Psychotherapy, Counselling, Psychiatric Medication
Anxiety disorder can be very debilitating. Between 15% and 20% of the population may at any point in time be affected by anxiety. From a communication perspective there is much that can be done to help a person suffering from anxiety with the help of psychotherapy. But medication can be an important and fast acting support in the process
Keywords: anxiety, generalized anxiety disorder, panic attacks, social anxiety, psychotherapy
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When patients come to see a therapist, they often have a long list of things that do not work for them in their lives. It is easy to overlook that one of the hardest steps towards health has been taken, stepping into the office of a therapist. Psychotherapeutic Technique is then largely about helping the patient find his or her path and to have the courage to follow it. Empathy, common sense, and a good dose of optimism are helpful in this line of work, as is thinking about what is happening and has happened in the life of the patient, how they relate to themselves and the world, and that in the end everything should make sense to the head and to the heart.
Keywords: psychotherapy, psychotherapeutic technique
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Psychotherapeutic Technique A Brief Overview (6) Ch Jonathan Haverkampf
A short 15 min talk on anxiety and panic attacks
Shyness
Dr Jonathan Haverkampf, M.D.
The world as one sees it
Shyness itself is not a medical condition. It is a subjective perception, which is triggered by a complex set of emotions. One actually has to see oneself as being shy. If an individual does not perceive oneself as shy, then there is no shyness. This may sound counterintuitive, but even if one is very introverted and prefers to spend all day reading a book, one does not have to experience shyness. It depends on where one sees oneself in a social context. Only if one’s expectations are different from present reality, one may experience negative emotions, which may lead to a sense of shyness.
Shyness is not social anxiety
Social anxiety, unlike shyness, is a psychiatric diagnosis and it is present if certain criteria are met.
Manifestations of shyness
Shyness means feeling apprehension and discomfort around other people. Quite frequently, there is concern about what other people think about oneself. Minor details of one’s outward appearance, voice or behavior are focused on repeatedly. This constant analyzing of other people’s opinions and thoughts about oneself is often associated with low self-esteem, depressed thoughts, anxiety and setting high standards for oneself. One becomes very self-conscious in the presence of other people rather than being really self-aware. One’s own unrealistic expectations about the outcome of a situation may make it even more difficult. It is quite often the fact that shy people often expect too much rather than two little in social settings. Romantic Hollywood movies with love on first sight or rousing boardroom speeches that completely turn the destiny of a company are not what usually happens in the real world. Most social interactions are much more mundane, which does not make them less important. To see this can be quite liberating to a shy person.
Unfamiliar situations
Shyness is most likely to occur during unfamiliar situations, although not always. Unfortunately, situations remain unfamiliar if shy people avoid them. Shyness may fade with time, but avoiding unfamiliar situations. Usually shy individuals want contact to other people and relationships, which makes them struggle against shyness. However, this often makes the problem worse. By focusing on shyness as a problem within oneself self-esteem and self-confidence can further be lowered.
Social Skills
Developing social skills may help, but it may not take care of the underlying problems. Especially if there is low self-esteem, there is a risk the newly learned social skills merely cover up a problem further down below. This can have a negative effect on one’s self-esteem and self-confidence in the long-run because deeper down the individual does not believe the image he/she is projecting into the world.
Learning communication skills can be helpful in giving shy individuals more confidence. Behavioral traits in social situations such as smiling, easily producing suitable conversational topics, assuming a relaxed posture and making good eye contact, may not be second nature for a shy person. It may also be worthwhile to explore other communication channels. The internet, for example, has helped shy people become more active in a dating environment. Exchanging a number of messages and photos first, makes the other person less unknown, which helps the shy person be less intimidated and self-conscious.
Communication training can improve the situation as the individual learns to more easily interact with others and receive valuable feedback in return. Focusing on an exploration of one’s values, interests and aspirations can facilitate communication by raising one’s confidence in talking about certain issues. If one sees meaning and value in a topic, it is far easier to converse about it.
