Posts Tagged ‘clinical psychology’

What actually happens during a therapy session?

May 12, 2016

MiaI’m excited about this referral because the money has been arranged by a health insurance company, so neither of us need worry about money. They have released money for 6 therapy session. She enters my room. I have no idea what I am going to hear, or what I am going to do. I begin in the same way that I always begin. I hear her story and watch her and help her feel comfortable in my presence. She is wringing her hands. She sits bolt upright. She is tense. I digest her story, process it, try to make sense of it, quickly enough to be able to feed back in that one session what I think might help her. As I listen, I mentally pick out her strengths, they will come in handy at some point (a technique from positive psychology and hypnosis). I teach her some calming and relaxation techniques, after helping her to understand why this is so important to do (when we are stressed, our thinking changes – it becomes narrower, more judgmental, more skewed, less rational, and things just seem much worse than they are. This is a change that is real, and has been demonstrated on brain scans). We record a relaxation session on her phone, tailored just for her. She told me she never relaxes, but in that five minutes, she did. She takes away the recording to listen to regularly (this activates the parasympathetic nervous system, triggering a calming response, helping her to think more clearly and calmly).

She comes in again the following week. She tells me that she has a major challenge on that week-end, so can we please help her cope with that. We do some cognitive work (challenging her negative beliefs about the stressful situation). We do some reframing (helping her to think of it differently). We do some behavioural strategy work (helping her to develop alternatives) and then we do some imaginary rehearsal (or rather, hypnosis, to get her to imagine herself actually acting out the coping behaviours. The brain needs to visualise to realise. Just talking isn’t enough).

We do some role play to cement the new cognitions (I give voice to the scary thoughts, and she answers them with the new ways of thinking). This bit is quite fun, and it gives me a really good idea of whether the work we have done so far has been understood by her. It has.

I then finish off the session with an NLP/hypnotic technique (neuro-linguistic programming technique) to cement at a deep level, the new behaviours. It’s called the Swish pattern technique, and I use it quite a lot. I can see in her face that it has worked supremely well (because she looks confused as she tries to bring up the old image of her previously anxious self. Her brain can no longer access it).

The next session, she comes in smiling. She relaxes onto my sofa. She tells me she is feeling good. She tells me she had a good week-end. It all went fine. It’s not that she coped with, or managed her anxiety, it’s that it wasn’t there in the first place. She tells me that it just didn’t really figure in any way. She doesn’t really know how it changed. I tell her that we had “reset the system” back to her old, relaxed happy self (that was the strengths that I had picked up on in the first session) but I don’t think she understands. This happens a lot. People get better, but they don’t know why or how. I do, but I don’t bother trying to explain it, as that would somehow take the magic out of it.

So, there’s no need to arrange a further session. She will call me if she gets any symptoms back again, and we will hypnotically release the past traumas that trigger her anxiety (using the Rewind technique). But we won’t do that now, because she chooses to just enjoy life and get on with it again (I did give her the choice).

So, the planned 6 sessions became 3. This happens all the time. Because when I introduced hypnosis and NLP into my cognitive behavioural model of working, change began to happen super-fast. And super easily. The adage “no pain no gain” is simply not true.  This super speed may not be good for my income ( I lost out on three sessions worth of pay), but it’s great for my work satisfaction.

Mia Scotland, Clinical Psychologist

www.miasscotland.co.uk 

 

“I’m scared I’m going to harm my baby…”

April 28, 2016

mia brochure photoWhat do you say when you hear the words “I’m terrified that I’m going to harm my baby”

Those words are ones that would be hard to say if you’re a mother. But if you’re a professional, be it a midwife, a health visitor, a doula or a counsellor, they can be hard to hear too. Those words represent an ultimate taboo.  A mother wanting to harm her own baby…..

But just wait a minute. If you are very astute, you will have spotted my deliberate error there. Can you see it? They are not the same thing. “I’m terrified I’m going to harm my baby” is not the same as “I want to harm my baby”.

