The acute mental health needs of men

men and depressionThe Men’s Health Forum men’s health week takes place this week and when one considers the mental health risks for men the statistics are alarming.Take, for example, the male suicide rate. The latest official figures for male suicide in the UK show 16.8 deaths per 100,000 of the population in 2014 (social researchers compare populations per 100,000 in order to offer a like for like comparison across countries of different demographic sizes). The rate for men is more alarming when you realise that the suicide rate for women was 5.2 deaths per 100,000 of the population.

The reasons for the disparity in rates of suicide between the sexes can be complex and multifaceted. However, I wonder how the psychotherapy profession can better target the specific mental health needs of men since two thirds of those seeking counselling in the UK are women (source NHS Improving Access to Psychological Therapies). I feel it is a worthy question to ask what more can be done to better attract men. As an aside, I was always intrigued during my psychotherapy training why so many trainees excluded men in their recruitment of participants for their workshops (workshops were part of the route to qualification in the final year of the study programme). Time and time again one would see workshop facilitators advertise for participants, invariably seeking to hold yet another workshop on contacting the inner goddess, and excluding men from participating in their experiential workshops. It is worth speculating if this ingrained bias against the inclusion of men might be a reflection of a greater bias in the provision of support services in counselling and psychotherapy.

I am reminded of this when considering the critical issues affecting men and ask myself whether men really feel heard.  Take, for example, depression, which in men can be difficult to spot since it can often be signalled by displays of angry behaviour in social situations. Can their anger be contained in therapy sessions or are men seen as a threat and better referred on to ‘anger specialists’ for their therapy?

Men are so often taught to believe that any problem must be solved by them, alone. In spite of the acute mental health needs of men, they are often reluctant to engage with the process of therapy. When they finally find themselves actually seeking therapy it is usually when things have reached crisis levels in their lives, when their jobs, relationships and homelife are at risk. They might also be coming as they are being pushed in the door by an insistent partner, often offering an ultimatum. Addressing the acute mental health needs of men must be a priority for us all.

See my article on how Therapy can be a lifesaver for men.


The Samaritans also offers a crisis listening service. Their telephone number is 116 123, which thankfully is now free, having previously been an 0845 number.
Men’s Health Forum offer a range of health promotion support materials for men.


Knowing your cognitive distortions to help with anxiety

It can be useful to bring awareness to your cognitive distortions especially in helping to cope with feelings of anxiety and depression. Cognitive Behavioural Therapy (CBT) can be very useful as a targeted approach to achieve balanced thinking.

CBT is flavour of the month in the NHS, and consequently can be downplayed by some within the psychotherapy profession, but I believe that it contains extremely useful tools and techniques for changing unhelpful thinking and behaviour. We owe a lot to Albert Ellis and Aaron Beck for helping us provide solutions to cognitive, emotional, and behavioral disturbances. See my article on identifying your cognitive distortions to help transform your relationships and better cope with anxiety and depression.



Mobile apps and managing your depression

apps for depressionThere are now a plethora of mobile apps for every condition known to man and you may be wondering whether they offer any benefit to diagnosis, treatment and ongoing management of your depression.

If you are worried about whether you have depression it is advisable to first pay a visit to your GP, who can advise you about your treatment options.  If you have already been diagnosed with depression you may be under medication and or in some form of talking therapy, or waiting for your counselling to start.  Or it may be that you are already in therapy and are wondering whether you can use mobile apps to support your therapeutic process.

The key with mobile apps is to make sure you use an app from a trusted source. You need to be aware of the risks associated with the privacy, security and confidentiality of your very personal data, even from trusted sources. In the UK there is a quality assurance process through the NHS Health Apps Library which seeks to offer safe and trusted apps for the management of your health.  There are currently 26 apps that the NHS has recommended (some of which are free) for mental health.   Government plans involve producing NHS ‘Kitemarks’ for trusted smartphone apps as part of an ongoing wider efficiency drive to reduce paper based patient records and to increase more electronic records to help improve health outcomes. Indeed, Mr George Freeman MP, Parliamentary Under Secretary of State for Life Sciences, recently launched a £650,000 prize fund to help in the innovation and development of mental health software and apps.

