As a psychotherapist I believe it’s important that we start telling our stories so we can change the landscape of our environment for the better.

Samantha Carbon UKCP

Jan 01, 2019

For many people, seeing a therapist is a major step in their lives.  There is something elusive about emotional health that makes this type of healthcare visit a little less routine and a little more daunting. Emotional or mental health issues cannot be seen or measured in the same way as physical ailments, but yet our emotions can cause us just as much or more distress. Some of my clients have described therapy like taking off a bandage and exposing a wound.

Below are 3 reasons why therapy represents a source of apprehension or fear, along with ways you can rethink any doubts or misconceptions about the therapy process.

1) The Ultimate Exposure

One of the purposes of going to therapy is to talk about and ultimately develop solutions for issues, problems, or symptoms. An important part of the process is divulging your innermost thoughts and feelings to the therapist, who will serve as your guide to achieving your best self. Many people fear therapy because they are afraid to reveal such personal things about themselves to a person who is essentially a complete stranger. Therapy can also mean exposure of your self and in the process of exposure, you may admit to issues you don’t want to face or that you have worked hard to avoid for a long time. There are a lot of dynamics that go on, especially during the early stages of therapy that can truly cause a fear reaction. Exposure is a big source of fear for most humans because we fear the judgment that may come as a result of exposure. The more we expose, the more we feel we will be judged. Many of us will find ourselves downplaying our strengths and amplifying our weaknesses rather than pushing to work on both of these areas of our lives.

It’s important to be honest with your therapist (and with yourself) and part of the therapy process is developing trust with your therapist so that you feel increasingly comfortable disclosing personal information and history.

2) What’s Wrong?

A common reason people fear therapy is due to worries about what the sessions will reveal about themselves. Nowadays therapy is moving in a direction of positive psychology where the therapist will support you to focus on your personal strengths so that you can use those strengths towards your better sense of self and emotional recovery. In other words, the focus is not about what you can’t do, but what you can do to improve. We are often harsh on ourselves and believe that something is very wrong and this is actually quite normal, especially during times of stress. Keep in mind that your therapist has heard it all and just the mere fact that you are seeking support is an indication of your true emotional strength. Many people have the idea that the therapist is there to “analyse” and then report back what is wrong and what needs to change. People often fear that they will be discovered as being “crazy” or as having serious problems.

Therapists practice a more collaborative approach with clients. This means that you will work along with your therapist to learn to cope with problems or concerns and develop problem-solving and other strategies to improve your quality of life.

3) Will The Truth Set You Free?

A major source of fear when people consider going to therapy is that they will have to face the truth. Whether it is admitting the truth to themselves or the therapist pointing out areas of concern, this is often a reason people fear therapy or avoid therapy altogether.  There are a variety of truths that are feared and this varies broadly from person to person. Some people may fear that going to therapy may reveal they should consider ending a toxic or abusive relationship. Others may fear that therapy will highlight concerns that they have settled in a job they are unhappy with and need to make a change. Whatever the source of truth is, we often at times want to avoid these revelations and we know that once we attend therapy, we may have to face things we know, deep down, need to be confronted.

In the long run, exposing the truth about things that we want to change about ourselves and our lives is a positive step forward. Being honest with yourself will ultimately be a very liberating experience. Trusting yourself is more difficult because you can’t escape you. Fortunately, you don’t have to do it alone because a therapist can be there alongside you as you pursue positive change.

There is no doubt that going to therapy is scary and although you may have an idea or fantasy of the events that will transpire during your sessions, there are an overwhelming amount of uncertainty. When you are willingly to seek therapy, you are agreeing to put yourself in a position of vulnerability and this takes much strength and courage. As a psychotherapist I believe it’s important that we start telling our stories so we can change the landscape of our environment for the better. Rather than seeing therapy as a source for those who are troubled, lost, or confused, consider perceiving therapy as a part of your 2019 journey towards better health, better self-care and your desire to grow and improve.

Samantha Carbon

Original post appears here: https://lifelabs.psychologies.co.uk/channels/629-ukcp-therapists-channel/posts/42584-why-people-fear-therapy?platform=hootsuite

This article originally appeared in Psychology Today on Jan 22nd 2017. https://www.psychologytoday.com/blog/here-there-and-everywhere/201701/11-warning-signs-gaslighting-in-relationships

11 Warning Signs of Gaslighting in Relationships

Gaslighting is a manipulation tactic used to gain power. And it works too well.

Gaslighting is a tactic in which a person or entity, in order to gain more power, makes a victim question their reality. It works much better than you may think. Anyone is susceptible to gaslighting, and it is a common technique of abusers, dictators, narcissists, and cult leaders. It is done slowly, so the victim doesn’t realize how much they’ve been brainwashed. For example, in the movie Gaslight (1944), a man manipulates his wife to the point where she thinks she is losing her mind.

