This blog has moved

New blog address!

Thank you for following ‘Let’s Talk!‘. Due to a new website, this blog has now moved and we would love for you to move with us, to keep up to date with our latest posts. Please follow us at:

http://www.the-terrace.co.uk/blog/

We have lots of new interesting and informative posts planned for the future!

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The Humanistic approach: Not what is wrong, but what happened?

Jane

Jane Gotto

The practice of Humanistic Psychotherapy has gained significant recognition in recent decades.   Having been a humanistic psychotherapist since the early 1990’s, Jane Gotto, Director of The Terrace, has noticed research and results have brought the humanistic approach – putting the person in the centre of the work – more mainstream. It is now challenging some of the more traditional ways of treating mental health, by working with the person not their symptoms. This piece links to  a letter sent by Terry Cooper, Founder Director of Spectrum Therapy, in which he talks about Richard Bentall’s response to Stephen Fry’s programme exploring manic depression, as part of the BBC’s In the Mind series.

In Terry’s piece, published by Spectrum Therapy, (http://www.spectrumtherapy.co.uk/images/resources/ALL_IN_THE_BRAIN_COMP_DOC.pdf), Bentall asks Fry to portray the conditions he is so keen to demystify and destigmatise – bipolar disorder and schizophrenia – in a way that does not, as much current thinking seems to do, decontextualize the disorders. Are they, as Fry maintains, based on ‘bad luck’ or ‘genetics’, striking the especially vulnerable and becoming a lifelong condition only treatable by medication or are there more complex conditions at work?

As Terry Cooper stresses, “any degree of self- influence is empowering and generates hope” and “trying to fix people -remove symptoms- rather than provide time for them….. creates a premature closure of underlying problems.”.

Eleanor Longdon’s moving TED Talk ‘Voices in my head’ (http://www.ted.com/talks/eleanor_longden_the_voices_in_my_head?language=en) is as chilling as it is eloquent and moving. Her description of the way in which the medicalisation of her mental health issues created a downward spiral from which she was lucky to escape offers an alternative to the conventional twenty-first century psychiatric response and asks the question in the title, focusing not on what others have said is wrong with the client, but on how the client really feels.

Eleanor Longden TED

Eleanor Longden

It takes in issues such as nurture versus nature.  Do we look at a client’s response as a consequence of the pre-wiring of their genetic make-up?  Or do we examine it as a result of external factors after conception? This includes environmental factors, life experience and the effect of learned responses.

Jane Gotto shares Bentall’s concerns that we should not be quick to assume that the hearing of voices is a dangerous medical condition only treatable by strong anti-psychotic drugs that, in their medical effects, mask the real problem rather than treat it.

‘I think it is important that, as professionals, we shift from looking at symptom based treatment to finding out about the person’s experience;  who they are, what their story is, and how did they get to the place they are in?’

Jane Gotto works with a formative perspective, developing an understanding of what the person wants for themselves, and addressing what would make them feel better in their life.

There is evidence that a genetic component to mental ill-health is likely, but it is not easily identifiable and can blur the distinction between recognised conditions, such as bipolar, schizophrenia, ADHD and, as Bentall highlights, even Autism.  He points out that many psychiatric patients are deeply dissatisfied with what medicine alone can do for them. Why, when other conditions such as cancer, are seeing improving survival rates, is recovery in those with mental illness just as elusive as it was fifty years ago?

Jane Gotto says “The fact that Eleanor was dealing with voices in her head was the symptom, and what was healing was the experience of being listened to by others. But fundamentally and importantly she learnt to listen to herself. That’s a hopeful outcome.”

We would love to hear your views on this complex subject.

Teenage time-bomb: Why are our teens struggling with their mental health?

The Terrace head in handsIt has always been tough to be a teenager – it is a rite of passage; a period when wanting to be treated as an adult combines with the vulnerabilities of childhood to make an often confusing mix of emotions. But are 21st century pressures increasing the risks of long-term health issues?

News today suggests that a Department of Education survey of pupils  aged 14 and 15 has found that more than one in three of the teenage girls report symptoms of anxiety and depression. This equates to a rise of 10% over the past ten years and as such is clearly a major concern for parents, educators and society as a whole.

Girls reported  considerably higher levels of psychological distress than the boys – 37% having three or more symptoms compared to just 15%, and in boys the percentage has fallen since 2005.

