BBC News story on smartphone addiction

13 02 2019

I made a brief appearance on the BBC London News last week, for a story on smartphone addiction. You should still be able to view the video clip here on iPlayer, for the next few days at least.

image1

The story was about a secondary school in Wembley, North London, which is selling old-style ‘brick’ mobile phones to its teenage students for just £10, to encourage them to stop using smartphones. Having trialled a smartphone amnesty, students who had switched to the older phones reported better sleep, better concentration, improved relationships, and increasing levels of happiness.

Smartphone and computer addictions are increasingly common, particularly among teens who may already struggle to regulate their rapidly developing brains and bodies. The lure of the smartphone means that we are often not fully present with those around us, which decreases levels of attunement and secure attachment, as seen in the Still Face Experiment. I often hear disconnected couples in therapy talk about how they feel that their partner’s laptop or phone has become the priority at home; pushing them into second place. This may also escalate into behaviours such as videogame or online porn addiction.

It is important to recognise that addiction is a habitual experience of disconnection. Disconnection from disowned parts of our selves, from uncomfortable feelings – such as boredom, loneliness, or sadness – and from others. Recovery, therefore, is the process of learning to slowly reconnect to these disowned parts of ourselves, these uncomfortable feelings, and others. The opposite of addiction is connection. This is why attunement and attachment, which shape our capacity to connect, are crucial elements in the recovery framework, and to work on in therapy.

If you would like to explore working on these, or any other, issues in therapy, please do not hesitate to contact me.





6 things a sex therapist wishes you knew

22 05 2018

Here’s an article I did for Prima magazine a couple of years ago, but omitted to post on here at the time:

6 Things A Sex Therapist Wishes You Knew

My 6 tips were as follows:

1. It’s good to talk about sex!
Lots of clients still feel like opening up about their sex lives is a real taboo, and that sexual thoughts should be kept private and hidden away. But the truth is that sex is a huge part of who we are – it plays a vital role in determining our identities, and in shaping the relationships we choose throughout our lives – so it’s good to talk about it, and there’s nothing shameful or degrading about doing so.

You might not think that your sexual thoughts are relevant to certain other issues in your life, but sometimes sharing these inner desires can really shine a light on something else that’s seemingly unconnected.

2. …but don’t JUST talk about sex
Sex is often the symptom, not the cause. Lots of people come to therapy looking to resolve a sexual issue, and often there’s a temptation to focus on that issue and not talk about anything else. But as you explore around the problem, you tend to find that what’s being played out in the bedroom is often related to other thoughts and feelings.

Even something as innocuous as moving house or changing job can have an unexpected impact on libido, as attention and energy levels are focused elsewhere. So it’s really important to get the full picture of what’s going on.

3. There’s nothing you could say that would surprise your therapist
People go to therapy for all kinds of sexual issues. This might be a question of their own orientation, making sense of a certain fetish, or exploring some kind of dysfunction, which they feel is preventing them from having the sex life they truly desire.

No matter how embarrassed you might feel about a certain sex-related issue, your therapist won’t judge you for it, and will remain calm and impartial as you explore the problem. Sexual issues are very common reasons for people to seek therapy, so your therapist has most likely heard it all before; and however filthy or unusual you might think your kink is, someone else has probably already shared it.

4. The biggest sexual organ is the brain
People spend so much time focusing on genitals, but often forget about the brain. Sex is a deeply psychological process, and one person’s turn ons can be another’s turn offs. This is because we all get aroused by different sensory stimuli, and have a different set of positive and negative associations for all kinds of situations and events; often relating back to previous experiences.

You can have a lot of fun with your body, but truly great sex needs to involve the brain as well. After all, it’s the brain that gets flooded with a magical cocktail of chemicals – dopamine, serotonin, oxytocin and endorphins – at the point of orgasm, to produce an almost trance-like experience.

5. Sex means different things to different people, at different times
There’s no single definition of a good sex life. Sexuality is fluid, and needs and desires can change drastically from person to person, and even day to day. For example, at the start of a relationship sex is usually about pleasure and passion, but over time it can become more about intimacy and connection, and then if a couple decide to have children it can suddenly become quite outcome-focused.

