Diary of a Global Therapist: Second Entry
Madrid, 4 pm
After a morning with interviews prior to expatriation processes and writing the corresponding corporate reports and recommendations, my afternoon begins again on the Sinews-online platform. I have a follow-up session with an employee of a multinational in the Oil & Gas sector.
These follow-up sessions that large companies make available to their employees are intended to help them with the emotional management of expatriation processes, their adaptation to a new life, and the prevention of problems or assistance. Today it is Mr. H who is waiting for me connected to the other side of the screen and the Indian Ocean!
Mr. H is already in his new destination, he has been in it for more than three months, he is in an Asian country and despite the fact that at the beginning his adaptation was simple, in recent weeks it has been complicated and his mood has suffered.
Mr. H has established good social relations and meets his family at the destination, they have also adapted without major problems, but his discomfort comes from another route, actually two different paths:
1) On the one hand, the tasks you perform are not exactly what you thought you would be assigned and, although you like them and see them as an opportunity for growth, they consume much more time than you expected.
2) On the other hand, before moving he had some expectations: travelling to nearby places, different family activities, learning the country's language ... and due to the process of adaptation and tiredness, he does not have time or energy to carry out all these activities.
All this generates in Mr H the feeling of "not taking full advantage of the experience" and of feeling disappointed with himself.
After years of working with expatriates, this problem is familiar to me, sometimes, very positive and enthusiastic people create high expectations and it is not that they are not met, but that they are not met at the exact time we want. Mr. H and I reflect on the need to be patient with yourself and to be consistent with the moment you are living. The image you created of what the experience would be like is probably not wrong, but it may not be realistic for the first few months. In this way we try to work to be kind to ourselves and consistent with the situation we are living in, assuming that other stages of adaptation will come in which your dreams will be more viable.
On many occasions, we need to normalize the discomfort. Understanding that all emotions have a function (for example exhaustion is our signal that we must rest and recover energy and stress alerts us that there are new stimuli and we must be vigilant to learn how they behave and thus be able to react). When we are able to understand what is happening to us and accept it, we can begin to make it easier for ourselves, be compassionate with ourselves and allow ourselves to live what we have to live.
Thus, after reviewing the functions of emotions together and sharing with him some strategies for managing discomfort, we end up laughing at the "pressure to do, do, smile and smile" that we often impose on ourselves and begin to think together about other ways to enjoy of current learning and set realistic goals for activities to do with his family. Instead of continually being concerned with “getting the most out of it and having to enjoy it” we can simply feel the experience day by day.
As I said at the beginning of my diary, the most globalized and diverse world of work we find ourselves in is an exciting challenge and a wonderful source to foster learning and commitment.
As in any challenge we need to incorporate the tools to face it in our luggage, here I share some of those who work in our services to companies in expatriation processes, we hope they are as useful as they have been for us:
1. Consciousness, the first and main. the knowledge of the difficulties that we will encounter due to the characteristics of the destination but also due to our personal characteristics.
2. The ability to create meaning in each task we do and experience we live, why is this important to you? What impact does it have on your personal growth? What impact does it have on the lives of others and on society?
3. The preservation of our habits and our identity, since only by being better with ourselves will we have a clearer and more open mind to understand, empathize, and adapt to differences.
4. Normalization and management of difficult emotions such as frustration or uncertainty
5. The amplification of our personal strengths, both innate and those created in previous experiences.
If we travel with a suitcase ready with resources to enjoy and others to handle the difficulties, without a doubt our experience will be easier and more exciting.
Division of Psychology, Psychotherapy and Coaching
Psychologist and Coach
Adults and couples
Languages: English and Spanish
Diary of a Global Therapist
Madrid, 9 am
Today I start my morning by connecting through the Sinews Online platform with an employee of a multinational company who is going to be an expatriate in northern Norway.
As usual, the interview begins with our respective presentations and exploring where in his professional career this assignment to the international mobility program arrives and what his expectations are. Right there the routine ends.
I enjoy this work above all because of that, each case is different, not because of the destination, not because of the job, but because of the person.
Today the employee who is on the other side of the screen and who speaks to me from Canada has vast international experience, he worked in Latin American and Arab countries and in his country of origin, but he has always done so accompanied by his family, in this new assignment it will not be like this, his children start college and the place where he is going to is considerably isolated so he will travel alone.
Throughout the interview we discuss his experience so far, he shares what he knows about where he will reside for the next three years and what he knows or needs to know about his new tasks. We also go over the personal resources he has from his previous experiences (many! I love to see such competent people) and we analyze his personality traits, those that will help him adapt and those that can give him problems and reflect on the difficulties which he anticipates he will face.
Mr. Z takes responsibility and he is looking forward to make the most of this new challenge but he is also aware that it will be very different since he will miss his family, he will be more isolated than on other occasions and the weather and food will not be the best.
