Attached

Attached

Attached

Attached, written by psychologists Dr. Amir Levine and Rachel Heller, is an interesting self-help book that aims to bring the reader the latest advances in scientific research on how adults tend to form emotional bonds with their partners. 

The authors do a great job in conveying, in simple and understandable terms, the main scientific findings on attachment theory and its influence on adult relationships. 

Attachment theory explains the way in which we establish affective bonds with other people, especially with people close to us, based on the experiences with our parents or main caregivers during the first years of life. Through these experiences we learn basic notions of the functioning of relationships in terms of intimacy, security, care, dependence and autonomy. The way in which adults establish affective ties with their partners is similar to those established between parents and children. Therefore, these early experiences will end up forging our particular style of attachment; that is, the specific way in which we tend to relate affectively with other people.

Attachment styles are stable over time. However, this does not mean that they are rigid. Attachment styles are malleable; that mean we can learn new ways of relating affectively with our partners in order to have healthier and more satisfying relationships.

This book focuses primarily on attachment styles in adult relationships. The authors of the book explain that, depending on our attachment style, we will differ in the expectations we have about the relationship and our partners, the ideas about intimacy, the attitude towards sex, the ability to express desires and needs, and the way we handle conflict.

If partners differ in attachment styles, this can lead to conflicts or misunderstandings, communication problems, difficulties in understanding each other's needs, as well as difficulties in meeting those needs. Therefore, knowing our own attachment style and the one of our partners, can provide us with relevant information to understand the difficulties we are going through in order to successfully address them. 

The authors describe 3 styles of attachment: anxious attachment, avoidant attachment, and secure attachment. Everyone fits into one of these categories; scientific studies have found these styles in different countries and cultures. These are the main characteristics of each attachment style:

Anxious attachment:

People with this type of attachment long for closeness and intimacy. They usually want to be with their partner 100% of the time and are often upset when their partner spends time with other people or doing other activities. They tend to be obsessed with their relationship and doubt whether their partners can meet their needs; they often feel that they have a greater need for intimacy than their partners, so they feel very insecure about the future of their relationship. The fear of abandonment is often very present.

Avoidant attachment:

People with this type of attachment long for autonomy and independence, so they are often cold and emotionally distant. Emotional intimacy makes them uncomfortable, so they avoid closeness. They do not like to feel dependent on other people, and have difficulty trusting their partner. They tend to have difficulties opening up emotionally and communicating their needs, problems or difficulties, and do not show much concern for relationships or how their partner may feel.

Secure attachment:

People with this type of attachment are usually warm and loving. They tend to feel comfortable approaching and becoming intimate with their partners. They tend to manage well the balance between intimacy and independence. They do not usually worry about their partner leaving them. They tend to communicate their needs and feelings appropriately and are responsive and their partner's needs by offering support when needed it.

Of the three attachment styles, secure attachment is the healthiest and the one that generates less conflicts and difficulties in relationships. Relationships formed by couples in which one or both partners are anxious or avoidant, tend to have more conflicts and more difficulties communicating and understanding each other needs.

This book provides a very detailed description of thinking patterns, emotional states, and behaviors of people in adult relationships according to each attachment style and provides useful and simple tools (questionnaires) to identify our attachment style and the one of our partners. In addition, it describes the specific emotional needs and weak points of each style and provides advice and strategies for dealing with the difficulties that can be encountered when the members of the couple differ in attachment styles.

Especially important is the book’s section that describes secure attachment, where specific guidelines and strategies are provided in order to improve communication styles, conflict resolution techniques and the expression of needs for people with anxious or avoidant attachments, to help them get closer to those with secure attachment styles.

In conclusion, this book is a useful guide to help us navigate the world of intimate relationships by providing a deeper understanding of how we relate to our partners in order to achieve greater psychological and emotional well-being within the couple.

Amanda Blanco Carranza
Division of Psychology, Psychotherapy and Coaching
Amanda Blanco Carranza
Psychologist
Adults
Languages: English and Spanish
See Resumé


Atypical

Atypical

Autism spectrum disorder, shortened as ASD, is a neurological condition that affects a person's learning abilities. Normally the signs begin to show, and consequently it is diagnosed, in childhood, and it’s one of the conditions that concern parents the most when they receive the news, as there is popularly a fairly limited or erroneous knowledge about the disorder due once again to the disinformation we have about it.

In summary, ASD is a neurological condition that affects the ability of an individual to adequately relate to their environment, everything and everyone around them, people who suffer from it may have problems with communication, learning knowledge, noise discomfort, a wide variety of other issues, which is why a few years ago it started being called autism spectrum disorder, since the same condition created a great variety of problems depending on the person.

In society, the information that we usually have about this condition, unless we know a family member or acquaintance who suffers from it, usually comes from famous movies and series, which usually generate myths and / or confusion about what it really is. A spectacular example of this is Barry Levison's famous movie Rain Man (1988), where actor Dustin Hoffman plays the role of a person with ASD and Savant syndrome (extraordinary abilities in a certain field such as memory or mathematics).

But all these myths and exceptional cases do not allow us to know what people with this condition really are, and they can create fear, as we have already said, in people close to someone who is diagnosed.

Fortunately, in recent years, more and more series have appeared that try to overthrow this lack of knowledge and show what the lives of people suffering from them are like, their potential and possible ways of relating to them.

One of the series that has drawn the most attention in this regard is Atypical (Atypical), created by Robia Rashid, which premiered in 2018 and tells the life of Sam Garden, an 18-year-old teenager suffering from an autism spectrum disorder. In the series we can see what Sam's day-to-day is like, the problems he encounters in terms of interaction with his family and friends, romantic problems regarding his first love, his high school life, his understanding of the world and personal development to understand himself.

They offer us the opportunity to see first-hand what the life of a person with ASD is like and they teach different guidelines on how we can interact with them and understand their difficulties, although we must bear in mind that each person will be different. Created with the collaboration of writers and actors suffering from the same disorder, Atypical has received astonishing reviews for the realism of the problems and for how they manage to transmit the information regarding the usual problems, so much so that it currently has 3 seasons available and has been renewed for the fourth and last season.

Atypical is an interactive and good way to learn about ASD, for parents and relatives as well as acquaintances or people who are simply curious. They remove the stigma associated with the disorder and allow us to enter their world in an exceptional way, with comic, dramatic, serious, and realistic touches all at once. For people who do not have reliable information about ASD, or who are curious to learn more, this series represents a perfect opportunity for it.

Tommy Gyran Norheim
Division of Psychology, Psychotherapy and Coaching
Tommy Gyran Norheim
Psychologist
Adults and adolescents
Languages: English, Spanish and Norwegian
See Resumé

Lacan: historia y aportaciones

Lacan: historia y aportaciones

Jacques Lacan fue un psicoanalista y psiquiatra de origen francés. Nacido en París el 13 de abril de 1901, es conocido por su “retorno a Freud”, actualizando y modificando la teoría de Sigmund Freud, conocido por todos como el padre del psicoanálisis. Su evolución teórica provoca la escisión de la Sociedad Psicoanalítica de París. Dicha evolución se caracteriza especialmente por un sustancial abandono de los aspectos más puramente biológicos, confiriendo una enorme importancia al lenguaje de cara a la comprensión de los pacientes, el cual, según su concepción, estructura el inconsciente a través de sus códigos.

El objetivo del presente escrito no es tanto aportar una explicación biográfica de Lacan, si no describir de forma breve pero clara alguna de las aportaciones más curiosas que esta figura del psicoanálisis produjo en esta corriente, así como algunos datos que rindan cuenta de la particularidad de esta figura del psicoanálisis. Este no es sino un primer contacto con la teoría de Lacan. En artículos posteriores se profundizará en otros aspectos.

Escansión

Una de las características de la terapia psicoanalítica de marcado enfoque lacaniano es el conocido corte de sesión o escansión. Se dice que la utilidad de este corte es el puntuar, el hacer hincapié en una verbalización llevada a cabo por el paciente y que guarda una enorme relación con los conflictos intrapsíquicos de éste.

El objetivo fundamental de este corte de sesión es fomentar la reflexión del paciente sobre lo que dijo, abrir la puerta a un discurrir por parte del sujeto.

