Mindfulness

We have more possibilities available in each moment than we realize
– Thich Nhat Hanh

Mindfulness. Presence. Awareness. Connection. Centred. Focused.

We hear about the miracles of mindfulness alot. Originally an idea taken from the Buddhist philosophy school, the technique of mindfulness has made it’s way through self improvement, self-improvement and therapy and now into our common parlance. I’m no buddhist monk, but let’s explore what mindfulness means and how we can use it in our lives and therapeutic growth.

It seems mindfulness, awareness and presence are interchangeable words when thinking about this idea. Mindfulness involves being aware of your thoughts, your feelings, your behaviours, your situation, the others around you and what I would describe as spirit or psyche or “who you are”. Putting up a mirror in this way towards yourself, your thoughts, actions and reality allows for insight and the experience of beauty.

Much of our experience is automatic. We breathe automatically, we blink automatically, we dream automatically. Whether we’ve gotten used to our realities, routines and relationships or we tune out to not feel psychological pain, it seems our brain often go into an ‘auto-pilot’ state where our minds are running primarily subconsciously. Mindfulness is the task of actively bringing this information into the conscious mind for us to experience fully in the present moment.

Awareness in this way can bring us into union with our experience and begin to foster a relationship of knowing and deep insight. It’s no wonder then that this practice has been adopted by many therapeutic communities. A branch of Cognitive Behavioural Therapy can MBCBT (Mindfulness-based Cognitive behavioural therapy) uses the practice of mindfulness to aid in becoming more aware of our thoughts, feelings, behaviours and felt sensations and how they relate. In Dialectical Behaviour Therapy (DBT), mindfulness is used as a tool to aid in recognising distress triggers and build-ups.

Mindfulness can be developed through meditation, as it is a key part of meditation, however mindfulness is not the same as meditation and you do not need to be a meditator to grow your mindfulness. Mindfulness can simply be taking moments to notice your feelings, taking a moment to really experience your senses or taking a moment to realise what your thinking. I find that actively breathing is a great practice to jump into awareness as that in itself is an act of making what is usually unconscious conscious.

Here’s an exercise for mindfulness:

  • Firstly take a deep-breath and slow your breathing, 4 seconds in, 4 seconds out
  • Notice our surroundings visually. See the whole field of your vision as one and then pick out three things you notice
  • Notice your hearing. What can you hear? Listen and pick out something loud and something quiet
  • Feel your body. Not by touch but through awareness. Are you moving or are you still? Can you sense your hands without touching them? Your legs? Your torso? Zoom out and experience them all together as your full body
  • Experience your mind. Is it busy and loud or quiet and subtle? What thoughts come up? Just notice them as they come and go. If you engage in the thoughts, just notice that and don’t resist them
  • Experience your world. Notice that you are one with a much larger system. The outside, the universe, humanity, God, however you perceive it.

Mindfulness is a subtle practice that helps us be more aware of our life and thus helps us engage with it more actively and willfully. With more knowledge we can act more appropriately or simply just experience life in truth and fullness

Crisis and Distress Tolerance Skills

A crisis; a time of intense difficulty or danger. High levels of distress can lead us into a crisis and crises can be particularly frightening and dangerous. Crises can involve but may not always include;

  • Extreme emotions such as; rage, despair, intense anxiety
  • Panic Attacks
  • Suicidal/Aggressive thoughts, threats or attempts
  • Inability to communicate; incomprehensible or muffled speech, inability to articulate thoughts properly
  • Loss of touch with reality; hearing or seeing things that aren’t there, strange thoughts and beliefs (paranoia, hallucination, psychosis)

If you believe you are currently undergoing a crisis, please reach out to a crisis intervention team now. You will be put in touch with volunteers who are trained in helping people through crisis.

Call Samaritans: 116 123
Text SHOUT: 85258

Distress Tolerance

Avoiding crisis involves managing distress as we experience it. Distress is when we experience extreme anxiety, sadness or pain. This could be due to a loss, a difficult life situation or unhealed past traumas. Some short term ways we can reduce distress include:

  • Activities: This could involve engaging in hobbies, going for a walk, watching a videos, listening to music. Activities are a good way to distract us from our negative emotion and build positive emotion through pleasant, enjoyable and healthy behaviors
  • Contribute: Volunteering to do something for someone or many can help us feel more connected to the world around us and we often feel positive emotions when helping others
  • Push away: There’s nothing wrong with pushing away or walking away from a negative or distressing situation in order to gain some mental space. This can help us let the negative emotion cycle to settle and give us mental clarity on the situation later.
  • Thoughts: We can use our thoughts to focus other things while our emotions reach homeostasis again

Mindfulness for distress

Mindfulness can help us develop our sense of in-the-moment awareness of how we are physically, emotionally, mentally. It can help us see the connections between our thoughts, feeling and sensations and how they relate to the events in our lives. Importantly with regards to distress, we can use this awareness to help us to wisely navigate our experience when undergoing intense emotions.

