what she offers. Together they uncover the meaning of the patient’s words and deeds. Therapy sessions are emotionally rich and alive, full of moments of tenderness, closeness and intimacy, anger and hostility, silence and withdrawal, dead ends and moments of insight and even epiphany.

One of the ways in which therapy works has to do with the concept of transference. Freud discovered transference when his female patients regularly fell in love with him. He came to understand that patients experience their therapists like important figures from their infancy and childhood, unconsciously transferring intense feelings and needs onto the therapist for satisfaction. In this way, the patient relives and masters unresolved conflicts or developmental steps from childhood, so that he can progress in life with greater freedom and security. Furthermore, old relational scripts developed in early life are unconsciously repeated in the therapeutic relationship and are relinquished in favor of more adaptive ways of relating.

The process is often heated and painful, but endlessly rewarding. Symptoms, inhibitions, relationship problems, feelings of hopelessness or futility or purposelessness or despair, all improve or disappear as a result of treatment. Therapy is not an intellectual exercise. It is not advice. And it is not a quick fix. But given sufficient time, intensive psychotherapy can transform your personality and your life, allowing you the freedom to be yourself.



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Psychology is a field of study that has gained enormous popularity in almost every part of the world in last number of years. Obtaining a Counselling and Psychology degree offers plenty of diverse employment opportunities for example colleges, universities, public-sector organizations or market research firms as well as private practice. Depending upon aptitude and interest you can specialize in the various fields of Counselling and Psychotherapy.

In recent times, there has been an increasing demand for psychologists in almost every sector and as a result many colleges and institutes are offering psychology degrees and counselling degrees at graduate level. Besides this, many online schools have also started offering online bachelor degrees in psychology. Consequently you must be very careful about selecting any of these programs. Here are few important guidelines that you need to look for while selecting a bachelor program in Counselling and Psychotherapy:

Cost of a program – Find out how much the course is going to cost you. Not just for one year but for the full course if you are considering a degree course. Take into account the cost of books and any other expenses and budget for them. Beware if courses advertised seem to be excessively cheap. Make sure you get what you pay for.

Faculty base – You need to know that the standard of those who will be teaching you is up to the standard that you would expect of a top notch educational facility.

Curriculum – Curriculum is vitally important. The curriculum must be acceptable to the accrediting agency in the jurisdiction in which you are studying. In the case of Counselling and Psychotherapy topics must include such subjects as: Counselling Theory, Therapeutic Intervention Strategies, Client / Counsellor Relationships, Work Experience and many others. Choose an institution that will provide you with all the information about the curriculum before you commit to the course and you can rest assured that the curriculum provided will always meet the requirements of the course.

Accreditation of a school – In any college or university, there are different types of accreditation, but the most important one is regional accreditation. These are the one’s that are recognized by the government and by employers. In Ireland HETAC and FETAC are the recognized accreditors in conjunction with recognized universities, colleges and Institutes.

Today a career in psychology is definitely rewarding but at same time it also demands a proper selection of program along with right school. Thus, the above mentioned points can be considered as few important guidelines that may help you in selecting a proper bachelor program in psychology and counseling.



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Forward-looking long term care administrators have long pondered how to eliminate the dejection and malaise that infests their facilities. They have heard about culture-change and tried various solutions: staff wearing regular clothes, pleasant bird cages, providing more resident options and meetings about communication skills with the staff.

However, nothing seems able to generate the meaningful changes needed for a pleasant and more optimistic environment.

How Do You Transform Long Term Care from Being A Festering Incubator of Malaise and Hopelessness to Becoming an Uplifting Gallery to Resident Achievement and Accomplishment?

I have practiced clinical psychology for 30 years and treated hundreds of elderly patients for depression and anxiety. I have concluded that insidious communication patterns within long term care facilities themselves are often at fault.

These, combined with the out-dated techniques used by the mental health providers they use, inadvertently create the conditions which cause residents to be even more depressed and dejected.

There is a growing concern that the only mental health care residents often get is from geriatric psychiatrists who often miss the feelings they experience about their plight. Just write a prescription, maybe tell them how their thinking processes are distorted, check in occasionally and see you later.

The use of medication is often the only treatment a resident receives, even though the research literature clearly and consistently emphasizes that it must be combined with psychotherapy to achieve optimal outcome.

However, many psychologists use pathology-driven psychotherapy in their treatments. They build and expand on the problems and repeated complaints of the resident thereby encouraging their impact on his/her awareness. They often contribute to the lack of significance and de-humanization residents feel because their approaches are often too impersonal, mechanistic and dismissive. Consequently, resident losses continually loom larger in consciousness.

