Effective Therapy from Psychologists

Central and East London

Glossary

Addiction

Traditionally ‘addiction’ was defined as a state of dependency on a chemical substance (e.g. alcohol, cocaine, cannabis, nicotine) which involved a strong physiological and psychological need and a compulsive inability to resist taking the substance; despite the individual anticipating probable negative consequences. More recently, it has been recognised that behaviours other than taking chemical substances can be highly addictive – such as gambling, over-eating, sex and pornography. See Alcohol Misuse, Drug Misuse, Sex Addiction and Pornography Addiction. For food addiction, see Comfort Eating.

Agoraphobia

Agoraphobia is a type of anxiety in which you become frightened of particular situations where you feel it would be difficult to leave or escape. Common examples include a fear of being in tubes, cinemas, supermarkets, as well as large open spaces such as parks. It is often associated with having panic attacks in the feared situation, or in anticipation of facing the feared situation. People who experience agoraphobia tend to avoid their feared situations, and gradually feel less and less confident about going out. Without treatment the range of situations in which you feel comfortable often narrows over time. Agoraphobia can leave you feeling ashamed and depressed as you are unable to participate in roles and activities that you used to value and enjoy. Treatment for agoraphobia involves understanding the nature of your fears and then learning skills and techniques to cope with them, so that you can gradually get back to doing the things you value. Cognitive Behavioural Therapy has been shown to be very effective for overcoming agoraphobia and panic attacks.

Alcohol – misuse, dependency and addiction

Many people drink more than they feel is strictly good for them, but it can be difficult working out whether drinking is really problem for you or not. On the positive side, alcohol can provide an easy way of relaxing, connecting with other people and feeling less socially inhibited. On the negative side, drinking heavily can leave you feeling out of control, tired, depressed and in poor physical health. Often people find themselves drinking more heavily when they are trying to cope with a difficult emotional state – such as feeling low, anxious, frustrated or bored. When considering whether to cut down or stop you may weigh up the pros and cons on your life; as well working out how able you feel to make changes on your own. Often therapy can be very helpful in deciding whether you really want to make a change, and if you do, helping you cope with the feelings (both physical and emotional) that underlie your drinking.

Anorgasmia

Also known as inhibited female orgasm. Characterised by consistent absence of, or significant delay in, orgasm in response to sexual stimulation that is judged to be adequate. It is important to note however that estimates suggest that only 20-30% of women are able to experience orgasm if solely relying on vaginal stimulation by penis so it may be more common to have difficulty achieving orgasm during intercourse (if no other forms of stimulation are used) than unusual. Therefore in these circumstances it is unclear whether a diagnosis of anorgasmia would apply. If difficulties achieving orgasm are experienced persistently and across different kinds of situation (e.g., clitoral, self, vaginal) then this might be more indicative of anorgasmia.

Anorexia

Anorexia shares many features with restrictive eating but is more severe. It is technically defined by a very low Body Mass Index (BMI) and, in women, the absence of regular periods (not due to any other medical condition). The drive to remain thin and feel in control is overwhelming, and many people with anorexia feel they have no real choice but to maintain a low weight. Therapy can offer an opportunity to be understood, without being judged or controlled. The therapist explores how you would like to relate to eating, food, and your body and then develop a ‘healthy side’ of yourself to move in a positive direction for you.

Anxiety

Refers to a state of uneasiness accompanied by dysphoria (unpleasant mood) and physical
signs of tension. Your attention is focussed on anticipating possible failure, misfortune or danger. In anxiety disorders, people become preoccupied with a feared event, and typically over-estimate the likelihood or severity of this event and underestimate their ability to cope if the event occur. Because severe anxiety is a very aversive experience people often develop ‘fear of fear’ in which you start to anticipate and fear becoming anxious (irrespective of any other event happening or not). This often results in an attempt to avoid situations which might make you anxious, and therefore a reduction in the range of things you feel able to do. Anxiety can become focussed on a wide range of events or situations including particular places, tasks or social situations. See Agoraphobia, Panic Attacks, Social Anxiety and Generalised Anxiety Disorder.

