I hope anyone reading this has had or is still having a good holiday...still got New Year's Eve to look forward to, although I'm looking forward to some more personal celebrations as lots of my friends have birthdays in Jan and Feb.

Anyway, back to matters therapeutic. I recently read about some research that I'd like to share about what clients say were the most important factors in their therapy. First cab off the rank was having a relationship with a wise, warm and competent professional. I've harped on about the importance of the relationship before, so I won't belabour the point again too much here!

The second theme identified was having a relationship with continuity, safety and hope when feeling inner discontinuity. One participant of this study, who had been hospitalised for long periods as a child, described periods in her therapy where the most important thing was not what the therapist did or said but that she was there. This point seems to me to also be about the importance of the relationship between client and therapist...again. Apparently I am labouring the point.

However, this theme does reflect the fact that most of the participants had been in long term therapy (not just my opinion, it's explicitly stated in the study), and that's something I ask people to consider when they ask me about what sort of therapy they should be looking into, or what might be right for them. I work in a number of different settings, one short term, offering clients 6 sessions and in most cases it brings a lot of stuff up to the surface and before you know it, the 6 sessions are up...no continuity and no safety. Creating continuity and safety takes time, it takes those moments when you test your therapist to see if you can still trust him/her, bit by bit. It's no wonder that people can leave therapy thinking it wasn't helpful at all.

The third theme identified in this study was having beliefs about oneself and one's world view corrected. This aspect forms a core part of most "brands" of therapy but usually if you're a client looking for a therapist what you're really concerned about is that someone can help you with what's bothering you right now. How your beliefs about yourself and your worldview are corrected will depend on the orientation of your therapist but something really simple I often attend is the language clients use - always, never, should, ought, but, because and so on. The first four are judgments ("I always do x, y and z" to which I usually respond "Really? Always?) and the latter change the direction of a sentence. Most of all, I'm interested when clients talk about themselves in general terms, they start describing what's going on for them using "you", for example; "when you're in this type of situation you can't help but feel angry". This sentence makes it sound like it's true for everyone...which it likely isn't so I encourage clients to say I instead of you. Small things like this can help clients challenge their world views in small but impactful ways...you can even try it out on yourself, just by paying attention to the language you use.

The final theme the study identified was the creation of new meaning and seeing new connections in life patterns. This is very true of the way I work with clients. We spend a lot of time together trying to identify what is most important to the client, what they most value in life, what they want their life to be about. Once we've defined some of those points, it's often the case that the client realises that she has been living in ways that fundamentally contradict what is most valued to them.

For example, a client might have been brought up believing that being a doctor or a lawyer is important, goes to university, law school, magic circle law firm and then discovers that he hates it there. He's become a lawyer for his parents, not for himself. In being encouraged to find new meaning, his own meaning and not anyone elses' (for only your own will do), he realises that what he values most is making the most of his creativity. Lawyers get a bad rap...we could reverse this situation...our hypothetical client could have been brought up by very creative parents who valued creativity, our client might actually want to pursue a career that's much more structured than the life of the artist. The point is once you've been encouraged to question some of the meanings you've ascribed to your life, you can chuck them out or own them for yourself and once you've done that, you can make decisions that you're at the heart of.

In the interest of proper crediting, the article I've talked about was published in Counselling and Psychotherapy Research, December 2009 by PE Binder et al.

I don't believe in the unconscious. How's that for controversial, me being a therapist and all.

Let's recap - Freud gave us the idea/concept of the unconscious. He regarded it as a vast, submerged portion of the mind. In his mind, the unconcious comprised of the id, which accounts for the instinctual drives, acts as the motivating force for human behaviour and contains desires and wishes that the individual hides - or represses - from conscious recognition.

Let's pause there, because that part really doesn't make sense to me...how can you, at one stage in your life, know something consciously but then somehow move it or refile it to a place where you no longer know it or have access to it?

To Freud, cognitive conscious functions like thinking are performed by the ego (and a bit of superego, but most of the superego is in the unconscious bit...come on, keep up!). Conflict between conscious and uncscious processes are said to give rise to anxiety.

