psychotherapy | Dr. Jonathan Haverkampf, M.D.

Depression and Psychotherapy (6)

Abstract – Depression has become highly treatable and this article explores some ways of treating it with the use of psychotherapy. The approach presented is a communication focused psychotherapy which has been developed and described by the author before. Psychotherapy alone may not be sufficient in more severe cases, where medication is usually added to bring faster relief to the symptoms of depression, which also facilitates the psychotherapeutic treatment.

Keywords: depression, psychotherapy

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Depression and Psychotherapy (6) Christian Jonathan Haverkampf

Communication-Focused Therapy (CFT) for Anxiety and Panic Attacks (2)

Communication-Focused Therapy (CFT) is a psychotherapy developed by the author, which can be applied to a number of mental health conditions, including anxiety disorder and panic attacks. It focuses on creating greater awareness and insight into internal and external communication patterns and making changes to them. This also helps gain insight into the basic parameters, the needs, values and aspirations which are important for motivation and the direction of changes, behaviors and interactions with oneself and others.

Keywords: anxiety, panic attacks, communication-focused therapy, CFT, communication, psychotherapy, treatment

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Communication-Focused Therapy (CFT) for Anxiety and Panic Attacks (2) Christian Jonathan Haverkampf

The Dreams We Have (2)

Our dreams are what moves us forward in life. Imagining what one day might be is highly motivating and an importing testing ground for current decisions. Imagination can provide the direction and the motivation for change. Fears, however, can reduce the flexibility and openness which are required to fulfill these aspirations of the future. These are fears which are basically maladaptive. Better emotional and cognitive connectedness with oneself and better communication with the outside world can help to overcome these fears, Communication-focused therapy is one of the approaches used to improve internal and external communication.

Keywords: happiness, motivation, fears, communication-focused therapy, CFT, psychotherapy

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The Dreams We Have (2) Christian Jonathan Haverkampf

Anxiety (3)

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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Anxiety (3) Christian Jonathan Haverkampf

Psychotherapeutic Technique A Brief Overview (6)

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 Brief Introduction to the Treatment of Anxiety and Panic Attacks Dr Jonathan Haverkampf MD

A short 15 min talk on anxiety and panic attacks

Shyness

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.

Psychotherapy and Weight Loss

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

deficient sense of self
lack of boundaries
strong emotions of loneliness, sadness or even anger that cannot be communicated.

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.

Depression and Psychotherapy

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

Projective Identification is an important concept in psychodynamic psychotherapy.

There is an interesting discussion on the following site: https://www.linkedin.com/groups/94332