Fertility treatments and counselling

18 03 2015

Last Sunday, the 15th March 2015, the Sun published an article about IVF treatments and the stress – both psychological and financial – that these can place on a family. They contacted me and asked me to say a little bit about the systemic, wider-reaching impact that such a process can have on all the family members. and how therapy can often be a way for everyone to come together and process these issues.

You can see some clips of the article  as it appeared in the paper, below.

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If you, or any family members, might be interested in counselling for fertility issues or any related problems, then please do contact me to arrange an individual, couples, or family session as soon as possible. I look forward to hearing from you.





Guardian Interview about sex for the over 60s

25 08 2014

A while ago I did a short interview with The Guardian, to discuss sexual health and relationships for the over 60s. It was recently published on their website, and you can read it here.

older couple

Unexpectedly, the story seems to have been picked up by a number of other international sites as well, including this American news site and some blog posts. It’s nice to see the story spreading around, and hopefully this will encourage further healthy discussion around the topic.

I think sometimes there’s a stigma that you “can’t teach your grandmother to suck eggs”; that after a certain age we just get stuck in our ways and refuse to change. So the misconception follows that therapy is reserved for younger people; from teenagers facing problems in puberty, up to married couples in their 50s facing divorce.

But the truth is that it’s always good to talk; no matter what age you are. I see many elderly couples who find it transformative to discuss their relationships and sex lives in therapy, and it’s always rewarding to see the progress they make together. It’s never too late to make a change!





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.





The internet, relationships, and the benefits of having a tech-savvy therapist.

15 04 2011

Although researchers continue to constantly explore the myriad of ways in which modern technology impacts our mental health, many mental health professionals still seem uncertain as to how to broach this subject or incorporate it into their clinical practice with clients. Increasingly, it is vital that counsellors stay up to date with the latest technological developments and gadgetry, so that they can be aware of the effects these may have on their clients and their relationships.

As a modern, systemic psychotherapist, I like to think of myself as pretty ‘tech-savvy’ too. I am consistently aware of the possible role technology might play in the lives of my clients. Be it smartphones, Android devices or iPads, technology has significantly changed the ways in which we interact with one another, and also shifted the boundaries of sexuality and intimacy. Explicit sexual materials are easily accessible online, and ‘digital infidelity’ and porn addiction are now problems in many marriages.  ‘Emotional infidelity’ is also becoming more and more common, as people explore intimate secrets which might have, in the past, been reserved for face-to-face time with their partner – or remained undiscovered altogether – through sexts, forums, chatrooms and webcams, with relative strangers. This article in the Huffington Post even goes so far as to suggest that modern couples should change their wedding vows to “until Facebook do us part”.

Similarly, this viral YouTube video suggests that Facebook may contribute to rising levels of depression, as it encourages us to constantly compare ourselves to others, or become competitive with people we barely even know (it’s somewhat ironic that the video spread so well across Facebook itself, though).

Furthermore, this recent story on USA Today suggests that social media websites can be bad for our children, too; exposing them to cyberbullying, depression, and inappropriate content (although Facebook has recently added a ‘suicide-alert’ utility to help identify those who may be at risk).

So, if this is the case, we don’t we all just shut off our computers for good?

Well, the answer is simple: the internet has a lot of advantages, too. It can be an incredibly unifying place for many people, not only as a great networking tool for businesses, but also a hub of infinite connections across the world. More and more of us meet our partners online; either through shared interests, online communities, role-playing games, or the plethora of dating sites which promise to help us find our perfect match if we just answer a few simple questions. Forums, chatrooms, memes and viral videos can help to create a sense of community, particularly for those of us who may not be able to find it elsewhere. If we’re seeking advice, information, or like-minded people, the internet offers us a unique opportunity to feel connected to others, no matter how far away they might be geographically. Social networking ensures that we all feel more connected than ever, to our colleagues, our acquaintances, and even our favourite celebrity Tweeters. And text messages, emails, Facebook and Skype all ensure that we need never lose touch with our friends and loved ones.

