Your Concerns?

The intention of this blog is to give people who are considering therapy information about therapy so they may make a more informed decision about whether and how to enter therapy.  The topics I have written about come from my clients who expressed their concerns when considering therapy and what had got in the way for them.  Each individual has their own concerns. So, if there is a topic you would like me to write about in this blog, please feel free to contact me.  If you would rather talk about it, I would happily discuss any concerns you may have about therapy, without obligation.

There are several ways in which you can contact me. You can place a comment on my blog. Or you can contact me via my website: www.garycooktherapy.co.uk

On the website are all the contact details for me or you can email me directly via the website. I look forward to hearing from you.

Client Stories - "Superwoman"

In today’s society, women have taken up the mantle of full time employment, but often without relinquishing much of their traditional, and also full time role in looking after their children and house-keeping. This week’s blog is the story of a type of client with whom I have had many dealings. This is not the story of any one person, but a composite based on many clients with similar issues.

She is used to being the strong one in the relationship, has always worked hard, both at home and in paid employment and has been successful in both.  Other people come to her with their problems and she is happy to take on this role and is good at being there for others. She has good relationships with her partner and family who are supportive. However, over many months, pressure at work has been building progressively and she finds she is struggling to cope.  Despite being desperately tired, her sleep is disrupted with her waking up early and being unable to get back to sleep worrying about work and not feeling rested in the morning.

The final straw came when a colleague had criticised her work.  She burst into tears and withdrew to the toilets. She was not used to crying, let alone in front of others, and even worse, at work, so she went home early, feeling ashamed, confused and overwhelmed.

She contacted me seeking help to “get back to my normal self as this just isn’t me”. In the first session, she told me her story as above and a bit about her background. When talking about the situation at work, she became tearful for which she apologised. When I said that she didn’t need to apologise for expressing her feelings and that it was important for our work together that I heard and acknowledged her feelings, she started to cry but quickly stopped. I wondered with her how she felt about crying. She said that she felt stupid & weak, which she hated. I asked her where she had learnt this, but she didn’t know. I asked her how she would feel if her daughter cried. She recognised that she didn’t think her daughter was stupid or weak when she cried and would comfort her.  I wondered with her about why it was different for her than her daughter. We agreed that we would continue with the sessions in an open ended contract to help her cope with the pressures she faced.

Over the course of several sessions, we explored various aspects of her life in relation to her current situation & feelings.  Having initially talked about how her childhood had been “fine”, as we explored the way the current situation resonated with her past, she began to realise that any tears when she was growing up were “shushed” and she was told not to be so silly.  She had quickly learnt that such expressions of hurt would not be heard or acknowledged in her family, so it was better to “toughen up” and “get on with it” – this isn’t about blaming her parents, but developing a compassionate understanding for her experience as a child. 

Ignoring her difficult emotions had worked well for her until recently when she had become overloaded, so now a new way of dealing with them was needed. She had forgotten that she had needs, having for so long prioritised her family’s needs and those of her employers. She realised that she had not allowed time for herself for ages.

Whilst she understood her need to pay attention to her emotions intellectually, the habit of ignoring them had been learnt unconsciously in childhood and unwittingly reinforced throughout her life. Thus, it took some time for her to start to practice paying attention to, and finding expression for, her emotions in our sessions, through my questions exploring her experience. 

After so long ignoring her needs, she had felt like a passenger in the car of her life, allowing her direction to be chosen by the circumstances of the moment without really being aware of it.  As she began to notice her own wants and needs, she spent progressively more time in the driving seat of her life which enhanced her growing self-confidence. She decided to take some time each week in an activity she had loved earlier in her life but had been phased out whilst focusing on her family.

She discussed her workload with her manager. Whilst the pressure of market forces remained intense, she agreed with her manager a process by which she could feed back to him when her workload was becoming too much.  They could then re-prioritise her workload, identifying what might be delayed or shortcut with the least impact. In the past she had spent time, both in and out of work, worrying about how to manage her workload. The recognition from her manager implied in this process freed her up to be more productive.  Now she was worrying less, her sleep became less disrupted and she felt more rested in the morning. 

She realised that through stress she had become tetchy with the children when they misbehaved. She now felt differently in her relationship with them. She spent more time playing with them and clearly, she and they enjoyed this time together. They behaved more calmly as a result. They still had their moments, but even then she was able to manage their crises without feeling stretched.  Following open discussions with her partner, they decided to regularly spend some time with just the two of them away from the children.  Just the act of deciding together to do this re-established the strength of their relationship and more explicitly expressed loving feelings between them.

