Effective Therapy from Psychologists

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Poor body image: why do we take our bodies for granted?

Posted: 18/10/2014

I was reminded yet again this week of how mainstream it has become in Western societies for people to view their bodies in a negative way. In a recent survey in a British women’s magazine of 5,000 women only 3% were ‘totally happy’ with their body and 73% thought about their size or shape every single day. Three-quarters were unhappy with their shape, 71% with their weight and 6 out of 10 said their body image made them feel depressed. The women who took part in the survey had an average age of 33 and more than half fell within normal weight limits for their height. Of course you may argue that readers of women’s magazines may be more conscious about their looks, but what we do know is that these findings are not exclusive to magazine readers, Britain, nor exclusive to women. Indeed, it now seems ingrained in our Western celebrity-obsessed culture that how we look is essential. So what’s happening here and what’s missing?

On an individual level, a common indicator of poor body image is the viewing of one’s body through a particular lens which selectively focuses on shape, size, skin texture or particular features and rates these against some kind of ideal – be that your former self, friends or contemporaries whom you perceive to be more attractive, or indeed celebrities or models which the media portray as the ideal. And we know that when this comparing takes place people consistently rate their bodies as worse than others and see themselves in a compartmentalised fashion (that is, focusing in on their ‘bad’ features) compared to how others see them as a ‘whole’ and in a more positive light.

So what’s missing here? From personal experience at times of injury or illness I notice how much we take our bodies for granted. Indeed it is often only when something ‘breaks’ or malfunctions in some way that we then appreciate it for what it usually does – so we change the lens of perception. I have found myself thinking at these times about the wonder of our bodies and all the functions they house – many unseen – such as metabolism, growth, repair, mobility, cognition, emotion, reproduction, resistance…and so on. A starting point in psychological therapy is to become an observer to these patterns. So, becoming aware of the persistent critical, negative thought processes involved in rating your body; the impact this has on feelings (e.g. self-disgust, distress, depressed, anxious); the consequent urges and behaviours that arise as a result of these feelings. For example you may find yourself becoming overly restrictive in your diet or engaging in excessive exercise – or feeling extremely guilty if you don’t. Or changing your body in some way (e.g. plastic surgery) but not feeling as content as you would have hoped. Equally it can be common that despite strong desires to change things, paradoxically you may find yourself engaging in self-soothing behaviours that sabotage your goals of ‘looking better’ but give you some respite from the bad feelings (self-disgust) albeit short-term. For example, comfort eating or binge-eating and drinking. This risks a vicious cycle developing whereby you may then punish yourself for comfort eating by restricting foods further or taking pills to somehow counter the effects. And so the cycle goes on.

Whatever the pattern, the goal in therapy is to help you mindfully and consciously develop a healthier relationship with your body by being aware of the influence of external factors like the media, redefining how you think about your body in ‘good vs. bad’ terms, and by working towards positive goals around fitness and health in a non-punitive way. Where would we start? Well, hypothetically speaking, what if ones body could somehow respond and answer back when it is repeatedly criticised? For example if your body was another person what would it tell you about the impact of those constant criticisms, disappointments, despair or self-contempt about what was apparently ‘wrong’ with it? How accurate would it say your judgement was? Is that judgement holistic or did you miss any positive qualities? How would it argue back in terms of what is right with it and what it does do for you? Would it think it was realistic of you to compare it to the body of a celebrity, model, top athlete, or your former self 5 years ago? And overall, what impact is this dialogue having on you generally and on your life? Is it helping you to live a fulfilled, positive life? Perhaps your body would ask you to stand up for its positive qualities, what it does for you and what it needs to ‘do its job’, and encourage you to feel at ease and content in your own skin.

Dr Samantha Leaity, Clinical Psychologist, Become Psychology

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What is the best way to overcome premature ejaculation?

Posted: 01/10/2014

Premature ejaculation is a common sexual problem affecting men. It is also something that in my experience men can feel ashamed about and understandably causes a lot of distress – often because men avoid sexual relationships.  Premature ejaculation is often thought of as ejaculating too quickly – in fact this is not the case.  There is no accepted “normal” length of time to last before ejaculating.  One survey found the average time to ejaculation during intercourse was two minutes.  The problem is actually one of lack of control over ejaculation.  Of course this usually means that men with this problem ejaculate before they want to and so usually report the problem as one of ejaculating too quickly. So why do some men have this problem?  The most convincing theory in my opinion is that control over ejaculation is something you have to learn and some men learn this skill while others do not.  This is probably because something stops this normal process of learning as men develop sexually such as lack of experience.  Masturbation during adolescence is an obvious way men learn to develop control and it is easy to see how if men do not practice masturbation for example, for religious reasons, they may not learn control over ejaculation.

In my experience there are a lot of myths and misunderstanding about the causes of premature ejaculation and many men suffer in silence or buy treatments online that have no evidence for effectiveness. There is no evidence that biological factors such as hormones play a role in premature ejaculation or that, treatments, such as desensitising sprays or antidepressants, solve the problem in the long-term. The good news is that there is good evidence that cognitive behavioural therapy can solve the problem.   Clients are taught to acquire control over ejaculation through a series of graded exercises that involve masturbation.  In my own clinical experience the exercises usually work well.  The skills acquired then form a solid basis on which to build upon during actual sexual encounters.  Unhelpful beliefs about the problem are also tackled during therapy.  I would recommend “The New Male Sexuality” by Bernie Zilbergeld as a good self-help book for premature ejaculation and other issues to do with sex and sexuality.  Or please do contact me to talk further.  I have worked with many men with this problem who suffered from it for many years, and overcame the problem quickly, and it was a shame that they had not accessed the right help sooner.  So I would encourage anyone with this problem to get help.

Dr Robert Watson, Clinical Psychologist, Become Psychology, October 2014.

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