"The BAD leg" - or how our mind can change our body

I was travelling recently and over the course of a few days my right foot started to hurt, quite badly, even when I was just lying down.

I didn't think about it too much at the beginning, but the pain only became worse with time, and I was quickly limping in pain instead of walking.

As I was visiting friends, one of them suggested to see his osteopath, but warned me "he'll see you for a whole hour, but the first half hour you'll just be talking". Great I thought to myself, I'll fix my foot AND get therapy for the same price!

And that's where it got interesting. As I was telling him what was going on, how my foot was hurting for no reason, I also told him that I wasn't surprised: after all this was my "bad leg", the one that always gave all sorts of trouble.

He listened, examined my foot and my leg, and told me there wasn't any injury he could see, but said he would try and relax my foot by gently massaging my lower leg and said words to the effect of "could I please think nicely about my leg during that time, telling it what a good job it was actually doing".

To cut a long story short, we did our respective parts and my foot stopped hurting when I put it back on the ground, and I could walk without pain. And the pain stayed away!

Now I don't think he did any miracles, but rather that my nice self-talk allowed me to relax enough to walk normally again, which in turn stopped the pain. Great outcome, right?

Now this is a slightly fantastic story already (at least for my inner rationalist), but it gets better!

I'm back at home, and I meet a very good friend of mine who is limping badly and clearly in a lot of pain from his Achilles tendon. He's seeing a physio, doing exercises, but he can barely walk. I tell him my story, and he listens, clearly slightly doubtful of my sanity...

Two days later I speak to him over the phone and he tells me "you know what, I was so desperate about the pain I was in, I started talking to my foot, telling it nice things, and bizarrely - the pain went away nearly completely!"

I had to laugh, because that particular friend is even more of a rationalist than I am! Of course I don't believe the self-talk fixed his tendinitis, but rather helped with how tense everything was, and hence on the "felt" pain. But hey - he could walk again, and the healing process became faster and much less painful!

I've been using this method ever since when I'm in pain. Instead of treating my body as an adversary that I have to subdue into submission, I treat it more like a valued collaborator. Not surprisingly, it is making a great difference!

We follow the same principle in psychotherapy. The parts about our inner self that we don't like (our angry, frustrated, sad parts) that we talk to in a mean way, that we exile, will create tension and sometimes pain.

But when we listen to those parts, hear what they want to tell us, welcome them as valuable parts of our self, then we can let go of the pain and tension around them.

Worth trying out?

The body-hack I wished I had learned earlier

For a long time now, I have resisted the idea that my body is anything other than the "carrier" for my brain. My credo was always "Mind over matter". Turns out that I was wrong. Our bodies are at the very least equal partners in this weird relationship!

Regarding my work, that means this: just addressing the thoughts and feelings is not always enough. Research for example has long pointed out how beneficial regular 20-30 minutes of walking (preferably in nature) is for our mental health. I hate that this is true (and I'm working on getting over myself)!

Recently I have discovered a much easier, quicker way to snap out of my head and its sometimes tornado-like thoughts. 

It's called box-breathing, and the simplicity of it makes it so efficient, because everyone can do this, even in the middle of the greatest (real or imagined) emergency, even whilst talking or listening.

Box breathing is an easy 4 steps (like the 4 sides of a square box):

1. Breathe in slowly whilst counting to 5.

2. Hold that breath in for a count of 5.

3. Slowly breathe out for a count of 5.

4. Keep your lungs empty for a count of 5.

And repeat.

What happens in that time is quite amazing. Our heart stops racing, our brain (by focusing on breathing) gets out of the looping thoughts, and our stress level goes down. 

Anger, sadness, frustration, all recede into the background.

It's like someone pressed the reset button. A wonderful calm descends. We actually get our thinking power back, the one that got high-jacked by our emotions.

This is too good to not share. Try it a few times and see and feel the big impact it has on your mood and thoughts.

And once the emotions rise again, faster than you can out-think them, do it again. A few boxes. And inner peace is within reach again.

It changed my life - let me know if it changes yours too.

Inflammation - a new theory about depression

The latest theory about depression links it to excessive inflammation in the body (which is also what happens in certain autoimmune diseases as explored here).

So what is going on? Why do we have those pesky exaggerated responses that at best give us allergies, at worst depression and psoriasis?

The role of inflammation is to allow our body to fight intruders because most bacteria and viruses don't survive a slight raise in temperature, hence fever and also to multiply our white blood cells faster. 

So far, so good. It's a useful system, that works pretty well. But why do some of us (yes, I am one of them) have too much of an inflammatory response, while other people seem to do ok with a normal/"good" level?