In this increasingly global world of work, with more mobility and with more diverse environments, accepting the challenge of moving to another country for work can be, at the same time, the most enriching work experience of your life and one of the most complicated. We know, getting out of the comfort zone costs but helps to widen your borders
By now, you may be wondering about the purpose of this interview. First of all, let me clarify that I am a General Health Psychologist and that I work for SINEWS, a company that since its birth has been dedicated to caring for expatriates and their families in their native language. Companies that move employees around the world ask us for these psychological accompaniment programs because of different reasons:
- They help both the company and the employee to assess the risk that their mood and mental health may be in making such a significant change.
- They encourage the professional to explore the possible difficulties that may arise at the destination and to be more aware of their coping strategies: what previous learning can be useful to them and what personal strengths and coping styles they have to handle these difficulties.
- They improve the link between the company and its workers since, far from being a human resources process, it focuses on the well-being of the employees. Putting the focus on people's well-being and not only on their productivity, we know that it is one of the best ways to retain talent and create a climate of trust and commitment.
As the interview progresses we also explore the social areas and relationships with other colleagues and here comes the most interesting part that will probably be the key to the adaptation of our client today. Already in the psychometric personality evaluation that he went through before conducting the interview (a super complete test that is done online and that I carefully review before contacting the employee), I found a high score in social indifference and in difficulty in managing interpersonal situations. Mr. Z affirms that he is not very proactive when starting social relationships and that he has not trained him in previous expatriations since traveling with his family it was not necessary because they frequently did sports or tourist activities on their own.
It is interesting that despite not considering himself a person with high social capacities, he admits that his well-being depends largely on relationships with other people since the best thing he has taken from his previous destinations is the people he has met and the feeling that you can trust the team and create a "small family".
To be completely honest this does not surprises me, neither in the case of Mr. Z nor in any other case, I apply it perfectly to myself. As human beings we are social beings, inevitably and despite our differences, we all depend on our state of mind and well-being on the quality and warmth of our relationships with other people.
The company Mr. Z works for is from the Oil & Gas sector and his next destination is a very isolated one, so generating a good social climate a working environment there will be crucial.
In my conversations with employees in the international mobility program, when we review what they have learned from their previous moves, a very high percentage of professionals talk to me about how “you learn that your way of seeing or doing things is not that it is more or less correct than others, it is only yours and you have to understand and learn that there are other equally valid forms ”, many also mention the power of listening as a key tool for adaptation and for creating bonds with other people.
But there is a question from these interviews that excites me and from which Mr. Z and I will propose a social adaptation strategy in his new destination. It is a question about the personality traits that facilitate our day a day. Throughout the scientific literature, they have been called personal strengths, virtues, values ... but I find it very useful to speak of them as facilitators. We all have traits of our personality that complicate our daily lives, which makes us feel bad ... but we also have facilitating traits, those that make us grow and bring us well-being. We found out that one of the most important for Mr. Z is curiosity, perhaps he is not very outgoing but his eagerness to meet different people and realities and his desire to learn may serve to create new relationships with those who will be his "little family" at his new destination.
We are already finishing our conversation and now we explore together life habits and strategies for coping with stress and emotional management . Finally, we end the interview reviewing the information we have seen and reminding Mr. Z that if problems arise at his new destination we are at his service for sessions online, proving him psychological support if needed.
I was delighted to meet Mr. Z and I am sure that he will do well, he is a flexible person and he has clear strategies. The plan that we have drawn together will help him.
Now it is time to put in writing the results of the test and the interview, I am now with Mr. Z's report, both the one that I will write for him and in which he will be able to read our plan and see a list of readings that I have given him. This report includes recommendations on how to deal with distance with his family and how to improve his interpersonal skills. I will also do a brief report with suggestions for the company.
I confess that this part is a bit more tedious, but I find it very useful and that helps me roll up my sleeves. I know it is important. I write with one thought in mind: Good luck with your new stage, Mr. Z!
Division of Psychology, Psychotherapy and Coaching
Psychologist and Coach
Adults and couples
Languages: English and Spanish
Literacy development and identifying bilingual children with difficulties
Each person has a particular rate of growth and development. The area of literacy (the process of learning to read and write) does not escape this determination. Each child has their own learning speed and this can vary even more in bilingual children.
Detecting the difficulties that an individual may present in this area early and effectively through an early evaluation can represent a significant improvement for the well-being of the person. For these reasons, diagnosis, evaluation and treatment can be decisive in the development of children.
Although we live in an increasingly digital world, reading and writing continue to be an essential tool in most people’s lives and it seems it will continue to be so at least in the near future.
In general, as adults we have forgotten how we learnt to read and write when we were children and simply carry out the process automatically, but it is in fact a complex and lengthy learning task for children, which requires effort and continuous practice. In order to start reading, it is necessary to understand that oral language is divided into isolated sounds, each with its matching graphic representation, which are the letters of the alphabet. As children learn the different sounds for each letter, they can join them to form words and in time will create mental representations of whole words that they can then recognise visually, helping them to read at a faster rate. Therefore, reading has a visual component, identifying letters and words, as well as a linguistic component providing access to the meaning of words, sentences and texts, enabling comprehension of written information.