Peaks and troughs of emotional activity

Mindfulness can help us understand this curve as it goes up and down. Things we can be aware of include the event that triggers the response, our perception of the event that took place, thoughts that arise from the emotions, the physical changes that come with the emotional and what happens as our body restores its homeostasis.

As well as helping us be aware of our emotional cycles, we can be mindful of things that may make use for vulnerable to negative emotion. Things that can effect our emotions negatively include physical illness, the quality of our eating, any medication we are taking, the amount and quality of sleep we’ve had and our level of exercise. Improving and treating these variables can give us more emotional stability.

In my experience, mindfulness is a very important part of good mental health and I will be writing more on this topic in the future

When reducing distress, we’re really wanting to reduce our negative emotions while increasing our negative emotions. To do this, we need to learn how different things effect our emotional states and then endeavor to nurture behaviours, thoughts and experiences that bring about these states. Journalling can be a great tool for this. We can record events as they have happened and examine our perspectives on them and explore ways we can remedy the negative situations or bring about more positive ones.

Positive routines to generate positive emotions

Giving ourselves good, healthy routines that bring about positive emotional experiences gives us a good foundation for keeping our distress levels down over time. While some routines will be very personal in their emotional outcomes, certain routines are generally effective for all. These include;

  • Getting the right amount of sleep – Good sleep routines improve our physical and mental health. REM (Rapid eye movement) sleep in particular has been demonstrated to help us regulate our emotional health.
  • Starting the day with good hygiene – Good hygiene in the morning makes us feel fresh and more presentable to others
  • Eating a healthy, balanced diet – Having the right amount of macro-nutrients (carbohydrates, protein and fat) keeps are body healthy and effective. Also micro-nutrients (vitamins, minerals etc.) perform a whole variety of roles that include regulating our mental health e.g. Vitamin B6 has been shown to help us regulate our moods and has been used to treat symptoms such as anxiety, depression and irritability
  • Taking time to plan your day – Planning our day can help us keep our routines together as well as make the most out of our day. For people who are more inclined to a free and open schedule, planning can still help us see what an ideal day would look like to us and we can use it as a reference for positive ventures
  • Physical exercise – Physical exercise releases endorphins that make us feel good and also promote self-esteem and cognitive functionality. Regular exercise has been shown to reduce anxiety, depression, negative mood and social withdrawal
  • Taking a moment to relax and reflect – Taking out a portion of the day to just sit with ourselves to relax and reflect with no distractions can help us check in with ourselves to see how we’re doing emotionally as well as give us a break from our activities to center ourselves and develop mindfulness
  • Spending time with loved ones – Spending quality time with those who are important to us gives us a feeling of connection that can reduce stress and improve psychological well-being. One study found that people who view their friends and families as supportive reported a greater sense of meaning in life and felt like they had a stronger sense of purpose.
  • Practicing gratitude – Taking time to be thankful for the positive things in our lives helps us develop a positive perspective and attitude. When we’re thankful, we find it easier see the positive aspects of life events and situations which is easier on us cognitively and helps us build emotional resilience
  • Helping others – Using our time to provide value to others can be very fulfilling and also leads us to social opportunities which can be beneficial to our own lives, such as creating and developing friendships. While helping others can be fulfilling, it can also be another source of distress. This is why it is important that we have healthy boundaries in place to protect our emotional well-being from being hurt.

We will all also have our own routines that provide us with positive emotion, whether that’s something relaxing, something thrilling or something that fulfills us intrinsically. What are these for you?

Truth: Part 1 – A Poem

Truth is an elusive thing
A stalwart beast whose speed
is matched only by her strength
In her stance, like trees
Unwaivering
Holds the Earth together in her roots


Man tries to tame her
With words to surround her
Psychic cages to bind her
With hope, that one day
They can ride her
On her back through the heavens
Around the sun and back


But words from weak lips
are not made from gold nor steel
but from iron and lime
Walls, that peel and crack in the north wind
And break as they fill with the sands of time

– Jonathan Pointer (10/07/2020)

Grief

Grief is the experience we go through after a loss. The losses we grieve for most are the losses of the most deep and important connections we have. For example, the loss of a loved one to death, a relationship to separation or even the loss of an object that you hold dear such as your business or a family heirloom. Grief is often described as a painful and stressful experience for grieving and can often go on for long periods of time before we adapt to the loss we have suffered. Understanding how grief happens to us, lends us an understanding that certain experiences are very normal and gives a sense of movement to the experience.

