Sunday, May 20, 2007

Anyone For EBT*....?

You may be aware that there are plans afoot to expand access to psychological therapies in the NHS. This is a Good Thing, in my opinion. You may also be aware that there are plans afoot to ensure that CBT will be pretty much the only therapy on offer. This is a Very Bad Thing in my opinion. Perhaps you already know that. We have had some stimulating discussions on this blog about the pros and cons of CBT. See here and here if you want to catch up.

I have worked with a number of clients who self harm; who will routinely cut themselves as a way of managing a deeper distress than the physical pain of a wound. I have a friend who does this. She is exceptionally bright. She runs a successful business and has a broad CV. She knows more about psychology and psychotherapy than most, including many who work in the field. She invests in her personal development, and has an awareness and intuition that make her a valuable friend. She also cuts herself.

We present to you a joint post, on cutting and soothing, from the perspective of the one who cuts and the one who listens to some of those who cut. Find her words here.

There are a number of techniques that therapists are taught to use with those who cut. These include:

  • Challenging the negative self talk, and replacing it with a positive internal narrative
  • Distraction techniques, like going for a walk or a run
  • Using an elastic band to inflict pain without damage
  • Stabbing a melon with a large knife (!)
  • Taking a bath with aromatherapy oils

These techniques don’t work. I know, because in my early days I have encouraged people to use them and have been dismayed at their lack of effectiveness.

They don’t work, because they absolutely fail to understand the purpose of the cutting. They fail to take account of the simple fact that, for those who do it, cutting soothes. That cutting has an effect on the physiology of the individual, and provides an experience that going for a run or pinging with an elastic band simply can’t replicate.

People don’t cut because they are attention seeking or histrionic. They cut because sometimes it is the only thing that soothes. Everyone who relies on self-harm for comfort has a level of significant internal disorganisation, resulting from either early trauma or lack of attachment in their early years.

This is hard for a therapist. We sit and hear the level of distress, the despair, the hurt and the pain and we feel overwhelmed. We may feel the distress ourselves. We feel pain at watching another in pain. We feel frustrated with ourselves that we cannot relieve it, and then we project that frustration onto the client for not making the techniques work for them. We may feel intolerant at their impotence and at their apparent inability to soothe themselves. We may pick up the projected impotence and feel like a failure at not being able to help. None of this is easy for a therapist.

And so we come up with yet another technique, the purpose of which is to soothe our own feelings of impotence or inadequacy. We Try Hard. It ceases to be about soothing the person in front of us, who is still in despair. The person who cuts knows that they are causing the therapist despair. It hurts them. They know that we are Trying Hard. They leave feeling misunderstood and blamed, confirming a belief that no one can help and they can only find respite through self-harm.

I have found something that sometimes works. It is not a technique. It is not a clever psychological trick. I have learnt that when I walk in their shoes, I start to understand what cutting gives them. I start to understand the primal experience, and recognise that inflicting deep pain on oneself can be physically soothing. It is a very different experience for each person who cuts, and it is not helpful to try to come up with a universal theory to explain the whys. For some people it is about manifesting psychic pain. For some it is about control. For some it is akin to a sexual experience. I have heard people say that it is like having an orgasm, only better. There is no doubt that the physiological experience is as important as the psychological one. Neuropsychologists are starting to research the possibility that cutting releases oxytocin – the same hormone that is released at the point of orgasm. It is possible that cutting performs a function of affect regulation.

So if I could sit alongside the person who is telling me of their pain and their need to cut, if I could walk in their shoes without acting out my own frustration, impotence or discomfort at my own distress, what effect would that have?

We know that to be in the presence of a self-regulating other is soothing in itself. We learn to tolerate our own deep despair by having another tolerate it for us, and show us that it is indeed tolerable. Neuropsychology tells us that when this happens in childhood positive neural pathways are formed, which allow us to continue to soothe ourselves in distressing moments when the other is not there. The secure attachment facilitates the production of oxytocin, serotonin and possibly other neurotransmitters. For those of us who don’t have enough of this experience in childhood, it is hoped that therapy can help us to develop it later in life.

So if the therapist can be a truly self-regulating other alongside the person who cuts, and a holding witness to their pain and distress, this will soothe. And as the relationship strengthens, the attachment will enable the other to internalise the positive object that is the therapist.

There may be time then for techniques. Or perhaps for simply saying “I don’t want you to hurt yourself. I want you to be safe because I care about you.”

I have grave concerns about CBT being the only therapy on offer for people who rely on the NHS. With many clients and issues it simply doesn’t work. With some clients it is positively harmful and reinforces their self blaming pathology. If you want to hear what this is like for users of NHS mental health services, read this excellent post by PatientGuard.



* Elastic Band Therapy

138 comments:

Monozygote said...

"if I could walk in their shoes without acting out my own frustration, impotence or discomfort at my own distress, what effect would that have?"

Oh. My. God. Finally. A therapist who gets it. I think I might die of shock and relief.

Any ideas why this is such a difficult concept for therapists to apply or even grasp, when they themselves profess to practice it? As a "client", it's hard not to take it personally, you know? The arrogance and selfishness of therapists who put their own stuff onto one's experience can often be a re-traumatising experience, you know...It really doesn't seem like too much to ask...

Sorry for the outpouring, but you've hit on a nerve there.

Ms Melancholy said...

Hey Dandelion, the outpouring is fine! I know many, many therapists who can do this. And unfortunately I also know of some who can't because their training has paid scant attention to the importance of the relational dynamic. And all of us have times when the 'counter-transference' (as our feelings are called) is strong and we inadvertently act it out. This is why it is important for therapists to have very good supervision, to have their own therapy and to pay constant attention to regulating themselves whilst in sessions.

There is a time when the relational rupture is therapeutically beneficial, and should be used accordingly in order to heal. But this is useful once the attachment has been made, and in my view we don't make an attachment without having the ability to walk in the other's shoes for quite some time. I think it was Kohut who said that we won't make changes until someone has understood exactly where we are now.

My worry is that CBT pays no attention whatsoever to this process, and if the government has its way this will be the only therapy that those most in need of a relational therapy will have access to.

Thanks for your comments. Much appreciated x

Stray said...

Oh! fab comment Dandelion :) Yes, goodness ... I think I know just what you mean about it being hard not to take it personally!

Ms M - this line is amazing: I think it was Kohut who said that we won't make changes until someone has understood exactly where we are now.