Sometimes people struggle to cope with these transitions, or may find that their own needs don’t match with their partners’, and this is why talking about sex is so important in relationships.

6. Don’t put it off
If you do have a sex-related worry or concern, it’s best to talk about it as soon as possible. If you don’t feel comfortable discussing it with a family member or a friend or partner, then seek out a good therapist to explore the issue with you. The longer you wait, the more it becomes likely that you build the issue up in your head, or start to complicate it even further.

It’s always best to tackle issues, rather than to let them fester or be ignored. More than ever, people are talking openly about their sexual orientations and desires, so there’s no need to deal with your worries alone. Everyone deserves to feel sexually fulfilled, and that includes you.

I specialise in sex and relationship issues, so if you would like to discuss any of these in a safe and secure environment, either individually or as part of a couple of family, then please contact me and I will schedule a session for you.





Dealing with Addiction

11 03 2015

Recently I saw a couple of encouraging articles in the news which inspired me to write a brief post about dealing with addiction. I will link to the two articles at the end of this post.

Addiction is an issue that comes up all the time in therapy. Sometimes it appears in very overt and obvious forms – such as substance misuse, gambling, or sex addiction – but often in more covert and subtle ways as well, such as compulsive exercise, workaholism, or obsessive thoughts and habits. In many ways all humans are addicts, as we are creatures of habit; we thrive on things that are familiar and comforting, and carve out repetitive patterns for ourselves. This is no bad thing, as it means that we can create healthy routines, or stick to a structured approach when making changes or adjustments; but it can also be dangerous and become an unhealthy, destructive force where a reliance on a certain way of thinking or behaving can start to interfere with the rest our lives.

So, why is it that some people can keep their habits under control and choose healthy routines for themselves, whereas others find themselves losing control to harmful urges? What decides whether we will find a healthy or an unhealthy outlet for our need for comfort? This is a complex issue, with numerous answers (see Gabor Mate’s talk on The Power Of Addiction for some great points), but I think these three are the most important:

1. Psychobiology. Some people inherit genetic traits or learned behaviours from their ancestors, where they may be predisposed to certain ways of thinking or doing things, or have a particular physiological ‘weakness’ for a certain substance.
2. Environment. We are hugely influenced by our surroundings, and by our social networks (see Nicholas Christakis’ wonderful talk on The Hidden Influence Of Social Networks for more information). The people around us shape our ideas of accepted norms and influence the behaviours that we establish; we often look to see how others are coping with their lives, and then we copy them.
3. Early attachment experiences. Our early experiences shape our identities and also, crucially, our emotion regulation strategies. If we have positive attachment experiences then we learn that we can rely on others, and turn to them during times of need; and this also teaches us that we are ‘worthy’ of other people’s care and attention. However, if we have negative attachment experiences then we learn that we cannot rely on others, and instead have to develop our own methods of self-soothing; and this also teaches that we are ‘unworthy’ of other people’s care and attention. It’s this latter group of people who often seek external sources of affirmation and validation, which can slip into addictive cycles: if it doesn’t feel emotionally safe to turn to other people for reassurance, then they will seek that comfort from the escapism and rush of sex, drugs, or gambling instead.

Amazingly, many addiction treatment programs continue to focus on only the first of those three issues. They see addiction simply as a psychobiological disease, and they dissect the cognitive, behavioural, and physiological components of this disease, and then set out to replace previous bad habits with healthy new ones. However, they often overlook the crucial factors of social networks and attachment experiences; factors which will be massively influential on a person’s chances of maintaining their recovery over time. I believe a crucial element in treating addiction is to process and repair negative attachment experiences from the past, and then to create new, healing attachment experiences in therapy; so that a client can feel a sense of attunement, and learn that it’s safe to turn to others for soothing and reassurance, rather than having to self-soothe or seek out alternative sources of validation. This process also empowers the client to develop a new sense of worthiness, overcoming internalished shame from past rejection, and recognising that they are indeed deserving of the attention, care, and love of others.

