The long white corridor

 

"A picture tells a thousand words"

Sometimes cliches can be unnervingly accurate. 

Photographer Laura Hospes' disarming and brutally honest self-portraits tell us things about mental illness that can never be captured through words.

These beautiful and haunting images also tell us something about the strange and secluded world of the psychiatric inpatient unit - where people's emotional wounds appear distressingly overt. These are places where screaming, crying and emotional collapse happen as if on cue, and conversations are peppered with acronyms like ABI, BPD, CAT, ECU, MSE and DSM. Nowadays treatment in facilities like these (especially in public mental health here in Australia) consists largely of management and containment, keeping people safe with drugs or restraints. For some, perhaps, it might serve as a retreat -  a place to stay when the world becomes overwhelming, but for many an inpatient stay can exacerbate the wounds they brought with them. Other people's pain can trigger our own.

Whilst still a student, Laura Hospes documented her stay in a psychiatric hospital where she was admitted following a suicide attempt. To survive and make sense of what was happening, she took photos. She found a way of reckoning with herself and her emotions through the lens of her camera.

Working in an inpatient unit has taught me that the people who come in often don't have a voice. They are either not listened to, ignored, dismissed, or lack the courage or the means to talk about how they feel.

That is why pictures are so important.

 

From Laura Hospes' website:

"About Laura.

Laura Hospes (1994) has been capturing her own self with the camera since the tender age of 16, out of a need to connect with people. This need has not waned over the years; it has only become more necessary. Hospes' self portraits are her way of making clear what is inside of her. Her camera consoles and understands her better than anyone else. Photography is her medium to accept and process the many struggles in her life. The resulting images are intense and arresting, as well as being a captivating glimpse inside the world of a young woman dealing with depression and anxiety. 

Hospes was named one of the 50 best emerging photographers of 2015 by the international jury for the Lensculture Emerging Talent Awards. Her work has been frequently featured both home and abroad."

 You can now find Laura Hospes’ work in a book entitled “UCP.” 

It can be hard for people who don't live with mental illness to understand the terrifying nuances that come with the disorders. That's exactly why 21-year-old Dutch photographer Laura Hospes published a series of stunning self-portraits that expose what mental illness can really be like.

The project, named "UCP-UMCG" after the psychiatric hospital where the photos are set, shows Hospes as she receives treatment for anxiety, depression and disordered eating. The images beautifully expose her daily life in the hospital -- and the strength it took to seek treatment.

"Having a mental illness is the hardest thing I experienced in my life," Hospes told The Huffington Post.

"People can't see that you’re ill, they just see a normal person that can still laugh sometimes and having a nice evening. What they don't see is the miserable hours after any social event and the breakdown I had every morning when I had to leave my bed. ... And that's just a small part of all the difficulties."

Hospes began taking the photos her first day in the hospital, adjusting her methods of photography based on what the center would allow. Her goal for the project -- in addition to documenting her own journey -- is to prove to others that you can be the textbook definition of "normal" and still need to overcome difficulties.

People can't see that you’re ill, they just see a normal person that can still laugh sometimes and having a nice evening.

 From Huffpost:

"I hope people are aware of the fact that people who are in a psychiatric hospital are not crazy. They have a very difficult period in their life and need time to recover so they can be themselves again," she said.

The photos were a cathartic way for Hospes to be in-touch with her feelings as she moved forward in the treatment process. She wants the images to serve as a powerful reminder for others whose loved ones suffer from similar mental health conditions.

"Stay with them in your mind and let them know you are thinking about them," she explained. "That is the most thankful thing for a person who feels to be slowly 'going crazy' and having no control of it."

When Dutch photographer and student Laura Hospes was hospitalized in a psychiatric hospital, she processed the experience one of the only ways she knew how — through her lens.

Now her photo series, “UCP-UMCG,” named after the psychiatric hospital in the Netherlands where she stayed, documents the 21-year-old’s journey to recovery through a series of self-portraits. After a suicide attempt, she began treatment for depression and an eating disorder, according to the Daily Mail.

During her stay, Hospes told The Mighty in an email, she was allowed to have one item in her room.

“I had no difficulties having my camera with me, only when I had to stay in an isolation room I couldn’t photograph anymore. But after a couple of days the rules were less strictly and I was able to have one item in my room. I changed from camera to laptop to phone etc.” she told The Mighty.

Feeling overwhelmed and confused when she first entered the hospital, Hospes used photography as a way to rediscover herself.

“I couldn’t make contact with my own emotions and I felt like I was floating somewhere in the air with heavy stones tied on my whole body,” she told The Mighty. “After a month I slowly found myself back and the emotions screamed in my head. I was extremely sad or extremely angry. I felt so desolated in hospital, even if there were friend or family around me.”

The photo series won the photographer a spot on LensCulture’s list of 50 best emerging photographers for 2015 in the LensCulture Emerging Talent Awards.

“At first, I made this complete series for myself, to deal with the difficulties and express my feelings,” Hospes told The Mighty. “After that, I want to inspire people who are or have been in a psychiatric hospital. I want them to see my pictures and recognize themselves in it. I hope they feel taken seriously, less crazy and less alone.”

 

Time Out?

We are all seduced by quick fixes.

For harassed and stressed parents, it can be tempting to believe that the answer to their child's behaviour is "out there" in publicised parenting tips or the latest fad doing the rounds of magazines and TV.

The reality is that parenting is a relationship and that your child's behaviour is influenced by your relationship with them, and by the home environment. 

Parenting strategies such as "time out" and controlled crying are a one-size-fits-all approach which deliver under the assumption that children need to adapt to parents in order to be effectively socialised.

The reality is that good-enough parenting involves keeping the child "in mind" and teaches children how to self-soothe and to relate well to themselves and to others.

Good-enough parenting looks to strengthen the relationship you have with your child and to help them understand their own emotions and behaviours.  Strategies like "time out" can ignore these important emotional learning opportunities.

Parents need to work to understand the emotions underlying their child's behaviour so that they can help meet the child's emotional needs rather than just focus on controlling difficult behaviours. This is what will work in the long-term.

 "Timeout" can end up teaching children that there is no help for them and no amelioration or soothing for the helpless and intensely aroused states that accompany tantrums.

 

Time Out

Australian Association for Infant Mental Health Position

(From the AAIMHI website)


The Australian Association for Infant Mental Health Inc. (AAIMHI) aims (in part) to:

  • improve professional and public recognition that infancy is a critical period in psycho-social development.
  • work for the improvement tof the mental health and development of all infants and families.

Time Out Defined

Time out involves time away from a rewarding or positive environment as a consequence of some form of misbehavior, usually for 1 – 5 minutes. The definition used by AAIMHI for this statement is where the child is also removed from the presence of and/or interaction with the parent or carer.


Background to AAIMHI’s Position

AAIMHI’s concern is that some parents and others caring for children in the community understand time out as exclusionary time out, that is, as separation from the parent or caregiver as well as from the activity in which the child had been involved. This statement refers in particular to the use of time out with children in the first three years. However, some of the issues raised will also be relevant to older children.

While there is research that supports using time out to control behaviour, especially for older children, this research does not address the emotional impact on the child. Developmentally, children less than three years cannot be expected to be able to self regulate emotionally. Therefore they still need the presence of a caregiver to assist them with this process, not separation from them. Separation may increase a child’s insecurity and distress.

Many older children have never had emotional regulation modelled to them by their caregivers in ways that enable them to learn self regulation. They therefore also need the presence of a caregiver to assist them with the management of their feelings.

Children under three years may not have the developmental capacity to keep in mind the connection between their behavior and the response of the caregiver, especially if there is any time delay.

Unregulated feelings are the cause of ‘out of control’ behaviour; responding to this behaviour needs to be about responding to the underlying emotional need of the child. The most effective, long-lasting way to respond to this behaviour is for caregivers to understand how the child is feeling and thinking. Then the parent or carer can anticipate when problems will arise and plan to prevent them.

When they do happen, the parent can show that strong feelings can be understood and managed. Sometimes therapy may be needed for persistent ‘out of control’ behavior.

Time out – AAIMHI’s Position

The AAIMHI position on responding to children’s behavior is informed by an attachment theory model of relationships which is now backed by a very significant body of research. The use of time out (where the child is removed from contact with the parent or caregiver) with children under three years is inappropriate. The use of time out with children over three years needs to be carefully considered in relation to the individual child’s experience and needs.

AAIMHI concerns in relation to use of exclusionary (where the child is separated from the parent or caregiver) time out for children less than three years are:
 

  • It does not teach constructive ways to deal with problems; instead it teaches separation as a way to deal with problems.
  • It does not take into consideration the developmental capacities of young children under three. From an attachment and development-based point of view, children this age are experimenting and do not yet have the necessary skills to control impulses and emotion, i.e. their behavior is not misbehavior.
  • It deliberately cuts off the child from the relationship with parent or carer so that the child feels powerless to connect with the adult; this cutting off from relationship is an intended consequence for the child’s behaviour and is seen by the child as a punishment.
  • It does not address the message (cause) behind the behavior.
  • It fails to recognise that young children do not learn self regulation of emotions by themselves; they need the support of a parent or carer.


Recommendations

Reinsberg (1999) lists five points to consider in responding to a child:

  • Is this a developmental stage?
  • Is this an individual or temperamental difference?
  • Is the environment causing the behaviour?
  • Does the child not know something but is ready to learn? 
  • Does the child have unmet emotional needs?


Some practical suggestions

1. Make sure the child’s environment provides for the basic needs of love, emotional and physical security, room to explore and encouragement. The emotional context should be with the parent and child in a partnership for growing and learning, not an oppositional one of controlling.

2. The parent needs to be the one in charge (in a guiding way), wiser than the young child. The child does better with a confident, kind caregiver.

