The last blog I wrote about the increase of autism resulted in many parents calling me and asking for more information.

While there is no doubt that the number of children who have been diagnosed with autism has increased, the question  being asked is: is it a new diagnosis or was it missed in previous generations?

One suggestion is that it is the way we measure autism that has changed. As knowledge about autism has advanced, so have the techniques used to measure the prevalence of the condition.

For example, early studies used  small samples and  relatively crude diagnostic tools. In contrast, the modern method of screening whole populations (e.g. states or countries), using improved diagnostic assessments,  is likely to be more sensitive in identifying affected individuals.

Another hypothesis is that certain societal influences make it more likely for an individual to be diagnosed with autism today than in the past.

These influences  include:

• increased awareness and understanding of autism among parents and health professionals

• the formation of specific autism diagnostic teams

• a lessening in the stigma associated with a diagnosis (particularly, the dispelling of the myth that autism is caused by “cold parents”)

• the availability of governmental assistance specific to children with an autism diagnosis.

A third  potential  reason is the increase in the survival of extremely premature infants. While recent findings suggest these infants are at increased risk of autism, research in this area is at too early a stage to make conclusive statements.

In sum, to date there is no single environmental factor we know of that has substantially contributed to the increase in autism diagnoses. However, research is now focusing on how genes and the environment combine to cause this condition.

Hopefully this line of research will provide answers to the “autism epidemic”.

Are you a worried parent? Please share your concerns.

A large percentage of  people suffer from stress. However, many  people manage their stress in varied ways that are not always ideal. Only a small percentage of sufferers obtain help from professionals.

A survey by the APS found that it is those people with high levels of stress who will seek help from qualified practitioners:  20%  seek help from their general practitioner and only 15% seek help from an allied  mental health professional.

The survey indicated that most people with moderate to low levels of stress have found ways of dealing with their stress themselves.

Activities to manage stress

• turn to a family member (22%)
• ask  a friend (25%) for help
• utilise distractions
• practice relaxation methods
• watch television
• read
• listen to music

These strategies are all appropriate and useful. However, many chosen strategies are not healthy or helpful in the long run.

It is of concern that 40% of Australians drink alcohol, 66% use food and 46% use shopping as a way of managing their stress.

These are escape or numbing techniques that work in the short term but lead to bigger issues in the long term.

If you utilise these dangerous methods, step 1 is to own up to it. Step 2 is to make a commitment to find better, healthier alternatives that will truly address the stress levels in your life. Step 3 is to relinquish these negative behaviours.

Can you relate to these behaviours?  What do you do?

The question of whether autism has increased is commonly asked and will always get parent’s attention. The simple answer in terms of numbers is “Yes”.

There has most certainly been a steady rise in the incidence (number of new diagnoses per year) and prevalence (total number of affected individuals in the total population) of autism during the past fifty years .

The finding has been  well-replicated and  observed in every country (including Australia)with an appropriate data source. Currently, the most widely recognised estimate is around one individual with autism in every 100 people (1% of population).

The increase in rate causes alarm in most parents and educators who are still unclear as to the reason for this. Andrew Whitehouse, Associate Professor, Telethon Institute for Child health Research at University of Western Australia believes it is the result of conceptual change.

He says that one of the most important discoveries in autism research over the past two decades has been that the syndrome varies along a spectrum of severity.

The understanding  that children can present with less severe autistic symptoms, which are often difficult to identify at  a young age,  led to the formulation of new  diagnostic categories – Asperger’s Syndrome and Pervasive Developmental Disorder – Not Otherwise Specified (PDD-NOS), both of which come under the collective banner of Autism Spectrum Disorders.

The expansion of diagnostic boundaries has meant that individuals who would previously have been placed under a different “diagnostic banner” are now more likely to receive a primary diagnosis of autism.

This is particularly true for the diagnoses of language disorders and intellectual disability, and the prevalence of these conditions has decreased over the past two decades as autism diagnoses have increased.

The positive thing about better diagnoses is that children can get the specific, relevant and appropriate treatment they require.

What are your views on this contentious topic?