Yes! Bloody hell, yes!

Many apparently destructive behaviours like cutting are a desperate attempt at communication. Often with other parts of our selves as much as others. I believe that the soothing can come as much from the clarity of this communication as any chemical reaction (as if the two could be separate which they clearly aren't).

Action is discourse and discourse is action, and all that.

So, wow, it makes perfect sense that until what the cutting is trying to say has been heard, our subconscious will persist in saying it.

Sx

Jenny Beattie said...

Ms Melancholy, this is such an important subject for people to understand. My thirteen year old son came into my room the other day at bedtime. He said he wanted to talk to me because something had happened to upset him in school. He told me that he had seen a child who was self harming; seen the fresh evidence on the peer's arm, and he felt very upset and wobbly. I think telling me helped, but I didn't really understand much of what it was about for the individual, so found it difficult to explain to him. It's a huge help to hear brave and articulate people discussing this subject.

Ms Melancholy said...

Hey jj, oh, that must be so upsetting for your son. I'm glad he felt able to tell you - we can probably presume that this is the bit that the other boy feels unable to do for whatever reason. Yes, it is important that we talk about this in an upfront, but not a sentimental, way. So often discussion on self-harm becomes awash with unhelpful 'milk and cookies' sympathy. Thanks for your comments.

PS I think it was Kohut who said that we won't make changes until someone has understood exactly where we are now.

I have just looked it up. Kohut was heavily influenced by the humanistic movement, and especially the work of Rogers (he of person centred counselling fame), and would probably credit Rogers as being the first person to stress the therapeutic value of empathy (walking in another's shoes.) Kohut emphasised this (empathy) heavily in his work but maintained his psychoanalytic roots and the importance of transference etc. He was probably the person who first successfully merged psychoanalytic ideas with the values of humanist counselling. Clever man.

Caroline said...

The joint posting has a depth of power that has covered me with hope. Not for me. I'm not even sure who for. Just hope.

(I can not formulate my words out of fear that I will say too much)

xx

trousers said...

Excellent writing Ms M. I'm off to read its counterpart in a minute. I'm a little frustrated about this because I went to an excellent event which looked at self-harm from a number of points of view and had a couple of speakers who were quite inspiring (my frustration is that this was a couple of years ago and so I can't give a coherent summary, the notes I took are at work as well).

It does seem to be a case where the less stigma is attached to self-harm (generally and concerning the individual who self-harms) the better. A basic point but one which is often overlooked or disagreed with. If the stigma is replaced by calm and empathy....well that leads on to the good points that you're making here.

Anonymous said...

My best friend, whose life ended in suicide, cut regularly. Her therapists went Freudian on her, her docs tried meds, none of it worked. The first time I saw the scars, I freaked. Later, I saw her do it, and could see the release and relief in her. I don't cut (but I'm a recovering anorexic, so self-harm isn't exactly a foreign concept), and I've struggled to find a good therapist for years (I think I have one now). And I've seen too many therapists whose work is more about themselves and their own problems than their clients. Glad to find this site and the great ideas here.

Badger said...

Wow... oh how I wish you were my therapist.

I have lots to say, I am just not sure if I am brave enough..... yet.

Badger x

Monozygote said...

Well, if I could just outpour a little more...

I don't think it is amazingly clever at all. I think it is stating the bleedin' obvious, if you'll pardon my french.

Therapists, even psychoanalytic ones bang on about the trauma involved in having a parent who can't/won't engage or empathise with you. So why is it so hard for them to practice what they preach? Talk about hypocritical. They should all be hung for the hurt that they do to already vulnerable people. Arrogant, ignorant bunch of do-gooders. And if they had any respect for their clients, they'd take it on board when we make this suggestion, even if they're too thick to work it out for themselves.

And I don't feel very forgiving, because this is hardly rocket science. It makes me sick to see people patting themselves or eachother on the back for this. What a crock!

Effing bunch of idiots (Not you).


Ok. That feels better. Thanks Ms M

PatientGuard said...

Hello Ms M

I just got my article written weaving back into yours and Strays.

I was so busy cheeking people with insights on another part of the web.

Flinging laughs and severe warmths...

I might have had a go yesterday but I have powerful flashbacks-like-stuff bombing me and have to work through it regularly to get back to the present ...So I was in the dynamite shitbin head mode yesterday ..

Luckily the Tear-God came and showed me a way to float out of my eyes back into Life ..

I'm glad Stray talked about herself. You can love people for that .. - that's the way for us all to share hells and make a campfire where its all acceptable ..Well at least its what some of Service Users are doing on the web now ..

TTT Tribal Talk Therapy ...

Many Warmths to you all


Silvis Rivers ..

Ms Melancholy said...

Stray my lovely, I missed you there! But thanks for that last line

until what the cutting is trying to say has been heard, our subconscious will persist in saying it.

you have summed up precisely what I wanted to say.

Hey lovely Caroline, you don't have to say too much. What you have said is just right x

Hey trousers-who-now-has-a-blog, (go and visit everyone!) Yes, the stigma thing makes sense, although I have never thought about it in quite those terms before. I think we need to normalise all of our experiences before we can fully integrate them, so perhaps what we need to do as therapists is normalise cutting as a coping mechanism but without entrenching it, if that makes sense. Thanks for your comments. Hope your hangover is better!

Hi emi, thanks for dropping by. I think I would like to mention here that in my experience most people who cut or self harm are not doing it out of a desire to end their life. Although of course there will be some who do. I hope your recovery continues x

Hey Badger, big hugs! xxx

Hey Dandelion, wow, please feel free! I felt a little tug there to defend my profession, but I don't think I really need to do I. Sounds like someone has really rocked your boat though. Ruptures can be very useful. Shan't say anymore. Take good care x

Hey Silvis, your elastic band therapy post is great, and I hope people have read it as a result of Stray and I. I shall keep an eye out for your next.

share hells, and make a campfire where it is all acceptable

what a great metaphor! See you again.

trousers said...

MsM, you've summed up nicely what I was getting at, and as I recall was very much what the best speaker at the aforementioned event practiced. Mind you this was a CPN who hears voices which for him was also perfectly normal until he started his training and realised that if the DSM criteria had been applied to him then he would have been liable to be placed under section. I wouldn't necessarily say this put him in a better situation to deal with the specifics of the topic at hand, but surely gave him a clearer handle on it in terms of normalisation.

