Do you ever feel as if you are the scapegoat in a group, the one who ends up carrying the blame for everything when things go wrong? Or perhaps you feel compelled to take the lead in a group, frustrated that no one else has stepped up to take some of the responsibility. If this is happening, perhaps the forces of group dynamics are taking hold. On one end of the scale, a lack of awareness about group dynamics might lead to your feelings or needs remaining unheard. At the more extreme end of the scale, this group dysfunctional group dynamics could lead to persecution of the more vulnerable members of the group. How can you protect yourself when you interact within a group, and how can you ensure that your feelings and needs are met? 

Every time a group is formed, it is arguable that group dynamics are being played out. Group dynamics comprise of –

1.    Group roles adopted by each member of the group
2.    The development of a group as it progresses through its process (group process)

You may have heard of group dynamics in the context of your working life. But you probably find yourself in a group in other parts of your life, whether that is in your immediate or distant family, your friendships, or the group of parents you meet up with as your child participates in sporting practice.

Let’s look at each part of group dynamics in a little more detail –

Group roles
When you are interacting in a group, you may feel that you are compelled to do something that other group members are not. You may not understand why you feel compelled to do this, but it may be because you feel a task of the group needs to be achieved. For example, everyone in your group might be complaining about the rise in crime in the area, and you are all wondering how you can stay safe. You might feel frustrated about these constant complaints without any action, and, as a result, you might decide to seek out the exact numbers of crimes in your area, to see if there has been a rise, or whether this is just perception. It is arguable that you are adopting a group role here, and that might be the role of ‘information-gatherer’. 

There is theory to explain why you may feel compelled to become the ‘information-gatherer’. In a paper called ‘Functional Roles of Group Members’ Kenneth Benne and Paul Sheats wrote about group roles and, in doing so, they identified several roles, including the role of ‘information-seeker’. Here are some of the group roles, and you can see that Benne and Sheats organised them into three different categories: 1. Group task roles; 2. Group building and maintenance roles; and 3. Individual (or dysfunctional) roles –
“Group Task Roles
Initiator-Contributor – suggests new ideas and ways of looking at problems or goals.
Information Seeker – asks for clarification and for supporting facts and authority.
Opinion Seeker – asks for clarification of pertinent values.
Information Giver – offers ‘authoritative’ facts or generalisations or relates relevant aspects of his or her own experience.
Opinion Giver – states belief or opinion, emphasising values rather than facts or information.
Elaborator – spells out suggestions (eg with examples), offers a rationale for proposals, and explores likely implications of proposals if adopted.
Coordinator – shows or clarifies relationships among ideas and suggestions, tries to pull them together, tries to coordinate activities.  
Orientor – defines the group’s position with respect to its goals by summarising what has occurred, identifies departures from agreed directions and goals, or raises questions about the direction discussion is taking.
Evaluator-Critic – assesses suggestions, etc, and questions their practicality, their logic, the facts, the procedure.
Energizer – prods the group to decision, action, ‘higher quality’, etc.
Procedural technician – expedites ‘group movement’ by performing routine, tasks, etc.
Recorder – writes down suggestions, records group decisions, acts, etc. As the ‘group memory’.
Group Building and Maintenance Roles
Encourager – praises, commends, agrees with and accepts the contributions of others. Conveys warmth and solidarity.
Harmonizer – attempts to reconcile disagreements, relieve tension by joking, etc.
[There is also the Compromiser, Gatekeeper/Expediter, Standard setter, Group Observer/Commentator and the Follower *** ]
Individual [or ‘Dysfunctional’] Roles
Aggressor – may seek to deflate the status of others, express disapproval of the values, acts and feelings of others, joke aggressively, try to take credit for another’s contribution.
Blocker – tends to be negative or stubbornly resistant, to disagree and oppose without and beyond reason, to reopen issues after the group has dealt with them.
[There is also the Recognition Seeker, Self-Confessor and Playboy [or Playgirl] *** ]
(*** For a full set of the group roles, please see ‘Functional Roles of Group Members’ - Journal of Social Sciences, Vol. 4, Issue 2)

