Over
the last ten years, our team of psychologists has specialized
in adults, professionals and their associated
disorders (anxiety, stress, phobias, agoraphobia, etc) including those produced by the phenomenon known as “social success”,
and perhaps, in this sense, you find that you are becoming more and more
limited.
Psychologists
offer effective methods that help you to deal with problems associated with both
your past or present lifestyle.
The therapies that identify and correct problems that have a major impact on or
influence human behaviour in general have experienced a series of significant
advances. For example, the handling of anxiety has effectively resolved phobias,
obsessions, and other associated disorders. The control of automatic thoughts or
irrational ideas is yet another major advance in depression, anxiety handling
personality disorder therapy,
etc.
Both
anxiety and thoughts are associated with the control of human behaviour. As a
therapeutic element, their control is considered as the nucleus of current
psychotherapy practice.
The terms psychologist and psychiatrist are often used as if they were
synonyms, leading to frequent misconceptions. Broadly speaking, a
psychologist is a health expert specialising in psychological disorders
that do not appear to be caused by alterations in the structure of the
nervous system. A psychiatrist, however, is a doctor specialising in
defects in the structure of the nervous system that result in
alterations in psychological functioning. However, in the latter case,
the psychologist can perform a role that complements psychiatric
treatment in that whereas the psychiatrist treats organic alterations of
the nervous system, the psychologist alleviates the psychological
disorders deriving from these alterations.
What is a psychologist?
A psychologist is a specialised
professional and a specialist, a scientist studying human behaviour and
thought. Psychologists work directly with people who, generally speaking,
are experiencing a difficult time in their lives or who are facing a
problem they are unable to resolve or deal with.
Psychologists are social scientists and/or professional health care
providers with training and expertise in the areas of human behavior and
psychological health.
As social scientists, psychologists have conducted extensive
research, over the past 100 years, to further our knowledge about human
behavior, human development, psychological problems, the measurement and
understanding of personality characteristics, and other important areas of
knowledge about how people think, feel and behave.
As health care professionals, psychologists apply what they have
learned about human behavior, human development, psychological problems,
the measurement and understanding of personality characteristics, and
other important areas of knowledge about how people think, feel and
behave, to help people resolve personal adjustment problems, overcome
emotional illness, and sek a better understanding of themselves. A
professional psychologist has broad knowledge about human behavior, and
understands how to apply that knowledge to help people change.
What is the difference between a psychologist and a psychiatrist?
Psychologists and psychiatrists both provide treatment to
individuals with emotional problems. Psychology is both a profession and
an independent scientific discipline. Psychiatry is a specialization
within the field of medicine.
There are many similarities in the treatment provided by
psychologists and psychiatrists, and there are also many differences.
Psychology is founded on the study of all human behavior, both
normal and abnormal. Psychiatry focuses on the treatmnt of emotional
illness.
Psychologists focus on the environmental and learning-based
causes for emotional problems. Psychiatrists see emotional problems as a
medical illness process, based on some abnormality or malfunctioning of
the human body.
Psychologists help people control and change their own behavior
as a primary method of treating problems. Psychiatrists prescribe
medication as a primary means of changing people’s behavior.
Both psychologists and psychiatrists assume that complex
emotional problems are more likely to be the result of both biological
and psychological causes.
What is involved in training a psychologist?
On average, psychologists complete approximately five to seven years
of graduate education and professional training, beyond a bachelor's
degree. In the United States, the practice of psychology is regulated by
law in all fifty states, plus Guam and the District of Columbia.
The minimal acceptable standard of training for a psychologist today
is a doctoral degree in psychology or a closely allied field.
Psychologists are "Doctors" but they are not physicians, and they do not
prescribe medication. The doctoral degree in psychology typically takes
four to five years of full time graduate study beyond a college degree.
The degree may be a Ph.D., a Psy.D. or an Ed.D., depending upon the
graduate training program.