Partiendo de la premisa que dice que el inconsciente se estructura como un lenguaje, Lacan se negaba a plegarse a la norma de la duración de las sesiones (que debían durar 50 minutos según la IPA).

Descrito por él como un imperativo obsesivo, esta duración rígida no respetaba las puntuaciones del sujeto en su discurso (y por ende, sus contenidos inconscientes), ya que el inconsciente, según Lacan, no obedece nunca a un tiempo preestablecido. Al cortar la sesión en este punto, el analista realiza una acentuación en forma no verbal, dejándole entrever al paciente que lo que ha dicho se trata de algo significativo y que no debe ser tomado a la ligera. El analista no es en absoluto un oyente neutral. Deja muy claro que ciertos puntos, que seguramente guarden relación con la revelación de un deseo inconsciente y con un goce previamente no admitido son cruciales. El analista dirige la atención hacia ellos, recomendándole al paciente más o menos directamente que piense en ellos y los tome seriamente.

Los pacientes no tienden a hablar y puntuar espontáneamente los temas más importantes. Es más, desde el punto de vista psicoanalítico, los pacientes tienden en mayor medida a evitar aquellos aspectos. Ejemplo de ello son los temas relacionados con la sexualidad, evitando, por ejemplo, asociar sueños y fantasías con elementos que conllevan mayor carga sexual.

Muy probablemente el lector se preguntará qué se espera de uno cuando acude a un terapeuta de orientación lacaniana. Pues bien, el análisis no requiere que relatemos toda nuestra vida en detalle ni toda nuestra semana y sus pormenores. Hacerlo convierte automáticamente la terapia en un proceso infinito. Para que el analista pueda involucrar al paciente en un verdadero trabajo analítico, no debe tener miedo en dejar claro al paciente que el contar historias, los relatos detallados de lo que pasó en la semana y otras formas de discurso superficial no son el material del análisis, aunque, por supuesto, puede ponerlos al servicio del análisis. El terapeuta tenderá por tanto a cambiar de tema en lugar de intentar, de forma obstinada, a encontrar algo de significación psicológica en los detalles de la vida cotidiana del paciente.

Cuando el analista de repente concluye una sesión, puede acentuar la sorpresa de lo que el paciente ha expresado, o introducir el elemento de sorpresa a través de la escansión, dejando que el paciente se pregunte qué fue lo que el analista escuchó y que él mismo no logró escuchar. Cuando las sesiones de tiempo fijo son la norma, el paciente se acostumbra a tener una cantidad de tiempo determinado para hablar, y calcula cómo rellenar ese tiempo, cómo hacer un mejor uso de él. Los pacientes saben a menudo que el sueño que tuvieron es lo más importante que deben relatar para su análisis. Sin embargo, tratan de hablar de muchas cosas de las que quieren hablar antes de llegar al sueño, si es que llegan a él. Establecer una duración determinada de la sesión no sirve, según Lacan, sino para alimentar la neurosis del paciente: el uso que hace del tiempo previsto para él en la sesión es una parte indisociable de su estrategia neurótica, que involucra la evitación, la neutralización de otras personas y demás.

El diagnóstico lacaniano

Para los profesionales que trabajen con los sistemas diagnósticos predominantes como el Manual Diagnóstico y Estadístico de los Trastornos Mentales (DSM), la sistematización llevada a cabo por Lacan resultará enormemente simplista. No obstante, ésta implica también precisiones mucho mayores respecto de lo que generalmente se considera que es un diagnóstico en buena parte del ámbito de la psicología y la psiquiatría. Los criterios diagnósticos de Lacan se basan fundamentalmente en la obra de Freud, siendo ésta ampliada en multitud de ocasiones, y en el trabajo de algunos psiquiatras franceses y alemanes como Kraepelin o Gatian de Clérembault.

En lugar de tender a multiplicar todavía más las ya numerosas categorías diagnósticas, de modo que cada nuevo síntoma o conjunto observable es considerado como un síndrome separado, el esquema diagnóstico de Lacan es enormemente simple, pues incluye solamente tres categorías principales: neurosis, psicosis y perversión.

A diferencia de las categorías diagnósticas como el DSM, los diagnósticos lacanianos proporcionan al terapeuta una aplicación inmediata, en la medida en que guían los objetivos del terapeuta e indican la posición que éste debe adoptar en la transferencia. La teoría lacaniana demuestra que ciertos objetivos y técnicas utilizados con los neuróticos son inaplicables con los psicóticos. Y esas técnicas no solo son inaplicables, sino que incluso pueden resultar peligrosas, puesto que pueden disparar un brote psicótico.

El diagnóstico no es, por tanto, una cuestión formal de papeleo, tal como requieren las instituciones sanitarias. Es fundamental para determinar el abordaje general que el terapeuta adoptará para el tratamiento de un paciente individual, para situarse correctamente en la transferencia y para realizar las intervenciones apropiadas. Lacan trata de sistematizar las categorías de Freud ampliando sus distinciones terminológicas. Lacan distingue entre categorías diagnósticas en función del mecanismo de defensa operante.

Es decir, las tres principales categorías diagnósticas adoptadas por Lacan son categorías estructurales basadas en tres mecanismos diferentes o formas diferentes de negación. Encontramos entonces que para la neurosis el mecanismo fundamental es la represión, para la perversión es la renegación y para la psicosis la forclusión. Retomando a Freud, el cual decía que mecanismo y estructura no son meras compañeras que presentan una fuerte correlación entre los pacientes. El mecanismo de negación es constitutivo de la estructura. Esto quiere decir que la represión es la causa de la neurosis, así como la forclusión es la causa de la psicosis.

Diversos estudios encuentran una relación positiva entre la impulsividad, la ira y la impaciencia. Cabe, en este contexto, mencionar la elevada de tasa de abandonos (egosintónico y suele provenir por parte de otra persona) cuando la ira es motivo de consulta. Como decíamos, la ira correlaciona con la impaciencia. Esto podría explicar que las personas que padecen este problema cuando no obtienen resultados deprisa, abandonan el tratamiento; cuando obtienen resultados deprisa, abandonan el tratamiento; cuando la pareja les deja, abandonan el tratamiento y cuando la pareja no les deja, también suelen abandonar el tratamiento.

Homosexualidad

Mientras que la corriente psicoanalítica predominante en la época de Lacan afirmaba rotundamente que los homosexuales no podían ejercer el trabajo de psicoanalistas, Lacan rompió con esta preconcepción, dando a entender que los homosexuales sí podían ejercer como tal. Roudinesco, psicoanalista de origen francés, afirma que Lacan aceptaba asimismo a pacientes homosexuales, sin el objetivo de adentrarles en lo que por entonces se consideraba la normalidad.

La Asociación Psicoanalítica Internacional (IPA) contaba en la década de 1920 con un comité encargado de gestionar esta cuestión. La rama berlinesa de dicha asociación decía así: “(la homosexualidad) es un crimen repugnante: si uno de nuestros miembros lo cometiera, nos comportaría un grave delito”, llegando incluso a considerarse como una “tara”.

En este sentido, la posición de Lacan resultó novedosa, evitando rechazar a homosexuales en su formación como analistas. Esta negación al estigma predominante, junto con su negación a establecer un tiempo determinado en las sesiones, así como su oposición al academicismo propio de la IPA conllevó su expulsión de esta institución en 1963.

A continuación, se ampliarán algunos de los aspectos descritos unas líneas más arriba, profundizando en las estructuras y en los pormenores que distinguen a dichas estructuras desde el punto de vista de Lacan.

Con anterioridad, se esbozaron de forma breve algunos de los aspectos más curiosos y característicos de Jacques Lacan. Esta no es sino una continuación de lo anterior, donde profundizaremos de forma sintética en una de las categorías diagnósticas descritas por Lacan: la neurosis. Retomando lo dicho en el anterior artículo, el abordaje lacaniano del diagnóstico puede parecer extraño y simplista para aquellos profesionales familiarizados con otras categorías diagnósticas como es el caso del Manual Diagnóstico y Estadístico de los Trastornos Mentales (DSM). El propósito de este artículo no es resaltar los posibles defectos de estos instrumentos diagnósticos.