Predisposition for Shyness
There is some evidence for a genetic predisposition for shyness. Some research has indicated that shyness and aggression are related—through long and short forms of the gene DRD4, but this is merely a working hypothesis. Further, it has been suggested that shyness is related to obsessive-compulsive disorder. However, because of the numbers of factors involved and the difficulties in linking a basic cell mechanism to a group of thoughts and behaviors, this remains speculative.
A long form of the serotonin transporter promoter region polymorphism (5-HTTLPR) seems to be somewhat correlated with shyness in grade school children. [1] Interestingly, a connection between this form of the gene and both obsessive-compulsive disorder and autism has been shown in previous studies. [2] The dopamine D4 receptor gene (DRD4) exon III polymorphism, had been the subject of studies in shyness and aggression and “novelty seeking” traits.
Medication
Substances from the class of antidepressants known as selective serotonin reuptake inhibitors (SSRIs) can be used to treat shyness in individuals who feel inhibited in their daily life because of low self-esteem and psychological symptoms, such as depression or loneliness. They can often be a valued support in combination with psychotherapy. As the individual can better communicate with his or her environment they may no longer be needed after a while. They are generally viewed as non-addictive and can be discontinued relative easily, but to solidify and maintain any positive changes they should be taken for at least a year, and especially in cases of social anxiety longer, if they are well tolerated.
Psychotherapy
Psychotherapy can help uncover some of the conflicts and emotions underlying the anxiety and fears in the presence of unknown others. Often there are issues from one’s personal history that add difficulties and fears. If they are dealt with, the shyness can become much less or even disappear. Imagining situations and developing a good communication skill set can go a long way. Ultimately, the explorations of one’s values, interests and aspirations can relieve stress, psychological pressure and help one avoid situations that are more harmful than beneficial, such as unwanted relationship constellations or work situations that lack meaning. (Re)establishing a sense of the inner compass can work miracles in cases of shyness.
According to research, early intervention methods that expose shy children to social interactions involving teamwork, especially team sports, decrease their anxiety in social interactions and increase their self-confidence later on. One possible reason is that a greater set of skills in communicating information, such as emotions and needs, to other people, allows for more variation and better adaptation to different communication situations and environments.
Being Oneself
Shyness can seem to be a part of one’s personality. The difference between this and anxiety is fluid. The important question is whether we are really dealing with shyness or heightened sensitivity and insight, which can also be central to creativity. The key is to find out what the person values and finds important and how the individual can lead a more fulfilling and happier life, which frequently resolves the subjective problems with shyness in the process.
References
[1] Arbelle, Shoshana; Benjamin, Jonathan; Golin, Moshe; Kremer, Ilana; Belmaker, Robert H.; Ebstein, Richard P. (April 2003). “Relation of shyness in grade school children to the genotype for the long form of the serotonin transporter promoter region polymorphism”. American Journal of Psychiatry. 160 (4): 671–676. doi:10.1176/appi.ajp.160.4.671.PMID 12668354.
[2] Brune, CW; Kim, SJ; Salt, J; Leventhal, BL; Lord, C; Cook Jr, EH (2006). “5-HTTLPR Genotype-Specific Phenotype in Children and Adolescents with Autism”. The American Journal of Psychiatry. 163 (12): 2148–56. doi:10.1176/appi.ajp.163.12.2148. PMID 17151167.
Dr Jonathan Haverkampf, M.D. trained in medicine, psychiatry and psychotherapy and works in private practice for psychotherapy, counselling and psychiatric medication in Dublin, Ireland. The author can be reached by email at jonathanhaverkampf@gmail.com or on the websites www.jonathanhaverkampf.com and www.jonathanhaverkampf.ie.
This article is solely a basis for academic discussion and no medical advice can be given in this article, nor should anything herein be construed as advice. Always consult a professional if you believe you might suffer from a physical or mental health condition. Trademarks belong to their respective owners. No checks have been made.
Weight Loss and Psychotherapy (2)
Psychotherapy of Weight Loss
Dr Jonathan Haverkampf, M.D.
There are many approaches advertised to reduce weight but I want to focus on one of them, which I also find the most important one, the psychotherapeutic approach. Being overweight or underweight can be due to a medical condition, which needs to be excluded first. Also, there may be a perception of being overweight even when the body weight is normal or even low, such as in the case of anorexia.
