“A relationship is like a shark. You know it has
to constantly move forward or it dies”

Woody Allen and Marshall Brickman, screenplay for Annie Hall 1977

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Individual (One-to-One) Counselling and Therapy, Alsager, Cheshire

I offer one-to-one counselling and psychotherapy sessions for adults and young people, working through issues in a confidential, nurturing environment. Sessions last 50 minutes and I usually see clients once or twice a week for a given period. I am based in Cheshire, working from Alsager (East Cheshire, Junction 16 of the M6), although my client base geographically includes North Staffordshire, the Peak District and beyond.

To date I have helped individual clients in both short- and long-term therapy, dealing with issues ranging from anxiety and panic attacks through chronic eating disorders, phobias and relationship problems to bereavement, post-traumatic stress disorder and abuse.

My therapeutic approach is integrative, which means that I borrow freely from various schools of thought to use the techniques that will work best for each client. These include psychodynamic and transpersonal therapy and CBT (cognitive behavioural therapy) as well as less mainstream creative techniques including bibliotherapy and eco-therapy in cases where they can be helpful for the client. I have also trained in animal-assisted therapy (AAT) which can be very effective in some instances.

For more information about individual therapy or to make an appointment, please contact me at jcsmith@therapy-cheshire.co.uk or call me on 07811 981645.

 

 

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Very good facilitation – encouraging and warm.

In Defence of ‘Conscious Uncoupling’

Gwyneth Paltrow and Chris Martin have been subjected to all sorts of abuse from ‘media commentators’ today in the wake of their announcement that they are “consciously uncoupling”. But in the difficult process of calling a day on their 10-year marriage, they’re wise to seek a therapeutic way of exiting the relationship.

Let’s first think about the idea of ‘coupling’. Two people meet, they fall in love (in theory) and they decide to stay together and form a couple. Perhaps they get married and have children together, or bring existing children into the new ‘blended’ family. So far, so good – but the problem is, coupling, or the process of becoming a couple, is often done fairly unconsciously – falling in love with someone is not, after all, a rational decision. In fact, it’s often a pretty rash way of forming a couple or a family, but one that feels right at the time.

That’s all well and good in those cases where the couple grow together (importantly), stay together and end up being a solid unit for years, maybe even decades. They’re the lucky ones, and the envy of friends and strangers. That initial rush of falling in love develops into something else – something stronger and deeper, perhaps, but certainly something more ‘grown-up’. The relationship continues to evolve and survives beyond the inevitable erosion of heady excitement, of new romance and perhaps even of sex.

For couples whose relationships fall apart, there are many ways of breaking up – all of which are difficult, even when the break-up is mutually agreed. Whatever the tacit reasons for the break-up, there’s often a toxic compound of disappointment and regret, which can be exacerbated by feelings of betrayal or failure. When children are involved, the whole process can feel even harder, and the stakes can seem even higher.

‘Uncoupling’ is a way of looking at the break-up as part of a process: “we met, we fell in love, it didn’t work out in the end, but what we will always be able to cherish is X, Y and Z, and what I’ve learned is A, B and C”. Some examples … ‘X’ could be having spent good years with the partner, ‘Y’ could be having made beautiful children together and ‘Z’ could be having enjoyed a particular path together, perhaps even having survived tough obstacles together. Learning ‘A’ could be around how people change throughout their lives; learning ‘B’ could relate to one’s own personality traits; and learning ‘C’ could be to do with what attracts you to people in the first place.

Conscious uncoupling means embedding the decision to separate in the 360-degree reality of what the relationship was, its ups and its downs, and what can be carried forward. It enables both partners to appreciate the legacy and learnings of the relationship and to take stock of what happened – together – in order to then move on.

Uncoupling can benefit from a very considered and conscious process, lending a useful counterpart to the largely unconscious experience of falling in love. Where coupling was rash and impulsive, uncoupling is considered and reflective. It allows a feeling of ‘completion’ or closure, and in some cases of a relationship having come full circle. It’s not unknown for couples undergoing a therapeutic leave-taking to come back together again, but that’s of course not the aim at all. The aims include awareness, consciousness, taking stock, being in-the-moment and then being able to move on.

It saddens me that Paltrow and Martin are being mocked for what some have said is a “self-regarding” way to break up. If we had more self-regard in all aspects of our lives (in the introspective sense), things would certainly be better for us!

Daily Mail columnist Jan Moir has implied today that the conscious uncoupling statement is the couple’s way of saying that they even do break-ups in a superior way to everyone else. Well, I’m afraid it looks like they really do – conscious uncoupling is to be applauded, whoever’s doing it, because it helps people take stock and then move forward with their lives.

For more information about couples therapy, including the conscious uncoupling process, e-mail me at jcsmith@therapy-cheshire.co.uk.

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Turning the Tables on Labels?: Diagnosis Up for Debate in Run-Up to DSM-5

In the run-up to next week’s much-awaited publication of DSM-5 (the fifth edition of the American Psychological Association‘s hugely influential Diagnostic and Statistical Manual), there has been a bit of a rumpus.

The British Psychological Society‘s Division of Clinical Psychology is calling for a “paradigm shift” in how mental health issues are understood, pointing to assumptions about biological causes of mental ill health as unhelpful and suggesting instead that a wider approach be taken that also looks at social and psychological environments.