We live in an age where things are done quickly. People are trained to look for a quick fix. Society believes that it is possible to reduce every situation down into a process that can be easy, convenient and cheap.

These principles may be true in many areas. However, they do not and cannot be applied to human relationships. They also are not appropriate for the therapeutic process.

Good therapy comprises a process. It involves making a space where feelings and events can be thought about and understood.

Since emotions and relationships are complex, often reflection takes some time. It cannot be rushed.

When you start a therapeutic journey, have realistic expectations. Give the process the time and thought that it deserves. You will feel the benefits and be glad you did.

Have you been reluctant to engage in a therapeutic process?  Why?

Marriage counselors have a traditional way of working. It goes like this:

“Hi Marissa. Would you like to tell me what is bothering you? Terry, I would like you not to interrupt and really listen to what Marissa is saying. You will have your turn later on”.

Marissa then says: “Terry always works late and I have to bath the kids alone.”

The counsellor than asks Terry to repeat what Marissa has said and to show that he understands her feelings. Ideally, Terry should say: ” I understand that Marissa is tired and wishes I could be home to help bath the kids. It must be hard for her to do it alone.”

Marissa should then feel understood and happier. The jackpot would be if Terry promised never to be late again.

In real sessions, that does not happen. Terry keeps interrupting Marissa saying that he needs to work hard and could not provide for the family if he did not. Rather than supporting her, he actually wants her support and understanding of how tired he is.

This is where traditional counselling  gets stuck. Two tired people who both want support and validation. Both too tired and frustrated to be bothered to give the other what they want.

Gottman, an expert in marriage counselling, has found this type of counselling is not as effective as trying to build the relationship in positive ways. He has found that by increasing love, bonding and shared moments, conflict reduces.

Gottman is of the mind that these types of issues can rarely be agreed upon. However, if there is more love and support generally, these issues become smaller and more manageable.

Are you stuck in circular arguments with your partner?

From today, try not to focus on them and build your happy shared moments together. Then  let me know what happens.

Mindfulness from a psychologists perspective

During my time as a therapist I have often made use of Mindfulness Principles and practice within session with my clients.

Mindfulness is derived from Buddhist tradition and helps one to bring attentive awareness to the present moment, your current experience, without judgement. This practice of being mindful has been incorporated into psychological therapies in modern times and I have first hand seen how my clients have made use of this practice to aid in managing their anxiety and depression.

One way to practice being mindful is to practice mindful breathing. This requires a person to bring all their attention to the experience of breathing in the moment without forcing change or judging it. To do this one starts by observing, noticing the breath, the sensations of the experience, all parts of breathing.

Being mindful helps take one from a place of analysis to a place of sensing the experience. This practice not only helps people to focus one’s attention but it also improves concentration, calms the anxiety response system, allows a person the time to just breathe and teaches you that you can choose where your attention goes.

It can help to soothe a racing mind as there is no fighting with thoughts or feelings, but a simple acknowledgement they are there, just a noticing and acceptance without further judgement.

It does, however require regular practice and I have found this to be an excellent skill that people will want to utilise regularly as the effects of increasing our mindfulness are numerous. Try it for yourself and see!

How to get the most out of therapy

Unlike going to a doctor who can give you a pill to take away your pain, therapy is collaborative and requires your full participation.

Here are some ingredients of successful therapy:

You must be willing to come to therapy. If you are coming because your wife or mother told you to, you will most likely drop out.
You must be ready to change.
You must value the therapy and be willing to pay for it. If you think $100 is expensive but you have no problem spending that on theatre tickets, then you do not see the worth of therapy yet.
You must be committed to the relationship and not miss appointments.
You should come on time so that every minute is seen as valuable. It is your time and it is more about not respecting yourself than not respecting the therapist if you are late.
You must be willing to put in effort. If your therapist gives you homework, then do it.
Be open to sharing your experience of the therapy. If you do not like something your therapist has asked you to do, say so.
Do not leave suddenly because you are angry with your therapist. As this is a collaborative process, tell your therapist why your are angry. Some of the best learning happens in these open discussions.
End properly, with a last session which gives closure. If you just do not go back, you may have unfinished business which adds to your woes.

