counselling Worthing

Talking, diet and sporting against depression

I work with clients with depression.

Some move and change some develop a different thinking, some work through. It all depends on the person. I do know however that I feel it is a privilege to be part of their journey and look at why, their life story and ways forward and or to change.

The two articles following argue that drugs don’t work and or that talking therapies are over looked.

I believe that talking to your doctor about taking medication is great, see what is right for you and also go get a therapist too, use both as an option. Reading can help, talking can help. A focused session where you have a set time concentrating on you is an opportunity. I also look at diet, exercise, social patterns and how you are as part of what I do.

 

 

  1. How to beat depression – without drugs
  • Jake Wallis Simons (http://www NULL.guardian NULL.co NULL.uk/profile/jake-wallis-simons)
  • The Guardian (http://www NULL.guardian NULL.co NULL.uk/theguardian), Monday 19 July 2010

Up to 20% of the UK population will suffer from depression – twice as many as 30 years ago, says Steve Ilardi. Photograph: Rob Lewine/Getty/Tetra

Dr Steve Ilardi is slim and enthusiastic, with intense eyes. The clinical psychologist is 4,400 miles away, in Kansas, and we are chatting about his new book via Skype, the online videophone service. “I’ve spent a lot of time pondering Skype,” he says. “On the one hand it provides a degree of social connectedness. On the other, you’re still essentially by yourself.” But, he concludes, “a large part of the human cortex is devoted to the processing of visual information, so I guess Skype is less alienating than voice calls.”

Social connectedness is important to Ilardi. In The Depression Cure, he argues that the brain mistakenly interprets the pain of depression as an infection. Thinking that isolation is needed, it sends messages to the sufferer to “crawl into a hole and wait for it all to go away”. This can be disastrous because what depressed people really need is the opposite: more human contact.

Which is why social connectedness forms one-sixth of his “lifestyle based” cure for depression. The other five elements are meaningful activity (to prevent “ruminating” on negative thoughts); regular exercise; a diet rich in omega-3 fatty acids; daily exposure to sunlight; and good quality, restorative sleep.

The programme has one glaring omission: anti-depressant medication. Because according to Ilardi, the drugs simply don’t work. “Meds have only around a 50% success rate,” he says. “Moreover, of the people who do improve, half experience a relapse. This lowers the recovery rate to only 25%. To make matters worse, the side effects often include emotional numbing, sexual dysfunction and weight gain.”

As a respected clinical psychologist and university professor, Ilardi’s views are hard to dismiss. A research team at his workplace, the University of Kansas, has been testing his system – known as TLC (Therapeutic Lifestyle Change) – in clinical trials. The preliminary results show, he says, that every patient who put the full programme into practice got better.

Ilardi is convinced that the medical profession’s readiness to prescribe anti-depression medication is obscuring an important debate. Up to 20% of the UK population will have clinical depression at some point, he says – twice as many as 30 years ago. Where has this depression epidemic come from?

The answer, he suggests, lies in our lifestyle. “Our standard of living is better now than ever before, but technological progress comes with a dark underbelly. Human beings were not designed for this poorly nourished, sedentary, indoor, sleep-deprived, socially isolated, frenzied pace of life. So depression continues its relentless march.”

Our environment may have evolved rapidly but our physical evolution hasn’t kept up. “Our genome hasn’t moved on since 12,000 years ago, when everyone on the planet were hunter- gatherers,” he says. “Biologically, we still have Stone Age bodies. And when Stone Age body meets modern environment, the health consequences can be disastrous.”

To counteract this Ilardi focuses on the aspects of a primitive lifestyle that militate against depression. “Hunter- gatherer tribes still exist today in some parts of the world,” he says, “and their level of depression is almost zero. The reasons? They’re too busy to sit around brooding. They get lots of physical activity and sunlight. Their diet is rich in omega-3, their level of social connection is extraordinary, and they regularly have as much as 10 hours of sleep.” Ten hours? “We need eight. At the moment we average 6.7.”

So we should all burn our possessions and head out into the forest? “Of course not,” Iladi shudders. “That would be like a lifelong camping trip with 30 close relatives for company. Nobody would recommend that.”

Instead we can adapt our modern lifestyle to match our genome by harnessing modern technology, such as fish oil supplements to increase our intake of omega-3. All well and good. But I can’t escape the feeling that the six-step programme seems like common sense. Isn’t it obvious that more sleep, exercise and social connectedness are good for you?

“The devil is in the detail,” replies Ilardi. “People need to know how much sunlight is most effective, and at which time of day. And taking supplements, for example, is a complex business. You need anti-oxidants to ensure that the fish oil is effective, as well as a multivitamin. Without someone spelling it out, most people would never do it.” Ilardi practises the programme himself. He’s never been depressed, he tells me, but it increases his sense of wellbeing and reduces his absentmindedness (his college nickname was “Spaced”).

It all makes sense, but will I try it myself? I don’t suffer from depression, but wellbeing sounds nice. I’m not so sure about the fish oil, but I might just give it a go.

Enjoy the sunshine, get plenty of sleep – and be sociable

▶ Take 1,500mg of omega-3 daily (in the form of fish oil capsules), with a multivitamin and 500mg vitamin C.

▶ Don’t dwell on negative thoughts – instead of ruminating start an activity; even conversation counts.

▶ Exercise for 90 minutes a week.

▶ Get 15-30 minutes of sunlight each morning in the summer. In the winter, consider using a lightbox.

▶ Be sociable.

▶ Get eight hours of sleep

 

 

2.Psychotherapy as Treatment Option for Depression Often Overlooked

By American Psychological Association

American Psychological Association

Last modified: 2012-10-10T19:01:21Z

WASHINGTON, Oct. 10, 2012 /PRNewswire-USNewswire/ — As mental health advocates observe and blog about World Mental Health Day today, the American Psychological Association (APA) is drawing attention to psychotherapy as an effective treatment option for depression and other mental health issues.

“Even though countless studies show that psychotherapy helps people living with depression and anxiety, drug therapy has become the most popular course of treatment,” says Katherine C. Nordal, Ph.D., APA executive director for professional practice.

APA launched a psychotherapy awareness initiative this Fall to educate consumers about psychotherapy’s effectiveness and encourage them to talk with their physicians about treatment options. APA’s efforts include resources about psychotherapy to help people understand how it works and a video series that illustrates the value of psychotherapy as a treatment option.

“Research shows that psychotherapy works. It is an effective way to help people make positive changes in their lives,” Dr. Nordal said. “We hope people will explore their treatment options to create a plan that gives them the skills they need to manage their condition.”

