About stewartoncbt

I run a private psychotherapy practice from Stewarton, East Ayrshire (Scotland). I specialise in cognitive behavioural therapy (CBT) and schema therapy. Full mental health assessments and treatment are available on a one-to-one basis in a confidential setting. CBT and schema therapy are talking therapies used in the management and treatment of common mental health problems including depression, stress and anxiety, as well as more complex cases including PTSD, OCD and addictions. I graduated from Glasgow University in 2009 with a Masters degree in Psychology and a COSCA accredited certificate in CBT in 2010. I am a former NHS practitioner and have worked in private, voluntary and charitable roles.

Self and Health

 

 

 

 

To be on Facebook or not to be? That really is the question that a lot of my clients have been asking themselves.

Personally, I find emails and texts enough to be keeping on top of, but I do have a Facebook page, albeit a rather dusty one. I visit my ‘face’ once every couple of months for a good nosey around, but once logged in, that’s me hooked for a few hours!

Why is it then, that I feel so darn empty afterwards?

Apparently I am not alone. Facebook is a common topic in the therapy room, and many a tear has been shed as a result of ambiguous comments and seemingly ‘perfect’ peers.

Please don’t think me an old stick in the mud, I am after all writing a blog, so can’t really bemoan the advances of social media. It’s just from a professional perspective, it’s hard to praise a platform that can also feed into our primal insecurities and magnify certain unhelpful beliefs about ourselves and others.

“All my friends are having babies, and they look so happy”; “Why can’t I see the world as positively as others, I mean, look at the inspirational quotes they post!”; “Everyone else’s lives are so full, what am I doing with mine?”

My reply – how do you know it’s true? Let’s be honest, not many of us would happily pass around a photo of ourselves looking worse for wear, or publicise our deepest darkest fears for all to see.

As social beings, we are driven to attach to others, but with this comes the danger of comparing ourselves and in some cases, creating false idols to emulate.

So if you do find yourself looking at that selfie and wondering just who that person is, remember it’s a pixelated reflection, not your true self (same goes for everyone else). We are so much more than what we project to the world! Failing that, why not try a Facebook sabbatical? It’s worked wonders for those I know who’ve taken the leap.

 

Borderline Personality Disorder for Family and Friends

This is a link to an interesting site… bpdfamily.com

It offers practical and emotional support to loved ones / family members who are living with an individual who may have the symptoms, and/or a diagnosis of Borderline Personality Disorder (BPD).
The comments regarding diagnosis of BPD sadly mirrors the judgment of some of my peers who fall into the category of clinicians hesitant to acknowledge / diagnose this particular personality disorder.
Working with clients who have BPD can be testing,however, the roots of the disorder and treatment plans are far from complicated thanks to the emergence of Dialectical Behaviour Therapy and Schema Therapy.  BPD does not have to be a life sentence and some  individuals can and do recover. Challenging historical perceptions of the disorder would go a long way to improving the lives of many individuals and their families.

Am I mentally ill or expecting too much of myself?

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This post is partly inspired by the ever increasing prescription of medications for depression and anxiety. It is also informed by clients who have been told, perhaps by friends or family, that they must be mentally unwell, given the symptoms they present with (fatigue, worry, low mood, tearfulness, etc.). This can be daunting for individuals who have perhaps watched relatives endure mental health problems, and naturally fear that they may be heading down a slippery slope.

I am not suggesting that changes in mood be dismissed; it is important to inform your GP if you are struggling with fluctuating mood that has gone on for some time with no obvious trigger. Anxiety and low mood often come to the fore when we find ourselves under pressure or faced with uncertainty. In some cases, we may be able to problem-solve issues resulting in an improvement in mood but this requires some detective work in the first instance to identify contributing factors.

Often, individuals are carrying enormous burdens that they have become accustomed to and therefore do not make the link between their responsibilities to others and their deteriorating mood. Exhaustion can have a profound effect on physical and emotional well-being and does not necessarily suggest an underlying mental health problem. In some cases medication can ease periods of extreme anxiety and low motivation but solving the cause of this exhaustion is the only real path to recovery.