Therapy is not magic nor is a therapist a magician. However, with a therapist’s skills and your collaboration, you could change your life for the better.’

What is your experience of therapy?

How to choose a therapist

Choosing a therapist does not have to be difficult or shrouded in mystique. A therapist is a person with a set of skills. Knowing what skills to look for will help you choose the best one for you.
Look for a therapist who is well trained. A psychologist has at least 4 years academic training plus 2 years practical training.
Choose a psychologist who is registered with a national body and adheres to a code of ethics.
Find a psychologist who is a specialist. There are clinical psychologists who specialise in mental health issues, counseling psychologists, health psychologists and so on.
If you have a mental health issue, make sure your clinical psychologist specialises in your condition. Some psychologists are excellent with depression, others with post traumatic stress disorder and yet others with insomnia.
Meet your therapist. How does it feel? Comfortable? Safe? Informed? The relationship you have with your therapist is the key to success.
If you like the therapist, inquire as to the exact type of therapy they do. For example, is it short term cognitive behaviour therapy that will focus on changing your thoughts? Or short term interpersonal therapy that will focus on your feelings? Or long term psycho analytic therapy that will take months and be non directive? Decide if the approach will meet your needs in terms of time, commitment and finances.

Once you have chosen a professional, well trained ethical therapist who you feel comfortable with, trust the process and you will soon feel the benefits. Good luck!

Group therapy from a psychologists perspective
As a therapist, running group courses for anxiety and anger has been an excellent growth experience for both myself and I believe also for the participants. Whilst individual therapy can be highly effective, group courses not only allow for the learning of helpful skills to deal with the relevant issues but also possess an extra dimension that individual treatment does not. One thing that is clearly present in group therapy is the supported feeling participants gain from being around others that have experienced similar issues. There is a dynamic that occurs within the group where participants can exchange stories of their experiences and share questions to help solidify skills discussed within the group.
Everyone learns differently and by being part of a group one can gain insights into other people’s views and methods of change that they may not have been exposed to before. There is also a commitment to the group by the participants and this creates a dedicated environment for participants to come back each week and learn together.
As they say, two heads are better than one, so imagine how a group of minds can benefit one another.
By Angela Skovron

Family therapy treats the family as a whole

Individual therapy works with individuals. Some individuals wish to grow and visit a therapist out of their own volition. Other individuals are in pain and need to work on changing their moods or behaviours. They may come of their own accord or they may be compelled to come by their doctor or family because they are suffering.

When a relationship is in trouble, couples may seek couple therapy. However, if one partner refuses to attend, the other may be forced to attend individual therapy in order to cope. This is not ideal because it means one member of the couple is assuming responsibility to fix the relationship alone.

Family therapy is based on the philosophy that families are systems and problems in families are seen as a problem in the way the system operates. The family therapist does not focus on individual issues but what each member of the system is contributing to the issues. The therapist also looks for ways that will shift the energy in the system to benefit all relationships in the family.

Family therapy is very effective and results can be seen immediately. The difficulty is getting every member of the family to agree to come to sessions and to take collective responsibility to make things better.

If your family is struggling and needs help,  family therapy and its systemic approach could be the best type of therapy for you.

What to expect in couple therapy.

Working with couples brings unique challenges.Here are some tips of what to look for when choosing a good couple counsellor.

1.When there is a  power struggle going on, couples try and get me to take sides. A good couple therapist will see the relationship  as the patient and not take sides.
2.A member of the couple often wants the therapist to validate their point of view. I have had a client bring an email written by her partner which she felt was abusive. She insisted I read the email and agree with her. A competent couple therapist will not be an adjudicator. In this case, her job is to encourage the wife to assert herself in the relationship.
3.A major reason couples seek counsel is that they find it difficult to communicate openly with one another. They depend on the therapist to speak on their behalf. A skilled counselor will assist the couple to speak directly to each other.
4.Sometimes, a member of a couple diagnoses his partner and wants the counselor’s back up. A strong therapist will not align herself with the husband but will keep the “power” in the relationship equal.