If you hear a mother say “I’m terrified I’m going to harm my baby” the chances are she is suffering from an anxiety disorder, and she is not a danger to her baby. She is about as dangerous as some-one with fear of heights, who stands near(ish) a cliff and says “I’m terrified I’m going to jump off”.  You wouldn’t call the crisis team in this instance would you? Instead, you might say “no you’re not, you’re just scared”. It’s the same with mothers. If a mother is anxious (and especially if she is suffering from perinatal or maternal Obsessive Compulsive Disorder) then she might talk about suffocating her baby, but she can be reassured that she isn’t mad or bad, she is scared.  And of course, if you make the mistake of reacting like she is mad or bad, and call the crisis team, you certainly aren’t going to ease her anxiety!

To find out more about perinatal mental health problems, come to my workshop for birthing professionals on Friday 10th June 2016. For details, click here 

Mia Scotland, Author of “Why Perinatal Depression Matters” and Perinatal Clinical Psychologist.

Pass The Bomb: who is going to contain your anxiety when you are with your newborn baby?

January 26, 2016

iStock_000064471321_SmallNew parents are anxious. And according to research, they are getting more and more anxious. I often hear cases of mums unable to sleep because they are terrified. Terrifed that their babies aren’t breathing. Terrified that the room is too hot. Terrified that baby hasn’t fed enough. Terrified that they will damage their baby. Dads are getting postnatal depression too, at rates almost as high as for women. They are scared too. I want to talk about a psychological piece of gold, that can ease anxiety, but that new parents are lacking in our modern lives.

Containment is a psychology term that basically means; the process of stopping anxiety from bouncing around the room.  Containing situations and emotions is something that all good parents do (and therapists too). It’s not easy to explain, but I’ll give you an example of when containment is NOT happening. My son may come to me in a flap because his friends have said to him (in a flap) that he has to start job hunting now, because a teacher said to his friends (in a flap) that jobs are very competitive and they need to take this seriously and start job hunting now. I can continue the flapping by saying “what? Are you serious? Now? That’s crazy. Can it really be that bad? Oh my goodness, I don’t know what we are supposed to do with that information, it’s a crazy world out there”. And in my exasperation, I tell my friends, who are also parents, and pass the flapping on. The anxiety continues down the line, because no one has contained it.

Or, as a parent, I can provide some containment. In doing so, the anxiety disperses. I do this by “containing” my own feelings of exasperation or anxiety, and I can calmly and warmly say “honey, that sounds very pressurising, I can understand that you’re worried (empathy). But you know what? It’s going to be fine, because you have at least a year before you need a job, you’ve already got a great CV, and I’m going to help you get yourself sorted. Shall we take a look this week-end?”  He relaxes, and the “containment” goes back down the line, because he tells his mates “actually, we do have a year, and we’ve got our CVs done already, and I’m not worried about it” and so on. Containment kills anxiety.

I was watching an episode of the British Sitcom “On the Buses” recently. It’s an amazing watch, because it is a rare glimpse into social history. It is set in working class London, in the early 1970s. It is clear, watching this, that it was normal to go through your first pregnancy, birth and babyhood, whilst still living with your parents. This was common before the 1970s, because newly weds couldn’t afford their own house. In one particular episode, a pregnant woman and her mother were chatting about the baby in a tiny kitchen, which serves as a wash room and a living room all in one. The pregnant woman was expressing anxieties about becoming a mum. The mother’s mother responded with something along the lines of “I’ll be ‘ere anyways, so you ain’t got narfin’ ta worry abart” (I made that bit up, I can’t remember exactly what she said). She was replying with reassurances, in a tone that kind of said “I totally get why you’re anxious, because I was” (empathy) and added “but really, it is so easy to look after a new baby, that you have nothing to worry about”. She was nonchalant, but empathic too, and containing.

Nowadays, new parents go home to their own house when they have their baby. And they don’t really want the mother in law around too much. And they don’t want her advice, because advice has changed so much. So they go home and do it themselves. Here-in lies the danger: What they don’t realise is, they have no-one to contain the anxiety. This is critical, but overlooked. Hazel Douglas defines containment as being “when one person receives and understands the emotional communication of another without being overwhelmed by it, processes it and then communicates understanding and recognition back to the other person. This process can restore the capacity to think in the other person.” Thus, it is a powerful tool for helping the person become unstuck from paralysing anxiety, to help them become functional again, to “think” again. Because, you know what? Working out what to do when a baby cries, learning how to pick up a baby, rock a baby, feed a baby, change a baby, keep it alive, is quite a big task when you are new to it.

