Rachel Cooper, psychotherapist
Yesterday we introduced the idea of ‘healthy selfishness’; but isn’t this a narcissistic way of thinking, believing that life is ‘all about me’? In fact, selfishness, defined by the Oxford English Dictionary as “…concerned primarily with one’s own interests, benefits, welfare, etc., regardless of others”, is not to be confused with pathological narcissism. This condition is characterized by self-inflation, grandiosity and lack of empathy, which are ways of coping with very low self-esteem. Narcissistic traits include self-serving attitudes and behaviours that exploit others. By contrast, therapy aims to help clients become less fearful and more accepting of their own feelings, which in turn fosters the capacity to build self-esteem, and relate more openly and fully to others through increased empathy, compassion and intimacy.
So, if ‘healthy selfishness’ actually promotes self-respect as well as respect for others, how can it be achieved? Our experience suggests the following:
* honest self-reflection, especially after setbacks
* taking responsibility for yourself
* self-care and self-respect
* acknowledging what you need and what brings you joy and meaning
* celebrating your achievements
* connecting with your authentic self
* learning to tolerate differences between yourself and others
Tomorrow, we look at the tricky issue of how an ‘unhealthy unselfishness’ can develop – can we ‘blame the parents’?
Author: Wendy Bramham
Editor: Briony Martin
Do you worry that having counselling might be indulgent or selfish? Do you fear that focusing on your own desires and needs might result in neglecting or hurting others? Lots of people who go into therapy have these fears. And the fear of selfishness is understandable given that many of us were brought up to put others first. However, I’m wondering if there is a different way to look at this issue? Perhaps there is a kind of ‘healthy selfishness’ that we can explore in therapy and which might help us get our lives in better balance?
Take journalist, Sally Brampton’s, experience. In ‘Shoot the Damn Dog’*, a memoir of her own suicidal depression, she recounts how a therapist told her she was abandoning herself every time she:
- pretended she was fine when she wasn’t
- refused to rest when she was tired
- didn’t ask for what she needed from a person with whom she was intimate, and
- put someone else’s needs before her own but resented doing so.
The therapist explained that Sally suffered from a failure of care; care for herself but also care from her parents who should have taught her how to take care of herself in childhood. Sally explains that as a child she unconsciously learned that it was better not to need or become attached to people or things, because anything she loved – people, dogs, houses, schools – were taken away from her. As an adult she was able to see other people’s needs but not her own, and this contributed to her serious depressive symptoms.
Over the next few days we’ll be blogging about this subject, challenging the idea that therapy is selfish, and looking at how a positive focus on ourselves can be good not only for us but for all those we relate to. Far from promoting selfishness, we think therapy might enable us to be less selfish and more loving.
Tomorrow we tackle the hot topic of narcissim… is therapy just ‘all about me’?
Author: Wendy Bramham
Editor: Briony Martin
* Shoot the Damn Dog – A Memoir of Depression, by Sally Brampton. Bloomsbury, London, 2009.
“Unlocking the Secrets of Dreams” with Matthew Harwood, Nov 2014
This seminar was akin to being in the theatre watching an absorbing drama unfold! Matthew Harwood treated us to a fascinating and crystal-clear presentation of how he worked with a former client’s particular dream to help the client free himself from outmoded attitudes and a long-standing depression.
We learned that it is possible for just one sentence of a dream to provoke an hour’s worth of investigation and produce a powerful “aha” moment of insight that can create profound change at a cellular level. Like adding a drop of wine to water, we remain changed forever.
Science tells us that we all dream for about two hours per night, whether or not we remember our dreams. Dreams produce words and images that are metaphors ….. they are direct messages from our unconscious that can “compensate” for, and illuminate, our conscious (often unbalanced) attitudes. Depression can often signify a fear of living, but when we remember a dream it is a sign that we are ready for change, and to have the courage to live. By asking the right sorts of questions which enable the client to give descriptive definitions (prior to their associations) of the objects, characters and places in their dreams, Matthew showed us that it is possible to unlock their central dilemma and blind spots.