Bereavement

Losing someone you love can be one of the most sad and painful experiences in life. Grieving and being able to move on can be a difficult journey, sometimes triggering unresolved losses from the past, as well as uncertainty about your future. Grief can evoke a whole range of emotions including hopelessness, anger and despair. Therapy can be helpful in coming terms with your loss, particularly if you feel stuck or unable to move on with your life after a period of grieving.

Bi-polar Disorder

Bi-polar disorder is characterised by a combination of manic and depressive episodes. A manic episode is defined as distinct period during which there is an abnormally elevated, expansive or irritable mood. The person also usually experiences some or all of the following symptoms including inflated self esteem, decreased need for sleep, racing thoughts, distractibility, a decreased awareness or concern about possible adverse consequences of their actions and an abnormally intense drive towards the achievement of a particular goal. During a depressive episode, the person experiences some or all of the following symptoms: depressed mood, diminished interest / pleasure in almost all activities, altered patterns of sleep and appetite, a feeling of being slowed down, fatigue and loss of energy, feelings of worthlessness and/or excessive guilt, problems concentrating and making decisions. Often people with Bi-polar Disorder experience their first manic episode when they are relatively young and it can be a deeply frightening experience, as they often feel confused and out of control. Your personal relationships can also suffer as people around you are usually unaware of why your behaviour has changed. A combination of cognitive behavioural therapy and medication can be very effective in helping to reduce the likelihood of a recurrence of manic and depressive episodes, as well as providing strategies to cope if you experience a relapse in your symptoms.

Borderline Personality Disorder / Traits

(also known as Emotionally Unstable Personality Disorder)

Borderline Personality Disorder (BPD) is defined by a number of characteristics including an unstable sense of identity, an strong fear of being abandoned or rejected, low self esteem, labile mood, suicidal feelings, and in some cases, self harm. Traditionally, BPD has been associated with some very negative stereotypes, however, in the last 10 years the view of BPD has fundamentally changed. There is a new understanding of the problem as resulting from very difficult early experiences, in some cases combined with a naturally sensitive temperament. In fact, most people have some fear of being rejected or abandoned, at times feel unsure of how they are, and find their mood can swing surprisingly quickly – in BPD these issues are just more severe and you find it more difficult to cope with your emotions. People with BPD have usually had very difficult experiences when they were children – typically they never learnt to feel that they were loveable, acceptable or wanted, or that other people could be trusted to meet their needs in a safe way. It is important to note, the borderline ‘traits’ are often present without meeting criteria for a full disorder. This means, for example, that you may have a strong fear of being abandoned or rejected but may not self harm or feel suicidal. Schema Therapy and Cognitive Analytic Therapy have been specially developed to help with the problems underlying BPD, and have been shown to improve people’s sense of well being, their personal relationships and to reduce self harm.

Bulimia Nervosa

In Bulimia Nervosa you alternate between episodes of bingeing on food, followed by an attempt to compensate – including vomiting, use of laxatives, excessive exercise and extreme dietary restriction. People with bulimia often have a sense of self-loathing and experience a feeling of release, comfort or self-expression through bingeing. Sometimes bingeing is triggered in response to breaking a dietary ‘rule’ (for example eating a biscuit when you are trying to keep to a 1,500 Kcal diet), whereby the feeling of guilt, self criticism and/or frustration of having broken the rule is so great you give up all control, promising yourself you’ll make up for it later. At other times, bingeing may be triggered by emotional factors, such as feeling rejected, let down or criticised. Many people with bulimia keep their problem hidden, as they feel ashamed and out of control. Therapy can provide the opportunity to understand the thoughts and feelings driving the problem, and form a healthier relationship with food and your body.

Chronic Illness

The term chronic illness or chronic condition covers a wide range of physical health problems relating to any/all parts of the body (chronic pain, diabetes, hypertension, heart disease, cancer, gastrointestinal disorders chronic fatigue syndrome, HIV to name a few). Clinical psychologists have a long history of providing psychological therapy for people with a wide range of chronic illnesses to address common issues including adjustment to diagnosis, adjustment to treatments or intrusive medical investigations; feelings of depression or anxiety as a result of illness; impact on daily life, sex and relationships; factors that can aid recovery; issues around death and dying.

