About Noel Bell

I am a psychotherapist practicing in London Bridge SE1 and Sydenham SE26.

The Blue Whale game is not as risky as we may fear

Today I was interviewed on Sky News about the risks posed by the Blue Whale game in the UK and about peer pressure facing teenagers. Blue Whale is an online game that originated in Russia and where it is claimed users are manipulated into self harming and ultimately encouraged to commit suicide.  This has led some to refer to it as the suicide game. It is feared that up to 130 deaths in Russia are linked to the phenomenon. Also referred to as the “Blue Whale Challenge”, it encourages users to complete a series of tasks over a 50 day period. There are fears that the game’s contagion could spread to the UK with police and teaching bodies issuing warnings about the risks posed by the game.

Whilst not wanting to minimise the danger or to downplay the potential risks I would caution against getting too worried.  The UK is not Russia. There is an absence of social mobility and economic opportunity amongst young Russians (particularly for those outside of elite circles) growing up in a post communist society, and perhaps living in a high rise block from the Soviet era in a grim part of middle Russia. British teenagers do not face anything as dismal in their lives. The suicide rate in Russia is high and Unicef reported in 2011 that the country has the third-highest teen suicide rate in the world. We can’t even be certain that the game actually caused the deaths or that these deaths would have occurred in the absence of the game.

The trouble with setting boundaries around technology more generally is that parents have knowledge of pre internet behaviour. Young people don’t have a baseline behaviour of something other than the internet, its as if it has always been here. Engagement with the internet is not optional for them. For them the internet and specifically social media engagement satisfies prime drives for survival and to affiliate. However, we wouldn’t allow children to go to a public park unsupervised but some teenagers are given unsupervised access to a smartphone, which is essentially a portal to the outside world with high potential for encountering inappropriate material. Most, however, will be fine and will have developed sufficient levels of resilience to cope with cyber bullying or inappropriate suggestibility from others.  But just like with alcohol and food there will be a small proportion who will develop problem behaviour with technology and will be susceptible to manipulation.

Some people might wonder how someone could fall under the spell of something so ridiculous as following the commands of strangers to commit actual self harm. Indeed, others would say that all you need to do is switch off the computer if being bullied online.  This is a little simplistic. The teenagers who are selected for cyber bullying are often vulnerable and are, therefore, at greater risk of being manipulated and exploited. Teenagers often worry about their appearance, their weight and whether they are cool and so can be vulnerable to being bullied. They often seek approval from others to satisfy their feelings of esteem. Children who suffered disorganised attachment whilst growing up are particularly vulnerable to exploitation.

The sinister aspect to the Blue Whale game is that other teenagers are also recruited by the gang leaders to select and recruit the most vulnerable users, called masterminders. The kids who create the peer pressure are often frightened and lost themselves and they seek strength in groups. We see this quite commonly as a feature of teenage gang violence in our cities. The even more sinister aspect is that some of the Russian gang leaders behind the game, and who referred to getting rid of ‘biological waste’, received love letters from teenagers after being locked up.

Whilst I have downplayed the risks associated with the Blue Whale game in the UK I would, nevertheless, suggest that parents remain vigilant about the risks presented by this and other online games. They can become more proactive in the active monitoring of their children’s web usage. Parents should keep lines of communication open with their children as they will need someone, who they can trust,  to turn to if they encounter any problems online, or in the real world for that matter. The key is to try to help them achieve a balanced level of engagement with technology and to ensure that their activity takes place within a safe environment. They can learn to say no and to only share information and content that they are comfortable with. Try to agree terms and conditions with your child around appropriate device time and above all don’t allow devices in their bedroom.

See also

NSPCCStaying safe online
Childline – Call them free on 0800 1111 or get in touch online. 
See also some related articles:
Do you have a problem overusing your smartphone
Digital detox from smartphone addiction
How to digitally detox and stay connected 

For anyone affected by the issues in this article, you can contact the Samaritans in the UK or call 116 123. Calls are free.

 
Share

Crisis counselling interventions do not work

I have always been sceptical about the usefulness of providing trained counsellors to help those impacted by incidents of major trauma. It is almost commonplace, nowadays, to hear in news reports that trained counsellors have been drafted in to help deal with the emotional carnage following a major incident. Such considerations for those affected may indeed be well intentioned but that is not the point. I have often wondered if such decisions to draft in a cadre of specialists might actually be counter-productive for the resilience of those affected by such events.

