Month: February 2018

It is a big step to come to a counsellor to talk about your traumatic past. Sometimes, having plucked up the courage to take that step, you just want to tell the counsellor the whole story. But that is not the best approach. Before you can tell me about those events when you felt out of control and unsafe, you need to be able to trust me. Trust can only be built by spending time with another person and getting to know them. And that is what you need to do in the counselling session. You need to get to know me and know you can trust me to maintain a safe place for you to talk about those events. So I always say, you can give me the headings, but not the content.

As well as giving you the chance to feel comfortable with me and decide that I can be trusted, you also need to learn some other techniques. Children depend on their caregivers to help them feel safe and learn how to cope with strong emotions. This is known as regulation. If a child does not have that support, or is in a situation where there is no one there to help them regulate the strong emotions, the child does not learn how to regulate on their own. Talking about the traumatic experiences can be very frightening for an adult who has never learned to regulate. So I will teach you techniques to ground yourself in the present before any in depth discussion of your past experiences. These techniques are helpful outside as well as inside the counselling session.

Of course, you do not have to share every event that happened to you, or any for that matter. You share only what you feel is important to share.

Sharing will not happen in the first session. It may take 2 or 3 sessions before you are ready to talk about your past experiences.

Working on your childhood trauma is not a quick process. It can not be attended to in just a few sessions. Anyone who comes to me, thinking they can attend for 3 or 4 sessions, will not be able to attend to their trauma. I will instead focus on teaching you some techniques to help you to self regulate.

Some people work on their trauma for one to two years. Then later they come back to work on more. That is quite normal.

When I work with trauma I always collaborate with you, the client. In trauma you never had any power or control in the situation. Now in therapy you have equal power and you have control of the situation. This is an important part of your recovery. I always teach you about how the trauma has affected you and will answer any questions you may have. I always encourage my clients to ask me about things, no matter how silly they think the questions are. You need to be informed about your therapy.

Trauma is very complex and before starting to work with someone on their trauma, there are a few steps that need to be taken first. Many people who have experienced trauma often feel anxious or find it hard to calm down. While I work through the steps prior to commencing treatment, I find it helpful to teach clients breathing.

The type of breathing I often teach is 4-7-8 breathing. So, what is 4-7-8 breathing? To answer that question, I need to explain a little of how the nervous system works. It was once believed that the brain and the body were completely disconnected. However, recent research has shown that this is not so. In fact, our bodies are where we store a lot of memory and feel our emotions. Research has also shown a link between psychological experiences and the way those experiences manifest in the body. We now know that we have several levels of defence mechanism in our body. Each one is related to a different part of the brain. We share defence mechanisms with reptiles in our most primitive brain, with mammals in our slightly newer brain and so on. Each more advanced defence mechanism can override the lower defence mechanisms to a certain point. Where that point is depends on our childhood experiences. Trauma in childhood lowers the point at which our more primitive defence mechanisms kick in. It is important to know that none of those defence mechanisms is something we can consciously control.

The lower defence mechanisms are the active defence mechanisms of flight or fight and the immobilising lower defence mechanisms of freezing.

Our most advanced defence mechanism involves social behaviour. This behaviour involves what is known as face to heart connection. This means that the muscles of the face and head are linked to the nerves that regulate the heart. Social engagement can be dangerous or safe. We know it is safe by the facial gestures of other people. If the gestures are friendly, we feel safe. If the gestures are unfriendly, we feel unsafe and our defence mechanisms will be activated. How we look, listen and vocalise communicates to others that we are safe to approach. This is why people avoid you when you are angry, because your face communicates danger to them.

Our bodies experience sensations in response to other people and in response to our feelings. If you ask children to colour on a body diagram where they feel anger they will immediately colour in parts of the body. An adult may tell you they “had an uneasy feeling in their stomach” about someone they felt uncomfortable about. These are all ways our bodies experience our emotions and where we store the memory of them.

The quest for safety is the basis of a successful life. Feeling safe depends on the state of your unconscious nervous system. Cues of safety help calm that system. When we don’t feel safe we are vulnerable to physical and mental illness. When we interact positively with other people, we do what is known as co-regulate, which means we help each other regulate our emotions. Coregulating is essential for our own survival.

But what if trauma has lowered your threshold for lower defence mechanisms to kick in? How can you remain calm and start to raise that threshold? 4-7-8 breathing is an effective way to deal with this. It involves sitting comfortably upright on a chair, or lying down on your back, or standing up. You must breathe in through your nose so that your stomach comes out. This means you are breathing properly deep into your lungs, rather than taking shallow breaths into the top of your lungs. Breathe in quickly to the count of 4, then hold your breath for the count of 7 (counting at the same speed as the inbreath). After that you breathe out to the count of 8 through pursed lips. This means your out breath is twice as long as your inbreath. Practice this for 5 minutes at a time. Try to do it at least 3 times a day. It does have long term benefits and in the interim can help you to feel calmer.

