Depression affects most of us at some time, either personally or indirectly with people we are close to. It affects people regardless of their age, occupation or level of income.
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Although depression is so common, people are often confused about what it is. It isn’t sadness such as we feel if a pet dies, as many people struggling with depression can feel numb, angry, agitated or anxious, but sadness is not usually what predominates.

Depression is a state of shutdown. It is also a shift in our emotional state, where we experience a significant increase in negative emotions, such as anger, irritability, despair and a down shift in our positive emotions, such as pleasure, curiosity and happiness.

Depression also causes people to feel fatigue, difficulty concentrating, problems sleeping and altered appetites for things like food and sex. In terms of thinking, depressed people tend to focus on things that have not worked in the past, rather than being able to see into the future where there are hope and possibilities. If the pain of depression and feeling trapped inside yourself is too great, then sometimes self-harm or suicide feels like the only way out.

Unfortunately, the paradox of depression is that it makes us want to do the very last thing we should do, which is isolate ourselves. We just want to hide in our cave, but if we retreat there then we are alone with no place to go. In effect, we just feed the beast that is depression and make it bigger and ever more overwhelming.

Although being in a state of depression might feel helpless, once we begin to understand the nature of this beast, then we have some tools to fight it. Certainly, the situation is not hopeless, even though we might feel totally lacking in the energy to do anything different. In my next blog post I will talk about how we can move from depression to solution, and a more fruitful state of being.

Dr Jules

If the subject matter in this article resonates with you, then counselling might be a good option to help you to move forward. I offer a free 20-minute consultation so we can explore how I might be able to help you. 

This week is Mental Health Awareness Week:

How many of you have paid attention to what you ate in the last year, maybe gone on a diet, or just tried to get healthier?
How many of you have been to a dentist in the last year, engaged in some form of physical exercise, or visited a doctor to get a checkup?

Our physical health is seen as hugely important, and most of us are aware of the need to look after it on a regular basis. Mental health, on the other hand, is invisible, and humans tend to disregard what they can’t see. However, just as the early detection of chronic illness risk allows us to change behaviours and prevent disease, so the maintenance of mental health can lead to the prevention of mental illness.

Many of the strategies that promote physical health, such as exercise, good nutrition and good sleep, also promote mental health and well-being. There are other things we can do to maintain mental health on a regular basis, and these include:

• Monitoring our stress and anxiety levels and being aware of when we are taking on too much.
• Being aware of when our mood declines for a prolonged period, as this can lead to depression.
• Noticing when our appetites (food, sex, social interaction) start to change.
• Be aware of the changes in our mood caused by alcohol or other substances and reduce their use accordingly. This is not the way to manage difficult feelings or challenging times.
• Seek social support and make time each day for communication with others.
• Take regular breaks to de-stress and wind down, even if it just going for a walk or meditating for ten minutes.
• Talk about your feelings, our emotions are important and shouldn’t be ignored.
• Do things you are good at, this brings about enjoyment and boosts self-esteem.
• Ask for help! Whenever you start to be concerned that you aren’t functioning as well as you normally do, talk to someone you trust or visit your GP, and consider seeing a counsellor or psychologist.

The prevention of mental illness is often an overlooked topic because we worry about the stigma if we admit we are struggling or need to seek help. People might tell us to pull ourselves together or get over it, which only exacerbates our sense that we should be coping better.

Remember, mental health is health. We cannot separate it from our regular routines of caring for ourselves, so care for yours on a daily basis.

Dr Jules

If the subject matter in this article resonates with you, then counselling might be a good option to help you to move forward. I offer a free 20-minute consultation so we can explore how I might be able to help you.

Conflict within relationships is inevitable; however rather than avoid it, we should seek to manage it so that it doesn’t become destructive.

One really helpful method of conflict management that I teach the couples I work with is to change the way they start a discussion with each other. This is vital because we can predict how a discussion will go (and what might ultimately happen to the relationship) from the first three minutes of the conversation.

As an example, consider these two ways of starting a conversation with your partner:

1. It’s Saturday, we have people coming tonight, and just look at this mess. Here I go again, picking up after you, why don’t you ever help?

2. I’m feeling overwhelmed by the state of the house and we have friends coming tonight. Can we please make some time to clean up the place together? I really appreciate how fast the work goes when we do it as a team.