Have you had these issues in couple counseling?

What is relationship therapy?

Therapy aims to achieve a combination of new understandings and new behaviours and one does not exist without the other. Different therapies focus on different aspects.
I myself lean towards the understanding end. This may involve inquiring into the past and family influences and the meanings attributed to events. For example what meaning does this person attribute to migration or his parents’ divorce, and how does this come into his life now?

In couples therapy, by understanding these old motivations we can recognize their influence, make some changes and develop some strategies more suited to this relationship..

Secondly, relationships therapy is about developing trust with the therapist, between the partners and most importantly with oneself. This trust is important so that parts of the self can appear and be recognized. Many times I have been told what has helped is to be able to talk and discuss in a safe place.

In marital therapy, I am working for the marriage, the relationship I am neither on the side of one person nor the other. What helps this relationship, what hinders it? are questions we talk about. How can the relationship meet the needs of the partners?

It is always up to the clients to decide what is best for them.
By Robyn Townsend

What is interpersonal therapy?

Interpersonal therapy, or IPT, is not as well known as cognitive behavioural therapy (CBT). However, like CBT, it is evidence based which means that research has shown that it works. In particular, it helps people suffering from depression.

IPT is short term therapy and usually takes up to twelve sessions. The first few sessions involve diagnosis and assessment and is regarded as central to getting the therapy right. This is one of the features I really like. You see, people are complicated and often present with multiple issues like depression, role change, personality issues and grief.

With IPT you choose 1 of 4 categories and focus only on that. You normally choose the most pressing need and often the benefits of that work spills over into all areas of the patient’s life.

The therapy is very structured. Patients know what to expect, how many sessions, what the focus is, and when it is ending. Patients feel very supported by structure. Afterwards, monthly maintenance sessions can be held.

The key difference to CBT is that one focuses on feelings rather than thoughts. Patients can share their feelings and express them without trying to challenge or change them.

Have you had IPT therapy? Did it benefit you? What did you like/dislike about it?

What is cognitive behavioural therapy

CBT is the most well known form of therapy in Australia. Most of the universities specialise in teaching it and Medicare is happy to offer rebates to patients receiving CBT.

The main reason for this is that there are decades of research showing that CBT really helps people with a variety of diagnoses. CBT is very skills based and is easy to teach. Patients do not have to understand deep concepts to get better.

CBT is focused, task oriented and can be completed in the short term. Patients who practice the skills they learn benefit most. Some psychologists will not work with non compliant patients.

So what is it? CBT involves changing cognitions and behaviours.

Cognitions are thoughts. Patients are helped to identify the negative thought patterns that cloud their thinking and then are encouraged to challenge them and replace them with positive thoughts.

In terms of behaviours, patients are encouraged to exercise, do breathing and relaxation and face their fears. Patients benefit from moving their muscles and filling in a daily monitoring schedule.

Once a patient has learned new thought and behaviour patterns, they are on the way to a fulfilling life.

Have you had CBT? Did it work for you?

The value of short term psycho-dynamic therapy

Psycho-analytic therapy is well known from its founder Dr Sigmund Freud. Freud devised a treatment where patients are encouraged to say the first thing that comes to their minds. He called this free association and he believed that whatever one says, no matter how random, reveals something about the unconscious.

Freud believed that many psychiatric symptoms came from repression. The main focus of his therapy was to make unconscious feelings, motives and fantasies conscious.

There is no doubt that Freud’s thinking has influenced all of psychology. However, his long term method has been very difficult to test under scientific scrutiny.

Short term psycho-dynamic therapy is based on many of Freud’s assumptions. In the past few years, researchers have begun to show that it may be benefit patients as much as other therapies like CBT and IPT.

Having originally been trained psycho-analytically, I am delighted and relieved that research is starting to back my clinical experience. I have witnessed clients grow and get well through free association,, interpretations and insights.