Children tend to develop these abilities at a different pace, often based on the amount of stimulation received. In general, at 5 years-old they begin to recognise the sounds of certain letters and to identify some words commonly found in children’s books. Around 6-7 years of age, children are considered to have enough tools to start formal literacy learning and progressively begin to decode words and sentences. At the same time they will also start writing some words. In the following years, the process continues to be gradually perfected, achieving independent reading and a progressively improved access to meaning. It is important to highlight that learning to read and write can be done simultaneously from the start in more than one language and that bilingual children learn these skills in the same way as monolingual children do.
Although there are many different definitions of the term bilingualism, in a broad sense it can be understood as the common use of two languages by an individual or a group of individuals inside a community of speakers. However, people who use more than one language do not often belong to a homogeneous group with many differences regarding the moment of language acquisition, the frequency of usage and the level of competence in each language, amongst other aspects. In the past, bilingualism was believed to be potentially harmful and have a negative influence on children’s linguistic abilities. In fact, today there is enough evidence to disprove that this is the case. Therefore, it can be concluded that bilingualism in itself does not cause oral language, literacy or learning difficulties, or any other cognitive or emotional issues whatsoever.
However, bilingual children can have difficulties when learning to read and write, just like children who only speak one language. As there are several factors that need to be taken into account, it is essential to analyse the reasons why the child is experiencing difficulties in each individual case. The following are some red flags that can arise at different stages: early difficulties in recognising or remembering letter-sounds, later slow reading and letter or syllable substitution, addition or omission errors, letter inversions, persistent spelling mistakes, difficulties organising ideas on paper, etc.
In any case, if there are signs of a possible difficulty, it is vital to carry out an early and individualised assessment, using specific tests in order to determine in which areas the child needs help, as well as providing specific recommendations and steps to follow, and establishing the right support at school as soon as possible.
On one hand, some children might show a mild delay, due to developmental delays or lack of stimulation and with the right help they are able to reach the level of their peers in a relatively short period of time.
On the other hand, other children show significant and persistent difficulties, presenting considerable differences compared to the expected level for their age with no apparent reason. In these cases a specific learning difficulty for reading and/or writing must be considered as a possibility. It is estimated that dyslexia, a specific learning disorder of neurobiological origin is present in approximately 5-10% of the population, whether or not there exists a bilingual situation. Bilingual children will show difficulties in both languages, and in all cases dyslexia requieres an early evaluation in order to avoid a possible scenario of school failure in the future.
When dyslexia is suspected, a multidisciplinary assessment and diagnosis should be carried out by a speech and language therapist and an educational psychologist. However, in Spain, speech and language therapists are the main professionals in charge of the detection, evaluation, diagnosis, and specific intervention, which needs to be individualised, explicit, systematic and designed with a mid-long term period in mind. This is different from English speaking countries like the UK or the USA, where the professionals are usually specialised teachers or tutors. In Spain, speech and language therapists specialise in reading and writing issues, as these are considered to be equally related to language, even though the communication channel is written instead of oral. Intervention consists of a specific approach to treatment focused on the rehabilitation of the reading routes and any other aspect detected during the evaluation, together with a series of recommendations regarding school adaptations.
In other cases it may also be useful to work with an academic tutor, whose job is mainly focused on supporting children with school-work and training them in study techniques. This is principally to help children with mild difficulties or those who have already received therapy. This type of support will be of great help to improve time-planning, organisation and self-monitoring skills, etc.
It should also be mentioned that oral language difficulties can affect reading and writing development, either because of specific issues in this area, or due to lack of development in the first language or in the language of instruction (vocabulary, sounds, etc.)
In every situation, oral and written language stimulation at home and at school will be essential with the aim of encouraging curiosity and a life-long love of reading. By making it as fun as possible, a reading habit can be established for life, and not just for studying or working purposes. If children are motivated, improvement will be consistent and observed on an academic and also a personal level, helping in their general well-being.
Sinews MTI
Psychology, Psychiatry and Speech Therapy
Quarantine in Children, what can we all do to mitigate the impact in the little ones?
In these difficult times, when the situation forces us to be isolated and stay at home; Children may feel like the most vulnerable in the family since many fail to assimilate the current state of day to day life in which their entire environment, routine and habits are affected. Their activities, sleep schedule, their games, hobbies, friends, neighbors, or schoolmates, every regular aspect of their life changed dramatically.
For parents it can be a difficult situation to cope with and it is very important to have the tools and techniques that help to cope with these circumstances, hence, the importance of being aware of the various methods to best deal with these family challenges.
According to the biopsychosocial model, humans’ beings are integrated by three main aspects biological (genetics), psychological (thoughts and emotions) and social (social context). Optimal development of the human being must contemplate their biological potential, adding the psychological aspects that define it, and integrating it in a social context where they can explore their potential until it is fully developed.
The social context is crucial to foresee the individual as an independent entity. From the first interactions with primary care-givers, human beings explored his social context and integrated it as a fundamental part of his being. These social interactions then expand first to their nearby family, and then to their interaction with peers until they form a proper social network.
School settings allowed the interaction with peers, in a routine, regular, and safely context, which let them explore their world based on such interaction.
