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Problems that counselling and psychotherapy can help

The following are just some of the problems that people can experience and that can be helped by counselling and psychotherapy. Please note that these are only thumbnail descriptions of some quite common problems, how they can develop and how they can impact on a person’s life. There are, of course, many, many more problems that can be helped by counselling and psychotherapy. In reality, the development, impact and treatment of each person’s problem are likely to be more complex than is conveyed here, with a convergence of many other contributing factors. Also, very often, particular problems exist together with others. For example, someone who is living in an abusive or distressing relationship may be experiencing continuously unhealthy levels of anxiety and low mood and may also be self-medicating with alcohol.

Like any emotion, anxiety is a call to do, or stay clear of, something. In the right measure, anxiety is a good thing that keeps us on our toes, such as when we undertake something that is dangerous or challenging. It only becomes problematic, or dysfunctional, when the anxiety, or fear, that we experience becomes pervasive and out of proportion with what is going on around us. Brief, but recurrent, periods of intense anxiety are known as panic attacks. At a physical level, anxiety can be accompanied by symptoms such as sweating, palpitations and trembling. In an effort to relieve our anxiety, we can develop many different dysfunctional responses, such as obsessive and/or compulsive safety behaviours, phobias and social anxieties. For example, we may develop a fear of leaving the house or a compulsion to check that the doors are locked, the windows are closed and electric devices are unplugged several times before leaving. A combination of our natural sensitivity and repeated or excessive exposure to negative life events are often related to the development of many anxieties, interfering with our ability to realistically appraise threatening situations and our ability to control them. The words ‘stress’ and ‘anxiety’ are often used interchangeably. However, it is probably more helpful to think of stress as being the result of excessive everyday pressure and challenges that, if ongoing, can lead to unhealthy levels of anxiety. The aim in psychotherapy is to identify the point at which a beneficial level of anxiety somehow began to be transformed into a pervasive fear, to bring understanding and context to its development, to help the person to find strategies to overcome their fear and, finally, to help the person to gain confidence that they can face everyday life without feeling unduly vulnerable.

What is often referred to as depression, I prefer to call low, or depressed, mood. Sometimes, things that happen to us, whether an event such as the loss of a loved one or a long-running adversity such as living in a dysfunctional or abusive relationship or circumstances, can have a devastating impact on us.  This impact could be described as emotional and psychological pain, or distress, or a grievous wound to our sense of who we are. When this happens, we often defend ourselves against this pain by avoiding whatever we perceive as threatening, withdrawing from society, becoming intensely self-preoccupied or going into complete shutdown. Common symptoms, or telltale signs, often associated with this state of affairs are, amongst others, loss of interest and enjoyment of activities, sleeplessness or excessive levels of sleepiness, a lack of energy, poor concentration, suicidal thoughts and feelings of hopelessness, worthlessness and guilt. Therapy provides a secure environment where the origin and meaning of a person’s psychological pain can be examined and steps explored that gradually counteract their negative experience of life.

In my view, one of the few psychological instincts that we come into this world with is to form relationships from a very early age, principally to ensure survival, but also to provide guidance, comfort and security. None is more important than the relationships we form with early caregivers, whether they are our parents, foster parents or other guardians. Thereafter, we form other significant relationships that provide partnerships, wisdom and succour in different measures, but always in the hope that they will somehow enhance our lives. Some relationships, particularly our early ones, are inevitable and when these are dysfunctional or distressing, we learn to exist in them in whatever way we can. Defences that we learn in dysfunctional or distressing relationships, usually subconsciously embedded in our minds, often resurface in new, later relationships, sometimes acting as wrecking balls. These defences can come to light when, for example, we find it impossible to trust others or when we have repeated relationship breakdowns. In turn, this can lead to other problems, such as intense feelings of loss, loneliness, anxiety, anger, very low mood and substance abuse. Therapy can help the person to whom this has happened to examine the course of their life and to support them in making more life-enhancing decisions and changes for the future.