3. Let young children be as much involved in helping with activities as is sensible. Show children how to do things that they can feel good about.

4. Monitor a young child’s activities and emotional state. Watch for early signs of distress or difficulty and act then (divert, attend to needs, give a hug, change the activity) rather than waiting for the emotional response to develop.

5. Respond to precipitating factors such as a child’s level of tiredness or excitement or family changes such as a new baby.

6. Calming routines before difficult situations are a good idea to get your child in a calm, well balanced state, e.g. a quiet game, a bath, a walk outside, a story.

7. Give young children choices where possible and within their capability.

8. Anticipate difficult situations. Think about when they happen and plan to avoid them if possible. For example, take with you some things to amuse a young child. Watching adults is very boring for them. If not, talk to the child about the situation ahead of time. Challenge the child with how you would like things to go: “I wonder if you would be able to (be clever, strong, etc.) and help me do this?” Have a plan in case things don’t go well.

9. Think about the event from the child’s perspective.

10. If you see an emotion rising in the child, note it and name it with them. For example:

“You are getting cross I know...”
“I understand you would like ... but we can’t because ...”

Give a short reason:

“We have to make sure you are (healthy, safe, kind to others, etc.).”
“I can help you (do something else).”

Or a challenge to the child of something acceptable to you:

“Maybe we could ... ”

11. If the above does not work, take the child away from the situation but keep the child with you (sometimes called ‘time in’). Remain as calm as you can and consistently restate your decision. Acknowledge the child’s feeling. Offer to connect with the child. “I know it is hard. Do you want a hug?”

12. Predict that this will be over soon. “I know we can calm you down. Very soon you will fine again.”

13. Importantly, parents who are very upset themselves need to take a break, as long as the child is safe. Helping parents to find support is important; there are always times in parenting when this is needed.


Specific resources for helping one and two year olds (and older) with behavior and feelings.


Time In

The Circle of Security model lists a step by step process called “Time In” during which the adult helps the child “organize their feelings.” In their approach, Time Out is for the parent to calm down (emotionally re-regulate) in order to be in a good state to respond to the child. See: www.circleofsecurity.com

Time-in Parenting

This book by Otto Weininger is highly recommended for helping children to learn strategies for self regulation. Weininger states,

When children are upset, out of control, rude or angry, what they need most is to be with a safe and accepting adult. They need to be with someone who is calm and non-punitive, and can recognize that anyone can get very upset at one time or other. They also need someone who can help them express these strong feelings appropriately.

The context of responding to young children’s behaviour is to use the parental relationship with the child to assist the child with emotional regulation, i.e. young children learn emotional regulation in the context of the relationship and with the support of the parent. It is not something they learn alone.

Weininger makes the following points about exclusionary time out:

[Time out] assumes that, at any age, we learn by ourselves and do not need others to help us. It assumes that we already somehow know the ‘right’ way to do things and can simply go to our room and ‘tune into’ the right way. Again, it appears to the child we do not need anyone to help us do this ... I do not believe that children of two, three, four, five or even six are able to perform such thinking tasks because they do not yet have the reflective skills to do so ... time out is a punishment that deprives a child of the very relationship that he needs at the time the punishment is given.

See: Weininger, Otto (2002). Time-in parenting: how to teach children emotional self-control, life skills, and problem solving by lending yourself and staying connected. Toronto: L. Rinascente Books. 

The Emotional Life of the ToddlerThis book by Alicia Lieberman also has very helpful information about toddlers and how the way we respond to them helps them with important learning and development. It gives parents and carers a real insight into the world of the toddler and what is behind their actions and feelings.
 

Related Reading:

 

Gentle Discipline Book Collection

Aware Parenting: Time Out

Circle of Security 

NAEYC Statement on Time Out (NaturalChild.org) 


References

Berlin LJ, Ziv Y, Amaya-Jackson L, Greenberg MT (Eds) (2005). Enhancing Early Attachments. Duke Series in Child Development and Public Policy. New York: The Guilford Press.

Betz C (1994). Beyond time-out: Tips from a teacher. Young Children 49:3, 10-14.

Cassidy J & Shaver PR (Eds) (2000) Handbook of Attachment. New York: The Guilford Press.

Elkind D (2001). Instructive discipline is built on under- standing: Choosing time-in. Child Care Information Exchange 141, 7-8.

Fonagy P (1996). Prevention, the Appropriate Target of Infant Psychotherapy. Plenary address at the sixth World Congress of the World Association for Infant Mental Health. Tampere, Finland. July.

Gartrell D (2001). Replacing time-out. Part one – Using guidance to build an encouraging classroom. Young Children 56:6, 8-16.

Gartrell, D (2002). Replacing time-out. Part two – Using guidance to maintain an encouraging classroom. Young Children 57:2, 36-43.

Haiman PE (1998). ‘Time out’ to correct misbehavior may aggravate it instead. Brown University Child & Adoles- cent Behavior Letter 14:10, 1-4.

Hannon J (2002). No time for time out. Kappa Delta Pi Record 38, 112-4.

Lang L (1997). Too much time out. Teacher Magazine 8, 6-7.

Lieberman A. (1993). The Emotional Life of the Toddler. USA: The Free Press.

Readdick CA. & Chapman PL (2001). Young children’s perceptions of time out. Journal of Research in Child- hood Education 15, 81-87.

Reinsberg J (1999). Understanding young children’s behavior. Young Children 54:4, 54-57.

Schore A (1994). Affect Regulation and the Origin of the Self: the Neurobiology of Emotional Development. Hillsdale NJ: Lawrence Erlbaum.

Schreiber ME (1999). Time-outs for toddlers: Is our goal punishment or education? Young Children 54:4, 22-25.

Weininger O (2002). Time-in parenting. Canada: Caversham Publishers.

Wolf T et al. (2006). Time-out interventions and strategies: A brief review and recommendations. International Journal of Special Education 21:3.

If you need help with your parenting or are feeling emotionally overwhelmed, please get in touch for a confidential discussion.

Amanda 0411749577
 

 

Ordinary People

"Uh... I don't know. It was like... falling into a hole. It keeps getting bigger and bigger and you can't escape. All of a sudden, it's inside... and you're the hole. You're trapped. And it's all over. Something like that. It's not really scary... except when you think back on it."
Con tries to explain his suicide attempt to Jeanine.
 

Ordinary People tells the story of a family at odds with itself after the death of the eldest son in a boating accident.

Their youngest son, Conrad, played by Timothy Hutton in the film, survives the boating accident which killed his brother and has left the family devastated.

Conrad is left with survivor's guilt, at least partially due to having clung to the boat during the unexpected storm and lived.

But there is much more to the story.

Unusually for a Hollywood picture, the "happy" ending brings us to a reckoning where the emotionally stranded Beth (played with intricate narcissism by Mary Tyler Moore) abandons her family in the wake of a realisation that things can't and won't be the same.

Threatened by the growing closeness of father and son, and the need to incorporate the emotional consequences of Bucky's death and Conrad's suicide attempt, Beth packs a suitcase and calls a taxi, leaving the family home in the middle of the night after a watershed conversation with her husband.

Beth's need for everything to be wrapped up nicely with the appearance of perfection becomes a more imminent threat to the emotional health of the family after Bucky's death and Conrad's illness.  She is a mother of shiny surfaces, perfect table settings and cocktail parties where family vulnerabilites, including Conrad's need to see a psychiatrist, are never aired in public.

Bucky's death provides the cataclysm that breaks the family's coping strategies apart.

Without that event, audiences speculate (with Cal) that perhaps they could have survived, with Conrad keeping his misgivings regarding Beth to himself, but I am not so sure.

Conrad's depression seems to be a mix of survivor guilt, anger at his mother, and a much deeper sadness. The feelings of worthlessness that contribute to his depression make him take out his anger on himself. His psychiatrist encourages him to sift through and express the feelings which he has been repressing and which seem to have swallowed him whole, absorbing his will to live.

In sifting through these issues, its important to look closely at Con's relationship with his mother and how this has affected his ability to cope with his brother's death - and his own survival.

Beth does not seem to be a good enough parent.

She views everything as a reflection on her and there is no room in her relationship with her surviving son for feelings which are messy, unmediated or don't coincide with her own thinking. She just can't seem to understand, acknowledge or accept that others may have a point of view which differs from hers.

Empathy definitely isn't her strong point.

At one stage in therapy, Conrad angrily accuses Beth of having been more concerned by the damage to her bathroom tiles than by her son's suicidality. Part of the problem and the reason for his depression is that he feels unable to express his anger and disappointment at his mother and his guilt over the boat accident. Although the film argues that a part of Beth died with Bucky, my sense is that she has been narcissistic for a long time, and that her ability to parent has been severely truncated by this primal soul wound.

In his "adaptive reparenting," of Conrad, Dr. Berger allows the young man to express his long-repressed wounded feelings: the anger, hurt and guilt, and eventually we reach the therapeutic catharsis of reliving the accident, where his seemingly stronger brother gets tired, slipping from safety into the water, while Conrad hangs on.

As part of his therapy Con is encouraged to forgive both himself and his mother, before he can move on.

Although I love Judd Hirsch in this wonderfully empathetic role, I feel that forgiveness is not necessarily a realistic goal for Conrad. Certainly he seems to end the film as a more mature and emotionally open person than his mother will ever be, but does he need to forgive her to reach this point? I would also argue that the idea that Beth "loves him as much as she is able" is also somewhat rose-coloured, letting her off the hook for the limitations that have traumatised all of them. My experience of severe narcissism tells me that love is not something of which sufferers are capable. Need, yes, admiration, perhaps, but not the kind of love that children need and not love as most of us would define it.

Forgiveness is not necessarily the ultimate goal in psychotherapy - self-knowledge yes, understanding the limitations of our parents and how they have affected us, certainly, but forgiveness?

