Mindfulness Meditation for Novices; sharing personal experience- Part 1

I am a middle aged mum (and incidental a psychotherapist) who wants to spread the word about Mindfulness. However the media hype is something that might put any novice off. I hope to provide a fresh and personal perspective.
I am not a Buddhist, I hold no particular belief about God or Allah, or paganism. I do believe that our busy world has taken our attention away from what it is to be human; what it is to have an inner sense of being OK; a belief that we have the skills to live our lives as best we can; that we are all OK, even if we sometimes feel otherwise. I hope to inspire mindfulness meditation for novices who are curious but don’t know where to start or anxious about doing it wrong.
I would like to say that I  agree with many of the supporters of Mindfulness, who feel there is potential to change how we respond to cultures different to our own, we often respond because of feelings of threat. We have a tendency to live our life based on fear. We make decisions to avoid harm or to minimise risk. I am not advocating risk, far from it, I notice how we have a strong need to plan, to stop bad things happening. We don’t believe we can manage should a bad thing happen; and we think, by planning, we can prevent the inevitable bad thing happening. I want to say, we are not fortune tellers! We have no idea what will happen in 2 weeks.

A spare pair of knickers in case I wet myself laughing

A spare pair of knickers in case I wet myself laughing

When was the last time you packed a spare pair of knickers because you anticipated wetting yourself laughing? It is far less often that we plan for unexpected joy.
We do not give ourselves space to experience the moment that is now. We allow the past or the future to disrupt now and that then generates feelings that may be difficult to contain.

We are in such a hurry to get on to the next task, to finish, to move on. To move on to what? When will it all be done?

Mindfulness Meditation for Novices-Wakening up to new possibilities

Mindfulness Meditation for Novices- Where to start?

Why do you want to do mindfulness meditation? This is not a miraculous cure for dissatisfaction, anxiety or depression. It will not change you directly, mindfulness is about being you, or awakening; being you in a way that is different, not preoccupied with thought.

You may have heard how mindfulness can help your mental health. Mental health issues may arise because we lose ourselves in thought, they become our reality, and the thoughts might trigger behaviours and we end up suffering in a way we do not like. Mindfulness can help and you can access some tailored support through your GP.

Or you may be intrigued, mindfulness meditation it is a new fashion after all. Great.

If you have already started reading or listening to meditations they often describe having an ‘intention’. This means; be clear why you are meditating. Identify your intention for yourself and also in relation to others. You will be reading this or considering Mindfulness because of something, a new possibility you see for yourself. It is worth thinking about this, either writing it down or telling someone. As your experience of mindfulness changes so will your understanding of the intentions you make, and these evolve. Mine are evolving all the time as I learn what ‘being awake’ feels like. ‘Being awake’ is the term often used by Mindfulness writers, I understand it to mean being conscious of every little moment, rather than being ‘in your head’ on ‘auto pilot’.

Lost in thought, we cannot remember where we put our keys

Lost in thought, we cannot remember where we put our keys

You may have those moments when you cannot remember locking the front door, or where you put your keys? These daily jobs are done on ‘auto pilot’ if we were totally conscious in these little activities things would not get lost.

We are often ‘lost in thought’ and the formal meditation practice is about noticing this, and providing us with an opportunity or even training to be able to separate ourselves from our thoughts.

Mindfulness Meditation for Novices-Trying to understand intentions

My understanding of Mindfulness is still very basic. There are some useful resources listed that might help you.

As a novice, I am finding it hard to understand ‘intentions’ as used for Mindfulness meditation. Here is my attempt at explaining intention, intentions are not goals or targets.

Initially I wanted to use Mindfulness in my work. So my intentions were about ‘learning’ and experiencing it. This was not the best way to start, as mindfulness is a lot more than a technique. I could compare it to learning to love, or learning to fear. Being Mindful is learning to be present, and ironically it is not until I started doing it, that I realised what this meant.

My early intentions were about changing me. This is a common intention to have, and it is not really what it all is about. It is more subtle. It might help comparing a goal with an intention, a goal might be ‘I want to be kinder’ whereas an intention is ‘I intend to give kindness’. As we become more ‘awake’, we notice our kindness and how kindness is already part of who we are, or we might notice others’ kindness and so learn what it is to be kind, or how it feels to experience kindness. We become more aware of kindness, and ‘kindness’ changes from being something that is ‘out there’ to strive for, to something ‘in your heart’ something already present; already available to give. I think this sounds exciting.

I suggest you give Mindfulness meditation a go. If you are suffering quite badly with a mental illness it is advisable to talk to your doctor first.

I share more of my journey in part 2

Resources

Books

  • Wherever you go there you are by Jon Kabat-Zin (2004)
  • Mindfulness: A practical guide to finding peace in a frantic world By Mark Williams and Danny Penman (2011)

For anyone interested in the science behind mindfulness-

  • The practical neuroscience of Buddha’s Brain, happiness, love and wisdom. By Rick Hanson with Richard Mendius (2009)

Websites

Emma Dunn Counselling and psychotherapy

Thoughts and Anxiety -Using Psychotherapy and Mindfulness to alleviate fretful thinking

Thoughts and Anxiety

Anxiety often manifests itself as poor eating, irritability due to poor sleep, and an inability to concentrate. First line treatment addresses these manifestations. Anxious people are encouraged to exercise to become physically tired; eat regular meals and to make lists  to feel less over- whelmed. These are useful for symptom alleviation but without identifying the cause there is potential for anxiety to continue. The link between thoughts and anxiety is not being addressed in these treatment. It is understanding the cause that will ultimately decrease the symptoms of anxiety.

