Different problems that can be treaten by psychotherapy:
1. Anxiety: Agoraphobia, Distress, Generalised anxiety, Panic attacks, Specific phobias, Social phobia
2. Accompaniment through illnesses
6. Emotional dependency and difficulties in intimate relationships
9. Emotional instability
11. Situations of change
13. Psychosomatic medicine
Anxiety is a natural emotion that is expressed when we face certain life situations. In this way, challenging or dangerous circumstances are frequently accompanied with a whole range of physical sensations like sweaty palms, faster heart rate, butterflies in your stomach… These sensations are normal and people perceive them as tolerable and even as stimulating. However, on some occasions, we feel anxious for long periods of time or in specific situations that are not harmful to us, but which still cause us feelings of concern. We don’t always know the reason why we feel this way, and we may even avoid doing certain daily activities or routines faced with the difficulty of controlling the intensity of these stressful emotions. In these cases, we may be showing signs of an anxiety disorder.
There are different types of anxiety disorders:
- Generalised anxiety
- Panic attack
- Specific phobias
- Social phobia
- Agoraphobia is the appearance of anxiety in places that may be difficult to escape from. These places, or situations, might be: being in or out of your home; travelling by bus, underground, plane or car; on a bridge, mixing with people, etc. People end up avoiding these types of situations with the resultant deterioration in their quality of life, not being able to do everyday activities in a normal manner.
- People experiencing distress worry excessively, with the implications or consequences that the symptoms of anxiety may have for their life. There are people that end up being incredibly afraid of fear and interpret these symptoms as the result of a physical illness that has not been diagnosed and which might be putting their life at risk. It is a normal occurrence that people go to medical check ups on a frequent basis in order to repeatedly confirm that they do not have a medical illness.
- The condition known as generalised anxiety is the manifestation of a concern and anxiety in relation with everyday life, which does not seem to have a justified cause. People suffering from generalised anxiety are unable to relax and, in general, expect the worst.
On many occasions they suffer from constant fatigue, restlessness, sleep disorders and muscular tension. Other somatic symptoms can appear such as perspiration, nausea, diarrhoea, dizziness, increased heart rate, difficulty to concentrate or the ability to “keep a blank mind”.
This condition significantly diminishes quality of life. It does not prevent people from living, but those that suffer from it are never completely alright, as they don’t have comfortable relationships and they experience permanent discomfort or dissatisfaction.
- The most characteristic aspect of panic attacks is the imminent appearance of a sudden and intense fear, which is uncontrollable and without measure in a situation that actually presents no risk. It can be presented in a wide variety of symptoms: perspiration, palpitations, shaking, feeling of breathlessness, chest pain, dizziness, fear of losing control, fear of death, fear of going crazy, fever and chills…
These attacks sometimes appear with such intensity that the person thinks that they are experiencing a heart attack, and it is a common occurrence that they go to A&E at the hospital.
On occasions people that have panic attacks can relate them with a specific stimulus. Nevertheless, on many occasions there is no awareness of what can cause this intense fear.
- In the case of specific phobias, an intense and irrational fear is expressed when faced with certain objects or situations, which can significantly affect the everyday activity of those that suffer from them. People suffering from this type of disorder do not have a permanent state of anxiety, but when it happens it appears with great intensity.
There are different types of phobias. The most common ones are:
• animal: fear of spiders, dog, etc.
• environmental: fear of storms, cliffs, etc.
• fear of blood and injections.
• situational: fear of lifts, planes, car, enclosed spaces, etc.
5.1 People who experience social phobias show signs of anxiety when in social situations, like for example: when meeting new people, talking, eating or drinking in public, due to fear of humiliation. People that suffer from this problem recognise that this fear is irrational or excessive. These situations are avoided or experienced with anxiety and extreme discomfort. In some cases, these people blush easily and show other symptoms associated with anxiety like palpitations, shaking, perspiration, gastrointestinal discomfort and tension. In more severe cases, it can be as serious as a panic attack in terms of its intensity.
Social phobias are commonly associated with a hypersensitivity to criticism and negative evaluation, as well as with fear of rejection and low self-esteem. Performance at work may be seen to be affected due to the difficulty in relating with colleagues or figures of authority. Intimate relationships might also be seen to be affected for this same reason.