It can take years to even begin to understand our own trauma and how we can and do live alongside it everyday. To reach the point of understanding and forgiving those who have wounded us - well perhaps that is a lifetime's work.

 


Still Talking After All these Years?

A recent article in the "Style" section of The New York Times celebrates the recent rise in the popularity of psychoanalysis.
But psychoanalysis has never gone out of "style" (especially in New York!) and most clinicians use psychoanalytic techniques and ideas in their practice - whatever works for the client and therapist and it's not that clear cut.

When I was studying social work, we were given a very small, rather dismissive introduction to psychoanalytic ideas as one of many theoretical streams upon which we could draw - even though the reality is that most current theories rely on psychoanalytic ideas for most of their assumptions.

I remember a colleague being shocked on starting a new job working with children and families, when she discovered that her supervisor had never heard of (influential child psychoanalyst) Melanie Klein!

There wasn't enough time or space in my social work training for an exploration of psychoanalysis, so I did my own reading and found that my placement supervisor was a wonderful mentor for using psychoanalysis and psychodynamic theory in family work.

The NYT article also discusses President Trump's mental health which I think is dangerous territory for any clinician. The student jumps in, but I note that the more experienced therapist declines the invitation to diagnose in absentia, especially not "on the record!"

 Yes, there are fashions in these things, but thoughtful practitioners find their own way through this and will use what seems relevant and helpful, even if it might be viewed as "old fashioned."

https://www.nytimes.com/2018/02/17/style/american-psychoanalytic-association-donald-trump.html

Identity

Searching for Self

“I used to spend hours when I was a kid just looking in the mirror, trying to figure out if I was handsome or not. It just depended on the day. If someone told me I was handsome, then I was handsome, and if someone told me I was ugly, then I believed that. I hardly ever look in the mirror anymore though, not if I can help it. It’s just too stressful.”

 

When Dane de Haan (as Jesse) appears for his last session in the HBO series "In Treatment", it’s a shock both for the audience and for his therapist. He arrives with Angelo, his adoptive father – a man with whom we feel he has little in common – at least from what we know of Jesse through his therapy. His therapist struggles to remain neutral in the face of this backflip – and Jesse’s choice to quit therapy. As viewers who have followed Jesse through his exploration of independence, we are also flummoxed - and disappointed, that this young man chooses to abandon therapy and what we might see as a search for his ‘true self.’

Part of his struggle is in trying to come to terms with his attachments, both biological and adoptive. Having “tested out” his biological parents by turning up at their home under the influence of drugs and asking them for money, he rejects them on the basis that they appear to have rejected him. Jesse’s step-father Angelo is waiting in the wings to provide reconciliation and the acceptance that the young man craves.  Jesse is seduced by this acceptance, even though we feel it comes at too high a price. His unstable sense of self is at risk, especially given Angelo’s scepticism about therapy and that he has disparaged his wife as part of his growing closeness with Jesse. These indicators provide evidence of an unhealthy tug-of-war for Jesse’s allegiance and affections that has little to do with allowing the real Jesse to emerge.

But just what is our true self?

The idea of identity is a fascinating one - who we are, what we believe in, what we value and how we manage our relationships in the context of holding onto a stable self-image. Identity is the way we picture ourselves and keep a sense of our needs, desires, ideas and thoughts consistent through time. It gives us a solid base from which to explore the world and relate to others. Without it we are at risk of being influenced too much by those around us, and by the external world.

For adolescents and young people, identity is a common arena of struggle and achievement. It is something that can preoccupy young people to a greater or lesser degree, without necessarily being a sign of illness.

Dramatic turns such as Jesse’s are uncommon, but there are times when young people will try on different ways to be themselves, join different peer groups, adopt different personas, and explore different interests. For example, they may go from being a sporty early teen who enjoys the outdoors and an easy physicality, to a moody and sullen emo, wearing black and hiding in their bedroom. It can be a pretty confusing time for parents.

“Consolidation of identity is one of the most central tasks in normal adolescent development…Despite experimentations with different roles, the experience of the self remains consistent across situations and across time, forming an integrated identity that is both flexible and adaptable. It is this core sense of identity that permits the maturing adolescent or young adult to develop rewarding and satisfying friendships, form clear life goals, interact appropriately with parents and teachers, establish intimate relations, and maintain positive self-esteem.”

In exploring the idea of identity it can be useful to look at what happens when things go wrong. Personality disorders, particularly BPD and NPD can be seen as primary disorders of the self, where the formation of identity has somehow been derailed.

“Some adolescents struggle with this process [of identity formation] and have a loss of capacity for self-definition, experience a painful sense of incoherence and chronic emptiness, exhibit contradictory behaviours, have poor anxiety tolerance and impulse control, and lack commitment to values, goals, or relationships.”

(From Adolescent Identity Treatment: An Integrative Approach for Personality Pathology by Foelsch, P.A., Schlüter-Müller, S., Odom, A.E., Arena, H.T., Borzutzky H., A., Schmeck, K.)

But what does that look like in the real world?

Problems with identity can manifest in both subtle and more concrete ways. We might meet someone or have a friend who seems very different every time we see them - they might seem to hold one view of themselves at one time, but a contrasting one in a different context. If we disagree with them, they might feel rejected or negated, becoming hostile or adversarial in the face of a challenging difference. It can often be very hard to maintain a relationship with people who have an unstable sense of identity. They have difficulty with the “long view” of relationships and will react strongly to perceived slights or rejections. You are either “in” (the most wonderful friend in the world) or “out” (the worst of the worst). It doesn't take much to tip them over.

People with this problem often appear to be unpredictable, because they don't have that core of stability to guide them through the ups and downs of life and the social world. They can also be volatile, highly influenced by the external environment - if those around them don't reflect back what they want, expect or need, they may become angry, or demanding. And, depending on how important we are to them, they may lash out, take revenge, or dissolve in tears that can leave us feeling guilty, confused or frustrated, which may in turn, escalate their distress. This is why carers and people close to those with BPD often feel like they are treading on eggshells, fearful of triggering an outburst.

Looking at the theory behind personality disorders and identity formation can help us understand adolescence as the second major crisis of the self (the first being the age of “practicing” when an infant starts to crawl). From toddlerhood onwards, every "no" or temper tantrum, every slammed door or disobedient challenge to the authority of parents is really an attempt to assert the self and “individuate,” continuously testing out the possibility of self in the face of relationship - is it safe to be me and still be close to someone - will they still love the real me? Those are the questions to which we absorb the answers in our early childhood. That doesn't mean that we should indulge our child's every whim, which would be just as damaging as a constant and arbitrary rejection. It is more a question of remaining consistent and validating our children's emotional states even if we need to say "no" to them.

In his theory of psychosocial development, Erik Erikson describes eight stages which he sees as psychosocial conflicts. All individuals must resolve them successfully in order to adjust well to the environment and mature into well-balanced adults. The period of adolescence (13-21 years) is seen as a conflict between “Identity and Role Confusion” (or diffusion). Crisis at this stage may be brought about by expectations from young people themselves and from people around them (parents, peers, romantic partners or valued friends). It can also be the result of earlier failures in the developmental pathway. According to Erikson’s theory, not having navigated any period securely leaves us with unfinished tasks, and we bring these unfinished tasks forward into the succeeding stages as emotional "liabilities" or vulnerabilites that can get us into trouble, perhaps leading to more serious illness as we mature. 

An adolescent who is struggling with self will oscillate between attempts to please those around them, rebellion and rejection of previously held values and ideas, and adoption of identities or personas that appear contradictory, inconsistent – and fragile. Their relationships will often be fraught, and their moods unstable (beyond normal teenage moodiness).  They will often be highly anxious and their ability to withstand negative feedback or rejection is usually quite poor. They just don't have the core of self-esteem or self-worth to carry them through the upheavals of adolescent development. It can be a tough road for young people who find themselves without that core stability and it’s not an easy fix.

Catching it early is the best way to help, but it can take a lot of hard work in therapy to restructure the personality (if there is a disorder present) – and not something that everyone is up for. Of course, it’s not something that can be diagnosed very easily either – it’s a long term problem that needs to be assessed over time. No young person is likely to come to therapy saying that they want to work on with their identity!

But problems with identity may lie underneath many of the more serious behavioural issues that parents and young people struggle with, and treating the symptoms alone may not have a lasting impact. In the end, psychotherapy is never a quick fix and serious problems such as BPD and other personality disorders require long-term solutions.

 

For more information on what to look out for please follow this link:

http://www.asmfmh.org/resources/publications/normal-teenage-behaviour-vs-early-warning-signs-of-mental-illness/

 

 

 

 

 

 

 

5 Ways to Help Your Shy Child Thrive

Extroverts tend to absorb most of the good things that come from social success: they attract all the attention, the friendships, the approval and the popularity. But parents can learn to encourage a shy child or teen to spread his or her wings and make the social forays that will expand their world – incrementally.

Children and adolescents who are shy may have a shy or sensitive temperament, but they may also be anxious, and their anxiety will manifest more strongly in social situations where they are likely to feel self-conscious. They may feel that they need to perform, and be unnaturally gregarious; they may also feel that they will be judged - these feelings can cause anxiety.

Children will want to avoid these unpleasant feelings and will need a gentle push to take the risks involved in trying new things. You can help them by modeling healthy management of anxiety.

1. Encouragement: Be realistic. Baby steps are better than taking too much on at any one time. Small successes will result in positive reinforcement and good memories.

2. Listening: listen to their fears and their feelings about social engagement. It may be that there is something specific holding them back – and if there is, it's a good idea for you to know about it.

3. Validation: make sure they know that you understand what is going on for them and that you accept them as they are, BUT you want a bigger, more opportunity-filled world for them that includes more people and more experiences. That is why you are encouraging them to be more socially active.