The work of a psychologist is to help you solve your personal problems, to
help and enable to cope with them and to function better. A psychologist
receives years of training and education to assess, diagnose and treat
people for a number of various problems. They apply their knowledge and
skills of human personality, mental processes, emotions and behaviors to
assist people in making healthy and positive changes in their life. They
help people recognize and change their behavior and emotional patterns as
well as their coping skills and styles, we all cope with things in
different ways. While many people see a psychologist on a one-to-one
basis, sometimes people see a psychologist in a group setting. For
instance, a couple (married or not), an entire family or a few, a school
class, company or department etc. may seek help as a group. When you or
anyone sees a psychologist, the psychologist will want to learn as much as
they can about you and the problems in your life. The more they understand
you and your problems, the better they can go about helping you. A session
with a psychologist can vary in length and some psychological testing may
be done. There is no easy answer as to how treatment will take as each
person and case is so different and unique. To discuss length of treatment
or get an approximate time length, it is best to speak with a
psychologist.
How can a psychologist help
me?
A psychologist uses evaluation,
diagnosis and treatment tools as a means of understanding the
problems encountered by patients and even helping patients
understand themselves. Psychologists, however, not only explain a
certain situation or behaviour, but also attempt to foresee and
modify behaviour in order to improve their patients’ lives.
Their work can be compared to that
of a coach in that they provide help at critical and decisive
junctures and also make resources and strategies available which,
once they have been taken on board, can be used by patients in the
future to prevent potential problems and make them feel stronger as
they go about their everyday lives.
The process begins with an assessment that allows the
psychologist to make a diagnosis and understand the factors causing
the problem. This information is then used to draw up a treatment
plan designed to help patients modify their behaviour.
A psychologist can assist patients in various ways. Individually
they can help them improve their quality of life by employing
various strategies: increasing the patient’s motivation to make a
change; encouraging behaviour and skills that may be beneficial;
reducing the frequency of or eradicating problematic behaviour;
controlling unpleasant feelings and thoughts; and modifying factors
in the patient’s environment contributing to the aforementioned
problems.
Psychologists also provide treatment focusing on human relationships
such as sexual therapy; couples therapy; family therapy, counselling
and mediation; and interpersonal therapy.
Psychological services can be viewed
as one important part of a complete health care plan. Despite
stereotypes that only "mentally ill" people require a psychologist's
help, in fact, one in six Canadians will experience a psychological
problem during their lifetime.
Psychological problems can be significant mood changes, such as
depression or anxiety, phobias, chronic stress, and difficulty adjusting
to significant life changes such as divorce, job loss, aging, death of a
loved one, or an illness. Difficulties in relationships with other
people such as a spouse, parent, child, or co-worker are often remedied
by psychological services.
Psychologists also support families and assist children dealing with
a variety of developmental issues including learning problems, emotional
difficulties, hyperactivity, conflicts with family, problems with peers
and coping with illness.
Individuals who have grown up in dysfunctional families, have been
sexually abused, or lived with and abusive or alcoholic partner often
benefit from psychological intervention.
Psychological problems may also be manifest in specific behaviours,
such as difficulty controlling anger, sexual dysfunction, substance
abuse, etc.
Psychological interventions can help persons having difficulties
coping with health problems including head injury, stroke, pain,
headache and chronic illness.
Not all persons consulting a psychologist have clinical problems.
Career/vocational assessments, preventative consultations, performance
enhancements and personal development are among the non-pathological
issues addressed by some psychologists.
Even organizations and corporations can
When should you go to see a psychologist?
People do not
necessarily go to a psychologist because they have a serious illness or
because they are “mad”. Like most people psychology patients lead
perfectly normally lives, but have problems and/or concerns connected to
their personal relationships, losses they have experienced or anxieties
and fears, for example.
Psychologists have
studied all these aspects, identifying their implications and finding
practical solutions to them.
There is a clear
criterion, however, that tells us when psychological treatment is
necessary, namely when people suffer psychological discomfort that
interferes with the social, work-related and emotional aspects of their
life.
In making the decision
to proceed with treatment or not psychologists follow a series of steps:
· Assessment
of whether the behaviour is normal, if it is to be expected at that
particular stage of the person’s life or if it results from the specific
situation they are experiencing.
· Monitoring
of the duration and the frequency of the behaviour. Normal behaviour
(e.g. crying, going out, etc.) begins to be worrying when it continues
for too long or occurs too often. In contrast, it may be the case that
positive behaviour (helping or meeting other people for example) does
not occur often enough or for long enough.