So you may ask: So what? This is all very interesting on a theoretical level, but what does it mean for me? With awareness of the group role we may be adopting, we can see that

1.    There is a purpose for our behaviour. If we each adopt different roles, this might help achieve the tasks that the group has (consciously or unconsciously) formed to achieve. Knowing this can often counteract the frustration we initially felt when we thought that we were always the one who was doing all the work. Instead, we might see that each group member is still working in a way that fulfils a particular group role. 
2.    Conversely, we might see that we are the only one who is adopting a task role, and others are adopting dysfunctional or individualistic roles. With this awareness, we are in a better position to assertively challenge this dysfunctional behaviour.
3.    We can be flexible as the needs of the group develop. For example, once we have achieved the task of information-seeking, we might need to then adopt the role of information-giver. To know what roles are required of us, we need to understand what stage our group has reached in terms of group development. As a result, we will turn to the second aspect of group dynamics, and that is ‘group process’. 

Group process
Groups usually develop according to a predictable process. My favourite way of putting this is Bruce Tuckman’s approach: 
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1.    Groups form, when there may be a lack of group cohesion, a lack of certainty as to which group roles each member should adopt, and a dependence on some sort of group leader.
2.    Groups storm, which means that group roles are slowly being allocated, but this may be the subject of dispute as the group establishes itself. 
3.    Groups norm, which means they (consciously or unconsciously) agree on how the group should be, and there is greater clarity in terms of group roles.
4.    Groups perform whatever task(s) they have (consciously or unconsciously) formed to achieve.
5.    Finally, groups adjourn, when the group task(s) have been achieved.

An awareness of group process can help us to understand what is happening, and it can offer the opportunity to become more sensitive to individual group members. For example, if we know that in the early stages of a group we are storming, we will expect more conflict and disruption, and we might be able to develop a healthy distance from this, seeing it as a natural, and important part of the group’s development. The same can be said for child development: If we have a general understanding of certain tasks that are expected of certain stages of child development, we can adopt a more understanding attitude towards that child or teenager.

Talking to a psychotherapist
Without awareness of what is going on, we can fall into a trap, and, as a result, we can end up doing things that we would not have chosen to do. Talking to a psychotherapist can help you to become aware of group dynamics. Once you have this awareness, you can work with the psychotherapist to make an informed choice about how to respond. You may decide to carry on in the same way, but if you decide to make a change, for example, by challenging a group member who is adopting a dysfunctional role, this can be difficult to manage alone. Other group members may have come to expect you to be a certain way, and so, working with the support of a psychotherapist, you can explore what life might be like if you did decide to change, and what strength and resources you have to face this challenge. 

Hope you found this informative.
 
Chris Warren-Dickins LPC is a Licensed Professional Counselor in Ridgewood New Jersey NJ 07450. 
To book an appointment, please telephone +1 (201) 862-7776 or email chris@exploretransform.com

“The shame tattoo.” I heard that phrase a couple of years ago, and it has stayed with me ever since. It is such a striking way to encapsulate the concept of shame: It is the insertion of something that leaves an indelible mark deep beneath the skin. 

Robert* also liked to call his shame ‘the shame tattoo’. When we came to the end of our counseling sessions, he added it to the list of things he would take from our work together. He also liked the fact that a tattoo was something from the past, and it was only a mark on his skin: It was not the whole of him, and so the darkness did not define nor consume him.

When Robert first came to see me his world was a place of enemies. Every encounter involved a defensive posture, with an occasional tight-lipped smile and short, non-committal statements weighed down by negativity. The strapline to social dialogue was persistently: ‘There is a trap here, so keep your guard up.’ Given his lack of faith in mankind, I was surprised he made the initial appointment with me, let alone turn up for it. But he did, and he persisted with the entire course of therapy.