The second conversation opener is more likely to elicit help from the partner, and its softer tone is less likely to start a fight or cause the other person to feel defensive. To break down the technique, try this formula:

1. Start your statement with “I feel …”

Saying ‘I’ instead of ‘You’ stops the other person immediately feeling criticized. You then name your feeling, such as upset, stressed, worried, sad, etc

2. About What

Describe the situation with facts and not accusations. Describe ‘it’ and not your partner or his/her behaviour

3. I Need

Tell your partner what you need to make things easier

4. Be polite and avoid blaming, keep your voice soft

5. Give some appreciation – recall when your partner did it right in the past and let them know how much you value that.

Remember, behind our harder emotions that we are sometimes tempted to show our partner first, such as anger or frustration, there are often softer feelings and vulnerabilities which are easier for them to hear and do something about. So, saying “it makes me feel lonely when we go to a party and we spend the evening in different parts of the room”, is different to saying “It makes me furious when we go to a party and you ignore me all night.”

Start entering your conversations with loved ones more gently and see how the results change. If you are struggling with your relationship, then couple therapy is a positive way to begin to repair and make positive changes.

Dr Jules

If the subject matter in this article resonates with you, then counselling might be a good option to help you to move forward. I offer a free 20-minute consultation so we can explore how I might be able to help you. ​

Most of us are our own harshest critics, but to have self-esteem means we have a realistic and positive opinion of our self, or confidence in our value as a human being. Good self-esteem is correlated with healthy relationships, satisfaction in life and achievement.

Too little self-esteem, however, tends to predispose us to lower levels of mental health such as depression, as well as falling short of our potential, or accepting abusive or disrespectful relationships. Too much self-love, however, can lead to an arrogant personality or be a sign of narcissism.

If you are one of the many people whose self-esteem could use a boost, here are some ideas to help you:

1. Make a list of your achievements and strengths. You might want to ask friends and family to help with this if you are not good at being objective about yourself. Then do something to demonstrate your ability. So, if you are a good organizer, plan the next family get together. If you are good with animals, get involved with a local shelter. Engage in the things you do well to build your sense of competence and esteem.
2. Become aware of the way you talk to yourself, or about yourself. As soon as you are aware of any self-criticism, remind yourself it is just a thought and not a fact. The risk is that if we continue to think this way, in time we can start to believe it.
3. Learn to accept compliments by saying ‘thank you’.
4. Think about the stories of you that people have told over the years, starting from your family when you were a child. Have you ever been told you are too fat, or too stupid, or that you fall short in some way? These thoughts can be changed with affirmations, so write out the old thoughts and write the new story about you next to them. Make it a story that is believable to you and not something fantastic that will make you feel worse if you can’t accept it as true. For example, ‘I am amazing and can achieve anything I set my mind to’ is probably not going to work if you are struggling to feel good about yourself; whereas saying to yourself each day ‘I am not those opinions others had of me, I am better than that’ can help you to start letting go of the poor self-image you carry in your mind.
5. Don’t compare yourself to others. Everybody on social media seems to be happy, successful and having a great time. This is just a mirage we all like to create, but it can lead to more negative thoughts about you. Why aren’t I out having a great time with lots of friends? Why aren’t my kids as successful as hers? Understand that we all have a reality where we struggle sometimes and accept yourself as being just fine as you are.
6. Make an effort with your appearance: treat yourself to a haircut and wear clothes that make you feel good.
7. Eat in a way that reflects someone worthy of care. Cook yourself good meals and even if you are eating alone, set the table and make your mealtime special to reflect your worth.
8. Set yourself small and realistic challenges or tasks, such as inviting a few people round for a meal or joining a local group activity that interests you.
9. Exercise! Whether it’s going for a brisk walk, cycling, or doing yoga at home with a teacher on YouTube, research consistently shows that exercise helps us feel better about ourselves, so prioritise it over other things on your daily To-Do list.
10. Do kind and caring things for others around you, even if it is just checking on an elderly neighbour or volunteering to do some dog walking at your local shelter. It always helps our confidence when we feel appreciated.
11. Don’t give time to people who treat you badly or sap your energy and leave you feeling worse about yourself. If you struggle with assertiveness, then consider reading up on how to be better at this so you feel able to say NO to people from time to time.
12. Recognise that you are not your current circumstances. We all have periods where things don’t work out as we hoped, or we don’t have as much as money, or it feels like life is stacking the odds against us. Differentiate between this challenge and your self-worth. Each of us has potential and value, so be compassionate towards yourself when things get tough.