· Analysis of
the discomfort caused to the people suffering from the problem, the
extent to which it interferes with their everyday life and the problems
it causes for the people surrounding them.
· Gauging of
whether the problem is limiting the individual’s opportunities for
self-fulfilment and their chances of leading a fuller life.
If you are in doubt
and are unsure whether you have a problem or not, you should always
consult a professional.
benefit from psychological
services. In industry, psychologists help companies with their human
resource and productivity concerns.
Although it is now
common practice to seek the services of a psychologist, there are still
many people who do not know what a psychologist exists for or what kind
of treatment they provide. There are also people who are unsure when or
in what circumstances they ought to go. As a result of these and other
misconceptions many people fail to benefit from techniques and methods
that would help them restore or increase their physical, mental and
social well-being, in other words, their health.
If you suffer any of
the symptoms listed below, you ought to consult a psychologist:
Feelings of sadness, emptiness and
depression.
The frequent desire to cry and feelings
of hopelessness and dejection.
Loss of interest in or the desire for
pleasure and enjoyment.
Feelings of worthlessness and an
inability to fulfil a useful role in life.
Tiredness and apathy
Frequent headaches for no apparent reason.
Sleeplessness.
Breathlessness, dizziness, irritability,
excessive sweating, nausea or abdominal pain, trembling, etc.
Nervousness, tension, boredom, insecurity.
Inability to think clearly or concentrate.
Memory loss.
Inability to take decisions or to focus on
your work properly.
Fear of death, losing control or going
insane.
Muddled or unusual thought patterns.
Family or relationship problems. Difficult
relationships with your children.
Agoraphobia is an
anxiety disorder sometimes associated with panic attacks. It is
characterised by an uncontrollable anxiety that arises in certain
situations, generally in public places, in which the sufferer attempts
to reduce their discomfort by avoiding the situation.
Basic treatment
In short, the
cognitive-behavioural treatment of agoraphobia involves giving patients
the skills they need to be able to cope with controlled gradual exposure
to situations they are fearful of.
Whenever related panic
attacks occur the disorder must be treated first of all to ensure that
exposure to such situations is appropriate. In such cases, exposure to
interoceptive stimuli (to the actual feelings of fear) using physical
techniques is highly effective.One of the
difficulties the psychologist has to overcome in carrying out treatment
is that the theory behind the therapy contradicts apparent logic.
Sufferers may think they ought to avoid suffering at all costs, but the
treatment, based on scientific logic, holds that only by facing what
they fear, including the very sensations of fear itself, can the
sufferer overcome the problem. As part of cognitive-behavioural
treatment, acceptance and commitment therapy establishes a framework by
which patients understand the need to face their fear so they can
continue living in accordance with the objectives and values that give
meaning to their lives, instead of focusing entirely on avoiding
anxiety, something that prevents them from leaving the safety of their
own home.
The results of
treatment and related problems
Cognitive-behavioural
therapy is effective for between 65 and 75% of patients completing the
treatment although a further 10 to 15% of people either give up or
reject it. It has, however, proved more effective than other therapies
such as medication.
The treatment involves
presenting two types of problems that can be solved and which help
improve its effectiveness. One of the problems patients face is their
fear of fear, an inherent factor in panic attacks, but which is in some
way common to all agoraphobias. Other problems concern the difficulty
patients have in continuing with the gradual exposure agreed on even
though they know and believe this to be the solution to the problem,
having already made some progress. Additional techniques are therefore
added to the treatment when necessary.
Additional
techniques
The fear of fear: exposure to interoceptive stimuli.
The training patients
receive in acquiring techniques to cope with anxiety and which enable
gradual and effective exposure includes physical techniques that teach
them how to deal with the proprioceptive stimuli associated with
anxiety.
It is now believed that training patients to control their breathing can
help them greatly during exposure to situations.
Clinical experience shows that training in physical techniques, not
just in breathing correctly, can play a significant and effective role
in any treatment. In fact, patients with agoraphobia are very concerned
with physical symptoms and in general with anything that may occur in
their body. As a result, they continually look for signs of problems
that may cause them to lose control or even die. In gaining greater
control of their reactions and learning alternative ways of reacting to
proprioceptive stimuli, patients find it easier to follow the necessary
steps in exposing themselves to the situations they fear.