El objetivo es describir una alternativa en un contexto donde la psicología ha tendido en gran medida a aproximarse a la medicina -y por ende, a la psiquiatría-, intentando operativizar y cuantificar aspectos que, al fin y al cabo, resultan intangibles. El diagnóstico lacaniano, en lugar de multiplicar las categorías diagnósticas, incluye tres categorías principales: neurosis, psicosis y perversión.

A diferencia de otras categorías diagnósticas, proporcionan una aplicacióninmediata al terapeuta, guiándole en sus objetivos e indicando la posición que éste debe asumir en la transferencia. Un aspecto interesante de este abordaje es que las personas que son habitualmente consideradas “normales” (Cabría preguntarse qué es normalidad y qué no lo es) no tienen una estructura especial propia. Por lo general, son neuróticas en términos clínicos. Esto quiere decir que el mecanismo de defensa básico es la represión. Freud sostenía lo siguiente: “Si adoptamos un punto de vista teórico y desatendemos el aspecto de la cantidad, podemos afirmar que todos estamos enfermos, o sea, que todos somos neuróticos, ya que las precondiciones para la formación de síntomas, a saber, la represión, también pueden observarse en personas normales”.

A diferencia de otras estructuras como la psicosis, la neurosis se caracteriza por la instauración de la llamada Función paterna, la asimilación de la estructura esencial del lenguaje, la primacía de la duda sobre la certeza, un considerable grado de inhibición de las pulsiones que se opone a su puesta en acto libre de inhibiciones, la tendencia a encontrar más placer en el fantasma que en el contacto sexual directo, el ya mencionado mecanismo de la represión, el retorno de lo reprimido en forma de lapsus, actos fallidos y síntomas, etc.

A diferencia de la perversión, la neurosis implica el predominio de la zona genital frente a otras zonas erógenas, cierto grado de incertidumbre respecto de lo que excita y lo que no o una importante dificultad para lograr la satisfacción aún sabiendo lo que excita. La represión: “Lo esencial en la represión no es que el afecto esté suprimido, sino que está desplazado y es irreconocible” Lacan, Seminario XVIII, p.168.

Como decíamos anteriormente, el mecanismo fundamental que define la neurosis es la represión. Este mecanismo es el responsable de que, mientras que,en la psicosis, tal y como veremos en el siguiente artículo, el paciente es capaz de revelar toda su “ropa sucia” sin aparente dificultad, el neurótico mantiene esas cosas ocultas para los demás y para sí mismo. A diferencia de la neurosis, en la psicosis no hay inconsciente, ya que éste es resultado de la represión. La represión puede ser descrita como la expulsión de la psique de pensamientos o deseos que no son aceptables para nuestra visión de nosotros mismos o para nuestros principios morales. Además, ésta puede explicarse como una atracción ejercida por el núcleo del material reprimido “original” sobre elementos relacionados con él. La represión no implica la absoluta y completa eliminación de ese pensamiento, al contrario que en la psicosis, como veremos que sí ocurre. En la neurosis, la realidad y sus elementos son afirmadas en un sentido muy básico pero desalojados de la conciencia. El afecto y el pensamiento están conectados, tal y como defienden también terapias de corte cognitivo como la Terapia Racional Emotiva de Albert Ellis. La represión ejerce una separación, “un divorcio” entre el afecto y el pensamiento, siendo éste excluido de la conciencia. Este es el motivo por el cual los analistas a menudo se encuentran con personas en consulta que dicen sentirse vacíos, tristes, ansiosos o culpables sin saber por qué. O bien las razones que esgrimen no parecen corresponderse en modo alguno con la magnitud del afecto que los acompaña. La carga afectiva perdura cuando el pensamiento ha sido reprimido, llevando a la persona a buscar explicaciones a ese sentimiento. Esto, es decir, la ausencia del pensamiento pero la presencia de un afecto arrollador son muy comunes en la neurosis histérica. En la neurosis obsesiva, el pensamiento puede estar presente pero no suscitar afecto alguno. Tenemos por ejemplo pacientes que relatan haber sufrido acontecimientos gravísimos pero éstos no suscitan absolutamente ninguna reacción afectiva. Aquí, el analista trata de traer esos afectos disociados al aquí y ahora del análisis. El retorno de lo reprimido:

Cuando un pensamiento se reprime, queda latente, no desaparece. Trata de expresarse allá donde pueda, conectándose con otros pensamientos relacionados. Estas expresiones adoptan la forma de lapsus, sueños, actos fallidos y síntomas. En este sentido, Lacan afirmaba que “lo reprimido y el retorno de lo reprimido son uno y el mismo”. Aquello que ha sido apartado de la conciencia aparece aparece de forma maquillada a través del olvido de un nombre, la rotura “accidental” de un regalo, o el rechazo hacia el cariño de una madre que desvela la represión del niño de su deseo por la madre. Otro ejemplo de esto son las interrupciones o irrupciones.

Existen multitud de ejemplos para exponer el retorno de lo reprimido. En cualquiera de estos casos, algún deseo está siendo sofocado. Para Lacan, el síntoma neurótico cumple el papel de la lengua que permite expresar la represión (Seminario III, p.72). Se trata de un mensaje dirigido al Otro. La insatisfacción del deseo y el deseo imposible o neurosis histérica y neurosis obsesiva : El neurótico obsesivo se caracteriza por su deseo imposible. El obsesivo puede, por ejemplo, anular o negar al Otro. Por ejemplo, mientras hace el amor, el neurótico obsesivo puede fantasear que está con otra persona, negando de esta manera la importancia de la persona con la que está. El deseo en la neurosis obsesiva es imposible: cuanto más próximo a su satisfacción se encuentra el obsesivo lo sabotea.

Es por ello, por ejemplo, que en la neurosis obsesiva sea frecuente encontrar narrativas de una persona (el obsesivo) que se enamora de alguien inalcanzable o establecer requisitos extremadamente estrictos a sus parejas y allegados. En la neurosis histérica, el sujeto adopta la posición de objeto de deseo del Otro. Asimismo, el sujeto puede identificarse con un par y desearlo como si fuese él. Es decir, desea como si estuviese en su posición. A menudo podemos encontrarnos con parejas donde uno aprecia ciertas cosas y el/la contrario/a acaba deseándolas. En la histeria, se detecta en el Otro un deseo, un consecuente posicionarse como objeto de satisfacción de ese deseo pero luego negar dicha satisfacción para seguir manteniéndolo vivo (el deseo). La neurosis obsesiva y la neurosis histérica en el análisis: Dado que el obsesivo intenta neutralizar al Otro, cuanto más obsesivo sea, menores serán las posibilidades de que se analice. El obsesivo puede, intelectualmente, llegar a aceptar la existencia del inconsciente, pero no la idea de que éste es inaccesible sin la ayuda de otra persona. Refiere dificultades, pero se limita a hacer un “autoanálisis” que toma la forma de llevar un diario, escribir sus sueños o preocupaciones de la semana. Comúnmente, el obsesivo vive su vida en rebelión contra uno o todos los deseos de sus padres, pero niega cualquier relación entre lo que hace y lo que sus padres quisieron que hiciera.

La primera maniobra que ha de efectuar el analista es asegurarse de que el obsesivo entienda que el Otro no puede ser anulado o pasado por alto. Es decir, tratará de impedir los intentos del obsesivo de repetir eso con el analista. Los analistas que trabajan con obsesivos están familiarizados con la tendencia de estos pacientes a hablar y hablar, interpretarse a sí mismos o asociar, sin prestar atención a las puntuaciones del analista. Éste muchas veces ha de hacer un auténtico esfuerzo para evitar que el obsesivo arrase con sus intervenciones, ya que suele tener la sensación de que el paciente se interpone en el camino de lo que quería decir. Podemos pensar, teniendo en cuenta lo anterior, que en la neurosis histérica el paciente será un paciente ideal, ya que éste está atento al deseo del Otro. Asimismo, el paciente quiere saber en estos casos. Es por esto que en la histeria es fácil pedir la ayuda del analista, pero también es difícil para ella trabajar una vez está en el proceso analítico. En el caso de que el analista acceda a darle al paciente lo que busca, es probable que éste lo cuestione, lo desarme y encuentre la falla en el saber del analista: esto la convierte en la prueba de que puede complementar el saber del analista. A menudo pueden resultar un desafío para los terapeutas, dado que pueden hacerles sentir que no están a la altura de la comprensión de la situación. Se convierten así en amos del saber del analista, ya que le empujan a saber y prontamente. En la histeria es frecuente que el sujeto traiga un nuevo síntoma cuando el anterior se resuelve.