Apps can be useful, in the same way as self-help books, in potentially offering you insight into your state of being and helping to teach you techniques that could  be positively life changing. Your therapist can support you if apps are used in conjunction with your therapy and can be useful in setting out daily thought and behaviour patterns as well as setting to-do lists. However, just like popular self-help books, apps may only provide a short term boost to your state of mind and emotional balance if used as a substitute for one to one therapy. Consider for a moment what might occur when your levels of personal motivation decline after an initial burst of enthusiasm.  Depression is a subtle foe whereby you can feel hopeless all of a sudden.

The constancy of therapy offered by one to one and face to face therapy, as well as the advantages of building a trusting relationship with your therapist, can potentially prove to be more robust and sustaining in the longer term. When you make the effort to visit your therapist for weekly sessions, in spite of sometimes not wanting to go, you secure additional benefits than just the talking time in your session. Making the commitment of seeing your therapist on a regular basis offers you the potential to gain more perspective and to reflect more meaningfully on your life as you benefit from dialogue and interaction with your therapist.

See my article on apps for managing your depression. To see me for therapy call now on 07852 407140


Baby blues or postnatal depression?

counselling directoryIt can be a particularly stressful and strange time after childbirth especially if it is your first child. You may be enduring a confusing time about what is actually happening to your state of mind given the strong emotions and hormones affecting your mood.  It can also be a time when you may experience mixed feelings towards your new arrival and indeed towards your relationship.  My article on the baby blues and postnatal depression can be accessed here.

See also

NHS Choices – Postnatal depression
Royal College of Psychiatrists – Information leaflet on postnatal depression
NCT – Postnatal depression resources
Netmums – Symptoms of postnatal depression



Stress and how to deal with it

Here is a link to my article on stress which was recently published on the Counselling Directory website. This followed an article by Alastair Campbell, which appeared in the Sunday Times, in which he proposed that all MPs should have a shrink, in the same way that top sports people readily access psychological support to help in their performance management.

Struggling with stress? Here are some resource links, outlined below:

1. NHS video and articles on coping with stress, anxiety and depression
2. Stress: symptoms, signs and causes
3. Stress guide.




World Suicide Prevention Day 10 September, 2014

World suicide prevention dayAre you looking for a fun bike ride, and help raise awareness for a worthy cause? Then how about participating in the suicide prevention day bike event organised by IASP on 10 September, 2014.

World Suicide Prevention Day in 2014 is significant because it is hoped that it will mark the release by the WHO of the World Suicide Report (WSR). This follows the adoption of the Comprehensive Mental Health Action Plan 2013-2020 by the World Health Assembly, which commits all 194 member states to reducing their suicide rates by 10% by 2020.

According to Luann Brizendine, boys and girls have the same risk of depression before the hormones of puberty. However, that all changes by age 15. By then girls are twice as likely to suffer  from  depression. One thing to know about suicide is that men are more likely to commit suicide after the end of a relationship than women. When love is lost, abandoned men are 3 to 4 times more likely, according to Brizendine, to commit suicide, whilst women will more likely suffer from depression.

The International Association for Suicide Prevention (IASP) is dedicated to preventing suicidal behaviour,alleviating its effects, and providing a forum for academics, mental health professionals, crisis workers, volunteers and suicide survivors.Download from here their suicide prevention links.


It is intriguing how some patients can invoke certain feelings and not others.

It was good to get back to my psychiatric placement at an NHS Mental Health Trust today and to a ward review meeting.  I have been sitting in on clinic sessions at a university hospital with consultant psychiatrists covering new assessments, outpatient follow up appointments as well as team meetings discussing the management of care. It was two weeks since I was last at this ward review and it was heartening to notice the visible improvement in some patients in the intervening period.

There were a couple of patients who had regressed and this was producing some feelings in me (what is called counter transference). One patient, a middle aged man suffering with severe depression, was continuing to present with anxiety and helplessness.   I felt like wanting to hug him.  However, his depression is so severe that he has been prescribed a course of ECT. It is intriguing how some patients can invoke certain feelings and not others. Perhaps counter transference is when our own stuff and issues have been triggered and when we identify with the personal circumstances. I was particularly taken by the love and support of his partner (who was present in the session) and who appeared to be a rock of support in spite of very challenging circumstances.  The experience made me aware of the vital role that carer groups undertake in the management of support networks for families and friends of those suffering from mental illness.

