Specializing in adults and adolescents
I only see children under the age of 13 in a family therapy context – with their parents and siblings. If the child has an emotional problem which is not directly related to family issues, I refer him/her to a child psychologist who uses methods like play and sand therapy to deal with the child’s emotional problem.
Many people think that depression will disappear if the sufferer just makes enough effort to think positively or to go out and enjoy him or herself. Unfortunately depression is a condition that requires specific treatment and intervention. People suffer from depression for various reasons and depending on what the circumstance is, therapy will vary from working with the current loss (divorce/death), to dealing with specific issues from the past that may impact on the person’s current state of mind, or looking at current relationships or circumstances that may make life unbearable for the patient. Depression is a condition that can affect anyone, but there are many ways in which the person suffering from depression can be helped.
Anxiety can exist alongside depression or may be a condition completely on its own. Anxiety varies from generalized anxiety, to panic attacks, to specific phobias, to obsessive compulsive disorder to post traumatic stress disorder. People usually control their anxiety with medication and use therapy to find ways to feel more in control of their lives, their thought patterns and their anxiety. Different techniques are taught, as different techniques work for different people. Patients often experience a huge sense of relief when they themselves feel more in control of their anxiety symptoms.
Psychological problems are often seen in the context of where the individual functions, whether it be work, school, or home. Family therapy is very useful in taking the context of the psychological problem into account. People often feel defensive to attend family therapy, as they feel criticized and feel as if their family gets labelled as disfunctional or abnormal. This is, however, seldom true as circumstances where a child feels he should protect a parent, where irrational fear of losing a family member or a function in the family may be an issue, or even keeping family secrets may be the root of the problem. Family therapy is very intense but rewarding work for both the therapist and the family members.
Marriage Counselling / Couples’ Therapy (including gay couples)
Marriage counseling/couples therapy always involves seeing both partners together for therapy. Couples often prefer to first have one or two individual sessions – which are kept confidential, but ultimately the partners need to be together in therapy in order to work with interactional and regressive patterns, finding compromises and enhance communication skills in order for them to work out their own problems in future. Couples therapy can take place at any stage of the relationship. In the beginning stages, couples attend therapy to sort out early disagreements, finding ways of understanding each other better and being able to communicate effectively about any issues in the relationship.
Sometimes couples go through difficult stages in their relationship, like the birth of a child, death of a parent, or children leaving home. They then attend therapy to find ways to work through this difficult phase and to make certain adjustments in order for them to carry on having a fulfilling relationship. Couples often attend therapy when they are in crises, for example when they feel they have “outgrown” each other, or that they have nothing in common anymore, or when the presence or interference of a third party in the relationship was discovered. In other instances couples who have decided that they want to get divorced attends therapy, in order to find ways of working together as a parental team and negotiating a fair divorce. Sometimes one of the partners will see me for individual therapy (with the knowledge of the other partner) if there are individual issues that need to be addressed that may have an indirect impact on the relationship.
This may be issues in any relationship, whether it is a spouse, a parent, a child, a work colleague, a boyfriend or a girlfriend, or a friend. Often patients experience crises with an important person in their lives and they need some guidance on how to deal with the person or situation. They discuss guilt feelings, or other emotions that get evoked in the relationship. Sometimes people need to end a certain relationship and need support through this process.
This is usually a process where people want to work on their relationships with themselves. They often challenge certain perceptions they have of themselves, they get challenged to escape certain comfort zones and we work with the feedback of this during the therapy process. Patients get confronted with certain realities or even certain illusions of themselves. They often try out new things, get feedback from important others or even decide to leave a relationship or to start a new relationship. Family members or important others sometimes get invited to one or two therapy sessions, to address certain issues or to receive feedback from them. The process of working on yourself is often longer term therapy, but can also be addressed in shorter term therapy.
Stress is a very general term and has a different meaning for most people. Usually people report that they are experiencing stress, when they struggle to cope with certain aspects of or people in their lives. Constant stress may spill over to other psychological problems, like depression, anxiety, or adjustment disorder, to name but a few. Stress may also be caused by difficulties in the person’s past, or difficult current life circumstances. It is important that patients find ways of dealing with their stress more effectively.