I was interested, therefore, to hear the recent statements from the President of the Royal College of Psychiatrists when he cautioned against the automatic provision of crisis counselling interventions for those affected by major public incidents including the recent terrorist attacks in Manchester and London.  Sir Simon Wessely, a specialist in the treatment of post-traumatic stress disorder (PTSD), believes that research has demonstrated that the routine screening of survivors as a way of seeking to find those most in need of psychological support has proven to be ineffective.  The research indicates that a policy of implementing routine counselling could potentially traumatise those who would otherwise have recovered from their experiences. There was a wider risk of “professionalising distress”, he cautions, in encouraging those going through sadness or grief to think there was something wrong with them,

This reminded me of the time when I worked at a national charity, offering a telephone sign-posting service for people affected by problem gambling. Managers would offer a debriefing telephone consultation (which alarmingly usually involved one’s line manager providing the debriefing) immediately following a shift in the misguided belief that debriefing was an appropriate tool of self-care to support helpline advisors to cope with potentially difficult material. They would almost pressurise people to take advantage of the debriefing service and there was little awareness of the risks associated with such early interventions or that such support, if it is to be effective, should be voluntary.

Most people who have been affected by major incidents will benefit from a normal healing process whereby they learn to cope by using their own support networks. The research would appear to show that affected individuals mostly get better by talking to and sharing experiences with friends, family and colleagues. Sir Simon suggests that only a minority will need specialist help and such need will only become evident after a period of what he terms “watchful waiting” (which could be a period of up to 12 weeks when the needs of individuals are properly assessed).

The provision of early counselling for those affected by major public events may, of course, be well intentioned. However, early counselling risked overwhelming survivors as well as possibly interfering with psychological defence mechanisms, which aim to protect against too much reality and horror. There is also a risk of pathologising distress and potentially undermining the resilience of individuals, if there is a rush to intervene too early. Further, with the power of suggestion, there is a risk that individuals might experience possible ill-effects merely from the thought that they might occur.

The people who need reassurance might be those who have unresolved and unprocessed trauma from the past which gets triggered by witnessing major public incidents of disorder. The risk for such individuals is that they will feel unsafe and might seek to engage in unhealthy safety seeking behaviours as a way of avoiding the heightened feeling of threat. In such instances it is vital that these people have the support to go about their business in a normal way and help in dealing with their hyper-vigilance. Therapy can help with dealing with historical trauma, acknowledging cognitive distortions as well as helping to reconnect with an internal safe place.  But crisis counselling should not be the first thing we think about for those who were unfortunate to witness the unpleasantness associated with major public incidents.

See also

Kings College study on returning soldiers

 

Share

Are fidget spinners a useful learning tool?

Have you heard of fidget spinners?  If not, you might be surprised to hear then that they top the lists of the best-selling toys on Amazon UK.  They are the latest craze amongst school children and are being hailed as a learning tool to help kids suffering from inattentive states of mind.

Today I was interviewed on Sky News about the latest craze of fidget spinners and the potential benefits for kids using the devices. See the link to the interview here http://news.sky.com/video/fidget-spinners-the-issues-debated-10881551 The central issue, it seems to me,  is whether these devices can be effective stress management tools in addition to being an aid to learning for kids suffering with the negative aspects of attention deficit hyperactivity disorder (ADHD), or whether they are distracting and could cause problematical behaviour in themselves.

The marketers claim that the devices can be an aid to learning for those suffering from ADHD in the classroom as well as potentially relieving the symptoms of ADHD itself, autism and even post-traumatic stress disorder (PTSD). These are big claims.

However, there are no clinical research findings to support these views, at this stage of their usage. At best what could be said is that there might be anecdotal evidence to suggest that these devices may help inattentive kids to concentrate on their learning. However, it would be inaccurate to suggest that these devices support the learning capacity of such kids, particularly those suffering with symptoms associated with ADHD.