Anxiety might be interpreted as a reaction to a real situation. Do you believe anxiety is a reaction to a real situation?

Have you ever considered your thoughts and anxiety as one problem?

The Neuroscience of Anxiety

Emma Dunn Counselling and Psychotherapy

Summary of the brains response to a threat

The stress response is the same whether there is a real threat to our physical safety or a perceived one. An area in our brain called the amygdala is the warning bell that makes us physically alert through a cascade of hormone and nervous reactions. One of the hormones released is cortisol, which further alarms the amygdala so it becomes even more alert to negative stimuli. Meanwhile, another area of the brain, the hippocampus, becomes less responsive. The hippocampus normally provides a control over the amygdala such that positive experiences are noticed as well as the negative ones and we can weigh up rationally what is the best action to take. The more often we are stimulated by anxious reactive thoughts the more readily we get to a state of alertness and vigilance, and less able to keep calm and rational. We attune into (implicit) memories that are not quite clear ‘the sense of something bad going to happen’; thoughts and reality become inseparable, we become less able to access reality, which might appropriately be remembered as as ‘when such and such happened, I was concerned but it all worked out in the end’.

Thoughts

Thoughts and Mindfulness

In the context of Mindfulness there are 3 types of thinking

  • Active-Useful, essential for planning, doing, reaching our goals
  • Flow-thoughts occur but are not judged, they pass by.
  • Fixed-unhelpful patterns of thinking, not usually based on reality.

Mindfulness aims to help us move away from fixed thinking to flow thinking and active thinking.

It is useful to remember that

  1. Thoughts are not facts
  2. We are not our thoughts

We are then in a better position not to let thoughts and anxiety dominate our thinking and behaviour.

A useful way to notice whether a thought is an unhelpful one is whether it creates an emotion, or whether it is helping or not, that is enabling you to do a task or stopping you from doing a task by relating to the past or the future, rather than the present.

Psychotherapy and Thought

Psychotherapy is about understand the workings of the mind, and bringing it into awareness. It is about recognising behaviours that are based on past experiences, and understanding that we do not need to repeat behaviours and thoughts, especially those that cause unhappiness.

The implicit memories that were mentioned earlier, it is these that psychotherapy can help unravel and challenge.
An example
As we grow up we often maintain the beliefs, behaviours and thinking patterns that were familiar to us as children, when they are out of awareness, as adults they can prove to be unhelpful. An innocuous example might be that as a child ‘greediness’ was discouraged. So little Billy, to please his mum would take the smallest bun when offered a plate of cakes. As an adult Billy’s wife offers him a plate of buns, obligingly he takes the smallest, not wanting to be disliked for being greedy, Billy’s wife is upset thinking Billy does not like her cooking. There is something in Billy’s wife’s belief, behaviours and thinking that feels rejected if someone doesn’t accept what she offers.

These actions can be so ingrained that we believe them. Billy believes he is greedy if he takes a big bun and his wife believes she is rejected because he didn’t take the biggest one. These are fixed thoughts. The reality of the situation has not been made explicit, spoken about. In a state of anxiety further implicit memories may be stored (remember these are not based on reality). Billy’s implicit memory might be is that he upsets his wife by eating buns, his wife’s that Billy doesn’t like her cooking. A tiny event reaffirming a whole set of thinking and anxiety based on past experiences not relevant in the present.

Through psychotherapy Billy will gain an understanding that perceptions of greediness are individual. He will identify with his own physiological experience about what it is for him to be greedy, or even whether greediness is an unhelpful experience that represents for him an interpretation of poor self-worth (i.e. he doesn’t deserve a big cake because his mother will not love him, and as an adult, his wife will not love him if he has it) He will become aware through dialogue that explaining why he makes certain choices can avoid future misunderstandings, and stop the perpetuation of irrational decision making. He will learn that other people, including his wife, experience his behaviours in their own way, not necessarily how they were intended.

Psychotherapy and Mindfulness

Thoughts and anxiety can be inseparable. Through Mindfulness practice there can be an awareness of our thinking, noticing spiralling sequential thinking sometimes pulls us away from reality into a repetitive story of stress, and worry; Mindful practice enables us to begin to slow down fixed thinking, replacing it with flowing thoughts.

Psychotherapy acts as an adjunct helping us to notice actions and behaviours that are based on habit, or implicit memories, and previously out of our awareness. It therefore helps us to modify our behaviour and take greater control, strengthening explicit memory formation and the role of the hippocampus, enabling rationality informed by experience.

Thoughts and anxiety lose their grip on each other. Thoughts become focused based on reality, and our physical arousal is appropriate based on actual threat or excitement.

We learn to make our thoughts explicit to help identify reality from ‘make believe’. Relationships improve and anxiety decreases.

Further information about mindfulness can be found below.

If you think counselling can help you please look at my website Insightfulness or visit Counselling Directory or British Association for Counselling and Psychotherapy where you might find some helpful resources.