The Daily Telegraph quotes Nick Harrop, of charity YoungMinds, who believes it has much to do with the way in which 21st century life impacts on young women:

“Teenage girls today face a huge range of pressures. Stress at school, body image worries, early sexualisation, bullying on and offline and uncertainty about the future after school are all piling on the stress,” he tells me. “Social media also puts pressure on girls to live their lives in the public domain, to present a personal ‘brand’ from a young age, and to seek reassurance in the form of likes and shares.”

Certainly, the rise of Instagram, Snapchat and the other image based social media channels has created more ways to challenge a girl’s image of herself compared to her peers, and sadly, to the photoshopped images of models and celebrites. Girls report issues with eating, with concentration and with anxiety, as they are constantly made aware of the importance of appearance in the media. Too little emphasis seems to be put on successful career women, perhaps, rather than those who model or walk the red carpet.

But others, such as former mental health tsar  Natasha Devon  think it is more to do with the kind of lives young people have to lead now, as parents work longer hours and success in life appears driven by higher salaries and working harder than ever to buy  those things, such as a home, that previous generations took for granted. In addition, all those subjects that supported good mental health are squeezed in the recent changes to the curriculum – music, art, sports and drama often provided a balance to the more academic subjects in which a young person felt more pressurised. Interestingly, those from a more affluent background were more likely to feel worried about achieving less than their parents hoped for them.

But Natasha Devon thinks the only difference between the sexes is how they deal with their mental health problems. She is quoted as saying:

“At an adult level, women are three times more likely to be diagnosed with anxiety and depression, which makes them look like primarily female issues. But men are more likely to seek help for substance abuse and are far more likely to take their own lives. It suggests to me women seek help for anxiety and depression but men self-medicate and tend to wait before they reach crisis point.”

This tends to suggest that where girls might be more ready to seek help, in the longer term it is boys who need greater support.

So what can be done? Here at The Terrace we have a number of therapists skilled in working with children and young adults, and we know how complex an issue this is. A good place to start would be in schools, where changes in behaviour can be noticed early and elements put in place during the school day to support self-confidence and self-esteem.

What do you think would be a good first step?  We would love to hear your views on what could be a proverbial ‘time bomb’, as a generation struggles to come to terms with the every-increasing and pressurised pace of 21st century life.

The Terrace Taunton: The first twenty years: An interview with Jane Gotto

Jane

Jane Gotto

2014 was an exciting year for The Terrace in Taunton, marking as it did the twentieth anniversary of its establishment and its development into a leading psychotherapy and complementary health centre in Somerset. There was much to celebrate, and even more to look forward to  – no one is slowing down now.

To mark the anniversary Jane Gotto, Director of The Terrace, was interviewed by Suzie Grogan at some length about the history and development of the business; the ethos behind it and the therapies available, as well as plans for the future – including her commitment to taking The Terrace into social media and the blogosphere!

As part of the on-line plan, The Terrace has opened a YouTube channel and the first videos uploaded are, of course, the interviews with Jane. In this first one, for example, she discusses how The Terrace came into being.

And in this one, she discusses future plans….

Do take a look at the channel, and if you have any ideas on other videos we can produce, or clips already on YouTube that we can link to we would love to hear from you.

So not only does The Terrace have a Facebook page at www.facebook.com/TheTerraceTaunton, you can also follow us on twitter @terraceclinic and on Pinterest www.pinterest.com/terraceclinic.

It isn’t all about promoting the business, although that is important of course. We find interesting articles on issues relating to psychotherapy, counselling and complementary health, alongside those campaigns we support  – most particularly the prevention of sexual abuse and female genital mutilation. And of course, on this blog we write in more detail on the same subjects and offer mindfulness practice and explanations of therapies you may not have considered before.

So after this shameless self-promotion we would love you to engage with us, comment on posts, converse on twitter and follow us on Facebook. We never spam and are always happy to answer questions. And of course, there are lots of lovely pictures and inspiration on Pinterest.

‘let’s talk!’ about ‘parity of esteem’ in mental health

esteemOver the past few weeks we have heard the term ‘parity of esteem’ used a lot, in relation to mental and physical health. It is an important phrase with an important meaning, but how many of us really know what it means? And would parity of esteem actually improve the way mental health services are delivered?
The NHS defines the term as meaning:

“My family and I all have access to services which enable us to maintain both our mental and physical wellbeing.”
“If I become unwell I use services which assess and treat mental health disorders or conditions on a par with physical health illnesses.”