Self-esteem is an important part of mental health, so learn to build yours on a regular basis if you know it could use some help. If your self-esteem has become too low, then consider seeing a therapist to learn to feel in control of your life again.
This is a free, quick online self-esteem test that you might find helpful:
https://www.psychologytoday.com/us/tests/personality/self-esteem-test

Dr Jules

If the subject matter in this article resonates with you, then counselling might be a good option to help you to move forward. I offer a free 20-minute consultation so we can explore how I might be able to help you. 

Most of us go through periods when good sleep eludes us. Either we struggle to get to sleep in the first place, or we wake during the night and then clock watch, getting more and more anxious about our precious sleep time slipping away and the thought that the alarm will be going off all too soon.

Sleep is vital for our health. Losing a few hours a night can impair our cognitive ability and mood, making it hard to get even the simplest tasks done. Constant lack of sleep can lead to us feeling depressed, anxious, easily over-emotional and more prone to illness.

Often my clients are having patterns of poor sleep when they come to therapy. They have developed patterns of anxious thoughts or worries that go around and around in their heads, making it difficult to turn off at night.

This is a technique that I teach to people, and that I use myself, to take your brain and body into a sleep state:

1. Allow yourself the correct amount of time you need to sleep and wind down. So, if you need 8 hours of sleep and have to be up at 7am, you need to be starting your wind down routine 9 hours before that.
2. Develop a good wind down routine before going to bed. This includes disengaging from stimulants, screens and phones an hour before sleep, making sure your bedroom is cool and dark and having some quiet time with a book or activity that calms your mind. If you are a light sleeper, consider having some white noise in the bedroom such as a fan running.
3. Empty your bladder before getting in to bed. The need to get up and use the toilet several times in the night can often impair our ability to get back to sleep, especially when we are worried about things.
4. If you have worries, once you are in bed ask yourself “Is this a productive worry, is there anything I can do about it tonight?” If not, then let it go and tell yourself you will deal with it again tomorrow when your mind is clear and rested.
5. Begin the process of releasing tension from your body. Start in your shoulders, clench them tight and hold for a couple of seconds, then let go. Then move to your arms and hands, clench, hold and release. Gradually work your way down your body clenching and releasing to let go of tension. Finally clench and release your face and jaw, which is where we often hold a lot of our tension without realizing it.
6. Move your body into its favourite sleep position.
7. Now you need to find a way to stop your mind from wondering and exhausting you! To do this we use a repetitive, calm and focused thought pattern that we find soothing. Some suggestions for this are:
   1. Imagine watching rain gently falling against a window
   2. Imagine sitting on a beach and watching small waves gently lapping the shore
   3. Imagine sitting in a meadow or forest and listening to the sounds of nature
   4. Imagine you are back in a place in your life where you felt extremely happy and safe and watch the movie of that time playing in your head.
   5. If you like numbers, start at 200 and subtract 7 repeatedly … 193, 186, 179 etc.
   6. Focus on your breathing in a 5-7 pattern: breathe in and count for 5, hold for 2, breathe out for 7, hold for two, and repeat. Keep this gentle breathing and counting going. If you find this length of breathing too strenuous then reduce it slightly to 4 - 6. If you are a yoga practitioner, you can extend the breathing to a 7-11 pattern.
   7. Count sheep! It’s an oldie but it works.

 
All these mental techniques take some minutes to work so don’t give up. You want to find a place you go to in your mind that is comfortable, and that with repeated use quickly signals to your body that you are going to sleep. Once you feel the waves of sleep start to wash over you, allow yourself to give in to them and let go.
 
If you wake in the night you can use the same technique to take yourself back to sleep again. Don’t let yourself be anxious and watch the clock, just let go of your worries, tense and relax and then take your mind back to its focused relaxation place. Do not get up and engage in an activity and keep your phone away from the bedroom. Sleep is a habit which we sometimes need to retrain our mind and body back into.
 