4. Acceptance: sometimes that’s just the way they are: being highly sensitive or introverted doesn’t equate to being socially inadequate. You can accept them for who they are RIGHT NOW, but also gently encourage them to take advantage of social opportunities.

5. Spend time with them: getting to know your child is important, spending time with them and leaving emotional space for your interactions can make a huge difference. A shy, sensitive child will often take on your moods and will be affected by your emotions. Best to “clear the slate” and give them space to be themselves rather than bring too much baggage to your time with them.

 

 

Dating & Romance: how to handle rejection

Romance and flirting, liking someone and hoping that they like you, thinking about someone and wanting them to like you, talking with friends about them. Imagining what it might be like to be with someone. Trying to find out if they like you. Biting the bullet and asking someone out. Becoming involved and maybe getting a bit more serious. Dreaming, hoping and believing.

It can be like practicing and trying out what it might feel like. Its all a natural part of growing up and also part of taking the steps that will lead towards a first real relationship.

Reality can be a little different to the ideas we have in our heads.

 Its natural to have strong emotions when you like someone or start dating. You can get anxious, feel sad or excited, get hyped up or be miserable or angry when things don't work out. It can be a bit of a roller coaster and not so easy to keep your footing when you are in the midst of some pretty unsettling moods.

Being rejected, for example, can feel like the end of the world. 

From LOVE: the good, the bad and the ugly

How to handle rejection

Nearly everybody gets rejected at some point in their life, no matter how smart, gorgeous or popular they are.  Some rejection, like attraction, doesn’t really make sense – it’s not about how likeable we are or how attractive, funny or adorable.

What to do when you ask and they say no…

  • If they say no nicely, smile and move on.

  • If the other person says no in a rude or mean way, they’re just a first-class arse and it’s lucky you found out now.

  • Keep your dignity. Try not to make a scene, throw yourself on the ground, burst into tears, abuse them, sneer or say something rude. You can do all those things alone in your bedroom later.

How to handle rejection: later

  • Don’t try to figure out why – it’s not because you are fat, ugly or stupid – it’s just because the other person can’t feel any “chemistry” or they have their own quirky reason. It means it wouldn’t have worked out, so move on.

  • Don’t wallow in self-pity, and make sure you’re not obsessing about them just because you can’t have them.

  • Hold out for someone who’ll really like you.

  • Get on with something else to take your mind off it.

  • Give it time: after a while you’ll notice things that will make you glad you didn’t go out with that person.

 

Dating & Romance: when things get serious

Falling in love can be wonderful. 

Its the singular experience of losing ourselves in pursuit of a dream or desire.

Creating a sustainable relationship, on the other hand, is hard work.

You want to be happy, be available, make time and have fun with the other person, but also keep something for yourself.  It can be a hard balance. Sustaining yourself and nurturing your relationship, having fun, keeping safe, riding the storms and managing the anxiety that's an inevitable part of any new relationship. It can be even harder for young people who are same-sex attracted, given the difficulties of potential stigmatisation and telling those closest to you about your feelings - although it doesn't have to be. 

All relationships have their ups and downs and we need to find a way to maintain our own equilibrium through these challenges. Sometimes it can be hard to balance our own anxiety and insecurity with the needs of another person. Will they be there when I need them? What if they don't like me? What if they end up being unavailable?

Where will my own needs be in this complexity of desires and expectations? Is there space for me in this relationship? 

These are important questions which we all need to ask before we embark on something that might feel great in the beginning, but may in the end thwart and frustrate us - or worse, break our heart.

Good relationships are all about communication. Being honest and real with the other person and spending time negotiating so that both parties can feel heard and supported. Arguments are a part of any relationship that lasts - but it is how we fight and the way we repair that are important. Repairing can mean exposing our most vulnerable feelings and that can be scary. But without being vulnerable we can never experience real intimacy.

The start of a relationship can be misleading in that most people tend to be on their best behaviour - trying to create a good impression. If we are in the obsessional realm of falling in love, it can be even harder to make good judgements. A relationship that is worth having will make us feel good, supported and nurtured overall, although there may be times when things are not perfect.  

From LOVE: the good, the bad and the ugly

Good relationships – signs that things are working

  • You like each other for who you are. You want each other to feel good and you support each other’s goals in life.
  • You are independent and have your own interests.
  • You see your own family and friends whenever you want – alone and with your boyfriend or girlfriend.
  • You are good at listening and talking to each other.
  • You have different opinions and sometimes fight but you listen to each other and compromise.
  • You make big decisions together, and you can both make compromises. For example, you take turns deciding what movie to watch!
  • You can tell each other truthfully what you think and what you want without being afraid of being hurt or put down. You trust the other person to be honest with you.
  • Sexual contact is what you both want – no one is pressured into it. You can be honest with each other about what you like/don’t like.
  • If there is jealousy, you listen to each other, talk about it, and try to work things out together (instead of making threats or demands that restrict the other person’s freedom).
  • You both respect the other person’s right to have their own private communication with their friends and family.
  • You agree about whether you are seeing other people or only each other.
  • You accept each other the way you are.

Bad relationships – signs that things aren’t working

  • Trying to change the other person rather than accepting them for who they are.
  • Not trusting each other or lying to each other sometimes.
  • You (or your partner) don’t talk much or open up about your feelings.
  • Fighting a lot. Things don’t seem to get worked out.
  • There is a lot of tension when you are together.
  • Constantly worrying that relationship is going to end or that the other person is interested in someone else.
  • One of you or both of you give up your friends or other interests for the sake of the relationship.
  • You have to see each other all the time.
  • Secretly reading the other person’s Facebook or texts to see what they are up to.
  • Feeling overwhelmed by the other person’s demands or needs.
  • Feeling like you don’t know who you are or what you want anymore.
  • Friends or family say they are worried about you or your relationship.
  • There’s lots of criticisms or jokes that hurt or embarrass the other person.
  • You don’t look forward to spending time together.

Some of these things can mean you need to sit down with your BF/GF and have a serious talk.

Some are early warning signs that things are not okay. Some  might mean you want to call it quits.

Abusive relationships – the signs of control

  • One person’s needs and decisions always come first. The other person feels they must go along with it.
  • One of you wants to know where the other person is all the time.
  • One of you checks up on the other way too much – texting to see where you are and who you’re with.
  • One of you stops the other from seeing family or friends. They say stuff like, “You don’t need to see them” or “we only need each other” or “you’re friends are boring”.
  • One of you is a snoop and disrepects the right to privacy – reading texts, a private diary or journal, phone messages, Facebook stalking, or installing software programs that record what websites are visited.
  • One of you feels pressured, tricked or forced to do sexual things they don’t want to do.
  • One person feels scared to end the relationship because they are worried their BF or GF will hurt them, or will commit suicide.
  • Emotional manipulation like “If you really loved me, you would… (have sex/stop talking to your ex-boyfriend/spend every night with me…”).
  • One person often humiliates the other and makes them feel bad  (eg. ”you’re stupid/embarrassing/fat /clumsy, ”no one else would want you, ”you can’t do anything right).
  • One person scares the other through threats, pushing, hitting, locking them in, smashing things or aggression –the other person feels so afraid of upsetting them that they just go along with the demands of their BF/GF.
  • Jealousy is used as an excuse to demand that the other person has to stop talking to other guys/girls, ex-partners, friends or family.
  • Sending nude or humiliating pictures around of your BF or GF without their consent.

If any of these sound familiar, see If things get ugly for information and advice.

Related links

Sex & Relationships

Its an important part of life.

Discovering and exploring our sexuality and becoming intimate with someone special.

Deciding whether or when to have sex with someone is a big decision which shouldn't be taken lightly. That doesn't mean that you need to stay celibate until marriage, just that its better to be cautious and to think about what it means to be intimate.

Intimacy with a special partner can be wonderful, and opens up a new and exciting part of our lives.  Sex can make us feel closer, can help us soothe one another and can bring emotional depth to our relationship. But it can also be a source of fear, anxiety and sometimes pain. Will we perform?  What will it feel like?  Will it be like it seems to be in the movies?

With the prevalence and accessibility of porn, most young people are pretty well-informed about the act of sex and its many permutations. But porn is always a fantasy, a projection of fantasies onto real women (and men) and a misleading abstraction of our bodies, behaviours and desires. It is often designed to be consumed by men and is, to a large extent, skewed towards their interests.

It can be very disappointing for both sexes when sex turns out to be nowhere near as "perfect" or as exciting as it looks from the images we find on the net.

The emotional implications of becoming sexually intimate are also sidelined by pornographic imagery. Yet they are an inevitable part of every sexual encounter - even if we choose to "turn them off" or seek sexual experiences removed from emotional intimacy. For young women especially, the implications of becoming sexually intimate can be complex and its a good idea to understand yourself and what you want before you leap into something for which you might not be ready.

From Young Women's Health

Making Healthy Sexual Decisions


Key Facts

You may be thinking about what it means to be involved in a sexual relationship. As a young adult, it’s normal to think about sex, have sexual feelings, and have a desire to learn more about your own body. Deciding to have a sexual relationship is an important decision since it involves both your body and your emotions. You need to make sure that it’s the right decision for you. It’s always good to have a trusted adult to talk to.

What should I think about before I decide to have sex?
There are many things that are important to think about before you decide to have sex, including whether this is what you want and whether this is the right time in your life. You should also think about how you will feel afterwards. It should be a decision made without any pressure from your partner or friends.

You should never let others pressure you into having sex if you don’t want to.

The decision to have sex for the first time (and every time after) is yours, not anyone else’s!
Remember that it’s completely appropriate to wait to have sex.
Young women choose to wait to have sex for many reasons, such as wanting to wait until they are older or married, being unsure about what they want, having certain religious beliefs, or wanting to avoid the possibility of getting a sexually transmitted infection (STI) or getting pregnant.
What do I need to know if I’m sexually active or I’m thinking about becoming sexually active?
Young women have to make lots of decisions about sex, including whether to abstain (not have sex), or be sexually active.

