Blog - Jonathan BosworthCounselling PsychologistJohannesburg

What is Parent Infant Psychotherapy?

17/7/2013

Babies have a rich mental life, and just like children and adults they can also experience psychological difficulties. Infants may not be able to convey their distress through language but often express their difficulties through restlessness, aggression, sleep, eating, elimination, relationship and developmental problems.

Babies' foundational way of knowing and experiencing the world is through their primary caregiver/s. The bond between the infant and their primary caregiver/s (commonly referred to as attachment) plays a huge role in an infant's mental and physical health. This bond can be disrupted for various reasons: due to difficulties within the infant (such as medical problems), difficulties within the primary caregiver/s (for example depression or loss) or in the dynamics between infant and caregiver (for instance a baby with a difficult temperament and a mother with low internal resources due to stressful circumstances).

Due to the importance of this bond and the baby not being able to experience psychotherapy by themselves, a strategic intervention for difficulties in infant (and sometimes parental) mental health is parent infant psychotherapy (PIP). In PIP both infant and parent/s are present in the room. The therapist particularly focuses on the relationship between the infant and their caregiver/s to help manage stress and work through psychological tensions in and between the baby and their caregiver/s. The therapist also provides the dyad (or triad) with support and guidance.

Columbia University's Center for Psychoanalytic Training and Research describes what parent infant psychotherapy is a different way and provides a useful case example to better understand what PIP may entail.

The Importance of Your Twenties

2/6/2013

Twenty-some-things or people in their twenties are often not taken seriously. This period of life is commonly associated as being fun and carefree. In the following Ted Talk psychologist Meg Jay points out how this may be an unhelpful misconception. She thought-provokingly points out how one's twenties can have a major impact on the rest of one's life: in one's career, relationships and beyond. Jay call the twenties the critical developmental period of adulthood. I think this video is not only important for twenty-some-things (and pre-twenty-some-things) but also for older persons contemplating their development, their life-defining-moments and where they are currently.

The Dangers of Trauma Debriefing

12/5/2013

Trauma debriefings often have been seen as an important preventative intervention for survivors of trauma. The trauma survivor is expected to express and process their emotions in this single "counselling" session soon after the actual trauma event. However, research has shown that this actually may be more detrimental to the trauma survivor than not having an intervention at all. Despite these findings and specific recommendations by the World Health Organisation trauma debriefing is still a common practice.

Only a fraction of persons who experience trauma will actually go on to have "abnormal" responses to trauma that require psychological intervention. Most people that experience trauma will understandably go through some distress but are actually able to go on to reconcile their experience by themselves or with the help of their family, friends and community. Thus forcing people to debrief directly after a trauma may disrupt "normal" processing of the event. What is also particularly disconcerting about the research findings on trauma debriefings is that many people interviewed about their experience of trauma debriefing expressed they found the trauma debriefing helpful. However, research actually indicates that the debriefing is still more detrimental than no debriefing despite what the trauma survivor may perceive.

The following article goes into some more detail about this and specifically talks of the dangers of well-intentioned trauma debriefings in the contexts of disaster relief (such as the 2004 Asian tsunami and the more recent events in Boston, Dhaka, Syria and Mali): Minds traumatised by disaster heal themselves without therapy

It is important to note that some survivors of trauma will experience particular difficulties and symptoms that may require psychological intervention. These symptoms are likely to include persistent re-experiencing of the event, avoidance of stimuli associated with the trauma and increased arousal (difficulties sleep, anger, concentration and hyper-vigilance). These symptoms persist for more than several weeks and cause significant distress, and impairment in social and occupational functioning. There are various psychological interventions - that are not debriefings directly after the trauma - that have been shown to help with these difficulties.

The Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People

9/5/2013

The World Professional Association for Transgender Health (formerly the Harry Benjamin International Gender Dysphoria Association) produces the Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People (SOC). The goal of the SOC is to: "provide clinical guidance for health professionals to assist transsexual, transgender, and gender nonconforming people with safe and effective pathways to achieving lasting personal comfort with their gendered selves, in order to maximize their overall health, psychological well-being, and self-fulfillment. This assistance may include primary care, gynecologic and urologic care, reproductive options, voice and communication therapy, mental health services (e.g., assessment, counseling, psychotherapy), and hormonal and surgical treatments."

The Standards of Care are not only an important document for health professionals but also for trans people and their significant others, friends, families and allies (SOFFAs). The SOC can be used by trans and gender nonconforming people as a guide for their transitioning and by SOFFAs to understand the transitioning process and how they may aid in maximising the health and well-being of trans and gender nonconforming people.