Often shame is at the heart of something else presented by a client: Addiction, anger, depression, anxiety. And so, with Robert, we examined his anger in the early sessions, and his disappointment, and his mistrust, and his anxiety, but there was no mention of the word ‘shame’. At times I struggle with the tipping point between taking the lead from a client (using their words and meaning), and offering my own insight. I continuously challenge myself on this, questioning whether I am bringing in stuff from the client or stuff from my own world. But part of our job can include imparting information, and so the information I imparted was that the word ‘shame’ has sometimes been used when other people have presented stuff that Robert was presenting. I offered it tentatively, and he snatched at it, stared at it, and then nodded.

By saying the word ‘shame’, Robert could finally identify what had been itching beneath his skin for all these years. Finally he could make sense of that nausea he felt when he looked in the mirror. He believed that people could see the shame etched across his face because he believed that what had been done to him had defined him. And he believed that this shame made him unlovable. 

And that is what shame is: It is about your very being. It is about something internal, a self-belief, whereas guilt is about something external: Guilt is about something you have done (or not done). Shame often emerges in someone’s core beliefs, usually in the form of statements such as ‘I am unlovable’, or ‘I am unworthy’, or ‘There is something about me that is just not right’. Shame might make someone withdraw, whereas guilt might make someone seek forgiveness.

Once we identified shame, we looked at what Robert might need.  He needed to tell his story, and he needed to be believed. That was hard enough when shame was undermining his very foundation. But as he told his story, and he saw that I continued to accept him unconditionally, he began to question the belief he had held onto for so long. Perhaps, after all, there was not something rotten about his core. 

It is difficult to step away from a belief that you have held onto for so long, especially if others have reinforced that belief. When I work with survivors of sexual violence, often the perpetrator has reinforced a belief that the survivor is somehow unlovable, or to blame. A child’s sense of survival is inextricably tied to a caregiver (whether that is a parent, older sibling or grandparent). If that caregiver is abusive, they may shame the child into secrecy. The survivor is essentially given a choice: Accept this shame and survive, or face extinction. Inevitably they are going to choose shame.

In her book ‘Narrative Approaches to Working with Adult Male Survivors’ Kim Etherington warned against ‘moving too quickly towards forgiveness’, pointing out that this can be an avoidance of anger and fear. This is especially so if the perpetrator was a caregiver. It is hard, after so many years, to accept that someone you might have loved actually abused you. When I work with survivors of abuse, we often end up turning shame on its back and seeing it for what it really is: Someone else’s shame. A client who has been abused will often believe that they were somehow to blame, or they are tarnished because of someone else’s action. In reality, they are taking on the perpetrator’s shame, and often the perpetrator has been complicit in fostering this belief. It helps protect the perpetrator: ‘If you tell anyone, they will think you are the unclean one.’ Or: ‘Keep quiet because they will never believe someone like you.’
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To work through shame, that person needs to feel accepted for the whole of who they are. This is where the relationship between therapist and client is so important: If someone can feel unconditional acceptance, they can start to distance themselves from the shame. But this is not a linear process. My work with Robert came to an end, but we were both aware that the process was not necessarily linear. The pressures of everyday life can have a triggering effect, so Robert knew that he would need to continuously monitor himself and watch out for times when he may need additional support.
*Names and details have been changed

Chris Warren-Dickins LPC is a Licensed Professional Counselor in Ridgewood New Jersey NJ 07450. 
To book an appointment, please telephone +1 (201) 862-7776 or email chris@exploretransform.com

There are plenty of headlines about blunt and crass remarks made by world leaders. And in the working environment, I am sure we have witnessed similar comments.  Nothing new there. But recently there has been a tendency to explain away these comments, even an attempt to justify them as signs of an ‘assertive leader’ because they are ‘telling it like it is’. Let’s be clear: blunt and crass remarks are signs of a weak leader who is too afraid to let anyone disagree. It is a fear-driven attempt to manipulate people into agreeing with them, and this is an example of aggression, not assertiveness. 

It is not just world leaders who exert themselves with aggression. I have worked with clients who have suffered stress and anxiety which is the direct result of aggressive behaviour from a manager or colleague. I have also worked with managers who have felt trapped in a toxic work environment, and it has taken a long time for them to realise that the conflict at work was due, at least in part, to their own aggressive managerial style. 