Given the current situation,
What happens when children are forced to be socially isolated?
Due to the mitigating circumstances that accompany us at the moment because of the presence of the coronavirus (COVID-19), individuals have been forced to renounce the social part of their being, generating an imposed social isolation. They have not only been forced to isolate themselves socially but to stay locked up at home without being able to go out except to go shopping or take the dog for a walk. Likewise, their freedom has been restricted to the length of their houses, which have become offices, playgrounds, schools, gyms, spas, among many other things ...
Although we continue with our usual work from home, there is an imminent loss of the usual routine, fresh air, and daily movement. The necessity to go from one place to another; take the children to and from school, or to go to their jobs; has been eliminated, limiting their current field of action. Besides, everyone has to comply with their work schedule and other house activities, in the same physical space, adapting themselves day by day to new forming circumstances.
Another fundamental consequence is the forced distancing of our loved ones. People has lost the physical contact as the principal source of vital affection, essential for human beings.
How can parents support children in this vital moment? How can we mitigate these effects?
Managing this situation in the best possible way implies knowing the psychological impact that affects parents, in order to empathize with the emotions and the impact that these has on the little ones.
Parents should set an example for their children, adapting the information they share with them to their age; taking each day at a time talking honestly about the changes produced by their current situation.
Emotions like "exhaustion, detachment and anxiety" are natural and expected in the present context. As a consequence, feelings of irritability, apathy and nervousness in young children could arise, triggering behaviours such as insomnia, poor concentration, lack of academic performance, rejection to tasks that require cognitive effort, among other.
Parents should accept those emotions and let their children express their thoughts and feelings to help them cope with this situation. Parents must recognize these emotions in children, help them put it into words and calm their fears or concerns with accurate and precise information adapted to their age. Through the recognition of their own emotions, parents can share those feeling with their children, making them feel understood and supported.
Some positive recommendations to follow with children would be:
- Take advantage of one of their most potent tools their imagination, which stands out above us. Their imagination allows them to create, invent new games, have fun initiatives, applying their own "magical solution". With this, they found a hopeful perspective for the outcome of the current circumstances.
- Another enhancing ingredient is to use humour and laughter. Sharing good moments with them helps to activate feelings of well-being and pleasure, very much necessary at the present moment.
- Introduce and involve them in the chores at home, especially those that involve movement, stimulating their "self-concept". Let them find the ability to feel useful with their effort and work, as well as a fundamental part of their family. If teamwork is stimulated, the benefits could be tremendous.
- Encourage interaction through creative activities, physical exercise, playing instruments or painting. Use actions that maintain a balance between their mental and physical health. For this matter, new technologies could help them share their activities and keep in touch with classmates and extended family. Not losing contact with all their love ones, even though they have to do it through the screen.
- Resilience has led us to find initiatives to alleviate, not only social isolation but also the lack of clean air. Sharing balconies with neighbours has been one of the main initiatives to help people cope with social isolation. Through songs, applause and drawings, everyone has been able to participate in social interactions hoping for a speedy recovery, and an early return to their routines. Also, challenges have been created to share on social media, trying to generate positive social interactions with our loved ones and friends.
This particular circumstance has changed lives in multiple ways, learning to appreciate aspects and details taken for granted in the past, which has brought out the best in every person. Such circumstances would allow people to emerge stronger, not only at an individual level but as a society in general, setting a former precedent for future generations.
Sinews MTI
Psychology, Psychiatry and Speech Therapy
Covid-19 and Anxiety
Question
Ines, initially I didn’t feel too anxious about the coronavirus and the quarantine, but I’m finding that as time goes on, and with no end in sight, my anxiety level are rising. Do you have any suggestions on how to deal with the fear surrounding the current situation?
Answer
Over the last few days, as a result of the current situation regarding Covid-19, we have all been exposed to alarming information from a variety of sources. Feeling a bit afraid is, therefore, to be expected. However, we should ask ourselves: When does fear become excessive and unhelpful?
Fear and worry are natural human reactions in situations of danger or risk. They are necessary in order to successfully manage the physical and mental challenges presented by a dangerous environment. Fear allows us to better handle obstacles and problems; it prepares our bodies to deal with possible threats, and our minds to consider different future scenarios and potential solutions and strategies. From an evolutionary standpoint the role of fear is to improve our odds of survival.
However, there are instances in which fear and worry do more harm than good. In some instances these feelings can spiral out of control, and we can find ourselves in a situation where our natural reactions, meant to keep us safe, do us more harm than good. We know fear becomes unhealthy when it is no longer productive and creates excessive suffering.
In the present situation with the coronavirus, once we have taken all the necessary precautions to prevent infection, living in a constant state of anxiety has little benefit. We are dealing with an unfamiliar, but temporary, situation and the concern provoked by this uncertainty is what needs to be managed.
A continued feeling of fear and worry can have a lasting negative emotional impact. Worrying can initially provide us with a sense of control and relief, but it can have a detrimental effect in the long term. Some of the potential negative effects are: inability to stay focused, problems falling or staying asleep, muscular tension, restlessness, anxiety, irritability or fatigue.