Phase of Life Crises
This refers to specific crises that the person is experiencing in the phase of life they are in, whether it is adolescence, leaving home, early marriage, difficulties with having young children, empty nest, or growing old – to name but a few phases of life. Often people struggle to adjust to change when entering a new phase, or even the change in identity when entering a new phase of life. Often people experience problems and self doubt when they have not reached certain phases in their lives, which they believe society expects of them to have reached by a certain age, for example getting married or having children.
Eating disorders refers to anorexia Nervosa, Bulimia Nervosa, as well as to obesity. An eating disorder is a complex symptom and often long term therapy is needed, which may include family and couples therapy, as these problems have an impact on various aspects of the patient’s life. Other professionals will most likely also get involved in the treatment, like a dietician and a psychiatrist. Patients may even be sent to an inpatient and/or outpatient program for the treatment of the eating disorder.
Bipolar mood disorder
Patients suffering from Bipolar Mood Disorder firstly need to be seen by a psychiatrist in order for them to receive the necessary medication before they can commence with psychotherapy. Therapy will involve psycho-education and also working with the patient’s family and partner. Intensive individual therapy is also needed after the patient has been stabilized on medication.
Sexual difficulties may imply couple therapy if the couple experiences difficulties in their physical relationship, but may also imply individual psychotherapy, where the person needs to deal with his/her sexual problems on his/her own and to also address underlying reasons for the problem. Sexual difficulties may vary from aversion to any sexual activity, low libido, erectile dysfunction, premature ejaculation, female orgasmic disorders, to pornography addiction and recurrent sexual relationships outside the relationship or marriage. These problems are often addressed within the context of emotional or psychological problems, which may sometimes spill over to sexual problems. It therefore implies that at times the patient needs to delve into his/her past, or past relationships, or the emotional context of their current life situation. Sexual difficulties mostly need to be addressed in conjunction with medical doctors, gynecologists and sexologists.
Crises around loss e.g. death / divorce
When people go through difficult periods like the loss of a loved one, divorce, break-up of a relationship, change in their work environment, or a change in their physical health/appearance, they often seek the help and support of a psychologist. A therapist is not there to change the situation, but rather to support the person through one of the most difficult periods of their lives. During this period, people do not want someone to try to fix matters for them, cheer them up, or look at the bright side. They rather want someone to share their deepest pain and fears with and to be able to voice their concerns. Later in the therapy process one will start looking at the future and how the person can co-construct a world without the person or object that they have lost.
Sometimes patients come to therapy to address specific problems at work, like having to deal with a difficult boss or work colleague, unfair circumstances, or an impossible work load. Again, people need to voice their concerns in an accepting and non-judgemental environment. In therapy the focus will be on the patient’s strengths, problem solving abilities and values in order for them to deal with the specific problem.
An adjustment disorder means the development of emotional or behavioural symptoms in response to an identifiable stressor. Again, this refers to some kind of stress in the patient’s life, which triggers behaviour that impacts on the person’s interpersonal relationships and general functioning. The context of the problem and reaction to the problem will be taken into account in therapy and problem solving behaviour, within the context of the patient’s ability will be accessed through therapy techniques.
Parent Child Relationships
After the relationship between spouses or partners, the parent/child relationship is probably one of the most complex and most frequently discussed relationship in therapy. Sometimes parents attend therapy if they have concerns about their children, their own parental style, or certain behavioural patterns their children exhibit, like addictions, relationship problems, poor academic achievement, constant conflict between siblings, or the impact of a death or divorce on the child. On the flip side of the coin, children often have issues with their parents – even long after a parent has passed away. They may experience difficulties in their lives and start realizing that they are repeating their parent’s patterns, or are involved with a partner that resembles certain aspects of a parent – of course this can be functional or less functional. Sometimes children feel regret and guilt when they talk about their parents and need to find ways to understand and cope with their behaviour at a specific time in their lives.
Addictions may vary from substance (alcohol and drugs) addictions to more emotional or functional addictions which may include pornography, internet and gambling addictions, Although therapy is a useful way in dealing with addictions, it is important that the patient is firstly prepared to attend rehab in order to deal with the symptom, namely addiction. After completing the rehab process, therapy plays an important role in supporting, understanding and abstaining from the addictive behaviour. Often couple and family therapy are part of the therapy process, in rehab as well as during the therapy process.