Depression

We all experience days where we feel sad, “blue” or down and the feelings would usually pass. However, for some people the feelings of sadness do not pass and they experience persistent low mood. Feelings of hopelessness, helplessness, guilt, sadness may come up. These feelings will often be accompanied by other symptoms which may include any of the following: lethargy, loss of interest in activities you once enjoyed, finding it challenging to engage in everyday tasks (e.g. getting out of bed, cooking a meal), sleep and appetite difficulties, loss of libido, social withdrawal, increased teariness, irritability, lack of motivation, and ongoing negative thoughts. People who experience depression will often find that it is a struggle to manage their social relationships, work/school, finances, and personal care.

Psychological therapy for depression focuses on skills to improve mood by engaging in activities that will give a sense of pleasure or achievement, ways to manage and challenge the depressive thoughts, improving your sleep and appetite, problem solving challenging issues you face, improving interpersonal skills and helping you feel better about yourself

Trauma

When we experience or witness a distressing or traumatic event it can cause psychological trauma. For some people they develop post-traumatic stress and they experience symptoms including: flashbacks or nightmares of the trauma, increased anxiety, difficulty with emotion regulation (e.g. getting angry very quickly), avoidance behaviours (e.g. avoiding anything that reminds them of the trauma), sleep problems, difficulties concentration and finding it hard to resume their activities of daily living. The symptoms can persist long after the trauma occurred and take a big toll on the emotional, physical and mental wellbeing. This is because the brain has been unable to process the trauma and as it continues to struggle to make sense of what happened the person continues to relive the events with intense emotions and physical sensations.

Examples of trauma can include motor vehicle accidents, witnessing or experiencing physical, verbal or sexual abuse, childhood abuse, natural disasters, terrorism and violence.

Psychological therapy for trauma focus on helping you process the trauma, equip you with coping skills, and help you to feel safe again by recognising the trauma has passed so that you can regain control of your life.

Eating disorders & body image concerns

When the term “eating disorder” comes up most people conjure an image of someone who is severely malnourished and “skeleton-looking”. However, eating disorders present in many different ways and are not always physically observable. Disordered eating will often involve a preoccupation and dissatisfaction with one’s weight and/or body shape. This can lead to some of the following symptoms: weight fluctuations, having “food rules” (e.g. not consuming carbohydrates or foods that have sugar or fats), decreased food intake, periods of excessive or restrictive eating, purging behaviours (e.g. excessive exercise, laxative use, vomitting), increased irritability, low mood, difficulties concentrating, decreased energy and constant thoughts about weight, food, body shape. People with disordered eating will often be very harsh and critical towards themselves (and sometimes others) and feel a great sense of shame or guilt about themselves.

Eating disorders typically develop in adolescence but can also commence in adulthood. Psychological therapy may differ depending on the age of presentation. For adolescents we usually focus on using a family based approach to help the young person overcome their eating challenges, whereas with adults it will often be individual therapy but using friends and families as supports where needed. Therapy will typically focus on regaining a pattern of regular eating, developing a healthy attitude towards food and your body, strategies to break any binge-purge cycles, improving body image and confidence, ways to combat the disordered eating thoughts, and being able to enjoy and experience a variety of food again.

Attachment issues

When we are born into the world we usually look to our parents to provide us with comfort, safety and to meet our physical and emotional needs. Parents typically provide us with the blueprints into living and we learn by observing their interactions with us, with one another and with other people. A secure attachment develops when a child’s needs are being adequately met and they feel safe in knowing that mum and/or dad is there for them. Unfortunately, for some people disruptions to the attachment system can occur (e.g. divorce, witnessing domestic violence, separation from parents) and can lead to them developing an insecure attachment style. This can present as an anxious style where the person is constantly worried about being abandoned or rejected and as a result will engage in excessive reassurance seeking and question other people’s love for them OR it can present as an avoidant style where the person keeps everyone at arm’s lengths and does not allow anyone to get “too close” as a means of self-preservation. Insecure attachment styles can affect one’s ability to have and maintain harmonious and fulfilling relationships. Some people feel they are trapped in a vicious cycle of bad relationships.

Within a therapy context, your psychologist can help you to examine your early life experiences and how this may have affected your attachment style. By gaining insight into your attachment style, therapy can help you heal from the pain of the past by helping you develop sound, healthy relationships by getting your emotional needs met and breaking the pattern of bad relationships.