Sweet dreams!

Dr Jules
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If the subject matter in this article resonates with you, then counselling might be a good option to help you to move forward. I offer a free 20-minute consultation so we can explore how I might be able to help you. 

“I can’t wait to get up on stage and share my ideas, I’m going to be amazing”

“I’m really excited to get to work tomorrow and see what my boss does next, and how well I cope with it”

“I am really looking forward to the Christmas party where I know nobody and don’t speak the language, it will be an adventure”

Does this sound like you? Probably not, but it’s a great technique to help people conquer their fears by flipping their thoughts around from fear to excitement; from crippling to enabling.

The process of anxiety involves our brain surveying our environment, deciding there is a potential danger and flooding the body with stress hormones such as cortisol, the fight or flight sequence that enables us to respond quickly. Often this process is triggered by memories of times when we have felt fear, such as standing up to speak in public or entering a crowded room at a party where we don’t know anyone, and while there isn’t a life-threatening situation, our brain still reacts as though there is.

Of course, this isn’t necessarily true if we are facing a true danger such as being in the path of an oncoming car, when your brain needs to signal to your body that you need to save yourself. That’s when our anxiety system is working well for us. However, there are other times when it fails us, opportunities where we can be feeling fear about a situation to the extent that it becomes overwhelming, even crippling.

At these times, most people say take some deep breaths to try and calm down, but instead say ‘I am excited’. Here’s why this works - both fear and excitement are states of high arousal where the body is preparing for action, so it’s much easier to go from anxious to excitement than from anxious to calm, which is generally what we are asking our brain and body to do when we combat the fear with breathing or just avoidance (the latter can set us up for all kinds of problems down the road, so it’s generally better to avoid avoidance!).

Here are some things to remember:

• We all have things that make us anxious, so there is nothing unusual about your thoughts and feelings.
• We DO have control over our thoughts and feelings.
• When we get irrational fear-based thoughts and feelings, we need to grab them and deal with them before they settle down and decide to stick around
• Both the emotions of fear and excitement come from the same starting place, it is how we choose to respond to them that will inform our experience
• When you change a threat mindset to one of opportunity, from what could go wrong to what could go well, research shows that our performance improves, so take the high arousal and flip it around to your advantage.
  

Give this technique a try next time you feel anxious about something you are putting off or dreading and see what happens!

Dr Jules

If the subject matter in this article resonates with you, then counseling might be a good option to help you to move forward. I offer a free 20-minute consultation so we can explore how I might be able to help you. Find my details on the Contact page and drop me an email, and I'll contact you to arrange a no-obligation chat where you can tell me more about your problem and ask questions about the process of therapy.

I’m a therapist who specializes in working with couples. I love the dynamics of the couple relationship, figuring out the ‘dance’ the two people are involved in with each other, and then helping them to learn new steps so the relationship can become satisfying again.

Most of the couples who come to see me complain of communication problems, which is a coded way of saying they are fighting more than usual. Disagreements between two independent intelligent people who live together are inevitable, so it is not the presence of conflict that is a problem. But how couples fight is something we do address in therapy to help the relationship survive, particularly as many of the things they fundamentally disagree on (money, in-laws, etc) are unsolvable.
Here then, are some golden rules on how to improve your conflict resolution skills in your relationship. These skills can also be applied in family relationships, friendships and work, but it tends to be our spouses who push our buttons the best:

1. Start softly
By this I don’t necessarily mean use a soft voice, although that can help, but if you start a discussion by being critical of your partner (going straight in with character assassination) or even contemptuous (sarcastic, hostile, eye rolling) then the discussion will generally be doomed to failure. Most of us already know how to manage our differences with calm and respectful discourse, it is usually how we function with colleagues at work, so apply the same rules when you are talking to your spouse, and don’t be drawn into accusations and assumptions.

2. Retain control of your physiology and emotions
When our pulse rises our body starts to flood with stress hormones and adrenaline, preparing for ‘fight or flight’. The more our emotional state takes over, the less our clear-thinking state can function. None of this is helpful when we are trying to have a discussion with our partner about a difficult issue. The key is to be mindful of what’s happening in your own body, pay attention to your stress levels and learn how to calm yourself down with breathing, or if necessary by asking to take a break from the discussion to allow you to calm down.
 