Sinews, Hacemos Fácil lo Difícil
Sinews MTI
Multilingual Therapy Institute
Psychology, Psychiatry and Speech Therapy
Clinic Appointment

Emotional validation: A fundamental need in childhood and adolescence.

Emotional validation: A fundamental need in childhood and adolescence.

I can’t remember exactly how old I was, but I was still small. The memory I am a bout to share happened definitely some years before my 10th birthday. I can’t remember exactly what had happened either or why I was upset, but I remember I was and I also remember that my inner turmoil had carried on for some days. By this point you must be wondering why I’ve chosen to tell a story which facts I do not seem to have in a straightforward manner. The answer is simple: because I remember how I felt.

Let´s go back to the story. As a result of my sadness, I spoke to one of the significant adults in my life about whatever it was that was occurring. Their answer -slight grunt included- went somewhere along the lines of “well, this can´t continue, something needs to be done and we need you to help us out with it”. I distinctly remember the tone of voice in which this was said to me and the expression on the person´s face, maybe the words weren’t exactly as I phrased them here, but I vividly remember the emotional tone of the whole interaction. One could argue the message in itself was good because after all, the adult in question was letting me know they were going to help me, but I remember feeling tense, worried and a little overwhelmed. I thought to myself “uh oh, this person is stressed and worried now and its because of me”. Having thought about this scene several times and years after, I was able to clarify something I was experiencing and didn’t quite know how to articulate at the time my foggy memory occurred: I felt as if there was a sense of urgency being conveyed to me, as if I need to “get well fast”, but no such words where actually used. It was as if there was no space for what I was feeling, and even though I know that this adult was well intentioned and that I mattered to them, this action-oriented problem-solving approach was short of a very crucial step that should have preceded it: emotional validation

What is emotional validation and why is it so important?

Personal experiences always awaken emotions. Human existence cannot be understood without taking feelings into account and feelings are what allow us to connect with others. We validate someone emotionally when we convey to them that their experiences, emotions and thoughts are recognized, make sense and are accepted. It´s an act of true human connection and everyone needs to feel it on a regular basis throughout their lives. Validation expresses I see you, you matter, I understand or try to understand you and I´m here, all without using these words. If you think about it, feeling validated has a core importance for any human (regardless of their age) yet sadly, not much is said to parents about this fundamental parenting task. Validation is a primary emotional need, (like safety and to feel loved) and should be a right.

Validation is important for a numerous amount of reasons: It impacts the capability of naming, expressing and understanding emotions (when it comes to a person´s own self and others as well), it helps the child, teen (or adult) internalize the validating model which then grows into self-validation, it helps build self-esteem and also contributes to the development of the capability of self-regulating emotions while diminishing impulsive behaviours. In terms of immediate consequences, validation helps to “emotionally hold” the child, teen (or grown up) in distress providing emotional containment, while helping them to regulate their emotions and feel secure.

To better understand what emotional validation is and how to materialize it, we also have to comprehend its counterpart: emotional invalidation. When a person feels that his or her feelings, thoughts and/or experiences are frowned upon, judged, and/or minimized, it is safe to say that invalidation is present. We have all felt invalidated at one point or another in our lives, even if we didn’t know the formal term for it. Emotionally invalidating environments in childhood can have long-lasting effects. These effects manifest themselves in the adulthood of those who have lived immersed such environments. The vast array of research available on the matter has shown that repeated and systematic invalidation can cause difficulties in identifying, expressing and regulating emotions, emotional inhibition and depression. In the most extreme cases emotionally invalidating environments have contributed to the development of difunctional behavioural tendencies, such as resorting to impulsive harmful behaviours as a means to quickly alleviate a negative emotion

But, what does emotional invalidation look like exactly?

In essence, invalidation occurs when the important adults in a child´s life aren’t attune with his/her needs and emotions. Furthermore, these adults respond to their children either by discounting or punishing the expression of such needs and emotions. Non-responsiveness is the first from of invalidation. if a child cries, soothing him or her is validating (either with words or actions) as opposed to labelling them as cry baby, for example, which conveys the non verbal message of: you shouldn’t be crying, it doesn’t make sense that you are feeling the way you are. If a child expresses a need, i.g, “I´m hungry”, responding to that need by giving choices of what he/she could have is validating, as opposed to saying: you can´t possibly be hungry, which would again convey the following non-verbal message: the sensation that you are experiencing in your body isn’t so.

If the same thing is done in terms of feelings and an adult tells a child that he/she isn’t or shouldn´t be mad (when he/she actually is), the child slowly learns that his emotions are wrong and that they don’t make sense, which can later resort in an inability to discern emotional states and also a lack of trust his or her emotions as valid and expected reactions to certain events.

Furthermore, if a family environment consistently fails in the task of paying attention to a child’s emotions, thoughts and bodily sessions, they might be inadvertently reinforcing emotional dysregulation. Why? Because a child might learn he only gets noticed and obtains what he might need form the environment, when his or her emotional expression escalates.

So, how can parents and other significant adults be emotionally validating towards their children?

Marsha Linehan, developer of DBT therapy, composed a theory of levels of validation for therapist to use in their sessions. The same theory could be extrapolated and used by parents and caregivers.

I will be using four of the six levels proposed by Linehan to give you examples on how to validate in a conscious manner.

Level one: Be present, be curious.  Pay attention to what your child says and does when he/she communicates with you. Tune in when he/she communicates (verbally or not) an emotion. Making sustained eye contact; kneeling, bending or sitting so as to be closer to the child’s actual size and level; a gentle touch etc, are all non-verbal forms of communication that can be validating.

Level two: Reflect back. Be a mirror. Accurately translate into words what you observe and let your child know. The goal is to truly try to understand your child’s inner experience and not judge it. Paraphrase when they are slightly older: “Let me see if I understood you correctly, you said that…”

Level three: Reveal the unspoken. Essentially, at level three, if the adult has been paying close attention, he can articulate things that haven’t been explicitly said. For example, a child might be crying and complaining about something his or her brother did. He hasn’t named his emotion, but the significant adult could say something along the lines of: “That must have made you feel angry”. Linehan refers to this level as mind reading and in its more complex forms, in entails figuring out not only what a person feels but what they are thinking, wishing for…etc. You can always ask if you got things right or if you are correct after mind reading.

Level four: It´s a premise from which to function: All behaviour is either caused by an event or it´s a response to one. In that light, all behaviour is understandable. This one of my favourite levels as it helps us understand and have compassion. It does not mean that any behaviour will be approved or excused. For example, a child lies to his or her teacher about completing his homework. It´s understandable that the child is afraid of telling the truth out of fear of the consequences of doing so. The adult here could let the child know that he understands that fear was felt (level 3 validation or two if the child has explained that he was scared). The adult could go on to explain that when we are afraid, most animals (humans included) do things to try to protect themselves, but that these things aren’t always the wisest. Sometimes they just serve in the short term, but only make things worse in the long run. The adult in question could then proceed to a problem-solving approach and address what the child could do to correct the dysfunctional behaviour.

So, if you are a significant adult in a child´s life, If you are his parent, his caregiver, his uncle or aunt, his teacher or perhaps his older cousin, remember the profound impact emotional validation can have in that child’s emotional development. Whether you are having a simple conversation, a heart to heart or a serious talk about discipline, please don’t forget to validate.

Rocío Fernández Cosme
Division of Psychology, Psychotherapy and Coaching
Rocío Fernández Cosme
Psychologist
Children, adolescents and adults
Languages: English and Spanish
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How do I choose a good therapist?

How do I choose a good therapist?