These spinner devices are visually distracting which could be their major drawback. Some of the devices have lights on them which could make them further distracting in addition to the whirr sounds. This could potentially act as a mitigating factor against their usefulness as a learning tool. Other fidget devices, which don’t have the visual distractions, could possibly be better gadgets as an aid to learning for kids suffering from inattention. Indeed, good old stress balls (with no visual distractions) would be more effective as an aid to learning for inattentive kids.

Riding a stationary bike whist reading would offer the potential for small and non-distracting motor movements. Fidget Spinners,however, don’t require gross body movement, which is needed for increasing the activity of the frontal and prefrontal parts of the brain that are responsible for sustaining attention.

Problem behaviour, as with any dependence on any gadget, is when negative consequences begin to occur in other aspects of the user’s life or when they act as barriers to communication.  Addiction is the search for emotional satisfaction. It is worth asking what happens to the emotional regulation and mood when the device is not available. The key is that kids are taught how to use these devices appropriately so that they do not prove to be distracting to their learning but can be used in a constructive way.

If you are a parent and worried about your child potentially having ADHD it could be worth a consultation with your GP who will be able to direct you to the appropriate support services. See the NICE guidelines for more information on support for ADHD.

See also

My son is addicted to computer games

Share

My interview with Mary Deitch about problematical sexual behaviour

Yesterday I chatted with Dr Mary Deitch, President of SASH, about working with clients suffering with problematical sexual behaviour. I first heard Mary speak at the Farley Center when she presented on understanding the basics of problematical sexual behaviour. (See the slides for that presentation here).  In the interview we discuss how to identify problematical sexual behaviour and the difference between what are sometimes termed lifestyle choices versus what is actually addictive behaviour. We also briefly discussed the disease model of recovery, attachment styles related to addiction and how useful clients can find attending meetings of 12 step fellowships, such as SA, SAA and SLAA.

For more information see the following links:

Addiction is not just about drink and drugs 
Sex addiction – why its so misunderstood
What to do when your partner has an active addiction
How to know if you have a problem with porn
Counselling for sex addiction London

Share

When integrative therapists debase some of the therapeutic approaches

For therapy to be successful I believe that it is essential that clients feel comfortable and safe with their therapist so that they can start an open and frank dialogue. Various research findings have indicated that the working alliance is as important as any other factor in successful therapeutic outcomes. John C. Norcross’s approach to integrative psychotherapy involves selecting models and methods from across orientations so that the client’s experience is best met and in context. He shows how meta-analyses demonstrates that tailoring therapy to the individual client enhances treatment effectiveness.

I sometimes wonder, however, whether integrative therapists debase some of the therapeutic approaches. When you look at various profiles on therapist directories, for instance, it is not uncommon to see practitioners describing themselves as analysts, gestaltists and CBT therapists. On closer inspection such profiles state that their psychotherapeutic training took place at generalist training institutes, usually integrative. Some profiles refer to offering ‘Jungian therapy’ as part of their counselling and psychotherapy private practice. In actual fact, what this means is that they had a few lectures on Jungian symbolism, at best. Their training was not in the Jungian approach, at depth, and they did not have analysis a few times weekly as part of their personal therapy (nor did they benefit from specific clinical supervision in the Jungian approach). The same is true of the Gestalt approach when integrative practitioners may have benefitted from a weekend of experiential work using some of the Gestalt tools and techniques in a very general way. However, they won’t have had any real thorough training in the Gestalt approach.As for CBT, it has been my experience that integrative training institutions are biased against the CBT approach and offer such a slimmed down version of it, as part of their core syllabus, that I wonder why they bother in the first place.

Of course, it is fine to say that as an integrative practitioner one can offer components of certain approaches as part of an overall psychotherapeutic offering, as a kind of generalist toolbox.  Indeed, one can use continuing professional development (cpd) to expand one’s knowledge base in particular areas throughout one’s career. However, I find it disingenuous to talk about being an analyst in the absence of specific training in that approach.

Share

Develop a healthy sense of self to overcome codependency

Do you struggle with your boundaries and usually give too much to your partner without receiving back the love and respect you expect?  Are you involved with an avoidant personality type and frustrated with the level of communication in the relationship. Do you see yourself as dedicated to the welfare of others? If these questions make you answer yes, then perhaps you might benefit from reading on.