Relationship difficulties

We all experience various challenges in our relationships but for some people it can feel like a never-ending cycle of downs. Interpersonal issues can be tough because it always involves at least one other person and we are only able to manage and control our own thoughts and behaviours. Relationship challenges can occur within the family, with friends, romantic partners or in a work/school settings.

Therapy can assist in examining your interpersonal skills and breaking bad patterns through skills such as assertiveness training, effective communication, mediation, boundary setting and problem solving about what is best for the relationship.

Generalised anxiety

Everyone experiences anxiety and gets worried to a degree, however some people find that they are in a constant state of nerves. They find themselves worrying about anything and everything! It may be anxiety about their health, the wellbeing of family/friends, school, work, finances, relationships, the future…the list is endless. Often there will be “what if” style thoughts and a preoccupation with the “worst case scenarios”. The anxiety can lead to physical symptoms (e.g. increased heart rate, shakiness, constantly feeling on edge, stomach pain, nausea) and some people will find that they start engaging in avoidance as a way of coping.

Psychological therapy will focus on helping you to manage your worries and decrease your anxiety by helping you to self-regulate, switch to effective problem solving where possible, managing and challenging your worry thoughts, limiting the time you engage in worrying and helping build up your confidence and ability to manage stressors.

Social anxiety

We all get nervous when we have to give a speech or presentation, however social anxiety is more than just nerves. Social anxiety is when someone has an intense fear of being negatively evaluated or judged and it can result in them avoiding social experiences or engaging in safety behaviours (e.g. drinking alcohol to settle the nerves) in order to cope. People with social anxiety often worry about saying or doing the “wrong thing” in social situations and can become easily embarrassed.

Within a therapy context, your psychologist will assist you in developing strategies to overcome your anxiety by helping you manage your anxious thoughts, help you gradually confront feared situations which will boost your self confidence, and decrease avoidance and safety behaviours.

Panic disorder & agoraphobia

Anyone who has ever experienced a panic attack will describe it as a horrible experience. A panic attack often results in the person struggling to breathe, feeling dizzy or lightheaded, shaking, tingling, tightness in the chest, having dry mouth and sweating. Some people will worry they are “going crazy” or having a stroke or heart attack. There is an overwhelming sense of feeling trapped and an urge to be able to escape. Panic attacks can last anywhere from minutes to hours. They can occur out of blue with no identifiable trigger. This can result in increased avoidance behaviours and some people develop agoraphobia which is where you fear and avoid places or situations that might cause you to panic and make you feel trapped, helpless or embarrassed.

Psychological therapy will include developing skills and techniques to manage panic symptoms when they do occur, calming the anxious mind in recognising that the symptoms cannot harm you in any way, learning manage feared situations (using a graded approach) and managing the feelings of panic and anxiety.

Obsessive compulsive disorder

The term OCD is often used colloquially to refer to someone as being super tidy or super clean. OCD as an anxiety disorder, however is much more than that. Individual who experience OCD have obsessive patterns of thinking which lead to repeated compulsive behaviours. Often these thoughts are very distressing (e.g. “did I turn the oven off, the house might burn down”) and the compulsions act to alleviate or neutralise the thought (e.g. going back to check the oven is off, all the powerpoints are off). The process of carrying these compulsions is often very time consuming and affects the individual’s quality of life. There is also often a great deal of shame experienced by the individual about the need to engage in the compulsions.

Therapy for OCD focuses on breaking the obsession-compulsion cycle by helping the individual manage the distress from the obsessive thoughts, challenge and recognise the thoughts are not necessarily true and through exposure response prevention disengage from the compulsive behaviours.

Stress (school, work)

We all experience stress as a part of daily living. However, there are times where people’s stress exceeds their ability to cope and they may experience emotional breakdowns. In today’s day and age (and thanks to technological advancements) we are all “online” and a lot of people find it hard to truly switch off (e.g. receiving work emails on the mobile and reading it outside of work hours). Going through big milestones can also be stressful (e.g. sitting the HSC, getting married, moving house) especially when we are overly focused on trying to get everything done “perfectly” or have high standards (refer to Perfectionism for more).

Learning to manage stress through good time management, problem solving and setting good boundaries is a big focus within therapy. A big focus is on self care and recognising the importance of being able to establish balance in your life (which can sometimes mean assertively saying no).

Family difficulties

Everyone has challenges within the family to some degree. Usually the more family members there are, the more opportunity there is for conflict. For some people they struggle with how the family dynamics affects their emotional wellbeing (especially when some relationships are toxic).