Professor Sir Simon Wesseley, incoming president of the Royal College of Psychiatrists, has highlighted this issue in The Guardian recently, as he took up his post, challenging Health Secretary Jeremy Hunt on his pledge to ensure mental health services achieve the same level of provision as physical health services . He believes the gap is already so great that finances will never be able to close the gap. If less than a third of people with cancer received any treatment at all, wouldn’t we be up in arms? What if they had to wait 6 months for a scan? These are the figures for those suffering with depression, a condition that can worsen, result in life-threatening illnesses and at its most severe, death.

On the Radio 4 programme ‘All in the Mind’ yesterday, Clinical Psychologist Martin Seager, who spoke so eloquently at the Taunton Association for Psychotherapy Conference in 2013, said that the well-known statistic that 1 in 4 of us will experience mental ill-health is misleading, and could even increase stigma. He feels that this discussion on parity of esteem hides the real issue – that we all experience mental and physical health or ill-health. There is a mental health aspect to physical health, and vice versa. Looking at those two NHS definitions above therefore, the first seems more appropriate, and is one that many therapists would endorse.

Simon Wesseley continued:

Professor Simon Wesseley

Professor Simon Wesseley

“The whole of our healthcare system is about separating mental and physical. You couldn’t devise a system better suited to separating the mental and the physical if you tried……..Most people have quite complicated views of their illness anyway…….They are not resistant to doctors offering cardiac tests and counselling for a recent divorce at the same time.” He has seen psychiatrists on general medical wards work with great success.

“But we know people with physical health problems who also have mental health problems cost about 45% more than those who don’t. That’s absolutely and unequivocally clear. The cost of their care goes up. They comply less with treatment, they come back more often, they have lower satisfaction and they have more complications.”

So the President of the Royal College of Psychiatrists is calling for more holistic treatment across the health service, which could achieve significant savings if implemented. Parity of esteem is surely all about keeping physical and mental health separate, thereby perpetuating the myth that we can be mentally ill but physically healthy, or physically ill but without mental health needs. Doesn’t this, as Seager suggests, increase the possibility that mental ill-health will remain stigmatised and disconnected from, and in competition with (for resources, time etc) with other health services?

We would love to know your views!

Shell Shocked Britain – The First World War & inter-generational trauma

Shell Shocked jacket high res jpegAs we approach the first Remembrance or Armistice Day commemorations of the First World War centenary  it is appropriate to be mindful of what exactly we are marking on Sunday, and on the 11th of November 2014. Yes, we are offering up our thanks to those who gave their lives in the Great War and subsequent conflicts, but we must also remember those who survived, lived, and are living with the aftermath of the war.

In Shell Shocked Britain: The First World War’s legacy for Britain’s mental health, Suzie Grogan looks at the impact of the First World War on the men, women and children who survived it. How did those four years of conflict affect the way we view the mental health of those traumatised by their experience of war, whether directly or indirectly?

Dr Peter Heinl, in Splintered Innocence and others have long studied how ‘neuroses’ can be transmitted from parent to child, replicating traits down the generations.  It has not been easy, as data is limited and follow-on studies of those diagnosed with shell shock or what we would now refer to as ‘combat stress’  is very limited, or non-existent.  Work with Holocaust survivors, however, has offered greater consistency in the results of studies into the intergenerational effects of parents’ traumas. Published work has suggested greater vulnerabilities to Post Traumatic Stress Disorder (PTSD) in second and third generation survivors. Responses to a traumatic event – whether in conflict situations or a personal trauma such as bereavement or serious illness can be more marked in the children of traumatised parents.

Arthur Addison, shell shocked soldier

Arthur Addison, shell shocked soldier

Suzie Grogan was inspired to write this book when she discovered that her shell shocked great-uncle Alfred Hardiman had killed his ex-girlfriend and himself in 1922. His act sent shock waves through his community and through the generations of his own family, but it was not an isolated case. She discovered that her grandfather had also suffered from shell shock, along with tens of thousands of other men who fought in the First World War. Identifying other members of her family who had subsequently experienced mental health issues, and acknowledging her own periods of depression and acute anxiety,  Grogan was keen to examine how the events of 1914-18 continue to resonate with us 100 years on and in doing so she uncovered new material to chart the many tragedies with their roots in the conflict.