3. Don’t bring up the past
Arguments between couples can often descend into flinging those long stored up resentments at each other. Transgressions or hurts from before can’t always be forgiven, but what happened has happened and can’t be changed. If you want to move on then leave the past where it belongs and focus on making the now better, otherwise you will only keep re-opening old wounds.
 
4. Accept your partner’s influence
Research shows that partners who have the emotional intelligence to give and take, and accept the other person’s point of view, tend to have happier relationships. You don’t have to be a doormat, but learn to share the power in the relationship rather than dominate and you will both be happier.
 
5. Don’t go in to the discussion needing to win
Compromise often doesn’t feel good, but it’s an essential skill. Each of you will gain and lose something, but the primary goal is to take care of the relationship and not your own ego.
 
6. Learn to take a time out
Once the conversation starts going off the rails and you can feel yourself flooding with stress hormones, then don’t keep going, it won’t end well. Often couples I see descend quickly into contempt, retaliation, door slamming or even violence. Successful couples, however, use repair attempts such as gentle humour, making silly faces to calm things down, or just calling a time out so both partners can retreat and then reconnect to talk again later.
 
Whether you are in a new relationship or have been together forever, it is important to know that conflict is part of the deal of being with someone. But if you can fight well, then conflict and its repair can actually strengthen your bond rather than destroy it. It is never too late to learn effective relationship skills. If I can help, then drop me a line via my website.

Dr Jules

If the subject matter in this article resonates with you, then counselling might be a good option to help you to move forward. I offer a free 20-minute consultation so we can explore how I might be able to help you.

In my work with couples, sex often comes up as part of the problem. Either there is too little, too much or what there is isn’t satisfying, and sometimes this leads one partner to look outside the relationship and enter into an affair.
To resolve these issues in therapy we need to work on the relationship dynamics in general, sex being a mirror of what is going on between the couple. But part of the problem can also be the narratives we believe or buy into about sex, e.g.,

• Sex should always be spontaneous
• Sex is only for love
• Both partners should orgasm, every time, preferably together (and she should have more than one)
• Male sexuality is simple, women are more complicated
• Women want intimacy and men just want to get laid
• Men always want it
• Women are much more monogamous than men.

In case you are wondering, all these narratives are untrue and can be damaging when we believe them! Men, for example, are often turned on by good relational sex and intimacy, where they can find a moment of closeness and acceptance, where they feel understood. If he is feeling anxious or is struggling with his perceived level of self-worth, then having a sense that he’s competent and loved because she is enjoying him and showing pleasure, this is an intensely important experience for a man. The quality of his experience often depends on the quality of her experience, so seeing her turned on really turns him on and makes him feel good about himself, which in turn helps him to feel safe and more content in the relationship.
Women, on the other hand, want to be the turn on. When I have worked with partners where the man has erectile problems, often the woman feels like there must be something wrong with her if he can’t do it. If she was more of a turn on, then there would be no problem. As New York relational therapist Esther Perel says, “The secret of female sexuality is how narcissistic it is”. So much of her life is about connecting with and caring for others, so for her to have good sex she needs to think of nobody but herself. For many women, it is a struggle to be that selfish and confident, but if they have an affair where they are free of their normal roles and responsibilities, suddenly they find themselves having great sex. With her lover she is interesting and wanted and she sees herself as desirable, and that’s a huge turn on.
All of this doesn’t mean that couples in a long-term relationship can’t have great sex. Quite the opposite. In therapy we explore and begin to understand the narratives that feel safe, but that constrain us, and then couples can be freed up to write a new story. Together.

Dr Jules

If the subject matter in this article resonates with you, then counselling might be a good option to help you to move forward. I offer a free 20-minute consultation so we can explore how I might be able to help you.

Lately I have seen a number of couples I know facing mental health challenges in one partner. Mental health is often still a stigma and many people may prefer to overlook changes in their loved one for as long as possible. Mental health, however, is as important as physical health, and we should work to maintain it, and get it attended to by a relevant professional as soon as possible when there are signs that something isn’t right. Early intervention can help to reduce the severity of an illness, or perhaps stop it developing altogether.