Clinical Psychologist

Clinical psychologists will have completed a three-year psychology degree and a professional three-year, postgraduate clinical psychology training course. They use their knowledge and skills of psychology and psychotherapies to help people address difficulties connected with various aspects of their lives and improve the quality of their lives. Clinical psychologists do not prescribe drugs, but are able to help people think about when such treatments may be appropriate.

Cognitive Analytic Therapy

Cognitive analytic therapy (CAT) was developed in the 1980s by Dr Anthony Ryle, as a time-limited collaborative psychotherapy.  CAT is about building a trusting and collaborative relationship with your therapist so that you can identify your current problems and how they affect your life and wellbeing.  CAT looks at the underlying causes of these problems in terms of your earlier life and relationships.  This helps you understand how you learned to survive sometimes intense and unmanageable feelings and situations by relating to others and yourself in particular ways.  CAT is also about finding out how you can continue to move forward after the therapy has ended.    The early sessions of CAT are devoted to exploring and understanding your relationships and experiences during childhood and adolescence and your social contexts such race, gender or sexuality to help you understand  more the person you are now.  These understandings are  used to find solutions or “exits” to the unhelpful or self-defeating patterns of thinking, feeling and acting learnt from your earlier life; this is the bulk of the work of CAT.  The therapist and client work collaboratively to provide the tools that will help you find solutions during therapy and beyond.  CAT usually lasts for between 16-24 sessions, although in some circumstances it can be shorter. CAT has been shown to be effective in the treatment of a wide vary of problems such as relationship problems, self-harm, mood disorders and addictions.

Cognitive Behavioural Therapy

CBT is an active and collaborative therapy which aims to help clients understand the ways in which they respond to the world around them. Through looking at the way we make sense of our experiences and everyday situations, the therapist and client identify alternative ways of interpreting and evaluating the world. One of the principles of CBT is that there is always an alternative point of view or way of looking at something.  In addition to helping clients identify new ways of looking things, CBT also helps clients understand how our evaluations impact on our emotional state. Further, CBT looks at how we respond behaviourally to the situations that we confront. By helping clients identify patterns in our behaviour, CBT helps the individual to find new ways of responding which can, in turn, lead to new experiences in terms of thinking and feeling.

CBT focuses on the client’s goals and the therapist works closely with them to help achieve the desired outcomes. There is a strong emphasis on homework and between session tasks. Clients are encouraged to become personal scientists in their approach themselves and their experiences by experimenting with new ways of thinking and behaving.  In this way, the client gradually learns to become their own therapist so that when they face difficult situations after the therapy has ended, they are able successfully to tackle them alone.

Research has shown CBT to be an effective treatment for a wide range of problems. The length of the therapy will depend on circumstances but CBT generally lasts for between 8-16 sessions.

Comfort eating

Eating lowers our level of physiological arousal, effectively having a calming effect on the body. It’s unsurprising then, that many people turn to food for comfort when they are faced with a difficult emotional state (for example feeling sad, anxious or frustrated). In moderation, comfort eating is largely harmless, however it can become a problem if it becomes more habitual. This can ultimately feel similar to an addiction, as for some people food provides immediate (if short lived) relief from feeling bad. Unfortunately, over-eating can then leave you feeling out of control, guilty and worried. To compensate, you may try to restrict your diet but this can swing too far the other way, resulting later in very strong urges to eat, followed by another cycle of overeating or bingeing. Some people do not compensate for comfort eating, but usually still feel very concerned about their weight. Breaking the pattern of dieting and/or overeating involves understanding the feelings that drew you to food as a comfort in the first place. The therapist can then help you learn new skills to negotiate these feelings without turning to over-eating.