Most people, at some point in their lives, find themselves in a situation where a problem arises that they cannot solve on their own, be it sleep problems, problems with their partner, grief, handling of emotions, or any problem that causes them significant discomfort in their lives that makes them need professional assistance to be able to solve it and they decide to seek psychological help. In this situation, some of the first questions that should arise are:

What do I need to consider when looking for a good professional?

What requirements should I consider ensuring that the help provided by my therapist will be beneficial to me?

The answers to these questions, and many others, are usually unknown to the general population that does not have contact with psychotherapy, and even to people who are already in therapy, and therefore I will try to give some guidelines in this article on how to choose a good therapist starting by describing the basic requirements and ending with some less intuitive questions, all of them can be grouped into 3 criteria summarized below:

Professional training

This first point may be the most intuitive of all, but it still deserves a section for some important questions that we are going to discuss. The professional you decide to attend for psychological therapy must have a minimum specific training to be able to offer therapy, which includes a degree in psychology and a health qualification that can be achieved with a PIR (Opposition to become a clinical specialist) training, MPGS (Master in General Health Psychology) or qualification in clinical psychology prior to the creation of these two.

. In psychology, there are many areas such as human resources psychology, sports psychology, Marketing or research-oriented psychology, areas that, although very valuable, do not enable or allow the person to offer psychological therapy of any kind (unless they also have health authorization). Any training other than those listed is not psychological therapy and precautions must be taken not to attend them due to the likelihood that their problem will worsen.

A good way to avoid falling into the hands of an unqualified person is to ensure that our Therapist is a member of the official school of psychologists in their area since without it they are not allowed to practice. All official schools allow people to consult about their therapist by name, and the professional must offer you information on where they are registered and their specific training of which you have the right to know.

The type of therapeutic approach

This section is probably less intuitive for a person who does not have knowledge of how psychological therapy works. In psychology there are different types of therapy, which use different techniques to address and solve the different problems that we may have, being important to ensure that the one used by your therapist is one that is based on evidence and shows efficacy.

Currently, in psychology, there are a wide variety of therapies, but not all have evidence of being effective, or have evidence of being harmful, and without training in the field it can be difficult to discern one from the other. The approaches that are based on evidence and with the best results are currently the behavioural approaches (behavioural therapy or behaviour modification) and the cognitive-behavioural approach (cognitive-behavioural therapy), which are the most used today.

On the other hand, we have approaches that are not contrasted or with evidence of not being effective , among which we could name 'past life therapy' or that known as 'Therapeutic touch or Reiki', which should not be offered by professional centres as they will not help to solve the problems that you may have.

To find out if an offered therapy is based on evidence or not, you can go to the website of the APA (American Psychological Association), the organization in charge of investigating the efficacy of different types of therapy, or conversely to the website of the APETP (association to protect the patient from pseudoscientific therapies) where you will find a list of uncontested therapies. As in the previous point, you have the right to know the evidence that supports the therapy that you are going to start.

Método de trabajo

If you notice your therapist isn't explaining what you have to do, doesn't ask questions about the problem or tells you you've got the solution, he is not doing psychological therapy.

Every professional in psychology has certain differences in the way they work, no two therapists are the same, but there are certain requirements that the therapist must meet in their work, which we can summarize in the following points:

  • Evaluation, diagnosis, and treatment: the professional who treats you must evaluate the problems with which you arrive to find out how it was established and how to treat it. The normal thing is to use the first 4 or 5 sessions to evaluate and then receive an explanation from the therapist about what is happening to him and how he plans to fix it. If you do not receive an explanation of the problem from your therapist, or they do not explain what they are going to do, or you see that you are not being asked questions about the problem, you should ask why. If your professional tells you that they do not work that way, they are not doing psychological therapy.
  • Directivity: one of the key points of therapy, although it is often overlooked, is that the professional who treats you is an expert in human behaviour, they’re the ones who knows how to ask questions about the problem and how to treat it, and they should communicate their work appropriately. If you see that your therapist is not explaining what you should do, does not ask questions about the problem, or tells you that you have the solution, you are not undergoing psychological therapy.
  • Progress and end of therapy: as much as it may sound intuitive, the ultimate goal of all therapy, and of the therapist, is that the person who seeks it no longer needs it, to be useless to the person. This is achieved by working on the problem, according to the instructions provided by your therapist, to solve the problem, find out how it originated and learn not to fall back on it. If after a long time you see no results, nothing changes, or your therapist returns to the same point over and over again, your therapy may not be working, and you should talk to your therapist about it.

It should be mentioned that there are more points to consider when choosing a therapist, but these general guidelines should help you know the minimum you need to know.

Tommy Gyran Norheim
Division of Psychology, Psychotherapy and Coaching
Tommy Gyran Norheim
Psychologist
Adults and adolescents
Languages: English, Spanish and Norwegian
See Resumé

Healthy Boundaries

Healthy Boundaries

This pandemic has been a global life-changing scenario: grieving unexpected losses, managing worry regarding financial instability, learning to balance work time and family time. This has triggered a lot of reflection in the news questioning the lifestyles we have been carrying until now. If you've been living abroad for some time, far away from your family of origin, you might have found yourself missing your family and friends back home and thinking again about your choice of living abroad. In my sessions with my expat clients, I frequently see them struggling to make peace with their decision to stay abroad. In the current world-wide crisis, that choice can feel more substantial than ever. Nobody wants to feel like they are leaving their loved ones behind. Neither we want to feel obligated to connect and reach out when the nature of our bond is complicated. 

In some cases, the decision to live abroad also comes with an inevitable push to find the much-needed emotional distance from unhealthy relational dynamics. Remember: in some instances, living abroad is the healthiest possible choice! However, particularly toxic dynamics are still in action thousands of miles away; in those cases, setting healthy boundaries and upholding them becomes paramount. 

During the lockdown, we often found ourselves with a lot of time in our hands. Did you take some time to reflect on the course of your life? Why not take advantage of it now and rethink our most significant relationships? What impact do those relationships have in your life? Do you find yourself struggling and overthinking whether you want to keep in touch with them? Do you find yourself continually justifying who you are to them? Do you dread getting in touch because every time you do subtle messages with guilt or threats is thrown into the conversation? Do you believe that no matter what you do, it's never good enough for them?

If you read the questions above and several dreadful familiar scenarios and memories came to mind, you've probably experienced some manipulation. Unfortunately, psychological and emotional manipulation is a very frequently-used powerful tool for gaining control by politicians, marketing campaigns, and close relationships. This manipulation is not always intentional and is quickly learned from one generation to the next one. Breaking free from passing down manipulative messages filled with guilt from one generation to the next one is not easy. Those messages are usually ingrained in interactions and disguised as pieces of advice from an experienced member. Other times they come in the form of reminding us of all the sacrifices they've done for us. Beware of those messages since nobody but ourselves is responsible for our actions. In Susan Forward's book, Toxic parents, she describes several family dynamics with different types of deep-seated psychological manipulation which can lead to direful interactions. From negligent parents who were unable to take care of their children's emotional and physical needs to any abusive dynamic.

If you've dealt with unhealthy family dynamics all your life, you've probably run out of ideas on how to heal those bonds. Maybe you also came to terms with the realization that they are most likely not going to change. You know you care a lot about them, and that to create a healthy relationship you need to start validating your own emotional needs and start setting up boundaries. However, upholding those boundaries seems like a terrible idea and impossible to put into action. What has stopped you in the past from making the changes you need? Is it the idea that you're selfish for needing that space? Or do you feel guilty because you think you're not a 'good daughter/son/sibling/...' if you ask for that?

Guilt is probably one of the most definite obstacles people find when thinking of setting boundaries. Imagine guilt as the tug-of-war between what you wish to do and what you think you should do. "Shoulds" often come from the legacy of family messages we've learned growing up. Some of them are direct, like: "Always put family first." However, in most cases, we learn those values just from observing our parents and closest relatives. For example, picking up from your mother's actions that being a good mother meant being selfless due to her always putting everyone else's needs before hers. Those family messages make up some of the moral rules you carry around. When you feel guilty about your interaction with your family, have you thought what "shoulds" are triggered? Do you still identify with those values as an adult? Or have you rebelled? And most importantly, what do you honestly want?