Mental health problems are one of the top three reasons why Americans seek medical treatment. In the United State alone, one in ten adults report having depression, which is being treated more frequently with medication — since the 1990s, the number of prescriptions for antidepressants more than doubled from 55.9 million to 154.7 million.

SOURCE American Psychological Association
Read more here: http://www.sacbee.com/2012/10/10/4899574/psychotherapy-as-treatment-option.html#storylink=cpy

YOLO, mindfulness in therapy

“Yolo” is a current piece of slang meaning you only live once. The question therapeutically for me is where is that once?  How do I impact right now, what is my part in right now, all great questions, yet by asking, are you taking yourself out of this moment?

Maybe it should read “timm,” this is my moment.

Eckhart Tolle states ” Whatever the present moment contains, accept it as if you had chosen it.” We often believe we have done just that, yet habits are hard to break and we look for confirmation in life that our habit, be that addiction, an eating disorder, a panic attack, depression, being a workaholic, any habit in fact, is one of choice. Is it? Chemically, biologically, phenomenologically and psychologically?

Research on the brain has shown that the brain will shape path ways to avoid pain. We are scared of making the same mistake again so avoid repetition and avoid the potential in the future. That effectively takes us out of right now. We attach a bungee cord to that time when we felt x, it is familiar, safe, so we are ripped straight back to that point as if on the fairground running as fast as we can until that stretch is so uncomfortable we are pulled back.

This means we are stuck in doing, rather than being. How many human doings do you know? I’ll do it, leave it to me, of course I can, I will, I’ll sort it, let’s do something different, let’s sort this, what is the solution?

http://www.psychologytoday.com/blog/the-mindful-self-express/201204/learning-be-present-yourself

John Kabat-Zinn suggests that

“Our brains operate primarily in ‘Doing’ Mode. We actively use our minds to solve problems, make plans, anticipate obstacles, evaluate how far we are from desired goals and choose between alternatives by judging their relative value.  While “Doing” mode is extremely useful for helping us advance in our careers, be popular, lose weight, and a myriad of other life tasks, it falls short when it comes to managing emotions.  Emotions cannot be reasoned away or “solved” and evaluating how far we are from feeling as happy as we’d like to feel only makes us feel worse.  This type of thinking can actually exacerbate “sad” emotions by introducing a second layer in which we criticize or judge ourselves for being sad. “Doing” mode also doesn’t work when there is nothing we can do to change the situation. We may desperately want to be married, rich, loved, or successful, but we cannot force these outcomes to happen right away, even with the best of efforts. “Doing” mode can also lead to disheartening comparisons with people we feel are doing better than us and ruminations of why we are not where they are.

 

living fully in the now

“Being” as an Alternative to “Doing”

 

Now, nobody is suggesting that we give up “Doing” mode altogether. If this were the case, we would never even find our keys to get out the front door. However, there is another way of being that many of us are not even aware of, and that is “Being” Mode. Unlike its counterpart, “Being” mode is not action-oriented, evaluative, or future-focused. It involves slowing down our minds and deliberately grounding ourselves by focusing on what we are experiencing right now. In “Being” mode, it is okay to just be us, whatever we happen to be experiencing; we do not try to change our thoughts or emotions into more positive ones or shut out aspects of our experience. Rather, we begin to develop a different relationship with our own senses, bodily states and emotions by deliberately focusing on what they are trying to tell us and allowing ourselves to be compassionately open to these messages.

“Being” mode involves accepting what is, because it will be there anyway. We begin to release energy, relax, and let go of the struggle to mould our reality into our preconceived ideas of what it should be. We begin to let go of judgments and regrets about the past and fear of the future. Rather than berating ourselves for not achieving the status in life we think we deserve or are entitled to, we allow ourselves to look fully and open-mindedly at where we are. Eventually we realise that this may not be so bad. We learn to extend love, compassion, and kindness to ourselves, and everything around us, rather than compartmentalizing reality into “good” and “bad,” or “winners” and “losers.”  We are all infinitely more complex than what we  earn or own; we are lovable and interesting, just by being human. This moment is just this moment and not where we are stuck forever. Ironically, by accepting the present, we open up space for internal and external movement and change.

 

The Advantages of “Being” Where We Are

”Being” mode is a core component of mindfulness and spiritual practices. It is something that requires practice and training because we need to overcome our minds’ natural habits and fear-based biases. Experiencing “Being” mode can help us feel more whole and relaxed; we move from reacting automatically to having more choices about how we respond, based on a fuller understanding and acceptance of our own sensory, physical, and emotional experience.  It is the opposite of dissociation and avoidance that many people use to cope with negative emotions and situations.  We activate the more loving “approach” circuits of our brain and move away from the “avoidance” modes.”

 

 

Recent research also shows that with fear and anxiety, which is clearly heightened when our brain is actively searching for that,”do over” to avoid,  feeds the brain’s chemical reactance creating adrenalin and cortisol. The more afraid we are the more fear we feel, that might happen, it did once, what if, I can’t, yes but…
Embrace the fear, I’m ok, I’m frightened, I’m worried. Treat the adrenalin shot like a free can of Monster or red bull. Wow, I have this energy right now, just think of all I can do and be feeling like this.
Practice mindfulness, living in the here. The following are a few exercises on mindfulness.
Breathe
Put your hands with the fingers just touching under the “bra strap line” as you breathe in; the idea is that your fingers will separate. This is breathing using the diaphragm.Once you can breathe, look at a clock and start timing 60 seconds. Focus on nothing but your breathing, if you start thinking, start again and aim for as long as you can, purely focus on breathing. Preferably with your eyes open. Some people take years to learn to do this, so be kind and don’t expect success or failure, be in the moment and breathe.

Counting

Count to ten, gently and slowly. As soon as your mind wonders and goes off on a tangent, start again, focus on the counting

Observation

Pick up anything close to you, feel it and get lost in it. Don’t think, define, analyse, critique it. Be with it and truly see what it is.

 

A mindfulness app on modern phones is a great reminder. While you’re at work or out, a gentle randomly timed bell goes off reminding you to be.  If you don’t have a smart phone, pick a sound you hear randomly during the day. Could be a phone, a tweet, an animal, a voice, pick anything and use it as a cue to be.

 

Being in the moment can affect panic attacks, anxiety, eating disorders, addictions, depression, self esteem and much more.

 

Therapy enables many to work out what happened yesterday, that shapes tomorrow and IF that is a choice we want to make now

 


 

Sleep is often linked to psychological issues, how much and when is enough?

There are many links to psychological conditions and our sleep. We must get 8 hours, best before midnight etc. Whats true though?

 

Monday’s medical myth: You need eight hours of continuous sleep each night

Waking up in the night is perfectly normal.