(As for my hangover - it was disconcertingly mild given that I tottered home after dawn had broken)

trousers said...

Oops, 'scuse that incredibly badly constructed and overly long sentence.

Monozygote said...

I felt a little tug there to defend my profession, but I don't think I really need to do I.

Nope. You can't be held responsible. But I would say it is an argument for better evidence-based regulation, even if we need to redefine what counts as evidence.

Monozygote said...

ps At least actual doctors are committed to the first principle of "do no harm". It sounds to me like "rupture" is another word for "thoughtless re-traumatisation", and I just don't think that's ok.

Stray said...

I just wanted to chip in to say that I think there is a whole world of difference between a rupture and a 'thoughtless re-traumatisation'.

My understanding is that ruptures occur in relationship when someone behaves in a way which is (negatively) surprising to us.

Given that therapists cannot be perfect, omniscient, utterly consistent beings, it is inevitable that there will be ruptures in the therapeutic relationship, because there are limits to their ability to help, hold, hear and know us.

My own experience has been that generally ruptures have occurred around my own inner conflicts: in particular the battle between the desire to make my needs explicit and the instinct to minimise my needs in order to make me more palatable to others. I have a habit of communicating very unclearly around certain issues - I will state that something is not important to me "hey therapist, read this email if you get a chance before the session, but no worries if you don't" when actually it feels vital. Then I'll be angry with my therapist because they didn't read my mind. *sigh*

Whilst yes, that does touch a nerve for me (and then some), and it feels like a huge threat to my relationship with this person, and they don't care about me and blah blah blah, I don't think it's a failing on the therapist's part! I would go so far as to say that I believe I have had re-traumatising experiences in therapy, and they were really very different from the normal ruptures in relationship.

The unpleasant reality is that every day we have interactions with people in which we are negatively surprised by the other person's response. If we don't learn to adjust our own internal world to accommodate that situation and, if possible, learn from it, then the world will always be a scary and uncomfortable place to live in.

There are some inadequate therapists out there, no doubt, and some arrogant ones, and some dogmatic ones ... and a lot of bloody good ones as well. I don't think 'frequency / occurrence of ruptures' is a stick by which they can be measured - ruptures are just a part of therapy, and the most we can hope for is a therapist who is open minded, patient and creative in exploring them, and who can somehow convey to us that all is not lost in the moments when we feel desperately disappointed by them.

Sx

Ms Melancholy said...

Hey Dandelion,, it sounds to me like you have probably had a bad experience somewhere. I am a bit loathed for this thread to get caught up in attacking bad therapists, however. I would like to say though, that the rupture is precisely where good therapy happens. Without ruptures, all we have is 'milk and cookies' - "everything you do and say is fine" - and that turns out to be one damn expensive waste of your time. Why would you want to pay good money for someone to actively collude with your defenses? You pay your therapist to say the things that your friends won't. However, re-traumatisation happens when the therapist does this unconsciously rather than using the process consciously and empathically.

It is not my place to probe into your experience here. Suffice to say that our experiences in therapy often mirror our experiences in life, and can be very healing if we have the courage to explore them.

Reading the Signs said...

I also wish I had had a therapist that practised what you speak about. My experience is that it's hard for many therapists to bear the idea that there may be no solution. This is where CBT, which is completely results-orientated, is going to fail those who are more than anything else in need of someone who is prepared to be alongside.
Why is there a sense that this is so rare, especially now? Old-school therapists may have got other things wrong, but I think they had more time, were less strung out. The therapists I know (well, two of them) are, like so many others, trying to pack too much into their lives, feeling that they are failing their clients, their families, themselves, constantly trying to meet some kind of target. Another therapist I know seems to send everyone away with a clutch of affirmations and begins the day with a formidable Gratitude list.
If I ever feel moved to look for a therapist again I will have a badge made that says "Just Walk With Me".

Anonymous said...

Add up all the coping mechanisms that people use:- Alcohol, cigarettes, anti-depressants, sleeping tablets, beta-blockers, food supplements, alternative therapies, pampering weekends, religious fundamentalism, chocolate, comfort eating, dieting, life-styling, life-coaching, personal trainers, retail-therapy, road-rage, violence, verbal abuse, soft-drugs, hard-drugs, solvent abuse, therapy.

It must mean something?

Anonymous said...

Stray - "Many apparently destructive behaviours like cutting are a desperate attempt at communication. Often with other parts of our selves as much as others."

You're so right - We so much want and need to understand ourselves, to understand others, and to have them understand us - to make sense of a world that at times is beyond understanding.
And all we have to do it, is language, with all its imprecision and inadequacies.
Empathy then seems a far more important ability than the understanding of neural pathways and hormonal imbalances - A recognition that we are all different, and yet all the same.

Anonymous said...

Thanks Miss M and Stray for showing us the healing potential of empathy. The other thing that really struck me is how difficult the process is for one individual to truly develop empathy for another. The self reflexiveness required for empathy is not really something many of us

Anonymous said...

... understand or just do naturally.

(sorry, not sure why it was cut off).

PatientGuard said...

Grief's Royality :


I suppose in blood
I'd put it like this
Don't tell me to shut up
For what I missed

Don't tell me how mom or dad
And other mistakes should never
Bleed out of my arm or wrist

Get in the boat in my heart

Lets travel my history veins
Secure the compass of squeal
And Real

You just help me , cry
My terrible pains..

How about the tear-sail
With the large eye ?

Let it wind-razor and rip
And the half of me
Dumbed and numbed
Coded to fail

Just help me therapist

Dilute the blood
Let it clear in my eyes
Of grey and shale

Help me for years to let it drip ..


...



As far as I am concerned there is a major taboo against showing "develpomental griefs" because in essence when released they are critical of family ands social "care"s ytems which bury the individual's pain and unmet needs ..

You are lucky if you ever develop the language (and emotional repretoire) for this given the state of health services in the UK

The UK mental health systems are emotional burial systems and the uncomfortable corpse of social lies and denial haunts..Boy does it haunt on the groups I am on - !

Monozygote said...

Wo Ms Mel. Good answer. And thank you for it.

I'm not trying to attack bad therapists, but I do attack the idea that for a therapist to walk in a client's shoes without acting out their own stuff is anything more than a blindingly obvious, bare minimum requirement, therapeutically prior to any transferential benefits that may be possible.

It's not amazingly clever at all, I wouldn't say. It might take some effort to actually do, and I'd applaud that, but therapists do get paid, on the whole.