Pause again...eh? I mean...what? I'm mentally battling something I consciously know with something I unconsciously don't know and don't have access to but clearly some aspect of me does because otherwise I wouldn't be feeling anxious...have I got that right? Is it just me, or does all none of this make sense?

The unconscious mind can't be proved to exist. Freud's notion of it, anyway. I'm certainly not denying that the brain regularly gets on with loads of unconscious processing, you'd be mad to do that! However, the idea that it's a large resevoir of potentially harmful memories that impact our conscious behaviour even though we're unaware of them seems a bit far fetched to me.

Check out this link for a great look at how advances in neuroscience have given us a much better handle on how memory works, perception etc.

Short answer...no. I read this at the weekend. Seriously...has the world gone mad? Angels can assist with everything from getting a date, losing weight and even finding a parking spot. I'm slack jawed in horror. Aside from the fact the existence of angels is (currently, at least...let's remain skeptical about these things) impossible to prove with any degree of reliability, what is dangerous about believing in ideas like this is that it encourages you to stop taking responsibility for your life.

Apparently I'm all about relationships at the moment...! I've spotted another interesting article which highlights how to argue better with you significant other. Apparently, couples who use anaylitical language when they argue fair better, so that means using words like "think", "understand", "because" or "reason". Well to be precise the article says that men fair better, women don't. The article is based on research that links language use and stress responses, a fascinating area of research that I'd like to take the time to learn more about, the language we use to talk about, well everything, always piques my interest.

You can read the article here.

If you're interested in learning better conflict resolution skills, I can recommend starting with Michael Rosenberg and the non-violent communication techniques he's developed. The principle is SO simple, it's easy to pick up (although, obviously its the practicing it that takes work!).

I got through the first "week" of In Treatment last night...great show, it gives as real an insight in what being in therapy is like as I've seen on the big or small screen ever. I must say, I don't currently work with couples and the session where the therapist is working with a couple who can't decide whether or not to keep their baby put me off ever wanting to! Claustrophobic is a word that sprang to mind when I cringed my way through that episode.

And speaking of couples counselling, I spotted this in the weekend papers...The whole IAPT (Improving Access to Psychological Therapies) programme jars somewhat with me. A one-size fits all approach ie: CBT for everyone doesn't sit well with me and I'm also astonished at the amount of money going into this in terms of training when there are loads of underused therapists out there with sufficient and necessary training already...why not just recruit them???

Lots of people start counselling thinking they're going to be advised on what to do, what not to do, what do more of...less of etc.

Therapists and counsellors can help in lots of ways but the one thing we always stop short of is giving advice to clients. Why...? Well, let's think about a scenario familiar to most of us. You're chatting to a friend about a pressing issue, you really want to get it all off your chest, you've just got going, you're just beginning to open up and your friend cuts in and starts saying "EXACTLY the same thing happened to me! What you need to do is this..." Therapists don't do this, doing this makes you, the client/person who wants and needs to talk, feel unheard, diminished and silenced.

Therapists are usually operating on the assumption that they DON'T know what it's like to be you. Even if we've known you for a while, we're always checking our assumptions at the door and we're ready, willing and eager to learn something new about our clients. So if therapists are operating on the assumption that we don't know what it's like to be you (but we're always trying to find out!), how could we be so arrogant as to assume we know what advise would work for you? Therapy is also a place to feel heard, as with the friend example above, is therapists were to dish out advise and send you packing, I'm willing to bet you wouldn't feel listened to. You might feel like a project being worked, but you wouldn't feel heard.

So, if you want my advise...don't go into therapy expecting advise.

Back from a holiday, that is and will be posting up more soon. Lots happened while I was away, most shocking for me to learn about on my return was the shooting on an army base in Texas by a military shrink. I'm still trying to get up to speed on the story.

I found this website today. It's very funny. Check it out.

The current debate about socialized health care in America is currently raging and while I’d implore all Americans to get behind it, it’s made me aware of a specific difference between healthcare provision there and here. The vast majority of Britain’s have absolutely no personal choice when comes to deciding who they see regarding their health care, be it physical or mental. So if you come for therapy on the NHS, you get who you get. But if you decide to go privately, you can and should shop around (remember, a lot of therapists have slots for low fee paying clients, do ask about this).