Physical techniques
are of invaluable help in this kind of work, helping rapid progress to
be made and improving the chances of success. They allow exposure to
bodily sensations to be linked to techniques that are intrinsically
relaxing, thereby making the exposure itself a technique that patients
can use to cope with their anxiety.
Analysis and
modification of underlying automatic thought processes
Another problem
encountered in clinical practice is that patients find an excuse for not
continuing with the plans agreed on even though they know they can and
indeed have overcome situations with an acceptable level of anxiety.
Such excuses are not based on objective obstacles, but on reasons that
are not always explicit and which are triggered automatically in
patients, preventing them from progressing. These reasons can
essentially be interpreted as secondary benefits or advantages that
result in the patient maintaining the disorder.
Social
relationships
The social
relationships of agoraphobia sufferers are greatly affected by their
condition. As they are unable go out or venture unaccompanied to many
places, the opportunities they have to be with other people are greatly
reduced, restricting their social life significantly as a result. This
inability to leave the safety of their own home unaccompanied also means
they very often rely heavily on a close relative or friend. In response
to this they develop special skills to attract company and control the
people who love them.
In some cases they may
even keep relationships going simply to avoid being alone, a situation
that sometimes generates a huge dilemma for them: the very thought of
breaking off the relationship is a source of great anxiety, but
continuing it causes an equal amount of concern.
The origins of
agoraphobia
It has been argued,
perhaps because of the aforementioned deterioration in the relationships
agoraphobia sufferers have with their partners, that the cause of the
condition is possibly connected with the emergence of serious problems
in these selfsame relationships. However, recent studies show that
although highly stressful events may act as catalysts for the problem,
relationship problems are not necessarily the most frequent cause,
although they are relatively common. In fact, agoraphobia patients
involved in steady relationships have a good chance of being treated
successfully.
Stressful events
triggering the condition may explain why the feelings sufferers
experience when subjected to extreme stress (feelings they were once
able to cope with) become much more unpleasant and why an increase in
anxiety may lead to their tolerance threshold being exceeded, triggering
alarms in the process. It is at this point that the struggle against the
suffering begins, with patients attempting to control their feelings
through physical reactions such as hyperventilation, tension,
dissociation, etc. As these sensations cannot be controlled, the effort
they expend increases anxiety levels significantly and may lead on to a
panic attack. The search for security, staying at home and avoiding
situations in which problems may be encountered are all indications that
the disorder has taken hold and feelings of agoraphobia will only
increase.
In many cases the
condition manifests itself immediately after a stressful event but in
others it may only appear months afterwards. When it does arise the
sufferer becomes so anxious that even the mere thought of potential
problems is enough to trigger an attack.
Anxiety is a universal human phenomenon.
It afflicts all human beings in varying degrees, from an adaptive
response to an incapacitating disorder.
In the majority of cases it requires no
treatment whatsoever. Only when it becomes so intense that it
constitutes a health problem, exceeds the adaptive capacity of the
individual or interferes in their everyday life should treatment be
contemplated.
In normal circumstances anxiety causes
individuals to take action in threatening situations in order to combat,
overcome or deal with them effectively. In some cases, depending on the
defensive strategy adopted, anxiety may actually prevent the individual
from acting.
Where anxiety arises, a particular
relationship develops between individuals and their surroundings in
which they identify a threat they are unable to deal with and which puts
their well-being at risk. The critical processes in the relationship
between individuals and their environment are cognitive evaluation and
confrontation.
Something virtually all experts on the
subject are agreed on is that anxiety is linked to the concept of
threat, so much so that threat is seen as its most significant defining
element.
Anxiety is a universal human phenomenon.
It afflicts all human beings in varying degrees, from an adaptive
response to an incapacitating disorder.
In the majority of cases it requires no
treatment whatsoever. Only when it becomes so intense that it
constitutes a health problem, exceeds the adaptive capacity of the
individual or interferes in their everyday life should treatment be
contemplated.