- Accompaniment through illnesses
We can define health as the main bodily functions that are all integrated into one harmonious model. If one of these functions gets out of balance, harmony is disrupted and this is when illness occurs.
Looking at it like that, illness means that there is a loss of harmony.
Each illness brings with it losses, not only the loss of health. On many occasions there is a loss of autonomy, of social relations, of working life, activities, projects and self-image. These losses stop the natural flow and development of life. This is when questions arise, to which we don’t have an answer: Why me? Why now? What did I do? What’s wrong with me?
In these circumstances, there is a great amount of vulnerability involved. Breaking our normal routine, stopping work, and ultimately everything that made us who we were before. A lot of difficult emotions arise that are hard to control, such as helplessness, anger and sadness which, at times, can lead to depression or anxiety. Faced with these situations, people closest to us feel overwhelmed with emotion and burdened, finding it very difficult to cope with the situation and offer support.
With all of this, the affected person may feel very alone and discouraged.
They lose confidence in their bodily functions and start to feel insecure and desperate. They are afraid of what is happening or what might happen. A deep fear of what is happing or what might happen arises.
Therapy could be a place where all of these emotions can be let out and dealt with, where alternative paths can be found that offer a chance to rebuild our life, despite the illness and its effects; in addition to dealing with other specific aspects that may present with the illness (pain control, preparing for surgery, controlling stress, etc.). We know that hypnosis is a valuable practice when it comes to chronic illness. It causes the organism to relax profoundly and it reduces fear, pain and creates a sense of calm that the body and mind need in order to recover.
In the words of Virginia Satir, self-esteem is a concept, an attitude, a feeling, an image, and it is represented by our behaviour.
Integrity, honesty, responsibility and compassion, love and competence are all easily expressed by those that have a high self-esteem.
We have the feeling of being important, that the world is a better place because we are in it. We have faith in our abilities, we can ask others for help at the same time as being able to make our own decisions. From our own self-respect we can respect others. We accept ourselves in our entirety as human beings. We are capable of recognising our feelings and channelling them in a healthy way, avoiding impulsive acts that otherwise would make our well-being in life difficult.
When somebody feels like they are not worth a lot then they don’t expect others to treat them well, and they can easily end up being a victim. Not trusting others comes about as a means of protection, a resource which, with time, leads the individual to having a feeling of solitude and isolation. This experience reaffirms their feelings that they are not worth a lot and that they can’t be loved.
The causes that give rise to a lack of self-esteem are varied. It can often be traced back to early infancy, due to situations that have made us feel insecure. In our past we have perhaps received messages like “you’re not going to be able to achieve what you want”, “what is going to become of you”, “you’re so egoistic”, all of which will have affected us and left us with the idea that we are not good human beings, or people worthy of being valued. There are individuals that have
experienced the abandonment of an important person in their childhood and this has imprinted the message of “not being worthy” deep inside them. The self-esteem of the people that have raised us and accompanied us through life is also a very important factor for our own esteem. Beyond all of this, we find ourselves in situations every day in which we must face success or failure. In this way, a series of failures may lead us to feeling “undeserving” or “not capable”.
Lack of self-esteem can leave us living our life in a rather unhealthy way. This lack of self-esteem can be seen in the relationship that we have with others, in the choice and control of our work life and in how we place ourselves in the world. We can also recognise it in the constant need to please others, in the difficulty in making decisions independently, in the fear of expressing negative emotions, in the difficulty to say no, by not feeling that we can ask for help, in the discomfort experienced when we receive compliments, by apologising too much or in being overly thankful.
With all of these requirements, limitations and pressures, life can be very difficult.
However, we always have the option to put ourselves in a better place, accepting ourselves as we are, giving us the chance to exist and act according with what we feel.
Anorexia, bulimia and obesity are formed by a group of problems involving eating behaviours. The common factor between all of these is the dysfunctional relationship with food. This no longer complies with its basic function, which is to nourish the body, and it becomes an expression of intraphysic and interpersonal conflict. These eating disorders are a visible expression of underlying problems that are supported by the whole range of symptoms that frequently appear accompanied with unacknowledged depression and anxiety.