Compassionate Mind Training (CMT)

Compassionate mind training (CMT) was developed to target self criticism, shame and difficulties with self-acceptance. If you are someone who tends to be highly self-critical and who finds it difficult to be kind and compassionate towards yourself, it can be doubly difficult to manage periods of stress, depression, relationship problems etc. Scientific evidence has shown that compassion towards oneself and others can increase happiness and wellbeing, which is particularly important in the face of any kind of suffering or distress. This training is skilled-based and looks at ways of shaping your behaviours, thought patterns, mental images and emotions to promote compassion towards yourself and others.

Couple Therapy

Couple therapy offers a safe, neutral space for couples to address difficulties in their relationship including issues around communication, trust, safety, intimacy, sex and negotiating sexual or other boundaries. Couple therapy draws from a range of psychological therapies including ‘systemic’ or family therapies which pay attention to both partner’s differences in values, cultures, genders, sexualities, ethnicities, backgrounds and life-experience and how these impact on the difficulties you are experiencing. This together with cognitive and behavioural therapy approaches will help you to understand what keeps difficulties going and why it has been difficult to overcome them so far. It focuses on how to build on your strengths and resources as an important step in enabling you to try out new solutions to your problems.

Depression

Most of us experience periods of feeling low at some stage, where life starts to feel like a struggle and it’s difficult to envisage getting back onto a more even keel. In more prolonged and severe depression, people typically feel some or all of the following: a loss of enjoyment in previously valued activities, difficulty concentrating, making decisions and initiating tasks, feelings of worthlessness or excessive guilt, altered sleep and eating patterns and suicidal thoughts or urges. There are many different theories about what causes depression, but most agree that it comes about when someone has experienced significant losses or deprivation in their lives, either as an adult, or in their early life. In some cases a person’s experience as a child has left ill equipped to deal with disappointments in adult life, and an adverse experience such as a redundancy or rejection triggers a strong sense of hopelessness and self criticism, which often results in the person withdrawing and becoming less active and involved in life than before. For others, there may be no obvious issues stemming from childhood, but they have suffered many losses and difficulties as an adult, leaving them feeling overwhelmed and unable to cope. Depression is one of the most common problems leading people to seek therapy. A variety of different approaches have been shown to be effective, so it is a good idea to discuss with your therapist which type of therapy might suit you best.

Drug misuse, dependency and addiction

Many people experiment with recreational drugs without any ill effects. However, some people find themselves relying on drugs in order to cope in their day to day lives, and feel otherwise unable to relax or enjoy themselves. Certain prescription drugs (for example Benzodiazepines and certain sleeping tablets) can also become a problem, and having initially intended to take a medication for a short period you may end up having trouble weaning yourself off. You may also feel quite torn about whether you want to change your drug use, as there are usually pros and cons to cutting down and you may feel unsure about whether you could stop, even if you wanted to. Therapy can provide a space to think about these issues without being judged. If you decide you want to cut down or give up using drugs your therapist can work with you to understand what is driving the drug use and help you make a change.

Eating Problems / Eating Disorder

See anorexia, bulimia, comfort eating, restrictive eating/chronic dieting

Emotionally Unstable Personality Disorder

Another term for Borderline Personality Disorder.

Food Addiction

See Comfort Eating.

Generalised Anxiety Disorder

In this condition you are preoccupied with worry about a range of different things (for example relationships, work, your children). You may find it difficult to control your worrying, and also feel on edge, tired, irritable and have difficulty concentrating.

HIV

The Human Immunodeficiency Virus (HIV) is a virus that attacks the body’s immune system. A healthy immune system provides a natural defence against disease and infection. HIV infects special cells, called CD4 cells, that are found in the blood and are responsible for fighting infection. After becoming infected, the CD4 cells are destroyed by HIV. Although the body will attempt to produce more CD4 cells, their numbers will eventually decline and the immune system will stop working. This leaves a person who is infected with HIV with a high risk of developing a serious infection or disease, such as cancer or pneumonia. HIV is spread through the exchange of bodily fluids. This most commonly happens during sexual intercourse, including oral and anal sex. HIV can also be transmitted through sharing needles, or from a pregnant woman to her unborn baby. There is no cure for HIV and no vaccine to stop you from becoming infected. However, since the 1990s, treatments have been developed that enable most people with HIV to stay well and live relatively normal lives.