In the words of Carl Jung:
In each of us there is another whom we do not know. He speaks to us in our dreams and tells us how differently he sees us from the way we see ourselves. [CG Jung: Collected Works Vol 10 para 325]
It was wonderful to learn how to work in such a creative way with our clients.
Many of us were shocked and saddened by the news of Robin Williams’ suicide in August 2014. In 2013 as part of BBC Wiltshire’s series on mental health, Wendy Bramham spoke about this devastating issue. The following information offers a resource for people experiencing suicidal feelings; or for those bereaved by suicide; and for people who are attempting to help those affected by this issue.
What causes a person to feel suicidal?
Suicide may seem to be the only way to end severe mental pain; the only thing that’s left within the person’s control. It may also be a way to convey desperate feelings to others. Most people who feel suicidal are actually quite confused and conflicted about the desire for death. Most wish there was an alternative.
What causes it is usually a complex mix of factors that builds up into despair that becomes overwhelming. It may be caused by a sudden crisis, a major setback or loss, but more typically there is a slower build-up over time.
Many kinds of emotional pain can lead to thoughts of suicide. Each person responds and copes differently and uniquely to the myriad problems and crises we all encounter through life. Each person has their own psychological and social history and genetic make up, which means that what is bearable to one person can be unbearable to another, and vice versa.
This devastating problem is much more common than many of us realise. Shockingly, in the UK suicide remains the most common form of death in men under the age of 35 (Mental Health Foundation and Department of Health). It is the second largest killer of people worldwide between the ages of 16-19. In the last 45 years suicide rates have increased by 60% worldwide (source: World Health Organisation).). It’s estimated that approximately 5% of people attempt suicide at least once in their life. Men are 3 to 4 times more likely to kill themselves than women. However, unsuccessful attempts are more common in women and young people. More people die by suicide each year than by murder and war combined.
Accusation of selfishness?
Some people accuse those who have committed suicide as selfish, and that they took the “easy way out”. This is extremely hurtful and shows a lack of understanding of mental illness and the suffering that some people try to endure. The following quote is taken from theguardian.com on 12 august by Dean Burnett who I think argues the point well:
“One of the main problems with mental illness is that it prevents you from thinking “normally” (although what that means is a discussion for another time). A depression sufferer is not thinking like a non-sufferer in the same way that someone who is drowning is not “breathing air” like a person on land is. (…..) The selfish accusation implies that there are other options that the sufferer has, but has chosen suicide or that it’s the easy way out. There are many ways to describe the sort of suffering that overrides a survival instinct that has evolved over millions of years, but ‘easy’ is not an obvious one to go for. Perhaps none of it makes sense from a logical perspective but insisting on logical thinking from someone in the grips of a mental illness is like insisting that someone with a broken leg walks normally. Logically you shouldn’t do that.”
Who is at risk?
Most important factors that put people at risk include mental disorders, such as depression, bipolar, schizophrenia, post-traumatic stress and obsessive-compulsive disorder (OCD). The second biggest influencing factor is substance abuse. Eg alcoholism is a factor in 15-60% of all suicides.
Having depression or bipolar increases the risk of suicide by 20%. Depression accounts for approximately 50% of suicides. Those suffering from severe depression and feelings of hopelessness, and who have little or no social support are probably the most at risk. Often people who are just recovering from depression are in fact more at risk of suicide, because it is then that they actually have the energy to carry out the act of suicide.
War veterans are a high risk category due to the mental trauma and physical ill-health from war. Genetics and social-economic factors play a part too, eg poverty, discrimination, financial worries, unemployment, bereavement, social isolation.
Some medical conditions can trigger suicidal feelings, such as traumatic head injuries. A diagnosis of cancer can double the risk of suicide. Such medical conditions can lead to depression and suicidal feelings, and carers should be aware of this.
Media and internet can cause a copycat syndrome of suicide whereby it is romanticised or glorified.