People who gaslight typically use the following techniques:

1. They tell blatant lies.

You know it’s an outright lie. Yet they are telling you this lie with a straight face. Why are they so blatant? Because they’re setting up a precedent. Once they tell you a huge lie, you’re not sure if anything they say is true. Keeping you unsteady and off-kilter is the goal.

2. They deny they ever said something, even though you have proof. 

You know they said they would do something; you know you heard it. But they out and out deny it. It makes you start questioning your reality—maybe they never said that thing. And the more they do this, the more you question your reality and start accepting theirs.

3. They use what is near and dear to you as ammunition. 

They know how important your kids are to you, and they know how important your identityis to you. So those may be one of the first things they attack. If you have kids, they tell you that you should not have had those children. They will tell you’d be a worthy person if only you didn’t have a long list of negative traits. They attack the foundation of your being.

4. They wear you down over time.

This is one of the insidious things about gaslighting—it is done gradually, over time. A lie here, a lie there, a snide comment every so often…and then it starts ramping up. Even the brightest, most self-aware people can be sucked into gaslighting—it is that effective. It’s the “frog in the frying pan” analogy: The heat is turned up slowly, so the frog never realizes what’s happening to it.

5. Their actions do not match their words.

When dealing with a person or entity that gaslights, look at what they are doing rather than what they are saying. What they are saying means nothing; it is just talk. What they are doing is the issue.

6. They throw in positive reinforcement to confuse you. 

This person or entity that is cutting you down, telling you that you don’t have value, is now praising you for something you did. This adds an additional sense of uneasiness. You think, “Well maybe they aren’t so bad.” Yes, they are. This is a calculated attempt to keep you off-kilter—and again, to question your reality. Also look at what you were praised for; it is probably something that served the gaslighter.

7. They know confusion weakens people. 

Gaslighters know that people like having a sense of stability and normalcy. Their goal is to uproot this and make you constantly question everything. And humans’ natural tendency is to look to the person or entity that will help you feel more stable—and that happens to be the gaslighter.

8. They project.

They are a drug user or a cheater, yet they are constantly accusing you of that. This is done so often that you start trying to defend yourself, and are distracted from the gaslighter’s own behavior.

9. They try to align people against you.

Gaslighters are masters at manipulating and finding the people they know will stand by them no matter what—and they use these people against you. They will make comments such as, “This person knows that you’re not right,” or “This person knows you’re useless too.” Keep in mind it does not mean that these people actually said these things. A gaslighter is a constant liar. When the gaslighter uses this tactic it makes you feel like you don’t know who to trust or turn to—and that leads you right back to the gaslighter. And that’s exactly what they want: Isolation gives them more control.

10. They tell you or others that you are crazy.

This is one of the most effective tools of the gaslighter, because it’s dismissive. The gaslighter knows if they question your sanity, people will not believe you when you tell them the gaslighter is abusive or out-of-control. It’s a master technique.

11. They tell you everyone else is a liar.

By telling you that everyone else (your family, the media) is a liar, it again makes you question your reality. You’ve never known someone with the audacity to do this, so they must be telling the truth, right? No. It’s a manipulation technique. It makes people turn to the gaslighter for the “correct” information—which isn’t correct information at all.

The more you are aware of these techniques, the quicker you can identify them and avoid falling into the gaslighter’s trap.

Copyright 2017 Sarkis Media: www.stephaniesarkis.com

“Oh God, I’m shaking, I feel sick!” (the physiology of fight or flight / panic attacks)

Evolution produced us: today’s fabulous human beings. But… there are a few design flaws. And some primitive responses we’ve been saddled with that often do more harm than good these days. But we can learn to understand and control them with CBT…

What is ‘fight or flight’? When we perceive a threat, our bodies go into ‘fight or flight’ mode in an instant – this physical response was developed during evolution to help us survive the sabre-toothed tiger, or that troublemaker that was trying to oust us from the tribe, or indeed anything that threatened our survival.

“Fight or flight is an instant pumping up of our bodies (with a series of physiological changes) that better equips us to fight hard or run fast from ‘danger’ – it prepares us for extreme physical action in an instant.”