I spent several years as the Clinical Lead of a substance misuse treatment agency within the NHS in North London, and always made sure that we were taking a holistic approach to our clients’ recovery; addressing all three of the factors I list above. I continue to use this approach in therapy with my clients.

Now, here are the two articles I referred to earlier:

1. A Huffington Post article, titled “The Likely Cause Of Addiction Has Been Discovered, And It Is Not What You Think”.
2. An NPR article, titled “What Heroin Addiction Tells Us About Changing Bad Habits”.

Hopefully you will find them as informative as I did. And if you are seeking information or therapy for issues related to addiction, then please do feel free to contact me.





Assessing Adult Attachment: A Dynamic-Maturational Approach to Discourse Analysis

10 09 2011

My review of “Assessing Adult Attachment: A Dynamic-Maturational Approach to Discourse Analysis”.

Assessing Adult Attachment front cover

Attachment theory has come a long way since John Bowlby’s paper “Forty-four Juvenile Thieves” was published in 1944. In the paper Bowlby wrote about his work with disturbed youth in London. He theorized for the first time that the nature and security of an individual’s relationships to their primary caregivers during infancy and early childhood equips them with the methods they will use to express their feelings and needs in later life. Those relationships also predict how people will form relationships with significant others during adulthood.

Through further research into Bowlby’s initial ideas – and the invention of the Strange Situation experiment – Mary Ainsworth was able to develop a clear system of classification for this theory, which could be used to identify three unique patterns of attachment: Type A (Avoidant), Type B (Secure), and Type C (Ambivalent).

This rudimentary ABC system has been at the heart of attachment theory since its inception, and has paved the way for a host of psychological texts and theories. Titles such as “Attached” by Dr. Amir Levine and the “Attachment-Focused Family Workbook” by Daniel A. Hughes join countless other attachment-specific books currently on sale, and Dr. Sue Johnson’s research into relationships and subsequent development of her Emotionally Focused Therapy (EFT) program have brought about a revolution in the field of couples therapy. Indeed, a recent issue of the American Association of Marriage and Family Therapy’s ‘Family Therapy Magazine’ was entirely devoted to The Science Of Love, reporting the recent findings of groundbreaking research focused on the understanding of romantic love and adult attachment.

It is clear, therefore, that the ABC classification system of attachment theory has a lot to offer those in the therapeutic field, but it is not without its problems, either. First, it often seems overly simplistic: the classifications can be vague and unreliable, everyone is forced to classify themselves with one of just three basic attachment styles, and there is no option of further classification within each division. Second, it is too limiting: people frequently feel typecast and stuck within one specific attachment style, with no option for change or progress. Third, it is outdated and culturally biased: the system was derived from work in the cognitive sciences in the late 1970s, and based largely on findings from observations of middle-income, low-risk American families. And fourth, it offers very little in terms of a solution: once someone has identified their attachment style, then what?

The main cause of these problems has been the source of the classification data itself: the Adult Attachment Interview (AAI), an interview and coding method developed by Mary Main and Ruth Goldwyn in the 1980s which has been the primary method of collecting and interpreting attachment information ever since. Now, at last, with this book, Crittenden and Landini have provided us with a more up-to-date, efficient and multicultural alternative, which continues to be compatible with the AAI data collection method, but works equally well with other forms of interview, too: their own Dynamic-Maturational Model (DMM) of attachment.

Various theoretical perspectives on attachment can be applied to the interpretation of the AAI. Main and her colleagues developed the AAI based on a version of attachment theory that assumed that (1) by adulthood most adults had a single representation of attachment relationships, (2) this relationship reflected one of the Ainsworth patterns of infant attachment, (3) these patterns were transmitted from mother to child across generations, and (4) frightening circumstances disrupted the organizational process, leading to a state of disorganization in infancy or lack of resolution of the frightening circumstances in adulthood.