If you are sexually active, you’ll also need to think about the:

Gender of your sexual partner(s)
Kind of relationship you have with them
Type of contraception (if you have a male partner) and sexually transmitted infection (STI) prevention methods you’ll use
Before you decide to have a sexual relationship, talk with your partner about whether having sex is what you both want.

Ask about his or her sexual history, including if he or she has had any STI’s.
Talk about what kinds of STI prevention methods you plan to use.
If you are in a heterosexual (straight) relationship, talk about birth control (condom, birth control pill, injection hormones, the “patch”, the “ring”, or IUD) and what you would do if it failed. If you feel that you can’t talk to your partner about these issues, then you should rethink whether or not you should be having a sexual relationship.


Be open and honest about whether you or your partner have been, or will be sexually involved with other people. Remember, the risk of getting an STI or a virus that can cause cancer or AIDS is increased if you or your partner(s) have sexual intercourse with other people. The more partners, the greater the risk!


Talk to your primary care provider about methods of birth control that are right for you, and about how to prevent STI’s.


Don’t forget that a female can get pregnant at ANY time if she has sex with a male without a condom, or if she is not using birth control correctly. To lessen the chance of pregnancy and STI’s, you should use a latex condom every time you have sex, from start to finish. The only way to absolutely prevent getting pregnant or an STI is to not have sex.

Who can I talk to about sex?
If you have questions about sex (whether or not you’re thinking about having a sexual relationship) you should talk to your parent(s)/guardian(s), a trusted adult such as a school counselor, someone from your religious center/youth group, or your health care provider. It’s a good idea to discuss all of your choices and any concerns you may have so that you can make healthy decisions. Deciding whether or not to have sex can be a difficult decision, so it’s always good to have someone to talk to.

How do I find a health care provider to discuss birth control and STI protection?
Many young women and men can talk to their parents or guardians about these issues, while others need confidential services. You can talk to your primary care provider (GP) about birth control or STI protection. You also have the option of talking to a gynecologist, a health care provider at a family planning clinic, or a health care provider at a student health center or school clinic or one of the GPs at a headspace clinic. You should feel comfortable with your provider, since it’s important to share personal information and any health problems with her/him. You need to find a provider who will listen to your concerns, answer your questions, and take the time to explain things clearly to you.

Ask your health care provider about the confidentiality policy. You should be able to talk privately about any health issues including your sexual choices and not feel judged.

Here are some sample questions you can ask your provider:

What if I want to be tested for STIs such as gonorrhea, chlamydia, or HIV?
Can you tell me what happens to my lab test results? Who do you call?
Will the bill be sent to my house?
If I’m covered by my parents’ insurance, will they find out about office visits and tests that are done on me?
What if I need birth control? Will my parents find out?
What if you find out that I have an STI? Who will you tell?
What if you find out that I’m pregnant?
Is there any information that you are required to tell my parents/guardians?
What happens if I have a big problem and need help telling my parents/guardians?
What should I know about emergency contraception?
What happens if I forget my birth control or the condom breaks?

If you forget your birth control or the condom breaks, you do have an option called emergency contraception, also known as the “morning-after pill”. Emergency contraception can prevent pregnancy up to 5 days after unprotected sex. The sooner you start the medicine after unprotected sex, the more effective the treatment is. Both females and males age 15 or older can buy it at a pharmacy without a prescription. Call ahead to make sure they carry it and ask about the cost. If you’re 16 years old or younger OR you don’t want to buy emergency contraception yourself, you may be able to get it from your health care provider or a family planning clinic at a low cost. 

Where can I get ECP?

You can get the emergency pill (sometimes called the "morning after pill") from your local chemist or pharmacy. The pharmacist may ask you questions about your health to make sure the emergency pill is safe for you to take. If you are under 16 years old, the pharmacist (chemist) may also ask you some questions to make sure you understand the effects of taking the emergency pill.

For more information about Emergency Contraception please click here.


What if I’m not sure whether I’m gay, straight, bisexual, or transgender?
You may also be trying to figure out your gender identity (whether you identify as a female or male) and your sexual orientation (who you are attracted to). If you feel like you want to talk to someone or you need more support, your health care provider can help you find a counselor or support group for gay, lesbian, bisexual, and transgender teens. If you don’t feel comfortable talking to your health care provider, you can speak with someone and get advice on where you can find a counselor or support group.

Reachout has some great resources for young people who are unsure about their gender or sexuality or just want to talk to someone. You can also call Swithcboard or visit MINDs Equality Centre located in Fitzroy.

It’s important that having sex is a positive experience and YOUR decision regardless of whether your partner(s) are male, female, or both. If sex is painful, not pleasurable, not your choice, or makes you feel that it is the wrong decision for you, you should talk with a trusted adult.

Ask yourself the following questions to see if you’re ready to have a sexual relationship:

Is your decision to have sex completely your own (you feel no pressure from others, including your partner)?


Is your decision to have sex based on the right reasons? (It shouldn’t be based on peer pressure, a need to fit in or make your partner happy, or a belief that sex is the only way to make your relationship with your partner better, or closer. If you decide to have sex, it should be because you feel emotionally and physically ready. Your partner should be someone you trust.)


Do you feel your partner would respect any decision you made about whether to have sex or not?

Are you able to comfortably talk to your partner about sex and your partner’s sexual history?

Have you and your partner talked about what both of you would do if you became pregnant or got an STI?

Do you know how to prevent pregnancy and STIs?

Are you and your partner willing to use contraception to prevent pregnancy and STIs?

Do you really feel ready and completely comfortable with yourself and your partner to have sex?


If you answered NO to any of these questions, you are probably not ready to have sex. If you think you should have sexual intercourse because others want you to or you feel like you should since everyone else is doing it, you should rethink your decision to be sexually active. You should only have sex because you: trust your partner, feel comfortable with yourself and your decision, know how to protect yourself against STIs and unplanned pregnancies, and most importantly because you want to and you know that you’re ready!

Reachout Guide to Romantic Relationships

Resources for young women in Victoria

Family Planning Victoria 
This organisation helps people make informed decisions about reproductive and sexual health and wellbeing. It has particular expertise in education, training and clinical services for young people.

Melbourne Sexual Health Centre 
This is a free, walk-in clinic that provides testing and treatment for sexually transmissible infections.

Royal Children’s Hospital – Young People’s Health Service 
This is a service for young people aged 12-24 years who are experiencing homelessness and/or marginalisation. It is based in Melbourne CBD providing primary health services, including sexual health services.  

Royal Women’s Hospital – Unplanned pregnancy support 
This service supports women who have an unplanned or unwanted pregnancy. It provides information, counselling, advocacy and referrals to help them make decisions about their pregnancy options.

Sexual Assault Crisis Line 
This after-hours telephone service provides counselling for victims and survivors of past and recent sexual assault. 

Youth Central – Relationships and sexual health 
This webpage has lots of information and links related to sexual health and relationships. 

 

 

What is Therapy?

(This article is from the website "Therapy Route")
 
From the outside, therapy doesn't look very different to any other conversation between two people.
There is, however, more to therapy than meets the eye. 
 
  • What is therapy?
  • Does therapy work?
  • What to expect
  • How long does therapy last?
  • Getting the most out of psychotherapy
  • How to tell if therapy is working
  • Questions to help evaluate how therapy is progressing
  • Assessing doubts about therapy
  • When is it time to end therapy?

 

What is therapy?

Unlike the supportive conversations that you hopefully have with your loved ones, therapy discussions are structured by trained therapists according to principles scientifically demonstrated to be helpful. This involves far more than talking about your problems in the hope that someone will listen and offer practical solutions or reassurance. Of course, therapy can include these aspects, but therapists aim to achieve lasting growth by helping you find ways of seeing, thinking and feeling that leave you more capable and prosperous.

There are many forms of psychotherapy and they differ in a variety of ways, but they also share a great deal in common. All therapists aim to provide a safe, confidential, non-judgmental, consistent, reliable and accepting encounter with a helpful human being. Therapy is designed so that you and your internal life take centre stage.

You are the one who shares personal details about your life, while the therapist works to help you to understand the situation you face and to be as open as possible. This includes the therapist refraining from sharing their political, religious, moral or any other views that might make it more difficult for you to be yourself. 

Some forms of psychotherapy involve a meeting between one patient and one therapist, while others involve more, e.g. group or couples therapy. Sessions are usually less than one hour but it is not unusual for initial assessment sessions (or groups) to be scheduled for longer. This is because assessments sometimes require many questions to be asked, whereas subsequent sessions might be less structured. 

 

Does therapy work?

Yes! Therapy does work. Research has shown that people who attend therapy are more likely to be better off than those who don’t. This finding has been repeatedly confirmed and researchers are now turning their attention from asking “Does therapy work?” to the more complex issue of “Which therapy works best for whom and under what circumstances?” 

Apart from the obvious expected benefits like feeling and functioning better, therapy can also improve relationship skills and work performance, and reduce the number of times a person sees a doctor or is admitted to hospital.

 

Some issues that therapy is known to be helpful for include:

  • Addictions
  • Anxiety
  • Depression
  • Emotional crises
  • Low self-esteem
  • Obsessive-compulsive disorder (OCD)
  • Personality disorders
  • Phobias
  • Post-traumatic stress disorder (PTSD)
  • Relationship and family problems
  • Schizophrenia

 

What to expect

No two therapists are the same, not even two therapists working under the same professional title, using the same orientation and applying the same techniques. The good thing about this is that you don’t need to write off an entire approach if you are unfortunate enough to have had a bad experience with one therapist. Try someone else; you might be pleasantly surprised. 