In my next blog I will continue to explain the process of trauma counselling.

Equine Therapy, using the EAGALA approach with a qualified practitioner can be a useful adjunct to therapy. Recently Kyra attended an equine therapy session. She has been struggling with a childhood where she had never been loved or accepted by her family and had been struggling with the grief over never knowing what it was like to be looked at with love and acceptance. She felt angry, cheated and damaged. She felt she was constantly seeking acceptance through her interactions with other people.

She walked into the therapy area with great trepidation. She was sure the horses would reject her and she would feel even worse. She walked up to a horse and tentatively patted its nose. It turned its head away and she thought it didn’t want her there. Nothing new about that. She was sure the therapy team were judging her, just as her mother would judge her. So she went away. Later she learned the horse had turned its head back but she was gone.

After learning of that she took the opportunity to connect properly with the horse and it was happy to stand there while she stroked its nose. She then felt confident enough to pat the other horses.

Later, in a counselling session, she reflected on this encounter with the horse and realised she was looking at things the wrong way. She felt unloved and rejected, so approached others expecting to be rejected and not liked. At the first hint the other person was not interested she was act to protect herself and run away. What if people were like the horses, just turning away to attend to something then turning back to continue relating to her but she was gone?

She realised her past did not matter. She may have been unacceptable to her parents but people now accepted her. Being unacceptable as a young child did not mean a lifelong unacceptability.

She was pushing people away at the first hint of what she perceived as rejection, when she was not being rejected. How many friendships could she had had if she had realised this?

She realised she wanted others to give her the acceptance her parents never gave her and set high standards on how she expected them to be and rejected them when they failed to live up to those high standards. She realised no one could give her what her parents failed to give her and that was okay. They could give her acceptance in their relationships in a different way.

 

So often in life we become so obsessed about something that we believe is essential for our happiness, that we miss the changes that lead to greater happiness. I was reminded of that a few months ago when I saw Kylie.

Kylie lived in a lovely leafy area. There were several houses nestled into a valley, surrounded by bush that covered the slopes around the houses. She had several beautiful trees in her own back yard. These were supplemented by the beautiful trees on the neighbouring properties.

Kylie could sit in her backyard, or look out the windows, and imagine she lived in the middle of the bush. This was important to her. She considered all the trees to be very precious. They allowed her to think she was living on an acreage somewhere in the bush. Something she could not afford.

One day a neighbour cut down the trees at her back fence. She was devastated. Suddenly she could see not trees, but her neighbour’s house. She was very upset and felt she could never enjoy living in her house again.

As she relayed the story of this devastating loss, she realised that cutting the trees down had opened the view to the wooded slopes behind the houses. This seemingly negative thing had opened a vista of the virgin bush on the slopes.

Kylie realised that she had concentrated so much on the loss that she had forgotten to see what she had gained was more precious.

Often in life we do that. We are so invested in what is there, that we focus on the negatives of losing those things we consider important. Yet, if we stop and consider, sometimes we discover that the new has opened possibilities for growth and greater enjoyment of life.

Sometimes is takes talking about our concerns and disappointments to be able to gain a new perspective. It is helpful to voice our concerns, in the presence of someone who is listening. Someone who will allow us to discuss what we are thinking and feeling. The process of putting our thoughts together and exploring them allows us to view them more objectively. When the listener allows us to explore the thoughts and feelings we will often learn many things about the distressing event. In Kylie’s case, she learned that the events she perceived as devastating actually had a wonderful benefit. She was able to realise the better view she now had. She was able to transform her disappointment and upset to joy and delight.

By visiting a counsellor, it is possible to be like Kylie. To be able to talk about the things that concern you. To be given the space to explore your concerns. To be able to see the concerns from a different perspective. And to find a way to move forward.

This article was written by Johan Hari and printed in the Sydney Morning Herald’s Good Weekend magazine on 2 February 2018.

Popping pills has become a panacea for depression across the Western world, in few countries more so than Australia. But what if the causes are societal rather than in our heads?

In the 1970s, a truth was accidentally discovered about depression – one that was quickly swept aside, because its implications were too inconvenient, and too explosive. American psychiatrists had produced a book that would lay out in detail all the symptoms of different mental illnesses, so that they could be identified and treated in the same way across the country.