Her thoughts now moved towards her future and what she wanted from her career and life in general. She was considering various options including reducing her working hours & specialising in an aspect of her current career. She also started thinking about what they might do once the children had left home.

By this time, she felt she had got what she wanted from the therapy and was ready to leave.  The changes had crept up on her incrementally. So, when reviewing her progress in our work together, as part of the usual work of ending therapy, she found it hard to imagine herself as she had been prior to starting the sessions.  

She recognised that there was potentially yet more we could work with, but felt that what had been achieved was enough for now and would take some time to consolidate these benefits on her own.  She was aware of the warning signs and knew what to do if she started to feel stressed at work. However, she strongly felt that having got back in the driving seat of her life, and with all the supportive mechanisms she had put in place, she was unlikely to let that happen again.

She had valued our relationship, appreciating what she had learnt about herself in the process, and was sad that it was ending. She felt that if she needed to, she would imagine discussing things with me and find her own way forward. 

If you have any questions about this blog or any of the issues raised please feel free to contact me via my website: http://www.garycooktherapy.co.uk

Head and Heart

Many clients have a clear understanding of their issues, but find themselves behaving in ways that they know are inappropriate or unhelpful to them and can’t seem to stop themselves. In this week’s blog we will be looking at how therapy can help with this dilemma.

I use a simplified concept of head and heart to represent these two aspects of a person. This does not relate to the physical organs. It is merely a way of helping the client to understand that they hold within them two perspectives which disagree. This is most often a thought process versus one based primarily in the emotions. E.g. “I want to eat more even though I know I've had enough”.

In my experience, the emotions have their own logic – what I term crudely as “heart logic”. This may be more subtle and harder to uncover than “head logic”.  At its core, “heart logic” usually has an underlying message. All emotions may be thought of as messages from ourselves, to ourselves. For example, anger is a prompt to action, hence we get all fired up in readiness for that action.  Fear is a prompt to take defensive action in anticipation of some threat.

Babies need their caregivers, usually their parents, to help them learn how to manage their emotions.  No parent is perfect, so there can be issues for the child in this learning process. For example, anger or sadness, crying or complaining may be seen as “negative emotions”. The implication is that such emotions are not desirable. The child may infer from this that such emotions threaten their relationship with their parents on whom they are dependent for survival. This can make it a matter of life and death. Little wonder they try to swallow their anger, or feel ashamed if they are sad. “There must be something wrong with me”.  All of this typically happens outside of their awareness. In addition, Western society privileges an objective stance, which typically means logical thinking without emotions.  Thus, the emotions may be seen as irrational. 

Once the client has learnt that emotions are irrational, unhelpful, to be suppressed, kept within a particular range (no outbursts), then they are likely to respect their head logic at the expense of their heart. This means that the messages of their emotions are not being received. When they are not received, then those emotions try again and again to find a way to be heard.  It is at this point that the dilemma is born. As an adult, the client is not under the same threat as they were as a child, but now the “heart logic” has been buried in the unconscious, they don’t know that. So when a desire surfaces the client has no idea why it is so powerful.

Helping the client develop a compassionate understanding of the underlying logic of their emotions is an important part of the process of therapy. For example, they may realise that they hold a profound shame about some aspect of themselves that they are unloveable, too sensitive, too much, too needy, spoilt. They yearn to soothe this deep wound by any means. If the values in which they were brought up associated food with caring, then perhaps overeating is the heart’s “logical” response.  The next step is for the client’s compassionate understanding of their heart logic to enable them to work with processing the difficult emotions which prompted its necessity. When the emotional wound is healed through a loving relationship towards themselves, the message of the historically unacknowledged emotion is finally delivered. That emotion is satisfied and can now withdraw. Thus, the heart logic becomes redundant, resolving the dilemma.

This sounds all very straightforward. However, it can take time in establishing the therapeutic relationship to such a depth that a lifetime of unconscious and subtle defences dare to relax. Then they can start experimenting with expressing their most vulnerable parts of themselves. In becoming open to their whole being (head and heart) they can become more fully engaged with others.

If you have any questions about this blog or any of the issues raised please feel free to contact me via my website: http://www.garycooktherapy.co.uk

Bottling up Feelings

Many clients experience difficulties managing their feelings. Frequently they have learnt to bottle up their feelings as a way of dealing with them, then find themselves struggling to cope when faced with the mounting pressures of living.  When they first come for therapy they may or may not be aware that this is what they are doing.  This week’s blog explores how we learn to bottle up our feelings and how therapy can help.

As babies we don’t know how to manage our feelings.  We are dependent on our caregivers, usually our parents, over the course of our upbringing to help us:-

1.  Identify each of our emotions
2. Learn to express our emotions appropriately
3. Learn that we are still loveable and acceptable when we express our full range of emotions.