Related posts. 
The 1-1 relationship between psychiatrist and patient
The importance of challenge in the therapeutic relationship 
Transference and counter transference
Resistance in therapy
Dr Marie Keenan interview


Medication and talking therapy fail to show any difference to placebo when treating depression

The treatment of depression has been in the news more than normal this past few weeks as a result of some high profile suicides. A new study has found that medication and talking therapy have failed to show any difference to placebo when treating depression. Read further information about the study and the story here.

The clinical research study led by Mr Jacques P. Barber, dean of the Institute of Advanced Psychological Studies at Adelphi University in Garden City, New York, involved a group of depressed patients and put them randomly to one of three treatment conditions: medication, psychotherapy, or placebo (patients were given inactive pills).

The lead researchers randomly assigned 156 depression patients to three outcomes. They put some in the group taking the antidepressant sertraline (Zoloft and other brands), which the patients took on a daily basis for 16 weeks.  Another group underwent a form of psychotherapy which the researchers called supportive-expressive therapy, and this took place twice a week for a total of four weeks (and then weekly for 12 weeks). Another group were pit in a placebo group and given the placebo (inactive pills).

Interestingly, the study found that after the 16 weeks of the trial was up, they did not notice any overall differences in how the three groups fared over the course of treatment.

“I was surprised by the results. They weren’t what I’d expected,” said lead researcher Jacques P. Barber, dean of the Institute of Advanced Psychological Studies at Adelphi University in Garden City, New York.

This is bound to be an issue that will receive significant debate over the coming weeks. To my mind, I am not that surprised. Psychotherapy is not a quick fix and things often get worse before they get better as clients often have to go deeper and uncover some murky issues in their back story. Indeed supportive-expressive therapy is not CBT. Furthermore,  placebo condition in clinical trials is not really “no treatment” as participants are being asked questions about their condition and are based within a setting that is different to their normal habitat. 

The research study, partly funded by the pharmaceutical industry, concentrated on urban, lower income adults who suffered with major depression. The study was comprised of an unusually large minority population for a clinical trial on depression. Nearly half of the 156 participants (45 %) were of African American ethnic origin.


Depression explained
Depression MIND 
Anti Depressants
Net Doctor
Royal College resource on depression


The clinical (illness model) of personality typology #Freud in the therapeutic setting

It was great to get back to term time lectures again last night even if it was not great to be back in the London climate.  I left Valencia (see above) on Monday when it was 37 degrees.  Last night’s lecture was on Freud.    I will be discussing Freud’s ideas later in the week but I wanted to continue my theme of applying personality typology to the therapeutic environment.

In the psychotherapeutic community we owe a great debt to Freud who was primarily concerned with exploring the personal unconscious. The clinical model has its origins in Freud and covers four types: schizoid, obsessional, depressive and hysterical.


In this model this type is described as introverted.  They are more likely to be avoidant in relationships and are fixated on oral development.  This type often fails to turn up for therapy. The defining feature is the distance between the conscious personality and the
feelings function.  There is very little sense of self and there is a fear of intimacy with this type. The schizoid likes to be alone and is not very good with manifestation.

The approach in therapy is to understand that fantasy is the way into feeling for
this type.  Patience is therefore needed in the therapeutic environment, as perhaps it is needed with all clients, but especially so here.  It is perhaps an over generalisation that this type is represented by ‘air’ in the elements model but it can feel like it when you are sitting and listening to a client who speaks non stop in an avoidant manner. With a contracted client, I would slowly try to ground them by getting them to relax and get in touch with their feelings. A number of transpersonal techniques could eventually be employed
when it is safe such as the pebble exercise, meditation, creative imagination
and deep breathing.


 The obsessional type is also described as introverted. The issue with this type is
control, therefore, this type is less likely to turn up for therapy. The feelings are not shown.  They are there, just that they are not shown. This type is associated with the “stiff upper lip”.  Obsessive compulsive disorder (OCD) can be a presenting issue which is about mastering, a form of control.  In Freudian terms, it emanates from a potty
training issue and a form of distortion which took place around 6-18 months
leading to a fixation.

Attempts at control and people pleasing leads to resentments with this type. Spiritual
experience can threaten them.   This type is more likely to become tyrants, controlling
their world through their will and ultimately leading to isolation.

An approach in therapy would be to investigate what is happening in dreams as obsessives
play out sabotage.  The real work in therapy is to uncover what is really going on.
No less with this type. How can the true feelings be revealed? I would seek to explore the source of the resentments and the need for controlling behaviour. The key is to get behind the primary behaviours to uncover what is really going on.