Suicidal feelings are more likely to build up when a person feels they can’t talk about their feelings. They may be experiencing or have experienced some of the following, which can also be signs and symptoms of depression:
- withdrawal from friends, family and regular activities
- isolation and hopelessness
- sense of futility and meaningless
- self-loathing (“everyone would be better off without me”)
- loss of energy
- major and sudden changes in personality or mood
- big changes in sleeping and eating habits
- difficulty in functioning, such as going to work, or cooking dinner
- unusual neglect of personal appearance
- feeling cut off from their body, feeling numb
- impulsivity, lethargy or aggressiveness (especially in adolescents)
Obvious major warning signs include
- talking about killing or harming oneself (it is a myth that people who talk about suicide don’t do it)
- talking or writing a lot about death or dying
- seeking out things that could be used in a suicide attempt, such as weapons and drugs.
The above signals are even more dangerous if the person has a mood disorder such as depression or bipolar disorder, suffers from alcohol dependence, has previously attempted suicide, or has a family history of suicide.
How to help someone who is suicidal
Talking about it can save a life. Try not to feel embarrassed or afraid. Talking about suicide won’t give the sufferer morbid thoughts – quite the opposite, it is the most helpful thing you can do.
However, it is not usually helpful to say things like “you should feel lucky because you’ve got a lovely house, job, family”, etc., or “that’s not enough of a reason to feel suicidal”. The best way to help is by offering an empathetic, listening ear. See notes below on “How to talk with someone about suicide”. Don’t take responsibility, however, for making the other person well. You can offer support, but you can’t get better for a suicidal person. He or she has to make a personal commitment to recovery. If you are helping a suicidal person, make sure you get support for yourself.
- Get professional help. Call a crisis line such as The Samaritans for advice and referrals. Encourage the person to see a counsellor, or take them to a doctor’s appointment.
- Follow-up on treatment. If the doctor prescribes medication, encourage them to take it. Help to communicate about any side effects and be aware that it can be a trial and error process to find the right medication.
- Be proactive. Don’t wait for the person to call you, or to return your calls. People who are severely depressed find it difficult to ask for help. Drop by, call again, invite the person out.
- Encourage positive lifestyle changes, such as a healthy diet, plenty of sleep, and getting out in the sun or into nature for at least 30 minutes each day. Exercise is also extremely important as it releases endorphins, relieves stress, and promotes emotional well-being.
- Make a safety plan, help the person develop a set of steps if they feel suicidal, such as who they will call. Include friends, family and crisis line numbers.
- Remove potential means of suicide, such as pills, knives, razors, or firearms. If the person is likely to take an overdose, keep medications locked away or give out only as the person needs them.
- Continue your support over the long haul. Even after the immediate suicidal crisis has passed, stay in touch with the person, periodically checking in or dropping by.
How to help yourself if you feel suicidal
Asking for help is not a sign of weakness but a sign of strength, wisdom and self-responsibility. If we try to do everything on our own we will become mentally, physically and emotionally exhausted.
However, if you have suicidal thoughts it can feel impossible to tell your family and friends how bad you feel. You may feel rage, fear, guilt and shame. If you have been hurt by someone, it is natural to feel anger, and sometimes suicide can seem a way to get back at that person. However, suicide is anger turned against ourselves.
The intense emotional pain that you’re experiencing right now can distort your thinking so it becomes harder to see possible solutions to problems, or to connect with those who can offer support.
It is important to work out with a professional counsellor why you feel the way you do. Give this process time and commitment even after you begin to feel better.
- Promise not to do anything right now. Make a promise to yourself: “I will wait 24 hours and won’t do anything drastic during that time.” Or, wait a week. Wait and put some distance between your suicidal thoughts and suicidal action.
- Avoid drugs and alcohol
- Make your home safe. Remove things you could use to hurt yourself, such as pills, knives, razors, or firearms.
- Take hope – people do get through this. Give yourself the time needed and don’t try to go it alone.