Well, there is a genetic component (yes, depression and autoimmune diseases run in families). And that's where it gets interesting and we have to go all the way back to the 14th century in Europe, to the Great Plague.

The pandemic of bubonic plague killed between 30 and 60% of all Europeans alive at the time. And guess who survived? the people with an overactive inflammatory system.

So what gives us depression, Hashimoto's, lupus, neurodermatitis (and the list diseases created or made worse by excessive inflammation is pretty endless) literally saved our ancestors' lives in the Middle Ages.

So now that we know why, let's focus on how we can harness that knowledge. 

I'm obviously not giving medical advice here, so ask your doctor, or naturopath, or grandmother (don't underestimate the wisdom of our closer ancestors) on how to lower the inflammatory response of your body. Hint: look at what you eat. 

I'm not suggesting that leafy greens (or any other particular food) will make your depression go away. But if the severity of it could be mitigated by reducing the inflammation in our bodies, isn't it a path worth exploring?

Time or money - which one do you prioritise?

In my experience, there are two types of people - the ones who prioritise time, and the ones who prioritise money - but what neither seem to realise, is that these are interchangeable.

So some people value time, and will do anything to save time - usually that means spending money to save time. You can save time by paying others to do chores, or by paying for tolls to avoid wasting time in traffic. But of course the money that is spent has usually been earned by working, which gets me to the other people:

The people who will spend time in order to make money: through work, or by saving money by spending their time - by cleaning themselves, or by taking the little roads that are free but take longer, or by driving further to find the cheaper petrol station - you get the gist.

What neither group seems to be aware of is that they are both doing the same thing - spending one in order to get the other.

Why is that important? Because you can only make conscious choices when you know that you are making a choice.

Mostly we will follow one road or the other unconsciously, following the "script" that our parents have followed. 

If our parents have grown up lacking money, their conscious or unconscious message will be about the importance of making, saving and having money.

And suddenly here we are, spending our life ensuring that we will "never" be poor - even if it means not having free time, not spending that time with our loved ones, always pursuing a hypothetical end-goal of financial freedom, at any cost.

Yet of the resources to pursue, it turns out that we can never have enough money to really feel free, and conversely, that time is always going to be limited - if we are lucky that means 80 or 90 years. 

I can't help but feel that though money is important to give us a minimum of independence, time is the one thing we can't multiply. The days we spend without our loved ones can never be made up for. 

So what is your priority? Do you put most days "in the bank" in order to spend a few privileged moments during weekends or holidays in the way you desire?

Or are you consciously choosing to use the time you have as much and as often as possible to be in the here and now with the people who really matter in your life?

Blame or curiosity - a very different outcome

This article is about how we can change the way an argument goes, and its outcome.

Most of the time when we are dissatisfied with the way someone else has acted or spoken, we go straight into “blame mode” – telling the other what they have done wrong.

The result? Usually defensiveness. If someone is told they’ve messed up, they normally start defending themselves by saying why they were justified, or why we deserve whatever they’ve done or said. 

Very quickly this veers into an escalation of aggression “you did this!” – “yes, but you said that!”. Most people will agree that it rarely takes us to a desirable outcome.

I am suggesting to start the conversation from a position of curiosity, rather than blame.

What does that look like?

“I notice you said/did this. I wonder what is happening for you at that moment?”

Or “It looks like you are feeling strongly about this. Please tell me what is going on for you right now.”

Suddenly the other person can actually explain what is happening for them, how they’re maybe triggered, or are having a bad day, or just misspoke. 

We get to see their intentions, which most of the times are not aggressive, but rather serve to protect them or to take care of their fears.

It becomes not about us, but rather about understanding what is going on for the other. 

Suddenly we’re having a dialogue, rather than a shouting match.

When everything is said and done, all we want is to be understood, and to connect with others in a supportive way. This is what is being fostered here:

No blame = no need for defensiveness.

Curiosity = allowing for understanding.

Worth a try?

How to change your life in 5 minutes a day - yes, really!

I have mentioned before how our world view is strongly influenced by our focus: 

Look for dangers, see the dangers.

Look for wonderful things, see the wonderful things.

Most of my clients, for different reasons (attachment issues, trauma and/or depression), have a mind that actively looks for whatever could go wrong. Consequently they focus squarely on the bad stuff in life.

And that makes sense from an evolutionary perspective: when we grow up in a dangerous environment, survival means looking out for what we fear. Research has shown that trauma develops survival skills that are quite extreme. 

The only problem is – once we are not in a dangerous environment anymore, we can’t just switch off this hyper-vigilance. Our brain has been hard-wired for that, throughout our traumatic childhood and/or adult life. 