I am going to place a bet on the basic goodness of mankind and assume that most leaders do not intend to lead using aggressive behaviour. Perhaps they just know no other way of relating to people, or they do not realise that squeezing out the views of others is simply not okay. They may not even see or hear the views of others, because if they have never been taught to watch and listen, how could they? 

In a study published in 2014 Daniel Ames and Abbie Wazlawek found that there was a significant difference between how a worker viewed himself compared with how his colleagues viewed him (Pushing in the Dark, Columbia University): A “large share of those seen as showing too little or too much assertiveness appear to be unaware” and “many people seen as getting assertiveness right mistakenly think they are seen as getting it wrong”. Ames and Wazlawek strikingly conclude: “oblivious jerks may indeed be as common as knowing ones and unwitting pushovers may indeed be as widespread as self-conscious ones”.  But also, to their surprise, they also found that “many of those seen as having the right touch think that they have gone too far.

So what might explain this discrepancy? It might be a genuine case of lack of awareness, on behalf of the leaders, or perhaps the actual employees. Or it might be that people don’t really understand what assertiveness means. 

Assertiveness sits in the middle of a spectrum where aggression is at the one end and passivity is at the other –

Aggression = Leaders are aggressive when they attempt to dominate others without respecting the rights or boundaries of others.   
Passivity = The opposite of aggression is a failure to communicate one’s needs, and/or to allow others to encroach on your boundaries. Sometimes this is as a result of fear of, or failure to, assert one’s rights. This behaviour can also be an attempt to manipulate someone into doing something that they want.
Assertiveness = Assertive leaders communicate their own needs in a way which respects the rights of others.  They listen carefully to those around them, and they are flexible in their approach. It is a careful balancing act of maintaining one’s own boundaries without encroaching on the boundaries of others.

Nobody is assertive all of the time. We can all lean towards aggression or passivity, depending on internal factors (such as anxiety, depression, stress levels), and depending on external factors (for example, we may become passive around certain types of people). But to maintain more of a middle ground on this spectrum, here is a quick reminder of the seven sides of assertiveness –

1.    Assertiveness includes the ability to make requests, to say no, to give and receive compliments, and to give and receive criticism. To evaluate your own level of assertiveness, ask yourself: ‘How easy is it for me to do these things? For example, how much do I do what I want to do, and how much do I do what others want me to? How easy is it to say no?’ 
2.    It might be useful to carry out a cost-benefit analysis in order to assess whether you should assert yourself in any given situation. There may be good reasons for not asking for what you would like.
3.    When you attempt to communicate assertively, keep it brief and get to the point.
4.    Make sure you do not offer inappropriate apologies or smiles. Also, do not expect them to agree with you, or you expect them to say no.  You are assertively communicating how you view the situation, or what your needs or feelings are. You are not seeking their approval of these.
5.    Some have offered the image of a swaying tree when they try to describe assertiveness. It may sway a little in the winds of challenge, but it remains rooted in the ground. In the face of a challenge, a calm repetition of your position is all that is needed to demonstrate assertive communication. If it helps, try and imagine that you have your two feet placed within a box, and this is your own space for your own views, feelings and needs. You can describe this viewpoint to other people but they do not have to accept it, just as you are not under any obligation to accept the viewpoint of others.
6.    If you continue to be challenged, you can communicate empathy with the other person’s position, and perhaps even offer alternatives.
7.    A useful tactic is to ask for more time, or for more information. You do not necessarily have to offer a response there and then.

Assertiveness requires self-awareness, but it also requires a certain knowledge of how others perceive our behaviour. As Ames & Wazlawek point out, this can be quite difficult as this relies on feedback from others. This is not always going to be forthcoming or as candid as we would hope for, especially if it is feedback from a current work colleague or line manager. As Ames and Wazlawek put it, “we are often pushing in the dark and our counterparts may sometimes be complicit in turning out the lights—or even firing up a beacon that leads us astray”.