The stages of grief

The stages of grief are commonly known, however the specific stages, number of stages and representations or these stages vary depending on the theory.  This variability, however, tends to follow the same ideas and they generally overlap. The stages usually identified tend to stem from Kubler Ross’ stages of dying (1973) which focus on the stages that occur to the dying themselves. These stages are; denial, anger, bargaining, depression and acceptance. But there are other models for this process such as Bowlby and Parkes’ stages of grief; numbness, pining, disorganization and reorganization. We can see lots of parallels in these models and knowing a few can help you to develop a better resolution idea for what grieving entails

Here is a six stage model of the grief process by Andrew Reeves in the book: ‘An introduction to Counselling and Psychotherapy: from theory to practice’. The model blends both Kubler Ross’ stages grief and William Worden’s stages of grief and goes as such:

  • Shock and Denial: The suddenness of the loss will create a numbness towards the event as a means of reducing anxiety, sometimes denying the reality of the event.
  • Pain and guilt: These follow as the denial and shock wane; the pain of the loss is realised. Guilt may sometimes be present surrounding the wish that there could have been more done or said to the individual.
  • Anger and bargaining: Emotional distress can manifest as rage or bargaining to change the situation.
  • Reflection and loneliness: Here we reflect on the loss and realising that their loved one is not coming back and experiencing loneliness in their absence
  • Reconstruction: This is where we begin to work on putting our lives back together in consideration of the loss and work towards building a new future.
  • Acceptance: We begin to accept the reality of the loss and live life without the attachment

The idea of grief began as a linear model and as we’ve studied grief more, we now see grief as a much more chaotic process, with people jumping between the various stages as our emotional and mental states influenced by many variables, from different life experiences to the ability of the individual to find their own sense of meaning and peace. Anniversaries or special occasions, for example, can reawaken feelings of grief and we experience and recognize the loss yet again.

The Tasks of grief

William Worden (2009) proposed the four tasks of grief, that one who is grieving flexibly undertake over time as they assimilate their grief into their new life:

  • Task one: Accept the reality of the loss: – One must both intellectually and emotionally accept that the lost love one will not return. Loss rituals, such as funerals, will help with addressing this pain
  • Task two: Process the pain of the grief: – Rather than trying to avoid the pain, it is important that one experiences the pain. Supportive people such as friends, relatives or therapists can help us through this pain. The only way out is through.
  • Task three: Adjust to a world without the deceased: – Adjustments will include changes to routines, self-identifications and emotional needs. These all need to be worked through in time. People may need to re-evaluate their future with the deceased no longer around.
  • Task four: Establish an enduring emotional connection with the lost loved one and move forward with life: – The deceased that is mourned will always be a part of that persons life, but now its necessary to re-frame that connection, not by forgetting, but by reconnecting with their life and celebrating the memory of the lost loved one.

Grief is a chaotic and painful process and the details of each case will vary on the individual and the particular loss that is grieved. Some losses we will have no problem accepting and moving forward from and other will require lots of time and patience. Each instance will be unique and so be caring to yourself when going through grief. Some grief in life isn’t always meant to be overcome. Sometimes the best we can do with our grief is accept that it’s there and that at times, it will cause us pain and that that’s okay.

The Cycle of Change

The Cycle of Change model, developed by Prochaska and DiClemente, helps us understand the process of how we change our behaviours. The model highlights the stages of awareness and commitment involved in behaviour change. Here’s a visual:

Let’s outline the different stages of the model and explain what may be going on here for someone with the addiction