If we are still worrying constantly about the Covid-19 despite having already taken the necessary steps and measures to deal with the situation, we should turn our attention to reducing the negative emotions we are experiencing; they are no longer of use to us.
Some strategies for reducing excessive fear and worry:
1. Avoid constant information seeking
Information helps us prepare for and navigate crisis situations. However, an excess of information can be counterproductive, as we may become overwhelmed with information which only creates anxiety. For this reason, it is important to limit the occasions in we seek out information regarding the virus to one or two times per day, rather than letting it become a constant behaviour.
2. Practice relaxation
There are a wide number of relaxation, breathing, and meditation techniques that help reduce physical, mental and emotional tension. They reduce the fight-or-flight response, create a sense of wellbeing and deactivate our constant mental loop. It is highly recommended that we practice these techniques in moments in which our anxiety levels might be higher.
3. Focusing on the present
In times of uncertainty, it is natural to worry about the different possible outcomes. When this process does not result in preventing or solving a problem, it is best to avoid letting our mind wander and contemplate the “what-ifs”. In order to do that, we can focus on the here and now. We can try, for example, to focus completely on a task or activity.
4. Remember the positive
When we are going through a difficult time and we feel vulnerable, it is important to remind ourselves of the things that are going well and that make us feel safe. In the case of the coronavirus, we must remind ourselves that this is a temporary crisis, that we are not facing it alone, but in a united and coordinated manner, using the necessary tools and procedures to combat it successfully.
5. Practice pleasurable activities
During difficult times, it becomes even more important to treat ourselves with enjoyable experiences. Everyone has a go-to treat: a nice meal, a warm bath, an episode of our favourite TV series, a call to a loved one, a nice book etc. The list is long and diverse depending on the person!
6. Good sleeping, exercising and eating habits
Having a balanced diet and sleep routine allows our body to maintain a state of stability and to be well rested mentally and physically. In addition, physical exercise releases tension and helps us focus on the present moment and our bodily sensations rather than being constantly in our heads. During the following days, we may have to avoid the gym, but we can still do simple workouts at home.
7. Maintain your usual routine
Although we might have to remain at home as much as possible in the coming days, it is important that we engage in our regular activities. Our routine is something we can control and that will help lend a sense of normality to our days.
8. Doing things we did not have time to do before
We may find ourselves with more time on our hands than usual and we can put that time to good use by reducing that long list of things we haven’t had time to do up to now (ironing, organising the closet, finally finishing that book or Netflix show etc.)
In conclusion, there are countless strategies that we can use to take the reins of our emotional state, which will positively impact how we handle the situation in the days to come!
Proofreading and editing by Gráinne Keeshan
Division of Psychology, Psychotherapy and Coaching
Psychologist
Adults and adolescents
Languages: English and Spanish
Why Do Therapy Online?
We are living in digital times. We send a Whatsapp message when we want to let someone know how our day has gone, after a long day we flop and the sofa and play Candy Crush on an iPad, we stay in touch using video chat to talk to far away friends and family, we write our to-do list on our phone and we google “how to (fill in the blank)”.
Despite technology being a part of our everyday, when we think of online therapy it can seem a little strange or unusual. Having been a Clinical Psychologist for a number of years now and being accustomed to seeing patients in-person, I also had my own doubts initially: Is online therapy useful? Does it work? Is it as effective as in-person therapy? Science has this to say:
A study published in 2018 in the Journal of Anxiety Disorders stated that online Cognitive Behavioural Therapy (iCBT) is “effective, acceptable and practical”.
The study found that online Cognitive Behavioural Therapy is as effective as in-person therapy for disorders related to depression and anxiety (panic disorder, social anxiety, general anxiety etc)
In 2104, another study published in Behaviour Research and Therapy found that online Cognitive Behavioural Therapy (iCBT) is effective and less costly for anxiety disorders. The effects were shown to be long-lasting, with benefits evident a year after therapy had been concluded. Link
Also in 2014, a study published in the Journal of Affective Disorders compared the efficacy of online and in-person therapy and found that online therapy is just as beneficial as in-person therapy. Link
Armed with this information, I decided to begin seeing patients online and have since had the opportunity to treat a large number of clients who, for one reason or another, were unable to, or preferred not to, undertake in-person therapy. These patients included students, travellers, expats, migrants and their children, people who were unable to leave their houses due to physical or psychological limitations, or those who, after a long day would like to have some “me-time” in the comfort of their own home.
Online therapy allowed these people to access the psychological support that would have been otherwise unavailable to them. Their experiences allowed me to identify and witness firsthand the benefits of online therapy:
- Location independent: It allows for freedom of movement. Sometimes, due to work, travel or other commitments, it can be difficult to attend in-person therapy.
- No travel required: It eliminates the time and cost of travelling to and from therapy.
- Continuity: As we can participate in a therapy session from anywhere, there is no need to stop or postpone my mental health care when I travel or move house.
- Flexibility: It allows me to choose from a wider timeframe when making appointments, making it easier to find a time that suits me and my therapist.