Parents are not perfect.  This leaves many clients remaining stuck with some aspects of this learning. There are many ways in which such problems may manifest.  Bottling up emotions is just one of these.  

If parents are uncomfortable with their emotions in some way, it can be very difficult for them to remain relaxed when their child is expressing forcefully some very intense emotions. Most often, it is anger that is seen as a “negative” emotion, although in some clients it is joy that has been inhibited. Thus it may be discouraged, consciously or otherwise.  The child then learns it is not safe to express that emotion which is when the strategy of bottling feelings appears to be protective and useful. 

Over the years, more and more of these angry feelings remain unexpressed with nowhere to be heard and understood.  Sooner or later, such feelings either leak out, or perhaps the individual learns that they are powerless to express themselves successfully.  These are the seeds of depression.  Such individuals sometimes “self-medicate” using alcohol as a means of managing their emotions which only adds to their problems in the long run.

Therapy offers a safe environment in which a relationship based on trust can aid the client to find more appropriate ways of managing their emotions.  Together, the client and their therapist, can explore how they learnt to bottle up their feelings. Through this, the client can develop a more compassionate understanding of themselves. In the safety of the therapeutic relationship, the client can begin to dare to express their full range of emotions, and experience the sense of release and their own power in doing so, knowing that the therapist accepts them as they are.

They learn that these feelings, far from being toxic, are there for their benefit, empowering them to express themselves and potentially move towards outcomes they desire. The final step in the process is when they can apply this to their relationships outside the therapy.  When the client can do this for themselves, they are usually ready to leave therapy.

If you have any questions about this blog or any of the issues raised please feel free to contact me via my website: http://www.garycooktherapy.co.uk

Breaks

Sooner or later in all but the shortest therapy, there will come a time when either you or the therapist will be unable to attend the weekly session due to holidays or illness.  The feelings that accompany the break can be very informative. This week’s blog looks at the sorts of feelings that may be elicited and why therapists are likely to ask you about them.

The most beneficial element in therapy is the relationship between the client and the therapist. Often, feelings experienced by the client before, during and after a break, can give a useful window on the nature of that relationship from the client’s perspective.  These feelings can express the pattern of relating that the client learnt in their formative years.  This pattern is most often not held consciously, “that’s just how it is” can be the client’s response if you only scratch the surface around this topic.

For clients who have learnt to be anxious about their relationships, a break can feel like a threat, particularly where it is the therapist who is not available for a session.  Some such clients may try to sustain contact over the break by emails or texts.  Others may subconsciously “punish” the therapist by not attending the session after the break or by turning up late.  It may also show up in the nature of the material spoken of in the sessions.  Underlying themes of abandonment and loss may emerge here even where it is not about the therapist.

For clients who have learnt to protect themselves from the vulnerability associated with relationships, a break can merely reinforce what they anticipated anyway.  Subconsciously, there can be a sense that “I knew they couldn’t be trusted”.   For some, this feeling is so strong that they may not return to therapy after the break, sometimes without any contact.

For these reasons, I find it important to explore with the client what their feelings are around breaks.  I would try to give at least 3 weeks notice of any holiday that I am to have and request the client to give me as much notice as possible before their holidays. This way, we have a chance to explore these potentially sensitive issues, so the client has the chance to gain a conscious awareness of how their patterns may be impacting their experiences of breaks.

Thus, if they find they are feeling hurt prior to a break, they can begin to recognise their pattern of relating which is the first step towards taking conscious control and beginning, through the trust developed in the therapeutic relationship, to learn new patterns of relating.  In the new pattern, they can begin to trust that they are loveable, are not about to be rejected, and can bear a gap in the support from loved ones without anxiety or hurt.

If you have any questions about this blog or any of the issues raised please feel free to contact me via my website: http://www.garycooktherapy.co.uk

Time

Time has a significance within therapy which may not be apparent to you if you have not had therapy before. So, in this week’s blog we will be exploring some aspects of time which are particularly relevant to therapy.

Often, therapists in private practice see clients in their own home and therefore do not have the luxury of a receptionist & waiting room to accommodate them if they are early.  Even practice clinics or agencies may not have such facilities although they are much more common.  Thus, you will be asked to wait until the agreed time before knocking on the door for your session.  Imagine how you would feel if at the end of your session, which may or may not have been very emotional, to have to walk past a stranger as you leave. I normally allow 10 minutes between sessions which gives time for one client to leave well before the next client is due to arrive.