Impotence

Or erectile dysfunction. This is a persistent or recurrent difficulty to attain or maintain an erection. Estimates suggest that between 10 and 20% of the population experience problems to this degree, but if occasional erectile problems are included, then almost 70% of men report problems at some stage in their lives suggesting it is extremely common to experience occasional problems with erections. Medical causes such as vascular disease increase with age, in younger people psychological factors, particularly performance anxieties, play more of a role. However, careful assessment is needed to determine what biological, psychological or social factors may be involved. Treatments for impotence can include medications such as Viagra or psychological therapies such as Cognitive Behavioural Therapy, or both, depending on the identified causes and impact upon the individual.

Low self esteem

Self esteem refers to your attitude, evaluation or opinion of yourself. Low self esteem is common in a range of psychological problems, as the fear that you are ‘not good enough’ can undermine your ability to form and maintain intimate relationships, perform at work and enjoy social situations.

Mindfulness

To be ‘mindful’ means paying attention to the present in a particular way – with purposeful intent, in the present moment and non-judgementally (Jon Kabat Zinn). Much of the time we spend our lives in ‘automatic pilot’ mode, reacting to situations based on particular thought patterns we have or emotions we feel, without being really in the present moment with total awareness of the situation and options for dealing effectively with it. This is particularly important at times of difficultly or when we feel distressed, depressed or anxious as thinking ourselves out of these moods or situations often doesn’t work and can create further frustration. Mindfulness-based therapies, including mindfulness-based stress-reduction (MBSR) and mindfulness-based cognitive therapy (MBCT) focus on building up meditative practices and daily skills in mindfulness as a means to getting to know your own mind, mood and body and learning to how to develop a new relationship to them. Mindfulness-based therapies have been shown to help people struggling with chronic illness (chronic pain, hypertension, heart disease, cancer, gastrointestinal disorders) as well as for psychological problems including anxiety, panic and recurring depression.

Narcissism

Dictionary definitions of narcissism usually refer to ‘self-love obtained by contemplating oneself’. However, modern psychological theories of narcissism have a different view. Narcissism is characterised by a preoccupation with your own worth or status, maintaining control and ensuring your needs are met at all costs. Unfortunately, when these characteristics are very strong, it is easy to alienate and hurt other people as their needs can get overlooked. Many people who are described as ‘narcissistic’ are in fact compensating for an underlying sense that they will be ignored, mistreated, or undervalued unless they are ‘the best’ and in control at all times. When this is unachievable (for example following a rejection or failure) people with narcissism feel very vulnerable and alone, and try and avoid these feelings by either distracting themselves or working even harder to regain their status/control. Therapy involves understanding your particular pattern of behaviour and the underlying need for status, approval and control. Over time therapy can be extremely effective in developing healthier relationships and a more balanced sense of identity.

Obsessive Compulsive Disorder (OCD)

The main feature of OCD is the occurrence of obsessions or compulsions that are time consuming or cause marked distress or impairment. Obsessions are persistent thoughts, impulses or images that are experienced as intrusive and inappropriate. For example, a religious person may have persistent blasphemous thoughts, or a mother may have thoughts of harming her new-born child. The most common obsessions concern thoughts about contamination, doubting (e.g. whether you have turned the cooker off), and violent or sexual images. A compulsion is a repetitive behaviour, which may be overt and visible to other people or covert (usually a mental act). Overt compulsions include checking, handwashing and ordering objects. Covert compulsions include counting, praying, repeating words or concentrating on opposite content from the obsession. Compulsions are initially aimed to neutralise or prevent a feared event or consequence of the obsession. However, they often develop into a ritual, so the person may not be aware of why they are completing the compulsion. You may find the obsession (for example a thought about being dirty) makes you anxious and performing the compulsion provides immediate (if short lived) relief. This is often followed by distress and guilt as you may then feel out of control, often with the obsession resurfacing quickly and a new need to perform the compulsion. Cognitive Behavioural Therapy has a strong evidence base for its effectiveness in helping people overcome OCD.

