How Can Therapy Help Members of Twelve Step Fellowships?

For people who have struggled with addictions, going to a twelve step fellowship is a brave and potentially life changing decision. Alcoholics Anonymous and other twelve step fellowships offer a place where a person struggling with addictions or addictive behaviours can feel safe, be understood and start to understand both themselves and other people. The meetings and fellowship offer a great deal of support and the steps offer a programme of recovery which promise freedom from obsession and relief from the desire to drink, gamble, take drugs, compulsively eat or engage in other addictive behaviours. These extravagant promises become reality for many sufferers who have battled and been baffled by their addiction for much of their lives.

The kind of inventory that is undertaken as part of the twelve steps is invaluable when it comes to acknowledging and understanding the resentments that have fuelled an individual’s addiction. The steps also help the person focus on their part in contributing to negative experiences in their life. For many, these steps allow them to get sober, abstinent or clean. They use the tools that are available to them via the steps and the fellowship and get on with the business of living.

However, it is at this point that some people are in a position to ask some of the questions that they have been avoiding for much of their life, such as questions about traumatic or difficult events that are in the past.

Whilst not all people who suffer from addictions have had adverse or traumatic experiences in childhood, the Adverse Childhood Experiences study (Felitti, 1998) which looked at over 17,000 patients, suggests that the more adverse childhood experiences an individual has endured, the greater the incidence of: –  

·         Smoking,

·         Obesity

·         Alcohol and drug use

·         Depression

·         Attempted suicide

When the researchers talk about adverse childhood events they are referring to experiences such as a household where drugs and alcohol were used, a child’s parents separating or divorcing, the presence of mental illness in the home, emotional, physical or sexual abuse of the child or a mother who was treated violently.   The research suggests that the more events the person has encountered whilst growing up, the more vulnerable they are as an adult. 

I would suggest that, for people who struggle with addiction-related issues, who have had had one or a number of these experiences whilst growing up, having therapy alongside working the steps can be invaluable.

For these people, psychotherapy provides a safe place to begin to understand the impact of these adverse experiences and to work through and process the difficult emotions that may have been buried for a long time. The therapist not only provides a safe place but builds a relationship with the client, providing them with the opportunity to find new ways of relating to themselves and others.

In conclusion, I believe that twelve step fellowships can and do offer an invaluable resource to the struggling addict. Whilst for many people this is enough and enables them to go on and live a richer, more fulfilled life, others will need to seek the kind of help on offer from a professional psychotherapist to more fully understand how their early life experiences have led them into addictive behaviours and how they can begin to change.

Boarding School - A Poor Preparation for Emotional Wellbeing in Adulthood

The website boardingschoolsurvivors.co.uk suggests that adults who were not able to cope with the shock and isolation of being sent away from home at a young age suffer a wide variety of symptoms including:

Of course, there are some people who have a good experience of boarding school, but others have found being sent away from their parents/carers at a young age was extremely traumatic. It left them unable to cope with or process very powerful feelings of homesickness and neglect. They were overwhelmed by these feelings and the people who they would turn to for help were not there. In fact, confusingly, it was the people who they would turn to for help who had sent them away and put them in this position; and this experience was repeated at the beginning of each term when the child was sent away again.

Joy Schaverien, a psychoanalyst who has written on this topic (1), suggests that seven and eight-year olds still rely on their carers for many aspects of their daily life including dressing, washing and putting to bed. Being removed from their carers is incomprehensible and causes a rupture in these most important relationships. As children they are unable to process these feelings. One way of managing is to cut off from the feelings and appear to manage. Whilst this might be a successful coping strategy for the child, if it is carried on as a way of relating to themselves and others during adulthood it can prove disastrous. They are left with a feeling of being isolated and an inability to manage difficult and painful feelings. This goes a long way to explaining the symptoms stated above.

Another aspect of the situation which is confusing is the fact that this sense of being neglected goes alongside an understanding of having had an education and a lifestyle that is very privileged. The sense of privilege is hard to reconcile with the feelings of neglect. It adds to the pressure to get on with life and makes it hard to acknowledge the trauma which is often at the root of the ex-boarder’s symptoms.