  • Pre-contemplation: This is before any intention to change behaviour is present. The individual may or may not be aware that they have a problem or of the harmful effects of the behaviour in question. This could also be where the client has tried changing before but has relapsed and now is back into the habit with the idea that they aren’t going to change or they would like to change but think it would be too hard to do so chooses not to think about it.
  • Contemplation: Now the individual is thinking about the change and what that may involve. This includes the benefits of change and the routes they may take to get there. At this point is aware that their problem is there but are not committed to the change. Here the individual will explore action plans, be looking into how to get help or maybe even just may talk about it with close relationships. Here the individual need to come up with a plan that they think is realistic and achievable and then they can commit to planning to change.
  • Preparation: Intent is fixed on change and the behaviour change is imminent. Now the individual prepares for that change. This will include planning for the eventual cravings and deciding on the choices they will make in turn. Good preparation may include having a support network for times of crisis, creating appropriate distance from any triggers for the addiction to relapse and creating a specific date for change and committing to this.
  • Action: Now is the time for action! The time has come for the behaviour to change and the individual has committed to it. For action to be successful, it will involve several positive decisions leading away from this behaviour and positive reinforcement from the individual in each success.
  • Maintenance: Now the behaviour has been changed. The individual now needs to nurture these new behaviours as they become easier and replace the old behaviours. It’s important to keep in mind the reasons we changed the behaviour because cravings and temptation can come back at times of stress or in certain environments and in these trying times we must remember the importance of the change and keeping the positives of being clean of the behaviour clear in the mind. Maintenance could potentially be a lifelong stage once the behaviour has changed for the better. However, sometimes we can slip back into old patterns and enter a relapse
  • Relapse: The individual in relapse has fallen back into the old behaviours. This usually happens little by little with small decisions and allowances. However, it’s not long before the old behaviour is back in full force. Paying attention to this time of relapse can bring great insight into holes in ones’ armour with regards to their maintenance skills.

The cycle above could repeat itself several times before a resilient maintenance is achieved. However, each attempt at behaviour change holds the opportunity for learning about oneself and one’s needs. This is why we can visualise this cycle as a spiral. Each time we gain insight and experience the change and new behaviour, we build more momentum into holding the change

Each behaviour we have will subjectively meet one or many needs and it’s important that if we are to truly change a behaviour that our needs are being met by healthy means and not by the means of a self-destructive addiction.

What is CBT? (Cognitive Behavioural Therapy)

CBT, or Cognitive behavioural therapy is a short-term talking therapy that focuses on the relationship between our thoughts and behaviours as they relate to our problems. CBT was developed by psychologist Aaron Beck and focuses on the way we think and how that affects our feelings and behaviour. It combines both behaviourist ideas like conditioning and ideas of cognitive therapy, creating a model of how we operate. Cognitive therapy proposes that people can become aware of their thoughts and can be responsible for changing them and that sometimes, our thoughts that surround a situation are sometimes distorted and do not always accurately represent reality. It suggests that these cognitive distortions and negative interpretations of reality are often the cause of our emotional distress. We then learn from these experiences that these interpretations are our reality and are likely to experience the same distress in the future

Cognitive behavioural therapy explores the link between our thoughts, feelings, emotions and behaviours in a given situation. If we can see how these parts interplay, we can gather a full picture, like a map, as to what is happening for us. The map looks something like this;

We find ourselves in a situation; The situation is perceived, and our perceptions will cause us to make sense of the situation with thought. The thoughts are then followed by responses to our perceived situation, through emotions, behaviours and physical sensations that result from our bodily responses. In this model it is important to distinguish between the separate categories and to help the client do the same. Emotions for example are very specific states of mind and body that will naturally result in certain thoughts, physical sensations and behaviours. Clearly identifying which things are which will give us a clear idea of the situation and how we are responding.

Once we have a model laid out, we can then challenge what is happening to make change. By changing one element, that will in turn affect the others. We can challenge the situation cognitively; by looking at alternative interpretations of the situation, identifying distorted and negative thoughts and coming up with more accurate and positive thoughts. We can also challenge the behaviours, spotting behaviours that may lead to us feeling negative emotions or thinking negative thoughts. Often behaviours will be more difficult to change than thoughts as they are reinforced by our emotions and thinking patterns, however certain behaviours may be easier to change than others i.e. our breathing patterns and posture. These can lead to reduction of negative physical sensations and encourage positive emotions.

Challenging thoughts and behaviours can take a while to take affect truly. We need to acknowledge that many of our behaviours and thoughts are learned in earlier life and have been reinforced over years of repetition. In CBT, homework is a very important part of the process. With homework, people can take notes of what is going on and attempt changes, taking note of the effects that result. In doing this, people can see what approaches and changes work for them, and those which don’t. These observations can then be brought to sessions for review or to explore different or more progressive action. The effort of doing homework can help the clients to develop the ability to self-heal and develop their own self-awareness through the framework of CBT and could reduce the time it takes for their healing to occur. Some exercises that people may do as part of their homework could involve learning relaxation techniques, practices slowing down the pace of their life so they can develop awareness, developing affirmations and positive rational statements and making them permanent.

Cognitive behavioural therapists use a method of communication called guided discovery. Guided discovery is a way of asking questions to help the client explore their problems and solutions to them consequently. This involves actively asking questions about the problem, active listening with empathy, summarising and helping to create prospective positive futures to work towards.

