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Making the Most of your Online Therapy Sessions

During the recent challenges brought about by Covid-19, we all had to make significant changes to our lives and adapt quickly to a new reality. This is also true for therapists and clients who shifted quickly from the safety and familiarity of their consulting rooms to video or telephone meetings. I would like to acknowledge the impact of these changes on both clients and therapists on a separate blog. But first, to help remove some of the anxiety of involved in this transition I want to outline how you can make the most of your online therapy sessions.

  1. Spend some time setting up

Although most of us are familiar with video technology in our personal and professional lives, meeting online for therapy requires some preparation. Not just in terms of tech but also allowing a psychological transition into the therapy space, especially if you are shifting from a different activity in your home.

Give some thought to the room you wish to use, making sure that it is private and quiet, and that you will be sitting comfortably for the duration of the session. Make sure your devices are fully charged or plugged in and well positioned, so that you can see and hear your therapist well. Preferably wear headphones for a better sound quality and experience. Have a phone available in case one of you encounter issues with your tech and need to continue your session over the phone.

Finally, make sure the lighting in the room is positioned so you can also be seen well. Seeing and hearing you well will enable your therapist to ‘tune in’ much better to you, reading nuances in your facial expressions and tone of voice.

  1. Avoid all distractions

Make sure your notifications are switched off and all distractions are put away, such as work and study materials. Most therapy rooms are deliberately thoughtfully furnished in order to offer a calming, comfortable and uncluttered environment.  Ideally try to replicate this in your home where possible. If you live with others, schedule your session at a time when no one will hear or interrupt you.

  1. Communication queues

Psychotherapy and counselling usually take place face to face because it important for both the client and therapist to be able to communicate well with one another. This communication is largely non-verbal and often ‘felt’ rather than spoken. Video can be an additional of barrier to communication, despite advances in technology and video quality. Therefore, it is important that both client and therapist flag up missed queues or gaps in connection as it can be the case with delays or frozen images. Voice any frustrations you are experiencing in relation to this and work with your therapist to try and improve them where possible.

  1. Transitioning into and out of your appointment

As in number 1., give yourself space before and after your session. The travel journey to and from a meeting can help with processing, reflecting and thinking. In the absence of this, allow yourself some quiet time before and after your therapy session. Dealing with difficult emotions and discussing sensitive topics can leave us feeling vulnerable for a little while. If you are using your therapy to work on relationship difficulties with someone you live with, engaging with them straight after your appointment might not be a good idea. Go for a walk, take a bath, or just ask for some quiet time on your own. Equally, moving from a therapy session straight into dealing with work emails might not be such a good plan.

  1. Remember the positives

With Covid-19, we have moved our face to face meetings online because of circumstance rather than out of choice. However, people have been offering online therapy for quite a few years now. Although my preference remains meeting people in person, I am beginning to appreciate some of the advantages of online working. For instance, it is nice to be able to use headsets and adjust the volume if I can’t hear someone well. Because I no longer need to travel to and from work, I now have more time to do things I used to have no time for. It has also given me much more flexibility to see clients at times I previously couldn’t. There are advantages and disadvantages of working at home and working online. It will take us sometime to get used to our new reality. If we can’t change our new predicament, we may as well make the most of it!

 

Sam Jahara is a Psychotherapist and Supervisor in private practice working with individuals and couples. She is also the co-founder of Brighton and Hove Psychotherapy, a multi-approach clinic, offering Psychotherapy, Psychology and Counselling to all client groups, both face-to-face and online.

 

Further reading by Sam Jahara

How Psychotherapy will be vital in helping people through the Covid-19 crisis

Leaving the Family

Psychotherapy and the climate crisis

Psychotherapy can change your life – but you may not want it to

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How Psychotherapy will be vital in helping people through the Covid-19 crisis

Many self-employed psychotherapists, psychologists and counsellors have immediately felt the economic impact of the crisis brought by Covid-19. As our clients began to either loose their jobs or face increasing economic uncertainty, many had to either put their sessions on hold or stop coming all together. Many of us have either dropped our fees or continued seeing people with the uncertainty of getting paid. Unfortunately, some people have lost their support system when they need it the most.