Psychotherapy is often sought to provide relief from these symptoms. An ex-boarder is often not initially aware of the link between the problems that they are struggling with and their childhood experiences. Finding a safe place to talk and reflect offers people an opportunity to make some links with their childhood and gain some understanding of their symptoms. It allows them to put into words the feelings that they had little awareness of and were unable to express as a child. This ability to recognise and communicate allows them to process and come to terms with what has happened to them, which in turn offers the opportunity to understand themselves and to change.

1.  Schaverien, J (2015) Boarding School Syndrome, London, Routledge

Turning A Blind Eye To Childhood Sexual Abuse

The recent report by Dame Janet Smith stated that the BBC repeatedly failed to stop ‘monstrous’ abuse by DJ Jimmy Saville and broadcaster Stuart Hall. The report states that the BBC missed at least five opportunities to stop the abuse. In fact, for most adults who were sexually abused as children one of the things that is very hard to deal with is the fact that on top of the betrayal of trust of the abuser himself, the child was also let down by other adults who should have been in a position of caring for that child, and who turned a blind eye to what was happening.

According to Maggie Schaedel, Consultant Lead Adult Psychotherapist with The Bromley Woman’s Service, the hardest thing for many survivors is recovering from the trauma of being betrayed.

Many people who were abused as children suffer with ongoing psychological and physical problems. Research has shown that the symptoms and behaviours can include low self-esteem, depression, suicide attempts, alienation, problems with sex, distrust and self-destructive behaviours. Physical symptoms often include IBS, chronic pelvic pain, sexual dysfunction, sleep disorders, respiratory ailments, chronic headaches and chronic back pain.

Many survivors of sexual abuse do, at some point, seek help from a psychotherapist. One of the most important things that they can get from this experience is being listened to in an empathic way – being believed and seen as credible. Particularly because being silenced and not being believed have been part of their experience as children.Psychotherapy can build on feelings of self-worth and help survivors think about feelings of helplessness and anger. It can offer a safe place. But I agree with Maggie Schaedel when she says that the prime task of psychotherapy is for the survivor to learn to trust another human being where previously adults were not trustworthy.

How Can Psychotherapy Help You?

Recent studies ask the clients what they think

People consider therapy and counselling for a variety of reasons. These may include struggles such as depression or relationship problems or following life changing events such as health issues or divorce.

It's important to know that psychotherapy is not a panacea for all ills, however there is a lot of good research about how it can help. As a psychotherapist I would suggest that it can offer you insight into yourself, a greater awareness of the different aspects of what you're feeling and what's happening in you. This will give you more choices and make you feel more connected with yourself which, in turn, allows you to be more connected with other people.

If you are considering therapy then you might be interested to know that some recent studies have asked people who are having therapy what they have found helpful and unhelpful about the experience.

THE THERAPIST
As a general principal, when discussing difficult feelings, many people find it very useful to speak to someone trustworthy and non judgmental who is outside the family.

According to one study (1) the qualities that clients find helpful in a therapist include warmth, honesty, genuineness, patience and trustworthiness. The findings suggest that if these things are available, it provides an opportunity for the person to express them self and to look at their feelings openly.

From my own experience I would suggest that people benefit from regular personal contact with the therapist and that this gives them a sense of feeling supported and understood which is also a finding of the research (2).

THE THERAPY
In a 2015 study (3) some of the main areas that were highlighted as helpful were:

- Being able to focus on yourself in a private, confidential space.
-The opportunity to consider ways of resolving specific problems, for example, relationship issues with family members and work colleagues.
-The opportunity to focus on difficult feelings in a safe and space. This included being able to acknowledge and name feelings such as fear, anxiety, grief, anger, sadness and depression.
-Participants felt that they could not be open about this type of feeling in their lives outside, and being able to talk about them brought great relief, and a renewed capacity to cope.
-The sessions provided the opportunity for people to unburden themselves - the relief of getting things off their chest in a safe space

Some of these things take time, and the process isn't always smooth or ideal. In fact this study talks about things that participants found unhelpful which included the fact that one person said that crying in a session made them feel out of control and another stated that something that the counsellor said did not fit for them.