There are some things that you can expect from most therapists. Most will want to meet once or twice weekly for under an hour (45 – 50 minutes). During this time, you will probably do much of the talking as your therapist works to understand the nature of your difficulties. Think of these meetings as an opportunity for the two of you to get to know each other a bit and decide if this relationship will work.

Some therapists will approach these initial (and perhaps later) meetings in a structured way, asking questions and gathering details about what brings you. Others might follow your lead and quietly form an impression of how to be helpful. At the end of your first session, some will invite you to return to continue where you left off, while others may have already formulated clear ideas about how to proceed. Neither approach is better or worse; the important thing is that the two of you are starting to clarify your expectations, establish a good rapport and build a connection. 

It’s understandable to want a professional who will tell you how to go about fixing things, but this is rarely the best approach. As the word suggests, psychotherapy is a therapy of the mind. The aim is to help you to change internally so that you can live more productively. Having a therapist solve problems for you or tell you what to do ‘out there’ feels nice, but it is a red flag and fosters dependence. Be prepared for the process to unfold gradually, to work together with your therapist, and to take risks as you feel ready and able to. This includes things like being open to feeling vulnerable, acknowledging the part you might be playing in something, or allowing yourself to trust your therapist. 

Working towards trust is an important part of most psychotherapies. You probably sought help because you have been suffering. Therapy involves talking about this and so stirs up painful memories, feelings of frustration, and sometimes shame-filled disclosures. A good therapist will guide you through this and will understand that this is difficult and takes time. Feel free to let them know how you are feeling, even if this involves your negative or positive feelings towards them. It’s okay to have mixed feelings about therapy and to let your therapist know if you have doubts about the sessions. 

 

How long does therapy last?

The length of therapy will depend on a few factors including your therapist’s talent, your goals, the type of difficulties you are working with, and your level of commitment to the process.

Therapies that aim to reduce one symptom (e.g. fear of flying) or that have a clear, focused goal (e.g. teaching relaxation techniques) are usually shorter-term (months) than those aiming for broader, less defined changes (years). Examples of the latter include aiming for greater emotional maturity or deeper interpersonal relationships. Also, some difficulties are easily addressed while others prove difficult to change and sometimes form part of a severe and chronic condition.  

The length of therapy often has little to do with what is needed and might be prescribed by practicalities such as finances and clinic policies. In instances where a therapy is cut short because of financial and policy restraints, it is helpful to think of your therapy as one step along a journey that may need to be revisited from time to time. Don’t blame yourself if you aren’t well at the end of a limited service, or relapse shortly after that; time limits are often based on available resources and not on what’s in the best interest of each person’s situation.

It is acceptable to participate with your therapist in setting goals and establishing the type of work that you are looking for. This is also something that is likely to change over time, and you can feel confident about revisiting these issues as and when needed.

 

Getting the most out of psychotherapy

As with most things in life, the more you put in, the more you will get out. In therapy, this refers to how often you attend, how engaged you are during the sessions, and then how hard you work on the issues that brought you to therapy between the sessions. The time you spend with your therapist is important and can provide a large part of what you need, but you will probably discover that being in therapy often means thinking about things in new ways for much of the time, including between the sessions.

The two most important things you can do to get the most out of therapy are: 1. be open with your therapist, and 2. attend the sessions. Being open is something many of us find more difficult than we would like. Even people who seem to be publicly open about the most personal things are often quite reluctant to talk about a host of ordinary things that would surprise you.

A significant part of many therapies is having the opportunity to share things with another human being that you would find difficult to tell your closest loved ones. This can be for a whole range of reasons, but shame and embarrassment are the most common. Openness is a quality best worked towards gradually. Blurting out all your secrets can be counterproductive since it might leave you feeling terrible, and this approach probably won’t change much.

Change comes from getting to a place where you trust your therapist enough to risk telling them. Repeatedly discovering that they aren’t driven away is transformative and can alter how you start to relate to yourself. In instances where it’s just too difficult to be open, the best strategy is to be open about why it’s too difficult. That way you are starting to understand what holds you back, while letting your therapist know that there is more and that you will get there in due course. 

Attendance is also very important. You aren’t in therapy if you aren’t in the room as agreed. This may seem an obvious point, but it is a frequent stumbling block to true progress. This is quite understandable: therapy can be painful at times and often involves confronting things that you might be trying to avoid. Attending regularly is the best way forward because it allows you to develop trust more easily, it prevents your session time from being hijacked by the need to update your therapist on recent news, and it helps you build momentum and pick up from where you left off. When you find yourself not wanting to go to a session, try to reflect on why. Could it be that the last one was hard? Did you leave a little angry with the therapist, or is there something you know you need to talk about but don’t want to? These are all good things to work through together with your therapist.

Remember: frequency, regularity and continuity are required to achieve depth.

You should also know that attending therapy, while most definitely a valuable and positive step, is not enough to lead to a healthy and reasonably happy life by itself. You will still need to work towards having the basics in place. These include eating properly, staying fit, socialising, keeping intimate, loving relationships, participating in productive activities, resting, having sex, taking the time to play, etc. etc. etc. Of course, it might be because you are unable to do these things that you are in therapy; unfortunately, the one doesn’t replace the need for the other. 

Try to take as much control of your therapeutic process as possible. For example, if someone plans to help you pay the account, still have the account sent to you and arrange for the money to be paid through you to the therapist. Similarly, do call your therapist yourself if you need to cancel, move a session or find yourself in crisis. Therapies that are carried out in this way are more successful because the patient practices taking responsibility, and the therapy is less likely to be hijacked or seem as though another person (e.g. Dad) is pushing the agenda. 

 

How to tell if therapy is working

This can be a difficult question to address because we all have different ideas about what ‘working’ means. Some enter therapy hoping to eradicate their need for others. Since humans are more like pack animals than lone leopards, this is not possible. The therapist might feel things are proceeding well if the person starts to understand their aversion to neediness, but the person may see this as a failure. Agreeing on clear goals (e.g. date more) makes it far easier to evaluate how things are going, but circumscribed goals rarely do justice to the complexity of living. In fact, many people only realise what they wanted out of the therapy quite some way into it. Also, different kinds of difficulties respond to therapy in different ways, so it isn’t always possible to sketch out clear guidelines regarding how to tell if things are going well. 

Having said that, there are ways to tell if things are working out or not. You should have a gradually deepening sense that the therapist you are working with is engaged with and interested in you. As time goes on, they should appear to be reliable and consistent, and they should be developing an understanding of the challenges you face. Your sessions should not frequently be rescheduled and cancelled by your therapist, and you can expect that them to remember at least the main elements of your story. 

Many people will start to feel better soon after entering a psychotherapy process. Taking steps towards changing in positive ways and finally having someone listen with sincere interest is uplifting by itself. Lasting change takes a little longer, but you should soon notice that you start to think a little differently about your life. These small changes are usually accompanied by a sense of hope, but some can also be quite painful. For example, it might initially hurt if you have been getting into trouble because you have found it difficult to think about certain things, and you have now found the courage to start doing so.

Progress in therapy is rarely one straight line upwards. As with climbing a mountain, you may find yourself descending into small valleys even though the overall trajectory is up. Don’t be discouraged; this is normal. Setbacks are an opportunity to learn something. The whole picture is what’s most important. Therapy is not easy; some patterns have been in place for decades, and it takes some effort and patience to shift them. A more productive and fulfilling life is possible. 

 

Questions to help evaluate how therapy is progressing

  • Are you socialising more or at least feeling less isolated?
  • Is it any easier to be productive?
  • Do you feel more connected to yourself or others?
  • Have you been able to broach topics in therapy that you never thought you would?
  • Do you like yourself more?
  • Can you have more fun than before?
  • Is hope a little more present? 
  • Do you notice any areas improving in your life?  E.g. work, love, play?
  • Are you more honest with yourself?
  • Do you feel challenged to grow?
  • Have other people’s actions started to make more sense?
  • Are you feeling better or more confident?

 

Assessing doubts about therapy

Sometimes doubts are no more than a sign of the typically mixed feelings that come about while doing something uncomfortable. Sometimes they are the expression of similar doubts that block you in your other intimate relationships. Unfortunately, they can also be a sign that something is wrong with the fit between you and the therapist.

 

Start by asking yourself the following questions:

Is this a familiar feeling that causes you to hold back from relationships generally, and is it something you would like to work through?

Does your therapist appear to accept, empathise with, or care about your situation?

Is it clear that the therapy is about you and your life rather than the therapist’s?

Do they seem to want to understand?

Are they working to make it easier for you to share difficult things?

Do they respond thoughtfully and non-defensively when you talk about your doubts?

 

Answering “No” to the above questions may suggest that it’s time to move on to someone else. If you find yourself in the same situation repeatedly, it may be worth considering the role you play.

 

When is it time to end therapy?

There are three points at which it is worth considering stopping your therapy: 

  1. 1. You have met your goals 
  2. 2. The cost outweighs the benefit
  3. 3. Something is going wrong.

The first of these is easy enough but requires that either your therapist or you had the foresight to establish clear and measurable goals at the start. Maybe you wanted to date more, perhaps you had a fear of flying, or it could be that you wanted therapy to help you to get through the first anniversary of a loved one’s death. These are all definable and measurable goals, and it’s easy to tell if they have been met. If they have, you can either bring therapy to an end or set new goals and continue.

Many people, however, enter psychotherapy with less measurable goals. They might sense that they are easily offended, intolerant of intimacy, or want to understand why they experience life differently to others, sabotage their success, or choose unavailable people. There are countless examples of situations like these, and while some do offer clear endpoints, many have the potential to lead to long-term therapies that end when the therapist or patient or both decide that it’s time to call it a day. 