I would advise people struggling with low mood to ask themselves if they are stretching themselves too thin, giving to the detriment of receiving, and asking of themselves what they would not ask of others. It can be tough to challenge our norms, especially if we have become accustomed to being the ‘strong’ one who never says no for fear of letting others down. However, the results could be surprising. When we reduce our desire to take on the world we may come to find that others have been dis-empowered by our input and can now start to develop their own coping mechanisms, freeing up more time to look after yourself.

 

Creativity and mental health

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It’s everywhere…search Google for mental health and creativity and a whole host of famous politicians, artists, and activists can be found; each with their own history of mental health problems. Their contributions to society are well documented, but what of the subtext – their own battles with mental health problems?

As Aristotle said; “No great genius has ever existed without a strain of madness.”

How often do we acknowledge the link between ‘greatness’ and Bipolar Disorder for example? It is not a word often associated with the highs and lows of emotional dis-regulation. However, there is significant evidence to suggest that these very highs and lows may be a key ingredient in the evolution of social and change, something we all benefit from.

Sadly, many of these great historical figures, such as Winston Churchill, went undiagnosed and unmedicated; forced to seek solace in alcohol and excess. Today, however, with the advent of greater access to psychotherapy and pharmacology, it might just be time to acknowledge and salute individuals who have the potential to offer such greatness to the world. Perhaps, if there was less stigma and negative press associated with mental health problems, we could remind ourselves of the talents that may be lying dormant in many people.

I have seen such talent, intellectual and emotional, in many clients. However, I also hear of their struggles integrating at work when a mental health disorder has been disclosed. If schools taught pupils a more balanced view of mental health difficulties, perhaps we could eradicate stigma altogether and champion all forms of creativity. Similarly, if employers could look beyond the idiosyncrasies associated with exuberance and innovative minds, they might just be privileged to bear witness to the next generation of ‘greatness’.

 

Resilience

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How I wish I could capture and distill the dignity and spirit of clients facing daily battles with mental health problems. It is quite extraordinary how the human spirit to survive and flourish can remain in the face of fear, anxiety and despair.

There is a great deal of research into factors affecting resilience; some point to positive role models, and others to character traits. In my experience, it remains a mystery.

I have met individuals who have endured multiple traumatic events, face obsessive rituals that dominate their days, and struggle with unimaginable inner torment. And yet, these individuals continue to seek answers and solutions to their unwelcome afflictions. It is a credit to them as individuals and a testament to the human determination to survive.

I believe it is near impossible for those who have never experienced a loss of reality or an event that defies belief, to imagine what life might look life in the aftermath of this: darker, more fragile, unjust? And yet, there are survivors, those who have been there and back again.

There is a theory, loosely based on the common dictum: ‘What doesn’t kill us…only makes us stronger’. It is called Post Traumatic Growth Theory. This theory suggests that it is not only possible to successfully treat symptoms associated with trauma but to growpersonally as a result of this. I am not entirely bowled over by this assumption given the perhaps overly positive spin it suggests. However, I would very much like to believe that the human spirit can accommodate significant blows and remain resolute in the face of an uncertain future where appropriate support is provided.

I can testify to what I have seen in my practice; a desire to find meaning where at first there seems none. This need for meaning aligns itself with the metaphor of the brain as an information processing system. If it is possible to locate trauma and injustice within some form of an extended world view, then what occurs to us over our lifetime, good or bad, might have some chance of being appropriately accommodated, along with all the other experiences and memories that we so efficiently store away.

Following successful treatment for post-traumatic stress disorder, I have often observed a shift in clients’ perspectives towards the self, others and the world. Where once there was no self-compassion to be found, kindness might evolve. Where there was no purpose, a desire to support others can emerge. Perhaps it is integral to the human mind to find meaning in the face of adversity.

Whatever may be the key to resilience, it must not be overlooked by the symptoms associated with poor mental health. To do so would be a huge disservice to those who have suffered and survived.

What is it to be traumatised?