Here are a couple of examples that will explain the immediacy and effects of fight or flight:-

• You walk over to your lovely bowl of fruit. Reach in, and… ‘OH! a big SPIDER! EEK’. The natural reaction is to jump back – our bodies instantly revving into fight or flight, our hearts thump, our stomachs tighten into a knot etc. But within a few moments, we (well most of us) realise there is no extreme danger here – and our bodies return to a natural balance very quickly.
• You’re in bed. You’re woken by a crash sound somewhere in your home. A BURGLAR?! You are instantly alert – you spring up, tilt your head back, eyes focussing in the middle distance for danger, ears straining to hear what’s going on, your heart pumping and lungs expanding to take more oxygen, heat rising in your body, ready to take whatever action is required (this can include ‘freezing’ which protected us from notice of predators etc)… then your flatmate shouts in ‘sorry, only me, I dropped a plate’. Deep sigh as your body returns to balance…

Those are examples of real practical problems that would benefit from fight or flight… after all, if you had to deal with a giant tarantula or a violent intruder, you would make good use of your body in its prepped and revved up state. And in both instances, within a very short time, we realise there has been a mistake in processing the event, and our body returns to balance (homeostasis) quickly. But – many of us fight ‘invisible tigers’ constantly – perceiving dangers and threats and sabre toothed tigers everywhere, which brings on flight or flight even when there is no real danger present.

Stress triggers that cause uncomfortable fight or flight symptoms are different for everybody, any number of things can mistakenly appear as a hazard or danger that we feel unable to cope with – general examples?  having to give a presentation, attend an interview, go on a date, drive in bad traffic, cope with your noisy children, sort out the bills, busy social occasions, talking to people you’re attracted to, oh… take your pick, you know who you are!

If you have anxiety (or are a ‘worrier), the chances are that you are fearful of many things, with the flight or flight hormones constantly simmering within, which may cause general fatigue, confusion, and ill health – this would also contribute to self-limiting decisions and behaviours, and would of course reinforce a negative view of the world.

Fight or flight carries a lot of unhelpful and debilitating effects – recognise any of these?

Of course, situations are only a ‘fight or flight’ danger if you perceive them as such – todays danger is often psychological rather than physical. Ideally, we would use CBT to recognise that our thinking causes our ‘upsettness’ and the idea that we are unable to cope – so that we could learn healthy new thinking that would prevent us perceiving hazards where there are none – and so that we could develop new coping skills for a better and more comfortable life experience.

But… for the purpose of this post – let us just look at the physiology of fight or flight here – as it is shown to help people better manage the situation if they understand, scientifically, exactly what is happening and why. Understanding that fight or flight is a natural bodily reaction with a beginning, a middle and an end – and that it is actually a sophisticated elaborate chain developed to help and protect you – can be hugely helpful. This learning and awareness helps us to break down the cycle of fear that can happen otherwise, and can even calm us down – ideally halting the symptoms, or at least decreasing their ferocity and duration – helping us to calm down and ‘right our body balance’ in a shorter time frame.

OK … common Fight or Flight physical symptoms – (the things we don’t realise are happening to cause the symptoms):

• Thoughts racing and disjointed – caused by an adrenaline release.
• Dizzy / lightheaded –due to adrenaline and increased oxygen levels.
• Surroundings seem distant or visual ‘tunnel’ –your pupils dilate to allow you to take in as much visual information as possible. Eyes refocus to the distance to spot danger.
• Heart pounding – The heart starts beating faster to increase circulation, since the body anticipates it will be working harder to service the muscles.
• Difficulty breathing – the lungs throat and nostrils open up to flood the lungs with enough oxygen to keep up with the increased circulation of blood (re-oxygenating it) – this can trigger shallow rapid breathing.
• Neck and shoulder tension – caused by oxygen pumping to muscles, or after effects as the oxygen reduces.
• Blushing – Adrenaline causes your blood vessels to dilate in order to improve blood flow and oxygen delivery. As a result, the veins in your face dilate, allowing more blood to flow through them than usual.
• Sweating – The body heats up because it is working harder to circulate blood. And then sweats so it can cool itself down / regulate temperatures.
• Butterflies/’sick’ feeling – Cortisol shuts down your digestive system, (as it is not needed to fight or run), redirecting blood to essential systems such as the heart, lungs, legs and arms. This can also cause irritable bowel syndrome, nausea and diarrhea
• Dry Mouth – Cortisol shutting down inessential systems reduces saliva in the mouth.
• Need to urinate (and maybe even pass a stool) – The bladder and bowels may open out to reduce the need for inessential internal actions (and faeces & urine may have put off our attackers)
• Trembling, wobbliness, tingling and shaking – an effect of adrenaline stimulus and oxygen overload.
• Tightness in the chest and throat, difficulty breathing – the body is overloading on oxygen – which is dangerous if you do not burn the extra oxygen off. Therefore the body tries to reduce the levels by constricting the chest and the lungs, reducing breath intake…

It is common that some people feel even more anxious and scared when these physical effects of fight or flight kick in (they start out feeling anxious about the situation, then they get the physical symptoms and are freaked out by them as well – which accelerates and amplifies the symptoms up to an actual ‘panic attack’). For some, it becomes the fear of the physiology itself that causes a major and ongoing social fear issue (blushing, sweating, breathlessness). Attempting to ‘fight’ against the physical manifestations of anxiety almost always has the opposite effect and intensifies them. Try instead to simply ‘let them happen’ – try to ‘observe’ outside of yourself… tell yourself what’s happening to your body and why – e.g.:

This sweating is simply my bodies way of regulating it’s temperature as it’s overheated because I’m scared of this situation and I’ve gone into fight or flight – it will stop as soon as I calm down – I’ll breath in and out slowly and deeply… I am ok, I can cope, this is ok…

Summary: what is happening with a person who reacts with anxiety and inappropriate physical symptoms is that their body is reacting to the situation as if were as dangerous as, say, a tiger or lion approaching to tear them apart. A false perception has occurred, triggering a very basic and automatic response. We can learn to challenge our perception of events, and because the fight or flight response occurs only when we perceive danger, it can be avoided or minimized if we can convince ourselves there is nothing to fear.

We can challenge and relearn our behaviour and responses to stress triggers by restructuring our thoughts in a more rational and healthy way with CBT – but we also need to be aware of how and why we are physically feeling the way we are – this can help us to stave off panic and remain reasonably calm.

Quick tips:

Deep breathing: because so many symptoms are caused by the oxygen/rapid breathing physiology – breathing control exercises are hugely helpful in easing them. 

Medication: if your anxiety is extreme and affecting your life, please go to your doctor and discuss the situation, there is no shame – if you had high blood pressure or diabetes you’d accept it and address it pragmatically, right? treat this in the same way.  If necessary, there are several medication options that can relieve your symptoms immediately while you work on your new coping skills (e.g. Betablockers, which suppress the stress hormone involved in the fight-or-flight response. This helps control the physical symptoms of anxiety, or a benzodiazepine/tranquiliser…).

Cardio exercise – when you feel your body go into fight or flight jitters, do 5 minutes of physical exercise if possible in the environment you’re in (run up and down stairs, do sit ups…anything cardiovascular, something that  makes you sweat!). The body has primed itself for something physically dramatic (the fighting the tiger or running away very quickly..) – and if you stay immobile it will be confused and take longer to return to homeostasis – the exercise will restore balance more quickly.

Relaxation – choose deliberately to do something you find relaxing (movie, book, candles and music, a walk in park, whatever) – the body has a ‘relaxation’ physical response, which releases chemicals that reduce stress hormones, this slows your heart rate and lowers blood pressure and relaxes muscles, returning you homeostasis (balance). A good source of relaxation/mindfullness exercises can be found on Beaumont Hospital’s site at www.beaumont.ie/marc

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EXTRA NOTE – BEWARE CORTISOL (the stress hormone, or the ‘death hormone’ as it’s scarily called!) – it gets secreted when we are under physical and/or emotional stress. No matter what the source of stress, cortisol is released into the blood stream to help us cope, aiding our fight and flight response by putting sugar into the blood stream so our muscles and brain have the fuel needed to react.

Cortisol is generally high in the morning, but should subside by evening when our rest and repair system (parasympathetic system) is supposed to take over and return us to metabolic equilibrium (homeostasis).  Or… at least that scenario is the appropriate stress response by the body – BUT, todays lifestyles and challenges mean that more and more of us are in a state of high cortisol most of the time – as our system keeps us in a constant state of ‘readiness’ for the perceived danger/threat of our ‘stressors’.

This is very dangerous to our health as cortisol curbs functions that are not essential for fight or flight, which alters the immune system responses and suppresses the digestive system, the reproductive system and the growth process. Long-term overexposure to cortisol and other stress hormones can disrupt almost all your body’s processes. This puts you at increased risk of numerous health problems, including:

Irritable bowel syndrom – Heart disease – Sleep problems – Digestive problems – Depression – Obesity (particularly depositing fat around our middle section) – Accelerated aging – Memory impairment – Skin problems – susceptibility to illness, etc.

These physical health implications are why it’s so important to learn healthy ways to cope with the stressors in your life to help the body stay at (or return quickly to) hormonal balance/homeostasis

CBT – learning how to view events and situations in a way that is in proportion to their actual effect on you/your life, will help control your emotional response to them… reducing the instances and strength of fight or flight manifestation. You should also explore relaxation and visualisation exercises, and of course a good diet and time set aside for regular physical exercise will play a part. As will maximising satisfactions and benefits in your ‘life areas’ (You like walking by the sea? Do it more! You dislike something? Do it less!)

Task: create a two column chart, in the first column write out a list of physical symptoms you feel when stressed, and in the second write out the scientific explanation for each one. Study & remember.

Some minor edits were made to the original article which can be found in Veronica Walsh’s blog at http://iveronicawalsh.wordpress.com/2012/04/08/oh-god-i%E2%80%99m-shaking-i-feel-sick-the-physiology-of-fight-or-flight/

This article was originally appeared in The Irish Times and can be found at http://www.irishtimes.com/life-and-style/health-family/what-are-the-different-types-of-psychotherapy-1.2059236