The New York Times, meanwhile, claims that practising mental health professionals won’t be paying much attention to the latest edition of the diagnostic bible, with Sally Satel arguing instead that the DSM‘s influence lies much more particularly in the fields of health insurance and access to specialist educational services and disability benefits.

In some ways, new diagnosis guidelines in the DSM are heralded in much the same way as new slang terms making it into the Oxford English Dictionary, provoking debate and sometimes outrage. It’s also a zeitgeist-watching tool par excellence; back in 1973, ‘homosexuality’ as a disorder was finally removed from the DSM, for example. DSM-5, in turn, replaces ‘gender identity disorder’ with ‘gender dysphoria’, in an attempt to destigmatize those who believe they were born into the wrong physical gender.

In the UK, the World Health Organisation‘s ICD (International Classification of Diseases) manual is officially used in mental health diagnosis instead of the DSM, so other than the usual ‘transatlantic influence’ route, we are not directly affected, strictly speaking. But the arrival of the fifth edition of DSM, a decade and a half in the making, gives us good cause to think twice about diagnosis in mental health. For some patients / clients, diagnosis of a recognised condition can offer untold relief, as described publicly by both Stephen Fry and Paddy Considine (see my related blog post) in recent years. For others, however, a ‘label’ can be a very negative thing, seriously affecting both self-identity and the way people are seen by their friends, families, colleagues and bosses – as well as by medical professionals, sadly.

In yesterday’s Observer, clinical psychologist Oliver James raises serious concerns about using genetic or neurological markers to identify mental ill health, arguing instead that early childhood experiences plus problems in adulthood are the major contributors to mental distress. In particular, he singles out psychosis, writing that “it is becoming apparent that abuse is the major cause of psychoses” [my italics].

In psychotherapy, we are trained to work with the person and his or her history, circumstances and environment rather than with diagnoses. Further than that, I have often asked clients during their initial consultation to talk about themselves rather than their supposed conditions or whatever other medical professionals might have labelled them. It’s been surprising to what extent this has brought immediate relief as well as a willingness to work hard in therapy to determine causes, behaviours and contributing factors – which are always complex and multi-faceted.

DSM-5 notwithstanding, discussion around diagnosis among mental health practitioners of all persuasions is very welcome, and it’s reassuring to see colleagues from psychology and psychiatry sticking their heads above the parapet to question the long-established authority of diagnoses, the effects of diagnosis upon patients, and within all this, the medical model itself.

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Loneliness Can Be Fatal, Says New Study

Social isolation in old age can literally mean an earlier death, researchers at University College London have found after a seven-year study. Read a related piece here. So why are day centres, an obvious lifeline, being closed down all over the country?

In its tips for healthier ageing, Age UK recommends that older people who can’t physically get out socially use Skype to stay in touch with friends and family. If you know someone who could benefit from this, tell them about Skype and check out whether your local Age UK can help – they sometimes run lessons and demonstrations. And see here for the story of centenarian Helen (her secret to longevity: “bread and dripping”) who uses Skype to keep in touch.

 

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Consequences of Rank-Centric Health Settings: Insightful Piece in the New York Times

The New York Times health section has run a great piece about patients’ conceptions – and misconceptions – around hierarchy in the medical and helping professions.

In the US as in the UK, nursing staff, doctors, surgeons and consultants – and we can add to this list those working in psychology, psychiatry and psychotherapy – operate in a notoriously rank-driven environment. This is, of course, picked up on by patients, who are understandably looking for ways to navigate a complex and often bewildering health system.

“Such an overly developed sense of hierarchy comes at an unacceptable price: good patient care,” writes Dr Pauline Chen MD in the article, who then goes on to illustrate her point with a tragic example.

The New York Times runs some very commendable pieces on health and wellbeing, with one striking feature of its coverage being the use of practising medical professionals who speak freely about problems faced within the field. Another feature, and one which to my mind makes the paper’s health coverage stand head and shoulders above its rivals, is the use of patients’ voices – conditions are often investigated in some depth by people who are actually suffering from them. The ‘Patient Voices’ section also uses audio and each topic comes with a health guide.

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Equine-Assisted Therapy to Help Paul Gascoigne on Road to Wellness

In the news headlines today is the story of footballer Paul Gascoigne‘s current visit to a rehabilitation clinic near Phoenix, Arizona, where the programme of treatment includes equine-assisted therapy.

Working with horses is one of the fastest-growing areas of animal-assisted therapy, and for good reason. Horses, in common with many prey animals, are highly sensitive to mood and atmosphere, and are excellent communicators, more than capable of giving immediate honest feedback. But additionally, their sheer size and weight can be an important factor for clients who need to learn to develop trust in their own emotional and physical reactions and in others’.

In the UK, we’re fortunate to have world-class equine-assisted therapy delivered through centres such as Sirona Therapeutic Horsemanship in Devon and the Barton Hill Centre in the Brecon Beacons, both of which I visited as part of my Masters research into animal-assisted therapy.

If you’d like to find out more, a great place for learning about the healing power of horses is Susan Richards‘ unforgettable memoir Chosen By A Horse, which tells the story of the author’s healing process through looking after her rescue mare Lay Me Down. The classic text on the theory of equine-assisted therapy, meanwhile, is Linda Kohanov‘s The Tao of Equus.

Horses in Snowdonia

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Impacts of Recession Discussed in ‘Therapy Today’

A piece here in the current issue of Therapy Today on the impacts of the economic recession on therapy clients – lots of food for thought, and good to see this subject being addressed at some length in one of our professional publications.

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