In normal circumstances anxiety causes
individuals to take action in threatening situations in order to combat,
overcome or deal with them effectively. In some cases, depending on the
defensive strategy adopted, anxiety may actually prevent the individual
from acting.
Where anxiety arises, a particular
relationship develops between individuals and their surroundings in
which they identify a threat they are unable to deal with and which puts
their well-being at risk. The critical processes in the relationship
between individuals and their environment are cognitive evaluation and
confrontation.
Something virtually all experts on the
subject are agreed on is that anxiety is linked to the concept of
threat, so much so that threat is seen as its most significant defining
element.
Cognitive evaluation is a process of
assessment that determines why and to what extent a certain relationship
or a series of relationships between individuals and their surroundings
is stressful or threatening.
Confrontation is the process through
which individuals cope with the demands of the individual-environment
relationship they see as stressful and the feelings this generates.
In order to understand the concept of
threat in terms of the relationship between individuals and their
environment the question must be posed as to how and why something is
viewed as such, in other words, why a threat is perceived to be a
threat.
Anxiety is linked to being, or rather,
feeling at risk. When we suffer injury, a threat or a loss, it is our
state of mind that is affected. Any lasting anxiety is linked to other
areas in danger, some of them as a result of the threat manifesting
itself.
Threat: Damage or loss that is yet to
manifest itself but which is anticipated and which individuals believe
to be too much for them to cope with.
Anticipation: A cognitive process
evaluating an event that has yet to occur and in relation to which
individuals assess possible risks, how they may arise and how to prevent
or deal with them.
Biological activation: The internal
overactivation and overstimulation of the body when faced with a
situation considered to be threatening.
Confrontation: Cognitive and behavioural
responses developed in order to deal with particular internal and
external demands that are deemed to be threatening and beyond the
capacity of the individual to cope with.
Results: The adaptive consequences or
otherwise of confronting the threatening situation and which impact on
the body’s affective, effective and physiological states/processes.
As we point out above, anxiety is not
assimilable with any of the variables or any particular relationship
between them but with the overall process.
Ineffective confrontation intensifies
anxiety. As a particular project or achievement is undermined and
physiological and psychological processes develop into a disorder,
anxiety endangers, hinders or degrades (threatens, to put it simply) the
continuity of other plans or plans connected to them that are, in
principle, non-problematic. In the process it gives rise to a process of
generalisation or a chain reaction that feeds the anxiety in a negative
manner as individuals see their resources gradually being overcome and
their well-being diminished.
Couples therapy
Cognitive-behavioural couples therapy
involves the detailed analysis of everyday conflicts that may lead to
the breakdown of the relationship, and looks at how problems appear and
how they persist. For the obvious purpose of making treatment
effective, techniques for overcoming these problems have been proposed
and focus on encouraging the couple to behave positively with regard to
each other, improve communication and resolve problems.
The effectiveness of
cognitive-behavioural couples therapy has been clearly demonstrated by
empirical research.
The appraisal of the structure of the
couple in its two basic dimensions, as a social entity and a dyadic
interpersonal relationship, has enabled the latest advances and
contributions in couples therapy to be integrated, contextualised and
understood, thereby creating a framework in which conflicts, the areas
in which they occur, the forms they take and their consequences, can be
placed. This approach generates a vision that facilitates understanding
of the solutions provided by cognitive-behavioural couples therapy, its
effectiveness and limitations and of how the latest contributions have
broadened the scope of therapeutic treatment, acting upon aspects of the
structure of the couple that transcend mere responses to conflict. It
also allows for the planning of future actions designed to improve
counselling for couples.
The couple, couples
therapy and social aspects
From society’s
viewpoint the couple is an entity based on the relationship between two
people. As a social entity the couple behaves as a single unit and is
recognised as such by the people around it. It is within the couple as a
social institution that dyadic relationships between its members occur.
Laws, customs and habits mark out and define basic characteristics of
the couple such as the commitment that binds its components, and endows
them with a social function, impacting decisively on the form and
content of the relationship between the couple.
Up until very recently, the vast majority
of couples consisted of two people of different sex who, depending on
any number of reasons decided to share their bodies and find mutual
support for better, for worse, for richer, for poorer, till death did
them part. The couple was married and its social function was to create
a family, its intentions having legally been set out in a marriage
contract.