- Speak to someone you trust, whether it be a friend, GP, clergyman, teacher, family member or therapist. Or call a helpline such as The Samaritans.
How to talk with someone who is (or might be) suicidal
Following text is taken from http://beta.helpguide.org/mental/suicide. Adapted from: Metanoia.org
Ways to start a conversation about suicide:
· I have been feeling concerned about you lately.
· Recently, I have noticed some differences in you and wondered how you are doing.
· I wanted to check in with you because you haven’t seemed yourself lately.
Questions you can ask:
· When did you begin feeling like this?
· Did something happen that made you start feeling this way?
· How can I best support you right now?
· Have you thought about getting help?
What you can say that helps:
· You are not alone in this. I’m here for you.
· You may not believe it now, but the way you’re feeling will change.
· I may not be able to understand exactly how you feel, but I care about you and want to help.
· When you want to give up, tell yourself you will hold off for just one more day, hour, minute—whatever you can manage.
When talking to a suicidal person
· Be yourself. Let the person know you care, that he/she is not alone. The right words are often unimportant. If you are concerned, your voice and manner will show it.
· Listen. Let the suicidal person unload despair, ventilate anger. No matter how negative the conversation seems, the fact that it exists is a positive sign.
· Be sympathetic, non-judgmental, patient, calm, accepting. Your friend or family member is doing the right thing by talking about his/her feelings.
· Offer hope. Reassure the person that help is available and that the suicidal feelings are temporary. Let the person know that his or her life is important to you.
· If the person says things like, “I’m so depressed, I can’t go on,” ask the question: “Are you having thoughts of suicide?” You are not putting ideas in their head, you are showing that you are concerned, that you take them seriously, and that it’s OK for them to share their pain with you.
· Argue with the suicidal person. Avoid saying things like: “You have so much to live for,” “Your suicide will hurt your family,” or “Look on the bright side.”
· Act shocked, lecture on the value of life, or say that suicide is wrong.
· Promise confidentiality. Refuse to be sworn to secrecy. A life is at stake and you may need to speak to a mental health professional in order to keep the suicidal person safe. If you promise to keep your discussions secret, you may have to break your word.
· Offer ways to fix their problems, or give advice, or make them feel like they have to justify their suicidal feelings. It is not about how bad the problem is, but how badly it’s hurting your friend or loved one.
· Blame yourself. You can’t “fix” someone’s depression. Your loved one’s happiness, or lack thereof, is not your responsibility.
How to help someone who is bereaved by suicide
Bereavement by suicide can be more complicated because it is common for people to feel confused or guilty that they didn’t know the extent to which the person was suffering, and that they were not able to help. They may also feel angry and disappointed with the person who committed suicide. Because of stigma, they may feel they can’t talk about either the mental illness (if this was a factor) or suicide, adding to feelings of isolation. Bereavement by suicide often carries feelings of deep shame. Following information is taken from sane.org
I don’t know what to say.
· If not sure what to say, ask ‘ How are you feeling today? ‘
· Tell the person you’re not sure what to say. Being honest will help to build trust
· Try to listen 80% of the time and talk 20% of the time
· Avoid making unhelpful statements such as, ‘It’s God’s will’ or ‘Time heals all wounds’.
I don’t want to make it worse for them. By allowing the person to express their grief you will be helping. Nothing you do can take away the sadness, but it is important to be there for them.
· Allow tears or accept no tears
· Understand that the way the person expresses grief may be different from the way you would express it
· Don’t take anger personally.
They have lots of family and friends around. They don’t need me. People with lots of friends and family still need support from others. It’s important to have grief acknowledged by friends and colleagues so the person doesn’t begin to feel isolated.
They need help from a professional. There is nothing I can do. While professional help can be very important, don’t underestimate the importance of friendship when someone is grieving. You can do things a professional person can’t such as going for walks, cooking a meal or being there in the evenings and on weekends, remembering the birthday and anniversaries of the person who died.