If you are looking for therapy, take you time to look for a therapist whom you like. Do not rule out psycho-dynamic therapy because it is not part of the popular culture. It is a valuable therapy. Over time, I am convinced additional research will be conducted to prove its worth.

What therapies have you tried? What has worked for you and why? Any thoughts on psycho- dynamic therapy?

It was not always believed that every adult could benefit from therapy. When I trained in the 1970′s, there was an acronym that described people who were supposed to be best suited to psychotherapy.

The acronym was YARVIS and stood for Young, Adult, Rich, Verbal, Intelligent and Sensitive. Imagine, it was believed that if you did not have these features,  therapy was not for you.

Today, we see it  differently.

1. Y: Research shows that adults of all ages can grow and change and being young is not essential for successful therapy. In fact, studies on emotional intelligence reveal that older people have maturity that ensures they develop fastest when taught emotional skills.
2. A: History has shown that individuals of nearly every age can benefit from therapy, from young children to the aged .
3. R: In Australia, therapeutic services are rebated by Medicare making it affordable for everyone. Hospitals and schools routinely provide therapy making it accessible for most people.
4. V: Therapies like play therapy, sand therapy, music therapy and art therapy mean that being verbal is no longer a criteria for meaningful results.
5. I: Since 1983 it has been  recognised that  there are multiple intelligences and varied skill sets. Every person can benefit from therapy provided the most appropriate modality is used.
6. S: Instead of having sensitivity as a criterion for “admission” to therapy, it is now often a goal of therapy. Clients may be out of  touch with their feelings and are helped to feel more vulnerable. Many therapies involve skills where sensitivity is not an issue at all.

In short, adults can unequivocally benefit from therapy. As always, finding a competent responsible therapist is the key.

Therapy is a unique relationship. It is not a friendship and it is not a partnership. It is a relationship where a qualified helper provides a service to their client.

That service is clearly defined. The therapist is there to bring clarity to a person about their issues. A close family member cannot do this because they are too subjective.

A therapist teaches skills so that the client becomes independent and has a healthy social structure. If the therapist adopts a friendship role, the client will not learn to develop friendships in their “real” life.

A  therapist does not give advice or place value judgements on their client’s decisions unless they are dangerous. The therapist is there to help a client clarify their values and make decisions that work for them. Family members who live together can give advice or insist on values being met.

If you are in therapy, have  realistic expectations of what your therapist can offer you. But do not feel disheartened. With these boundaries, you will have the most effective therapy and beneficial therapy which is what you truly need.

People often ask me if I offer CBT counselling. I do.  In fact, I have developed my own structured program of CBT which works so well that it can feel like magic. Clearly, I am passionate about it.

However, that does not mean CBT is for everyone or for every circumstance. Therefore, when people ask me, I try to ascertain what the problem is. Often 3 sessions are required to decide which is the best course of therapy for that individual.

CBT stands for cognitive behavioural therapy. Basically, it means that therapists work with thoughts (cognitions) and behaviours.  It is based on the premise that if you change your thoughts, you will feel less anxious/depressed/angry. Also, if you change certain behaviours, you will feel better.

What makes CBT so effective in my opinion, is when clients comply. If homework is done, worksheets completed and daily monitoring schedules filled out, CBT is amazing.

There are times when CBT is not my  treatment of choice. Sometimes a client needs to have emotional support and flexibility. Other clients benefit from deeper work with the unconscious.

If you are thinking about therapy, do not ask for CBT as a matter of course just because everybody talks about it. Make sure it will work for you. Find a competent psychologist and let him/her guide you.

What are your thoughts about CBT?

A main focus of my work is to provide parenting advice. However, sometimes it is not sufficient and children need their own therapy in order to move forward successfully.

I am thrilled to announce that Sharni Brodeski has joined my practice and will working with children and adolescents. She has had twelve years of experience working with this age group since she completed her B.SC (psychology) at UNSW.

Currently Sharni is completing her masters in psychotherapy which  deepens her understanding of childhood issues. Her knowledge, insight and relaxed manner make her a hit with young people.

If you are interested in making an appointment, please call Teresa on 02 93285899.