Cognitive behavioural therapy can be quite difficult work for people and may not appeal to some people due to the hard work involved. Unfortunately, many people who undergo cognitive behavioural therapy drop out. However, for those who undertake the therapy, there is a very strong rate of improvement and success

The Wheel(s) of Life

Here are some tools for assessing our lives periodically to make sure we’re getting the most out of our lives!

The wheel of life is a tool we use in therapy to help somebody examine different areas of their life and see where there is satisfaction and dissatisfaction in them. We use it to rate the areas in overall satisfaction and what it gives us is a representation of how we feel our life is going and may point to areas we could lend some attention to so that we can improve it.

Here’s a wheel I found from coaching site: https://titaniumsuccess.com/titanium-wheel-of-life/.

Each sector has a rating between 1 and 10. Rate each sector with your overall satisfaction and a wheel will begin to show. This is your wheel of life.

Naturally, your wheel is likely not going to be the smoothest wheel. A bumpy wheel shows us the areas that could be improved in our lives. Bigger wheels are better too!

Once you’ve identified the less fulfilled areas, ask yourself: What are one or two things I can do now to improve this by one, maybe even two points?’, and write them down as goals.

The wheel of life can be a good tool to use at regular intervals in your life. It’s like checking in with yourself and saying; ‘Okay, where I could I be focusing my energy moving forward?’. Self-inquiry like this can really help us get in touch with our feelings and our drives and dedicate some solid attention to our life.

The wheel of life doesn’t just have to be a method of scrutinizing our shortcomings either. While there is merit in this, we can use it to celebrate our areas of success, reflect on how we’ve gotten there and appreciate our victories and efforts.

The Wheel of Dharma

Another favorite wheel of mine is the Wheel of Dharma. Yeah, that’s right, I have favorite wheels. This comes from the Buddhist and Hindu religions and is used to help describe our engagement with our lives. Dharma means ‘duty’, making sure we are engaged in life in the right way is an important responsibility when it comes to living the best life we can, for ourselves and others

  • Right Mindfulness: I am aware of what I’m experiencing now
  • Right View: I’m aware of what I need to be
  • Right Intention: I’m aiming to my highest good
  • Right Speech: I’m articulating my thoughts well
  • Right Action: I take the proper action
  • Right Livelihood: I live toward the collective good
  • Right Effort: I give what’s necessary
  • Right Concentration: I am aware of my focus

Wheels are good visual ways to remember a collection of ideas. These wheels can help us check in with ourselves and to give us insight into where and how we can improve our life position. Awareness of where we are, where we want to be and how to get there will give us direction and while keeping us centered.

Working with the future

Introduction

Many people are likely to come to therapy with some sort of goal in mind as they are going to want to live, to some extent, free of the suffering they’ve felt in the past. Whether they are coming for help with anxiety, depression, stress, they desire to change will be what brings them to therapy in the first place.

It is likely though that the client will not have a clear picture of what they are moving towards, and instead be primarily concerned with moving away from the source of their unease. For example, someone with social anxiety may not know how it is to experience life without their anxiety being a problem, their main desire could be to get away from anxiety but may have no idea what it would be like to be acting conversely and acting embrace social situations and develop relationships.

As therapy begins, we want to focus on the present but towards the end of therapy we need to begin to conclude the therapy itself and look forward to the future of the client after the therapy ends.

Identifying client’s aspirations in relation to their presenting issue

When considering goals and aspirations of the client, we want to elicit the exploration of the client’s potential future. Throughout therapy it’s important to be aware of the client’s hopes for the future so the first thing to do is to determine what the client wishes to achieve. It may be difficult for some clients to look ahead given their state of mind or position at that time, so it’s good to discern the person’s state and respect the place they are in.

We want to take note of any possible future issues the client feels they will face after changes, especially in relationships. Fear of these issues could be preventing the client from facing their presenting issue, so it’s important that they are prepared and aware of the consequences they will incur.

We need to determine the client’s consciousness of their future. Whether they feel optimistic and ready to face their hurdles or they are fearful of what may come. We can explore these fears, whether past or present, as it’s important that the client is ready to move forward to a different future. It’s important for the client to understand what elements of their past and present affect their future self. Some tools for exploration of consciousness of the future include free association and guided visualisation.

The image of the client’s desired future self will be emerging slowly. This is good for the therapeutic relationship as we are both exploring the place we are moving towards. This is resonant with the person-centred concept of the ideal self. Moving towards this ideal self is known as ‘self-actualisation’ or ‘individuation’ in Analytical psychology.

