Discover Chris Warren-Dickins, Psychotherapist with practices in South West London and Central London. 

The areas covered in South West London (Southfields, SW18 - near Wimbledon) include: Southfields , Wandsworth , Earlsfield , Wimbledon , Putney , Clapham, Merton, Clapham, Roehampton, Kingston
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Chris Warren-Dickins BACP Registered Counsellor
E:  chris@exploretransform.com
T:  07816681154
W:  www.exploretransform.com

​The first step to recovery is to recognise the different stages of addiction. Check out the Jellinek Curve and let me know what you think

Chris Warren-Dickins BACP Registered Counsellor
E:  chris@exploretransform.com
T:  07816681154
W:  www.exploretransform.com

Still unsure whether counselling is right for you?  Have a look at this short video and decide for yourself.  
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If you are interested in counselling or coaching, do get in touch to book a free initial appointment.

Chris Warren-Dickins BACP Registered Counsellor
E:  chris@exploretransform.com
T:  07816681154
W:  www.exploretransform.com

​‘I don't want to see anyone. I lie in the bedroom with the curtains drawn and nothingness washing over me like a sluggish wave.’  In her novel ‘Cat’s Eye’, this is how Margaret Atwood describes depression.  As a psychotherapist, I have worked with a number of clients who have worked through their depression, and Atwood’s description is spot on.  

Someone who is depressed will often find himself caught in the following double-bind –

• He assumes that there will be a negative outcome to most situations, and
• He assumes that he is inadequate or deficient.

As a result, if something negative does happen, this simply proves his assumption that he is inadequate or deficient.  Trapped in this double-bind, he does not have the ‘escape clause’ that other conditions offer:  For example, if someone with OCD follows a routine, they will find relief from the anxiety.  With depression, it often feels like there is no end to the ‘sluggish wave’.

The World Health Organization predicts that by 2030 depression will be the ‘leading cause of disease burden’ worldwide (‘The increasing burden of depression’, Jean-Pierre Lepine and Mike Briley). In the UK it is reported that one in five people become depressed at some point in their lives (Royal College of Psychiatrists), and so it is very common.  Sadly, not enough people talk about having experienced it, and so there is often an element of shame attached to it.

If someone is experiencing depression, they may find that they are helped by –

• Talking to a trained expert , and/or
• Seeking a prescription of anti-depressants from their GP.

If a person with depression decides to talk to a trained expert, one of the approaches is Cognitive Behavioural Therapy (CBT).  This is the approach recommended by NICE, but there is some debate about whether this is the only approach that is useful.  As I am an integrative psychotherapist, I would work with the client to make choices about how to work through their depression.  These choices would be informed by the client, the presenting issue, and any current research. 

Whichever approach we choose, I always work from a person-centred core.  This means that I listen actively to the client, paraphrasing their experiences back so that they know they are understood.  I do not make assumptions and instead I work hard to understand the client’s meanings (for example, what he means by ‘depressed’ and how this impacts on his life).  Sometimes just having the magnitude of one’s feelings acknowledged can be healing in itself.  But sometimes this is not enough, and so I work with the client to see what else we can do with the client’s experiences.

There is currently research being carried out to investigate what is known as theanalytical rumination hypothesis. In brief, this hypothesis suggests that depression serves a function, just as a fever indicates that the body is fighting an infection.  Some have suggested that the ruminative thoughts involved with depression might offer opportunities for that person to improve.  What a trained expert can do is to help that person along the rumination process, finding solutions for the problems that are causing the depression. For example, someone might be depressed because of a recent relationship breakup, and the ruminative thoughts might be about the depressed person trying to work out how they will live as a single person, or how they might live in a relationship differently in the future.  

This implies that there is a resolution to the process, once the depressed person makes sense of this new information.  If this is true, trying to medicate someone who is depressed might not be useful, as it might prevent the person from working through these ruminative thoughts and finding some sort of resolution.  The research on the analytical rumination hypothesis is far from conclusive, and so professionals urge people to not stop taking prescribed medication, but it is interesting to at least consider this as a possible explanation for depression.

Some clients have found mindfulness to be a useful approach with depression.  This approach was best described by Jon Kabat Zinn in his book ‘Full Catastrophe Living’:  ‘The essence of the practice is non-doing', it is a letting go’.  The purpose is not to achieve anything but to acknowledge and be aware of what is’.  So one approach might be to stop trying to fight the depression and see how it might be to accept it, in the hope that this might give it less power, and it might eventually fade into the background.