They generate impersonal case histories, which fail to illuminate each individual’s experience in the struggle to survive illness. Residents, too, increasingly complain about this crisis of having no meaning-nothing to live for.

This underscores the need for a cutting-edge mental health program that addresses meaning obtained by the resident from his/her travails and his/her strengths and successes, no matter how small. This dignifies him/her. After all, that is what culture-change is all about!

What Most Mental Health Providers Do Not Know about How Residents in Long Term Care Become So Depressed

Conventional mental health providers miss the point that the resident makes sense of his/her world by creating a coherent facility persona by subconsciously crafting a particular story and role for him/her in it. We have all seen the abandoned residents, betrayed residents, and the ostracized residents. When we see no objective verification, we conclude that they are the result of internal dramas that the residents are really feeling and living which have been created by inadvertent, though insidious, hypnotic processes taking place in the facility itself.

Just like the stage hypnotists subject really feels like and becomes a barking dog, the facility resident becomes and feels like a victim drowning in his/her own tragedy. Therefore, the residents hopeless story, though not necessarily a FACT, becomes one.

And unfortunately the screaming misery that results becomes the biggest FACT of all!

Implications For Your Facility:

This insidious waking hypnosis is induced by repetitive problem-saturated conversations taking place in the facility. THAT IS Right! The CNAs, nurses, therapists, families, doctors and residents themselves unknowingly collude, by their use of various interactions and words, to create a reality which is catastrophic, demoralizing and futile.

We undergo waking hypnosis all the time e.g. in the theatre when an endearing character dies we may cry and feel hopeless; if our parents continually told us how stupid we were, we may grow up actually feeling stupid. THE SAME SITUATION can be perceived differently by different people based on the story of themselves that was internalized by repetitive pervasive conversations.

One person is treated for cancer and describes the therapeutic experience as miserable and the worst time in my life. Another describes it as just a difficult challenge.

Both had almost identical experiences and walked away with vastly different interpretations, stories and feelings. We learn thru repetition. Repeated suggestions and conversational themes associated with emotionally charged experiences are powerful in crafting a certain role for a resident in a particular story.

The residents internalized story can change over time because it is contingent on the type of consistent interactions in which s/he is engaged. Interactions or conversations need not be verbal, but are often composed of nonverbal components. A nurse who is gruff in manner is sending the suggestion that the resident is a pain or perhaps inept. Every interaction with a resident should be seen as resulting over time in a better or worse outcome for the residents felt sense of self.

Strength-Embedded Psychotherapy starts to treat resident depression and anxiety by using asset mining, a method of sensitively, yet tenaciously, unearthing any improvements, large or small, that can be credited to the resident. Then s/he implements the skillful use of conscious conversation: manifesting attention, imbuing constructive meaning and significance to resident suffering and replacing problem-saturated conversations with strength and progress saturated ones.

These techniques are reinforced by the long term care staff and are used over time with repetition and consistency. The therapist then incorporates them deftly in the residents internalized story, occasionally over his/her objections, so that the new plot can be internalized and eventually changed from one starring resident victimization to one showcasing mastery.

Throughout the process, the resident will often tenaciously attempt to revert to saturating conversations with problems and references to victimization. The resident craves continuity of the problem-saturated story which s/he has internalized.

After all s/he has depended upon it, often at great emotional cost, for a consistent sense of identity. However, with consistency and over time, the new trance starts to take effect with the resident experiencing him/herself as masterful and potent, rather than miserable and hopeless.

Compare SEP-strength-embedded psychotherapy with the usual pathology-focused techniques of most mental health providers. Talk to a resident for 15 minutes; just write a prescription and follow-up occasionally. If you are a psychologist, tell them how their thinking processes are distorted. Then over-use empathy to the point that the resident is repeating the same miseries and complaints over and over to the point that they loom ever larger in consciousness.

These pathology-driven treatments continue to infest long term care with dire results. They build on the problems of the resident and build their impact on his/her awareness. They often contribute to their insignificance and de-humanization because they are impersonal, mechanistic and dismissive. Consequently, resident losses continually loom larger in consciousness.

The train to culture-change is moving faster. Not changing your mental health provider to one who emphasizes strength and success-based approaches can put you in danger of being perceived as an uncaring dinosaur later. On the other hand, enthusiastically adopting it now can position you as a forward-looking pioneer who is contributing to the historic changes taking place in the long term care industry.



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