Symptomatic and Relationship Counselling

SYMPTOMATIC AND RELATIONSHIP COUNSELLING

Depression
Loneliness

Responsibility (Locus of control)
Self-sabotage
Anger management
Assertiveness
Self-confidence, self-esteem and self-efficacy

Depression:

Depression is caused by a combination of genetic, biological, psychological, social and environmental factors. It isn't a sign of weakness. It's not something you can just "snap out of”. Sometimes it helps to gain expert advise in what you need to do to rise up out of the symptoms of living with depression.

The three main therapies Marcus uses for depression are:

Cognitive Behavioral Therapy (CBT): This is a type of therapy in which patients learn to identify and manage negative thought and behavior patterns that can contribute to their depression. CBT helps patients identify unhelpful or negative thinking, change inaccurate beliefs, change behaviours that might make depression worse and learn how to interact with others in more positive ways.
Interpersonal Therapy (IPT): This is a form of therapy in which patients learn to improve their relationships with others by better expressing their emotions and solving problems in healthier ways. IPT helps patients resolve or adapt to troubling life events, build social skills and organize their relationships to increase support for coping with depressive symptoms and life stressors.
Mindfulness-based cognitive therapy (MBCT): Although MBCT is generally delivered in groups, Marcus uses this technique in a one-to-one basis and involves a type of meditation called 'mindfulness meditation'. This teaches you to focus on the present moment, just noticing whatever you’re experiencing, whether it's pleasant or unpleasant, without trying to change it. At first, this approach is used to focus on physical sensations (like breathing), but then moves on to feelings and thoughts. MBCT can help to stop your mind wandering off into thoughts about the future or the past and avoid unpleasant thoughts and feelings. This is thought to be helpful in preventing depression from returning because it encourages you to notice feelings of sadness and negative thinking patterns early on, before they become fixed. As a result, you’re able to deal with the warning signs (tiredness, tearfulness, increased alcohol/drug use for example) earlier and more effectively.

Inner Voice Therapy: This can help you to combat the “critical inner voice” that underlies depression, another cognitive-behavioral approach. This ‘voice’ represents a vicious anti-self that can be formed out of negative early life experiences. The anti-self can fuel depression, leading people to experience a cycle of self-criticism and a feeling of worthlessness. In this therapy, you are encouraged to critically analyse your own inner voice by actively having conversations with your inner voice. When you ‘answer back’, you learn to be critical of the inner voice, encouraging positive responses and discouraging negative thought patterns and behaviours.

In dealing with depression, it is also important for you to uncover any anger that could be underlying your depressed feelings. Anger can lead to depression when, in attempting to suppress it, you turn it on yourself. Even though you may feel uncomfortable at first, you should be encouraged to acknowledge, explore and express your anger in a healthy environment, such as in therapy. People have to tolerate their angry feelings; if they don’t allow themselves to feel their anger, they run the risk of turning these emotions on themselves, a process that strengthens their critical inner voice and exacerbates their depression.

Loneliness:

Loneliness is controlled by the brain. Social isolation affects the activation of the dopamine and serotonin neurons, which are key to our emotional well-being. Dopamine neurons in the brain region called the dorsal raphe nucleus are activated in response to acute social isolation and triggers the motivation to search for and re-engage in social interactions. It is a biological mechanism that pushes people to find the social interaction that they lack and need. The brain will push the lonely individual to find someone to interact with, because we are social beings. We need company because our prehistoric ancestors desperately required company in order to survive; the presence of other human beings ensured protection and support, both for themselves and for their offspring. Our brains still think we need to be surrounded by others to survive and thrive. A chronic state of social isolation is linked to depression, anxiety, and PTSD (Post-Traumatic Stress Disorder).

The alternative to viewing loneliness and the fear of being alone as a defect or as an unalterable personality characteristic is to recognize that loneliness is something that can be changed. Loneliness and the fear of being alone are common experiences. Loneliness is neither a permanent state nor ‘bad’ in itself. Instead it should be viewed more accurately as a signal or indicator of important needs that are not being met.