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Clients often report feeling fraudulent entering therapy, stating that they had a happy childhood and no significant traumas in their life to date. In their mind, it is they who are fully responsible for their ongoing depression or anxiety. We tend to think of traumatic events as those extremes we hear about in the media: rape, assault, terrorism etc. In reality, the link between trauma and a traumatized brain is less clear cut.

Life is littered with uncertainties and perceived threats, to our lives, self-esteem and confidence. In the face of such threats, some of us are simply unequipped to deal with the psychological fall out – through no fault of our own. To assume full responsibility for how we react to these events, is inaccurate and disregards all that we now know about the brain. Brain imaging has revealed our limitations as human beings to differentiate between perceived and real danger. As a result, it may be more accurate to attribute some responsibility to our innate physiology.

I prefer to use the word ‘traumatized’ in therapy rather than labeling specific events as the moment trauma occurred. This allows clients to identify behaviors, emotions and thoughts that may indicate a ‘traumatized brain’. Put simply, a traumatized mind is a ‘confused or disorganized’ mind, involuntarily firing on all cylinders and largely out-with our control due to our evolution.

A traumatized mind is separate from the traumatic event. We are not born with the skills to self-soothe in the face of danger (perceived or real). We may seek them out in infancy but there is no guarantee these needs will be met through our environment. We have to learn these skills, to enable our brain to successfully access the parasympathetic nervous system, which essentially sends in the ‘para’-troupers in times of stress to calm the flames of anxiety and fear.

We learn key nurturing skills in early childhood, largely from care givers. Given that care givers are only human, and may well be inexperienced at managing their own emotions, we may find ourselves vulnerable to developing self-compassion. This is not to say our parents or peers are to blame for our underdeveloped brains rather that it is in no way our own fault as individuals for getting trapped in a traumatized mindset.

The good news is, no matter how traumatized our brains may be, brain imaging has shown that these key nurturing skills can be learnt at any age with the help of psycho-education and/or appropriate psychotherapy. Schema Therapy, Cognitive Behavioural Therapy, Psychoanalysis and Mindfulness all offer ways to calm the traumatized mind and gain essential self-regulatory skills.

It might be useful to consider the mindset that is engaged in the face of danger for you personally? Remember, our brains may be limited by insufficient development, but they are also extremely flexible, allowing new neural pathways to develop and arming us with more efficient and effective skills. A traumatic event can never be eradicated from our memories but we can significantly re-wire how our brains relate to these memories.

Shame and Compassion Focused Therapy

I wrote a while back about the impact of shame and how often this can lie at the root of psychological distress. Here’s a few more pointers on how shame can be tackled with compassion focused therapy.

Shame often disguises itself in more easily identifiable emotions, including, anger, disgust, anxiety, and depression. When shame is unresolved it can lie dormant for a long time. Typical behaviours that we might find ourselves caught up in are, self harming and aggression (attack), submissiveness to other’s demands (submit), and withdrawal from others (hide).

Shame is a normal human emotion, essential for the survival of social evolution, however, if left to eat away at us, it will often raise its ugly head again and again when we are feeling vulnerable or stressed. The power of shame is such that it can feel like a knife in the back, knocking our confidence and sense of direction and self worth. We can feel shamed socially, leaving us vulnerable and highly alert to other people’s judgments, and shamed internally, where we become our own worst and punitive critic, irrelevant of other people’s comments.

The good news is, no matter when or where our sense of shame comes from, the shameful mindset has been learned and therefore, we have the opportunity to learn a new mindset, one based on compassion.

The compassionate mindset involves first looking at the root cause, usually a situation or comment from others in the past, that first sowed the seeds of shame. This is followed by skills based training in Mindfulness, a meditative technique, which opens the door to a new way of interacting with our emotions, behaviours and thoughts. In a nutshell, Mindfulness increases self awareness of the shameful mindset, promotes self healing, and nurtures our ability to develop kindness, compassion, and a non-judgmental stance towards ourselves.

A great book for anyone struggling with shame and looking for an alternative path to freedom is The Compassionate Mind Approach to Recovering from Trauma by Deborah Lee.