We’re often told by the popular press and well-meaning family and friends that, for good health, we should fall asleep quickly and sleep solidly for about eight hours—otherwise we’re at risk of physical and psychological ill health.

 There is some evidence to suggest that those who consistently restrict their sleep to less than six hours may have increased risk of cardiovascular disease, obesity and diabetes. The biggest health risk of sleep deprivation comes from accidents, especially falling asleep while driving. Sleep need varies depending on the individual and can be anywhere from 12 hours in long-sleeping children, to six hours in short-sleeping healthy older adults. But despite the prevailing belief, normal sleep is not a long, deep valley of unconsciousness. The sleep period is made up of 90-minute cycles. Waking up between these sleep cycles is a normal part of the sleep pattern and becomes more common as we get older. It’s time to set the record straight about the myth of continuous sleep—and hopefully alleviate some of the anxiety that comes from laying in bed awake at night. So what are the alternatives to continuous sleep?

The siesta

The siesta sleep quota is made up of a one- to two-hour sleep in the early afternoon and a longer period of five to six hours late in the night. Like mammals and birds, humans tend to be most active around dawn and dusk and less active in the middle of the day. It’s thought the siesta was the dominant sleep pattern before the industrial revolution required people to be continuously awake across the day to serve the sleepless industrial machine. It’s still common in rural communities around the world, not just in Mediterranean or Latin American cultures. Our siesta tendency or post-lunch decline of alertness still occurs in those who never take afternoon naps. And this has less to do with overindulging at lunchtime and more to do with our circadian rhythms, which control our body clock, hormone production, temperature and digestive function over a 24-hour period
Read more at: http://medicalxpress.com/news/2012-08-monday-medical-myth-hours-eachnight.html#jCp (http://medicalxpress NULL.com/news/2012-08-monday-medical-myth-hours-eachnight NULL.html#jCp)

On the road DNA daddy van, ethical implications?

 

Who’s your daddy van?

Morality and therapy aren’t bed mates. Ethics and therapy are. I was interested  to read that for £2/300 you can flag down a man in a van and ask for a DNA test in nyc right now.
What are the moral and ethical implications for this? Could  counselling and therapy be involved as the potential fall out is catastrophic for some with huge emotional and financial implications. For the person asking, the other parent and especially the child.  If the test is the easy part, what then?

http://news.sky.com/story/973246/whos-your-daddy-van-offers-dna-tests (http://news NULL.sky NULL.com/story/973246/whos-your-daddy-van-offers-dna-tests)

A ‘Who’s Your Daddy’ van is travelling around New York City, offering men the chance to find out whether they are the father of a child.
The owner and operator of the vehicle, Jared Rosenthal, is selling DNA tests, mostly to those who suspect youngsters may not actually be theirs.
Costing around £200-£300, men just have to give a cheek swab. Then there is a laboratory analysis and the paternity results are available in a couple of days.
Mr Rosenthal told CBS News: “They flag us down, they pull us over, they talk to us.
“Sometimes, because of the nature of the services, they want to be a little more discreet about it, but they do come or they’ll call the number.”
Mr Rosenthal said he deals with all kinds of strange situations in his line of work.
“We have people that want to get the specimen from their spouse without them knowing about it. We deal with a lot of drama. It’s constant drama,” he said.
One unidentified man, who was asked why he was taking the DNA test from the travelling truck, said: “I’m paying child support anyways and I would do it anyways. You just want to know.”
Mr Rosenthal went on: “There’s a lot of difficult situations and tough moments and heartbreak,” adding there are happy endings as well.
“There’s a lot of good news that we’re able to deliver and there’s a lot of happy moments.”
For example, the test helped a 44-year-old Harlem man find his long-lost 20-year-old daughter.
Mr Rosenthal maintained that his credentials are legitimate and that his business is legal.
He believes he is providing an essential service. “It’s not something people talk about, but there is a big need for it,” he said.

Anxiety even if mild and undiagnosed raises risk of early death

OUT OF 100 PEOPLE IN A ROOM, 25 WILL HAVE A DIAGNOSED MENTAL ILLNESS. OUT OF THE 75 LEFT, 56 REMAIN UNDIAGNOSED, SO THAT LEAVES 19. IT’S TIME TO START TALKING

Anxiety is spiraling it seems if you judge by reported cases. Cases are up by 10%, 1 in 7 people are already on anti-anxiety medication and spending is increasing dramatically and this latest research states that anxiety raises your chance of death. Now of course that’s reporting and sensationalism when written in a head line and yet as a statistic it might just scare you in to doing something. The group looked at weren’t those diagnosed with anything. They were people with milder levels of stress, depression and or anxiety. At a mild level people still need to do something states Dr Russ. Not medication, but an alternative. As Paul Farmer, chief executive of the mental health charity Mind, said: “This research highlights the importance of seeking help for mental health problems as soon as they become apparent, as early intervention leads to much better health outcomes all round.”

So come see me and let’s start talking.

 

http://www.telegraph.co.uk/health/healthnews/9441038/Anxiety-raises-risk-of-early-death-by-a-fifth.html

Anxiety ‘raises risk of early death by a fifth’

Even low levels of stress of anxiety can increase the risk of fatal heart attacks or stroke by up to a fifth, a study has shown.

Anxiety and low-level depression appear to set off physiological changes that make the body more prone to death from cardiovascular disease. Photo: ALAMY

 

By Stephen Adams (http://www NULL.telegraph NULL.co NULL.uk/journalists/stephen-adams/), Medical Correspondent

A quarter of adults are at risk of an early death even though their problems are relatively mild, it found.

People who suffer from clinical depression or other major mental health problems have a greater chance of dying early.

But now British researchers have found that even those with problems they don’t consider serious enough to bring to a doctor’s attention, are at an increased risk.

The team found those with “sub-clinical” anxiety or depression had a 20 per cent higher chance of dying over a decade than those who did not.

The researchers, from universities and hospitals in Edinburgh and London, looked at deaths in 68,000 middle aged and older people who they followed from 1994 to 2004.

They found those suffering from sub-clinical anxiety and depression were at a 29 per cent increased risk of dying from heart disease and stroke.

They were also at a 29 per cent increased risk of dying from ‘external causes’ like road accidents and suicide, although these only accounted for a tiny proportion of deaths.

It had been thought that depressed or anxious people were more likely to die early because they failed to take good care of themselves – perhaps smoking and drinking more, eating worse and doing less exercise.

But Dr Tom Russ, lead author of the study, published in the British Medical Journal, said: “These ‘usual suspects’ only make a small difference to mortality.”

Even when these factors and others – including blood pressure – were stripped out of the equation, the link remained, he emphasised.