How to set and uphold healthy boundaries

To begin with, do you know for which aspects of your relationship with them you need boundaries? Your body might be your ally in learning when someone has crossed your limits. You can notice when they break your barriers because your body will also react with anxiety, feeling rigid or tense, etc. Take some time to think what made you feel upset: does it feel you have an obligation to talk to them every day? Or that you think they could interrupt your life unexpectedly with their emotional crisis?

Then, think about what you need to protect yourself and your emotional needs. To do that, reflect on what aspects of your life you share with them, how often you are in contact with them, and consider if the relationship is one-sided or not in terms of emotional support.

Tip #1: What do you share with them? 

You grew up feeling invalid or continuously depending on validation for who you were. Do you still think you need to update them regularly on your life getting to the point of oversharing? How is their reaction when you share vulnerable experiences? Choose wisely who you are sharing with- it should be someone you can count on responding compassionately. Especially if your life and identity are things they disagree on (i.e., sexual orientation or identity, religious beliefs, politics, etc.) and often criticize you about it. Remember, in dysfunctional dynamics, the more you share, the more private information can be used against you. Instead, why don't you focus the attention on them or on neutral topics? 

Tip #2: Who do you go to for emotional support?

When you've carried around emotional wounds from your childhood, it's understandable that you long for the support, guidance, and validation you've never had. Watch out for what Freud[i] called repetition compulsion. In simple terms, this means endlessly engaging in situations similar to past experiences where you were hurt before, but hoping this time, things will go differently. Do you expect that your parents will react in a supportive way this time? And afterward, do you find yourself wishing you hadn't gone to them and getting mad at yourself for getting your hopes up again?

Tip #3: When do you answer them?

If, in the past, you felt you were the emotional caretaker of your parents, most probably, you are still unintentionally carrying on with the same roles throughout your adult life. This interaction can be challenging when living abroad, primarily due to time difference: are you supposed to be available any time of the day? Do you feel you are their emotional firefighter- always on-call and ready to calm them down? Have you ever thought of changing your communication patterns? If you're still answering them whenever they call with a crisis, you're unknowingly reinforcing that unhealthy dynamic.

Tip #4: Rethink the frequency of contact:

How do you connect with the person you are trying to set new boundaries? Do you call them once per week? How do you feel after you connect with them? What would be a reasonable frequency of contact for you?

There are several ways you can show them you care: for example, sending them an article or a joke that reminded you of them.

Why not reduce your call frequency and demonstrate them in another way-a more respectful way with your needs- that you are there for them?

Tip #5: Learning to break guilt-tripping messages

Sometimes guilt and shame are sturdy emotional chains that prevent people from leaving unhealthy relationships. Guilt can be experienced internally when questioning if it is fair to ask for what you need. It can also be imposed externally- with what is known as guilt-tripping. Be careful with how you reply to those messages: the real message or demand is often hidden. Learn to address the real issue directly while ensuring not to take responsibility for the other person's feelings or falling for the trap of guilt. Write an example?

Do you feel that showing your loved ones you care about them and being available for them means forgetting your own mental well-being?

Then it's the time to face the reality that changes always start and finish with you! Why not give it a try to embracing your choices and making the changes you need to do?  

Lucía Largo
Division of Psychology, Psychotherapy and Coaching
Lucía Largo
Psychologist
Adults and adolescents
Languages: English and Spanish
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After Life: A learning medium to help understand what happens to people who suffer from depression

After Life: A learning medium to help understand what happens to people who suffer from depression

Depression, this word is associated with a lot of meanings that we’ve learnt according to the popular meaning of it in our society. The most popular notion that we all have is probably a sad person (be it for something specific or general) who spends the day in bed without being able to do anything due to a lack of energy, and that is how most of us have been sold the disorder through popular series and movies of our time.

There is a reason why depression is the most popularly known mental disorder and it’s that at some point in life we ​​all have a passing episode of it, a period of time where we feel without energy, without the desire to do anything, and with a general sadness about everything or even a lack of emotions in general.

But the truth is that depression encompasses many more things, and the fact of making it a popularly known phenomenon has also generated a large number of myths about it, myths such as depression is just a lack of desire, that over time the person who suffers it overcomes it without help, that depression appears because something bad has happened to us or that we can always see when a person is depressed. The truth is that none of this is totally true, depression englobes many different behavioural patterns and it is more common to find two completely different cases than are the same, even if it is the same disorder.

As we’ve already mentioned, there are a large number of series and movies that deal with depression, although many of them fall into the error (whether intentional or not) of romanticizing it or generating myths, and therefore I want to recommend a series that is a mixture of drama and comedy written by, and starring, one of the world's most renowned comedian Ricky Dene Gervais, called After life. In this series Ricky Gervais plays the role of Tony Johnson, a journalist for a small local newspaper in his town, who enters a depressive state after the death of his wife from cancer.

Tony views suicide as a way to end everything and realizes that he no longer cares about anything, all the 'social' norms, his well-being, hygiene,friends and other things no longer matter to him so he is free to do and say what he wants, but his plans of being 100% free are 'frustrated' by the continued insistence of his family and friends to make sure he's okay and to try to help him, which only makes his situation and feelings worse.

In addition, we can see how Tony is enduring day by day due to some recordings that his wife left him where he is periodically reminded that he has to keep trying, that he doesn’t have to give up and that he has people who love him, being a magnificent representation of the thoughts that many affected people have and that leads them to continue holding on. Another important aspect is his dog Brandy, who accompanies him in almost the entire series and is painted as a protection factor against the need he has to continue taking care of her, even if he doesn’t care about anything.

The series shows in a very realistic way, but also with very comic touches, what the day-to-day life of a person with depression is like, how they think and rationalize the things they do and the factors that can make the depressive state prolong itself in time, giving us a hard but very accurate notion about what can lead to suffering from a depressive disorder. Proof of its realism is the acclaimed criticism that the series has had not only by its fans but also by some mental health organizations that endorse its realism and are grateful that the taboo to this disorder is removed in a comical but hard way. For all this, I would recommend the afterlife series as a learning medium that can help understand what happens to people who suffer from depression, be it for close people like friends or family, or even for the person who suffers from it.

Currently, the After-life series is available on Netflix and already has 2 seasons with a third season confirmed and in production.

Tommy Gyran Norheim
Division of Psychology, Psychotherapy and Coaching
Tommy Gyran Norheim
Psychologist
Adults and adolescents
Languages: English, Spanish and Norwegian
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Your Psychologist with you: Therapeutic accompaniment

Your Psychologist with you: Therapeutic accompaniment

By Tommy Norheim, psychologist on the SINEWS clinical team. Tommy has extensive experience in the field of home care for patients with severe mental illness in his country of origin, Norway, and later during his internship in the Master in General Health Psychology at SINEWS.

In our present, in the age of information, the existing figures in the health area are well known to the entire population, figures such as professionals in medicine, nursing, physiotherapy, psychology, assistants of different types, etc. But even with the enormous amount of information we have about these experts, there are still some that are not as well known, and in this article I will try to shed light on one of them that, in my opinion, is still not completely known, specifically that of the therapeutic companion, the functions it performs and how it is done from the area of ​​psychology.

A therapeutic companion is a health professional who performs the task of assisting a person with health problems, whether physical or mental, in those areas where they cannot cope independently, usually in a field other than the clinical or hospital context such as the family home, school, work, etc. Very often, the cases where these tasks occur are with people suffering from severe mental disorders, developmental disorders, autism spectrum disorders, people disabled by reduced mobility or other problems that limit their ability to cope.

Unlike therapies in clinical or hospital contexts, the main job of a therapeutic companion is, whatever the redundancy, accompanying the person in the areas where they have specific problems, making sure to supervise the activities they can do on their own and helping, in the form of guidance rather than substitution, in activities that are difficult.

Having explained and understood what a therapeutic companion is (in general), it is worth asking what role a profesional in psychology who performs this function can play, what kind of problems can a psychologist solve by accompanying a person during their daily chores that are problematic.