SO - HOW CAN THERAPY HELP ?
The participants of these studies give an idea of how the therapist has provided them with a framework that has enabled them to think about, express and process the emotions and feelings that they have been faced with. When therapy has been helpful it has meant that the relationship with the therapist has allowed that person to feel supported.

From my own experience as a psychotherapist, I would suggest that the answer to the question 'How can therapy help?' will be different for each person. It will depend on what the person is looking for and struggling with. I am aware that asking for help from a therapist is a big step; it involves uncertainty - about the process, and finding the right person, and hoping for something different and better. One thing is certain however; if you don't try it - you will never know if therapy could help you.

1 MacCormack et al (2001). Someone who cares: a qualitative investigation of cancer patients' experience of psychotherapy. Psycho-Oncology, 10 52 - 65

2 Timulak, L. (2007). Identifying core categories of client-identified impact of helpful events in psychotherapy: a qualitative meta-analysis. Psychotherapy research, 17, 305-314

3 Morgan, C. & Cooper, M (2015) Helpful and unhelpful aspects of counselling following breast cancer: a qualitative analysis of post-session Helpful Aspects of therapy forms. British Association of Counselling and Psychotherapy Research, September 2015; 15 (3).

The Beauty Myth

The World Health Organisation guidelines state an adult with a BMI below 18 is considered malnourished and 17 severely malnourished. The average catwalk model has a BMI of 16.

When Rosie Nelson, a size 8 model, walked into a London model agency she was told she needed to 'get her measurements down'. Four months later she went back, having lost nearly a stone, and was told that she needed to loose more weight and get 'down to the bone'.

At that point she started a petition calling for health checks for models that take part in London Fashion Week. Parliament has listened and MPs are to investigate whether very thin models should be banned from British catwalks.

But whether this will help to bring down the record numbers of women who are suffering from anxiety about their body image is another question. The language of weight, size and shape has become a major factor in how women evaluate themselves, and whilst very skinny models are almost certainly part of this problem it is much more complex than that.

Photoshopping

Indeed, there is another technology that now influences our view of women and how they are valued, that is photoshopping. Women no longer compare themselves to their friends, family, or people they see in the street - or even to 'severely malnourished' models. They now compare themselves to photoshopped images of other women. Some estimates suggest that in Britain we see thousands of these digitally altered images each week.

I want to feel as good as she looks

Where does this leave us? Destined to be unhappy in our skin? Reaching for something unobtainable and chronically dissatisfied with ourselves or on a permanent diet and exercise regime?

The myth that youth, thinness and perfection are the way to achieve happiness seems to be pervasive. Somehow attractiveness and states of mind get confused. It is believed that if someone looks great then they must feel great. An individual's own unhappiness and sense of dissatisfaction can be blamed on the fact that she doesn't look her best or as good as the images that surround her. It therefore makes sense to put her time, effort and money into changing how she looks.

This can lead to a vicious cycle of hope, and either failed attempts at dieting or successful dieting and exercise, followed by eventual weight gain and disappointment. And it seems that some people can stay in this loop for many years; with how they look and what they weigh being as important as anything else in their lives.

In this frame of mind there is no space for looking ordinary, there is only the desire for and pursuit of an 'ideal' body and the hatred of their own 'fatness'.

Does thin mean happy?

My experience of working with women who struggle with these issues is that, at some point, it is possible to realise that the diet and exercise regime doesn't work for them - either because it doesn't provide them with the body they hoped for or, having finally got the long-desired svelte body, it doesn't actually give them the feeling that they thought they would get from looking like that.

This kind of realisation can be life changing. If someone reaches this point then other questions can be asked. They can start thinking about what their struggles with body image, weight and food have done to them. How have they been left feeling about themselves? What damage have they done to their bodies and to their relationships with others?

Another question that can be asked is what has this struggle done for them? This may seem a strange question at first, but as Julia Buckroyd suggests in her book "Understanding your Eating", for many people a preoccupation with food and their body is a way of expressing things that it has been difficult to put into words. These preoccupations can be ways of expressing, coping with or avoiding underlying issues such as intimacy, how they relate to others and how they deal with change.

What next?

Thin cat walk models and photoshopping definitely help sustain an environment where women are judged by how they look and where their body size and shape can become disproportionately important. Any steps towards changing that environment should be taken seriously.