Setting goals and therapeutic aims

Client’s may not have a sense of a future after therapy or even how they want to change and develop, so as therapist we can help the client in exploration of this. We can use several exercises with the client to explore potential areas of development and/or goals. ‘The Wheel of Life’ game can be a good exercise to do throughout therapy to explore areas of where development or where focus could be shared to different areas in their life and being. ‘The Lottery Test’ can be used to test for aspirations and life goals. Exploring a ‘5-year plan’ can be used to determine long term goals with realistic steps. For setting new habits we can use the reward to cycle also by creating a cue, understanding the process of the habit and then knowing the reward or even giving a reward for the behaviour.

Once we have identified goals, it’s important the we prioritise our goals and address the most important goal first. We can also assess each goal and see what each goal will entail and how much time and energy each goal is going to require.

For assessing goals, we can use the SMART model. The goal will be:

  • Specific, – Is the goal specific? What is it exactly we want to focus on?
  • Measurable – Can we observe this change? Can we measure and notice as change is happening, gradually or suddenly?
  • Achievable – Is it?
  • Realistic – Do we think it is?
  • and within a Time frame – How long do we want to be working on this? Do we have a specific time we want to have this goal achieved? Also, what time frame are we going to use to give time to approach this goal?

The way the therapy will concluded should be explored in the early stages of therapy and involved in the contracting. Conclusion could come after the first session or after many and could change as the client explores their self. This is why goals are important in therapy as this way we know what we are working towards and whether we are achieving things or are on the way to achieving things. The achievement of one goal could also lead to another goal being made and it’s good to be flexible to the client’s needs. Whatever happens, it’s good to know where we are going always.

 The therapy is going to end eventually and so achieving closure is important for the therapeutic relationship. Closure can happen in several ways. It can be created by the therapist after determination that goals have been met and that for their own autonomy to kick in, it’s now time to take their goals on with their own volition. It could also be that the therapy leads to more complex issues that the therapist is unequipped to deal with and so refers the client on to a new course of therapy. Of course, the client can also elicit closure at any point either through discussion about their desires to cease therapy with the therapist or by simply deciding to longer attend therapy. It’s important to keep records of closure with client’s so that therapy may continue or if we are to refer.

Psycho-dynamic Therapy

Freudian Psychodynamic theory

Sigmund Freud was an Austrian psychologist who is seen as a godfather of western psychology. He contributed a collection of ideas still accepted now by many and, while lots of these ideas have been further developed and/or reconsidered, are practiced widely by psychotherapists. He discovered so many psychological axioms that many of his terms are now in common language i.e. the conscious and subconscious, libido, oedipal complex etc.

Conscious, subconscious and unconscious mind

Freud described three levels of awareness within the human mind. These levels are the conscious, subconscious and unconscious. Together they create our perceived reality. The conscious mind functions to direct focus and to actively imagine that which is created with the mind. It will store information either in the unconscious or the subconscious, or pre-conscious mind. The subconscious mind is for storage of information, memories, needed for quick recall, such as recurring thoughts, behaviour patterns and habits. The unconscious hold all of our memories and past experiences including, memories that have been repressed or conscious forgotten. From these memories our beliefs, habits and behaviours are formed. Proportionally only 10% of our mind’s work is through conscious activity.

Id Ego Super Ego – Models of self

Freud described three elements of self, naming them the Id, the Ego and the Super-ego. As a model, it aims to describe how our reasoning and rational self, the ego, works to balance our inner desires and urges, the Id, and our developed sense of morality and perfection, the super-ego. These components of personality are said to be in conflict with one another as person goes through life and if the conflicts are not resolved this will lead to anxiety and stress contained within the ego.

Freudian Drive theory

Freudian drive theory aims to understand how people are driven into their actions or behaviours. Freud employed two symbols, Eros and Thanatos of Greek mythology, to describe certain energies that motivate people. Eros, the god of love in Greek mythology, describes the drive towards life, of sexuality, love and creativity. Eros comes from the Greek for ‘desire’. Eros in psychodynamic thinking symbolises the building of tension of desire, such as sexual desire or the desire to self-actualise in some way.  Eros works with the pleasure principle; the guiding force of the Id. Thanatos is a personification of death in Greek mythology and is used in psychodynamic theory as a drive towards death and self-destruction. Originally termed by Freud as the ‘Death instinct’, Thanatos is self-destructive drive that works against the pleasure principle. It seeks to return life to its inert, inanimate state, a place of no suffering or pleasure, of death. This death drive is a way that the body mind will aim to achieve homeostasis through the release of anxiety or death, which can symbolise an end of the present to allow for the new. The death instinct was the driving factor for people reliving traumatic experiences, engaging in risky and self-defeating behaviours and for being aggressive with others

The drives are fuelled by the libido. Libido, in Freudian psychology, is a life energy that fuels our actions. It is a sexual energy that is stored in the Id. In the psychosexual stages of development, the libido will fixate on certain sexual areas in the body, known as erogenous zones. Libido will motivate someone to seek sex. However, if someone is unable to achieve this, this desire can be repressed (pushed down and out of awareness) or sublimated (channelled into other activity). Libido is affected by a range of hormones of neurotransmitters including testosterone, oxytocin, oestrogen and serotonin. In women, libido will be affected by the menstrual cycle. It an also be affected by several physical and psychological variables.