The Standards of Care were originally drafted in 1979 but have been revised and reworked numerous times. The latest SOC is in its 7th version and were released in 2011. The SOC can be downloaded from the following link:
http://www.wpath.org/documents/Standards%20of%20Care%20V7%20-%202011%20WPATH.pdf

What is Play Therapy?

1/5/2013

Children may experience life very differently from adults. They often do not have the ability to fully process difficult experiences independently. They also lack the language and expressive abilities that adolescents and adults have. So just as adolescents and adults have "talk therapy", children have play therapy. In play therapy the therapist helps the child to express themselves through play (which comes a lot easier than talk) and assists them in processing their emotional difficulties in this child-friendly way. My colleague, educational psychologist Nikki Barnfather, describes the play therapy process in more detail: http://www.nikkibarnfather.com/1/post/2012/12/what-is-play-therapy.html

When is Therapy Over?

30/4/2013

Clients often start therapy asking how long the process will take to get them to where they want to be. The length of therapy may differ greatly depending on the patients symptoms, personality, goals, the type of therapy and several other factors. Clients may decide to end therapy because their goals have been met, they are relocating and cannot see their therapist any more, for financial reasons or because therapy brings up difficult content and feelings that the patient may feel that they do not want to deal with or are not ready to deal with (this list is by no means exhaustive).

It is important for both therapist and client to think about what it means to end therapy: has the patient's goals been met? Is the ending premature? Is the client ready to continue to work on these things by them self? Does the client need to put into practice what has been learnt in therapy? Is therapy ending because of difficult feelings between the patient and therapist? Does ending mean that important material is being avoided?

These are just a few questions that may come up when thinking about ending therapy. Most psychological difficulties will never fully be resolved and the patient may continue to work on and process things long after therapy has ended. The ultimate goal of therapy thus may be for the client to be able to become their own therapist. There are numerous factors that may equip and ready an individual to be open enough to their psyche, relationships and world to be able to continue the work of therapy. The following article provides a thought-provoking exploration of what the characteristics of a person that may be ready to end therapy are: http://www.psychologytomorrowmagazine.com/the-talking-cure-are-we-there-yet/

How Therapy Works

18/4/2013

How does therapy work? Is it more important for therapy to be scientific and evidence-based or to be something more idiosyncratic? A subjective experience that captures an individual's unique reality? A distinctive, understanding space created between therapist and client? Wellness and meaning-making beyond symptom reduction?

In the following article psychotherapist Mike O'Connell explores these questions and emphasises the significance of therapy being more than scientifically-based techniques. He also notes the benefits of having different types of psychotherapy. Furthermore he backs up his arguments with examples specific to LGBT persons.

http://www.psychologytoday.com/blog/quite-queerly/201304/be-or-be-well-how-therapy-works

The Efficacy of Psychodynamic Psychotherapy

9/4/2013

Research and media coverage often focuses on the efficacy of Cognitive Behavioural Therapy (CBT). But what about other psychotherapies? Specifically what about Psychodynamic Psychotherapy? The following article in the Harvard Mental Health Letter summarises research on the merits of Psychodynamic Psychotherapy. Some of the key findings of meta-analyses mentioned were that Psychodynamic Psychotherapy is just as effective as Cogitive Behavioural Therapy with a variety of mental health disorders (such as depression, anxiety and personality disorders) and that the benefits of Psychodynamic Psychotherapy increase long after therapy has been ended. The article also provides a good introduction to what Psychodynamic Psychotherapy (including both time-limited and long-term approaches) is and what patients could expect from this type of therapy:
http://www.apsa.org/portals/1/docs/news/HarvardMentalHealthLetter092010.pdf

Choosing a Therapist

25/3/2013

Choosing a psychotherapist can be an anxiety provoking experience for many people, especially if it is their first time attending therapy or counselling. Therapy often involves sharing vulnerable parts of oneself and difficult feelings. It is therefore important that one finds a therapist that they can trust and feel safe with. Finding a suitable therapist frequently involves trying out a few sessions with a psychologist or counsellor to see whether there is a 'good' fit between the client's needs and what the therapist provides as well as the therapist and client being able to work well alongside one another. If the client does not feel that there is a 'good' fit between themselves and the service provider, one should not feel pressured to stay with that therapist. It is a good idea to bring this up with the therapist to make sure that wanting to change therapists is about the therapist-client fit and not about an avoidance of dealing with difficult material or the like. It is good practice for the psychologist or counsellor to find the client another therapist better suited to the client's needs and personality if the client and/or therapist decide that they may not work well together.

There are a number of other consideration that one may take into account when looking for a psychologist or therapist. There are also a variety of questions one may want to ask a therapist when booking an appointment or in their first session. The following article covers many of these considerations and questions: http://www.goodtherapy.org/blog/how-to-find-a-therapist/