Also I do not like that when a gazillion clients ask their therapist for empathy, well, they've obviously had a bad experience (doh! why else would they be in therapy...), yet when a therapist suggests it's a good thing and it works, then suddenly it becomes a really amazing clever idea. D'you see where I'm coming from?

Also, if I may add, the notion of a therapist's empathy is totally orthogonal to the question of whether they agree with the client all or any or some of the time. Or not. That's a totally separate issue, to my mind, and I don't think it's helpful to muddle them up.

Monozygote said...

One doesn't need to negate one's own viewpoint or feelings, or wisdom in order to have empathy.

Believing that one does leads to a defensive avoidance of empathy, which I think is re-traumatising. I can understand it, but it's damaging. And therapists shouldn't damage people really, I don't think. That's all
:-)

Ms Melancholy said...

Hey Signs, you say

My experience is that it's hard for many therapists to bear the idea that there may be no solution.

I agree, by the way. I think we are hooking up into the 'life coaching/cbt' culture, where everyone wants an answer, wants it snappy, and doesn't want to really explore their interior life and tolerate the fact that maybe life is just pretty hard sometimes. The process is stressy for therapist and client. I am becoming more and more intolerant of CBT for exactly this reason. Lovely pics of the isles, by the way.

Hi there Paul, sometimes people come to therapy saying that they just want to get to know themselves a bit better. My heart soars, and I know we are in for a stimulating and interesting exploration. I honestly think that is all that we can do.

Ah Bindi, the self reflective capacity is precisely what therapists strive to develop, and what sometimes eludes us however much we invest. You are right, that it doesn't necessarily come naturally or easily to us.

Wow Patientguard, I think as a culture we cannot deal with it, and I think this is why our mental health services are so impoverished. I feel sad about this, because I know that there are many, many good people working in mental health and this is not what they would wish for.

Hey Dandelion, you say

but I do attack the idea that for a therapist to walk in a client's shoes without acting out their own stuff is anything more than a blindingly obvious, bare minimum requirement,

I really do agree with you here. This is why I am so despairing of the prevalence of CBT and cognitive psychology generally: firstly, CBT places no value whatsoever on the importance of empathy as a requirement for successful therapy; secondly, CBT practitioners are not required to pay any attention whatsoever to the process of the relationship or reflect on their own practice with regard to the relational dynamic. This makes it far more likely that they will unconsciously act stuff out, and be unable to repair the rupture when it happens.

Hey, do you think it's possible we are starting to agree here??!

trousers said...

Some good, thought provoking stuff here. Excellent thread.

Ms Melancholy said...

Hey Trousers, yes, thanks for your contributions. I think it is truly wonderful that we have this arena (blogging) for these kind of discussions. I just wish I had more time to really get round all of the blogs that inspire me.

PatientGuard said...

Today was a good day to savage NIMHE's ankles in my blog article and connect it up to "superficial" therapy EBT approaches with the help of my my friend and Service User co-alligator who is developing some stuff about Govt thrusts to "modernise" services for learning disability folk (see his lethal no screwing around blog at :

http://justice4sabtworkers.blogspot.com/ )

I even managed to bite CSIP and few Mental Health charities who are rapidly turning themselvesw into super businesses and funding-wolves hanging around we Service Users cattle ..

Beware some of us User-cattle have fitted chromium canines - we too are modernsiing ...

Growwwwwlllllll .. Mooooo ..


Warm regards to everyone ...

.

anticant said...

I find this post, and many of the comments, deeply troubling for several reasons.

First, that so many people seem to have had bad experiences with insensitive therapists. I don't want to 'attack' the latter, but I do deplore them. I wonder who they are, and how they managed to slip through the training net? Also, what kind of supervisors they have? A counsellor who wasn't aware that empathy is one of the prime requirements of the trade wouldn't have been allowed to qualify in the 1980s, when I did my training.

I was struck by the remark that "there are things your therapist says to you that stay with you forever". That is true, and it is the measure of the responsibility which therapists bear to their clients.

As to self-damaging behaviour, my belief is that everything we do is with the aim of making us more comfortable - to feel better, at least in the short term. Just as we all do things "for the best" as we conceive it, even though we may be grievously mistaken, so we follow faulty behaviour patterns which are in fact self-destructive because we have learned them as the "best" coping mechanism at some point in our lives, and don't know anything better. It is the therapist's task to help us identify, and to start practising, better solutions.

Sorry if these reflections seem inadequate - it would take a long essay to do justice to your moving and insightful post, Ms. M.

Anonymous said...

I am currently having CBT with a CPN, I seem to be the first person she has tested her skills on... I am not enjoying it, we seem to be concentrating on one thing every two weeks going round in circles and I am finidng that we are dragging a lot of stuff up that I don't wish to talk about at the appointments.

Dark Side said...

CBT worries me, mainly because of the small amount of training some of them are given, I am led to believe they can become a therapist after a 16 weeks course or something of similiar ilk...it scares me that the NHS thinks this is an answer to the every expanding mental health problems we seem to suffering from.

I have been with my therapist for since February and seen her weekly since then, I find it hard to believe that someone who has not had all the relevant training of walking in their shoes to coin you phrase, has very little insight to what people are suffering from.

Sorry for the long sentence but I think I know what I mean.

I just don't think CBT is right for everyone and by offering it in the way that they are it could affect the "real" therapists in the long run, i.e picking up the pieces.

I firmly believe that my therapist couldn't have helped me like she did if she hadn't aired all her own demons first...xx

Excellent post by the way!!

Dark Side said...

Please accept my apologies for not previewing that post, I have just read it back and the grammar and spelling are atrocious...xx

Monozygote said...

Hey, do you think it's possible we are starting to agree here??!

You sound surprised...?! I think we kind of do agree, but I also sort of think that CBT makes no claims to offer empathy, whereas other things certainly seem to. And others still (psychodynamic approach for eg) can lead to the implicit expectation of empathy, when in fact that is unrealistic, and thence to disappointment and distress.

Forgot to say before that I thought Stray's comment was wicked, and also, Emma, don't you mean "atroshus"?

PatientGuard said...

Meanwhile back in the satire razor zone, a Flash movie was posted onto my Blog by a bloody cheeky contributor User-shark to do justice to the rotating prize winning "Distractor" .....

It does work if you tweak the bottom left corner ..