Panic attacks

A period during which there is a sudden onset of intense terror, fear or apprehension accompanied by physical symptoms such as shortness of breath, smothering or chocking sensations, increased heart rate, palpitations, chest pain, dizziness and nausea. Panic attacks are caused by a massive rush of stress hormones which are triggered by the brain when it detects some kind of threat, which can be either physical or psychological. People can become very frightened of having a panic attack and often avoid situations in which they have experienced them before. This can result in them feeling unable to participate in things they used to value, reducing their self-confidence and enjoyment in life. Cognitive Behavioural Therapy has been shown to be highly effective in the treatment of panic attacks.

Personality Disorders

Personality Disorders are defined as an enduring pattern of inner experience and behaviour that deviates markedly from the expectations of the culture of the person who exhibits it. To be given a diagnosis, this deviation has to be severe, pervasive, chronic and have a significant negative impact on the individual and/or those around them. Most people who are given a diagnosis of a personality disorder experience problems in their relationships, find it hard to cope with their emotions and feel unsure of who they are or their worth. In the past personality disorders were seen as an innate set of characteristics that were resistant to any attempt at change. The term itself unfortunately has connations that there is something fundamentally and pervasively wrong with the person. Recent research and theory has radically revised this view. It has been shown that most people with a PD diagnosis have had very negative experiences as children, making it harder for them to learn how to cope with their own emotions and get on with other people. In addition, recent outcome studies show that people diagnosed with PD can do very well in a number of different types of treatment. The therapies that appear to be most helpful are well structured, have a clear inter-personal focus, and allow for a strong attachment between the client and the therapist. Cognitive Analytic Therapy and Schema Therapy both have good evidence for their effectiveness in treating personality issues / disorders. (See Borderline Personality Disorder and Narcissism.)

Pornography Addiction

A situation where the use of internet pornography escalates to the point that it causes significant problems to the individual’s ability to function in daily life and produces adverse negative consequences in the areas of relationships, work or emotional well-being. An individual suffering from pornography addiction might typically spend hours using internet pornography each day, with the result that they may not for example, be able to meet their job demands or engage in relationships with others. There is debate about whether the term addiction is appropriate in this context as with sex addiction overall, but it is recognised that for some people their use of internet pornography can become highly problematic and in some cases lead to contact with law enforcement agencies.

Post-Natal Depression

Women experiencing post-natal depression experience similar symptoms as people with depression with an onset within around 4 weeks of giving birth. It should be distinguished from a short period of low mood and tearfulness in the first week after giving birth, commonly known as ‘baby blues’. Women with post natal depression usually feel very anxious and emotionally distant from their baby (despite a strong conscious desire to connect with the infant). Many women feel especially guilty and ashamed about feeling depressed at a time they believe they should be happy. This can make it harder to talk openly, even though you may feel in desperate need of support and reassurance.

Post Traumatic Stress Disorder (PTSD)

PTSD is an anxiety disorder arising as a delayed and prolonged response after experiencing or witnessing a traumatic event involving actual or threatened death or serious injury to self or others. It is characterised by intense fear and a sense of helplessness, the traumatic event being persistently re-experienced in the form of distressing memories, recurrent dreams, sensations of reliving the experience or flashbacks. People also experience intense distress and physiological reactions in response to anything reminiscent of the traumatic event. Cognitive Behavioural Therapy and EMDR (Eye Movement Desentisation and Reprocessing) have both been shown to be effective in the treatment of PTSD.

Premature Ejaculation

Or lack of ejaculatory control is where men have difficulty or find it impossible to control the timing of their ejaculations usually doing so well before they would want causing significant distress. Rapid ejaculation is almost always due to a lack of sexual knowledge, attention to subjective arousal level, or skill. Anxiety can also cause loss of control over ejaculation. Biological causes are very rare indeed. Ejaculatory control is a skill or habit that can be learned and around 80% of people improve their degree of ejaculatory control with sex therapy, which usually involves undertaking a programme of exercises over several weeks or months.