A lot of this is often overlooked, as it is easy to just point the finger and blame technology for modern woes, and remember the mythical ‘good old days’ when everything seemed so much simpler.

I believe that we should all keep our computers running,  and that the internet holds a lot of benefits for us all, both as individuals, couples, and families, as long as we remember to invest plenty of time and effort in our real lives and face-to-face relationships, too. Ultimately it is those that are the most rewarding and the most important. I believe that ‘everything in moderation’ is a healthy motto, and that the internet can be a great source of fun, facts, and friendship, as long we don’t let it turn into an addiction or an obsession.

In addition, I’ve had many clients roll their eyes wearily when I suggested they keep a paper journal or write something down, only to see them light up with excitement when I recommend using an online journal or creative writing website instead. It’s just a fact that the keyboard is sometimes easier to fit into our daily lives that the old fashioned pad of paper.

So, if you’re a client looking to see a therapist, don’t overlook the benefits of having a tech-savvy counsellor. I’m not saying it’s a necessity by any means – in fact, it shouldn’t really matter, if your therapist is good at what they do – but it can be nice to have a counsellor who knows the ins and outs of your situation and can really relate to what you’re talking about; particularly if the issue you want to discuss is directly connected with technology or the internet.





Government reform and the protests in London

23 03 2011

Up to half a million people took to the streets of London yesterday, to protest against the recent spending cuts announced by the Government. I won’t talk too much about the cuts themselves, as I am by no means a politician, but I was both happy and dismayed to hear about the protests: happy, because we are lucky to live in a society where people can openly disagree with the Government, and make their voice heard, and dismayed, because of the violence which took place, and because the media coverage of these events seemed to overshadow a couple of positive developments which went largely unnoticed this weekend, so I thought I’d post about them here.

The first piece of good news could easily have been overlooked, as it appeared in a small three-paragraph article on page 24 of today’s Sunday Observer, titled “Care rather than prison for those with mental illness.” The article states that “the government will make a commitment tomorrow to ensure that more mentally ill people are diverted from the criminal justice system and into care”.

The question is: why has it taken them so long to make that commitment? Articles such as this one, published three years ago, have made it clear that these changes are long overdue, as our criminal justice system continues to spiral further into debt and to incarcerate, rather than rehabilitate, those with mental health issues in our community.

The Ministry Of Justice’s own Green Paper was published last December, promising a new integrated approach to managing offenders, and a new focus on Restorative Justice in the UK. The Green Paper, titled “Breaking the Cycle: Effective Punishment, Rehabilitation and Sentencing of Offenders”, spoke of “fundamental changes to the criminal justice system”, and suggested a “commitment to decentralisation”; moving away from the ‘Whitehall Knows Best’ approach and giving power back to local people and communities. This all fits in well with David Cameron’s continued push towards a ‘Big Society‘; a fantastic idea on paper, although it still remains to be seen exactly how (and whether) it will work in practice.

The Green Paper also warned that the ”plans are supported by changes right across Government, from radical reform of policing to fundamental changes to the health service”. Presumably it is these changes which have necessitated the spending cuts which incited yesterday’s protests. Let us hope they are worth it.

Today’s newspaper article concludes by reminding us that “more than two thirds of prisoners have mental health problems”. The Green Paper promised that “the Government will shortly be setting out a new approach to cutting crime with the publication of a Crime Strategy in early 2011″. Hopefully this will tackle these issues with more clarity and ensure that we start to see real changes in our criminal justice system, as soon as possible. It should also mean good news and more jobs for mental health professionals!

The second piece of good news (although also well overdue) was the announcement that the UK has finally signed up to the new EU directive to fight human trafficking. This is great news, although it is shameful that it took so long. As a strong advocate for those who are victims of trafficking, I look forward to seeing this new directive empowering the EU nations to fight together to stamp out this heinous crime.