Let’s think about this in terms of the numbers – by far the most influential decider as to whether or not you’ll find therapy helpful is down to you. Do you want to go? Are you committed to change? Are you there because it’s what you want or is someone forcing you to go? A whopping 40% of a successful encounter with a therapist is down to you, the client, and is completely beyond the ability of the therapist to influence. It doesn’t matter how many brilliant, sparkling observations I make or how oozingly empathic I am, all of that will count for nothing if you profoundly don’t want to be there.

The second most important factor in a successful block of therapy (block? There has to be a better noun than that…!? Anyway) is down to the relationship that develops between you and the therapist. My first ever therapist, Dr Sara Dryburgh puts it this way : “Therapy is fundamentally about a relationship with the therapist. Qualifications, training, theoretical knowledge and mastery of specific techniques are of course essential, but not sufficient in themselves. The essential thing which makes therapy effective is the quality of the relationship that you form with the therapist”.

If you don’t like your therapist, look for another one. End of story. I can’t stress enough how important this is, imagine opening up and revealing the most secret things about yourself, remember how you felt the last time you had a good cry, think about coming face to face with the things that really matter to you. Now think about doing all of that in front of someone you don’t really like. See what I mean? So shop around, be fussy, think about whether or not you’d like to see a male or female therapist, even if all you can afford to pay is £10 per week, therapy is a major commitment in terms of time and emotional energy. You owe it to yourself to pick someone who you feel can accompany you on that adventure.

Guilt. Like sitting in a rocking chair, it gives you something to do, but it doesn't get you anywhere.

Actually, I've altered that quote from the original which is "anxiety is like a rocking chair, it gives you something to do but it doesn't get you anywhere" and it's from a very silly movie called Van Wilder: Party Liaison. In fact I agree with both, and I am clearly over-simplifying the issue but for me guilt is such a wasted emotion.

For starters, guilt often isn't a surprise emotion that sneaks up on you, I've found you usually have some awareness of the things that make you feel guilty. Which begs the question...why are you still doing/not doing whatever it is that makes you feel guilty?

Feeling guilty about something is often preceeded by one these two words - should or ought. "I should tidy up", "I ought to call my mum" followed by "but I can't be bothered" which leads to "now I feel guilty".

Should and ought (let's call them ought-isms) imply you don't have choice in the matter, when of course, you always have a choice. So don't tidy up and don't call your mum but make a firm choice in the matter and get rid of that guilty feeling.

That's not to say that you have free reign to neglect your responsibilities to others...flatmates/boyfriends/girlfriends/partners get annoyed if you don't tidy up and mum's like to hear from their kids, so acknowledge you need to do those things and make a promise to do them when it suits you better. How about this statement - "I need to call my mum, but right now I'm tired and grumpy and I know I'll end up bickering with her. I will call her tomorrow after a good night's sleep".

As a follow up to my post about boundaries, I spotted this today. Useful-ish advise, although I personally don't find that many of these tips particularly empowering. Actually learning to say "no" in an assertive way is an important part of setting and maintaining boundaries.

Ignoring people, smiling and nodding, literally not being there isn't actually saying no. How about experimenting with saying no on some smaller things, see who you go and then once you realise the consequences aren't as bad as you thought they were, you'll have a bit more courage to start saying no on some bigger things. Trying "no...but" can also work well. A friend asks "are you free for a drink this evening" during a crazy week where you've been non-stop and really a night to yourself, try saying "no, not tonight but how about next Tuesday". It can help with that most pointless of feelings - guilt. But more on that one later!