And getting stuck in survival mode is usually not conducive to a happy life. If I can’t trust anyone, I will struggle to build the meaningful connections all humans need to thrive.

The good news is that this is not a life sentence, thanks to brain plasticity (for a very good book on that, please read “The brain that changes itself” by Norman Doidge).

And there is a simple exercise that – if practised regularly – can help us rewire our brains to focus less on danger, more on the good things.

It’s the gratitude list. I’m sure you’ve all heard about it.

It’s startling in its simplicity: at the end of every day, take a few minutes to write down three things that you are grateful for. 

I know when you are stuck in depression, or PTSD, that sounds like a joke. “My life is so shit, there is nothing good about it”. But that isn’t the whole reality.

Yes, your work day might have been awful or repetitive. But the bus driver on the way there smiled and said “have a lovely day possum!”.

The neighbour’s cat came by to ask for pats.

Someone you know texted to ask how you are.

You tried out a new recipe and it actually was nice.

You ate a chocolate croissant that tasted divine.

The tree in front of your flat has started flowering.

You get the gist? Often small things. That we overlook when our focus is on all things sad or dangerous. 

By writing that list, every day, we get into the habit of paying attention also to the good stuff. 

We then might start noticing the little nice things even during the day: “that’s something I’ll put on the list tonight”. We stop seeing our life as just black, and start adding a few little patches of colour to it. 

We allow our brain to slip out of constant survival mode – and to slip into living.

For my clients who try it, it has a transformative effect. 

But like any exercise, it works best when practised regularly, until it (rather than survival mode) becomes second nature.

Like meditation it has the power to change our life by changing our brain.

You may want to try it - what do you have to lose?

A lion in Hyde Park!!! or the difference between fear and anxiety

Have you ever wondered about the difference between fear and anxiety? Apart from the vague feeling that one doesn't last as long as the other?

Let me set you two scenes that will make it really easy to see.

First scene: you are in Africa, on a safari, walking away from your vehicle (and your guide told you to never, ever do that!), in lion territory, and you suddenly hear roaring. What you feel in that precise moment is fear, in the presence of clear danger.

Second scene: you are in downtown Sydney, about to cross Hyde Park, and you start worrying about lions hiding there. Obviously you know there are no wild lions in Australia. 

But you think to yourself - "there are some lions at Taronga Zoo, one of them could have escaped from there, crossed Harbour Bridge (or swam across) and be hiding right now in the bushes of Hyde Park".

What you're experiencing is anxiety, a diffuse feeling of fear about something that *could* happen, in the sense it is not quite impossible, just highly, highly unlikely. Anxiety is about an imagined (but not necessarily imaginary) danger.

Why is it useful to know the difference?

Because it allows you to respond appropriately. Once you work out when there really is something to be feared, you can take action and protect yourself. 

And by realising when it is anxiety, you can choose to question it and hence get the choice back to do what you really want, in this case walk through the park.

Next time you get that niggly feeling, maybe ask yourself - "is this a lion in Hyde Park or a real danger?"

My "3-legged dog" theory

Welcome to my latest theory - that we are all like 3-legged dogs.

Let me explain. We go through life thinking that people have got a pretty good handle on it, and hence are like 4-legged dogs, fully functional and "best day ever".

And even more, we think that the other people in our life - our partners, our friends, our parents - all are 4-legged dogs too!

And we set our expectations, towards ourself and towards others accordingly. We/they *should be able* to react rationally, to treat us fairly, to learn and of course - gasp - change if necessary.

Well there is my news: we are not 4-legged dogs. Barely anyone is fully functioning. Most of us have an emotional disability, an internal struggle, that allows us only just to run and look at first sight like a complete dog, when really there is a whole limb missing.

Some hide the missing leg better than others. Some take classes in living with the disability (therapy anyone?). But for most of us, we just limp.

Why is it so important to realise that we're only 3-legged dogs? Because it allows us to cut each other, and ourself, some slack. Maybe the other isn't hurting us because they don't care, or because we aren't worth being treated nicely. Maybe they don't do what's good or necessary, because they just can't.

Look around you. The bitchy girl, the bullying guy, the failing partner? Just 3-legged dogs trying to survive in a dog-eat-dog world.

Realising this can help us to let go of our resentments and allow us to feel compassion instead of judgement.

Seeing ourself and others as the fallible human beings that we are gives us back our humanity. We are not superman or superwoman. Most of us are trying hard to be decent. Let's not judge ourselves and each other when we fall short.