It was called the Diagnostic and Statistical Manual. In the latest edition, they laid out nine different symptoms a patient had to show to be diagnosed with depression – such as decreased interest in pleasure, or persistent low mood. For a doctor to conclude you were depressed, you had to show five of these symptoms over several weeks.

The manual was sent out to doctors across the US, and they began to use it to diagnose people. But after a while, they came back to the authors, and pointed out something that was bothering them. If they followed this guide, psychiatrists would have to diagnose every grieving person who came to them as depressed and start giving them medical treatment. If you lost someone you love, it turned out these symptoms would arise automatically. So, the doctors wanted to know – were they supposed to start drugging all the grieving people in America?

The authors conferred, and decided that there would be a special clause added to the list of symptoms of depression. None of this applied, they said, if you had lost somebody you loved in the past year. In that situation, all these symptoms were natural, and not a disorder. It was called “the grief exception”, and it seemed to resolve the problem. But then, as the years passed, doctors came back with another question. All over the world, they were being encouraged to tell their patients that depression was the result of a spontaneous chemical imbalance in your brain – it was produced by low serotonin, or a natural lack in your brain of some other chemical. It wasn’t caused by your life, but by your broken brain.

Some of the doctors began to ask how this fitted with the grief exception. If the symptoms of depression were a logical and understandable response to one set of life circumstances – losing a loved one – might they not be an understandable response to others? What if you lost your job? If you were stuck in a job you hated? If you were alone and friendless? The grief exception seemed to have blasted a hole in the claim that the causes of depression were sealed away in your skull. It suggested that there were causes out in the world, and that they needed to be investigated and solved out here, in the world.

This was a debate mainstream psychiatry (with some exceptions) did not want to have. So they responded in a simple way – by whittling away the grief exception. With each new edition of the manual, they reduced the period of grief allowed before being labelled mentally ill – down to a few months and then, finally, to nothing. Now, if your baby dies at 10am, your doctor can diagnose you with a mental illness at 10.01am and start drugging you straight away. Some 32 per cent of grieving parents in the US are drugged within the first 48 hours.

Dr Joanne Cacciatore of Arizona State University became a leading expert on the grief exception after her own baby, Cheyenne, died during childbirth. She tells me that this debate reveals a key problem with how we talk about depression, anxiety and other forms of suffering: we don’t, she says, “consider context”. If we start to take people’s actual lives into account when we treat depression and anxiety, she explains, it will require “an entire system overhaul”.

“When you have a person with extreme human distress, [we need to] stop treating the symptoms,” she says. “The symptoms are a messenger of a deeper problem. Let’s get to the deeper problem.”

There is nowhere I went to, in the research for my new book, Lost Connections: Uncovering the Real Causes of Depression – and the Unexpected Solutions, that needs to think about this more urgently than Australia. On the entire planet, only one country, Iceland, has a higher rate of use of antidepressants. Since 2000, this rate has more than doubled, and nearly one in 10 Australians are taking them. They are even being prescribed to more than 1000 children aged between two and six. It’s a sign of a deep crisis.

When I was a teenager, growing up in London, I went to my doctor and explained that I felt pain was leaking out of me uncontrollably, like a bad smell. He told me a story – the story that has subsequently conquered Australia. He said there is a chemical called serotonin that makes people feel good, and that some people are naturally lacking it. You are clearly one of them. Take these drugs, and you will be normal again.

I believed and preached this story for 13 years – but there was something painful to admit. Apart from short pockets of relief, I remained depressed, no matter how many of these pills I took. I thought I was weird.

But when I spent three years travelling all over the world researching what is really causing this crisis, I learnt something startling. I was totally normal. Between 65 and 80 per cent of people taking chemical antidepressants become depressed again, according to the clinical psychologist Dr Steve Ilardi and research published in the New England Journal of Medicine. There is a real effect – but, alas, for many users, it’s not enough to lift them out of depression. I don’t want to take anything off the menu for depressed people, but it’s clear we need to add far more to it.

Dr Christopher Davey at the University of Melbourne, who has done some of the most interesting Australian research on this question, explains that the story I and millions of others were told by our doctors about why we were depressed is false. “The idea you could reduce it to one neurotransmitter [like serotonin] is obviously, obviously absurd. I don’t think anyone seriously believes that … That’s just absolute nonsense,” he says. “It has much more to do with social connectedness, and social supports.”

There is scientific evidence for nine different causes of depression and anxiety. One thing connects them. We all know human beings have natural physical needs: for food, water, shelter. It turns out human beings have natural psychological needs, too – but Australian society, and the wider Western world, is not meeting those needs for many of us, and that is the primary reason why depression and anxiety are soaring.