The main therapy I use for loneliness is CBT, reality therapy and behavioural therapy. Relaxation and stress relief techniques are frequently an accompaniment to other therapeutic approaches. Relaxation techniques may include things like specific ways of breathing, or muscle relaxation training. Associating these relaxation techniques with being alone can help you deal with, and overcome, feelings of loneliness, depression and anxiety.

Yet again, whenever you're not willing to feel an emotion, your choices and behaviours stem from your avoidance of that emotion. I ‘dial’ into where the feeling of loneliness exist in the body and apply the juxtaposition process (hyperlink).

Responsibility (Locus of Control):

An internal locus of control is about responsibility. Early on in life, complex interplays of intersectional factors such as family, culture, gender, socioeconomic status, experience of poverty or violence influence childhood development of whether locus of control is self-perceived as internal or external.

The natural process of cultivating an internal locus of control back from an external locus of control begins happening when past trauma is released from the memory cells of the body after successful therapy, which has the effect of completing the trauma. If the trauma is unable to be completed, the memory of it remains in the body. As the energy is released, the brain reorganises that completion process. Yet again, whenever you're not willing to feel an emotion, your choices and behaviours stem from your avoidance of that emotion. By taking responsibility for everything that happens in your life, good or bad, helps you to shift your perspective from a victim mentality to a more proactive one.

Key points of an internal locus of control:

Becoming aware that you do have a choice,
Review your options,

Choosing what is best for you,
Remember your choices.

Self-Sabotage:

Behavior is said to be self-sabotaging when it creates problems and interferes with long-standing goals. The most common self-sabotaging behaviors are:

Procrastination,
Self-medication with drugs or alcohol,
Comfort eating,
Forms of self-injury (such as cutting),

exhibiting extreme modesty.

Procrastination is the most common behaviour within the self-sabotage category. It is the gap between intention and action and it is within this gap the self operates. The undermining behavior lies in not closing the gap. We make an intention to act, and when the time comes, instead of acting, we get lost in our own deliberation, making excuses to justify an unnecessary and potentially harmful delay. Who makes this decision? We do. The self, in fact, sabotages its own intention.

Self-sabotage is not an act. It's a complex process that pits people against their own thoughts and impulses. Though we all make mistakes, a true self-saboteur continues to try to fix those mistakes by top-loading them with increasingly bad decisions. Yet again, whenever we’re not willing to feel an emotion, our choices and behaviours stem from our avoidance of that emotion.

The main treatment I use for self-sabotage is Dialectical (balancing opposites) Behavior Therapy (DBT). It provides you with new skills to manage painful emotions and decrease conflict in relationships. DBT specifically focuses on providing therapeutic skills in four key areas:

First, mindfulness focuses on improving your ability to accept and be present in the current moment,

Second, distress tolerance is geared toward increasing your tolerance of negative emotion, rather than trying to escape from it,
Third, emotion regulation covers strategies to manage and change intense emotions that are causing problems in your life,
Fourth, interpersonal effectiveness consists of techniques that allow you to communicate with others in a way that is assertive, maintains self-respect, and strengthens relationships.

DBT is influenced by the philosophical perspective of dialectics: balancing opposites. I work with you to find ways to hold two seemingly opposite perspectives at once, promoting balance and avoiding black and white. DBT promotes a both-and rather than an either-or outlook. The dialectic at the heart of DBT is acceptance and change.

Anger Management:

Whenever you're not willing to feel an emotion, your choices and behaviours stem from your avoidance of that emotion. Like other emotions, anger is experienced in our bodies as well as in our minds. There is a complex series of physiological (body) events that occurs as we become angry.

The emotional response of the anger that we display bypasses the area of the brain (cortex) that regulates our behaviour before the action is taken. This means that learning to manage anger properly is a skill that has to be learned, instead of something we are born knowing how to do instinctually.
Your body's muscles tense up

Inside your brain, neurotransmitter chemicals are released causing you to experience a burst of energy lasting up to several minutes
Your heart rate accelerates, your blood pressure rises, and your rate of breathing increases.
Your attention narrows and becomes locked onto the target of your anger and you pay attention to nothing else.
In quick succession, additional brain neurotransmitters and hormones (adrenaline and noradrenaline) are released which trigger a lasting state of arousal and you are now ready to fight.