The concept of the couple has broadened
considerably since then and society today views neither of the
aforementioned aspects as fundamental in the consideration of two people
as a couple, with many couples having no intention of starting a family
or of affirming their commitment through a legal contract.
The role of the couple and the family in
society has gradually changed over the years and couples therapy has
adapted to these changes. In the last two hundred years, the family has
changed from being a production unit to a consumption unit. Each member
of the family earns a separate income and the family shares consumer
goods, food, a house, etc. The social existence of the couple means that
in many respects it acts as a single, common unit and enjoys the single
ownership and use of a series of goods, referring to itself in the first
person plural with regard to its possessions and the activities it
engages in.
It is now believed that the implicit
objective of forming a couple is to make the other person’s life happier
and more fulfilled and to receive the same treatment in return. The
members of a couple therefore reciprocate behaviour and share, from a
social viewpoint, a series of goods and activities. They do so as a
priority, a priority that becomes a commitment of exclusivity.
They
also make an economic commitment by which they agree to share their
possessions. They usually have a house together although many couples
now own different houses and choose to spend only short periods of time
together such as weekends and holidays. Such couples are engaged in an
ongoing courtship and have no plans to commit to each other or share
anything else with each other.
The
commitment to sharing economic goods is not necessarily formalised in
law. In common-law couples, for example, there is no legal commitment to
sharing possessions and neither, generally speaking, are the rules the
couple observe explicitly agreed on.
Fatherhood/motherhood. This is one of the reasons why people decide to
form a stable relationship. But even this aspect is changing. The
proportion of children born to single women is gradually increasing and
single mothers now outnumber their married counterparts in countries
such as Iceland, Sweden and Norway.
There are other elements that are shared in some form such as social
prestige or friends, but this does not occur exclusively and in this
respect the variations between different couples can be considerable.
For instance, the question of exclusivity when it comes to sharing free
time has changed significantly. Although it has never been a determining
factor for men, increasingly fewer demands are now being made with both
members having greater freedom to enjoy their free time on their own.
These aspects ought to be borne in mind as the issue of prioritising
financial security in the case of women or social prestige in the case
of men can lead to widely varying perceptions and conflict in the long
term.
Whatever the circumstances, a workable
basis for sharing has to be defined in couples therapy in order for the
personal interests of each member to dovetail with each other.
The structure of the couple as a social
entity and in its dyadic relationships is determined by the evolution
and transformation of society, and differs in each individual,
religious, financial or geographical context regardless of the process
of globalisation we are currently immersed in. Knowledge of the
structure of the couple in each social situation allows couples therapy
to identify areas of action that can enhance its effectiveness and
broaden its scope. By assessing the social and dyadic processes upon
which a relationship is built we can define and outline the process
therapy follows in the future.
Direct approaches to basic aspects of
dyadic relationships, such as intimacy and validation or the analysis of
ingrained behaviour patterns linked to strong emotions such as intense
attachments, are now being put forward as a means of ensuring couples
therapy can alter behaviour related to emotions and feelings, something
that has only recently figured as a main objective of such therapy.
Acting upon the component closest to love and passion involves taking
into account the enhancement of the sexual relationship, not as the
resolution of pathological problems but as an improvement and
enhancement of the passion component in the relationship, thereby
avoiding routine and boredom and preventing love and passion from being
extinguished over the course of time.
The importance of strengthening
commitment in the couple can be seen in the results. In becoming aware
of the importance of commitment in achieving their own objectives, the
members of the couple strive more effectively to resolve conflicts and
to maintain the relationship without the need for intervention from
third parties. In order to increase commitment it should be borne in
mind that its creation involves conscious decisions to share possessions
and behaviour with the other partner. It should also be remembered that
commitment is inextricably linked to the social pressure surrounding the
continued existence of the couple, and that we are living in a time in
which the importance of commitment has been undermined along with the
effort it involves.
MeSH is NLM's controlled vocabulary used for indexing articles in PubMed. MeSH terminology provides a consistent way to retrieve information
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The Abstracts of Cochrane Reviews are available without charge, and can
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It is important to us that the information we help to assemble and
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full texts of a large number of historically significant public domain
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