The impact on the couple relationship of one partner with mental illness can be extremely stressful, sometimes leading to the breakdown of the relationship. Considering this, learning about some warning signs of mental illness can help you to act sooner rather than later. Here are some things to look for:

• Dramatic changes in sleep pattern or appetite for food. If the partner is depressed they may often feel tired a lot of the time, regardless of how much more time they are spending in bed.
• Noticeable, prolonged changes in mood, particularly if the person is becoming depressed, irritable or anxious, or if they swing between mania and depression.
• The person starts to become withdrawn and take less enjoyment from activities they once wanted to participate in. They may also withdraw from social activity and friends.
• Functioning at work starts to drop, and the person seems less able to cope with daily problems and activities.
• Multiple physical ailments without obvious cause, such as vague aches and pains and head or stomach aches.
• You sex life together changes, or maybe disappears as your partner becomes withdrawn.
• Starts to show cognitive difficulties, such as difficulty thinking as clearly, poor memory and lack of concentration, or confused thinking.
• Seems to be losing touch with reality or the consequences of their behaviour or displays delusional thinking.
• Starts abusing alcohol or drugs.
• Becomes a risk to his or her self, or to others or property, this includes talking about death, self-harm or suicide.

One or two of these symptoms alone don’t indicate a mental illness but may be worth an evaluation. Several symptoms at one time, particularly if they are causing a change in the ability to function daily or interact with others, should be discussed with your GP. If a person has suicidal thoughts or intent, or thoughts of harming others, then you should seek immediate attention.

If you have any concerns, contact your GP in the first instance to discuss the symptoms, and what steps should be taken in terms of assessment and possible treatment. There may be physical health problems with similar symptoms that need to be explored. If psychological treatment is necessary, then you should also discuss couples counselling as an adjunct therapy. Working with an experienced counsellor can help you to repair any damage caused by the symptoms, as well as adjust to the changing demands of your partner’s health.

If the subject matter in this article resonates with you, then counselling might be a good option to help you to move forward. I offer a free 20-minute consultation so we can explore how I might be able to help you. Feel free to contact me via the Contact page on this website.

This article was also published here: https://www.theenglishinformer.com/article_detail/Mental-health-is-as-important-as-physical-healthwww.theenglishinformer.com/article_detail/Mental-health-is-as-important-as-physical-health
 
 

In my last blog post, I focused on the need for couples to create and maintain emotional connection with each other. Part of the way we do this is by making regular Bids for Connection where we attempt to get the other person’s attention and some positive interaction. We don’t often indicate this desire by saying “Hey, let’s connect”, instead we tend to use more subtle methods such as sighing, touching, messaging a link to an article the other person will find interesting, or wanting to talk about our day.

What all these attempts are saying is “I really want your attention, I want to feel a connection with you, and I hope you will respond positively by showing some interest in me”.

Sadly, if we fail to respond to our partner, or we don’t respond in a positive way, then we send the message that we don’t care. This concept is the same with our children too by the way, only they often up the stakes by behaving badly so that we cannot fail to give them our attention!

Couples researcher John Gottman, who developed this concept, observed in one study that couples who were still married after six years made successful bids for connection 86% of the time, while couples who had divorced in this period only tended to do this 33% of the time.

Gottman tells us there are three ways we can respond to bids for attention:

1. We can turn AWAY from the person, ignore them or change the subject.
2. We can turn AGAINST the person, and say something critical or undermining.
3. We can turn TOWARDS the person, and give them the positive response they are looking for.
   

In his research, Gottman observed that happy couples turn towards their partners approximately twenty times more than couples in distress during every day discussions.

So, if your partner is wanting to connect with you by seeking your attention, then give it to them. If they want to share a moment with you because you are on their mind, then be soft and meet them in that place, don’t shoot them down, ignore them or leave them feeling bad. Every time you turn towards your partner’s bids for emotional connection, you are making a deposit in what Gottman calls your Emotional Bank Account, and your relationship is ideally a constant long-term investment in that account.

A strong relationship is made up of a million little instances where you showed care and attention for each other. None of these will cost you much in terms of time or energy, but they will collectively build over time to create an emotional connection that will reward you for years to come.

Dr Jules

If the subject matter in this article resonates with you, then counselling might be a good option to help you to move forward. I offer a free 20-minute consultation so we can explore how I might be able to help you.