Shell Shocked Britain looks at:

  • the direct effects of shell shock on the troops and their families,
  • the different medical approaches to ‘cure’ shell shock, including electric shock treatment, hypnotism and the talking therapies, as well as ‘miracle’ cures.
  • The impact of the1922 Committee Report on Shell Shock that was supposed to change the way men were treated in future conflicts.
  • the devastating air raids that brought the war, literally, into the domestic lives of the Home Front, killing civilians as they stood in the streets and wrecking the Upper North St school in Poplar, East London, killing 18 children.
  • The lingering after –effects of the Spanish influenza virus and the horrors of an outbreak that killed 200,000 in Britain alone as war continued to rage.
  • why thousands turned to séances and spiritualist church and how the rise of the Eugenics Society had direct links to the conflict, with leading thinkers supporting unthinkable responses.
  • how tragedies such as that perpetrated by Alfred Hardiman and suicides in general increased even into the 1930s.
  • the legacy of shell shock and lessons for future conflicts – 1914 to 2014

In the book Suzie Grogan asks tough questions of her 21st Century audience. We are told not to attribute modern views on historical events, but, she maintains, these are our close kin – parents, grandparents and great grandparents. For hundreds of thousands of people the trauma of the Great War never left them, and in the modern army highly trained men and women still break down, coming back to a civilian life for which they are ill-prepared.

To ensure children are protected from the higher levels of family breakdown, substance misuse, domestic violence and homelessness  that affect troops now as they did 100 years ago, it is important, as this book highlights, to use the next four years of commemorative events to remember those who continue to struggle with the fallout of war, and support them.

Suzie Grogan is talking at the Taunton Literary Festival on 11th November 2014 and for Taunton Association for Psychotherapy on the 14th November . See suziegrogan.co.uk for more details

Dealing with anger in angry times (2)

angerIn a previous post we looked at the ways in which we can cope with feelings of anger in a society that is increasingly prone to focus on the negative; stereotyping and reporting on issues that can make our blood boil. We looked at how we can focus on those issues that we can influence, and how certain coping strategies can increase our chances of remaining calm and ensuring relationships are not damaged by unexpressed, or hastily expressed, anger.

We mentioned at the end of the last post that this time we would examine who is responsible for our personal response to anger. Of course, the answer is ourselves. We can choose whether to act hastily or with a more measured tone. But we acknowledge that in some situations this is difficult, or impossible. So why do we get angry?

There are obvious causes: a threat to ourselves or the ones we love, being actually assaulted – verbally or physically, losing money, finding our property has been damaged. Then there are less obvious ones: hearing someone has acted against a principle we hold dear, being interrupted when something is important to us, feeling undermined or humiliated among our peers. If it seems we have been hurt deliberately it can make matters worse.

If we are in imminent danger, the anger can be productive and protective, but if the causes are less obvious, then our responses can affect the outcome for our health, and for our relationships.  If we are living in a state of constant tension we might snap, regretting it later when we find we have over-reacted and must build bridges. Or we might repress  our anger, only for it to surface days, weeks, months or years later.

Some anger can drive change for the better, lead us to campaign for what we believe to be right. But repressed anger, or long-term anger that is not expressed in a constructive way can lead to depression, anxiety and self-harm, alongside physical ill-health, such as high blood pressure, heart disease, strokes and gastric problems.

The Mental Health Foundation offers some great advice for those of us faced with a situation where we sense our blood is up. Where in our last post we offered some general advice, here are some specific exercises to adopt:

Count to ten before you act.
Drop your shoulders and breathe deeply to help you relax – your instincts may be telling your body to get ready to fight, but your rational self can reverse this message by telling your body to chill out.
If you feel the urge to throw something or hit out, remove yourself from the situation and try taking it out on something soft like a cushion that you won’t damage and which won’t hurt you.
Try screaming if it won’t disturb people near you or scream into a pillow to release your tension.
Talk yourself down – imagine what your calmest friend would say to you and give yourself the same advice
Imagine yourself in a relaxing scene.
Distract yourself or take yourself out of the situation that made you angry – read a magazine, do a crossword, listen to soothing music, go for a walk.
Pour out how you feel in writing or redirect your energy into another creative activity.
Offload to a friend who will help you get perspective on the situation.

We know it is not easy to deal with anger, but most of us can learn to respond in a healthy way. Next time we will look at triggers; if we know in advance what ‘sets us off’ it can make us better able to cope with a situation before that moment of no return…..

The Terrace is hosting a ‘Shaping Anger’ workshop on 25th and 26th October. For more details go to What’s On.