Resources

Books

The practical neuroscience of Buddha’s Brain. By Rick Hanson, with Richard Mendius

Mindfulness; a practical guide to finding peace in a frantic world. By Mark Williams and Danny Penman

Web Sites

The Mindfulness Project

Oxford Mindfulness Centre

Counselling Directory

British Association for Counselling and Psychotherapy

Eating Disorders- Do you Recognise Physiological Hunger?

Prompted by Eating Disorders Awareness Week 2015

Identifying the motivation behind our eating.

Part 1

An article on ‘Anorexia’ and ‘Bulimia’ this isn’t for me? Stop a minute. This is not about these conditions. Both Anorexia Nervosa (AN) and Bulimia Nervosa (BN) are familiar terms to describe mental distress that has manifested as an altered eating pattern. They tend to be diagnosed when the eating habits cause physical symptoms. Unfortunately this is often years after the illness first started. The symptoms associated with AN and BN can also be attributed to other conditions delaying accurate diagnosis still more. I want to make readers aware that unhelpful eating behaviours can be disordered before they manifest in a physical illness. If you want to know more about AN and BN visit Beat Eating Disorders  or Eating Disorder Help where some really useful information and support can be found.

6.4% of adults display signs of an eating disorder. I hope this blog raises awareness of eating habits and how they become unhelpful and the lack of trust we have in ourselves.

Many parents will be vigilant towards their children, especially daughters, watching for signs of dieting, over eating, missing meals and vomiting, some may be aware of over exercising too. When does this vigilance start? It’s interesting isn’t it? The vigilance regarding what you put into your child’s mouth will start the moment they are born. It happens partly as a result of the monitoring that is done by your well intentioned health visitor, who weighs and checks your baby to see that they are ‘normal’ to check for early signs of failure to grow, really key in spotting childhood illnesses. Do you remember how keen you were to know their opinion, and these results, and how they were interpreted? How much did you pay attention to this information, getting reassurance that little ‘Sammy’ was following the right ‘centile’? Or did you have confidence in yourself that you understood your baby’s needs? I imagine with each child you had your self-confidence grew.

Perhaps it even started earlier, the great debate to breast feed or to bottle feed?

The point I am making is that from our start in life there are external influences for example; societal, health, cultural, economic and fashion that detract us from our instinct, and heighten our anxiety about what we feed our children. For some this can have an influence on our relationship with food, body image and eating habits. For others it may manifest as ‘keeping up with the Jones’. Reassurance and a sense of belonging; being ‘normal’ is very important to us. Below I demonstrate that when we are children, dependent on others, food can be attributed qualities that are not real. It is these qualities that may contribute to an impaired ability, for us as adults to eat instinctively.

Two common examples that can become deeply imbedded in our unconscious are;

  1. Food as a prize

This emotional labelling of food may start very early, the weaning infant given a ‘treat’ for eating something we as the adult perceived as not nice. Little Sammy finished the browny-green looking sludge that was a ‘casserole’, carer smiles and looks happy, and then gives Sammy something that excites (or over stimulates) his taste buds. Sammy is stimulated emotionally, seeing his carer happy and this is rewarded by sensory stimulation, in this case taste (a fix).

In isolation this is quite normal, it’s when emotional stimulation are void in other situations. Seeing a carer happy when Sammy does other things, experimenting with touch, walking, playing, etc. will provide a balance. Sammy will get a sense that many things can please the people around him.

The lesson that is unconsciously learnt is ‘If I eat my food I get something really tasty and then those that look after me are happy’

The potential unhelpful lesson is ‘If I eat all my food, I get more nice things to eat and make the people I love happy and pay attention to me’ or ‘foods that are really tasty give me an emotional fix’. Emotional fulfilment over rides physiological need. Food can be eaten even when we are not hungry.

  1. Food as a weapon

Little Sammy is still being weaned. Carer is not able to focus on little Sammy, they have so much other stuff to do. Sammy isn’t sure what is expected. He might eat some sludgy casserole, he might feel it in his hands, rub it over everything, and spit it out, all such fun. Unfortunately all busy carer sees is a mess. The carer starts to engage with Sammy, they might be cross, or just chatting, but she is at least engaged, and not ‘busy’ elsewhere. Sammy responds to this engagement and it is good. The lesson Sammy learns is ‘at meal times my carer is busy, I need to do lots of stuff to get her attention’

Unconsciously this can manifest as ‘I can use food to manipulate people to pay attention to me’

These examples describe how food can be used, unconsciously, not as a fuel to keep our body nourished, but as an emotional tool to get something we want, to feed an emotion. Clearly we all were exposed to these types of scenarios as infants, and are not all affected by unhelpful eating habits as adults. But those that find themselves yoyo dieting, eating in times of stress, or happiness or during relationship breakdowns may well be drawing on childhood experiences that had historically been useful and provided emotional satisfaction.

To help understand the concerns you might have with your own eating behaviours it is useful to take a step back and focus on becoming attuned to what is going on for you when you eat both emotionally and physically.

If you have practiced mindfulness or other relaxation techniques, you may find them helpful.

For a day or 2 each week, or more if you find it really useful, try to focus on these questions EVERY time you eat.

On these days, before you eat spend a minute or two deep breathing and focusing on something simple, such as your breath going in and out.

Ask yourself

  • Where you are on the Hunger Scale?