"How to talk to blokes" - or a general guide on how to be heard

I often hear complaints about how "men don't listen" both by friends and clients and when I question what exactly happened a few key phrases keep popping up:

"I hinted at ..."

"He should know that ..."

"I emailed him some ideas ..."

"I told him I'd love this to happen ..."

"I said to him that this needed to get done ..."

See a common thread? Ideas are being floated, needs are being hinted at, wants are described - but why isn't there a simple request of "darling, could you please do this, if possibly in X timeframe ..."?

I'm told repeatedly that men are simple creatures - don't be fooled, they are complex human beings just as women are, but what is true is that they often have a more direct communication style, and if you learn to use that, they will simply struggle less to understand whatever message is being conveyed.

I've mentioned before that expecting the other person to read your mind is a most inefficient way to communicate, that mostly leads to frustration.

So why don't we just ask for our needs or wants to be met?

The answer is simple yet reflects all the complexity of what goes on in our brains.

Whenever we express a direct request, we make ourselves vulnerable to being told "no" which we interpret as rejection. So by tiptoeing around what we really want, we try and keep safe from a possible refusal.

But the price we pay is only getting our needs/wants met by fluke, when your conversation partner happens to think along the same wave-length and at the same time is tuned into the fact that you may be trying to ask for something.

How about we try to cut out this whole layer of guesswork and just trust that our partner is receptive to requests? Knowing that it is his right to say "no" and that the beauty of good communication in a relationship is to say it lovingly? 

We may just save us all an huge amount of frustration...

When soothing your anxiety is becoming a full-time job

We all have ways to soothe our anxieties away - some more healthy than others.

For some it's about interrupting it through physical stimulation: a run, a hug, touching something comforting, sex or eating.

For others it's with more mental ways: mindfulness, gaming, gambling or reading.

For some it's using numbing or exciting substances like alcohol, drugs, nicotine ("I'm so stressed, I need a cigarette/glass of wine/joint/valium").

Personally I'm partial to apps on my phone and a glass of wine, and of course reading. And I can tell when it gets out of hand.

What all of these ways have in common, the healthy and the unhealthy ones alike, is that they only take care of the symptoms, i.e. the anxiety.

Anxiety, like any other emotion, is usually not a problem in itself - unless we refuse to look at its causes: then it will tend to develop a life of its own.

In most cases, our anxieties are about real or perceived problems we have. A job we don't like, a bully at work, someone's health issues, our difficulties connecting with others, the list is long.

Most of the time, we get away with ignoring the underlying issues. They are not so acute that we can't push them away. But when we bury our feelings, we bury them alive - they don't go away, they fester in the underground of our mind.

Eventually we spend more time soothing than living. More time pushing away than solving.

That's a good time to ask yourself "what feelings am I avoiding? what are they about? what would I rather be doing? how do I want to live?"

It's also a good time to ask for help, when the soothing has become an addictive behaviour you can't control anymore, interfering with the rest of your life.

Please reach out - there is nothing shameful about telling a friend that you are struggling, and enlisting them to support you in regaining independence from your anxiety.

Healthy boundaries are like a good garden fence

For those of you who have been reading my blog for a while, you might remember how I have likened our mental space to a garden, and psychotherapy to gardening.

Today I'd like to talk about boundaries, as it is one of the main subjects that come up in my work with clients and their relationships.

If you imagine that "you" are a plot of land that you are (hopefully lovingly) tending, of course that has to be protected from others, and you have lots of options for fencing it.

You could have just a line on the ground to delimitate your plot from your neighbours' ones. The advantage is that your neighbour can pop over all the time, which is also the disadvantage of course - it offers no protection from people with a less well-developed sense of where their plot stops and yours starts. After the hordes of elephants from their side have trampled your vegetables a number of times, you might decide to go the opposite extreme.

You build an elephant-high fence, potentially even with razor-wire and miradors with sharpshooters. No one will come over uninvited now! True, but trust me, even those whose visits you'd like won't come over anymore - who wants to makes friends with someone who shoots first and asks questions later!

The ideal fence is somewhere in the middle. A fence that lets you have a chat with your neighbour, establish relationships, pass a cup of tea over. Maybe a picket fence, low enough to see each other, but not so low that people mistake your garden for a public park where they can take their dogs to do their unmentionable things...

You get the gist. Healthy boundaries follow the same principle. They need to protect you, but not to the extent of keeping other people out completely.

This is the idea of vulnerability: in order to connect to others, the fence can't be made from concrete and be so high that no one can see you. Connection does require taking the risk of wolves or elephants attacking your garden and your chickens, but honestly, how often do these come around in the suburbia we live in?