In the Dynamic-Maturational Model of attachment and adaptation, none of these four assumptions are made. To the contrary, the DMM approach to attachment theory presumes that adults have multiple dispositional representations, each unique to the information processes underlying it. Second, the array of strategies is developmentally expanded from its roots in infancy, with endangered individuals most often using the later developing and more complex strategies. Third, it is understood that each individual constructs his or her own dispositional representation from his or her own experience. Sometimes this will reflect similarities to the parent’s dispositional representation, but, especially in cases of parental disturbance or inadequacy, children will often organize the opposite strategy from the parent… Finally, exposure to danger is assumed to be the essential condition that elicits attachment behavior, and, across repeated experiences, leads to organized self-protective strategies.

Clearly, the introduction of this model represents a major leap forward in our understanding of attachment and attachment theory, offering a far more detailed and multicultural system of classification than the old ABC model. Over the course of this book, Crittenden and Landini fastidiously lay out a new classification system, with many numeric subdivisions within each individual attachment strategy. In fact, the research is so exhaustive and delivered in such great detail that it seems almost impossible that any clinicians reading this would not recognize each of their clients at least somewhere within the text. The downside to this is that this is not an easy book to read; it is certainly not something you will want to flick through to help you relax at the end of the day. But those who do make their way through the sometimes dense and challenging text will come out feeling incredibly rewarded for their perseverance, armed with a new treatment model for working with their clients and a new understanding of the complexities of adult attachment.

Essentially, what the field of attachment theory has been sorely lacking is its own Diagnostic and Statistical Manual — a modern, flexible, and multicultural tool which will provide practitioners with the common language and standard criteria for the classification of specific attachment styles, and their best-practice solutions. Now, with Crittenden and Landini’s long-awaited book, it finally has it.

Critically, though, this book aims to do much more than serve as just a DSM for attachment theory. As well as a basis for gathering empirical data, the authors provide us with a compassionate new guide for treatment formulation, and there is a chapter – titled ‘But What Shall I Do?’ – dedicated specifically to this cause:

Researchers are happy with a reliable classification, but not so psychotherapists and others who must guide troubled individuals and their families. They need an action plan. In this chapter we describe how one uses an AAI classification, combined with information about the history and current functioning of the speaker and his or her family, to derive a functional formulation. The functional formulation is the professional’s dispositional representation (DR) of the relation between the service structure and the individual and his or her relationships. Like all DRs, a functional formulation is dynamic; it is always changing as new information is integrated into the existing set of information… We describe how to derive functional formulations that can guide treatment both at its onset and, with feedback and updating, across the course of treatment.

Crittenden and Landini then go on to demonstrate exactly how their model can be used as a therapeutic tool, using the initial classification as starting point to guide both the therapist and client toward the resolution of past issues and the reorganization of the thoughts and language that shape both our ideas of self and attachment strategy. Furthermore, this model aims to shift the focus on attachment styles from one of disorder to one of function; from the old deficit-based model to one that is dynamic and optimistic. Rather than an emphasis on diagnosis simply for the sake of identification or labels, the authors stress their hopes that this model might open the doors to new ways of thinking in not just the mental health field, but others as well, concluding that:

When functioning is understood as attempts to protect rather than to damage or harm, alliances between mental health professionals and people in need of care become more likely.

Many say that DMM theory and methods are complex, too complex for working clinicians. After a century of trying to understand and ameliorate mental illness, it seems unlikely that simple theory, simple assessment, and quick manualized treatment will be more successful than our past efforts. It is more likely that theory needs to be sufficiently complex to represent the crucial aspects of the life experiences of people with mental illness. The assessments need to be sensitively attuned to the encrypted communications of very distressed adults, and to be coded by skilled professionals trained to a high level of reliability.

Possibly, the greatest potential of the DMM-AAI is its capacity to focus observation precisely while retaining the openness to expand and change understanding of observations. We hope this book will be used to promote accuracy of observation, clarity of interpretation, and – most important – discovery of new ideas about human adaptation. Psychological tools that yield useful data without restricting thinking are very valuable. The DMM-AAI does more: It opens the door to groundbreaking basic and applied research of as much relevance for the social sciences as for the healing professions.