Today there is still a lot of misinformation regarding the role of psychology in society, although in general the public begins to form an idea of ​​what psychological therapy would be, and in summary we could say that it consists of speech therapy, describing in words the different problems that a person has in their daily life (regarding habits, emotional state, thoughts, relationship with other people, etc.) so that the professional may help you find ways to change, improve, or accept the problem with which they come, but all this is done in consultation. In the vast majority of cases, the therapist does not have information with which to work beyond that provided by his client through what has been spoken, which, even though it is of incalculable value, it can sometimes make the task of helping difficult due to lost or omitted relevant information. Below I will roughly expose an example of how a treatment can be improved if the role of companion is performed from the area of ​​psychology, using for this a fairly typical example, depression:

Case 1

A person comes to the consultation with an acute depression problem that has been developing for several months. Let us say that the problematic behaviors that are present are the following: feeling of constant sadness, lack of appetite, lack of meetings and social communication, and a general lack of motivation to do things. When evaluating all the problems, talking to the person, we found that there seems to be no ‘reason’ behind all this, it just started to be like that little by little and they feel unable to change it. Let's focus on the social sphere for this example, let's consider that we ask the person what they feel and think when someone contacts them to go out with their friends or make some other type of social gathering and they tell us that they don't feel or think anything in particular, it just happens that they feel no motivation for it and decide not to, which is also influenced by their general state of sadness and lack of appetite. To help change this, the therapist would probably try to design and establish an action plan where the person would have to say yes to meeting up with someone even if the motivation is not present, and before they’d have to eat something to have energy for what awaits them, but this design would be based solely on the information given by the patient, which, although being incalculable as we have already said, could be omitting some important parts for some reason (among them, that they don’t know what information is important since they have no training in psychology).

Case 2

Now, let's change the perspective and suppose that instead of doing the intervention from the clinical context, we go directly to the person's home as therapeutic companions. Suppose we arrive at the house first thing in the morning to be with the person, as soon as we arrive someone calls the person to go out for breakfast and they immediately say no, getting nervous. When asked what they thought about, they say that they cannot do it, they say they’re feeling ill and does not want people to see them like this, they wonder what other people will say about them or what they would think, having an anxiety response to this idea, but when asked how they feel they say good (they’re not aware of the response they have to the situation). Later, we propose the person to clean up the house (assuming that due to inactivity it is not cleaned) and we see that the person becomes paralyzed, begins to see everything that needs to be done and does not know where to start, they see a load of work that’s so big that it gets coupled with the lack of motivation and paralyzes them, when asked what they think they say that there are too many things to do, that they would exhaust themselves to the point that they could no longer do anything else (thought that could perhaps be omitted in the clinic due to not giving it importance or not remembering that they think about it). Our job here would be to guide and tell them that they can do the activity one by one, you don't have to do it all the same day.

As it may have been observed, in the role of the companion, an incalculable amount of information could be received that in another context could be omitted for various reasons, which shows the value of the role the therapeutic companion plays. As we’ve already mentioned, the role this professional plays is not well known today, both in the general population and by health professionals, which is why a good option for both populations to learn about it, in case this small introduction attracts attention, would be the book by Leonel Dozza de Mendoça entitled 'Therapeutic and clinical accompaniment of everyday life'. In this book, Leonel not only explains the different functions of the companion in a language understandable to all populations, but also describes and bases the reasons why the figure of the therapeutic companion is, and will be, a necessity in our society, the benefits it has and why betting on these professionals is a necessary investment in many current cases.

Tommy Gyran Norheim
Division of Psychology, Psychotherapy and Coaching
Tommy Gyran Norheim
Psychologist
Adults and adolescents
Languages: English, Spanish and Norwegian
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Diary of a Global Therapist: Third Entry

Diary of a Global Therapist: Third Entry

It is 5 pm in Madrid and 10 am in the United States city where the person with whom I have a session today is. It's my "tea time" and her morning coffee.

Today's session is a follow-up session with an employee of a multinational company in the Gas & Oil sector, she is an expatriate in this American city and today's session is not so simple.

Mrs. X has been going through a difficult emotional situation for months but it was three weeks ago when she summoned up the courage to ask for help and that is why we are here today, in our third session together.

Mrs. X arrived more than a year ago at her new destination; she was traveling alone since after two months her partner with whom she had a relationship for 5 years would join her.

As she told me in the first session in which we met and began the evaluation, the first two months were difficult since she had to adapt to new tasks and in a language that despite being proficient was not her mother tongue, she also felt considerably alone outside of work. Still, Mrs. X was encouraged thinking that her partner would arrive soon and they could explore the area and make all the plans together that she was organizing.

Days before the first two months in that new destination, she received the news that her partner wanted to end the relationship, he had not felt the same for a while and these two months had helped him to understand that he no longer saw Mrs. X as the person with whom to share his life.

Since then her mood and well-being went through ups and downs but it is especially since three months ago that Mrs. X feels daily sadness, sleep issues at night and the need to spend the day in bed, she has altered her patterns of physical activity and eating and all this is affecting her work performance.

From the department of international mobility, they have told her about the possibility of returning to Spain if she continues like this since there are days when she does not go to work and if she feels hardly concentrate and very irritable with her colleagues.
What I have just described, the alterations in routines, mood, sleep, and concentration are clear symptoms of a depressive episode but I consider much more interesting the thoughts and emotions that are feeding these symptoms and that we have explored in previous sessions.

Thoughts related to decision-making to travel to the destination where she is since she would have preferred another project that was offered to her in another country where she knew the team and was more interesting to her, but she chose this American city since it made it easier for her ex-couple could travel with her. She is disappointed with the situation and with herself for having made this decision but also for the possibility of having to return before having learned and grown everything she expected.

Thoughts on the other hand related to guilt and comparison at a social level since she had previously had two similar breakups and the idea of ​​“What is wrong with me? ; "The same thing always happens to me." Adding to this an absolute feeling of loneliness since most of her coworkers lived in family and she felt out of the plans they were making and without the possibility of having a support group.

All these emotions and thoughts of guilt, sadness, loneliness and disappointment with herself and with the situation make Mrs. X live on a roller coaster of constant decisions (which has a lot to do with the alteration of rest and concentration) on whether to going or staying and what to do in both cases. It seems like every time she makes a decision a voice flares up in her head in favor of the opposite and she ends up feeling hopeless at the feeling that whatever she does she won't feel better.

I began this post by saying that it was not a simple session since, on the one hand, it may not be time to make a decision taking into account your mood but on the other hand the well-being and health of the employee and being in a place where she feels alone, without her family and in a stressful environment is not the ideal environment for her mental health.
These types of sessions also produce a waterfall of emotions in me, not only because of concern for Mrs. X's health but also for others like empathy.

Although each experience is unique and personal I think that all of us who have lived outside at some point have had similar thoughts and emotions such as nostalgia, the feeling of loneliness, guilt for not enjoying as much as we should, the comparison with the experiences of other ex-pats and disappointment with certain situations.
I have also experienced weeks in which those monsters in my head did not stop appearing at the least opportune moments and I have also had the feeling of changing my mind several times a day regarding my future.

Of course, almost all of us have also felt anguished after a breakup and blaming ourselves for what happened, thinking about what we have done wrong.

But not all the emotions that appear in me during the session are so difficult, I also feel curious and comfortable.

It is curious that before starting to work on this type of projects with multinationals and of course before the COVID-19 crisis, I thought that online therapy was a way to replace face-to-face if there was no other possibility but today the I find it very interesting and pleasant not only because of the possibility it gives us to help people who are far from us but also because of what we learn from each other.

Mrs. X, like many other clients, has our sessions from home and unless I am in Sinews' office, I usually do them from mine as well.

I see behind her a set of different photos framed in what looks like three white-painted weathered wood frames, they are symmetrically arranged and especially beautiful. In them I can see Mrs. X in what seems like different trips, in one of them she is skiing with some mountains and snow-covered pines behind her, in another she seems to be in a swamp doing a kind of water skiing and in another, I think she is with a group of people. It is curious that although I have asked her in our sessions about her interests and hobbies she has not mentioned any of these activities.