I am going to do a report later over on Nowpublic.com (US) where I "report" for my part of the UK about MH services .

Stray the brill and Ms Melan will be linked to for sure .. We are positive insight-umbilicals. We will be born again ..Kind of...Tripleting over our wisdoms ...

You know, we Users are not polite to the Services who do little good for some of our broken tribes and we know many who are just dead ...

FST

Final Solution Therapy ..

Today I was in thick of it showing off my film (and cheeking people) about narrative mental health "Lifebooking". I was amongst other Users and a few staff ... I love other Users - they are teddies with a straight tongue sometimes ..

One staff who de-forked HER tongue (and had a very wide knowledge) admitted there is hardly any therapy for people (locally) who have just come out of core crisis and who are discharged back to the GP's care .

Hell ....There is not even Elastic Band Therapy for them

But abandonment void therapy AVT is what they are offered .. It has a bad service delivery record though

Yeah.....Like Zero ....

Its a paradox because the more you get of it the sicker you get ..And you move towards crisis again ..

No-one can hear your heart in a void ....

I need a good bark at the moment and the garden fence looks good to bite ...

See you all later ...

Boris said...

Thanks for that. Very informative.

By the way, does nail biting REALLY count as self harm?


B

anticant said...

Ask Gordon Brown.

Ms Melancholy said...

Hey anticant, I share your concerns about empathy - or lack of it - as a core requirement of our practice. I wonder if the current fad for solution focused therapy, CBT, brief therapy etc has caused us to lose our focus on the quality of the relationship and the value of having another really see where we are at. I blame capitalism. (That last bit was only a half joke, by the way.)

Hey alison, thanks for taking the time to comment. I don't feel it's my place to comment on the therapy that you are having. However, I would tell any client that it is helpful for them to take ownership of the process, and that might mean sharing your concerns about therapeutic direction. And of course, it might be a good thing to talk about the things that you don't want to talk about! Hope you find the courage to do whatever you need to do.

Hi emma, you say

I firmly believe that my therapist couldn't have helped me like she did if she hadn't aired all her own demons first

I happen to agree with you. We go with people to difficult places, because it doesn't frighten us to be there. It doesn't frighten us, because we have been there for ourselves. It is easy sometimes to use cognitive techniques as a way of avoiding the pain of the difficult places. Which ultimately is self defeating. Thanks for your comments.

PS You don't get marks deducted for bad spelling or grammar here!

Hey Dandelion, well, maybe just a tiny bit suprised! Don't you think it's so much more fun when we disagree?!

Hey PatientGuard, thanks for the stream of consciousness. You always make me smile x

Hi lovely Boris, only if you swallow the nail, I think x

anticant ;) xxx

Spilling Ink said...

I have had this problem. It has been a while since I have felt the need to do it. I have never talked about it on my own blog because I know people do not understand and they would just be shocked and horrified. I have always had the pain and problems that have caused me to need to do it and I have tried every self-help, different CBT type therapies, positive thinking, busyness (ended up as OCD) and nothing could ever fix the mess that I carried with me. I finally have a REAL therapist and things seem like they are finally (after 22 months) starting to change. Maybe I have a chance after all. There are some problems caused by hateful and selfish parents that 8, 10, or 12 weeks of "just stop thinking and behaving that way" cannot do anything about.

Anonymous said...

Hello !.
You re, I guess , perhaps curious to know how one can make real money .
There is no need to invest much at first. You may commense to get income with as small sum of money as 20-100 dollars.

AimTrust is what you haven`t ever dreamt of such a chance to become rich
The company incorporates an offshore structure with advanced asset management technologies in production and delivery of pipes for oil and gas.

Its head office is in Panama with affiliates around the world.
Do you want to become a happy investor?
That`s your chance That`s what you wish in the long run!

I`m happy and lucky, I started to get real money with the help of this company,
and I invite you to do the same. It`s all about how to choose a correct partner utilizes your funds in a right way - that`s AimTrust!.
I make 2G daily, and my first deposit was 1 grand only!
It`s easy to join , just click this link http://oguqamiri.100megsfree5.com/ohujysa.html
and lucky you`re! Let`s take our chance together to get rid of nastiness of the life

Anonymous said...

Hello !.
might , probably curious to know how one can reach 2000 per day of income .
There is no need to invest much at first. You may commense to get income with as small sum of money as 20-100 dollars.

AimTrust is what you haven`t ever dreamt of such a chance to become rich
The company represents an offshore structure with advanced asset management technologies in production and delivery of pipes for oil and gas.

Its head office is in Panama with affiliates around the world.
Do you want to become an affluent person?
That`s your choice That`s what you really need!

I`m happy and lucky, I began to take up real money with the help of this company,
and I invite you to do the same. It`s all about how to select a proper companion utilizes your money in a right way - that`s the AimTrust!.
I make 2G daily, and my first investment was 500 dollars only!
It`s easy to start , just click this link http://suwitedu.lookseekpages.com/jodymab.html
and lucky you`re! Let`s take this option together to feel the smell of real money

Anonymous said...

Hello !.
You may , perhaps curious to know how one can reach 2000 per day of income .
There is no need to invest much at first. You may commense earning with as small sum of money as 20-100 dollars.

AimTrust is what you need
AimTrust represents an offshore structure with advanced asset management technologies in production and delivery of pipes for oil and gas.

It is based in Panama with affiliates around the world.
Do you want to become a happy investor?
That`s your choice That`s what you wish in the long run!

I`m happy and lucky, I started to take up real money with the help of this company,
and I invite you to do the same. It`s all about how to choose a correct partner utilizes your money in a right way - that`s it!.
I take now up to 2G every day, and what I started with was a funny sum of 500 bucks!
It`s easy to join , just click this link http://pekudyfag.angelcities.com/biquny.html
and go! Let`s take our chance together to become rich

Anonymous said...

Hi there!
I would like to burn a theme at here. There is such a nicey, called HYIP, or High Yield Investment Program. It reminds of financial piramyde, but in rare cases one may happen to meet a company that really pays up to 2% daily not on invested money, but from real profits.

For quite a long time, I earn money with the help of these programs.
I don't have problems with money now, but there are heights that must be conquered . I get now up to 2G a day , and my first investment was 500 dollars only.
Right now, I managed to catch a guaranteed variant to make a sharp rise . Turn to my blog to get additional info.

[url=http://theblogmoney.com] Online investment blog[/url]

Anonymous said...