Codependency is rooted in addiction. It is about over-functioning in someone else’s life but under-functioning in your own.To have a working understanding of codependency is to see a co-dependent as someone who cannot function from their innate self and whose thinking and behaviour is instead organised around another person, or even a process, or substance.

The term is located within a systemic framework. Codependency was originally a term used to describe a particular relationship dynamic where one partner had a substance abuse problem and the other didn’t. The individual who didn’t have the substance abuse issue became caught up in a cycle of excusing, tolerating, defending and even enabling the addiction of the other. In Alcoholics Anonymous (AA) the problem became known as an issue not solely with the addict, but also the family and friends who constitute a social network for the alcoholic. Al-Anon (the sister fellowship of AA) was formed in 1951, and holds the view that alcoholism is a family illness. Al-Anon is one of the earliest recognitions of codependency.

The term codependency is not universally accepted in the therapy world. For some clinicians codependence is over-diagnosed. For them, people could be helped with shorter-term treatments instead of potentially becoming dependent on long-term self-help programmes or therapy. Such treatment, they argue, can be theoretically misplaced as the direction of the treatment can follow the disease model of addiction. For others it is a healthy personality trait, albeit just taken to excess. The key in determining whether you have a problem yourself is to assess the extent of the under-functioning in your own life as a result of caring for another. Does your own life suffer as a consequence of your concentration on the needs of another.

Clients don’t often attend counselling and psychotherapy for codependency, or other addictions for that matter, but might present with problems associated with anxiety in their lives, for example, or relationship issues more generally. Once in the process of attending therapy sessions,however, they can become more conscious of their underlying codependency issues.

In order to understand codependency it is useful to gain insight into what kind of attachment style you operate from in relationships. We develop a style of attaching that affects our behaviour in close relationships throughout our adult life. One of our prime drives, after all, is to affiliate, just like our drive for survival.  Our attachment style is largely dependent upon our mother’s behaviour, in addition to later experiences in childhood and other environmental and social factors.  For more information on this see my article on attachment styles and recovery from codependency.

Recovery from codependency, like all addictions, involves the development of a healthy self and allowing for an expansion of consciousness.  Healthy relationships are when each person can remain themselves and when the dynamic allows for change and flow. If you are in a codependent relationship a recovery path could be to detach with love, face illusions about your life and your relationship, set healthy boundaries and develop your spirituality.This can help build a healthy sense of self going forward when you learn to take care of your own needs and ultimately learn to be happy with your own company.

See also

Any book by John Bowlby
Attachment in Adulthood: Structure, Dynamics, and Change –  Mario Mikulincer & Phillip R. Shaver
Adult attachment – J Feeney & P Noller
Handbook of adult attachment – J Cassidy & R Shaver
My life as a border collie – Nancy L. Johnston
Codependency no more – Melody Beattie
CoDA UK – 12 step fellowship and a checklist for codependence

 

Share

Chemsex partygoers and improving access to psychological services

I often wonder how the whole field of counselling and psychotherapy could help to better address the needs of those who are essentially most in need of psychological support. Men, for instance, who suffer from depression often present as angry individuals but the anger is often hiding the pain of depression. Depression in men is so often difficult to identify as it can be accompanied by displays of angry behaviour in social situations. Men, in effect, can more easily end up in prison than in a therapist’s room.

The stigma for men surrounding not only drug use but also gay sex can act as a barrier for individuals who really need help accessing psychological support services. The drug-fuelled party lifestyle associated with chemsex can destabilise the mental health of those already suffering from pre-existing mental health problems. These issues will be presenting more and more in the coming years in counselling rooms with the advances in mobile telephony and hookup apps. But a prevalent culture of silence, secrecy and stigma in the chemsex world can keep individuals isolated from accessing services. Chemsex users perhaps need to be reassured, more than any other client group, that they will be understood, and not judged, if they do end up presenting for help.

Therapy can offer people a vital place of safety to unravel their story so that greater insight can be obtained for problem behaviour. It can be common for attachment issues to get played out in all forms of addiction, as well as past traumas and previous psychological wounding.  Therapists need to be even more aware of their need to make personal connection with the presenting issues with such clients. An abstinence based approach might not always be appropriate for them, at least initially, as the thought of complete abstinence might make them run away. Harm reduction and psycho education could be useful areas to cover as well as the principles and ethos of motivational interviewing. These clients are often in a contemplative mode when assessing the options about their future intentions. Chemsex users are familiar with high adrenaline excitement as a means of mood regulation and will be easily frightened about slowing down and getting in touch with difficult personal material that might threaten their equilibrium.