Body Mass Index
The first question if one’s body weight is too high. A good tool used in many medical settings is the body mass index (BMI). Roughly, a BMI of 18.5 to 25 is seen as ‘normal’, although this always depends on the individual cases, if there are medical or other reasons to divert from it. But the BMI is usually good starting point.
‘Intake’
If the BMI is greater than 25 and there is an increased calorie intake (without clear binge eating), the situation appears to be relatively straight forward. One’s ‘intake’ is too high. Reasons for such behaviour, absent any medical condition, can be manifold.
‘Taking in’ food can have a soothing and calming effect because it reconnects one with the world, also in a physical way. But there can also be neurobiological processes, reaching back into the time when a baby sucked at the mother’s breast, which get activated and lead to a secretion of hormones and neurotransmitter substances which have a calming and relaxing effect.
Food intake therefore can be too high because of tensions or stress that increase the urge for relaxation and calming.
Stress and Tension
Psychologically, there can be a number of reasons for stress and tension, including a
Since there are so many possibilities in terms of psychological dynamics that can trigger and maintain a calorie intake above normal, it is always important to look at the individual case.
Life Experiences
There can be several reasons which lead to weight problems. Traumatic life experiences, unstable relationships, low self-esteem, and more are commonly present, but this need not be the case. In a number of instances eating more than one can metabolize may also be a ‘bad habit’ in the sense of a behaviour that has been learned and is difficult to unlearn. Maybe it is out of convenience or a lack of awareness, but change may also be difficult because one does not know how to go about it. Some structure and planning is usually required, at least when it comes to deciding what to order in a restaurant. There are many self-help books and therapists who can help one to deal with this problem. Cognitive Behavioural Therapy (CBT) often provides an effective approach if deeper personality issues and more severe mental health problems are not present.
Self-Esteem and Self-Confidence
In another article, I have discussed what to do about low self-esteem and low self-confidence. Psychodynamic therapies are helpful if there are ‘deeper’ issues are present. Insight at least shifts the underlying emotions away from the eating problem towards other strategies. But over the long-term the resolution of conflicts or any other underlying issues that are present and maintain the weight problem usually also make the weight problem go away or improve it considerably. Learning to experience and accept oneself more fully is often helpful in reducing an unwanted behaviour, such as elevated calorie intake.
The Sense of Self
The main strategy should be to focus on establishing a sound sense of self that increases happiness and enjoyment in life. This often means identifying one’s values, interests and aspirations. The more the focus can shift to enjoyable ways of constructing one’s life, the less a weight problem will be an issue. The less one actually has to think about the ‘weight problem’ the less it often is a problem, but this requires living more fully. This does not mean drastic changes in one’s life, but a gradual process towards a more fulfilling life in single steps.
Dr Jonathan Haverkampf, M.D. MLA (Harvard) LL.M. trained in medicine, psychiatry and psychotherapy and works in private practice for psychotherapy, counselling and psychiatric medication in Dublin, Ireland. The author can be reached by email at jonathanhaverkampf@gmail.com or on the websites www.jonathanhaverkampf.com and www.jonathanhaverkampf.ie.
This article is solely a basis for academic discussion and no medical advice can be given in this article, nor should anything herein be construed as advice. Always consult a professional if you believe you might suffer from a physical or mental health condition. Trademarks belong to their respective owners. No checks have been made.
© 2012-2017 Christian Jonathan Haverkampf. All Rights Reserved.
Depression and Psychotherapy (2)
Depression usually means feeling low and lacking motivation and energy to do anything enjoyable, but sometimes it may predominantly show in disturbed sleep, a lack of appetite and other diffuse bodily symptoms. The latter condition we call an atypical depression. Often individuals remain undiagnosed or misdiagnosed for a long time before someone correctly identifies the underlying problem as a depression. Frequently, depression is associated with anxiety, and in many cases also with OCD, because they involve some of the same neurobiological pathways, and the same medication can have an effect on all three.
Projective Identification is an important concept in psychodynamic psychotherapy.