Hunger scale

  •   Why am I eating?
    • Because I am at an appropriate place on the hunger scale, and feel physiological symptoms of hunger
    • And/or Because it is a meal time/ a meal is to be eaten
      • If you are eating because it is a meal time, and not because you are hungry reflect on whether you can eat at a different time. Or how necessary is it for you to fit in to meal time.
    • I don’t know, I know I want this particular food.
      • If this is the case, try identifying where the need comes from. An emptiness somewhere? A desire for a sensation in your mouth which will give you pleasure (a fix) it could be anything.

Having answered these questions, eat and enjoy.

Establishing your motive for eating is useful and the first steps to changing eating habits that you know are not helpful to you.

In part 2 I will describe how this can be developed to help you become attuned to food types and self acceptance.

You may find it interesting to look into Mindful Eating, or Intuitive Eating and the organisation Health at Every Size (HAES)

Some of these ideas evolved from Judith Matz and Ellen Frankel’s book Beyond a Shadow of a Diet.

Lent. Why do we need to give up chocolate?

A debate; Why do we  give up pleasurable experiences for 40 days?

I noticed something that made me curious today, the day before Shrove Tuesday (Pancake Day).

A debate, on social media, about what to give up for Lent. It struck me as interesting the need to give up something. Lent, traditionally is a period of penance. Penance, making an atonement for a sin, or for having done something regretful.

Cutting a delicious iced chocolate cake

Is the motivation behind giving up something for 40 days actually primarily about seeking penance for a misdeed?

The debate I hear is not ‘What is it I am sorry to have done so I can reflect on and learn from it’ but ‘Which will I be most successful in giving up; wine, cigarettes, chocolate, cakes or biscuits?

The difference may seem trivial. I wonder if the difference is actually quite crucial.

  1. Giving up something we enjoy. Why would we do that? Is it because there is some belief that self-denial is good? What does stopping doing something you enjoy mean to you? Why do you want to stop doing pleasant things? Have you ever given yourself space to reflect on why giving up something is an important act? Perhaps you are asking yourself what is my guiltiest pleasure. What do I feel bad about enjoying (a paradox in itself)? There are some things we feel guilty about doing. We give up things we enjoy because enjoying them makes us feel guilt. It is interesting that we do not address the guilt. Guilt can be two sided, guilt because we have let ourselves down, the values by which we would like to live by, our authenticity, or guilt because of falling short of perceived expectations of society. Does stopping having pleasure remove the guilt?

Or

  1. Giving up something we enjoy. Why do we do that? An obvious answer, looking at the things most commonly given up, is that it will do us some good. Help us to lose some weight, give our liver a break, a bit of ‘detox’. We give up things that we believe are causing us harm, but there is also a sense we chose things that we will manage to give up for 40 days, avoiding a risk of failure. This is hardly penance! Find me someone who gives up walking to work? There is someone who is challenging themselves, isn’t that more like a penance? Typical Lenten acts do not appear to reflect on a misdemeanor far from it, we find ourselves becoming virtuous, and self-congratulating. Interesting, is this the intention of Lent?

It appears Lent is a period to treat some aspects of the ‘human condition’ the relief of guilt, or possibly an opportunity, which we do not usually indulge in, to pay attention to our health .

Why do we need to do this?

Would it be more helpful to be penitent?

So many questions, and I am not attempting to answer any. Guilt is a universal, existential emotion that pervades our society and has a very significant impact on mental health. It is as if we have responsibility for the cause and suffering of others. We have responsibility for our own actions, and our own self-care; for being authentic to our own standards for living. Creating cycles of enjoyment and self-deprecation, and abstinence is not helpful. We find ourselves not enjoying that which is there for our enjoyment, and preoccupied with worry. Worrying about whether we have the ‘will power’ to abstain from those things we like, but feel guilty for indulging, and to what end?  Does this diminish others’ suffering? No. It creates anxiety for ourselves.

As a psychotherapist with a passion for the attunement of mind and body, may I encourage you, this Lent, that rather than give up something, you give yourself permission to enjoy the things you love. But significantly and, whilst being kind to yourself, you notice when the enjoyment isn’t complete and then stop, and wonder why. Pay attention to your body, your emotions, and feelings. Are you properly understanding what they tell you? Are you being authentic?

It is then that seeds might be sown to facilitate giving up habits that are truly not even enjoyable, but have become a false relief for an emotional dissatisfaction. It is useful to notice what emotions you have, acknowledge their pain or joy, not deny them or impulsively satisfy them inappropriately.

Lent clearly serves a purpose in our secular world. Maybe a little reflection on the purpose of our sacrifices will help us grow to be more authentic; true to ourself.

Obesity; A Man-made Mess

Health Care Professionals must exhibit true empathy with their ‘over weight’ clients. Judgement and stigmatisation is not helpful.

This blog is a personal reflection of the knowledge I hold regarding obesity and its treatment. Information I have gained as a dietitian and latterly a counsellor. Counsellors generally try to follow three core behaviours; empathy, unconditional positive regard and congruence. It is these that have stimulated my re-evaluation of my beliefs about obesity and created a need for me to hold several positions of understanding all of which contain truths.

It is normal for our understanding of what is true and what is not true to be about facts, and interpretation of data. I see truth as this and more. There is truth in human experience for example. A client sat opposite me, suffering with self-loathing who says;

                                   ‘I just start to eat and just cannot stop

The client is telling me the truth. That is what they experience. Another parallel truth is that the body responds physiologically to satiety and so individuals know when they are full. Both are true simultaneously.