And when there is no-one around to contain the anxiety in the middle of the night, it all gets a lot more stressful. And if you are scared and anxious, you are passing that on to your baby. Your baby picks up on “something is the matter”. So your baby is more likely to cry. So it gets worse. What you need, is someone to come in and contain the situation. Some-one who has done it before, who can calmly, empathically and warmly turn the situation around with one look and one smile. She sprinkles magic fairy dust into the room, just like a real life fairy godmother. Who is going to do that for you? Traditionally, it would have been mothers, sisters, midwives or aunties.

Nowadays, fathers are courageously trying to fill this gap. They are mucking in with the night time nappy changes and the job of caring for the baby. That, in itself, is a big job if you’ve never done it before. But dads, you have an extra job. You are also there to support the mother, so that when she is crying on day three of the baby blues, you can hold her in your arms and tell her that you love her. All very well, but can you tell her, knowingly, that it’ll be okay? Can you tell her, from experience, that it’ll pass? Can you tell her, and feel, that you are calm and strong and capable of handling all of this? Can you contain the situation?

Probably not. Because you have never done this before, either. You are tired from the birth too. You are on unknown, scary territory. You haven’t got the benefit of wisdom and experience on your side. You need some-one to come in and say to you “it’ll be okay, hold her in your arms, tell her you love her, let her cry all over you, you are doing an amazing job by just being there for her”. Dad needs containment too, so that he can be there for the mother. The mother needs containment so that she can be there for the baby.

So, how can you build in the psychological gold nugget that is “containment” into your postnatal birth plan? Well, you haven’t got time to wait for the NHS to provide it in the form of regular midwife visits postnatally with continuity of care, so you need to do it yourself. Think about which members of your family help you feel safe, nurtured, and cared for. Bring them in to help. Ask them to move in! If no-one is available, think about paying for this kind of help. Lactation consultants, postnatal doulas, night nurses, private midwives, all do a fantastic job. Postnatal doulas are not expensive. They are trained in all aspects of new parenthood, and they are exceptional at taking care of your needs so that you can take care of your baby. This will take the pressure off the father too, so that he can remain strong, and enjoy the process.

Think twice before you spend your money on a travel system, or on pretty wall paper with matching bedding. Think about your emotional wellbeing before your physical wellbeing, and you, your partner and your baby can thrive as early as possible in your incredible journey as that most precious thing in the world: creating your very own family.

mia brochure photoMia Scotland is a Clinical Psychologist and author specialising in the Perinatal Period. See her website at www.yourbirthright.co.uk or buy her book, Why Perinatal Depression Matters from Pinter and Martin.

Why I left the NHS and why I don’t want to become a midwife

May 26, 2015

I haven’t been able to put my finger on it, ever.  Until I read the chapter by Robin Youngson in “Roar behind the silence”.  And I’ve had an epiphany.  His honesty about the kind of anaesthetist that he was before he embraced compassion, and the kind of anaesthetist that he is now, his ability to face his shame and his demons, has helped me to do the same.  Thank-you Robin.  Thank-you so much.

When I am honest about the kind of psychologist I was before I left the NHS, and face my shame and my demons, I understand a little better, what went wrong.  I have never liked being a psychologist.  I have always grappled with why I don’t like being a psychologist.

I don’t want to be a midwife because I don’t want to work in an institution that can medicalise, depersonalise, and reduce women to bodies that need to have a finger put inside their vagina regularly to check whether they are “failing” or not.  I do not have the resilience, and I do not have the people skills, to go in and help in the tide of change – that tide of incredible midwives, doctors, lawyers, doulas and so on, fighting the system and building, piece by piece, a better maternity system. Thank-you to those amazing people.

I am clear about why I don’t want to be a midwife.  I don’t want to take on the system. I don’t want to have to witness it any more that I have to as a doula.