If CBT is the chosen approach, this would involve examining a client’s thoughts and assumptions.  For example, by talking to a trained expert the following clients might start to understand that –

• Jane often labels herself a ‘failure’ simply because she has made one or two mistakes at work.
• Paul often personalises situations, assuming that when something goes wrong, it is automatically his fault.
• Bill often lives by ‘rules’ that were once useful but now trap him in a depressed state: For example, he believes in the ‘pleasure-pain principle’, assuming that if it is pleasurable to have lots of money he will be in perpetual pain if he is not rich. 

Using CBT, a trained expert would help these clients to challenge these assumptions. For example –

• With help, Jane could start to question whether one or two mistakes at work necessarily means that she will always make mistakes. Reality testing is important here, so it would be important to find examples where she has done well, or when she has not made mistakes. 
• With help, Paul might begin to realise that a situation might have gone wrong for a whole number of reasons that do not involve him (a process known as ‘decentering’).
• Finally, with help, Bill might begin to challenge these constraining ‘rules’, and he might look for evidence to the contrary (for example, he might realise that there is pleasure derived from non-monetary sources).

In addition to challenging a client’s thoughts or assumptions, behavioural techniques might also be explored.  For example –

• A depressed client could explore the possibility of participating in activities that lead to a small success. As confidence grows and apathy diminishes, these activities can increase in number and duration.  This can help counterbalance the hopelessness that is an inevitable part of depression.
• One technique might be to consider things that stimulate the client, such as pleasant smells, sensations, sights, tastes or sounds. Having a list of these can be useful when the ‘sluggish wave’ draws in.
• The client could also start to engage in more physical activities. It is well established that exercise can increase the endorphins, and so even a regular short walk every now and again might help.  

With all behavioural techniques, it is important to explore all the possible risks and benefits of these techniques, paying careful attention to any assumptions that the client might offer to avoid pursuing or sustaining these activities.  One common assumption amongst depressed clients is that the activity will inevitably fail to achieve any change, or they believe that they lack the ability to succeed in the task.  But it would be important to ask the client: 

• What would the client lose by trying?
• Has their previous approach really been helpful?
• How do they really know they will fail, if they don’t try

It might be useful to end this article with a checklist of assumptions that often trap people in depression.  How many of these ‘rules’ do you live by, and how helpful is it for you?  There is a big difference between rules to improve your life, and rules to trap you.  If you are at least aware of the rules that you live by, you can then decide which ones are useful, and which ones are destroying your life -

1. If I make a mistake, that means I am a failure
2. If I do not succeed at a task, there is no point in trying
3. I must be liked by everyone at all times
4. Because it is pleasurable to be wealthy, it is painful to have little or no wealth
5. My value depends on how other people view me
6. Disagreement means conflict, which is to be avoided
7. To be loved, I must fulfil certain conditions

 
​Chris Warren-Dickins BACP Registered Counsellor
E:  chris@exploretransform.com
T:  07816681154
W:  www.exploretransform.com

I have a particular interest in working with those affected by parental alcoholism.  Have a look at this video put together for the Fragile Childhood activity which has been running in Finland since 1986 - https://www.youtube.com/watch?v=XwdUXS94yNk

Chris Warren-Dickins BACP Registered Counsellor
E:  chris@exploretransform.com
T:  07816681154
W:  www.exploretransform.com
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​Work or live near Wimbledon Park?  If you need to talk to an experienced psychotherapist or counsellor, get in touch to book an appointment

Chris Warren-Dickins BACP Registered Counsellor
E:  chris@exploretransform.com
T:  07816681154
W:  www.exploretransform.com

​If someone is suicidal, how can talking to a trained expert help? Here is another chance to hear my radio interview where I discuss this. Let me know your thoughts https://soundcloud.com/wandsworthradio/wandsworth-tonight-210715
 
Chris Warren-Dickins BACP Registered Counsellor
E:  chris@exploretransform.com
T:  07816681154
W:  www.exploretransform.com

​We all get angry.  Anger is an emotion as acceptable as any other, and yet for some their anger has become a problem.  They feel that they tend to react more angrily than the average person, and for some it has even threatened to ruin a career or destroyed a special relationship. So at what point is the expression of an emotion a problem that needs to be managed? 
To help us understand this, we can look at anger in contrast with other emotions.  Why do some people feel that they react more angrily than others? –

• Anger and anxiety - If someone feels threatened and she tends to perceive herself as unable to cope in a situation, she will tend to feel anxious. However, if someone tends to focus on the violation of her rights when she feels threatened, she will tend to get angry rather than anxious.