There is an interesting discussion on the following site: https://www.linkedin.com/groups/94332
Better Communication
Dr Jonathan Haverkampf
Life is communication. Once cells in an organism stop communicating with other cells, the organism dies. Once partners stop communicating in a relationship, the relationship dies. Once countries stop communicating with each other, the world is economically a poorer place. Trade is communication, science is communication, art is communication. Life as a whole is the transfer of meaningful messages between cells, people and populations. Meaningfulness is the potential to bring about at least a tiny change in someone else. Emotions are as much a meaningful message as is a word in a personal email. (Spam messages are only meaningful if they make you angry.)
Communication enables us to better deal with whatever life throws at us, because it allows us to see more of the world around us. It provides us with more information to base our decisions on, but it also changes what we see of the world around us by changing the information we have about the world. Internal communication means observing and thinking about our own thoughts and emotions, and the more we do it, the more we see of the world inside us, ourselves.
Success in many endeavours depends on how we communicate what we need and what we want. Often, this is not easy because as children or adults we might have ‘learned’ not to say what we need and what we want. However, it is important that we need to verify for ourselves that this is true. If one feels that one does not deserve someone or something, it is important to ask where this voice comes from. Often we find the cause in past interactions with a parent, an ex-partner or other people in life who had issues with themselves, and projected these issues into us, not necessarily out of bad intentions but because they could not deal with their issues themselves. By this process, exploring our own inner world can lead to a sense of more self-confidence.
To improve self-confidence and self-esteem it is important to communicate one’s needs, desires and aspirations in a way that fit one’s personality. Communication at its core is a transparent process. Make belief communication cannot work in the long-run because you send billions of mostly unconscious messages in an instant, and it is impossible to control them all. A 200 millisecond twitch in the lateral edge of your left eye brow might give away information to an observer who, as unlikely as this may be, focuses on your left eyebrow. Even if you do not send any information at all, you still communicate something. Communication can be used strategically in love, business and politics, but people usually underestimate how much they are communicating and that the best strategy is not controlling one’s communication but finding out more about oneself, and become a far better communicator through this process.
If you watch a couple in a bar who just freshly met, you will notice how she might play with a strand of her hair, rock her foot or the short and stealthy glances he throws at her. They establish communication on so many more levels, and they do it automatically! So, what decides whether a kiss is in the cards for later in the evening? Primarily, it is that it has to feel right to each of them, and this is the result of what goes in on the inside, their respective values, preferences and aspirations. And the more they communicate with each other in meaningful ways, the easier it is for each of them to feel ‘right’ about the other.
Communicating better means not just being in touch with the world but also with oneself. The best preparation to go into a negotiation is to know what your values and preferences are, what is important to you and what your aspirations are for the future. Knowing these parameters makes it easier to communicate clearly, to be able to say ‘Yes’ and ‘No’ in just the right moments. You might not know consciously everything about your values and preferences, but your brain processes most of its information outside of your consciousness anyway. This is why we have a ‘gut feeling’ which often seems to be better informed than our consciously thinking parts. Better communication leads to higher quality information, which leads to a more informed gut instinct.
Selling someone on something you do not believe in does not work in the long-run. Communication is largely an automatic process, and to become better at communicating primarily means figuring out what you believe in, what your values are, and what you need and want. I have worked with many people with social anxieties and debilitating fears to give presentations, conduct meetings or speak to other parents at a local school meeting. The anxiety often resolves once people know what is important to them. This might not change one’s life from one day to the next but it gradually takes one to a place of less anxiety, a mutually more effective communication style and helps oneself and one’s environment in the process.
© 2012, 2016 Dr Christian Jonathan Haverkampf. All rights reserved.
Psychotherapy & Counselling, Medicine (Psychiatry), Communication; Dublin, Ireland
For psychotherapy, counselling and communication visit www.jonathanhaverkampf.com, www.jonathan-haverkampf.com, www.wordnets.com and www.jonathanhaverkampf.ie.
This article is solely a basis for academic discussion and no medical advice can be given in this article, nor should anything herein be construed as advice. Always consult a professional if you believe you might suffer from a physical or mental health condition.
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