The death of a loved one is probably the greatest loss that can happen to anyone. However, the feelings that someone’s death can bring up in us can also be brought up by other losses, such as the end of a significant relationship or the loss of health or the health of a loved one or the loss of employment. Grieving is the process of reconciliation to the loss and is an inevitable and normal response to it. Stages and feelings often said to be associated with grieving are denial, anger, bargaining, depression and acceptance. However, because the meaning of the loss is personal to everyone, these stages are only indicative of the kinds of experiences that bereavement can bring about in us. For the same reason, it is impossible to say how long it takes before we move towards accepting the loss and begin to experience life as meaningful in a positive way once more. Therapy can be helpful for someone who is finding it especially difficult to move in this direction, providing support while they explore the feelings that they are finding particularly painful and hard to reconcile.

Bullying could be regarded as repeated, inappropriate and unwanted behaviour that is perpetrated against another person. Although it often takes the form of direct behaviours, such as physical assault or name-calling, it can also be perpetrated in very subtle ways, such as excluding or isolating the person. It is often thought of as happening at school, but it also happens in the home and in the workplace. Initially, it makes the victim feel offended and intimidated, then often leading to loneliness, low self-esteem, anxiety, depression, even thoughts of suicide. In many cases, especially when the victim is still in their formative years, bullying can have a devastating impact on the person’s long-term sense of security in themselves and in the world and on the quality of the relationships they form with others around them. Psychotherapy will provide the person with a safe place in which to explore their fears, the origin of their fears and possible ways to change the footing of their life. Not least, psychotherapy will support the person in their journey towards recovery whilst they learn how the impact of bullying can be halted and overcome.

Like anxiety, anger is an emotion. Its purpose is to mobilise our defences against perceived threats to our survival, success, the image we have of ourselves or beliefs that are central to who we are. Perhaps when our self-image is already fragile, and when we overestimate the threat to it, our resulting anger may become uncontrolled or excessive, leading to inappropriate and dysfunctional behaviours such as becoming overly hostile to minor irritants or rushing to swift and harsh judgmental statements to or about others. It can also lead to passive aggression, such as social withdrawal and disrespecting attitudes. The aim of therapy is to bring understanding to the underlying causes of the person’s anger and to learn to recognise and assess the triggers and the physical sensations that escalate it. In combination, these will enable the person to better control and manage their emotions, behaviours and relationships.

Very often, these problems start out because certain substances, for example, alcohol, make us feel good and better able to participate socially. For most people, that is the extent of it. Unfortunately, for some, there are contributory factors and circumstances that draw them into a spiral of increasing use that grows into abuse and addiction. These contributory factors may have to do with growing up in circumstances where substance abuse was the norm, very often as an antidote to some unresolved pain or adversity. In any event, the highs produced by stimulants, or the calming effects of depressants and opioids, are experienced as preferable to the psychological pain that the person perceives as being the reality, the lived experience, of their world, leading them to use more and more of the substance. The consequences can devastate the person’s psychological wellbeing, their relationships and physical health. Psychotherapy is usually part of the person’s journey towards recovery, although, often, it is part of a more intensive, in-patient, programme. In private therapy, substance abuse and addiction usually present in the context of other problems and the person’s growing relationship with, and need for, the substance.

ADHD usually appears first in childhood, but it can also be diagnosed in adults (when some symptoms were present in the person’s childhood, but were simply never diagnosed). The condition is characterised by a pattern of inattentive behaviour and is often combined with impulsivity and hyperactivity. This pattern of behaviour makes it difficult to focus on details, sustain attention, listen to others and follow through on instructions or duties. Although the exact causes of ADHD are uncertain, it is believed that the condition arises from a combination of neurobiological and social factors. Whilst ADHD is difficult to deal with for everyone involved, it is readily treatable. Medication may help with some immediate relief from some of the symptoms. However, medication alone is seldom the answer. Psychotherapy can help the child or adult to talk about upsetting thoughts and feelings, explore self-defeating patterns of behaviour, learn alternative ways to manage their emotions, identify and build on their strengths, challenge unhealthy or irrational thoughts, cope with everyday problems such as controlling their attention and aggression.

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