- Comfort: It allows me to participate in therapy from the comfort of my own home, or the place where I feel most relaxed and safe.
- Secure: Online therapy is facilitated by secure, encrypted platforms that guarantee that the information shared remains private and confidential.
- Immediacy: I can access the documentation shared with me by my therapist immediately.
Online therapy has understandably been growing in popularity over the last few years. With ever-increasing frequency we use the tools provided by technology and science to serve the most human of needs; connection.
Online therapy provides us with the opportunity to attend to our mental health, with the warmth and humanity of our therapist, from the comfort of our own home.
Sinews MTI
Psychology, Psychiatry and Speech Therapy
Interview with a Specialist in Family Therapy
How long have you been seeing families at Sinews?
I have been seeing families in therapy at Sinews since I joined the team in 2017. This is an element of my practice that I really enjoy as, unlike working one-on-one, working with the whole family paints a fuller picture of the some of the problems or history that has been faced. It allows the psychologist to “zoom out”, see the wider picture and access an abundance of information which is harder to get at through individual therapy.
What sort of problems are addressed in family therapy?
Family therapy can help address any number of issues, but it’s main focus is on difficulties in the dynamics between the family members. Family therapy can be most helpful when poor or little communication between family members results in conflict within the family, something which can cause much distress. Family therapy can be a great tool in helping to manage situations involving mental health diagnoses, substance abuse or addictions, behavioural problems or academic difficulties in children, a death or illness in the family, caring for a family member with special needs or an impending divorce or separation, especially when there are children involved.
Who needs to attend a family therapy session?
This depends on what is to be worked on in that session. In some cases, the whole family is invited to attend, but in others it might be preferable to see a specific subsystem within the family, like the parents, or just the mother and daughter. Before attending your first family therapy session, it might be a good idea to give the therapist, or centre you’ll be attending, a general idea of what difficulties your family is facing, and they can help inform your decision. Once in treatment, your therapist may have sessions will all or some of the family members as needed.
What if a family member doesn’t want to attend?
While family therapy can certainly benefit any family that wants to improve their dynamics or get support while going through a difficult time, this is only true if all family members who attend are able and willing. If one of the family members doesn’t want to come, it’s best not to pressure them. The family members who do come can learn skills that will benefit them, which in turn could have a positive impact on the family member who is not attending.
What does family therapy look like? How does it work?
Family therapy is a space that encourages and promotes healthy communication, which aims to create empathy, trust, and ultimately, a stronger bond within the family. It is meant to be a safe space for conflict resolution, forgiveness and stress-reduction. Sometimes this might be through dialogue, through play, or by learning new skills and applying them, inside and outside of therapy. The idea is for every member of the family to be able to express themselves openly, all the while reconstructing their story as a family unit.
Is there anything families should know beforehand?
Family therapy, just like any other type of therapy, is a process that takes time. There is no magic solution, especially considering that a family is made up of so many fluid and relational interactions. Each member should take the time to think about how and what they are willing to change and to take responsibility for and commit to it.
If you think your family, or a family you know, could benefit from family therapy, feel free to get in touch with the Sinews team for a consultation.
Sinews MTI
Psychology, Psychiatry and Speech Therapy
What Exactly does the School Counsellor do? Can my Child Receive Therapy at School?
What Exactly does the School Counsellor do? Can my Child Receive Therapy at School? In the school context, there can be a wide variety of difficulties and challenges. Schools are, by nature, a very dynamic and complex environment. Students at the same school can have a wide variety of very differing needs, and it is of the upmost importance to provide them with the specific support they require.
There are many terms to describe the process of helping an individual overcome challenges and maximise growth, such as counselling, coaching or psychotherapy. The professional who is best placed to provide these services, such as counsellor, coach or psychotherapist, varies depending on the goals to be achieved, the approach or model used or the context in which they work.
Counsellor and Psychologist are the terms that are most often used broadly and interchangeably, and although both provide support and encourage healthy development and mental health, they take different approaches to achieving these goals. It's important to make this distinction to provide clarity and recognise the differences in the roles.
The main objective of the School Counsellor is to identify and address the social, emotional and behavioural needs of the school community (students, families, teachers etc) and provide the necessary emotional support, allowing everyone to have an optimal experience at school. The School Counsellor employs a consultation approach.
In the case of a School Psychologist, they work with an intervention approach, with a focus on understanding and intervening in the emotional and behavioural context, as well as with academic issues. This is done in a more exhaustive and specific way, analysing the problem through testing and assessing.
En otras palabras, los psicólogos escolares son los profesionales de la salud mental que están capacitados para evaluar y hacer un diagnóstico oficialmente, mientras que los school counsellors pueden sugerir que existe esa problemática y derivar a un psicólogo escolar para pruebas adicionales.