Post-Freudian Psychodynamic Theory

Freud developed a very successful and well received theory of psychology. He went on to teach his methods and theories to other psychologist and so his ideas were used by others in the pursuit of psychotherapy and the understanding of the human mind and its development. The theory has since had others develop some of his ideas into other theories that move away from Freud’s original ideas. Some of those others include Melanie Klein, Erik Erickson and William McDougall.

Object Relations

One way that psychodynamic therapy was changed and adapted was in the moving away from Freud’s focus on the sexual and aggressive aspects of his developmental models. Object relations theorists moved to the focus of importance of relationships between our selves and others, or objects.

Object relationships are intrapsychic structures that relate the self to others. The term object was coined by Freud to mean other people. In Id psychology, objects serve to provide instinctual gratification through the pleasure principle. The theory has a strong focus on the early relationships in childhood. The theory holds that we are relationship seeking, rather than pleasure seeking. For example, Kohut (1971) put it forth that children have a need to be mirrored and will seek relationships for idealisation and the creation of role models.

The development of self is different to psychosexual model of development proposed in id and ego psychology. Margaret Mahler (1968), an influential object relations theorist describes the first stage of an infant’s development as normal autism. In this stage, the child has no concept of self and other. Through the process of attachment, the child enters the stage of normal symbiosis. In this stage, the child is attached to their experience but is still confused with what is their self and the other, as they are perceived as one and the same. The child will then enter the process of differentiation where the child will explore with individuation from significant others and relationships. This process will normally take about two year before the child begins to integrate both their separate nature and their relationship between themselves and others. The task of development is to integrate these elements and to develop a sense of identity. Children will do this by expressing different parts of themselves and the process of splitting, which is when a subject will choose from two contradicting elements of character or personality. Another process in identity development is introjection. Through introjection, the subject brings the experienced forms of objects into the mind. While having their autonomy, a subject can this way have a sense of community. As the subject begins to relate to objects, these begin to develop their identity.

Objects relations therapy uses Projective identification as a means of communicating felt experience of the counsellor relating the clients object relations. For example, if the counsellor would have a feeling of anxiety when the client mentions their father, the counsellor may share this and enquire into any significance. It is thought that this is felt from a counsellor’s attempt to mirror their client and that these feelings may be related to something the client is feeling.

Erik Erickson’s stages of developments

A follower of Freudian psychology, Erik Erickson focused a lot on the development of people as they go through life. While having several distinctions, Erickson’s model is similar to Freud’s psychosexual model of development. One primary distinction Erickson’s theory had was that development does not stop once adulthood is reached and that life has a variety of development ‘tasks’ that an individual must face as they mature. These tasks will decide whether the person will err to one of two opposites