From a clinical point of view, anorexia can be considered as more severe, given that its development can seriously damage the health of the person that suffers from it, and, in extreme cases, can even lead to death. It normally starts in adolescence, but can also develop later on. The focal point of this disorder is the desire to lose weight and the intense fear of putting on weight. Anorexia involves the existence of a serious distortion of the self-image and the body. Therefore, someone with anorexia may see themselves as fat, despite actually being underweight. The methods used to lose weight are normally: reducing the amount eaten, the use of laxatives and diuretics, induced vomiting or excessive physical activity. These symptoms may be the expression of internal conflict related with the process of maturing and with the conception of a feminine figure. People that suffer from anorexia feel the need to have control over their body and there might be a fear of the emerging sexuality. Therefore, the increase in weight is deemed as an intolerable failure of their self-control. Unacknowledged conflicts normally exist within the family, like a lack of limits that make it difficult for each member of the family to be independent. People that suffer from anorexia normally have a low self-esteem that they try to resolve by trying to have a high level of self-demand on a personal, academic and professional level.
All of this creates a dynamic that is difficult to stop. In order to break it, in the majority of cases, it is necessary to carry out a multi-disciplinary intervention.
Bulimia normally appears later on than anorexia, generally towards the end of adolescence. The difference between anorexia and bulimia is that the latter can be recognised by eating excessively followed by induced vomiting.
The symptoms of anorexia and bulimia are sometimes confused, in these cases the disorder is called “bulimarexia”. There are also cases of anorexia which, in time, end up presenting as bulimia.
The predominant symptom of bulimia is anxiety about eating, which we could call “food binges”. At these times the person “swallows” large amounts of food in an uncontrolled manner, which is then followed by induced vomiting. In the same way as with anorexia, the person that suffers from bulimia feels concern about putting on weight, however, with bulimia we can find examples of extremely thin, normal or overweight people. Managing to keep their weight within certain normal parameters makes the problems less visible upon appearance. Nevertheless, unlike with anorexia, people suffering from bulimia are aware of their difficulties and suffer, feeling increasingly more vulnerable and insecure. They acknowledge their dysfunctional relationship with food and this makes them feel a great deal of guilt, shame and hostility towards themselves. Despite being aware of the problem, it is not enough to stop the compulsion, as in the same way as with any symptom, it complies with a function which, in this case, is to control and manage intense emotions. Vomiting frees the person of the pressure that they experience and causes a sense of calm. The symptom appears then as a solution. A person with bulimia normally finds it very hard to acknowledge and admit certain needs and feelings that are repressed, sacrificing their well-being, in order to keep the peace around them.
On a therapeutic level, there are many aspects to deal with, but the most difficult one is the patient’s willingness to be committed to and involved in a course of therapy.
- Emotional dependency and difficulties in intimate relationships
There are people that repeatedly find themselves trapped in negative emotional relationships without being able to get out of them, even though they experience emotional or physical abuse. By trying to leave the relationship they suffer from a severe sense of distress, and even though they know on one level that it would be the best thing to do, they feel unable to properly function by themselves. They have difficulties in everyday decision making if they don’t have the advice and reaffirmation of others. It is not easy for them to express disagreement or to show anger, which would be suitable in certain situations. This comes as a result of fear of abandonment or fright to stir the anger of those they depend on. Their whole existence is in the hands of others. The way in which they let others control their life reaffirms the belief that they already have inside them that “I am not worthy”, undermining their self-esteem even more. In general, these people are trapped in a single relationship or go from one relationship to another, without assessing if the partner they are with is suitable or not.
On the contrary, we find those people that have great difficulties when it comes to starting or maintaining a relationship. They normally experience intimacy as a threat. For these people, establishing a close relationship means making sacrifices or subjecting themselves to feeling pain. They decide that the best thing is to continue alone rather than reliving the pain that they have repeatedly felt in their childhood and subsequently in their intimate relationships. Nevertheless, they don’t feel happy with life alone either.