I am going to identify some of the truths that I believe about obesity. This is a blog. These are my educated beliefs.

Personally held truths

EMOTIONAL TRUTHS

When self-acceptance is dominated by the need to conform to external messages we become less attuned, less able, emotionally and physiologically to be who we are.

There is no such thing as a bad food, a diet that is balanced and varied can include a variety of foods. By this I do not mean a daily diet but a diet taken over weeks.

Labelling foods as ‘good’, ‘bad’, ‘naughty’, ‘rewards’, ‘treats’, ‘healthy’, unhealthy’, ‘forbidden’, ‘wicked’ is unhelpful, and potentially damaging.

We are a complicated animal, our physiological development runs parallel to our emotional one. Issues of self-esteem, self-worth, identity, recognition are all developing as we grow. In families it is common to create an emotional meaning to food, either knowingly or not and this becomes imbedded in our emotional responses as adults.

A simplified example might be the use of sweets as a reward. Because sweets (chocolate, biscuits, cake etc) may not be freely available to a child and are associated with being good a child will become less able to control their consumption using physiological markers and more likely to be influenced by emotional markers. The absence of sweets therefore being associated with negative emotion and their presence a reward. So as an adult in low mood, it is logical to make oneself feel better by giving oneself a reward, (of sweets) just as their parents would, irrespective of hunger.

Finish you meal’ A young child (age 1-3 ) eating to appetite-(i.e. using physiological cues) may leave food on his plate. A parent, for one of many reasons does not want this. The child who is also learning about the affect his responses have on receiving attention from his care-giver, is encouraged to finish his plate. Instead of affirmation that he knows when his body is satiated (i.e. allowed to leave food) he is encouraged to over-ride this by finishing his meal in order to get affirmation from another. He is being taught how food can manipulate others, and/or that finishing food beyond satiety pleases those he cares about. These messages become embedded and may not even be part of our conscious decision making by the time we come to adulthood.

These are two simplified examples of what might go on in childhood that has a profound affect of appetite control in adulthood. Instead of labelling them as greed and lack of self –control, perhaps HCPs think of these as examples of self-soothing, or self-affirming behaviours.

Knowledge of food and good nutrition is empowering

  • Mothers-It is our mothers, or primary care providers, who significantly influence our food choices throughout life. A mother with an adequate knowledge of nutrition and meal planning will provide experiences and habits that are reinforced throughout childhood
  • School- The curriculum can teach children about health, and this can be reinforced by the provision of appropriate food in the school environment.
  • Families-Awareness of cross-generation food preferences provides opportunity to create and sustain a varied diet, incorporating a variety of foods and cooking methods.
  • Ill health- Often this provides a motivator to be curious about optimising health, empowering individuals to take control of health, exercise and diet
  • Work place-Reinforcement of positive food choices
  • Public Health messages-By which I mean consistent, easily accessible information- for those who want to learn, feel able to change, are literate and motivated. Is an useful way to advice on evidence based dietary guidelines.

The regular supply of a varied diet throughout the life cycle without recourse to bribery or reward, would greatly enhance the normalising of food.

Lack of knowledge does not directly cause obesity

It would be paradoxical to believe the body is able to control energy intake and also believe individuals are not able to control their intake through lack of knowledge of nutrition.

Energy balance

Individuals gain weight if they consume more energy than their body requires over a long period of time

                    Energy intake =Energy output=Weight maintenance

Physiologically control

There are ways in which the body has evolved to control energy intake. These include muscle receptors along the gastrointestinal tract, secretion of regulatory hormones, nerve stimulation and brain involvement and several endocrine functions.

Breast feeding- There is a link between breast fed infants and decreased incidence of obesity. I believe the cause is multi-factorial, some factors being:

  • Demand feeding-The infant demonstrates an ability to react to hunger and satiety
  • The infants success at being fed to appetite is positively reinforced-the infant ‘learns’ to trust his body.
  • The mother responds at a physiological level to provide the necessary nutrients
  • The mother responds at an emotional level to positively reinforce that she is able to respond to the infants needs timely and appropriately. The supply of food is met without creating emotional stress or anxiety from either infant or mother.
  • The composition of breast milk is appropriate for the growing infant.

 Other factors that inhibit or prevent or disguise our ability to control physiologically our energy balance.

External factors

  • The food industry-Expansive food choice, manufacturing methods, marketing, additives-colour, flavour, and preservatives all these and more serve to stimulate desire for foods outwith physiological need.
  • The glamour industry-How an idealised body shape, both for men and women detracts from the beautiful array of healthy shapes and sizes that men and women naturally have, these become unacceptable especially to those with low self-esteem and self-worth. We only need to look at other cultures and through history to appreciate how our interpretation of a ‘beautiful’ shape and sized body is a societal concept not a health one.
  • The health industry- Obesity has become a disease measured by a scale created for insurance purposes. It has made the assumption that there is a direct correlation with weight and health for all resulting in the belief all people with a BMI (for example) of 27 are equally as ‘unhealthy’. This belief is rarely challenged.

So what?