For example, there has been an explosion in loneliness. Australian social researcher Hugh Mackay has his own theory. “The biggest contributor is social fragmentation,” he says. “Humans are social animals. We need communities.

“The story of Australia over the past 50 years – accelerating over the past 20 years – has been the story of those traditional groupings coming apart. There’s been much more social fragmentation.”

Why is this causing so much distress?

Human beings evolved to live in closely knit tribes that were constantly co-operating. We only survived as a species because we could work together so tightly, and take down animals bigger and stronger than us. Just as a bee’s instincts are to connect with a hive, a human’s instincts are to connect with a tribe.

But we are the first humans to try to live alone and to imagine we can provide what we need for ourselves, as isolated individuals. In the circumstances where humans evolved, if you were apart from the tribe, you would feel depressed and anxious for a very good reason – you were in terrible danger. “When you have an epidemic of anxiety and depression, that is a societal warning bell,” Mackay says. “If we don’t attend to that warning bell, we’re in for a very difficult future.”

To begin to respond, we need to shift the way we think about this problem. In the early 2000s, South African psychiatrist Derek Summerfeld went to Cambodia, at a time when antidepressants were being introduced there. He began to explain the concept to the doctors he met. They listened patiently and told him they didn’t need these new antidepressants, because they already had some that worked. He assumed they were talking about a herbal remedy.

He asked them to explain, and they told him about a rice farmer they knew whose left leg was blown off by a landmine. He was fitted with a new limb, but he felt constantly anxious about the future, and was filled with despair. The doctors sat with him, and talked through his troubles. They realised that even with his new artificial limb, his old job – working in the rice paddies – was leaving him constantly stressed and in physical pain, and that that was making him want to just stop living.

So they had an idea. They believed that if he became a dairy farmer, he could live differently. They bought him a cow. In the months and years that followed, his life changed. His depression, which had been profound, went away. “You see, doctor,” they told him, the cow was an “antidepressant”. To them, finding an antidepressant didn’t mean merely finding a way to change your brain chemistry. It meant finding a way to solve the problem that was causing the depression in the first place.

I interviewed huge numbers of scientists who were trying to find ways to do that, and learnt about seven antidepressants that really work. For example, in a surgery in east London, a doctor named Sam Everington was becoming uncomfortable. Patients were coming to him depressed because they were lonely – and he was drugging them. So he began an experiment. He “prescribed” for them to take part in a group activity. One patient had been shut away in her home for seven years. He prescribed for her to take part in a gardening group, where she and other depressed people were given a patch of scrubland, and asked to make it into something beautiful. Over the next year, slowly, she began to reconnect with the land, and with the other depressed people in the group. Today, she is free from depression, and running a gardening centre.

That grief and depression have the same symptoms isn’t a coincidence. Depression is a form of grief – for your life not going as it should; for your psychological needs not being met. With grief for somebody who has died, we offer love and support to the people who remain. With grief for our lives going wrong, there’s a different solution – one that is lying there, waiting for us. It is a program of deep reconnection with the things that really matter in life.

Lost Connections: Uncovering The Real Causes of Depression and Anxiety – and the Real Solutions by Johann Hari (Bloomsbury, $28), is out now. 

 

Do you want to get better?

It may seem like a no brainer. You decide to see a counsellor. That means you want to get better, right?

Not necessarily.

What is better? What do you consider ‘better’ to be? It is important to have an idea of that. People come to counselling for many reasons that have nothing to do with feeling or getting ‘better’. Getting better does not have to be the end result of counselling.

For some people, the thought of being better is frightening. If you are used to coping with life as someone who is ‘not well’ and receiving a lot of support, then what will ‘better’ with no excuse to get support mean? Getting ‘better’ is not an overnight thing. It takes time and will occur alongside other changes that improve your ability to cope with life. But do you believe that? Do you trust another person well enough to let yourself experience those changes in your life? Are you willing to give up the benefits of not being well? They are important questions to consider.

When I see someone for the first time I often ask what that person would like to see happen in that first session to make him or her feel coming to see me was worthwhile. That question could be repeated every session. Then there is that person’s idea of what counselling would achieve. Sometimes that is not clear or well understood at the first session. It is not unusual for a person to decide after some sessions that he or she wants something different from counselling. Some people never get that clear idea. All those experiences are fine. Counselling is a journey. You may start that journey with a clear idea of where you want to go and may end up somewhere else. And you will realise your destination is the right place to be. As a counsellor, I don’t tell you where to go. I just journey with you, allowing you time to reflect and explore what is on your mind.

In eight years as a counsellor, I have learned that the journey of counselling often has nothing to do with ‘getting better’.

So if your answer to the question is “no I don’t want to get better”, that does not mean you can’t benefit from counselling.