• Anger and sadness - If someone is insulted and she tends to accept the insult, devaluing herself as a result, the emotion would tend to be sadness. However, in the same situation, if the person tends to reject the insult as unfounded and unacceptable, the resulting emotion would tend to be anger.  

Feeling an emotion, whether it is anger, anxiety, sadness, or any other emotion, is neither good nor bad.  It is just an emotion.  So at what point can we say that an angry reaction is unacceptable and problematic?  Most would agree that the tipping point is

• When the anger is in response to a distorted version of reality. Is it reasonable to say that one’s rights are really being violated, or is this just an imagined incursion, perhaps an echo from the past? 

• When the anger is a disproportionate reaction, when the situation does not warrant such an extreme reaction. Are we slamming our fist into the wall even when we cannot find our keys?  

If anger has become a problem, how can talking to a trained professional help?

• Twisted thinking?  A cognitive behavioural therapist would focus on a person’s thoughts and assumptions.  It might be that the client is thinking in an unhelpful way (some therapists refer to this as ‘twisted thinking’) and the therapist would offer the client an opportunity to challenge these thoughts.  Examples of twisted thinking include jumping to conclusions, generalising about situations, assuming things about other people (or ‘mind-reading’) and living by the ‘tyranny of the shoulds’ (the client believes that she should live a certain way, and the world should be a certain way). 

By way of illustration, a person might assume that everyone should be polite to each other, and as a result that person might feel angry every time someone is impolite to her.  Once the thoughts and assumptions are identified, the therapist will help the person to change any thoughts and assumptions that are unhelpful.  For example, the therapist might suggest that the person changes the shouldstatement into ‘I would like people to be polite to each other, but I am aware that not everyone will be’.  This change in assumption might lead to less anger, as a result of less perceived violation of that person’s rights.

• Unmet needs and assertiveness. Anger is often a communication of unmet needs.  Talking to a therapist can help someone to identify those needs, and together the therapist and client can work out a more constructive way to ensure that those needs are met.  This can often involve assertiveness training, so that the client is able to communicate those needs without expressing anger in a disproportionate manner.

• Expression of emotion (rather than venting) Talking to a therapist might be an opportunity to express the anger, which might lead to new insights.  Many therapists draw a distinction between venting and expression of emotion.  Venting implies that anger is something to be eradicated, whereas expression of anger implies that this emotion might be a communication of something important about that client.  In their book on expressing emotion, Kennedy-Moore and Watson suggested three conditions for a constructive expression of anger –

‘1.  When it is directed at the appropriate target.  Indirect strategies like punching pillows…do nothing to alter the source of anger…

1. When it does not lead to further retaliation by the target’ (for example, one could write an angry letter which is then torn up)
2. ‘When it results in changes in the perceptions of the expresser or the behaviour of the target.’

Talking to a trained professional about anger management can be useful, but we cannot do anything until we are fully aware.  Some people deny that they are ever angry, and so it is important to reflect on this as anger can be communicated in a number of ways, passively and actively.  Consider carefully how you feel and how that makes you behave in certain situations.  It is okay to feel angry, but to what degree is that anger a response to a distorted version of reality?  And even if it is not distorted, is the extent of our anger a proportionate reaction to the situation?
What are your thoughts on this?
 
​Chris Warren-Dickins BACP Registered Counsellor
E:  chris@exploretransform.com
T:  07816681154
W:  www.exploretransform.com

Some find it helpful to look on addiction as a cycle, and by viewing it this way, they can see how to break that cycle:

1.  Someone may experience distress or discomfort
2.  In response, that person might seek relief through alcohol, drugs, excessive eating, gambling, or whatever behaviour that may become addictive.
3.  The relief is only temporary, and so, when the relief subsides, the distress or discomfort returns, perhaps this time with guilt or shame over the addictive behaviour.
4.  In response to the return of the distress or discomfort, and perhaps the guilt or shame, that person engages in more of the addictive behaviour.

Awareness of this cycle of addiction is the first step to learn how to break it.

Chris Warren-Dickins BACP Registered Counsellor
E:  chris@exploretransform.com
T:  07816681154
W:  www.exploretransform.com
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