As we can see, the difference between these two roles is that generally school counsellors work at the level of the entire school community (students, families, teachers etc), while school psychologists tend to focus on working with individual students with more specific issues. In other words, school psychologists are the mental health professionals that are trained to test for and officially make a diagnose, whereas counsellors can only suggest those conditions exist, and make referrals to a school psychologist for additional testing. These two school-based professionals typically provide counselling rather than psychotherapy (Hess, Magnuson and Beeler, 2012). There are similarities between counselling and psychotherapy, such as the provision of a confidential space in which to explore personal difficulties or the effectiveness of the intervention depending, to a large extent, on the quality of the relationship. However, there are also important differences.
In general, we can say that counselling is a short-term service delivered to individuals or groups to increase their adaptive functioning. In the case of school counselling, the adaptive functioning is relative to the school setting. An illustration of a counselling intervention is when a student who is struggling in her peer relationships finds, with the help of the school counsellor, solutions to reduce the conflict.
Conversely, psychotherapy provided by a psychologist tends to be a longer-term practice, representing a deeper, more fundamental level of work, over a longer period. Also, the issues or concerns that an individual presents can be more serious and may reflect a pathology (e.g., depression, suicidal ideation, eating disorder (Hughes and Theodore, 2009).
However, this distinction does not mean that School Counsellors never work with students who have a diagnosable disorder. It just means that their focus is one of support rather than treatment. For example, a student may have a serious disorder (e.g. generalised anxiety disorder) but still be seen by a school-based professional who works with the student on strategies to manage the anxiety while he or she is at school in order to achieve academic goals. Ideally, the student is also working with an external therapist to manage the anxiety disorder.
Here, School Counsellors can play an important role by providing the family with a referral to a local therapist, by staying in close contact with this therapist, by reinforcing the student’s use of newly learned coping strategies, and by consulting with the student’s teachers as appropriate.
It is important to emphasise once again that the complexity of the issue to be treated in the individual student, and the goals to be achieved will require the intervention of one professional or another. As we have seen, school is not the right context in which to carry out a therapeutic intervention and similarly, the school counsellor is not the professional best placed to carry out such work. The School Counsellor does carry out interventions throughout the school community, which can complement therapeutic interventions. Many times the work carried out by the School Counsellor is preventive, increasing exponentially the welfare and health of the entire school community.
Bibliography:
Feltham, C. (1995). What is counselling?: The Promise and Problem of the Talking Therapies. Sage Publications Ltd
Henry, A (2012). How Do I Select a Therapist or Counsellor? Recuperado de https://lifehacker.com/how-do-i-select-a-therapist-or-counselor-5874359
Hess, R.S., Magnuson, S. and Beeler, L. (2012). Counselling children and adolescents in the school. Thousand Oaks, CA: Sage.
Wake Forest University (s.f.). What’s the Difference: School Counselor vs. School Psychologist? Recuperado de https://counseling.online.wfu.edu/blog/whats-difference-school-counselor-vs-school-psychologist/
Sinews MTI
Psychology, Psychiatry and Speech Therapy
Depression After a Cardiac Event
Interviewer: How can we improve the quality of life in these patients?
The most important thing would be to treat depression, as it has been established that depression more accurately predicts quality of life than other factors, such as lifestyle or other comorbidities.
However, treatments that reduce depressive symptoms do not necessarily result in improved quality of life. Psychotherapy might be more effective as it directly targets general well-being.
A recent meta-analysis by Hofmann et al concluded that both psycho-pharmacological treatment and cognitive behavioural treatment improved quality of life in depressed patients. Specific interventions should include enhancing socialisation (as isolation is a risk factor), treatment adherence and self-care.
Interviewer: You mentioned before that there are specific measures to combat depression in patients who have suffered a cardiac event?
Fortunately, most hospitals now have cardiac rehabilitation programs, which are a crucial element in the recovery of these patients. They form an essential component of the comprehensive management of cardiac patients, largely to reduce the detrimental emotional, psycho-social, and physical consequences of cardiac events.
Interviewer: How should these patients be treated then?
These patients should be attended by a multidisciplinary team of coordinated professionals that include: a cardiologist, a rehabilitation specialist, nursing staff, a psychologist and a psychiatrist.
Interviewer: How is treatment organised?
Treatment can be divided into different areas, such as cardiac monitoring, physical exercise and mental-health treatment. Even though I will focus on the latter, let me just give some pointers about physical rehab. Exercise training is useful for these patients, not only because of the effects on the heart but also because it has an impact on mood.
It is known that supervised physical exercise reduces the rates of depression in patients recovering from a cardiac event and could even reduce the dose of antidepressant medication.
Psychological treatment is necessary for most of these patients for several reasons, the principal one being that it can be difficult to come to terms with a life-threatening experience and patients benefit from the guidance of a trained professional.
Interviewer: How are patients treated psychologically then?
Patients usually receive cognitive behaviour therapy (CBT) which, according to Beck and Dozois, aims to counteract psychological disorders or problems that arise from dysfunctional thoughts, feelings, and behaviours that develop early in life and can become activated in response to stress. Patients are trained to modify negative and distorted thoughts, change maladaptive behaviours, and develop new coping mechanisms and skills. CBT has been proven to be useful for depression after a cardiac event.
Interviewer: What about antidepressant medication? Is it safe?