The psychiatrist, of the Alzheimer Scotland Dementia Research Centre at Edinburgh University, said this suggested stress altered the physiology of the body to make it intrinsically less healthy.

In particular, he said it could make the body more vulnerable to heart attack and stroke.

He said: “It’s early days, but there’s growing interest in potential physiological changes associated with both distress and cardiovascular pathology.”

Dr Russ pointed out that the group they looked at were not those with serious depression who were simply avoiding medical help.

“If these individuals went to a doctor, they wouldn’t be diagnosed with depression,” he said.

So many people had mild anxiety or depression, “that we really need to take it seriously”, he argued.

But he said neither he nor colleagues who worked on the project were advocating “the medicalisation of anxiety”, nor suggesting people suffering from it should go on drugs.

If anything, they thought treatments not based on drugs should be investigated.

Paul Farmer, chief executive of the mental health charity Mind, said: “This research highlights the importance of seeking help for mental health problems as soon as they become apparent, as early intervention leads to much better health outcomes all round.”

*Meanwhile, new figures show that the number of anti-depressants prescriptions being issued in England has risen by almost 10 per cent in just a year.

Data from the NHS Information Centre for Health and Social Care show that the number rose from 42.8 million prescriptions in 2010 to 46.7million in 2011 – a rise of 3.9 million, or 9.1 per cent.

The NHS is now spending £49.8 million on anti-depressants such as citalopram and fluoxetine, better known by its brand name, Prozac.

Of all drug types, antidepressants saw the biggest rise in cost and items dispensed between 2010 and 2011.

 

HOW you ask yourself why am I depressed really does matter

 

I recently read an article that interested me as it is something I have noticed with clients with depression. HOW you ask yourself a question, look at what’s going on and why, REALLY does matter. To distance yourself from what’s going on, be able to ask why am I feeling what I am, what’s happened, when, with whom in an analytical way IS, it seems more effective at breaking that cycle of negative thoughts, behaviours and feelings.
Talking therapy can really enable you to recognise that pattern of negativity and open up different ways of asking questions of yourself and looking at yourself. The fact that the study showed that people with even major depression can choose to distance really matters too. Choice used as a word doesn’t sit with clients at first, yet is an important part of the process, even if that original choice to react in a certain way was effective when the decision was first made. It isn’t any more, hence people email, phone or text and ask for therapy. People with depression will often share that they are drowning, to accept that ‘self emersion’ is a possibility and to work with choice is a great goal for anyone with depression. Please note i do use the word goal as most people with depression reading this will state categorically there I have no choice, which I totally understand.
It’s an interesting article based on incredibly experience proving research!

http://www.goodtherapy.org/blog/self-distancing-depression-emotions-0713122

Distancing Oneself from Negative Emotions Decreases Depressive Symptoms
July 13th, 2012 |
Rumination is a key characteristic of depression. Individuals with depression have high levels of negative affect and tend to recycle negative thoughts and emotions. This behavior of ruminating on negative experiences perpetuates the cycle of depression and increases the severity and length of depressive symptoms. How individuals approach their negative emotions has been the subject of much research on depression. In a recent study, Ethan Kross of the Department of Psychology at the University of Michigan looked at two different ways in which people view negative thoughts in order to determine if one increased depressive symptoms more than the other.
In the study, Kross evaluated 51 individuals with major depressive disorder (MDD) and 45 individuals with no history of depression as they analyzed their emotions in relation to a negative life event. The participants were instructed to view their feelings using either a self-distanced approach or a self-immersed approach. Kross gauged how these two perspectives affected negative affect, avoidance, and emotional content and discovered several interesting findings.  First, Kross found that both the MDD and non-MDD participants were able to self-distance. This is a key finding because many depressed individuals do not automatically choose to use this perspective when in the midst of troubling feelings but may be inherently capable of doing so. Kross said, “Second, depressed participants who analyzed their feelings from a self-distanced perspective displayed lower levels of depressive thought accessibility and negative affect than their self-immersed counterparts.” These same individuals also gained more awareness of the negative situations and achieved a sense of closure that the self-immersed group did not.
Kross did not find any differences in the levels of avoidance, regardless of how the participants viewed their negative events. Overall, the research demonstrated that individuals with depression do not always have negative outcomes when they question the circumstances that led to the negative emotions. Rather, their emotional outcome is predicted more by how they ask the questions. Specifically, a self-distanced approach of analyzing emotions seems to lead to a more adaptive and positive outcome than a self-immersed approach, which appears to contribute to further rumination and negative emotions.
Reference:
Kross, E., Gard, D., Deldin, P., Clifton, J., Ayduk, O. (2012). ‘Asking why’ from a distance: Its cognitive and emotional consequences for people with major depressive disorder.” Journal of Abnormal Psychology. Advance online publication. doi: 10.1037/a0028808

Shades of grey…

There is an irony when I give out my card and I hear, ooooh grey …..  Sales for 50 shades of grey have reached 660,000 a week at one point.

Every so often bdsm gets trendy. Lots of people think mmm, must try that. Tipping the velvet was the same for the UK, just in a television series.

Bdsm participants are still judged however. This book may put an angle on it for you yet how would you feel if the guy over there who likes his testicles nailed to a plank offers to baby sit your child? Or finding out that woman who works with you likes to be tied up and pee’d on? It’s alright to try to a certain point, but oh I’d never go that far? The book sells the romantic side with a hint of pain. The reality is open communication,  negotiation, meeting lots of people who potentially don’t have the same kink as you let alone the same vanilla ( all the “normal” people) interests.

I see bdsm clients. I see the person and work with the issue they bring which may or may not have anything to do with their kink. I am kink aware and kink friendly and my clients are very aware of that non judgemental stance.

One thing that strikes me is how knowledgable people become. About themselves, their limits, what they want and what they don’t want. They become aware. They also look into safety. It terrifies me that floggers and nipple clamps are increasing in sales. The romantic ideal is one thing, the reality on risk awareness is another. If s/he hits me there that’s my kidneys or potential hip damage. If the clamps are strong, blood supply issues etc etc etc.

Plus life gets in the way for kinky people too!  To have to cook, clean, sort the kids or run late after that meeting means you really have to want to “play”. Thw coming out or staying in the closet and the implications of being outed to friend and family, let alone work. I also see bdsm clients with anxiety, relationship issues and low self esteem and depression for example.

Having fun is great, risk awareness is paramount. Selling the idea that bdsm is the ultimate relationship though? They seem to be more intense, more passionate at times yes. They also suffer from normal relationship issues as the common denominal factor here is simple. They’re still human beings!

Also for couples with issues who use bdsm to spice things up, while sex really matters, introducing bdsm into your bedroom or life could potentially add to your issues eventually. It takes excellent comunication and what happens if one likes it more than the other or one says enough.