Coming to therapy to deal with family challenges can be useful in setting good interpersonal boundaries, dealing with attachment issues (refer above to Attachment Issues) and improving relationships all around. It can also be useful in gaining further perspective on family members and understanding their behaviours (as opposed to feeling that you are to blame for their behaviours).

Self esteem

How we feel about ourselves plays a big role in how we interact with other people. People with low self esteem often experience difficulties with confidence, independence, self-trust and make upward comparisons (comparing the self to people who are seen as being “higher” on the totem pole e.g. richer, better looking, more successful). Low self esteem can develop via different paths such as frequent criticism as a child, bullying or lack of praise.

Psychological therapy focuses on building your sense of self efficacy/esteem through developing a strong sense of compassion towards yourself, being able to challenge and modify the unhelpful negative thoughts and boosting your confidence in your abilities.

Perfectionism

Perfectionism is not necessarily a bad thing, it can often motivate and drive us towards working hard to achieve. However, perfectionism is detrimental when it takes a toll on our wellbeing. Individuals with high levels of perfectionism are often preoccupied with the “small details” at the cost of their time and health, be highly critical towards themselves (and sometimes others), set unrealistic standards, and focus on the glass being “half empty.” People with perfectionism often experience an “inner critic” within themselves that pushes them to keep going harder at whatever expense.

In therapy, skills and techniques to disarm the inner critic are developed, learning to allow yourself to have a break (and be human!) and focusing on celebrating the achievements you have rather than the ones you have not gained.

Grief and loss

We all ultimately experience grief and loss at one point in our lives. It is normal to need some time to process the loss of a loved one, however for some people they struggle to recover from the loss even years later. Some people also go through a process of grief before they experience loss (e.g. when a loved one has a terminal diagnosis) and find it very challenging to know how to prepare (or when to prepare) for their loss. Prolonged grief can result in frequent teariness, ongoing sad and depressed feelings, preoccupation with memories of the past, and occasionally trauma memories of the loss. This can result in feeling trapped in the past and being unable to “let go”.

Psychological therapy can assist in processing your grief and loss in a healthy way to gain closure and move forward with your life instead of feeling trapped in the past. This can involve talking about the relationship you shared with that person and also being able to externalise any feelings or words that were left unsaid in order to gain closure. We can be respectful to the memory of our loved one and continue to feel their loss but still be able to live our lives to the fullest.

Adjustment

Experiencing life transitions whether they be major or minor can take a toll on our wellbeing. It is normal to have some difficulties after these transitions (e.g. moving house, getting married, going through a career change), however some people notice the adjustments taking a big toll on their mood and feeling constantly overwhelmed. This may be due to challenges in adjusting to change.

In therapy, strategies to manage and adjust to change are discussed including ways to manage your emotions, problem solving the issues that have arisen from the transitions, reframing the changes in a more helpful manner and decreasing the anxiety you may experience.

Anger

Experiencing anger is very normal as anger is a universal core emotion. We all get angry from time to time (e.g. when someone offends us or sitting in peak hour traffic) and usually this feeling will pass as we learn to blow off steam. For some people, they find it challenging to regulate their anger and can go from 0 to 100 in a matter of seconds. They often describe it as “seeing red” and feeling a lack of control over their angry outbursts. This can have a destructive impact on relationships, work, and many other aspects of life.

Psychological therapy can help in learning to regulate the anger via diffusing from challenging situations, being able to communicate assertively, and deal with difficult situations in a more productive manner.

Personality disorders

We all know at least one person who has a “challenging personality” and this often impacts how we interact with that person. Personality disorders are experienced by people whose personality traits cause distress to themselves and/or others. The origin of personality disorders is often traced to early life experiences (e.g. abuse or neglect as a child, trauma, chaotic home environment) as well as a family history of personality disorders or other mental illness. Some signs of a personality disorder may include narcissism, volatile mood swings, social isolation, difficulty maintaining and sustaining relationships, poor impulse control, excessive reassurance seeking and alcohol or substance abuse. There are ten types of personality disorders which you can read about further here.

Psychological therapy for personality disorders will vary based on the personality challenges you present with. A common theme in therapy is learning to gain insight on how your personality and behaviours affect other people, establish good interpersonal boundaries, processing the traumas that may have led to the personality disorder, how to break the unhelpful behaviour and thought patterns that maintain the problems you have and developing healthier coping mechanisms.