I’m not sure what to say about the mental illness. Ask the bereaved person how they feel about this and reassure them you are happy to talk about mental illness if they want. Seek out some information so you know something of what the person may have been experiencing. Be compassionate and understanding about difficulties it may have caused in their relationship, and encourage them to talk to a bereavement counsellor if they are not coping or do not feel they can talk to anyone else.
Useful Contact Numbers
Survivors of Bereavement by Suicide – 0844 561 6855
Samaritans – 08457 90 90 90
by: Wendy Bramham
Written as a resource for listeners of BBC Wiltshire mental health series, October 2013
Updated August 2014
Mindfulness is paying attention, on purpose and with acceptance, to direct experience as it is. It is not a concept but a practice, and its benefits can only be gained through regular, formal practice. Mindfulness has always been a part of the ancient Buddhist meditation traditions, but has been developed recently into a more secular approach and used in various psychological therapies, for example to help with stress reduction.
Mindfulness is an important resource and life-skill for everyone because it helps regulate stress, promotes positive mood, supports the immune system and increases our ability to concentrate. Above all, it helps us to accept “what is”, enabling us to become curious rather than anxious, and so enabling us to respond more creatively, rather than reacting or behaving in “auto pilot”, driven by old beliefs or habits.
We learned in our recent seminar with Margaret Landale that, as therapists, one of the best ways to “teach” clients is to model it through our own mindfulness practice – to “embody” mindfulness ourselves – which will then be communicated non-verbally to our clients. Margaret says: “Communication is determined by sensory and felt experience. The client will subconsciously respond to the therapist’s facial expression, eye contact, tone of voice and body posture/language. Language arises from a deep level of relational attunement”.
Margaret’s style, delivery and content were all excellent and we received extremely positive feedback from our attendees. We all enjoyed her enthusiastic, informative and gentle approach to learning new techniques. Best of all, I now have a much more accessible key to my own meditation practice which, prior to the workshop, had been tentative at best and quite often non-existent. We look forward to part 2 when we will be applying mindfulness to helping our clients with complex trauma.
by: Wendy Bramham
We often talk about the mind and body as though they are completely separate – but they aren’t. The mind can’t function unless your body is working properly – but it also works the other way. The state of your mind affects your body. If you feel low, you tend to do less and be less active, which makes you feel worse – you can become more tired, feel more depressed and tense, plus you miss out on things you enjoy. So it can easily become a vicious cycle.
The Study of Psycho-Neuro-Immunology
This is the established scientific study of how the mind and body communicate, and how stress can affect our immune system and susceptibility to disease.
It is only since the advent of modern medicine in the 19th and 20th centuries that we seemed to lose the ancient wisdom of how illness and wellbeing are connected to the mind, society, morality and spirituality. However, in recent years the study of PNI reminds us that psychological states like chronic stress, depression, anxiety, fear produce profound effects on the body. Most of us will have our own experiences of how headaches or digestive problems can result from stress. But PNI has extended that to include the way in which genes express themselves in genetic illnesses like rheumatoid arthritis and multiple sclerosis. Over time, mental and emotional states take a heavy toll on the body and are a significant risk for illness.
The field of PNI has documented different physiological responses to stress. Various forms of stress management have been found to be helpful in modifying the body’s stress response. These include:
counselling & psychotherapy
volunteering in the community
nutrition, acupuncture and other complementary therapies
sunlight and nature
Exercise Until the last 100 years or so, you had to be quite active to just live your everyday life. Now, in modern Western societies, so much of what we used to do is done by machines.
Exercise doesn’t have to be about running around a track or working out in a gym. It can just be about being more active each day, and may include things like washing the car, gardening, strolling around the block etc. It is however, important to do something quickly enough so that you raise your heart rate (aerobic exercise), as it is then that the “happy” chemicals called endorphins are released into our body and make us feel good.