This is a groundbreaking piece of work, containing a life-span view of adaptation that is both intuitively succinct and simple in structure, yet also completely nuanced in execution. Researchers and clinicians alike will undoubtedly benefit from the wealth of information shared here, and it is a must-have for anyone with an interest in attachment theory, representing a major evolutionary step forward in the field.

5 out of 5 stars.





Saying No To Naked Women

28 05 2011

I thought I would share some of my book reviews on this blog, as they do contain some interesting themes.

I’ll start with my review of “Saying No To Naked Women” by David R. Yale:

Saying No To Naked Women

In the summer of 1974, Jack Derritt leaves the city and all of his material possessions behind and heads out to the Arkansas countryside, to live in a shack and take stock of his life. Tired of meaningless flings and constant feelings of misery and self-doubt, Jack wants to figure out why he’s never been able to find a stable, loving relationship, and why he never feels good enough for anyone. He asks himself: “Why is there a throbbing hurt inside me that never leaves?”

This is the opening to David R. Yale’s “Saying No To Naked Women; the story of one man’s struggle to free himself from porn values and sexual addiction”. With Jack’s story as an example, Yale’s novel shows us how our childhood fears can continue to haunt us as adults, manifesting themselves as self-doubt or insecurity, and preventing us from living fulfilling lives or maintaining loving relationships.

As Jack attempts to settle in his new home, he comes to realize that there is no escape from his inner monologue, which is often delivered in his father’s voice, constantly reminding him what a failure and a disappointment he is.

“I’ll never produce anything worthwhile. No woman will ever want me – once she sees my terrible faults. I’ve managed to fool people, but they’ll see: I don’t know what I’m doing. My father is right. I’m a parasite.”

We learn that Jack’s parents were Orthodox Jews and Marxists, and that Jack was raised in a climate of fear and secrecy, and taught to hide his identity. His parents never told him they loved him; instead they made him feel inadequate, and different from the rest of the world. The legacy of the Rosenbergs hung over his head, as a reminder of what might happen to his family if their religious and political beliefs were discovered. It’s these feelings of fear which continue to haunt Jack as an adult, as he remains convinced that he’ll never meet anyone who could possibly understand or value him for the man he is, and that he must always conceal his true self if he wants to be accepted.

Jack seems trapped in a spiral of loneliness, depression and paranoia, and at times this can be frustrating to read. Yale’s story takes a while to get going, and his pace is slow to start with. He focuses closely on setting the scene and building up the characters, but it is not always clear where this is leading, or to what end. Readers who find themselves struggling through the first half of this book should be encouraged to persevere, as the second half rewards us with plenty of valuable lessons and the denouement contains a powerful and important message. Yale’s prose is engaging and easy to read, and I found myself deeply involved in the story, once I had decided to stick with it, past the uncertain beginning. After around 200 pages, the story finally takes an interesting twist, as the solution to Jack’s torment begins to unfold.

One day, divine intervention strikes: he gets stung by a bee in the woods, and the resulting adrenaline shot sends him into a feverish dream world. In this dream world, Jack is visited by a mystical mentor, in the form of a Chassid, who begins to lead Jack through a number of conversations and sessions of immersion therapy which transform his way of thinking about himself and others.

This exposition is somewhat reminiscent of “A Christmas Carol” by Charles Dickens; just as Scrooge meets the Ghosts of Christmas Past, Present, and Yet To Come, so too must Jack accompany the Chassid on a journey through his childhood, a summary of his present life, and an enactment of what the future might be like if he continues along his current path. Yale’s novel is a Dickensian fairytale for the modern age, demonstrating the ways in which childhood fears and insecurities can leave many men struggling with the porn values and sexual addictions that are so prevalent in society today.