Chemsex parties offer excitement and the apparent lure of social connection. However, for those vulnerable to psychological wounding the lifestyle can be a dangerous playground and chronic feelings of aloneness can persist. Addiction can be viewed as a search for emotional satisfaction, as a place of safety, balance and comfort. If the connection in the consulting room is robust the underlying psychological issues will get played out in a safe environment through projections and transferences.

To read more about chemsex and what is involved see my article: When the chemsex parties stop being fun

Share

My contribution to the Insight programme on TRT World for Safer Internet Day 2017

Yesterday I appeared on the Insight programme on TRT World discussing online safety, with particular reference to young people, as part of Safer Internet Day 2017. Click on the link below to see the discussion.

When discussing the impact of the massive social change that has been underway for the past 25 years with the advent of the internet, it is worth remembering the accelerated change that has occurred only relatively recently with the increased speeds associated with mobile telephony. The first generation iphone came out in 2007, even though it would seem to have been around forever, and it is only very recently that we have seen the introduction of fast 4g superfast smartphones. As consumers we have incredible search capacity on these powerful multi media devices and with exciting apps we have never had it so good in terms of personal entertainment on the move. However, there is always downsides to everything that is good and young people in particular need to be aware of the risks associated with sharing personal information and engaging with others online.

See the links below for some useful lists of resources and further information about staying safe online. There is also a resource pack for parents on how to engage with their children and the digital world.

See also

Advice centre for staying safe online
Childnet resource – tips for young people staying safe online
Power of image report for Safer Internet Day 2017
Social media risks for teenagers
How to digitally detox and stay connected

Share

Internet addiction and problems overusing social media

Today I had fun chatting to the Doha team of Aljazeera TV (Arabic) about internet addiction and specifically problem behaviour with social media. I was on a live feed in the London studio (based in the Shard) and my views were sought through a translator about the universal problem of overusing smartphones and social media apps.

I am often asked what constitutes problem behaviour around the internet and mobile telephony. You might have a problem when you can’t stop checking social media updates in spite of negative consequences in other parts of your life. It is not the number of devices you own but rather the amount of time on the devices and the negative consequences on other parts of your life. So, you may have a mobile phone, tablet, laptop and main computer in your possession but your life may well be better for it if you are using social media apps to further your career and social life. However, if you start to experience anxiety and depression from seeking emotional satisfaction through social media engagement then you find have a problem. Try setting time boundaries about your use of mobile devices and also set phone and non phone time in your day. See what happens?  Do you panic at the thought of restricting your access?

Addicts tend to be ‘do it yourselfers’, to coin an expression,  so will tend to be reluctant to seek help and if they do attend therapy they can stay in a very defended position. Asking an addict why they did something might risk a very long answer as addicts tend to have massive self-justification and rationalisation for everything they do. If you think you or a member of your family has a problem click on the links below.

See the attached link for the interview (scroll to 23:30 in the timeline).

See also

Do you have a problem overusing your smartphone
Digital detox from smartphone addiction
How to digitally detox and stay connected 

Share

CPD event in London: A date for your diary

4 March 2017 Central London 10am – 5pm

Are you a therapist, counsellor or life coach and struggling with your journey in seeking to build a thriving private practice? This one day CPD event may well be for you. It is for therapists, counsellors and coaches who want to kick-start or develop their private practice.

The workshop will equip you with the knowledge to boost your private practice.

Specifically the event will cover the following:

  • building a successful online marketing strategy (website, social media and SEO)
  • fees and self-worth
  • how to write web optimized content and articles
  • building a successful business strategy
  • developing professional networks that result in referrals
  • practical advice on finance, ethics and administration

The workshop will be experiential and will allow participants to explore personal self-limiting beliefs. The workshop will be facilitated by myself and Louise Gulley.Louise is a change enabler, group facilitator and BACP accredited counsellor based in London and Kent and built a thriving practice within 6 months of graduating.

* An early bird discount applies until 30 January. See flyer for booking details.

Share