In both cases, there is a need to discover a way in which happiness can be found in a relationship. In the first case, it means creating a sense of self-competence, self-sufficiency and independence, developing confidence in abilities and increasing self-esteem. In the second case, it is important to heal the wounds of previous relationships and attachment experiences that course them pain, learning from what has happened. Finding out about how a healthy relationship can work creating different and more adequate patterns for the future.
It a complex disorder, but one that is very frequent nowadays. The group of symptoms may be presented in a very varied way and therefore, at times, it can be difficult to diagnose.
Depression can be expressed physically with sleeping disorders, low libido, loss of appetite or an exaggerated appetite, difficulty concentrating, digestive disorders, headaches or tiredness. On a cognitive level, it can be expressed in the difficulty to stay focused and in a state of “forgetfulness”. On a physic level, it is expressed in apathy, dysphoria, lack of motivation, avoiding social contact, low self-esteem, negative thoughts about the future, fear of failure, feelings of guilt and rumination.
The causes of depression can be just as varied. On the one hand, depression can occur after an important loss, a traumatic event or excessive strain. On the other hand, it can occur as a result of intrapsychic conflict between one’s duty and will, autonomy and dependency, etc. At times, depression can finds its cause in biological foundations, in which case it is fundamental that medication is used.
As we get older we suffer more losses. At many times these losses also lead to states of depression. This is what happens during menopause in women, during retirement, some changes in family and social surroundings, physical illnesses, etc.
Mourning is an experience which, sooner or later, will be experienced by all human beings. It is unavoidable. We all go through it, given that we always lose someone or something that we love.
Every loss or death of a loved one and its subsequent integration is experienced in a different and subjective manner. The factors that determine the period of mourning are:
- The relationship with the person that has died.
- The duration of this relationship and the intensity of the bond, which will determine how the process is assimilated.
- The circumstances that surround the death: an unexpected death, traumatic deaths, witnessing the death of a loved one in traumatic situations, suicide, serious losses, losses in which bodies cannot be found or recovered, losses in which one person survives and subsequently feels guilty, losses that are taboo, in which one person has had an ambivalent relationship with another person who has died, a loss of a child, losing parents in infancy.
- The personality of the person who is mourning.
- The social support system that they have around them.
The mourning process is complex and personal, extraordinary and unique. It is an experience that can even be perceived by means of psychosomatic processes like chest pain, loss of weight, sleeping disorders, etc.
Its development is not lineal, as it evolves in the form of a loop. Throughout this process, the person experiences a polarity of intense emotions, such as pain and anger.
It is an attempt to internally reorganising the loss that the individual has suffered. Due to the complexity of the process, people can come to a standstill and become trapped.
The characteristics that determine difficulty during the mourning process are as follows:
• Suicidal thoughts and inclinations that last for more than approximately half a year following the loss.
• A massive and persistent feeling of guilt.
• Extreme feelings of despair and hopelessness.
• Uncontrolled anger and bitterness.
• Psychosomatic symptoms.
• Immeasurable fear of illness and death.
• Prolonged emotional withdrawal.
• The person mourning has developed physical symptoms, such as those that the person that has died had prior to their death.
Mourning heals the wound that is caused as a result of the loss of a loved one. With the passing of time, if there is no difficulty, then the wound will start to heal. The person that we have lost ends up having another place in our life.
Mourning expresses our ability to love and our dedication to others. It is an acknowledgement of love. This process gives a sense of meaning to the loss that we are suffering and helps us to release vital energy so it can flow again.
- Emotional instability
When someone is experiencing emotional instability, their feelings are intense, constantly changing, and highly receptive. This leads to very severe mood swings. They may feel anxious, irritable, depressed, hyperactive or euphoric for short periods of time. In the majority of cases, these feelings arise as a result of two experiences: the fear of abandonment that means that any form of temporary distance is experienced by them as a perpetual loneliness and inappropriate rage when faced with frustrations which, still being insignificant, are based on a host of fears. These emotional reactions are due to chronic feelings of emptiness and them being unable to calm themselves down. They feel lost and confused about who they are. This is expressed in the frequent changes of friends, professions, partners, and even sexual orientation. There is a great difficulty in integrating ambivalent ways of perceiving reality, which as a result means that they express themselves as changing and extreme in their evaluation of things. Although they have a high intellectual capacity, they come across as rather unrealistic in their setting of goals and problem solving, which frequently leads them to failure in their studies, work, relationships with others, fear of intimacy and intolerance to separation. They live out the union with another person as a loss of autonomy that gives them a feeling of being of little importance and separation is interpreted as abandonment.