Private Psychotherapy has always been enjoyed by many in the UK and around the world, as most national health services cannot offer the same level of professional service due to cost.

Psychotherapy practices have always offered a vital service to the community, whether through charities, low cost services or full paying clinics. Psychotherapy is a place where people’s deepest mental anguishes have a place to exist, to unfold and to be healed.

The health and consequent economic crisis brought by Covid-19 is already affecting people’s mental health in several ways, some of which have not yet come to light. This is being felt and will continue to be felt for a while to come at all levels of society.

An Existential Crisis

Covid-19 has highlighted our main vulnerabilities as human beings. It has hit many people at a very fundamental existential level as many have lost their jobs and their livelihoods overnight. In addition to this, as more people become infected and die of Coronavirus, we have become much more aware of our mortality and that of those we love.

Living in a globalised world, the spread of the virus had happened so rapidly that we have not had the time to process and digest the changes which we have been required to make as a result of the restrictions imposed to keep the virus from spreading. Never could we have imagined that something which started in China a few months ago could spread and reach our doorstep so rapidly and dramatically. This further highlighted our lack of immunity to world events.

Impacts of Lockdown

With people being asked to stay at home to protect the NHS, schools and businesses closing and people being asked to work from home (if they still have work), suddenly the home has become office, school, gym, social hub and place of relaxation. Whilst some families are feeling more crowded as a result of these changes, some people living on their own have become more lonely, isolated and vulnerable.

Some families trying to make life work under lockdown are finding that their relationships are being put under more strain, whilst children of unhappy and even abusive families are being made to stay at home more.

Of course, there are also positive stories emerging as a result of families spending more time together and solidarity between people. In times such as this, we are seeing the best and the worst of human nature.

Why is Psychotherapy vital during these times?

To put it simply, in times of crisis psychotherapy helps us to hold onto our thinking. When our survival is threated, our ‘reptilian brain’ takes over and we can act impulsively (panic buying for instance) often resulting in harm to self or others. Thinking makes us slow down and consider options. In times of crisis we sometimes need to think quickly and make decisions. However, buying time to think enables us to put things into perspective and to make wise rather than impulsive decisions.

Because this is both a health and economic crisis, it is hitting many of us at our very core. The British attitude to “keep calm and carry on” works to a degree. Of course, we need to keep calm, but we also need a place to acknowledge and talk about our fears, losses, despair, sadness, anger, etc if we are going to survive this crisis in good mental health.

 

Sam Jahara is a Psychotherapist and Supervisor in private practice working with individuals and couples. She is also the co-founder of Brighton and Hove Psychotherapy, a multi-approach clinic, offering Psychotherapy, Psychology and Counselling to all client groups, both face-to-face and online.

 

Further reading by Sam Jahara

Leaving the Family

Psychotherapy and the climate crisis

Psychotherapy can change your life – but you may not want it to

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Popping a bluey – young men and Viagra

Following on from my earlier blog about the physiological effects of Viagra, in this blog I am going to discuss some of the psychological and social issues that make young men pop a blue pill.

There is common notion that young men are constantly getting erections and always up for having sex. Various sources indicate the reality is different. Peggy Orensteins’s recent book ‘Boys and Sex’ cites a General Social Survey study showing young men between 18 and 29 are having less sex. This is indicated by the increase in the number of men who declare themselves abstinent, which rose from 10% in 2008 to 28% in 2019.

Orensteins’s conversations with young men reveal the extent of their performance anxiety. They fear that girls would be more knowledgeable and experienced and in contrast they will be unsatisfactory sexual partners. They are anxious that any inadequacy, such as not being able to undo a bra strap or coming too quickly will be broadcast to their peer group on social media and result in humiliation. They are also concerned that girls will take it personally if they can’t get an erection. Young men seem to feel that they are responsible for the success of a sexual encounter.