If you keep active, you are:
less likely to be depressed, anxious or tense
more likely to feel good about yourself
more likely to concentrate and focus better
more likely to sleep better
more likely to cope with cravings and withdrawal symptoms if you try to give up a habit such as smoking or alcohol
more likely to be able to keep mobile and independent as you get older
possibly less likely to have problems with memory and dementia.
Tips on getting started:
It is vital to pick an activity that you ENJOY
any exercise is better than none.
BUT a moderate level of exercise seems to work best.
This is roughly equivalent to walking fast, but being able to talk to someone at the same time.
Don’t start suddenly – build more physical activity into your life gradually, in small steps.
How well does exercise work for depression?
For mild depression, physical activity can act as a natural anti-depressant, and be as (or more) effective for some people than medication. In some areas in the UK, GPs (family doctors) can prescribe exercise.
Doing 30 minutes or more of exercise a day for three to five days a week can significantly improve depression symptoms. But smaller amounts of activity — as little as 10 to 15 minutes at a time — can make a difference. It may take less time exercising to improve your mood when you do more-vigorous activities, such as running or bicycling. (Ref: Royal College of Psychiatrists).
The mental health benefits of exercise may last only if you stick with it over the long term — another good reason to focus on finding activities you enjoy.
Why does exercise work?
It helps to release feel-good brain chemicals (neurotransmitters and endorphins) into the brain, which can ease depression. Brain cells use these chemicals to communicate with each other, so they affect your mood and thinking.
Exercise can stimulate other chemicals in the brain called “brain derived neurotrophic factors” (BDNF). These help new brain cells to grow and develop. Moderate exercise seems to work better than vigorous exercise. BDNF seems to reduce harmful changes in the brain caused by extreme stress.
Harder exercise (perhaps needed to fight or flight from danger) can help to dispel the physical effects of a trauma, loss, shock or crises as it helps reduce adrenalin and produces endorphins. Animals in the wild naturally do this by fleeing from or fighting danger.
Exercise can also reduce risks of high blood pressure, diabetes, arthritis and cancer.
Exercise can also help you:
Gain confidence. Meeting exercise goals or challenges, even small ones, can boost your self-confidence and help you to feel more in control.
Take your mind off worries. Exercise is a distraction that can get you away from the cycle of negative thoughts that feed anxiety and depression.
Get more social interaction. Exercise may give you the chance to meet or socialize with others.
Cope in a healthy way. Doing something positive to manage anxiety or depression is a healthy coping strategy. Trying to feel better by drinking alcohol, dwelling on how badly you feel, or hoping anxiety or depression will go away on its own can lead to worsening symptoms.
How do I get started — and stay motivated?
Starting and sticking with an exercise routine can be a challenge. Here are some steps that can help. Check with your doctor before starting a new exercise program to make sure it’s safe for you.
Identify what you enjoy doing. Figure out what type of physical activities you’re most likely to do, and think about when and how you’d be most likely to follow through. Do what you enjoy to help you stick with it.
Get your mental health provider’s support. Talk to your doctor or other mental health provider for guidance and support.
Set reasonable goals. Your mission doesn’t have to be walking for an hour five days a week. Think realistically about what you may be able to do. Tailor your plan to your own needs and abilities rather than trying to meet unrealistic guidelines that you’re unlikely to meet.
Don’t think of exercise as a chore. If exercise is just another “should” in your life that you don’t think you’re living up to, you’ll associate it with failure. Rather, look at your exercise schedule the same way you look at your therapy sessions or medication — as one of the tools to help you get better.
Address your barriers. Figure out what’s stopping you from exercising. If you feel self-conscious, for instance, you may want to exercise at home. If you stick to goals better with a partner, find a friend to work out with. If you don’t have money to spend on exercise gear, do something that’s virtually cost-free, such as walking. If you think about what’s stopping you from exercising, you can probably find an alternative solution.
Prepare for setbacks and obstacles. Give yourself credit for every step in the right direction, no matter how small. If you skip exercise one day, that doesn’t mean you can’t maintain an exercise routine and may as well quit. Just try again the next day.