But I have never been clear about why I don’t want to be a practicing psychologist. I have never understood this struggle within me, this reluctance to sit in front of some-one in distress and try to help them.  I remember, 23 years ago, in my first year of Clinical Psychology training, sitting in front of my mentor, the lovely Professor Gilbert, telling him that “I’ve made a mistake. I don’t want to do this job after all”.  We didn’t understand my reticence.  I stuck at it. But I spent the next 13 years not enjoying my work.  Then, I left the NHS and began to apply my psychology to a different arena – that of “normal” people, people who are not in distress looking for me to solve the problems for them.  I began, finally, to enjoy my work. Why?

I have just read a chapter by the inspiring Robin Youngson in the amazing book “Roar behind the Silence” and all is clear. I’ve literally had an epiphany, and I’m sitting here, very excited, and very moved.  Waves of relief and emotion are washing over me.  I’m trying to formalise it and understand it as I write.

And I’ve realised that there is so much wrong with the way that I was trained in clinical psychology.  I couldn’t understand what was wrong, I couldn’t see what was wrong, and so I couldn’t address it.  I just felt uncomfortable the whole time.   And it seems so obvious to me now.  I was taught to be clinically detached.  I was part of a system that differentiated between “them” and “us”.  This suited me, because I am not particularly good at being warm and open when I first meet some-one.  And yet, it didn’t suit me, because I never enjoyed my job.  I always felt the responsibility of being the “expert” in an arena where I knew deep down that the person was the expert, and the problem was society.  How could I sit in front of some-one who was distressed, and pretend that they were struggling because of some fault in their thinking style?  Or try to help them in a little bubble of a therapy room, when I knew that it was their family, or their society that was crazy?

I remember the discomfort when I had to reject a lovely present that a client with Down’s Syndrome had given me. (I had been told never to accept presents, so I didn’t).  I remember not even questioning, during preparation for my interviews for a place as a trainee, why I was advised never to say that I “want to help people”.   I remember hiding all traces of my personal life, and not divulging anything during therapy because I was taught that that would spoil the transference (or something like that).

So, I left the NHS, which felt a little like severing an umbilical cord.  People envied me, and told me I was brave.  The change in me was very quick.  I began to free myself up to be warm, friendly, open and honest as a person. I no longer needed to be “clinically detached”.  I began to enjoy my job. Yippee. I could accept gifts.  I could have a laugh with people, chat to them about me, tell them it was okay to phone me before the next session, and so on.  Of course, I could have done all those things before I left the NHS, and all the good therapists that I know did it right from the start.  Just like all the good midwives don’t necessarily stick to the rule book, and they might get reprimanded for the times when their compassion got in the way of their diligent note taking.  The NHS is working on increasing compassion as one of the 6 C’s.  We know that compassion makes for resilience and job satisfaction.  It’s certainly helping me enjoy my job.  I ditched the detachment and opened up to compassion.  Thanks Robin, for spreading the word.

To find out more about Compassionate Midwifery workshops for all birth professionals, go to www.yourbirthright.co.uk/birth-professionals/. 

Mia Scotland

Clinical Psychologist, Birth Doula and Hypnobirthing practitioner

Birth Trauma – Can it be fixed?

January 21, 2013

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The word “traumatised” has become like the word “starving” and the word “depressed”.  It has been watered down,  from something quite serious and potentially life threatening, to something we flippantly say when chatting about our experiences.  We might say “I am absolutely starving” instead of “I’m famished”.  We might say “I was so depressed” because our Christmas pressie turned out not to be the long awaited diamond ring.  And we might say “it was traumatic” when we mean “it was horrible”.  But we all know that to actually be starving means something very different.  And we might or might not know that to actually be depressed is a miserable state of being, a condition, not a fleeting  emotion.