The odds are that most people we meet are not very dangerous and as long as we have clear boundaries, they will not take advantage of us. The trick is to be consistent in defending our boundaries when someone does try to climb the fence or knock it over.

Don't forget to build in a couple of gates too, so you can invite in the people you like - ask yourself, how do you allow people to come closer into your life?

The impact of isolation on mental health

Here we are, the world as we know it doesn't exist anymore - no more travel, no more restaurants, and no more school!

Hopefully this is all temporary of course, but as we have no real end date, and are still heavily encouraged to stay home and not socialise, our everyday life is heavily impacted.

Our children are missing their friends, our elderly parents are missing us.
People who live on their own and rely on their friends for company suddenly are alone.
Families and couples who live together and don't get along are unable to escape the tension.

It's pretty crap really.
So, apart from the obvious impact on our lifestyle, what else is going on?

Well, unfortunately there is a much more worrying impact on our collective and individual mental health.

Humans are herd animals - we are meant to live in groups or families, with regular social contact.
Social contact that has nothing to do with the social of social media, and everything to do with physical and emotional presence.

We need to "rub" against each other, for comfort.

A few serious mental health issues like depression and addiction can actually be dramatically improved through human connection - the presence of others that makes us feel that we matter.

So what can we do?

The answer is simple: reach out: call, text, zoom.

Smile to the stranger on the street.

Ask your checkout person at the supermarket how they are doing.

Get in touch, repeatedly if necessary, to those people you know who have gone silent - odds are they are struggling (suicide is up).

Give the people in your life an opportunity to talk. Remind them that things will get better and until they do, you're there to listen to them.

Speak up or call the police if you hear signs of domestic violence (yep, that's up too).

And if you struggle yourself, please reach out to others, give them an opportunity to be there for you.

Be the person who cares actively, not the one who just worries actively.
Bonus: it might actually make you feel better.

It's not about saving the world.
It's about making a difference, one person at a time.



Charlotte is a psychotherapist in Sydney working with clients on four continents thanks to the miracle of modern technology. Don't hesitate to get in touch with her via charlotte1010@gmail.com

How perfectionism is a sure way to fail

I've been wondering why it has become so difficult lately for me to write new articles for this blog.

I have plenty of ideas, subjects that I'd love to write about, yet something interferes with the actual writing. Partly it is procrastination of course, but I have been wondering if perfectionism isn't the main culprit...

You see, as much as I am an avid and enthusiastic reader, I find the opposite exercise of writing very difficult. I like my sentences to be polished, and my meaning ultra clear, and when I can't get that happening quickly I postpone it until later (more and more often later seems to become never).

In some ways, I convince myself that not writing ensures that I'm not writing badly - if I don't try, I can't be crap at it, right? Wrong!

This is what psychologists call a cognitive distortion, when our brain tells us something is rational when it isn't actually; because the reality is that if I don't try, I have 0% chance of succeeding, but when I do try, even not terribly well, I have at least some chances of succeeding.

That is one dark side of perfectionism: it paralyses us.

The other issue is that we try, and try, and try, and try (you get the gist) but cannot stop working on what we do, never being satisfied with where we get to, because perfection is not reached.

The dark side here is of course that very few things in this world are made to be perfect, so basically we are failing our own expectations all the time, where perfection isn't even possible.

Motherhood is an example I have written about previously (here and here), where our expectation of being perfect drives us into the ground, and we beat ourselves up because we "fail".

So we are left with a huge amount of effort that we put in, and results that never measure up.
Sounds exhausting? It is!

But hey, I'm not just here to talk about all the problems that exist, but to also suggest an idea that leads to different perspectives:

In the case of motherhood, and most other areas where we could put in infinite amounts of effort for an ever diminishing rate of return (work being the other big one that comes to mind), the answer might lie in the beautiful concept of aiming for "good enough" instead of perfect.

Good enough is exactly what it says, it's good, and it's enough. Yes, more could be done, but it is not necessary or even desirable (because of the inordinate amount of extra time that would take - and time is the one thing of which we have so very little).

Because the aim of life is not to produce near-perfect outcomes and kill ourselves in the process, but to do what needs to be done in a reasonable way and so to find time to live, to find joy, to connect with others, and to read more books!

What might perfectionism prevent you from doing?

Phone addiction: it is real and it is hurting our relationships

Odds you are reading this on your phone right now.

And as much as I am pleased that my writings find an audience, I am also scared by the pervasiveness of phones in our lives.

When exactly did we tip over the edge from talking to people on our phones to getting our entertainment from them?

When did phones stop being about connecting with others and more about disconnecting?