If you are late, then the session still ends at the agreed time, 50 minutes after the scheduled start time.  It avoids one client having to meet the next client as mentioned above.  More importantly, it is one of the many ways in which therapists demonstrate their reliability in providing support for the client.  By repeatedly being on time for the start and the end of each session, over many sessions the client can feel at a gut level that here is a pattern of support on which they may rely, even when the client themselves may be irregular in the timings of their attendance.  For clients whose formative experiences when young were of care-givers who were unreliable in their responsiveness this can be an important aspect of the support offered.

It is often enlightening to explore with a client what happened and how they felt about being late. It can often be a window onto how they manage their world and their expectations of it. This is especially true if there is more than one non-attendance and/or lateness. Do they view therapy as an indulgence, therefore not to be prioritised in the face of regular traffic problems? Do they not prioritise themselves and therefore the therapy? Are they trying to impress upon you just how busy they are? The list of possible reasons is endless. What is important, is to try to understand what is going on for the client when this happens. This is all part of the work of therapy.

Sometimes, clients will be full of things to say during the session, and only in the last few minutes engage more fully with their emotions.  There may be many reasons for this.  Often, it is an unconscious strategy to avoid having to stay with difficult emotions for long. Once they recognise this pattern they soon get frustrated as they realise they are getting in the way of helping themselves move forward.  Some clients can feel hurt by the seeming coldness of the therapist in ending a session whilst the client is in the middle of some intense feelings. Different therapists work with this in different ways. Personally, I monitor the intensity of the client’s feelings in the last few minutes of the session, offering them a choice as to whether they wish to go that deep so close to the end of the session. Even so, at times the client may be profoundly emotional in the last minutes, in which case I would allow the client a minute or so to compose themselves before facing the outside world.

Clients can think of things to say just as the session is ending. At that point, there is no possibility of exploring what the meaning is for the client of this story.  Thus, it may be better to ask the client to bring it next time if they wish.  It would be particularly important to address this, if it were a pattern. What is the meaning of the pattern?  To avoid the ending?  To avoid having to stay with difficult emotions that might be evoked by the story? All useful information about how the client relates to their world.

Through all of these issues around time, the client can experience the therapist’s questions around it as criticism for being early, late or whatever. However, the work of therapy is always to try to understand what meanings these events and patterns might have for the client and how they experience, & relate to, the world.  It is an exploration not a judgement.

If you have any questions about this blog or any of the issues raised please feel free to contact me via my website: http://www.garycooktherapy.co.uk

Confidentiality

For therapy to be effective, the client needs to feel free to talk about their issues.  These issues often arise because of the sense of shame which prevents the client from talking them through with others. Thus the client needs to know that whatever is disclosed in therapy remains confidential.  For this very reason therapists are rightly very protective of their clients’ confidentiality. There are however a few exceptions to this rule. This week’s blog explores the limits of our confidentiality.

Supervision:– The therapist will identify the client by a first name only, and give enough detail about the client’s life to help the supervisor understand the background to the process unfolding between the therapist & the client. The supervisor is also bound by their professional code of ethics to maintain confidentiality.  See the earlier blog entry on Supervision for more details.

Risk:- If I have concerns about the safety of the client or of those around them, I may, if the circumstances are appropriate breach confidentiality by expressing my concerns with the client’s GP. This is a last resort and even then, the only information disclosed would be the minimum sufficient to advise the GP of the nature & degree of risk involved, so they are best placed to manage that risk.  If at all possible, I would encourage the client to seek help directly themselves to manage their risk, e.g. take themselves to the Accident and Emergency Department of their local hospital, contact their local GP or out of hours service.  If I felt that the client was unable, unwilling or unlikely to do this, then I would seek their permission to contact their GP on their behalf.  If that permission were denied and I was seriously concerned for their immediate safety I would then contact their GP. This is never undertaken lightly and in practice is quite rare. See the earlier blog entry on Managing Risk for more details.

Legal Requirements:- There are a number of laws which may require the therapist to breach confidentiality. This may be around disclosures of impending terrorist activity or of an ongoing child protection issue. My first reaction would be to encourage the individual to report the matter to the appropriate authorities e.g. the police or social services. Only if they were unwilling to do so would I seek their permission to disclose the information on their behalf, and failing that advise them that I will be breaching confidentiality in the interests of safety. It is also possible (albeit extremely remote) that a therapist’s client notes will be subject to a subpoena from the courts. For this reason, client notes are usually limited to recording brief details of what the client disclosed and no conjecture about the client by the therapist.

In summary, breaches of confidentiality are rare and in the best interests of the client. Therapists are highly protective of their clients' confidentiality as it is the basis of trust in the relationship.


If you have any questions about this blog or any of the issues raised please feel free to contact me via my website: http://www.garycooktherapy.co.uk