The main treatment I use for anger is CBT. You learn to identify unhelpful or negative thought patterns and change inaccurate beliefs. One CBT-based anger treatment is known as Stress Inoculation. This method involves exposing you to imaginary incidents that would provoke anger, providing opportunities to self-monitor your anger and practice coping methods. This is my preferred therapy for anger management counselling.

Controlling anger involves learning ways to help your prefrontal cortex get the upper hand over your amygdala, so that you have control over how you react to anger feelings. Anger has a physiological preparation phase during which our resources are mobilized for a fight, it also has a wind-down phase. We start to relax back towards our resting state when the target of our anger is no longer accessible or is an immediate threat. It is difficult to relax from an angry state, however, the adrenaline-caused arousal that occurs during anger lasts a very long time (many hours, sometimes days) and lowers our anger threshold, making it easier for us to get angry again later on. Though we do calm down, it takes a very long time for us to return to our resting state. During this slow cool-down period we are more likely to get very angry in response to minor irritations that normally would not bother us.

There is an optimum level of arousal that benefits memory and when arousal exceeds that optimum level, it makes it more difficult for new memories to be formed. High levels of arousal (such as are present when we are angry) significantly decrease your ability to concentrate. This is why it is difficult to remember details of really explosive arguments.

Assertiveness:

Passive behaviour usually means putting up with a situation in which you feel uncomfortable, rather than being honest about what you really think or feel. It involves being apologetic about your own views and putting yourself down rather than expressing them positively. Being assertive is usually defined as standing up for your own rights without dismissing the rights of others. It means being honest with yourself and others, putting forward your own views and stating clearly and honestly what you want, think and feel. It means being self-confident and positive but not dogmatic. Behaving assertively means being firm in expressing an opinion, but understanding the other person’s point of view and being prepared to reach a workable compromise. Aggressive behaviour means asserting your rights regardless of the rights and feelings of anyone else (getting your way at others’ expense). Aggressive behaviour has control at its heart.

Assertiveness is based on the principle that we all have a right to express our thoughts, feelings and needs to others, as long as we do so in a respectful way. When we don't feel like we can express ourselves openly, we may become depressed, anxious, or angry and our sense of self-worth may suffer. Our relationships with other people are also likely to suffer because we may become resentful when they don't read our minds for what we are not assertive enough to be telling them.

Assertive training:

Helps you learn how to judge when it is reasonable and appropriate to stand your ground, rather than giving in to others.
Is based on the idea that assertiveness is not inborn but is a learned behavior.
Can be an effective treatment for certain conditions, such as depression, social anxiety, and problems resulting from unexpressed anger.

Can also be useful for those who wish to improve their interpersonal skills and sense of self-respect.
Helps you learn how to judge when it is reasonable and appropriate to stand your ground, rather than giving in to others.

Self-confidence, self-esteem and self-efficacy:

The frontal lobes of the brain are the area associated with self-esteem. The neural pathways in this area mediate motor, cognitive and behavioural functions within the brain. Self-esteem changes are guided not only by whether other people like you, but is also dependent on whether you expect to be liked. Those who suffer from low self-esteem can have underlying mental health issues.

The subconscious mind absorbs messages and conclusions from a very young age. It is not set up to rationalise what it records, but simply takes in the information and records it like a tape recorder. To increase positive self-confidence, the key to retraining the brain is through affirmations. Repetitive, positive statements, spoken as truth, eventually will replace conflicting messages.

The area of the brain where self-esteem exists is also the same area of the brain used in solving problems associated with self-esteem and self-confidence. This is where I apply the juxtaposition experience (hyperlink). The stronger and more active this area becomes, the more self-esteem someone has. This area of neuroscience has the potential to change the way we understand self-esteem, not as a solution for all problems, but as a physical indicator of risk for psychological disorders.

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