For most of us - and congratulations to those who are still resisting - our phone screen is the first thing we check in the morning and the last thing we look at in the evening.

I plead guilty too. My particular phone addiction is a game, that takes a few minutes to play and keeps my brain occupied enough not to think about whatever might give me anxiety. At least for those few minutes. Then I can either return to real life, or play another round. I may have wasted several hours in a row on more than one occasion...

It has all the hallmarks of addiction - it's used to avoid certain emotions, I do it more than I intend to, and it interferes with my relationships as my attention is not in the here and now.

The good news is that I am aware of it. The bad news that I still haven't quit cold turkey, by simply uninstalling that game.

In the grand scheme of things it could be much worse of course. But I'm not kidding myself - time spent on any app repeatedly and without any productive outcome is avoidant behaviour.

Who hasn't missed out on a story told by their kid because they were checking emails? Who hasn't had dinner and instead of conversing with the person at the same table has spent their time checking out Instagram or Facebook? Who hasn't watched porn instead of looking for intimacy with their partner?

The thing with the phone is that it is easier. You're less vulnerable than when engaging with real people, where there might be boredom, or worse, rejection when you interact with them.

The problem is that eventually we lose the capacity to hold long meandering conversations.
The ability to be there and listen without channel-flicking through the boring bits.
The bravery to truly engage with another person. 

And I'm only referring to adult use of phones, not children's - that is an even more frightening aspect, as children's brains are so much more malleable and hence prone to addiction, and need true social interactions in order to grow into healthy adults who can handle conversations but also rejection without falling apart.

So how can we kick the habit in order to put the phone back into its rightful place, as a tool of productivity rather than entertainment centre?

Cold turkey seems difficult in our world, we do need - or appreciate the convenience of - our phones. But quitting the apps that we idle on can be a start.

Actually looking at our consumption - how many hours a day - can be another step.

But probably the best way, is to start filling our life with real interactions again.

Meeting people for coffee. Talking on the phone rather than multi-tasking an online chat.

Spending time with our loved ones and giving them the gift of all our attention.

There will be less time left to spend on our phones.

And I'm guessing that we might feel better in our skin, in our family, in our community - and hence experiencing less anxiety of not being good enough, not beautiful enough or not popular enough.

I promise you this - if you call me, I will make time to meet with you face-to-face. In my office if you need my professional help, or for coffee if you want to catch up. And during that time, my phone will be switched off, and out of reach.

I look forward to my improved social (not social media!) life :)

Psychiatrist, psychotherapist, psychologist - who's what?

"So, what do you do?"

Most of the times when I answer "I'm a Psychotherapist" to that question, I get a puzzled look and the next question is "what is that?" or "what's the difference between what you do and a psychiatrist or a psychologist?".

So I thought I'd write a brief post to explain the differences.

Psychiatrists are medical doctors, who specialise in mental illnesses. Surprisingly, that covers a lot of conditions that the layman may not think of as mental illnesses, such as eating disorders, addictions, depression as well as the more classic ones such as schizophrenia, bipolar etc. Psychiatrists are the only mental health professionals who can prescribe drugs, and being doctors, this is often their first and sometimes their only port of call.

Psychology on the other hand is the study of the human mind in all of its applications, which is why you can find psychologists in professions as diverse as human Resources, marketing or advertising - they study how humans "tick". Clinical psychologists are not medical doctors, but have to do a specialisation which makes them part of the medical model, and hence some of their sessions can be covered by Medicare. Their main tool is cognitive behaviour therapy (CBT), which is about changing your thoughts and behaviours in order to change your feelings.

Psychotherapy by contrast is the study of the human mind in its therapeutic applications. It is a "helping profession" only. The tools at our disposal are very varied, you can find people working in psychodynamic, Gestalt or existential therapy, following Carl Rogers' Humanistic approach, Victor Frankl's idea of freedom to choose, Murray Bowen's Family systems theory, Sigmund Freud's Psychoanalysis or Carl Jung, and for some of us, the "eclectic" therapists, many of the above.

In my practice I rarely decide which modality I will use, it happens organically and I will often only realise later on that "oh, I've used CBT with this client today" or "I've worked existentially with that client". I like having a full tool-box, because the risk of only having a hammer is to be only able to see the whole world as a nail...

So while I can't prescribe you drugs, and won't give you advice or tell you how to think or what to do, what I can do is offer you is a safe space to confide yourself and help you work out your own personal way to heal yourself.

That is what I do.

Vicarious trauma - the hint is in the word "trauma"

Vicarious trauma in short is the trauma that you experience hearing or seeing someone else's trauma.
It shows up with similar symptoms to the original trauma (like PTSD for example).