Good day, sun shines!
There have were times of hardship when I didn't know about opportunities of getting high yields on investments. I was a dump and downright stupid person.
I have never thought that there weren't any need in large starting capital.
Nowadays, I'm happy and lucky , I begin take up real income.
It's all about how to select a proper companion who uses your money in a right way - that is incorporate it in real deals, parts and divides the income with me.

You may ask, if there are such firms? I have to tell the truth, YES, there are. Please be informed of one of them:
http://theinvestblog.com [url=http://theinvestblog.com]Online Investment Blog[/url]

Anonymous said...

Glad to materialize here. Good day or night everybody!

Let me introduce myself,
my name is Peter.
Generally I’m a venturesome gambler. all my life I’m carried away by online-casino and poker.
Not long time ago I started my own blog, where I describe my virtual adventures.
Probably, it will be interesting for you to find out about my progress.
Please visit my web site. http://allbestcasino.com I’ll be interested on your opinion..

Anonymous said...

Sorry for my bad english. Thank you so much for your good post. Your post helped me in my college assignment, If you can provide me more details please email me.

Harley Street Psychotherapist said...

So informative, i believe many people find there ways from this article.

submit said...

wehfjkfdjg;ljds;rlgjs

Tourism Authority of Thailand Medical Travel and Information said...

Simply stunning! I've never really tried to make tags before. Yours are absolutely amazing!

cheap flights to lagos from London said...

Well thanks to you so much for such nice and fit ideas, as I was so much worried for my fats, I am gaining weight day by day, all because I do not use to do exercise or something else, but now I will must do these...

India Florist said...

Nope. You can't be held responsible.

thrillpier said...

Write down anything that your reader's might like to hear,
and they will be impressed with your work.
übersetzung Deutsch EnglischExtended Auto Warranty

Hals said...

How much experience do you have? (It is advisable to check the qualifications of the surgeon that you have chosen, before going and talking to him personally.)
How many such surgeries have you performed? What is your success rate?
bilutleiesilver charms for charm bracelets

Hals said...

What are the risks associated with this surgery?
What are the side effects of the surgery and how long do they last?
Free Vectorsit business support

Hals said...

If you are satisfied with all the answers, and decide to proceed with the surgery, then good luck to you. Have a speedy recovery.
Richmond Hill Real EstateBroker Properti

Hals said...

• Prevents blood clots
• Reduces cholesterol
• Acts as an antioxidant
cheap hotel in dublinAustralia Shoes

Hals said...

Pimples on tongue is not a very serious health problem but it can cause a lot of uneasiness for the person suffering from it. Read this article to enhance your knowledge about its causes and treatment.
ForumLinkBuilding.com scamsalles de mariage

Hals said...

Get up and get going, it's a new year, and definitely a new day to get into shape and flaunt a well-maintained figure. The workouts mentioned here, will help you develop a dynamite figure and aid you outperform in your daily activities.
cacaobean bag chair

Hals said...

♦ Side Stretch: Raise your hands above your head, with figures pointing straight up, or fold hands above the head and bend sideways. You can even try the side arm swing, with swift side pushes. It works best to enhance your side profile.
Forum Link Building servicepayday advance loans

Hals said...

♦ Lower Body Raise: Lie flat on the floor, rest your arms by your side, lift your lower body up balancing your weight on your shoulders, arms and neck. Hold position for a few minutes before returning to flat position.
Sprachkurs Englischpure acai berry max

Hals said...

♦ Leg Lift with Exercise Ball: You need to lie flat on your back and grip the exercising ball in between your legs, raise your feet at an angle and try lifting your upper body off the ground. If you are an amateur, you can skip the latter half of the exercise and raise only your feet.
wool rugsOR tables

Hals said...

Baby colic is very stressful for both the baby and the new parents. Sometimes, parents end up blaming themselves as they do not know the actual triggers behind it. This article will help you understand what causes colic in babies.
generadores electricosreplica breitling bentley

Hals said...

This article on mosaic down syndrome will help you get a better understanding on this health condition! Read on to know about how mosaic down syndrome develops and what does it mean for a child.
Buy PrimobolanExtended Warranty

Hals said...

What is Down Syndrome
Have you ever seen someone with a flatter face than normal, and eyes that are slanted. In general someone who looks and responds differently as compared to a normal person. Chances are this person is suffering from Down syndrome.
VW Ignition CoilGet Well Cookies

Hals said...

Children born with Down syndrome develop more slowly (mentally and physically) than normal children. They may suffer from digestive problems, they get infected more easily; mostly lung infection affecting proper breathing, constipation, eye and ear infections, and in rare cases leukemia
cake topperdatingsites

Hals said...

Someone who does not have Down syndrome at birth can't get it for life. It is not contagious and can't be spread by any means.
fiction writingbackup active directory

Hals said...

Due to their unusual looks and behavior many think that those with Down syndrome are mentally retarded. Those suffering from Down syndrome are not mentally retarded. The following two points prove this.
climber com ratingsAudi AC Compressor

Hals said...

Coping with Down Syndrome Children
Parents who hear that their child is born with Down syndrome usually break down. What comes to their mind instantly is a child that is not normal, and will continue to grow up abnormally life long. With this the extra care that will be constantly required.
discount ink cartridgeengagement rings

Hals said...

Down syndrome is a chromosomal disorder that results in the impairment of physical and cognitive abilities in human beings. It is caused by the presence of an extra 21st chromosome.
flavored olive oilnail art

Hals said...

The American Cancer Society advises that even people who follow a balanced diet and lead a healthy lifestyle should go for regular cancer screenings. Early detection is probably the best weapon we have against cancer. Help spread the awareness and make this world 'Cancer Free'.
Seaside Fl real estateVA Home Loan

Hals said...

Fats: Let us deal with the much feared fat content first. A cup of simple fried rice has 12.34 g of fat. No no. Do not start with your impromptu jogging yet, as only 2.25 g out of this comprise fattening saturated fat. The rest is 3.77g of monounsaturated and 5.34 g of polyunsaturated fat. These fats are the good types which are required by the body for various purposes to keep a person hale and hearty. So, chill!
Free Mobile DownloadIs phen375 Safe?

Hals said...