Jack comes to realize that he views sex as a form of validation. He tells the Chassid, “I feel like there’s something wrong with me if I’m not having sex on a regular basis.” The Chassid then helps him see how this is connected to his childhood, and he how can end this cycle:

“Some of your anger was at your Dad for not teaching you how to be a man?”
“Yes.”
“And you turned that anger against women – the more frustrated you got the angrier your fantasies got?”
“Damn! What do I do now?”
“Learn how to communicate your feelings to women.”

The Chassid requests that Jack repeat a mantra: “I define myself. I do not let others define me. I do not let my parents define me.” Through this mantra, Jack begins to understand that his parents do not control him any more, and that he is able to live his own life. He begins to let go of the fear and secrecy he learned as a little boy, and to set himself free of the doubt and anger that have controlled him for so long.

“You must affirm yourself… Every time you think a negative thought about yourself, you have to confront it, and contradict it… You can’t deal with yourself the way your parents treated you. I forbid you! When you find you’re making harsh, critical judgments about yourself, stop! And then affirm yourself.”

Through these teachings, Jack is finally able to forgive his parents for their shortcomings, and to uncover the happiness and confidence he has always longed for. He begins to feel accepted by others, and understands what it takes to have a healthy and fulfilling relationship; knowing that the sexual fantasies and flings of his past were just a repeat of the anger and confusion he felt as a child. Finally, by the time he awakes from the dream world of the fever, Jack has learned to integrate the Chassid’s teachings into himself, as an alternative to the voice of his father, which once ruled his thoughts:

“I’m sure not used to thinking strategically like this. It’s a new experience.”
“Do you like it?”
“It makes me finally feel like I have power over my own life.”
“Even without the Chassid?”
“Yes. But maybe the Chassid has become part of me.”

Yale’s novel teaches us that we must understand, forgive, and honor both ourselves and other people in order to find happiness, and that, instead of holding on to our anger, living well is often the best revenge of all. Jack’s story is one that many men will be able to relate to, and the teachings of the Chassid will no doubt resonate with them, too.

One criticism I have, though, is that the book seems unsure of its audience. As a fictional novel about a man setting off into the wilderness to reflect on his life, the book might initially seem to fit alongside classics such as Thoreau’s “Walden”, Kerouac’s “Lonesome Traveler”, Pirsig’s “Zen and the Art Of Motorcycle Maintenance”, and Krakauer’s “Into The Wild”. However, what separates this book from those (including its misleading title) is the suggestion that it is some kind of self-help manual. The back cover suggests that this book “unlocks invisible behavior patterns you must understand to solve personal troubles and identify problem people”, and this certainly seems a little far-fetched.

As a systemic marriage and family therapist, I enjoyed reading about the Chassid’s immersion therapy techniques, and recognized the narrative therapy methods employed to help Jack re-write his own story and take control of his life. I’m sure many readers will benefit from Yale’s suggestions of how to find happiness and overcome the demons of the past. But, while these techniques may work well for some, suggesting that this book could serve as a universal guide to love and happiness seems a little extreme. Those who are simply looking for an engaging fairytale about a man in the wild, on a journey to self-fulfillment, will find that this is a story worth reading. It won’t appeal to everyone, but this is a worthy book, and one that should be recommended to anyone struggling to find love as a consequence of painful childhood experiences.

3 out of 5 stars.

In addition to my review, I’d like to add that I agree with Dr Thaddeus Birchard, an expert in sexual compulsivity and addiction, who states that “sexual addiction, like any addictive substance or process, is a response to the pain and distress of narcissistic damage. All addictions have a common underlying psychobiological process. I think of narcissistic damage as the outcome of a disturbance in attachment. The function of an addiction is therefore to anaesthetize the subjective distress created by the narcissistic damage.”

In other words, sexual addiction often forms as a means by which to avoid dealing with the pain that is caused by attachment injuries from the past. And it is only by identifying and resolving these injuries -through successful therapy sessions – that the addiction can be truly cured.

If you currently suffer from sexual addiction – or are in a relationship with someone who you suspect may be a sex addict – I can help you with these issues. Don’t wait for that change – make it happen now!