Healthy boundaries. What does that mean? Well first let’s take a look at what unhealthy boundaries are and how people violate them

• Trusting no one - trusting anyone - black and white thinking
• Telling all
• Talking at intimate level on first meeting
• Falling in love with a new acquaintance
• Falling in love with anyone who reaches out
• Being overwhelmed by a person - preoccupied
• Acting on first sexual impulse
• Being sexual for partner, not self
• Going against personal values or rights to please others
• Not noticing when someone else displays inappropriate boundaries
• Not noticing when someone invades your boundaries
• Accepting food, gifts, touch, sex that you don't want or aren’t comfortable with
• Touching a person without asking
• Taking as much as you can get for the sake of getting
• Giving as much as you can give for the sake of giving
• Allowing someone to take as much as they can from you
• Letting others direct your life
• Letting others describe your reality
• Letting others define you
• Believing others can anticipate your needs
• Expecting others to fill your needs automatically
• Falling apart so someone will take care of you
• Self abuse
• Sexual and physical abuse
• Food abuse

It seems to me that our society doesn't really support healthy boundaries. This is reflected particularly in popular culture, here are a few examples:

*Saying "no" might hurt someone's feelings (so you need to take care of their needs rather than your own)
*TV and Film don't model healthy boundaries – unhealthy boundaries seem to make for better plot lines…Grey’s Anatomy anyone?
*People who have firm (not rigid) boundaries are often tagged as mean, bitchy or needy - particularly women.
*Sexuality is often portrayed as a manipulative tool to get what you want as opposed to a loving expression between two adults

Healthy boundaries are about knowing where you end and the other persons begins and respecting that. It also means assertive communication. It isn’t needy to ask to have your need met in a clear, straightforward way. Everyone has needs, that doesn’t make you needy. What makes you needy is how you communicate. Hinting at what you’d like and then sulking when you don’t get it is not a way to assertively communicate your boundaries!

Last week I got the chance to be part of a focus group looking at the effects that cold sores have on sufferers. I was there to provide a mental health angle on the discussions and something that came up in all three of the groups that were sharing their experiences on cold sores was that what immediately preceeded the outbreak was a period of intense stress. Some group members said they knew the cold sores where a sign that they need to slow down, take a break and start making a real effort to look after themselves.

That got me thinking about the clues our bodies give us that we need to slow down. I don't know about you, but I frequently ignore the signs my body is giving me that I need to chill out and I've come across both friends and clients for whom the same is true. At some point, our bodies will just hit the over-ride button, as if to say "you're not in control of this operation any more and we're shutting it down!". Cue a bout of flu that has you bed ridden for a week or worse, a trip to the hospital.

We aren't floating heads that happen to have a life support system underneath us. Our heads (by that I mean our inner world of day dreams, big ideas, everyday worries, major stresses etc) and our bodies are connected, they work symbiotically. We do need to tune in to what our bodies are telling us and then take action, largely because our bodies can't do two things at once. I'm referring to the sympathetic and the parasympathetic nervous systems in our bodies. The former controls things that need to happen quickly - the fight or flight/stress response and the latter, things that take more time - digestion all the way through to sexual activity. Our bodies can't power both systems to run at full capacity at the same time.

So, if you're stressed a lot of the time, your body simply doesn't have the spare power to do things like fight off infections, digest meals properly, support active sex life...see where I'm going with this? Listen to your body, do what it's telling you. It evolved that way!

Where is it? I'm sure the more astute among you will have already guessed it's a northern hemisphere country, and it's Greenland according to this article here.

It's the world's largest island but the least populated. Very sadly, those most at risk are teenagers and young people, opportunties for the future of Greenland's youngsters seem limited and perhaps that leads them to think that their only way out is to take their own lives. Something about that sounds familiar to me...rising unemployment, fewer jobs, a huge number of recent graduates with no jobs to progress into...that's all happening here in the UK. This is seems to be high on the politicians' agendas at the moment, but in the short term I think there's a lot that could be done to bolster our teenagers' and young peoples' self esteem and sense of self worth.

First up, a confession...my Sunday morning guilty pleasure is slumping on the sofa with a copy of the Style section of the Sunday Times. I flip through ooohhhing and aaahhhhing at the nice clothes and then I start to race toward Sally Brampton's Agony Aunt column. I think she gives great advice. This past weekend she wrote a great piece about finding a therapist, something that's a major bugbear of mine which I'll be posting about regularly. You find the piece here:
http://www.timesonline.co.uk/tol/life_and_style/health/mental_health/article6863131.ece