So, how many calories in simple fried rice? 333 in a cupful. 113 comes from fats, 170 from carbohydrates and 50 from proteins. As is noticeable, 51% of the calories are donated by carbohydrates and that has to be paid heed to by those on a low-carb diet. The following table will give you the calorie break up of the other varieties fried rice which are quite popular.
maldives holidaysHRT Men

Hals said...

103 mg of cholesterol is found in one cup of fried rice. I know that it is the general tendency to link cholesterol and 'bad for health' immediately. But, how many of us know that the body actually requires the steroid metabolite called cholesterol for several biochemical processes in the body. Given that the DV of cholesterol is 300 mg/day, you will get ⅓rd of it in just a cup of fried rice.
Laptop Jack RepairLos Angeles Dentist treating Snoring

Hals said...

Everyone of us, some or the other time, experience lack of concentration while doing some important work. What to do during such situations? Well, I have an answer. Yoga is the best way to improve concentration. Let us explore various yoga techniques that can help in improving concentration.
günstiger security shop versandgrow hair naturally

thrillpier said...

Or, to put it another way, where
investors would think twice before entrusting their assets with a Panamanian
offshore bearer share company.
Currys Promotional CodeCar Insurance Quotes Online

thrillpier said...

Factoring is provided by financial institutions, for example banks and individual factoring brokers. It is a
form of asset-based financing, where the factor provides funding based upon the values of a borrower’s
accounts receivable, i.e. corporate debtors.
wall gun safePersonal Life Insurance

Hals said...

Diagrams! They remind me of school textbooks which used to have plenty of them, providing a visual aid to understanding difficult subjects. This article explains the nervous system function and structure with the help of a human nervous system diagram and gives you that erstwhile 'textbook feel'. Read on...
doormats with sayingsprom dresses

Hals said...

Fibrous carbs are a component of complex carbs, just like minerals and vitamins in any other foods.
Learn Spanish and discover Ecuador - Flying teaching programelectronic cigarette

Hals said...

Possible Causes
Excess buildup of fluid around the human heart is not age and/or gender specific. Following are the health conditions that can lead to fluid around the heart.
clawfoot shower faucetEducational Games

Hals said...

X-ray: A chest X-ray is the first test that helps in identifying this problem. An enlarged outline of the heart is observed if it is surrounded by fluid.
cool teen jewelryporcelain marker boards

Hals said...

These include non-steroidal anti-inflammatory drugs (NSAIDs) like indomethacin or ibuprofen, steroids, diuretics, other heart failure medications, and /or infection fighting antibiotics.
Music Instoremake a website

Hals said...

Ultrasound-guided pericardiocentesis: Commonly performed, this is a safe and effective medical procedure used to remove or drain excess fluid from the pericardium.
free text messagestardbroke island accommodation

Hals said...

The different parts of the human ear that help in balancing are the semicircular canals consisting of the utricle and the saccule present in the inner ear.
clases particulares barcelonaturbo fire

Kamen said...

Do not scorn the person who is perpetually happy. He does know something you don't.
_________________
online texting

3 Mobile Voucher Codes

Kamen said...

Be good and you will be lonesome.


Everything human is pathetic. The secret source of humor itself is not joy but sorrow.
____________________
wholesale formal dresses

Transfer Factor Trifactor

Uno said...

still exists or not he is not sure but heart felt as if relieved the burden on the shoulders of thousands of weight loss tan lazy. Perhaps he has learned to forgive.
Alcohol Addiction Treatment
guitar chords

Uno said...

"I do not want to see the dead ..." Yunho slowly collapsed, bleeding profusely from the corners of the mouth "But the face of Kim JaeJoong Gloo are nothing, because you will never get his heart ... . "
apartment hotels in edinburgh
Rehab Pennsylvania

Kamen said...

Attack life, it's going to kill you anyway.

The happiness of the bee and the dolphin is to exist. For man it is to
know that and to wonder at it.
_________________
Escort Storkøbenhavn

electric bicycle kit

Uno said...

The final image is determined Yunho saw her dive down toward the sea floor, bring a pair of red-tinged sparkling ring he barely gave him. Soul throughout the formless waters soundless, dully
Rent List
iphone accessories

Uno said...

Yunnie-cat he is a special cat. Is not to implement the requirements of him as a dog-not because it does not understand, but do not want to show that she knew too much. But it's well-Yunho him, loved him, the way love, now, very similar.
IT Support UK
cannabis vaporizers

Uno said...

Do not harshly so, sister. - Shiru walked up to her - I know you are not satisfied that he made ​​pioneering general commanding the battle with National Express this time. But you should know he is a prince and a prince's duty is to protect their people.
tablet android
Rechtsanwalt Siegen

Kamen said...

The nature of life is to change.
The challenge of life is to overcome.
_______________
ansi flanges

marbella property

Uno said...

Very good-The women let the light sentences as non-response next princess to learn the genealogy of the Uchiha clan in five hundred years along with the names and positions of fifty senior courtiers in the imperial home.
hotels in mount abu
catering brisbane

Uno said...

The other strange white smooth hand to pull the shirt slender boss, revealing a beautiful baby girl face with deep brown eyes, high nose and curved eyebrows. Her hair tied into a long braid and advice and
groupon south africa
Maintenance skills training

Kamen said...

Life is short. Live it up.


Joy is not in things, it is in us.
________________
chauffeured cars sydney

carbonfolie aanbrengen

Kamen said...

He is happiest who hath power to gather wisdom from a flower.
______________________
silver and gold charms

Phen375

Kamen said...

What does not destroy me, makes me stronger.
_____________________
Boston Website Hosting

jobs

Kamen said...

All animals except man know that the ultimate of life is to enjoy it.

Life is not lost by dying; life is lost minute by minute, day by dragging
_________________________-
Proactol Plus

personal concierge brisbane

Kamen said...

Decay is inherent in all compounded things.Strive on with diligence ( Budha)
____________________
Igrice

balers

Kamen said...

Thoughts are the gun, words are the bullets, deeds are the target,
the bulls-eye is heaven.
__________________________
como ganhar dinheiro na internet

Fort Collins Spinal Decompression

Kamen said...

Don't underestimate the value of doing nothing, of just going along, listening to
all the things you can't hear, and not bothering.
________________________________
negle tipper

denver dental group

Uno said...

free soul under the provision that takes away the music that made people wary of the Hyuga. English make this board knows what dangerous!
rolex replica submariner
Window replacement

Uno said...