This whole group of experiences may have their origin in early traumatic experiences like primary relationships with conflict, experiences of abuse or growing up surrounded by high levels of hostility and communication difficulties. If this type of symptom is a constant occurrence in someone’s life, then it may derive from what is known as “borderline personality disorder” in psychiatric terms.
The treatment could be a chance to create new ways of relating with others, to control intense emotions, to reduce impulsiveness, to learn to co-exist with ambiguous and uncertain matters without suffering from distress and having emotions that overpower everything, affirming and consolidating their individuality, creating a sense of self.
“Many a time they tell me that they can’t love themselves because they are too fat, or as one girl put it, “too round around the edges”. I explained to them that they are fat because they don’t love themselves, because when we start to love and accept ourselves it is overwhelming how that weight simply disappears from our bodies”
Louise Hay -“You can heal your life”-
Obesity does not only constitute an aesthetic problem, it is a condition that leads to serious health risks such as type II diabetes, heart disease, sleep apnoea, gastrointestinal problems, etc. Furthermore, it also brings with it many inconveniences: not being able to find clothes that are the right size, or feeling uncomfortable in social situations, to having difficult tying shoelaces.
We know that the bodily function known as eating is necessary to give the body the nutrients required for the body to survive. In obese people, this function has been lost. Food starts to mean something else, such as a way to avoid anxiety and stress or controlling different emotions that are difficult to otherwise express or tolerate. This is easy to understand if we know that our first experiences with food have a high level of emotional content. Eating and being fed complies with a function of interaction with another and binds us with the feeling of being sustained and protected. In this way, food provides us with a sense of deep connection and gives us a feeling of peace and serenity. Therefore, for someone with obesity, food becomes a form of self-comfort, although in the end it ends up being a form of self-punishment. However, on many occasions, obese people are not aware that they are using food for such a purpose.
In our society, the most common way to combat obesity is with a diet or weight-loss plan. Despite the initial success of these procedures, in the majority of cases, its effects are not maintained over time. Our body is a wise organism and its main task is for our own survival. A vicious cycle is produced when dieting, in which a dynamic is created that is difficult to break free of: diet- stop diet- increase weight to more than initial weight- diet again- etc. In addition, these constant failures normally have a negative effect on our esteem, causing feelings of personal incompetence. At the end of these diets, far from being the solution, they become an additional problem.
Once medical factors have been ruled out, a more suitable alternative might be to learn to deal with stress and anxiety, becoming responsible for our emotions, identifying the factors or situations that prompt us to eat compulsively, re-establishing a healthy relationship between hunger and food, so that they once again play the role that they are intended to.
- Situations of change:
Life requires flexibility and the ability to change. Throughout our life cycle we have to face a series of changes which, although being natural and necessary, can create a great deal of stress for us. Changes of this type might be living with a partner, the birth of a child, searching for a job, moving house, children moving out of their parents’ house, menopause for women, retirement, etc.
In addition to these natural forms of crisis, nowadays we add to them with the demands of modern society. It is difficult to find a balance between family life and work. Work increasingly requires more travel and the market is more demanding. Many relationships fail as a result of such demands, there are more divorces and increasingly more one parent families. The old ways of doing things are no longer suitable.
All of this requires flexibility, energy, the ability to adapt and be strong in order to deal with the loss of an established security, generativity faced with new things that happen and an acceptance of the new reality. However, none of this is easy, and we can get trapped along the way expressing symptoms of anxiety and depression. The need arises for us to find a new balance. At times this is acquired by means of a simple change of perspective. Other times, it involves finding alternatives or accepting and learning to manage our reality in a different way.