Along side this is each individual's personal struggle with these issues. In my experience, for many people, a big part of the solution is first of all being able to recognise the preoccupation for what it is and then taking time to attend to some of the underlying difficulties, a process which opens the door to feeling good about oneself from the inside out.

Are You Beach Body Ready ?

Did you see this recent advert for a weight loss product? it features a barbie look-a-like, tiny-waisted, blond haired woman in a bright yellow bikini with the question 'are you beach body ready?' next to it.

The suggestion being, it seems, that if you want to feel good about yourself and enjoy your holiday you need to lose weight. I often ask myself why advertisers are still using such body shaming strategies and I think the answer must be - because they work. it seems that we buy into the concept that we need to look a certain way in order to enjoy life, and we therefore feel ashamed enough of our own bodies to spend money on diet products. This is done in the belief that it will make us look more like the model in the picture which will make us feel better. In fact, the advert was withdrawn in the UK in April after concerns were raised about health issues.

According to the latest government statistics, the majority of people in the UK are overweight. And at the same time we have become obsessed with thinness and a need to transform our bodies and look our best. In fact, even our best isn’t good enough. We are encouraged and cajoled by advertisers not only to lose weight in order to look better but to have cosmetic procedure’s in order make ourselves more attractive.

Perhaps the reason that this kind of advert works when it comes to selling weight loss products is that feelings of low self esteem and poor body image are often linked to problems with food and eating. Many women and girls think about food, weight and body image from the moment they wake up in the morning to the moment they go to bed in the evening.

The conversation goes on and on, inside people's heads but also with their friends and colleagues, and prompted by the magazines that they read which are full of dietary advice and pictures of celebrities' bodies.

How can we make sense of this obsession with thinness which is combined with a reality of overeating and obesity? In her book 'Bodies' Susie Orbach suggests that 'a search for contentment focused around the body is a hallmark of our times' . She goes on to suggest that our bodies are increasingly being experienced as objects to be honed and worked on. She makes a link between these cultural expectations and the kind of problems so many people have managing their appetite and their desire to eat.

So, whilst some people who want to lose weight just eat less and exercise more - many people just can't do that. They have been trying to loose weight, or struggling to maintain a healthy weight for most of their lives. This is a group of people who might want to think more about the psychological aspects of their eating. For example, how their eating disordered eating might be linked to relationships, emotions, family background and daily stresses.

In her book 'How to understand your eating' Julia Buckroyd suggests that disordered eating is linked to childhood experiences. In adulthood, many people use food to soothe themselves, to take the edge off of life. Other times there might be a sense of deprivation and food is used to make up for something that is felt to be lacking.

The reasons for disordered eating patterns are in fact varied and individual to each person. Psychotherapy is one way of giving people a chance to think about these issues in more depth. During therapy the client and the therapist can consider where patterns such as overeating, yo-yo dieting and binge eating might have arisen, what purpose they might have served, and how this might be linked to other aspects of the client's life, both in the past and the present.

This is a way in which symptoms can be given meaning; and these same symptoms can act as signposts - pointing to areas that need addressing. So, once you know that you are eating out of a deep-felt sense of dissatisfaction, you can think about what it is in your life and relationships that leaves you dissatisfied.

Working with a psychotherapist is interactive and offers a way for the source of problems to be known about in a real rather than a theoretical sense. Once links are made they might make perfect sense, but somehow they have previously been obscured. In this way issues such as low self esteem, a sense of deprivation, inconsistent relationships and perfectionism can be thought about and tackled, creating an environment where new relationships with people and a healthier relationship with food can be fostered and maintained.

So, in order to change your outlook on this issue perhaps you need to rephrase the question and ask 'how can you get the best out of your holiday if you don't feel good about how you look?'. Part of the answer may lie in taking a step back and giving yourself time to get a different perspective on how you relate to yourself and to food. In doing this, I think it is helpful if you can hold onto the fact that not only is there a multi- million pound diet and advertising industry which benefits from the fact that you feel dissatisfied with how you look, but there might also be a part of you (that is hard to get to grips with) that is very unforgiving and undermines your own best efforts to feel good about yourself.