On no rain but clouds still dancing spell. Green forests and lonely solitude, quiet and dreamy. Dew still remain on the foliage causing dampness of the air increasing more. Spider silk spun over the line
Boots Sale
House of Fraser Discount Codes

Uno said...

Hayate suddenly worried when strange observation tower standing on landscape. Feeling insecure and yet would make him hard to describe the vague thoughts. It seems that something very
bareboat charter balearic islands
free sms

Uno said...

Sakura put a hand to mouth, smiled and whispered softly afraid to have plenty of confidence in her future husband. Although not what he loves but she is not out of insecurity. Perhaps, she is gradually
Kia Cooling Fan
Automotive Service Equipment

Kamen said...

Ultimately, man should not ask what the meaning of life is, but rather
recognize that it is he who is asked.
__________________________
smafolk sale

psicologos forenses y clinicos las rozas

Kamen said...

And see the rainbow, not the falling rain
If you can lose and never give up trying
_______________________
psicologos aravaca

wholesale designer handbags

Uno said...

right of soldiers he led during the war in Nakkmi corps Shimoss . He did not care to know the people and treason because everything is in absolute secrecy, and when things broke out he was probably sitting warm on the other kingdom and the power
Credit Card Reviews
domain anmelden

Uno said...

Last season Wind shatters the harsh cold of the winter cold. Coated with a translucent dew on every leaf, every blade of grass. Crescent drainage exit is hidden behind thick clouds and the red roofs of the palace lonely night seemed endless.
.
keratin hair treatment
car rental lancaster pa

Negi said...

Thanks for great information you write it very clean. I am very lucky to get this tips from you


psychotherapist new york

Anonymous said...

I am not sure where you're getting your info, but good topic. I needs to spend some time learning more or understanding more. Thanks for great information I was looking for this information for my mission.

my website :: loss weight pills
My page :: weight loss pills reviews

Anonymous said...



Here is my blog - how to win the lottery

Anonymous said...

simply dropping by to say hello

Anonymous said...



Also visit my web-site ... cordyceps benefits

Anonymous said...

alprazolam without prescription xanax potentiators - xanax xr 2mg dose

Anonymous said...

I like the helpful info you provide in your articles.
I will bookmark your weblog and check again here frequently.
I'm quite certain I will learn plenty of new stuff right here! Good luck for the next!

Review my web-site ... proactol

Anonymous said...

Just wish to say your article is as astounding.
The clarity to your put up is just nice and that i could think you
are knowledgeable in this subject. Fine along with your permission
let me to clutch your RSS feed to keep updated with coming near near post.
Thanks 1,000,000 and please continue the gratifying work.


Look at my web blog proactol

Anonymous said...

I always emailed this weblog post page to all my contacts, because if like to read it after that
my links will too.

my blog: Stretch mark creams

Anonymous said...

I drop a comment each time I appreciate a article on a
blog or I have something to add to the discussion.

It's caused by the sincerness communicated in the article I read. And on this article "Anyone For EBT*....?". I was excited enough to drop a comment :-P I do have 2 questions for you if you don't mind.
Is it just me or do a few of the remarks come across as if they are left by brain dead people?

:-P And, if you are posting on additional online sites, I'd like to follow you. Would you make a list every one of all your community sites like your linkedin profile, Facebook page or twitter feed?

Here is my web site mfortune

Anonymous said...

google law firm

Anonymous said...

google law firm

Anonymous said...

Admiring the hаrԁ woгk you put into your
blog and dеtailed information you proνіde.
It's nice to come across a blog every once in a while that isn't the same unwantеԁ rehashed
material. Excellent reаd! I've bookmarked your site and I'm including yοur RSS feeԁs tо my
Googlе account.

Herе is my ωeblog: diamondlinks review

Anonymous said...

Greеtings! Very hеlpful adviсe in thіs
ρartісulаг article!
It's the little changes that make the most significant changes. Thanks a lot for sharing!

Feel free to surf to my blog ... reputation management

 Drug recovery houston texas said...

Thanks For this article. I appreciate, it was helpful

Biznes Joker said...

Succeed! It could be one of the most useful blogs we have ever come across on the subject. Excellent info! I’m also an expert in this topic so I can understand your effort very well. Thanks for the huge help what business to open

United Recovery Project said...

Great post full of useful tips! My site is fairly new and I am also having a hard time getting my readers to leave comments. Analytics shows they are coming to the site but I have a feeling “nobody wants to be first” Substance abuse treatment new york city new york

United Recovery Project said...

We are really grateful for your blog post. You will find a lot of approaches after visiting your post. I was exactly searching for. Thanks for such post and please keep it up. Great work. Saint Louis Missouri drug rehab

QQ Slot 4d said...

wow, great, I was wondering how to cure acne naturally. and found your site by google, learned a lot, now i’m a bit clear. I’ve bookmark your site and also add rss. keep us updated. QQ slot terpercaya

Anonymous said...

Great post full of useful tips! My site is fairly new and I am also having a hard time getting my readers to leave comments. Analytics shows they are coming to the site but I have a feeling “nobody wants to be first” Substance abuse treatment centers in fort  myers  florida

Growroom Canada said...

wow, great, I was wondering how to cure acne naturally. and found your site by google, learned a lot, now i’m a bit clear. I’ve bookmark your site and also add rss. keep us updated. Hydroponics Regina

Western Elevator said...

Your website is really cool and this is a great inspiring article. Thank you so much Elevator Company in Vancouver

Slot Online said...

Great post full of useful tips! My site is fairly new and I am also having a hard time getting my readers to leave comments. Analytics shows they are coming to the site but I have a feeling “nobody wants to be first”

United Recovery Project said...

I was surfing net and fortunately came across this site and found very interesting stuff here. Its really fun to read. I enjoyed a lot. Thanks for sharing this wonderful information. Drug Rehab boynton beach florida

Ever Lighten said...

Great post full of useful tips! My site is fairly new and I am also having a hard time getting my readers to leave comments. Analytics shows they are coming to the site but I have a feeling “nobody wants to be first” https://everlighten.com/

O'Flaherty Law of Des Moines said...

Very efficiently written information. It will be beneficial to anybody who utilizes it, including me. Keep up the good work. For sure i will check out more posts. This site seems to get a good amount of visitors. family lawyers

Heavy Armour Security said...

I was surfing the Internet for information and came across your blog. I am impressed by the information you have on this blog. It shows how well you understand this subject. best armed security services

DIN Flanges Manufacturer said...

Very nice & informative article