But she can also learn a little more about me on a personal level after these sessions. Even though I try to have a neutral and distraction-free environment when I work from home, there are things that we cannot avoid such as the appearance of my dog, a mastiff as large as it is affectionate during sessions whose head is common to appear or one of his huge legs asking for love. I have also seen the dogs and cats of different clients over the past few years and have occasionally heard relatives or Amazon dealers calling home in the middle of the session. At first, this made me a little uncomfortable, nowadays and as long as it is not a great distraction, I think that these details humanize us, help us to get to know each other and connect us much more despite the distance.

Besides, doing the session from our home, with our favorite tea and mug and the comfort of a rug or the wood under our feet creates a feeling of safeness and self-care very optimal for therapy. Today at the beginning of the session Mrs. X tells me that she wanted to have it, that this morning she returned to do a little exercise, she had breakfast and made a coffee with her favorite vegetable milk to take it with me in session because she has thought that this is a morning that she wanted to dedicate to herself and to take care of herself physically and mentally. This attitude on the one hand surprises me and makes me very happy and on the other it makes me feel similar, comfortable with her, and willing to share and work together during this hour.

We will work together on the importance of normalizing certain emotions, of giving them space but trying not to give them all our attention, we will talk about emotional regulation and we will begin to carry out certain practical exercises and we will also try to incorporate behaviors and activities very little by little and progressively that she used to enjoy.

It is still too early to know how Mrs. X will progress and experience tells me that it is better to be cautious and go step by step, but we will try to learn from this experience and finally decide what to do.

We finish our time together and I send her by email different materials to practice, that, and the invitation to the next session.

See you next week for our next coffee/tea time together. Thank you for sharing so much with me, Mrs. X.

Leticia Martínez Prado
Division of Psychology, Psychotherapy and Coaching
Leticia Martínez Prado
Psychologist and Coach
Adults and couples
Languages: English and Spanish
See Resumé


Reseña de Libro: Controle su ira antes de que ella le controle a usted

Reseña de Libro: Controle su ira antes de que ella le controle a usted

Reseña de Libro: Controle su ira antes de que ella le controle a usted

El propósito de las siguientes líneas es esbozar de forma breve aquellos aspectos más importantes del libro de Albert Ellis y Raymond Chip Tafrate “Controle su ira antes de que ella le controle a usted”. En un primer lugar, se expondrán los motivos por los cuales se considera pertinente hablar de esta temática en términos generales y en términos más actuales. El Trastorno Explosivo Intermitente (TEI) consta de una prevalencia entre el 1,4% y del 7%. Por otro lado, a la época actual de confinamiento tan longevo se suma la sombra de la violencia intrafamiliar. De ahí se desprende, a juicio del autor, la necesidad de abordar este tema, apoyándose en el libro que motiva esta reseña.

La época que estamos viviendo demanda de nosotros recursos que hasta hace poco teníamos olvidados o a los que habíamos tenido que acudir en momentos muy puntuales o por períodos breves de tiempo.

Se puede hablar en estos casos de aspectos como la resiliencia, la paciencia o la perseverancia entre otros. Esta situación y sus características pueden producir en nosotros reacciones de irritabilidad y enfado.

Muy probablemente el lector haya sentido, al salir a la calle, las miradas de desconfianza de otros ciudadanos, o cierta irritabilidad referida a la mera presencia de otras personas en el supermercado o el transporte público. Además, la preocupación por la salud se ve acompañada de una preocupación de corte económico que no facilita alcanzar estados de ánimo especialmente positivos. Si a esto le sumamos un confinamiento extendido en el tiempo, con la sombra de la violencia intrafamiliar flotando sobre nuestra sociedad, obtenemos una mezcla de lo más explosiva y necesaria de aplacar. Con todo esto, es más que probable que se den reacciones de enfado o ira. He aquí la utilidad de este libro tanto para el momento presente como para otros momentos no exclusivamente relacionados con el confinamiento y las consecuencias de éste.

El interés de este libro reside en varios pilares. Por un lado, la manera en la que está escrito lo hace enormemente asumible para pacientes y profesionales de la salud mental. Su lenguaje ameno y explicativo le proporcionan una notable utilidad. Por otro lado, el libro aúna varios aspectos enormemente importantes y que se podrían enmarcar en las terapias de tipo cognitivo-conductual: aborda el poderosísimo componente cognitivo de la ira, así como técnicas más procedimentales y comportamentales para amansar reacciones propias del enfado. El libro, asimismo, no edulcora el tema que le compete: la ira presenta unos efectos devastadores para el individuo y su entorno. Mi experiencia en el campo de la clínica con personas que sufren este tipo de problemática me reafirma en el acierto de comentar este último aspecto y en la enorme necesidad de darle su cabida a lo largo del proceso terapéutico: estas consecuencias devastadoras no son en absoluto eludibles.

Este libro es además una extraordinaria oportunidad para adentrarse y comprender la principal aportación de Albert Ellis, que podría resumirse de la siguiente manera: uno no se siente de determinada manera por el acontecimiento o hecho en sí, sino por el significado o la interpretación de ese mismo hecho. Esto significa que el resultado emocional no dependerá del evento, sino de lo que pensemos al respecto. Si me molesto porque mi familia no me presta ayuda, no es solamente por ese hecho, es por lo que significa para mí (“Yo siempre les ayudo y ellos no me ayudan nunca”). Aquí reside la importancia del libro objeto de este análisis. La ira, o el resultado emocional, no es debida al acontecimiento o a “lo que ha pasado”: es debido a qué significa para la persona lo que acaba de pasar.

Por ejemplo, un hombre puede sentirse molesto cuando su mujer le dice que no presta suficiente atención a sus hijos. A ese evento puede, muy probablemente,  seguir un pensamiento como “Estoy harto de me vea como un mal padre”. Su mujer no ha dicho que él sea un mal padre, ha dicho que no presta suficiente atención a sus hijos. Hemos ahí el poder de las interpretaciones que nosotros hagamos en relación a lo que nos ocurre. Ese hombre se siente mal por pensar que su mujer le vea como un mal padre, no por lo que ella dijo.

Diversos estudios encuentran una relación positiva entre la impulsividad, la ira y la impaciencia. Cabe, en este contexto, mencionar la elevada de tasa de abandonos (egosintónico y suele provenir por parte de otra persona) cuando la ira es motivo de consulta. Como decíamos, la ira correlaciona con la impaciencia. Esto podría explicar que las personas que padecen este problema cuando no obtienen resultados deprisa, abandonan el tratamiento; cuando obtienen resultados deprisa, abandonan el tratamiento; cuando la pareja les deja, abandonan el tratamiento y cuando la pareja no les deja, también suelen abandonar el tratamiento.

Esto es una llamada a la responsabilidad y el compromiso por parte de aquellas personas que se sientan identificadas con lo que se ha descrito a lo largo de estas líneas. Lejos de culpabilizar, el propósito es también hacer visible el sufrimiento de la propia persona, no solamente de su entorno. A pesar de ser la familia, los amigos, los compañeros de trabajo el termómetro más fiable, la cara visible de las consecuencias, el sufrimiento que padece la persona está lejos de ser un villancico.

Quien “tiene” arranques de ira, explosiones de enfado y actitudes enormemente hostiles a ojos de los demás, también “tiene” una arrolladora sensación de culpa, disgusto e inadecuación, que, sostenidos en el tiempo, facilitarán a su vez un nuevo episodio de enfado.

Este libro puede ser de enorme utilidad también para ellos: hablar de nuestros aspectos más lesivos y “repugnantes” con un desconocido puede no ser plato de buen gusto para todos. El uso de un libro como el que se está comentando puede servir de hoja de ruta, de material a modo de refugio al que acudir. Además, este libro no es indiferente a esto que comentamos: lejos de aplastar cualquier tipo de enfado futuro, también se hace referencia a la función de un enfado adaptado a la situación, como el establecimiento de límites, el hacer partícipes a los demás de aquello que hacen y nos disgusta, etc. Es decir, el enfado forma parte de la vida y cuenta con una función necesaria, siempre y cuando exista una pertinencia y proporcionalidad. 

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Sinews MTI
Multilingual Therapy Institute
Psychology, Psychiatry and Speech Therapy
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