If a relationship isn’t going well then therapy can help, there are no guarantees yet change often occurs.

 

 

http://www.standard.co.uk/lifestyle/esmagazine/the-fifty-shades-of-grey-effect-how-london-got-kinky-7938483.html (http://www NULL.standard NULL.co NULL.uk/lifestyle/esmagazine/the-fifty-shades-of-grey-effect-how-london-got-kinky-7938483 NULL.html)

The Fifty Shades of Grey effect: how London got kinky There was a time when Londoners were nervous about nipple clamps and freaked out by floggers. Not any more. The BDSM bestseller Fifty Shades of Grey has the capital on its knees

Fan-tastic, how fiction written in homage by fans on the internet paved the way for Fifty Shades of Grey

‘I’m not into pain, but I was inspired to go out and buy a flogger. I love it’

Last Christmas, if you’d mentioned BDSM over drinks (and as GQ’s sex columnist, I stand guilty), you’d have been met with blank looks. ‘Floggers?’ Piers Morgan once confided. ‘A glass of wine would be a better aphrodisiac.’ Today, however, Bondage, Dominance and Submission Sado-Masochism is so now. And rocketing sales of a colourful gamut of bondage toys would suggest that we’re not merely reading about this summer’s ruling literary hero Christian Grey’s Red Room of Pain, but recreating it.

Because the sudden acceptability — even voguishness — of relatively hardcore erotic adventure seems to have been triggered by the remarkable success of the kinkbuster novel Fifty Shades of Grey, now the fastest-selling paperback in history, with some ten million print and more than one million e-reader copies devoured so far. Couple its colourful contents with tumescent media revelling in any opportunity to discuss the S&M nature of the novel, and it is perhaps unsurprising that naughty sex has sashayed out of the shadows.

Matthew Curry, head of e-commerce for the UK’s largest online retailer of sex toys, Lovehoney.co.uk, has seen a huge change in buyer behaviour as a result of the book. ‘First-time customers are especially emboldened: normally they’d pick something like a small vibrator; instead we’ve seen a huge growth in sales of items such as nipple clamps.’ The figures are impressive. In March the site sold just over 200 pairs of nipple clamps. In June it sold 1,214. Over the same time, sales of whips and floggers have doubled, and sales of Ben Wa Balls (metal balls used for internal female stimulation, which cause Fifty’s heroine Anastasia’s ‘inner goddess [to do] the dance of the seven veils [and make her] needy, needy for sex’) are up by 400 per cent.

The Hoxton women-only erotic emporium Sh! reports similar spikes. It has seen partic-ular interest in entry-level spreader bars (bars designed to hold arms or legs apart, in this case with Velcro fastenings); Sh! ball gags — and spanking classes — have repeatedly sold out.

Where Fifty Shades has come to be known as ‘mummy porn’, enjoyed secretly on the Kindle by older women, it has exploded across all ages and definitely no longer just appeals to mothers. ‘I’m not into pain, but I was inspired to go out and buy a flogger. I love it,’ says Gemma (not her real name), 34, a single management consultant from South London. ‘The way EL James describes the toys in the book makes them sound glamorous and accessible — not cheap plastic things that would be ugly.’ Over the past few years high-end designers have quietly been working the erotic arena: the award-winning designer Yves Béhar, for example, collaborated on sex toys with manufacturer Jimmyjane, and Alex Monroe, a jeweller more usually known for nature-inspired pendants loved by Elle Macpherson and Emma Watson, has created a beautiful range of gold-plated, butterfly nipple clamps. ‘I also bought a tickler,’ Gemma adds. ‘It’s an amazing device. I couldn’t believe I’d never even heard about ticklers before. But then, I don’t spend time in sex shops so how would I have done?’

Mistress Absolute, a West London-based dominatrix who runs Club Subversion (a nightspot that twins dance spaces and dungeons) on the Albert Embankment, and organiser of the annual London Fetish Weekend, also recognises the Fifty Shades effect in inspiring interest in Londoners who might not otherwise have considered BDSM. But she’s equally keen to place the trend in a larger context. ‘Sexually our tastes are developing,’ she says. ‘We’re moving away from a hegemonic society, where 2.4 kids is the ideal, and seeking new things to try. The foundations of this move are various: shops such as Coco de Mer, for example, have for a while now made kink feel less smutty. On the club scene we’ve also seen more events based around fantasy. It’s a reaction to the economic situation: when times are tough, people want to dress up and go crazy. BDSM is an escape from the real world, creating a domain which is sub/dom but also consensual and safe.’

She also emphasises the role of the media, and in particular celebrities such as Lady Gaga. Where the lesbian kiss was de rigueur to demonstrate their sexed-up credentials in the early Noughties, that has now been tossed aside in favour of BDSM references. As well as Gaga, Christina Aguilera went for it with a diamond ball gag in the video for ‘Not Myself Tonight’; and Rihanna aced them all with her single ‘S&M’, the video for which saw her swinging from the ceiling in Japanese Shibari bondage rope and flicking her crop at journalists whom she’d trussed up with tape.

‘Of course, what they’re doing isn’t new. It’s a throwback to what Madonna based her early career on — kink repackaged for a new generation,’ says Absolute. S&M has breezed in and out of fashion almost as far back as records exist. Images on pots from the 6th century show that Ancient Romans had a taste for it, and culturally it has popped up in everything from the Earl of Rochester’s bawdy 17th-century verses to the infamous butter scene in 1970s erotic classic Last Tango in Paris.

The consensual nature of Anastasia and Christian’s relationship in Fifty Shades is emphasised via a 50-page Submissive Contract, which Anastasia is free to edit according to her limits (and which, when she reads with her ‘heart still pounding’, she discovers includes gems such as there will be ‘No acts involving children and animals’). The power that Anastasia wields is surely a key part of the book’s appeal. Perhaps as much as anything it made female readers recognise that, even as a submissive, they still could choose what happened to them in a BDSM scenario.

‘I used to have a judgement on BDSM,’ says sex and relationship coach Sue Newsome. ‘But once I studied it, I realised that while the dominant has control, the submissive has the power. If they are not responding, the master has to change what he is doing.’ Newsome is excited by the possibilities afforded by the popularity of the book. ‘I’ve noticed the buzz and think it’s brilliant. Sex games can help people to have open and honest communication about their curiosity and desires.’ But she advises caution: ‘Having read it, people have been coming to me to understand how to explore BDSM safely. I emphasise to them there has to be trust. There are risks. All kinds of equipment are readily available; for a few pounds you can buy a cane, and with it you can inflict an immense amount of pain.’