The decision to end often comes down to an assessment of whether the benefit continues to outweigh the costs, i.e. are you still making good progress or finding help? Assuming the therapy is affordable and providing value, there is no inherent reason you should end it. Emotional growth and development unfold over time, and some have found integrating psychotherapy over the course of their lives enormously enriching. Of course, you may not want to do this, and there is nothing wrong with that either. But there is no need to end therapy out of fear you might become dependent, or fear that being in therapy proves you are weak. Well-trained therapists know how to establish a long-term therapeutic relationship that breeds independence and strength rather than dependence and weakness. This is one reason they don’t tell you what to do and encourage you to find your own solutions. 

Unfortunately, therapy doesn’t always end because things have gone well and your goals have been reached. Sometimes it must stop because things have gone or are going wrong. It might be that the therapy frame has become eroded. The frame includes all the things that distinguish being in psychotherapy from having a friend who is also a psychotherapist. This includes the rules that structure the engagement, e.g. who’s there to get help, the length and frequency of sessions, who speaks first, whether meetings can be rescheduled, whether contact is avoided outside of sessions, etc.

An eroded frame will render the therapy ineffective. It is always the therapist who works to maintain the frame, but it is sometimes the patient who must call it a day if the therapy relationship has turned into something else. 

Signs that your therapy has an eroded frame include: your therapist telling you their difficulties; holding long, unscheduled telephone conversations; meeting casually outside the therapy room; spending therapy time catching up on each other’s lives; and flirting (or worse) with each other. Ending a therapy that has reached this point can be especially painful since you may have developed a strong bond with your therapist by then. Try not to let this prevent you from moving on to the real help you need. It is unethical for a therapist to allow the frame to erode; consider reporting them to their respective licensing authority.

Here are a few other signs that indicate things are not going well in your therapy: a clear sense that the therapist is uncomfortable about discussing what troubles you (e.g. sex); having the therapist dismiss each of your concerns or worries; finding that your therapist needs constant reassurance or admiration; being subject to your therapist’s agenda (e.g. applying pressure to attend their expensive workshops); and finding that the therapist pushes their moral view, tells you how to live your life or speaks more than they listen. 

The ending of a therapy can be a surprisingly emotional time. It is not unusual for symptoms to return around the time, and many people find that they doubt whether they are ready. This is quite reasonable, and things do usually settle down again. For many, this will have been the most open and supportive relationship they have ever had. It is not uncommon to have told your therapist more intimate things than any other person before. There is a good chance that you formed an important and powerful bond with your therapist and this can make saying goodbye quite challenging, since it involves facing genuine loss. 

When you do decide that it is time to end, it is wise to set a future date for the last session and then to use the run-up time to properly say goodbye, and process the feelings that saying goodbye can evoke. This is particularly useful if you tend to dismiss goodbyes or minimise loss, because it can help you to hold onto the good of the experience you have had by allowing you to face the end in an authentic way. The length of this ending period should be proportional to the duration of the overall therapy; a week or two for short-term work and possibly many months for therapies that have lasted years."

If you would like to explore therapy as an option for you, please get in touch on 0411749577

This article originally appeared on the website "Therapy Route."

The Trouble with Belle

The Trouble with Belle

I have been reading The Woman who Fooled the World, an eye-opening expose of Belle Gibson by Beau Donelly and Nick Toscano, the journalists who broke the story.

It’s hard to put down — a thriller that tells us a lot about our own vulnerability to marketing and branding — and to hearing what we desperately want to believe. Gibson is the very good looking young woman whose profile rose along side that of social networking photo-sharing app Instagram. She falsely claimed to have cured her brain cancer through natural healing and nutrition. She also fraudulently claimed to have donated a large percentage of profits from her app and cookbook to charity, garnering huge donations from people who believed in her and her philosophy and misleading those who were desperate for comfort and hope in the face of a cancer diagnosis.

It seems like we all wanted to believe in the happy endings she concocted through slick marketing and beautiful images. From the book, we understand that her closest friends tried to intervene much earlier than The Age online article exposing her charity frauds. They cared about her and wanted to stop her from perpetuating the lies she used to help build a global brand.

The story is shocking, fascinating and by turns unbelievable — much like Belle herself. In some of the articles I have read there is speculation regarding her mental health, but I certainly don’t believe she had — or has, Munchausen’s syndrome. Perhaps it’s more likely that she may have a personality disorder, although of course we can’t be sure.

Although Belle’s dishonesty and willingness to exploit people’s generosity and desperation are shocking, I have been struck by her inability to apologise or take any steps to make amends for her actions other than where she has tried to cover up and escape the consequences. In the days and months following her exposure, she tried to remove incriminating posts, emails, and an online presence that was a combination of wishful thinking and bald-faced lies.

Having become increasingly fascinated by her story, I landed on the 60 Minutes interview with Tara Brown.

Here was a young woman — way out of her depth, being held to account for her actions, and at every turn trying to slip out of responsibility, blame, reckoning or reflection. It was particularly hard to understand her feelings — or her deeper motivations. She was unable to even partially acknowledge what she had done.

In the end, I found it overwhelmingly sad.

Perhaps it would have been too painful to incorporate this less than wholesome self into her self-image. It takes some ego strength to admit when we have done wrong or made a mistake.

Perhaps the whole thing had ballooned into something that she couldn’t control or back out of. Perhaps she even believed some of her own lies. At one point in an interview after being exposed, she appears to wonder who she might be without cancer — or without the acknowledgement and support that her public image has brought. It’s a telling moment where we get a glimpse of what might be internal emptiness behind the glamorous facade.

“It’s just very scary, to be honest,” she says, her voice wobbling. “Because you start to doubt the crux of things that make up who you are. You know, I’m blonde and I’m tall, and I’ve got hazel eyes and I’ve got cancer. And all of a sudden, you take away some of those high-level things and it’s really daunting.”

(From Clair Weaver’s interview with Belle which was originally published in the Women’s Weekly)

It seems clear that she enjoyed the attention — and the benefits of wealth and fame that accrued after the success of her app. But it was all built on something that wasn’t true— she never had cancer. Other interviews conducted after the scandal broke are equally telling — far from being apologetic, she seemed to see herself as the victim of unfair vilification — and betrayal by those closest to her. She may have felt genuinely victimised as those who once supported her shifted sides in the face of mounting evidence.

One incident from the book stands out.

At her son Olivier’s 4th birthday party, she shocked guests and frightened her son by collapsing against the wall and falling to the floor in what seemed to be a potentially fatal seizure. It must have been a terrifying moment for Olivier — and for those who cared about Belle — yet it was all apparently faked. The authors argue that she has factitious disorder and although we cannot be sure, this and other somaticising illnesses involve bodily responses and manifestations that mimic and are experienced by the sufferer as if they are real. It’s hard to know.

People started asking questions. The goodwill and sympathy she had exploited started to drain in the face of increasingly unbelievable, illogical — and even contradictory statements. And yet nothing happened until two journalists started uncovering the extent of her deception through investigating her relationship with the charities she had foregrounded as partners and beneficiaries of her business success. Most had never heard of her. They certainly had not received any money. She argued that the business was having “cash flow problems.”

In bringing down her findings, the presiding judge in Gibson’s court proceedings expresses her anger at Gibson’s behaviour “She has chosen not to explain her conduct. She has chosen not to apologise for it…It appears she has put her own interests before those of anyone else….If there is one theme or pattern which emerges through her conduct, it is her relentless obsession with herself and what best serves her interests.” Perhaps she may have been more prepared to try to understand Belle’s point of view if Belle had fronted up to the hearing.

But we know from the interviews post-exposure that it was just too difficult for Belle to acknowledge how badly things had gone, that her reality didn’t match what was really happening and that she had caused pain to the people who were closest to her. No doubt it would have been too hard to face a court room full of judgement — but she couldn’t escape the judgement of those who had once supported her, and the online communities she had built turned on her in the blink of an eye. Donnelly and Toscano argue that the vilification and shaming of Belle Gibson “crossed a line.”

The extremity of the abuse demonstrated how easy it is to behave online in ways which in our off-line lives we would never consider. We are all a bit tempted by the opportunity that the web offers us to vent and to manifest our worst selves without any apparent consequences. No doubt Belle’s success -and her downfall are all part of the same phenomenon.

Although there is some confusion regarding Belle’s background, it seems likely that her mother allowed her to move from home at 12 to live with a man more than 50 years her senior. Her mother has also appeared to change her own story at times. As related in The Woman Who Fooled the World, the author’s interactions with Belle’s parents paint a picture of unpredictability, a marked lack of both stable identity and moral certainty. They seem to change their position on Belle and her actions every time they call. At one stage Natalie (Belle’s mother) leaves a message of breathy seductiveness which points to a troubling lack of boundaries. Natalie and her husband both claim that they wish to have nothing to do with the press, to be left alone, yet they keep ringing.

Donelly and Toscano posit the possibility that Belle has factitious disorder, and she does seem to have some some sort of somaticising problem, but there is also a sense of narcissism in her narrative. Given the transmission of the idea of narcissism into a kind of generalised cultural bugbear, it’s hard to see it for what it is — a personality disorder caused by trauma and a fundamental lack of identity. People with NPD rely on social feedback to manage their self-esteem — their sense of self. Belle’s need to market and inflate her self-image through the medium of social networks could be seen as part of this kind of strategy. Her apparent exploitative approach to relationships also seems narcissistic — it seems to be “all about her” and how she can get what she needs from the world around her. Her rise to fame could be seen as a struggle to define herself through the markers of worldly success. When it all came crashing down, and the feedback turned negative, she seems to have found it impossible to reconcile internal and external worlds. Built on a fragile base, her inner structure was in danger of fragmenting or collapsing with every criticism.

We have some idea where she has come from and how her upbringing may have contributed to her behaviour, but what will she do now? I wonder, in the end, how she will move on from this. I hope that she can eventually find it within herself to acknowledge what she has done, the pain she has caused and to ask for help.