Depression can be endogenous, reactive and bi-polar (previously called manic). This type in this model is extroverted as the feelings are shown.  There are lots of water qualities. They are more likely to turn up for therapy because of their extraversion inclinations.

Endogenous depression is not a type of depression rather it is biological depression. The defining characteristics are helplessness and hopelessness. What is behind this is an internalised sense of not feeling good enough.  They seek out scripts that are self-deprecating as they are seeking to have their poor self image reflected back to them.

The manifestations of low self-esteem usually bring them into therapy.  Unlike schizoids, there is a sense of self, but it is lacking or weak.

Reactive depression specifies that depression comes from some event or some stress occurring. For example, problems in a relationship, bereavement, loss of a loved one, changing job or anything that directly affects one’s life.  Other people can sense the
vulnerability of depressives and can seek to exploit their victim status. This is a major liability in dealing with life’s problems since in the workplace there are invariably bullies lurking to pick up on any vulnerability.

Depressives are water types in the elements model as there is distortion.  The water is stagnant.  Bi-polar (formerly termed manic) depression is the toughest to live with and requires medication for chemical rebalancing. Bi-polar clients can be as high as a kite and can be very sexual, or spendaholics. But then there is a crash.  It is about extremes with this type. If they are challenged they can be very defended.  Lithium is the usual
prescribed medication.

The approach in therapy is to be aware of boundaries which are very important for depressed  clients.  CBT interventions such as “to do lists” can be very useful. They need
accurate mirroring and reassurance and require an acknowledgement of their
accomplishments.  It can be safer to access anger (fire) through creativity, in the form of gestalt therapy or working with images. Fire is the expressed form of the water element as the depressed feelings can be akin to stagnant water.

I find the description of this type in this typology limiting in that I believe we are all a bit depressed, to a greater or lesser degree.  How, for example, can you distinguish between sadness of true feelings, perhaps in response to a harsh event, and the sadness brought about by depression?   Perhaps it is best to think in terms of extreme distortion with this type.   We might all be a bit depressed at times but the issue is when the depressed feelings become our defining quality.


Like depressives, hysterics are more likely to turn up for therapy because of the extraversion in these types.  They are extrovert because the feelings are
being displayed (symbolically) and they are demanding attention. In Freud’s day,
the hysterical type was seen as classically female. Hysterical types seek
attention by whatever means. They are invariably still raging at a parent.  They need attention but the right kind.  These are the type that will commit suicide
by accident. The suicide attempt is really a cry for help, for attention, but it
went too far.

There is always a drama going on with them.  Hysterical types are prone to sexually provocative behaviour or to sexualizing non-sexual relationships. However, they may not really want a sexual relationship; rather, their seductive behaviour often masks their wish to be dependent and protected. They have a tendency to “make mountains out of mole hills.”  The proverb rings true: ”Empty vessels make most noise.”

The strategy with this client is to try to find what is really going on and therefore one needs compassion.  They can be hard to like as they seem to be sabotaging themselves.  They are like a hurt child running the show and are distorted earth types.  They look
fiery, but it’s more like an earthquake or a volcano. The presenting issues
with these clients can entail bad physical conditions. Physical holding can be
a positive reassurance, such as a hand on back, a hug, or a holding hand.

Critique of clinical model

Freud has contributed a great deal to our profession but the psychoanalyst tends to have
the role of the wise initiate who ‘knows’ and disagreement would be seen
usually as a defence or a manifestation of pathology. This is at odds with the
transpersonal school, which most certainly does not ‘know’ but finds creativity
in holding and exploring the mystery.  The clinical model can be useful when seeing extreme, distorted types.  It is an illness model and the conflict is the need to conform to society. I would contend that the need to conform to society is less of an issue nowadays.

There are wide differences of opinion within the transpersonal community
as to the appropriateness of doing transpersonal work with psychotic
individuals. Jung, Wilber, and Grof and Grof  have argued that transpersonally oriented therapies are not appropriate for psychotic individuals.  Lukoff and others, however,  suggest that transpersonal psychotherapy may be particularly appropriate for psychotic disorders, even serious ones. In general, initial evaluation should include not only the usual elements of a psychiatric history, but also an assessment of the patient’s spiritual experiences, developmental level, premorbid functioning,  and interest in exploring the symptoms.

More on Freud soon…..

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