Antidepressant medication is only used for those cases identified and diagnosed with major depressive disorder; they have proven to be an effective treatment for depression. When considering antidepressants, one has to bear in mind several aspects that include safety, tolerability and efficacy. There is evidence that while some medications have better efficacy, others have shown more tolerability.
Antidepressants are generally considered safe in cardiac populations, but different classes have been associated with different risks.
Almost all selective serotonin receptor reuptake inhibitors (SSRI) are safe as they have little effect on the electrical activity of the heart, except for escitalopram. In the benefit/risk assessment, it is clear that the benefits of treating depression with antidepressants in a patient recovering from a cardiac event is much higher than the risk of any side effects that could undermine their well-being. Overall, SSRIs have good efficacy in treating depression and, for reasons of safety, are the antidepressants of choice. All this said the importance of potential interactions between antidepressants and cardiovascular medications should be considered when treating depression in cardiac patients.
Interviewer: How would you sum up everything we have spoken about?
The key points would be:
• Depression frequently appears after a cardiac event and it has been linked with increased morbidity and mortality.
• Depression is an independent risk factor for cardiovascular-related death and all-cause mortality.
• Depression is often under-diagnosed and under-treated in patients with cardiovascular disease.
• To date, there is no specific test to assess depression in patients with cardiovascular disease.
• Compared with men, women have higher rates of depression and higher mortality rates after myocardial infarction.
• Antidepressants are generally safe, effective and well-tolerated.
Sinews MTI
Psychology, Psychiatry and Speech Therapy
Quality Time with Kids at Christmas
With the arrival of the Christmas Holidays, our family routine changes, both in content and in rhythm. We have a short break from set routines, never-ending school hours, homework, extracurricular activities and everything that we associate with school-time fades into the background. Giving way to a period of rest (both physical and mental), to relaxation and enjoyment and to the opportunity to spend some quality time together. Our job as parents does not come to a halt during the holidays but with this change in activities and in pace, new opportunities arise to educate our children. The holidays provide us with the opportunity to partake in fun activities with our children that during the rest of the year we are otherwise unable to enjoy.
These moments are necessary and something we should give more weight to as they strengthen the bond we have with our children and can help them in their personal development. In short, they can serve to satisfy some of the most basic needs that children have; to feel loved, protected and valued. These fun activities also provide an opportunity to continue educating our children in values, beliefs and codes of conduct that, once internalised, they will continue to use throughout their lives.
One example of these kinds of activities, which as well as being fun can also be educational, is to watch a movie together. There is a wide variety of movies to choose from and the one we ultimately choose depends on the message/s that we wish to transmit. One movie that I recommend is Wonder, based on the book by R.J Palacio that tells the story of Auggie Pullman, a 10 year old boy that was born with congenital facial deformities. The first 10 years of his life were spent between hospitals and staying within the confines of his house. The 27 operations that he undergoes allow him to see, talk and hear like everyone, but his face looks unlike that of any other 10 year old child. He has never been able to go to school, with his mother always home-schooling him.
Auggie has his parents and his older sister who love and protect him, but he is fully aware of his appearance and suffers when other people reject him. When his mother believes that the time has come for him to face the world and attend school for the first time, he is petrified, but at the same time holds out hope that he will be accepted and be able to live the life a normal child. The movie focuses on Auggie’s first year at school and narrates his experiences as well as the experiences of those around him. The environment and the situations that are described in the movie are real and relatable, allowing the audience to easily empathise with the different characters.
The movie touches on some very important issues such as bullying, friendship, the need to feel accepted, tolerance, respect, kindness, empathy, humour, strength in the face of adversity, the need to confront difficulties in order to overcome them and many other life lessons. The way in which the film is narrated by different characters permits us to appreciate the different interpretations of the same event and the impact that these events have on each person. In fact, although the central focus is on Auggie, the secondary characters also face difficulties and learn different life lessons over the course of the movie.
Wonder is a moving and touching film portrayed with sensitivity that will appeal to both children and adults. The story is so relatable that it encourages us to think about our own lives, it invites us to be more conscious of what is happening around us and, I believe, it even pushes us to try to be better people. In the movie, there is a quote by Wayne Dyer, a well-known American psychologist, made by one of Auggie’s teachers that sums up part of the message of this movie:
“When given the choice between being right and being kind, choose kind."
This movie can be used to discuss and to highlight some very important values. After watching it, we can start a conversation and ask questions which will help our children reflect on what they would do in these situations. For example: What would you do if someone new or different came to your class? How would you react? Would you think how difficult it must be for someone to experience something like that? Would you try to help them? How?
In fact, the movie can also help parents to be more attentive to the needs of all our children and not only to those that are in obvious need of attention and support.
While the Christmas holidays can provide many opportunities for fun and overindulgence, we can also ask ourselves where the opportunities for connecting and teaching lie. Watching a movie like Wonder together with our children is a magnificent opportunity to spend some quality time with them while at the same time transmitting fundamental values that will ultimately help them to become better people.
Sinews MTI
Psychology, Psychiatry and Speech Therapy