How can it affect you if you're not the victim of the trauma itself?
I'm hoping the following might give you an answer to that.

We all have some idea of what trauma looks like: you get beaten up. You live in a war zone. You get raped. It happens to you.

But what about if you see as a child your mother being beaten up by your father? Though he's never laid a hand on you, odds are you witnessing it will leave you traumatised. It happens to someone close to you.

Or if you're a soldier, and you witness your mate being literally blown to pieces? Though you may be physically unscathed, you will experience trauma. It happens to someone close to you.

Vicarious trauma is once removed. It doesn't happen to you, you don't witness it - but it still affects you.
If you're a reporter, putting together a documentary on a genocide, you see it on a screen.

If you're a soldier, safe in your home country, whose job it is to deliver the news to parents that their sons have "died for their country", you see it in your mind's eye.

Can you see how being confronted with trauma, first hand or second hand, it then becomes only a short step to imagine what you'd feel like in the same situation, feeling the same fear?

Vicarious trauma is a "disease" of empathy - if you can see other people's pain, and if you care about those people, odds are that you will feel that pain yourself.

In my work as a psychotherapist I am sometimes confronted with stories of unimaginable suffering. They happen in the present or the past of people I care deeply about.
I can never forget them.

If I want to continue working and not to start despairing of the human condition, the worst of which I sometimes hear, I have to find a way to both acknowledge the horrors I hear, and not live them in my mind.

I have to accept that the trauma I hear about can become the trauma I feel, and seek help for it.

In order to do so, I go and see my own therapist. He helps me to find ways to give meaning to the pain I witness, and to take care of my vicarious symptoms of trauma.

The gift we give those whose pain we witness is that they are no longer alone.

What you focus on is what you will see.

No, this is not a "state the obvious" blog post - it's not about seeing what you look at.
It is about how our focus includes and excludes things from our field of vision.

In normal life, it looks like this:
My children love to spot and count yellow cars in traffic (anything really to compete with each other, but that is a blog post for another day). Though I don't participate in their game, I now notice yellow cars even when they are not with me in the car! The focus has created an awareness has created a "standing out" of yellow cars.

Let's get a little bit closer to my field of work:
Women wanting to conceive but having difficulties with it have an increased focus on and thus awareness for pregnant women and babies. They will literally "see babies everywhere" - yet the amount of babies hasn't changed of course, but they are taking a much increased notice of them.

Basically our brain filters in and out information. Things it thinks we need to see (or hear, smell etc) or which it thinks are not relevant to us. In that way, our sense of smell will stop smelling something once we got used to it (putting it in the background if you want) to ensure we don't miss any new smells (this used to be key to the survival of our species).

Our brain even goes a little bit further though in this - and that can be good or bad: our focus will also determine how we process the information we are given.

If I assume that life is dangerous, I will focus on preventing danger, and hence see it everywhere.
If I assume life is fun, I will see opportunities for fun.
Same life, same facts, different perspectives.

I was raised by a pessimistic perfectionist (my father) and have taken on some of his traits. It is easier for me to see flaws than to see the rest (i.e. I see the pimple and not the face). This is a well-ensconced focus in my life, but that I have to battle against if I don't want to sink into doom and gloom.

And this is where the interesting bit comes in - how can we change our focus, when it is usually something that is very much part of us? I can't become an optimist just by wanting it (trust me, I've tried).

I found that what works the best is to imagine the opposite. Instead of focusing just on doom and gloom, I visualise what I actually would like to see.  I imagine - yes, preferably in images, not just words - what a good outcome would be like.

It works in at least two ways:
First, I spend less time in doom and gloom, which helps.
Second, by imagining good outcomes I can often see ways to achieve those, and get started on actually making them happen.

It's the whole difference between just trying to ward off bad stuff and actively seeking out good stuff.

Just take a minute to think:
What is your focus directed on?
How do you influence your perception of reality?

Why depression is a mental illness

Surely you have also wondered how depression is a mental illness when pretty much everyone sometimes suffers from feeling down or depressed, without necessarily having a mental illness?

When sufferers or mental health professionals talk about depression, we mean clinical depression - not temporary feelings of being down or of unhappiness.

So what differentiates these from those? What - other than length of time - makes depression a true mental illness?

In my experience, clinical depression comes with a side-serve of cognitive distortion, which means thinking thoughts that just don't correspond to reality.

This is all very theoretical so far, so let me give you an example:

A person suffering from clinical depression might "think" it perfectly rational to commit suicide, as they cannot imagine a way out of how they're feeling. Yet for most sufferers of depression, the illness has both a beginning and an end, and things do get better.