As a first step, she highlights the importance of knowing what you want to get out of erotic experiments, of having rules about your limits and also having safe words. (Since half the fun of power play is pretending that you are being forced to do something against your will, yelling ‘Stop!’ tends to imply the opposite. If you really mean, ‘Desist immediately or I’m calling the police,’ then a safe word such as ‘red’ is a better bet.) ‘BDSM can be a fantastic gateway to sexual pleasure and connection for everyone,’ she finishes. So, listen closely as you walk down the street on a quiet evening. You may just hear the creaking of women’s bodies suspended from the rafters, or even the crack of a whip…

Even spiderman’s girlfriend gets anxious, so, what happens in our brains?

 

http://www.entertainmentwise.com/news/80708/Emma-Stone-Reveals-Pain-Of-Childhood-Insecurities-

With her amazing Hollywood career, screen siren looks, wardrobe to die for and hot boyfriend Andrew Garfield, it’s hard to believe that Emma Stone lacks confidence.
But in a recent interview with Vogue magazine, the 23-year-old has proved that it’s not just us mere mortals that suffer from personal insecurities, having confessed that she took up acting only to help her deal with her own demons.
“I had a panic attack when I was eight,” she tells Vogue. “My mum couldn’t put notes in my lunch because I would be reminded that she existed and I would want to go home. And I was sick all the time.”
“When I went through therapy, I tried improv for the first time, and I think there was some cathartic element to it,” she added.
Loved up couple Emma and Andrew recently moved into a New York apartment together having fallen for eachother during filming The Amazing Spider-Man movie.
But after striving for acting success after all this time, she simultaneously fears it. She said: “I worry about my fame making New York unliveable. To not walk around would be awful .  .  . that idea makes me physically ill.”
Emma, who was born in Arizona, shot to fame in 2012 with teenage comedy Easy A and has since won much critical acclaim for her performance in the Oscar-nominated the Help, and has ever increasingly been blossoming into a world-wide renowned fashionista.
You won’t be able to walk freely around NYC soon, Emma…
So what does happen to the brain during anxiety or panic attack?
Amygdala – a brain part where anxiety, fear and panic originate from. It’s sometimes called Anxiety Brain.
Anxiety is a natural human emotion that all of us experience from time to time. It comes with a feeling of nervousness, apprehension, worry, or fear. Typically, this emotion may be experienced during times when you are in a lot of stress such as before taking a test or walking down a dark avenue alone. These illustrated occasions where anxiety is felt are actually helpful for you. In the test-taking situation, anxiety helps you to be more focused on your examination so that you can answer correctly each test item, thus get a high mark. While for the dark alley situation, anxiety helps you to be more alert so that you are prepared for any danger that the dark night might bring. In conclusion, anxiety protects us from any danger that our senses have perceived. It acts like a guardian for our self-preservation. This is clear enough. But what if you want to get to the particulars on how our body does this instinctive mechanism?
Truthfully, it does not quite matter what the real cause of your fear and anxiety is. You just have to remember that this feeling expresses itself throughout your whole body. It does not merely affect or linger in your mind alone. This fearful feeling always connects with your body.
So how does this feeling of fear, anxiety, or panic actually created? What happens inside the brain or what is usually called as the ‘anxiety brain’?
Scientists have moved very far in the area of neurophysiology of anxiety and fear in the last few decades. Just imagine for one second that you get back home from work, it is late, you open your house’s door and suddenly you see a moving shadow inside one of your rooms. In a split of second, the whole chemistry in your body changes. It could be a threat to your life, so your neural circuits become pumped up and start their job. And usually this happens before you can even rationally digest what is really happening. It is just that fast.
So the signal enters your eyes and your ears and then to your brain stem. From there, it travels to the thalamus where the impulse branches off. One part of the signal moves to the part of the brain where it will be interpreted and the other part of the signal moves to your anxiety brain – the amygdale – and hippocampus. Although amygdale is a small part of your brain, as small as an almond, its size is insignificant to the role it plays in your everyday life. On the other hand, the hippocampus is a part of your brain that is responsible for remembering things such as your memories. When the nerve signal reaches the hippocampus, this part of your brain will analyze it with the memories it has already stored to find out if this is a threatening situation.
If you are sure that the stimulus means nothing, the signal’s journey will stop right there. However, if you are not really sure about it, your brain will go into a ‘warning’ mode. Then that impulse will be sent back and forth between the hippocampus, your temporal lobe and amygdale (the anxiety brain); your whole body becomes alert and you are prepared for the worst.
As mentioned, your emotional brain (amygdale) plays a major role in this whole process. This is a place where anxiety, fear and panic originate from. If there was a way to physically remove amygdale out of your brain, you wouldn’t feel fear, anxiety or panic at all. Furthermore, you wouldn’t be able to tell if people around you are scared or not.
Your anxiety brain is always on alert, sorting every signal received to see if you are facing anything threatening. If some signal will be recognized as threatening, this little almond-shaped anxiety brain will signal other parts of your brain to put those scary expressions on your face and stop everything that you are doing in order to fully concentrate on the possible danger ahead.
Understanding your anxiety and its probable causes is crucial, because it gives you a starting point – a steady foundation from which you can build toward your well-being.
Make a change, go see someone and start accepting, breathing and changing

You + stress = Alzheimers possibly?

People are stressed. I often hear people talking about their stress, how acceptable it is, how normal, what does it matter, I’m ok, I cope. They then wonder why they collapse or carry on yet feel worthless, unhappy and exhausted. 1 in 7 people in the UK alone take an anti anxiety medication. More children are being prescribed the same medications and people over all are more stressed than they have ever been. Why is too big a question with lots of answers. The real question for me working with people is what can you do, now, here and today to enable yourself to let go of stress. The implications of stress related illness are many. Death in some cases.