There will be individuals, physically fit and healthy with a BMI of 27, a proportion will have low self-esteem, a poor sense of self-worth, and generally not feel good about their size- (after all society teaches them it is ‘bad’). Assuming they can actually control their weight perfectly adequately using physiological markers, there self-worth is undermined by external factors and they begin dieting. They are told they are unhealthy! Foods that were once enjoyed and managed become ‘naughty, bad, denied’ and then craved. Their weight yoyos. Ironically it is this yo-yoing in weight that is more harmful than obesity per se. So the diet industry and our obsession with the perfect form and an inappropriate non-reflective use of BMI as a measure of health have made low self esteem into an obesity problem.

Just this month (Jan 2015) research from Cambridge has provided evidence that inactivity is more significant than obesity in increasing mortality rates. http://www.cam.ac.uk/research/news/lack-of-exercise-responsible-for-twice-as-many-deaths-as-obesity

As a counsellor and dietitian my approach to clients who want to change their eating habits, is to first help them love and honour themselves. In time, with support and empathic challenging their emotional hunger will not need to be satisfied by diet, and their self-esteem not affected by inappropriate stereotypes.

The weight loss industry should perhaps begin to feel some responsibility for its perpetuation of the false idea that obesity is self-inflicted, and begin to offer empathy and positive regard for those it serves.

I endorse regular activity and a varied balanced diet as a means to good health.

Counselling can be for anyone.

It is interesting how counselling is associated with mental ill health. Nick Clegg at the Liberal Democrats conference (2014) promised to increase spending on mental health, and there is frequent debate about putting mental health spending on a parity with that of physical health. I however, am not debating whether your mental health is sub-optimal and you ‘need’ treatment, I am proposing that just like we indulge our body, we should perhaps be a little more attentive to our mind/soul/spirituality.

I could google the cost of a spa break, or how much we spend on wasted gym membership. Or I could start on the cost of teeth whitening, facials, liposuction, a touch of Botox, these are accepted behaviours, which incidentally, are not inexpensive, that are used to help us ‘feel good’ about ourselves. Behaviours which we do regularly and then need to do them more frequently for the same benefit and then up-grade, and repeat the cycle.

We attend to the body, the shell, our physical form. This is how we see ourselves in the mirror, and it is important. Our acceptance of this picture in the mirror, is often conditioned by a view that society gives us regarding what is aesthetically pleasing. Some of us our more bound by this view than others, and constantly need to pay attention to how we look in order to feel ‘acceptable’ and ‘accepted’ to others and ourselves.

I recently was introduced a group ‘Health at Every Size’ one article caught my eye, Weight Science: Evaluating the Evidence for a Paradigm Shift . This article demonstrates how powerful non-health based influencers have been on defining what a ‘healthy weight’ is. This has not been challenged enough by scientists and health professionals.

The general dissatisfaction of our ‘form’ that many of us have is not a ‘mental illness’ and yet it impacts on our relationships, our ability to get satisfaction from social events, our enjoyment of holidays, because it results in us  carrying an anxiety about how we see ourselves and also how others see us.

Then there are those of us who despite having a good quality of life, the family we aspired to, the regular work promotions good physical health who feel guilty that despite this they do not feel satisfied/happy. We wonder ‘what is the point’. This is not ‘mental illness’ yet impacts on our relationships our potential to do well, and our overall enjoyment of what we have.

Another group of us carry a sadness (which may be experienced as anger or frustration), it is associated with an aspect of the world, people, society, animal or human welfare, our environment, things that are ‘not good’, for example war, pollution, famine, global warming. Often we have little control of this as an individual but feel as a race/ species uniting we can have greater influence, so endeavour to put energy into this. This sadness can be overwhelming, it has a moral or ethical feeling and is hard to ignore. This is not a ‘mental illness’ yet impacts on our relationships, and our satisfaction with our own life journey.

These issues can slip from being motivators to de-motivators, we may feel like a failure, or unlovable, or even worthless, or insignificant. Not a mental health problem, but nevertheless leads to low mood.

Many of us with strong social networks, good communication skills, and who trust those that love us and are close to us, can share these doubts well enough to grow through them and understand themselves better.

Those that are not so fortunate may find their support through counselling. Counselling provides an unconditional space to explore what is that makes us who we are, counsellors generally believe that we are all ok, exploring the things we don’t like about ourselves can be done safely and without fear of judgment. Allowing reflection and opportunity to see things from a fresh perspective.

The benefit of doing this is often felt immediately; having the space to be who we truly are and explore our defences and anxieties in a contained consultation with a stranger who has no vested interest is liberating.

You may even want to try counselling just for the experience!

 

 

A Brief Demonstration of how Neuroscience Substantiates Counselling Practice

Emma Dunn Counselling and psychotherapy

Eye contact in counselling;  An example of  when it might be one sided.

Eye contact is often highlighted as an important part of engagement with an other. When I am counselling others my gaze is focused on the eyes of the person sitting in the other chair; ‘my client’. This is regardless of whether they are looking at me. It is as if I am saying to them I am here, ready, attentive and available for you.

However it is more usual for them, in times of deep reflection to have their eyes averted, almost glazed over.