Worse, a person in the depth of depression might think that it would place a terrible burden on their children to have a parent who suicides, and so think of killing his/her children too, to "spare" them.

Now, would you think that any person "in their right mind", i.e. not suffering from a mental illness, would think along those lines?

The difference between being depressed and having clinical depression is about whether we can still see our reality clearly, or whether our mind distorts them into something that a "normal" (i.e. non-ill) person would not recognise as reality.

And that is the terrifying "reality" for sufferers of depression - viewing life through a dark grey filter created by their own brains.

Well-meaning advice about getting more exercise or "looking at the bright side" just won't be helpful; they will sound to a person with depression roughly the same as "grow a third arm" - completely impossible.

Instead, try sitting with them, holding their hand, literally or metaphorically, so that at least one cognitive distortion, the one that tells them that they're all alone in this world, is proved to be wrong.

The notion of "enthusiastic consent"

In the wake of the #metoo movement, light has been thrown on different definitions of rape - clearly the legal fraternity has a different one to the sisterhood of #metoo...

Some very clever metaphors have been used to try and get across the idea of what consent looks like, and my personal favourite is this video illustrating how in the same way you wouldn't force a person to drink the tea they may have asked for, you shouldn't force sex on someone if they don't want it anymore, even if they did ask for it earlier.

Consent is such an apparently difficult idea because until now, absence of refusal was taken as meaning consent - i.e. if you don't say no, you're really saying yes. In no other area of law does this hold up: if I say "buy this car" and you don't say "no", you still don't have to buy the car - you have to expressly say "yes" in order for a contract to come about.

Somehow though, for a very long time (and without getting into feminist conspiracy theory, I'd guess that laws were mainly made by men, and rape victims were mainly women) it was considered that if you were not saying "no" - you were de facto consenting to sex.

The lawmakers eventually added that you had to be in a state fit to give consent (yes, that had to be added!!) - so no consent was possible if you were say asleep, passed out, or highly intoxicated. Some progress I guess.

It leaves the problem that, when confronted with danger, there are three possible responses dictated by our brains: fight (yes, usually the message gets through that it's not consent), flight (ditto) and freeze. Now, freeze could look to the untrained eye of a horny male like "she's lying there, not fighting back, not saying no, so she's ok with what I'm doing". He would quite possibly be wrong - she could just have gone into a frozen state.

Here comes in the notion of enthusiastic consent. The idea is that, in order to be sure that sex is consensual, both parties participate enthusiastically. You can tell when enthusiasm is present, be it verbal or non-verbal. How easy is it to just stop what you're doing unless the other one is clearly as much into it as you are!

I like to bring up the idea of enthusiastic consent in other areas than sex. It is a good yard stick on what is happening in other types of relationships as well.

For example, if you're suggesting to get married, and you get anything less than an enthusiastic response (after the potential shock), then maybe it's not such a good idea.
Or if you're suggesting a change to an employee or a boss, and you get a lukewarm "maybe" - assume the other one is not on board with the change.

Enthusiastic consent allows to remove any doubt on what is going on, any misunderstanding - which I think is the best outcome for everyone involved; and where sex is concerned, it will actually be something enjoyable *for both parties* which I will make the bold assumption is the idea for most of us in the first place!

The two main conditions for successful therapy

Have you ever wondered what helps make therapy successful?
Which are the main tools, the modalities, the therapist training that mean you will get the best results?

The answer will possibly surprise you. When research was done into classifying the factors contributing to a successful outcome of psychotherapy, the two by far most important factors were actually unrelated to school of thoughts, modalities or training!

The first predictor of therapeutic outcomes is about you, the client: it is your desire to change. It is the realisation that if you want to improve your life, you are responsible to make it happen. Mostly that translates into three options: change your circumstances, leave your circumstances or find a way to make peace with them.

Once you accept that you are responsible for your life, and no-one else, your therapy can become about how to change.

The second most important factor is the relationship you develop with the therapist. Yes, getting on well (which does not mean being unchallenged!) with your therapist, trusting him or her, having a close relationship is the second biggest healing factor.

Only then, way further down, come in factors like training, modalities etc.

So basically, once you're ready for change, seek a therapist who you can relate to, whom your gut feeling endorses and you feel comfortable with, who will still challenge you where appropriate, yet not judge you, and your therapy will be most likely to succeed.

To me, the therapeutic relationship is one of the most intimate relationships there is.
To be trusted with someone's innermost thoughts and feelings is the most sacred bond I know.
And it fills me with joy to be able to repay this trust by being there for my clients, not only reliably, but wholeheartedly.