Now new research is proving that chronic stress could also lead to Alzheimer’s. So we push, to get, to enjoy, and maybe now to forget why we ever did in the first place? Go see someone, counter your stress and any traumatic experience.

http://www.alzheimers.org.uk/site/scripts/news_article.php?newsID=1243 Stress link to Alzheimer’s goes under the spotlight Published 25 June 2012 Chronic stress is being investigated in a new Alzheimer’s Society funded research project as a risk factor for developing dementia. It is part of a £1.5 million package of six grants being given by the charity fighting to find a cause, cure and way to prevent the disease. Professor Clive Holmes is lead investigator for the stress study at the University of Southampton. He said: ‘All of us go through stressful events. We are looking to understand how these may become a risk factor for the development of Alzheimer’s. ‘This is the first stage in developing ways in which to intervene with psychological or drug based treatments to fight the disease.’ More effective coping methods for dealing with stress and a greater understanding of its biological impact may provide the answer. The study scheduled to start in in less than a week will involve 18 months monitoring 140 people aged 50 and over with mild cognitive impairment. The participants will be assessed for levels of stress and assessed for any progression People are stressed. I often hear people talking about their stss, how acceptable it is, how normal, what does it matter, I’m ok, I cope. They then wonder why they collapse or carry on yet feel worthless, unhappy and exhausted. 1 in 7 people in the UK alone take an anti anxiety medication. More children are being prescribed the same medications and people over all are more stressed than they have ever been. Why is too big a question with lots of answers. The real question for me working with people is what can you do, now, here and today to enable yourself to let go of stress. The implications of stress related illness are many. Death in some cases. Now new research is proving that chronic stress could also lead to Alzheimer’s. So we push, to get, to enjoy, and maybe now to forget why we ever did in the first place? Go see someone, counter your stress and any traumatic experience.  http://www.alzheimers.org.uk/site/scripts/news_article.php?newsID=1243 Stress link to Alzheimer’s goes under the spotlight Published 25 June 2012 Chronic stress is being investigated in a new Alzheimer’s Society funded research project as a risk factor for developing dementia. It is part of a £1.5 million package of six grants being given by the charity fighting to find a cause, cure and way to prevent the disease. Professor Clive Holmes is lead investigator for the stress study at the University of Southampton. He said: ‘All of us go through stressful events. We are looking to understand how these may become a risk factor for the development of Alzheimer’s. ‘This is the first stage in developing ways in which to intervene with psychological or drug based treatments to fight the disease.’ More effective coping methods for dealing with stress and a greater understanding of its biological impact may provide the answer. The study scheduled to start in in less than a week will involve 18 months monitoring 140 people aged 50 and over with mild cognitive impairment. The participants will be assessed for levels of stress and assessed for any progression from mild cognitive impairment to dementia. About 60% of people with mild cognitive impairment are known to go on to develop Alzheimer’s. Prof Holmes said: ‘There is a lot of variability in how quickly that progression happens; one factor increasingly implicated in the process is chronic stress. That could People are stressed. I often hear people talking about their stss, how acceptable it is, how normal, what does it matter, I’m ok, I cope. They then wonder why they collapse or carry on yet feel worthless, unhappy and exhausted. 1 in 7 people in the UK alone take an anti anxiety medication. More children are being prescribed the same medications and people over all are more stressed than they have ever been. Why is too big a question with lots of answers. The real question for me working with people is what can you do, now, here and today to enable yourself to let go of stress. The implications of stress related illness are many. Death in some cases. Now new research is proving that chronic stress could also lead to Alzheimer’s. So we push, to get, to enjoy, and maybe now to forget why we ever did in the first place? Go see someone, counter your stress and any traumatic experience.  http://www.alzheimers.org.uk/site/scripts/news_article.php?newsID=1243 Stress link to Alzheimer’s goes under the spotlight Published 25 June 2012 Chronic stress is being investigated in a new Alzheimer’s Society funded research project as a risk factor for developing dementia. It is part of a £1.5 million package of six grants being given by the charity fighting to find a cause, cure and way to prevent the disease. Professor Clive Holmes is lead investigator for the stress study at the University of Southampton. He said: ‘All of us go through stressful events. We are looking to understand how these may become a risk factor for the development of Alzheimer’s. ‘This is the first stage in developing ways in which to intervene with psychological or drug based treatments to fight the disease.’ More effective coping methods for dealing with stress and a greater understanding of its biological impact may provide the answer. The study scheduled to start in in less than a week will involve 18 months monitoring 140 people aged 50 and over with mild cognitive impairment. The participants will be assessed for levels of stress and assessed for any progression from mild cognitive impairment to dementia. About 60% of people with mild cognitive impairment are known to go on to develop Alzheimer’s. Prof Holmes said: ‘There is a lot of variability in how quickly that progression happens; one factor increasingly implicated in the process is chronic stress. That could be driven by a big change – usually negative – such as a prolonged illness, injury or a major operation. ‘We are looking at two aspects of stress relief – physical and psychological – and the body’s response to that experience. Something such as bereavement or a traumatic experience – possibly even moving home – is also a potential factor.’ Alzheimer’s Society research manager, Anne Corbett, said: ‘The study will look at the role chronic stress plays in the progression from mild thinking and memory problems – Mild Cognitive Impairment – to Alzheimer’s disease. ‘We feel this is a really important area of research that needs more attention. The results could offer clues to new treatments or better ways of managing the condition. ‘It will also be valuable to understand how different ways of coping with stressful life events could influence the risk of developing Alzheimer’s disease.’ The participants in the trial will be compared to a group of 70 people without memory problems, who will be tested as a ‘control group’ All the people taking part will be asked to complete cognitive tests in order to track their cognitive health. Questionnaires will assess their personality type, style of coping with stressful events and their perceived level of social support and mood. The process will be repeated after 18 months to measure any conversion from mild cognitive impairment to Alzheimer’s disease. Stressful life events will also be recorded. The researchers will take blood and saliva samples every six months to measure biological markers of stress. Blood samples will measure immune function and the saliva samples will track levels of cortisol, which is released by the body in response to chronic stress. A number of illnesses are known to develop earlier or are made worse by chronic stress, including heart disease, diabetes, cancer and multiple sclerosis. Surprisingly little research has been done in people with mild cognitive impairment or Alzheimer’s disease in relation to their experience of stress. be driven by a big change – usually negative – such as a prolonged illness, injury or a major operation. ‘We are looking at two aspects of stress relief – physical and psychological – and the body’s response to that experience. Something such as bereavement or a traumatic experience – possibly even moving home – is also a potential factor.’ Alzheimer’s Society research manager, Anne Corbett, said: ‘The study will look at the role chronic stress plays in the progression from mild thinking and memory problems – Mild Cognitive Impairment – to Alzheimer’s disease. ‘We feel this is a really important area of research that needs more attention. The results could offer clues to new treatments or better ways of managing the condition. ‘It will also be valuable to understand how different ways of coping with stressful life events could influence the risk of developing Alzheimer’s disease.’ The participants in the trial will be compared to a group of 70 people without memory problems, who will be tested as a ‘control group’ All the people taking part will be asked to complete cognitive tests in order to track their cognitive health. Questionnaires will assess their personality type, style of coping with stressful events and their perceived level of social support and mood. The process will be repeated after 18 months to measure any conversion from mild cognitive impairment to Alzheimer’s disease. Stressful life events will also be recorded. The researchers will take blood and saliva samples every six months to measure biological markers of stress. Blood samples will measure immune function and the saliva samples will track levels of cortisol, which is released by the body in response to chronic stress. A number of illnesses are known to develop earlier or are made worse by chronic stress, including heart disease, diabetes, cancer and multiple sclerosis. Surprisingly little research has been done in people with mild cognitive impairment or Alzheimer’s disease in relation to their experience of stress. from mild cognitive impairment to dementia. About 60% of people with mild cognitive impairment are known to go on to develop Alzheimer’s. Prof Holmes said: ‘There is a lot of variability in how quickly that progression happens; one factor increasingly implicated in the process is chronic stress. That could be driven by a big change – usually negative – such as a prolonged illness, injury or a major operation. ‘We are looking at two aspects of stress relief – physical and psychological – and the body’s response to that experience. Something such as bereavement or a traumatic experience – possibly even moving home – is also a potential factor.’ Alzheimer’s Society research manager, Anne Corbett, said: ‘The study will look at the role chronic stress plays in the progression from mild thinking and memory problems – Mild Cognitive Impairment – to Alzheimer’s disease. ‘We feel this is a really important area of research that needs more attention. The results could offer clues to new treatments or better ways of managing the condition. ‘It will also be valuable to understand how different ways of coping with stressful life events could influence the risk of developing Alzheimer’s disease.’ The participants in the trial will be compared to a group of 70 people without memory problems, who will be tested as a ‘control group’ All the people taking part will be asked to complete cognitive tests in order to track their cognitive health. Questionnaires will assess their personality type, style of coping with stressful events and their perceived level of social support and mood. The process will be repeated after 18 months to measure any conversion from mild cognitive impairment to Alzheimer’s disease. Stressful life events will also be recorded. The researchers will take blood and saliva samples every six months to measure biological markers of stress. Blood samples will measure immune function and the saliva samples will track levels of cortisol, which is released by the body in response to chronic stress. A number of illnesses are known to develop earlier or are made worse by chronic stress, including heart disease, diabetes, cancer and multiple sclerosis. Surprisingly little research has been done in people with mild cognitive impairment or Alzheimer’s disease in relation to their experience of stress.