So what about trauma?  If something was really scary and upsetting and horrible, were we traumatised?  Well, to a psychologist, trauma is as much about the aftermath of an experience, as it is about what actually happened. It is about how it leaves us feeling, long after the event.  It is not always about what actually happened, or even about how bad it was at the time. I’ve heard some birth stories that are so horrible, my insides are shrinking when I hear them.  But the mums are fine with it.  In fact, sometimes, the mums are remembering the experience fondly (I kid you not!  It must be the oxytocin).  I hear other birth stories that sound wonderful when described.  But the mums are sobbing with grief and horror while they tell me, even when the birth was years before.  How can that be?

Trauma is about the injury, not the event.  It’s like breaking a bone.  I might fall down a big flight of stairs, and walk away unscathed.  On the other hand, I might trip up over nothing, and break my ankle.  One cannot predict this, or control it.  The person who broke their ankle is not weaker or more stupid, and they cannot “pull themselves together”.

So when we are listening to a birth story, we don’t need to know about the event. We need to know about the reaction to the event. I want to know “can you talk about it without crying”.  I want to know “does it impact on your dreams”.  I want to know “do you try to shove it to the back of your mind, but you find it impossible”.  I want to know “what impact is it having on your life”.  I want to know “how long ago did it happen”.  If it is less than a few months, and the person is telling me about it, the chances are, she will be okay.  Usually, I’m hearing the story years later, because the person is pregnant again, and this flares up the previous trauma.

Is birth trauma treatable?

Yes.  I have been treating trauma for over 20 years, with an enormous amount of success.  It is treatable.  I promise you.  Time isn’t always enough. Some people go all their lives traumatised, until they receive treatment.  War veterans have suffered for decades with PTSD , until a short course of treatment lifts it.  And it can really feel like something has been lifted.  As one person once said to me “it was here – in my forehead – I couldn’t get rid of it – always there – always in my way.  It has gone.  I can’t believe it, it has totally gone”.    There are treatments out there that work.  We aren’t exactly sure what the treatments actually do, we just know they work.  They seem “move” the memory from the “I’m not safe” (threat activated) part of the brain, and lay the memory to rest in the “it was awful but it’s over” part of the brain.  While traumatised, the person feels as if it as just happened, and the body and brain are in a state of hyper-arousal.  This might involve nightmares, flashbacks, irritability, moodiness, tearfulness,  sleep problems , anger with your loved ones, constant memories of the incident, and efforts to push it out of your mind unsuccessfully.  If you are a new mother, it has even more consequences, because it interrupts the process of bonding with your baby.  Furthermore, the normal chaos that comes with adjusting to a new baby is heightened to create a potentially miserable cocktail.  Fathers can be traumatised by the birth too, but they often go under the radar, so we know very little about this. Mothers have been going under the radar for a long time, because many cases of PTSD were misdiagnosed as post natal depression.  We are only just beginning to realise how common post natal depression is in fathers (almost equal to mothers, in some studies) and the fact that this might be related to birth trauma in fathers.

In our society, we are led to believe that we should be able to control our emotions, but if we have been traumatised for 6 months or more, then trying to control it may exacerbate the problem. This is because, with PTSD, the more we try to “control” the emotions (in other words, the more we try to push the memory to the back of our minds), the more the problem anchors itself in the brain, because you are preventing the brain from processing  the event properly.  This is where therapy can help.  Therapy enables the brain to change the memory, so that it becomes processed into the “history” part of the brain rather than the “I’m not safe” part of the brain.  Before that, the memory seems to be stuck in the “oh my god I’m not safe and this is awful” part of the brain, leaving the person with “symptoms” as outlined above.

There are many effective therapies out there. I’ve tried a few of them. I now mostly use the rewind technique (a hypnotic technique, taught to me by the Human Givens Institute) which seems to be the most effective, the quickest, and the least distressing.   It can be one session.

I am now teaching this fast, fairly painless and effective technique to professionals who find that they want to help parents let go of the horror of a difficult birth. It’s a two day course which gets great feedback. It gets great feedback on the day, but also great feedback when people start applying the technique. There really is nothing better than knowing that you have made a dramatic difference to some-one’s life. To find out more about the upcoming training workshops, go to http://www.traumaticbirthrecovery.com/courses-for-professionals/

Mia Scotland

Clinical Psychologist

http://www.yourbirthright.co.uk