Trauma can be understood as a unique, intense and boundless experience, which cannot be assimilated or integrated by the psyche. We know that human beings have the capacity to assimilate life experiences. This capacity differs amongst people, depending on hereditary and constitutional characteristics and different life experiences. Therefore, when we find ourselves facing a situation that breaks our patterns, as is the case of abuse from a family member, a serious accident, or a criminal act, our understanding of the world collapses, changing our conscience in a radical way. This situation moves us mentally, emotionally and physically. The individual feels strange, disconnected from life, and there is a loss of confidence in the world around them.
These types of experiences create immediate effects: anxiety, explosive rage, nightmares and flashbacks. The individual might feel blocked and refrain from having feelings of defencelessness, fear and panic. These same symptoms can appear in the long-term if the traumatic experience is not suitably integrated. This means that if the trauma is properly overcome then the symptoms diminish; nevertheless, not facing up to this internal development of the traumatic experience could allow these symptoms to become chronic.
Two types of trauma:
1. Trauma that is caused by another human being: physical abuse, sexual abuse, rape, criminal acts, civil assault, war, torture…
2. Trauma as a result of catastrophes and accidents.
We also consider that living with a serious illness can be traumatic, as well as emotional abuse.
Although the causes of trauma can vary, in all of these situations it is important to recover a minimum amount of security and confidence to allow the person that has suffered, to connect again with life and integrate the traumatic experience into their sense of self.
- Psychosomatic medicine
The psychosomatic theory alludes to the interaction between body and soul. A psychosomatic problem appears when an emotional or psychological discomfort is denied or not acknowledged by an individual. In these situations, a large percentage of the population turn to their primary care physician, given that at first, the symptoms do not tend to point towards a psychological difficulty. The symptoms that most frequently appear are tiredness, pain, sleeping disorders, gastrointestinal disorders, heart problems or high blood pressure. Three groups of conditions should be distinguished between, depending on the extent to which the soma (the body) is being affected on an organic level.
The body is capable of expressing, both directly or symbolically, what is happening in our lives and what we are not capable of accepting. When this happens on a symbolic level we talk about a conversion. The symptoms affect the voluntary or sensory motor function. Frustrations regarding love or suffering as a result of the loss of a loved one can be reflected physically as pain in the heart. Fear of expressing something can lead to difficulties talking such as hoarseness or a clearing of the throat. In an intimate relationship, when one person wants to break up on an unconscious level, they may have difficulties walking. In all of these cases that have been mentioned, there is no organic condition involved, but the symptoms are very real and the person suffers from them.
Many times the symptoms do not have this type of symbolic connotation, but rather they are caused as a result of a psychological discomfort, given that when they are examined for physical or organic symptoms, there is no medical evidence that explains such symptoms. In these cases, we are dealing with somatization disorders, which can be expressed in the form of: headache, backache, diarrhoea, lack of appetite, excessive perspiration, sleep disorders, irritable bowl syndrome, cardiovascular symptoms, skin conditions, etc.
It is worthwhile highlighting those that do actually exist as an organic condition with a tested morphological change and in which psychological and emotional factors have had a notable influence on their generation or on their development. The most common conditions are asthma, ulcers, ulcerative colitis, dermatitis and chronic polyarthritis. The importance of the psychological factor in each one of these illnesses can vary according to the individual. For this reason, it is necessary to evaluate each individual case. A visit to a doctor and psychologist is recommended.
The therapy process, in addition to dealing with any psychological consequences caused as a result of a physical discomfort or deterioration, aims to tackle emotional factors involved in these disorders, in order to free the body of unnecessary burdens and to enable individuals to recover their health.
- Treating smoking
Nowadays, and as a result of the recent anti-smoking law, the pressure that smokers feel to stop smoking has considerably increased. Over the last few years a new level of awareness has been triggered with respect to the damaging effects that tobacco has for the health. Faced with these facts, many smokers take the decision to stop smoking. Nevertheless, the syndrome of abstinence presents a great problem for these individuals, which ends up leaving them frustrated with all of their attempts.
In these cases, hypnosis is a valuable tool that greatly enables and speeds up the process of breaking the habit. Hypnosis undermines the desire to smoke, it connects us with our own resources and opens us to new alternatives, giving us the possibility to control stress in a different way and motivating smokers to develop healthier habits.