At the same time online pornography has set up unrealistic expectations about opportunity, performance and satisfaction. The Reward Foundation is an educational charity that focuses on the internet, love, sex and relationships; they have found a correlation between erectile dysfunction in young men and an increase in access to internet porn. Whether or not young men actually believe that the sexual relationships and encounters they view on screen are ‘real’, these representations have an impact. As a young presenter on VICE online magazine said, “In my head I’m thinking that girls will be expecting me to fuck them like a porn star.”

First dates or sexual encounters can be extremely anxious events. Dating apps like Tinder and Grinder make it easy to move on to a new sexual partner if the sex does not meet expectations the first time. This may increase pressure on men to have a prolonged erection or several erections and Viagra can be an ‘insurance policy’ or a ‘booster shot’ to ensure a good performance the first time they have sex with a new partner. If the relationship continues they may continue to take Viagra to maintain their performance and hide the fact that they took it in the first place.

So what’s the problem with young men using Viagra to perform better? If young men believe that the standardised notion of good sex is a good performance as Orenstein’s study suggested, we can see that taking Viagra would be a way to avoid some of the stress about being a good performer. Unfortunately this can create a psychological dependency making it more and more difficult to stop taking Viagra and harder to open up the subject with a partner. Like any kind of emotional withholding keeping Viagra a secret is likely to be a negative factor in a sexual relationship.

Good sex can be whatever is good for each couple and is far more nuanced and complex than a good performance. In a relationship of mutual consent sex can bring physical and emotional intimacy but sex does not always go smoothly, misunderstandings and disappointments happen. Exploring sexual dissatisfaction and difficulties makes people feel extremely vulnerable. By using Viagra to focus on performance, young men are avoiding the opportunity to speak honestly about what they expect and want from sex as well as finding out what pleases their partners. Trusting each other and exploring differences and desires together can build a stronger relationship as well as a more satisfying sex life.

Angela Rogers is an Integrative Psychotherapeutic counsellor working with individuals and couples in Hove.

 

Further reading by Angela Rogers –

New Year’s Resolutions – Why change might be so difficult?

Viagra: Some ups and downs of the little blue pill

The Menopause – Women of a Certain Age

A couple state of mind

Men, Sex & Aging in Relationships

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Using the body to calm the mind

When we think about psychological difficulties, we often think of these as being purely in the mind.  In some of my other blogs I’ve spoken about the link between mind and body, and this is something I work with a lot in my therapy sessions with clients. 

This is particularly relevant with issues of anxiety; where the fight-flight-freeze system comes into play.  This ancient pathway in our brains allowed us to detect and respond to threats before we even had a conscious awareness of them.  Nowadays of course often the ‘threats’ are more likely to be psychological (fear about a situation for example) rather than a physical threat such as being attacked by a wild bear.  However, our bodies still react in the same way, by preparing our bodies to fight, run, or stand very still and hope the bear doesn’t notice us.  This is why stress and anxiety tends to lead to symptoms such as racing heart, tight muscles and increased breathing rate; all things that would help us to fight, run or stand very still.

We often might think of needing to use our minds (thoughts) to calm ourselves, and certainly in Cognitive Behavioural Therapy this is an important part of learning to manage anxiety.  However, we can also use our bodies to calm our minds.  As well as the messages coming from our brain to our body to say ‘quick, get ready to respond’ our bodies also send messages back to our brains.  So if we can do things with our bodies to calm, that in turn can send messages of calming back to our brains.  A good example of this is breathing:  In flight-fight-freeze mode our brains’ automatic response is to send a message to our bodies to make breathing shallower and faster in order to get oxygen to our muscles to prepare to run, fight or stand really still.  If, however, we over-ride this and purposefully slow our breathing to take deeper, slower breaths, that will send the message to our brain to say ‘it’s ok, we don’t need to be anxious’.  Some people find using a breathing square or star can be helpful.  If you imagine the shape and trace round it in your mind, breathing in as you trace along one side, and out as you trace along the next and so on.