I noticed myself doing the same, glazing over, when trying to describe to a friend, how I might feel if I could sail. I was trying to describe the sensation of being at one with the boat optimising the energy of the wind. I was disengaged from eye contact but became aware of this only after I had formed the words and understood what it was that I was wanting to express. It was then that I was reminded of the work of John Kounios and Mark Beeman, on the neuroscience of insight and why I believe so passionately about listening to our own experiences, and facilitating insightful moments. Picture Blog 2

Neuroscience is tending to indicate that insightful solutions to problems occur when the right hemisphere of the brain, notable the anterior superior temporal gyrus, is active, working creativity, and the left brain becomes less active- not working at interpreting external, in particular visual stimuli. This is seen clearly when my clients look away and appear ‘vacant’. This is why holding silence can be so powerful, it allows the right hemisphere priority to act on stimuli from the prefrontal cortex and the limbic system where emotion, non-verbal activity is shown to occur. Getting in touch with our feelings and experiences. Then, once some sense has been made, the left hemisphere, logic and language come into play and the state of introspection returns to engagement and ideas are articulated and a clarity follows. Client’s and counsellor’s eyes then meet, as if to provide assurance that the experiences are valid.

It is during the silence, when I as a counsellor have been fully available, I too have been using the right side of my brain. Activity of mirror neurones in the here and now, combined with personal experiences based on my attachment history will inform me in a way that enables me to show empathy. When my client articulates her reflections I too am in tune with the implications and emotions that these generated and our counselling relationship deepens and work progresses.

photo Blog (1)

 

I believe, psychotherapists who practice reverie and/or use  the impact of clients on their sense of self, either as countertransference or somatic experiences, even in dreams or in the supervision process are demonstrating how powerful it can be to allow our right-sided creative, emotional brain to speak to us. The antithesis of active problem solving, where we consciously piece the clues together, reverie allows the insights to suddenly arise within the process of being in relationship.

 

It continues to surprise me when counsellors are fearful of the work of neuroscience which is helping us to understand the work we know can happen in counselling. This brief exploration of insight, demonstrates how concepts from other models for example reverie, relational depth, empathy, dream work and Gestalt ideas can all be substantiated at least in part by science, this is a wonderful truth that endorses psychotherapy and counselling as an effective means of helping people to understand themselves, come to terms with this and make use of experience to reach whatever goals they are aiming for.

The Johari Window and Improving our Understanding of our Patients

Joseph Luft and Harrington Ingham in 1955 created this ‘Window’ concept to understand how individuals work  within teams and to improve productivity, communication and collaborative working. It is frequently used within counselling to explore self awareness.

It is a metaphor for displaying ourselves, drawing on ideas of visibility and transparency as well as curtaining off areas to keep them protected from on lookers who may mean harm.

I wonder if this tool can also be used to understand the complexity of the patient presenting to their doctor or Health Care Professional (HCP)?

The Open Quadrant

The transparent two way picture.

This is what the patient is willing and able to show to their doctor. But what is it that the doctor believes they are being shown? And what are they willing to see? The picture is quite a simple discrete one, I believe that too often the view for the doctor and HCP is the illness and  treatment for which their patient has been diagnosed. This is not necessarily so for the patient, their presenting picture; what they make visible, may be quite different, not even on the radar of the doctor or HCP. For example they may be showing as an anxious parent unsure of their ability to provide for their children, a highly paid business man who is in denial  ‘not very ill at all’. So  despite this quadrant being ‘open’, and that our patient willing to disclose some of them self, is the same picture being seen by the doctor? Is the doctor, only looking to see a patient with an illness, not a person?

The Blind Quadrant

This area is designed to represent what the other person can see but the patient themselves cannot see. I have  interpreted this slightly differently to emphasise the knowledge the HCP or doctor has about the patient because of their illness.

This area is saturated by the doctor’s knowledge about the patient’s diagnosis, prognosis, and expected complications. So they see, or focus on their own intelligence and ‘dump’ it on the patient. Whether they are able to tune into other aspects of the patient ( not their illness) such as their bravado, courage, or fear,  would provide potential for an improved empathic relationship. Do the blind and open quadrants merge, the patient becoming the illness, detached from the person?

Perhaps the doctor too is being blind?

The Secret Quadrant

This is describing the things the patient is keeping well guarded and hidden from the HCP or doctor who will be completely unaware of them.

An acknowledgement by HCP’s that they in fact are not being presented with the whole of their patient and the patient is concealing aspects of themselves may be useful. It may be relevant to reflect: what is my patient hiding from me?Is this related to their illness?  The situation, environment? Am I being presented with the whole person? How can I facilitate openness? What impact will this have on concordance? Self management?

The Hidden Quadrant

Neither the HCP nor the patient knows what is hidden. But by providing space to explore the potential for understanding how the patient’s illness is impacting on relationships, behaviours and emotions will only serve to increase the potential for our patient to modify their behaviour  to help them reach the potential they hope for themselves. So facilitating the exploration of anxiety, poor sleep patterns, bad dreams and other negative characteristics may prove beneficial for physical health and the relationship between patient and HCP/ doctor,  and patient and their illness.

Johari-Window-Medical-Model

I would just like to conclude that there are missed opportunities within the NHS care settings that deny the patient the opportunity to be truly known by health care professionals such as doctors, who claim to wish to do patients no harm and yet understand very little about the patient they wish to avoid harming.

Is the medical model the right way to support people with long term medical conditions?

I am writing this as a concerned health professional with experience of the NHS for over two decades and also as a psychotherapist, with an appreciation of why individuals may behave contrary, to what might be thought of, as against their best interest. My thoughts are my own. I have used the term ‘patient’ reluctantly; this term, inherent in the medical model is probably the most familiar to my readers.