Amanda Robins, MSW, PhD Psychotherapist

The Woman Who Fooled the World by Beau Donelly and Nick Toscano is out now, published by Scribe.

Click here for a link to the publisher’s website.

SKOOLDAZE

The teacher was non-plussed. She pursed her lips and sighed, underlining her frustration. I could feel every nuance of her irritation as she leant over me.

Her patience was at an end. 

She had been trying to show me a mathematical principal and in doing so had asked me to move the pointer to the right. Right and left meant nothing to me. They were just words. Space and structure, and the experience of being a body in the world oriented in a particular way - that I could understand, if she had bothered to explain it to me.

I wasn't the learner she wanted. Approaching my desk to explain something, she hovered over me, seeming to expect something from me that I just couldn't come up with. She had made my 8 year old self so nervous in her focus and imposition, that I couldn't think straight, and holding onto the arbitrary dimensions and orientations humans impose on space was beyond me in that moment. I wasn't trying to be difficult. I just couldn't think. And she was making it much worse, bending over me and imposing her anger and frustration onto me like an approaching storm.

It was frightening.

Maths had been my bugbear ever since I had a teacher who threw dusters and chalk at students and grew so angry at innocent questions that she shook the inquirer until they quivered in fright. Nowadays she would be "redirected", but back then teachers like her were still an unwelcome part of the system.

I remember hanging onto the wall, desperately trying to avoid being pulled out of bed and sent to school on a day when I knew I was going to have to face the maths dragon, Mrs S. Just seeing the green maths bag with its protractor, compass and set square made me quake. To this day if I see a similar coloured or shaped bag, my fears come flooding back to me.

No wonder I was maths phobic.

Later, in my high school years, I had trouble seeing the blackboard. I dreaded the moment when my maths teacher would call on me to do a simple arithmetical calculation in my head and give the answer. It was torture - what if I got it wrong?  Frozen with anxiety,  I had no hope of giving any answer, let alone the one my teacher seemed to want.  

We just don't know how many students are experiencing the rigours and structure of the classroom as anxiety provoking, dreading every new school day and hiding at the back of the room, trying to avoid prying eyes. Being called upon to give an answer in front of class can be particularly daunting for students who suffer from performance anxiety.

And for some young people, school is a nightmare.

Being bullied, not fitting in, judged harshly or having expectations placed on them that they just can't meet. These are all difficulties that many students find overwhelming, sometimes insurmountable.

Schools are regimented environments and many students just can't manage the confinement and routine of a day sequestered into the same dreary four walls. The enforced social interaction and claustrophobic, unyielding environment of large modern schools can turn some high achievers into lost souls, daydreaming the school year away - or worse, school refusers, spending their formative years hiding in their bedrooms. 

Students drop out of school for lots of reasons. Often they are having trouble fitting in. "School refusal refers to severe emotional upset experienced by a child at the prospect of attending school that can result in significant school absence. School refusal is different from truancy in that the child is staying at home with the knowledge of the family and despite their best efforts to enforce attendance. Children who refuse school do not typically engage in antisocial behaviour that is associated with truancy, such as lying, stealing or destruction of property. School refusal is also different from school withdrawal, a term used to refer to circumstances in which the family keeps the child at home for various reasons (eg to support a family member who is ill)." (From the Kidsmatter website.)

Without sensitive support these students can be lost to the system entirely. We need to remember that not everyone can fit into the demands of the schoolroom, although the expectation is that they do. With the recent increase in funding for mental health training for teachers and extra support for schools, we can hope that some of the "lost souls" of the system can find their way back. But its best to keep in mind that many young people who "fail" at school are themselves failed by an inflexible system that can't meet their needs and requires them to conform in ways that they just can't manage.

 

 

Anxiety

I had to get out.

I found myself rushing through peak hour traffic to catch a tram. My heart was pounding, pulse racing - I thought I was going to die.

The feeling of being out of control, that my body wasn't going to survive this adrenal onslaught, that I was having a heart attack, escalated my fear and desperation. I wasn't in physical danger, but I was absolutely terrified and focussed on escape, more so than on the basics of road safety and taking time to cross the road at the lights.  

I was having a panic attack.

It was my first and most bewildering experience of overwhelming anxiety.

For many Australians this might be just one of many experiences of anxiety and the crippling sensations and fear that are its unwelcome companions. Some young people live beside anxiety everyday. "One in six young Australians currently has anxiety. This equates to 440,000 young people, aged 12-17, who have experienced anxiety in the past 12 months. 

Young people with anxiety might feel anxious, on edge or worried most of the time. Feeling overwhelmed or frightened is also common. They may experience a range of physical symptoms as well, such as a racing heart, butterflies in the stomach, muscle tension, shaky hands or perhaps feel nauseous.

Despite the prevalence of anxiety, there are strong indications that stigma still exists amongst young people. A beyondblue survey of 600 young people across Australia revealed the strongest barrier to seeking help remains other people’s judgment; four in five Australian teenagers may not seek support when they are experiencing depression or anxiety because they are worried what other people will think." From Mindmatters https://www.mindmatters.edu.au/about-mindmatters/news/article/2016/05/05/anxiety-in-young-people

Despite the good work done by organisations such as Beyondblue and headspace and the difference made by celebrities and sports stars talking openly about their struggles with mental health, there still remains some negative stereotyping around common mental health conditions like anxiety and depression. Its not the image of youth or young people with which we like to identify.

Anxiety is a part of the human condition - all of us experience it at some time in our lives. Its when anxiety gets in the way of us doing the things that we want to do that it becomes a real problem. It might for example, stop us from socialising or going to parties, taking risks, doing new things, meeting new people, joining a team or learning a new skill. We learn to dread the unpleasant and debilitating feelings and bodily sensations. We can start to avoid situations where we might experience anxiety. This works in the short term, but in the long term it can make things worse because we don't get to have the experience of successfully managing anxiety or of doing something that might seem scary, but that, in the end turns out OK.  Most of the time the bad things we were expecting to happen don't happen, but if we avoid doing something that means a lot to us because we are feeling anxious, then we never get to find out that things will be OK.

Growing up, we learn to manage anxiety through good modelling and through containment, validation and naming our feelings. Our parents teach us how to understand what we are going through, put a name to it and help us to self-soothe. They let us know that it is something all humans experience and that it won't destroy us - even though there might be times when it feels like it will.

Its hard to make anxiety go away just by wishing it wasnt there. Mindfulness, meditation, being physically active, sleeping well, doing the things that we enjoy, and taking small steps towards our goals can help us. Focusing on what we really want out of life and working towards that rather than focusing on our anxiety and fears can show us the way forward. We can learn to live alongside our anxiety and in the process of living it diminishes and ceases to control our lives.

 

Headspace article with some useful links to information about anxiety.

 

Self-harm

 

It was a memorable email.

A young girl wanted to know how to cover up her self-harm scars so she could look great in the sleeveless gown earmarked for an upcoming High School formal.

Her friends didn't know about her cutting.

But they were going to find out -  if she wore the coveted strapless dress which had now taken pride of place in her wardrobe.

Recovering from a period of self-harming behaviour and doing well in school, she was ready to have fun at the most important social night of the year. And maybe, just maybe, she was ready to have a conversation with her group about self-harm and how it had taken over her life - for a while.

I found myself in tears, because, yes, she had recovered and yes, she was brave, BUT she didnt know whether her friends would accept that damaged and vulnerable self - the one who took a blade to her bare arms when she felt overwhelmed by emotion. And maybe she wasn't sure whether she felt OK about that history and that other, troubled and troublesome self.

Stigma is a terrible thing.

It can stop us from telling people how we are really feeling and it can stop us from seeking help. It can stop us from taking a chance and talking to the people who matter about the more vulnerable parts of us. Maybe our friends aren't ready to hear, maybe they will shrink away, maybe they will judge us, or even reject us. Peer acceptance is so important at this time and fitting into the group can seem like its the most important thing in the world.

hands-istock.jpg

As a clinician specialising in young people's mental health, I have helped many young people with self-harming behaviours.  In "Young Minds Matter" a summary of the second Australian Child and Adolescent Survey of Mental Health and Wellbeing published this year, the authors find that "1 in 12 adolescents aged 12-17 have self-harmed in the past 12 months." A worrying statistic - unfortunately, self-harm is becoming more and more common.

So why do young people do it?

 I think it is for many reasons, not all of which can be summarised here. Often it is a coping mechanism for feeling states which are overwhelming to the young person, who may be struggling with the stresses of home and school or coming to terms with discovering who they are and how to be. Adolescence and young adulthood is a time of tumultuous emotions and some young people find cutting or other forms of self-harm will help them to ride the storms - temporarily. It can become the go-to "solution" which they revisit when everything becomes too much.

Parents who discover that their child is self-harming are often too shocked and overwhelmed themselves to understand that for the young person the behaviour is intrinsically rewarding - it helps them feel better. Often a discovery of self-harm can lead to a power struggle - a tussle between child and parent over what is, for parents, a very distressing behaviour. Its important to get to the bottom of why a child is behaving in this way, rather than just trying to prevent them from doing it.

For the girl who sent me the email, things had improved. She was recovering and no longer used self-harming behaviour to help regulate her emotions. But for many other young Australians, its something that they do - and keep doing, because it makes them feel better and nothing else can provide that reprieve. Taking away the safety net of self-harm can cause more distress. Talking through the issues, and finding distraction techniques to manage overwhelming emotions can help. But in the long run, we need to help them come to a place where the behaviour isn't necessary anymore. That is something that can only happen through the work of therapy. 

If you would like more information on self-harm, if you are worried about a young person who is self-harming or about your own behaviour, please contact me via the "get in touch" button.