Perspectives on what works in psychotherapy

 

I love what I do, I am passionate about what I do and I enjoy what I do and all that it brings. If you were to ask me what and why, I am not sure I could answer that specifically. When people get what they wanted, when I see a shift in someone’s thought process, when I see an acceptance or a coming to terms with something. Or when a new feeling is accepted or experienced and growth takes place. They’re all amazing and rewarding, yet to sum those feelings up, they’re about a connection based on our relationship in that moment. that’s the key to therapy and change, that relationship.
It’s not always easy to determine if you’re going to connect with someone yet that’s the key, the relationship.
This article talks about clients with anorexia, yet it could be written about any issue you may bring to therapy. To trust, to allow challenge, to experiment with what does and doesn’t work, to express emotions within a therapeutic safe relationship and to live in today,  not yesterday’s out of date decisions nor in the fears of tomorrow.

http://www.huffingtonpost.com/dr-david-herzog/eating-disorder-therapy_b_1565261.html

DR. DAVID HERZOG
Psychotherapy: What Works?
Posted: 06/04/2012
“What is REAL?” asked the Rabbit one day, when they were lying side by side near the nursery fender, before Nana came to tidy the room. “Does it mean having things that buzz inside you and a stick-out handle?”
“Real isn’t how you are made,” said the Skin Horse. “It’s a thing that happens to you when a child loves you for a long, long time, not just to play with but REALLY loves you, then you become Real.”
— Margery Williams, The Velveteen Rabbit
There is no “one-fits-all” psychotherapy for anorexia nervosa. In an effort to learn more about what “works” and what doesn’t, my Massachusetts General Hospital colleagues Eugene Beresin, M.D. and Christopher Gordon, M.D. and I interviewed a group of women who had received individual therapy and recovered from the illness. Their perspectives on psychotherapy helped inform our work with individuals who are struggling with anorexia.
New patients don’t open the door of the therapist’s office bright-eyed, cheerful, and eager for treatment. For the most part, individuals with anorexia don’t feel ill or see their eating behaviors as unhealthy. They want no part of therapy. The idea of sitting down and talking about themselves feels foreign and scary. From their standpoint, the therapist is out to make them fat. Particularly frightening — almost unthinkable — is the possibility that the therapist will raise the topic of eating more and gaining weight. Tense and shaky, or sullen and defiant, patients sometimes experience the urge to bolt out of the room.
“First, I had to trust.” This is easier said than done. At the beginning of therapy, patients don’t know what to expect. Some individuals sense that they are better off remaining silent and that anything they say will be held against them, as if they are standing trial in a court of law. They may feel very alone or bombarded with powerful pangs of guilt about calories eaten or ounces gained. They may be thinking: “What is this thing called therapy?” “What am I expected to talk about here?” How is therapy supposed to help me?” “What does the word ‘help’ mean?” This last question is important, and a patient’s answer to it can fluctuate or change as therapy proceeds.
“I didn’t know how I felt.” Trapped in an unforgiving world of shoulds and should-nots, individuals have a hard time recognizing their feelings. They are often receptive to therapists who participate actively in sessions, helping them to better understand themselves and coaching them on how to relate to others. The very nature of the patient-therapist relationship can help individuals learn where emotions come from and how to manage them. For example, becoming angry at the therapist and being encouraged to talk about this in session can gradually instill confidence that it is natural and human — or, as the Skin Horse suggested, “real” — to experience and express emotions.
“I wasn’t sure I wanted to grow up.” Teenagers experience huge emotions and extreme moods. One moment they long for independence; and the next, for security. As they mature — emotionally, cognitively, physically — relationships, academics and athletics take on new importance, and pressures seem to mount. The stress of adolescence is significant, and teens often feel overwhelmed. For these individuals, anorexia can represent a way to slow down the biological clock, to get their bearings, and to maintain control before traveling on to adulthood.
“It was important to like myself better.” Well into treatment, individuals with anorexia continue to consider themselves defective, inferior, or “bad.” They may come to realize that anorexia gave them a sense of accomplishment or specialness. The challenge is to find ways to experience these positive feelings without focusing on weight loss.
“Experimenting helped.” Insight alone does not free individuals from the grasp of anorexia nervosa. There must be a willingness to experiment — to take risks. People with anorexia go about everyday life in a very structured, programmed way in an effort to cope with their fear of the unknown. Although it is very challenging for patients to modify their routines, they are often able to do so once they feel that the therapist values and respects them for who they really are. Risk-taking becomes possible when it is introduced in small, achievable steps that gradually build self-regard. In this way, patients — with the guidance of the therapist — chip away at the anorexia, a little bit at a time.

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