BLOG003cThe first paradox I encounter is that the medical model extrapolates clinical evidence obtained from Randomized Controlled Trials (RCT) to individuals. Is it appropriate to apply objective data (data aiming to be objective) directly to an individual subject?

Secondly the general assumption of the medical model is that the ‘patient’ wants his illness to progress slowly to maximise life expectancy, and consequently there is an implicit power differential that the health professional has the knowledge to help the patient achieve this outcome.

Thirdly this implicit power differential can be disempowering for the ‘patient’, this can have a variety of consequences:-

  1. He rebels against the health professional and so behaves contrary to advised,BLOG003
  2. He submits to the Health Professional; complies but is not doing so for themselves and so may become angry, frustrated, depressed or rebellious
  3. He becomes dependent on the Health Professional and loses self autonomy
  4. He avoids the situation; begins to fail to attend and aims to manage their illness on their own,
  5. It can prevent a significant number of ‘patients’ from asking personal or challenging questions, resulting in dissatisfaction.
  6. It creates additional barriers to forming healthy, useful relationships, ‘patients’ being labelled as ‘poor attendees’ ‘non-compliant’, ‘troublesome’, ‘time consuming’ and sometimes relatives also being labelled similarly.

Finally (in this blog at least) the NHS does not appear; yet, to add equal weighting to  Patient Reported Outcome Measures (PROMs) compared to mortality rates or length of hospital stay, as a measure of its success.

BLOG003bThe outcome of the medical model, to varying degrees is that individuals with long term conditions have an increased incidence of mental illness, unemployment, and reliance on others for financial support, the latter most likely due to lack of independence but, ironically, on the positive, possibly live longer than had they not had health care input.

Health professionals declare that they should knowingly do no harm. Currently interpreted as insuring the ‘patient’ has been provided with everything they need to know (within their capacity) regarding how to manage their illness appropriately, and which medication to take. Is failure to provide this unasked for information being negligent? I have indicated doing so may in fact cause more harm than not.

What is the alternative?

It is difficult to change a culture. As I see it there are two factors that need addressing. The first is the power and authority that is given to knowledge by health professionals. Knowledge is only valuable to those that seek it. An individual will value knowledge about his illness when he has sought it and that is likely to be when he will find it applicable and appropriate for his own personal needs. As health professionals we need a new set of skills. We need to know how to use our ‘expensive’ time to listen to the person sat facing us, and hear them as a fellow human being who has to deal with what might colloquially be called ‘crap’ and then give them the information they ask for and is relevant for them. This month NICE has introduced a new guidance, on Behaviour Change, which may help http://guidance.nice.org.uk/PHG/55

Secondly, there are many theories regarding the roles we create for ourselves, our need to fit into social norms-conforming; they can be below the surface or in the sub conscious. One of these is the relationship between patient and doctor/ health professional. I described this relationship as one about power earlier. I do wonder whether we used different labels, ‘patients’ became people and doctors or health care providers were ‘advisers’, as any other advisor, available when needed. Not thrust upon us like a PPI sales man.

I am aware, people do not know what they do not know, and this can be where my ideology fails. May I just pose that we, Health Professionals- need to shift our priorities from informing to listening?

Overeating at Christmas- Enjoying the food that passes between your lips (Part 2)

Overeating at Christmas – Enjoying the food that passes between your lips (Part 2)

Overeating at Christmas- Enjoying the food that passes between your lips (Part 2)

Overeating at Christmas- Enjoying the food that passes between your lips (Part 2)

Temptation, too hard?

So why not enjoy the food that passes your lips, eat less: enjoy more
1. Write down the consequences for you of losing control, eating too much.
2. Look at this constantly and be reminded how good you will feel if you avoid losing control.
3. Find an ally who can motivate you, support you when you are struggling
4. Temporarily move yourself from temptation; go into another room
5. Reflect on whether you are enjoying what you are eating. Ideally you are enjoying it, if not put it down.
6. Did you know fatty foods-crisps, nuts, cheese, chocolate and pastry taste so good because the flavours are dissolved in the fats and create a nice sensation in your mouth.
7. Think about giving yourself a cut off time, after which you are not going to eat anything

Mindful Eating
Why not try mindful eating. See how much enjoyment you can get out of one piece of chocolate, or a crisp.
Look at it, think of the colour and whether the colour reminds you of anything. Look at the shape, how was it made? Who made it? Was it handmade or produced in a factory? See if you can spend 30 seconds to a minute thinking about the food you are going to eat. Now begin to smell it. Does the smell bring back memories or experiences? This may seem odd, but it is a useful exercise to slow down eating and to notice the enjoyment you are getting from the food. Again see if you can take up to a minute or even longer savouring the smell. Once smelt, bite a little bit and notice how it feels in your mouth, enjoy the flavour. Notice when you need to swallow it. Once swallowed why not reflect on where it is going, what happens now. Your digestive system will kick into action, acid in your stomach will break down some of the larger molecules and then when it enters the intestine all the goodness will go into the blood where it will be used or stored. Spend a little time reflecting on whether your stomach begins to feel full, and whether you still feel in control.
This might be very challenging for you, but it is a useful tool to slow eating behaviour and to register mentally what you are gaining from the food you are eating. This will naturally help you to limit your intake of the food.