Psychosis

Psychosis refers to the experience of delusions, hallucinations and thought disorder. Delusions are beliefs held by an individual despite clear evidence to the contrary, which are also inconsistent with his/her peer group. Common delusions include the belief that you are being persecuted, that you have special powers or that your mind and body has been taken over or controlled by another person/agency. A hallucination is essentially a sensory experience (e.g. tastes, sight, touch, smell, hearing) in the absence of an external stimulus. Though disorder refers to persistent and extreme breaks in your train of thought, usually evidenced by disrupted patterns of speech (such as shifting from one topic to another), apparently irrelevant speech of inclusion of invented or meaningless words. Delusions, hallucinations and thought disorder can occur as a result of taking certain recreational drugs, or as part of a psychotic condition such as schizophrenia. In these cases, you usually also experience what are known as ‘negative symptoms’ including apathy; incongruous emotional responses and social withdrawal. A combination of psychological therapy and/or medication can be very effective in helping people understand and manage their condition.

Relationship problems

Most of us aim to get on well with other people and feel close in our intimate relationships. However, this is often easier said than done with a range of problems cropping up at work and at home. These can span from having difficulty being assertive, to losing your temper, to finding it hard to open up to your partner or friends. Both individual therapy (see Cognitive Analytic Therapy and Schema Therapy) and Couple Therapy can help change the patterns that are causing a problem. It is usually best to discuss which would be most helpful for you at your assessment.

Restrictive eating and chronic dieting

This refers to a pattern of continually trying to restrict how much you eat, often in order to lose weight, but also sometimes to feel in control. Typically, if you have this pattern, you constantly strive to follow an eating plan; and feel frustrated and self-critical when you deviate from it. Success in following the plan leaves you feeling great, but the sense of achievement is often short lived, either because you find yourself lapsing into eating more again – or because the rule becomes tighter (see Anorexia). Most chronic dieters feel preoccupied by food and their weight, and continually dissatisfied with themselves. The hope the new regime ‘will work this time’ is incredibly tempting, but the cycle of dieting and lapsing tends to resurface – leaving you feeling very stuck. Effective therapy for this pattern involves learning a new healthier relationship with food and your body.

Retarded or delayed ejaculation (Inhibited male orgasm)

This refers to the persistent or recurrent delay in, or absence of, orgasm in the male during sexual activity judged to be adequate in duration and intensity. However in reality what is judged adequate is hard to determine. A total absence of orgasm in men is extremely rare and research suggests delayed ejaculation is much more likely to occur for heterosexual men during vaginal intercourse than in self-stimulation or oral sex. Pressure to perform, anxiety, and excessive importance attached to ejaculation can all inhibit ejaculation in men.

Schema Therapy

Schema Therapy is an innovative psychotherapy for long lasting problems such as relationship issues, chronic depression, anxiety and personality difficulties. It integrates Cognitive Behavioural Therapy (CBT), Object Relations, Attachment Theory and experiential techniques into a unified whole. There is good evidence that it is effective in treating a wide range of problems including complex cases such as personality disorders (Giesen-Bloo et al, 2006).

Therapists are drawn to the therapy not only because of strong evidence for its effectiveness but also because it provides a structure for developing a joint understanding of clients’ difficulties, a clear focus for treatment and strategies for deep and sustained change, within an emotionally healing therapeutic relationship.

Sex Addiction

There is a range of opinion about what constitutes sex addiction. Some experts believe sex addiction is very similar to substance addiction, where a state of dependency develops and physiological withdrawal is observed. Other experts believe that sex addiction is a form of obsessive-compulsive behaviour. It is generally accepted however that some people can lose control over their sexual behaviour and it can cause significant harm to their relationships, work, and emotional well-being. Physiological phenomena observed in substance addictions are often seen in sex addiction such as a need for markedly increased amount or intensity of the behavior to achieve the desired effect and the same (or a closely related) behavior is engaged in to relieve or avoid withdrawal symptoms. Psychological understandings of sex addiction do acknowledge these kind of physiological componets, but attempt to undertsand the reasons behind the behaviour and the functions that it serves. In many cases people come to use sex as a way of trying to cope with overwhelming or diffuclt feelings like emptiness or anger. Sex can alleviate these feelings in the short term so it becomes reinforcing, but the behaviour causes harm to self-esteem, interpersonal relationships and overall well-being in the long-term.