Using progressive muscle relaxation (PMR) is another body based technique that can be really useful.  This involves working through the body from feet to head, tensing and then relaxing different parts in turn.  There are many scripts available online, or even YouTube videos which take you through a PMR exercise.  Again, this helps calm the mind by sending messages from the body back to the brain.  Even just going for a walk can be really useful when we are stressed or anxious.  At times of anxiety or high stress our bodies get flooded with hormones, including adrenaline.  This is what tells the body to prepare to run, fight or stand really still.  All the time high levels of adrenaline are present in our blood we will be in fight-flight-freeze mode.  Adrenaline is used up by our muscles, so doing activities that use our muscles will reduce the amount of adrenaline in our system.  So things like going for a walk are great for reducing adrenaline.

Most people anecdotally have probably found that when we are stressed or anxious going for a walk or taking 10 deep breaths can be useful.  As we can see there is a very real reason for why this can help; our bodies can be used to calm our minds.

Dr Emma Stevens, HCPC Registered, is an experienced Clinical Psychologist. She has an integrative approach drawing on Cognitive Behavioural, Systemic and Psychodynamic models, as well as Attachment Theory. Emma sees individuals primarily for sort-term work. Emma is available at our Lewes Practice.

 

Further reading by Dr Emma Stevens

Emotional Well-being

What is EMDR?

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The dangers of over medicalising

Earlier this month (October 2019) the government announced a new service for gaming addicts aged 13-25 at the Centre for Internet and Gaming Disorders.  According to the World Health Authority Gaming Disorder is a pattern of persistent or recurrent gaming behaviour so severe that it “takes precedence over other life interests”.  This description could equally be applied to any addiction be it an addiction to gaming, alcohol, dieting, exercise, drugs or sex to name a few.

New addictions and other mental health categories are being ‘discovered’ almost weekly.  The current version of The Diagnostic and Statistical Manual of Mental Disorders – DSM-5 published in 2013 contains 541 categories of mental disorders. This version replaced DSM-IV published in 1994 containing 383 disorders.  That’s an increase of 158 categories in 19 years – just over 8 new categories per year, a little more than 1 every couple of months.

GPs, psychiatrists and other mental health clinicians use the DSM to diagnose their patients.  Each category has a list of symptoms and as long as the patient presents with a required number of symptoms within the category a diagnosis is given.  Alongside a diagnosis there is a choice of treatment or treatments which will typically be a combination of medication and/or some form of psychotherapy to treat the symptoms.

So far so good, however with new diagnostic categories based on surface symptoms springing up so regularly the structural causes that lie beneath these symptoms are given less and less attention.  Two people may present with the same surface behaviour, for example, a pattern of persistent or recurrent gaming behaviour.  In both cases the person might describe significant impairment in important areas of functioning like work, relationships, their social life, education or occupation and so the label gaming addiction may be applied.  Dialogue however may show that for one the symptom is linked to how they wish to escape from feelings of anxiety and depression whereas for the other it is a consequence of the delusional belief that the gaming world they enter is in fact the real world and one in which they have a real place.  Similarly we might consider two people who are persistently restricting what they eat leading to weight loss or a failure to gain.  Again a discussion may show that for one person the reason they are dieting is because they imagine that the thinner they are, the more lovable they will be whilst another person may be refusing food because they believe it to be poisoned.

In this way the same symptom covers two very different causes and psychological structure.  In order for the symptoms to be reduced the underlying cause needs to be explored.  This is the work of long term psychotherapy where the person is treated as a whole and is encouraged to speak about themselves and their relationships both as they are now and also as they were in the past.  Personal history and family dynamics are thought about so that the meaning behind the symptoms can slowly emerge.

Anna Reynolds is a UKCP registered Psychoanalytic Psychotherapist qualified to work with a broad range of psychological issues as well as more complex mental health conditions in adults.  Anna works with individuals and couples.  Anna is available at our Lewes Practice.

 

Further reading by Anna Reynolds –

Attachment styles & how they affect relationships

The language of love: how couples communicate

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