The stages outlined by Erickson are as follows

  • The Oral Stage / Trust vs. Mistrust – This stage occurs in early infancy, between birth and the age of 12-18 months. This is when the infant feeds from their mother. Here the infant will develop trust while maintaining an appropriate capacity for mistrust if necessary. The child needs consistency and a sense of safety for this to develop properly. If not, for example, if the child is neglected, the child will go on to have a sense of mistrust towards others. This will affect a child’s ability to develop relationships
  • The Muscular or Anal stage / Autonomy vs. Shame/doubt – This stages spans between 18 months – 3 years of age. Here the infant explores their self through muscular control, including acts such as walking, grasping and the control of their anus in toilet training. They will here begin to explore their environment and their ability to control and manipulate elements of it. When allowed free expression, the child will develop a sense of autonomy and in turn gain some self-esteem. If the child is hindered in this through excessive control, the child may develop a sense of doubt in their independence and socially this can lead to shame and low self-esteem
  • The Locomotor Stage / Initiative vs. Guilt – This stage occurs during the ages of 3-6 years. A child here will start to become more assertive and to take their own initiative towards their responsibilities. Here a child will start to become aware that their choices and actions have consequences and will begin to take responsibility for those. This responsibility will bring the capacity to feel guilt if their actions are deemed wrong or unfavourable by themselves or others.
  • The Latency Stage / Industriousness vs. inferiority – This stage occurs between the ages of 6-12 years. Here the child will usually have begun school and a process of socialisation. Through school they will begin to see how they are perceived socially, their level of competency in school and capabilities. Failure of tasks can lead to a sense of inferiority and inadequacy.
  • The Adolescent Stage / Identity vs. Identity confusion – This stage occurs during adolescence between the ages of 12-18. Here an individual will develop a sense of how they fit into society and the roles that they will take on. This will involve finding strengths and weaknesses, gauging social standing and the development of social, political and religious views. For the adolescent, there should be clear social and cultural rites of passage to signify the becoming of a powerful and responsible adult. If the adolescent struggles with finding their place socially or what it means to be an adult, they will experience identity confusion.
  • The Young Adult Stage / Intimacy vs. Isolation – This stage happens between the ages of 18-30/40. This stage is becoming longer now that the age that people are starting families is getting later in life. This stage is concerned with development of intimate sexual relationships. The individual will explore how to coexist in partnerships and how they relate to their significant other. This will lead to the development of love and devotion to a partner and the intimacy that comes with this mutual adoration. Failure here may lead to fractured relationships and a difficulty with love and commitment
  • The Middle Adult Stage / Generativity vs. Stagnation – This middle adult stage tasks the individual supporting future generations. They will provide some meaningful contribution to something ‘bigger than themselves’ and involving some expression of love that isn’t necessarily reflected directly. This involves raising children, teaching, writing, creating music and art. Success here will give the individual for the ability for caring and compassion throughout their life
  • The Late Adult Stage / Ego Integrity vs. Despair – Here the adult will reflect on their life and either be secure in themselves and their lives, decisions and experiences, or will reflect with regret and, in the inability to accept this will fight their upcoming mortality.

The success made in each stage will lead to an increased likelihood of the next stages being secured. However, the result of the tasks in the stage are not permanent and can be changed in the future.

Gestalt Therapy

What is Gestalt therapy

Gestalt therapy was developed by Fritz and Laura Perls in the 1950s. The word gestalt means ‘wholeness’ or ‘shape’ and is concerned with just that. It primarily works towards the development of awareness in an individual. To do this, Gestalt therapy says that we must be, here in the present moment. Gestalt therapies often aim to develop this connection between self-awareness and being present. To do this, Gestalt therapies aim to focus on what is presently happening. In this effort we seek to help a client develop insight, knowledge, acceptance of self and responsibility for self and actions

Perls’ noted that people often avoid change or realisation for the necessity of change and so regularly interrupt their contact with experience. They do this by being deceptive and avoidant of responsibility. However, for a person to develop they need to act and become a self-reliant entity. Because of this, Gestalt therapy used confrontation to get past these interruptions.

Gestalt therapy identifies several different contact disturbances, or, ways that clients avoid contact with their gestalt. To name a few we have:

  • Confluence: This is when the boundary between an individual and others becomes weaker and people start to behave not as individuals but as part of a collective.
  • Deflection: This is when the person attempts to distract attention away from themselves as a way of avoiding contact
  • Introjection: This is when the values of others are taken onboard without being subject to their own personal valuation and scrutiny.
  • Projection: This is when a person assigns ideas of themselves onto others as a way of reducing their own personal responsibility
  • Retroflection: Retroflection comes in two forms. The first is when people behave towards themselves in ways they would like to act onto others. The other is when you do to yourself what you would like to have done to you by others.

Techniques of Gestalt therapy

Dream work

In Gestalt dream work, the client will be directed by the therapist to explore the dream from multiple perspectives of being, taking on a first-person perspective with each element in the story of the dream. By the creative exercise being different characters and even objects, the client can get deeper into the significance of the symbols and stories in their minds.

Empty chair and Two-chair techniques

The empty chair technique involves the client having a conversation with an empty seat, imagining that someone of significance is in the chair. Rather than recount what I client would say to someone, Gestalt therapy invites the client to engage in a conversation with the image of that person, exploring thoughts and feelings that may arise during the process.

The two-chair technique is a variation of the empty chair technique, in which the client engages in empty chair dialogue, but also switches and endeavours to take on the being of the other character in the situation. This aims to develop empathy for the other person in this situation and to gain more understanding of the positions both people are taking.

Strengths and Weaknesses

Strengths of Gestalt therapy

  • Gestalt therapy put an emphasis on awareness and increasing awareness of the self and others. It presents active techniques that engage the imagination and could even be fun for to engage in.
  • Gestalt therapy encourages self-dialogue. I think this will present the opportunity for self-exploration

Limitations of Gestalt therapy

  • The confrontational side of gestalt therapy could be potentially harmful to progress if used in the wrong way. I think because of this reason; many Gestalt techniques should be used with caution.