Sex Therapy

Sex therapy uses cognitive behavioural therapy ideas and techniques to identify the psychological, emotional and situational factors that may be interfering with sexual activity. Therapist and client then work collaboratively to design and implement strategies for to help overcome the problem.

Sexual Problems

Some form of interruption to the processes associated with the phases of the human sexual response cycle (desire, excitement, orgasm, resolution) for example, pain on intercourse for women or absence of ejaculation in men. Experts have found it difficult to achieve consensus on what constitutes “normal sexual behaviour” given the diversity of sexual behaviour in humans, for example, what is the normal time taken for a women to become sexually aroused following the commencement of stimulation? Or similarly what is the “normal” duration for a male to hold back ejaculation once sex starts? Because of these uncertainties, a sexual problem is usually considered to be present only when the response e.g., orgasm, is either totally absent or rarely present for more than a few weeks AND causes significant distress. Sexual problems can be lifelong if they have been present since the person became sexually active, or acquired if they developed after a period of normal functioning. They can also either be generalised across types of sexual activity, situations and partners or situational, that is, limited to certain circumstances e.g. casual partners only. A range of biological, psychological and social/cultural factors determine sexual responses in humans. Therefore sexual problems can be caused by any of these factors. People often want to know if the problem is biological or psychological. The more useful question to ask is how much of any given biological, psychological or social factor is contributing to the problem. (See Anorgasmia in Women, Impotence, Premature Ejaculation, Retarded Ejaculation, Sexual Aversion Disorder, Sexual Desire Disorder, Vaginismus).

Sexual Aversion Disorder

The persistent aversion to, and avoidance of, all or almost all sexual contact. An aversion to and avoidance of some forms of sexual activity such as oral-genital contact is relatively common and would not be considered a disorder. This is only said to exist if aversion and avoidance responses are sufficiently generalised to include all forms of sexual contact with a partner.

Sexual Desire Disorder

This is characterised by persistent low desire for and interest in sexual activity or sexual fantasies. It has been suggested to be a relatively common problem and one that increases with age. Many couples report some loss of sexual interest as length of time together increases and highlights the need for continued communication and effort directed towards the sexual side of the relationship. Often the problem is about differences between the couple in their level of desire as it is hard to determine normal level of sexual desire. E.g., it would be unlikely that a couple would seek help if both had low levels of desire and found this satisfactory. However as people commonly think more is better with sex the person who may have lower levels of interest is often viewed as the problem. Loss of interest in sex can be associated with depression so it is important that this is excluded as a cause as it would need treatment in its own right.

Social Anxiety

Social anxiety refers to a fear of being exposed to unfamiliar people or to possible scrutiny by others. You fear that you will act in a way (including showing your anxiety) that will be humiliating or embarrassing and that other people will form a negative view of you. Social anxiety can cause you to withdraw from other people, often resulting in low self esteem and loneliness.

Stress

Stress can be defined as psychological and physical strain or tension generated by physical, emotional, social, economic or occupational circumstances, events or experiences that are difficult to manage or endure. Stress can be maintained by worry, in which you perpetually ruminate on perceived problem or fear (see Generalised Anxiety Disorder).

Vaginismus

This is the involuntary spasm of the outer muscled area of the vagina in response to real, imagined or anticipated attempts at penetration to the extent that it makes penetration difficult or impossible. More likely to be lifelong than acquired, and can be associated with faulty beliefs about sexual anatomy or intercourse e.g. that the vagina is too small to allow penetration. Most women who experience Vaginismus do not have an aversion to sex, in fact many report enjoying other forms of sexual activity. There is also no general established link with sexual abuse/trauma although could develop as a response to sexual trauma. Vaginismus can be easily treated in sex therapy using a cognitive-behavioural approach that involves using a graded hierarchy starting with vaginal self-exploration and insertion to gradual penis insertion at a rate that allows the anxiety response to be overcome at each step.