According to research, assertiveness ‘is a highly valuable characteristic’ and ‘leaders who are perceived as being more assertive are also perceived as being more honest and having higher integrity than those who are not’ (Joseph Folkman, Forbes). Some say that assertiveness can also lead to a less stressful lifestyle. If you feel able to communicate your needs, and you have stronger, healthier relationships as a result, it is arguable that this would make life a little less stressful. I have not yet seen hard empirical evidence to say one way or the other, but coming across a little less like some of our world leaders may be a strength to be proud of.
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Chris Warren-Dickins LPC is a Licensed Professional Counselor in Ridgewood New Jersey NJ 07450. 
To book an appointment, please telephone +1 (201) 862-7776 or email chris@exploretransform.com

I was once told that physical conditions such as hepatitis and diabetes are not my concern.  ‘As a psychotherapist’, the person said, ‘you should focus on the emotional needs.  Leave the physical ailments up to the doctors’.

I happily ignored this person.  I know that to live with a physical condition can have a significant impact on one’s emotional wellbeing, and if someone’s emotional wellbeing is suffering, this can often have an adverse impact on the way that they take care of their physical health.

Today is World Hepatitis Day, and last month we had Diabetes Awareness Week.  I had noticed that both conditions seemed to receive little attention compared to other conditions, such as HIV and the various cancers, and yet hepatitis and diabetes can have a significant impact on a person’s physical and emotional wellbeing.

Hepatitis
The World Hepatitis Alliance states that ‘worldwide 400 million people are living with hepatitis B or C, and every year 1.4 million people die from viral hepatitis’.  A significant number of people with hepatitis also have depression.

At a recent Hepatitis C & Chemsex training event for health professionals, a speaker stated that treatment success for hepatitis C (often referred to as the ‘silent killer’) is relatively high but the following issues can often arise –

• In this country there is a lack of funding for the right sort of treatment
• Not enough people are getting tested – treatment can only be used on those who have been diagnosed
• Even if people get diagnosed, not everyone is adhering to the treatment
• Even if people get diagnosed, and adhere to the treatment, there is an issue regarding people becoming re-infected. Treatment is not a permanent cure

 
Diabetes
Diabetes UK states that 6% of the population in the UK is living with diabetes.  According to Dr Mark Pemberton, in an article in the Spectator, there is a greater risk of stroke for those who have type 2 diabetes.  In addition, ‘people with diabetes are four times more likely to have cardiovascular disease’ and ’20 to 30 per cent of people with diabetes’have damage to the kidney filtering system.  Statistics also show that a significant proportion of people with diabetes have depression. 

How a psychotherapist can help
If we accept that physical and emotional wellbeing is entwined, what are the different ways that a psychotherapist can help someone who has a physical condition such as hepatitis or diabetes?

• On initial diagnosis, clients are often anxious or depressed because they feel overwhelmed by the enormity of the diagnosis.  Talking to a trained expert can offer someone an opportunity to break down the concerns into manageable pieces. 
• By talking to an expert, someone with a physical condition will be able to see that the physical condition is not the full extent of their identity.  They will be able to see all the other aspects that make up their life, even if these other aspects have been somehow altered by the condition in some way
• A diagnosis is often about change:  someone’s body might change, or their significant relationships, or their lifestyle, or their work life.  Talking to a trained expert can help someone to make sense of these changes, allowing them to plan for what they may do about these changes
• A psychotherapist can help someone tolerate the uncertainty that the condition has created.  Suddenly the world will not seem like such a predictable, controllable place, and this can trigger significant anxiety.  It can be helpful to have a trained expert there to accompany someone through this anxiety, helping them to tolerate a measure of uncertainty, but also helping them to see where they may still have control over their life
• There are many myths surrounding physical conditions such as hepatitis and diabetes.  A client might need to work through experiences of discrimination and stigma, or the daily frustration of people being generally inconsiderate.
• It isn’t all about talking – Some clients find it helpful to draw out their feelings about the condition, and often the client will want to do something significant with that drawing, such as tearing it apart or stamping on it.  I have also worked with clients who have given the condition a name and spoken to it, sometimes even shouting at this unwelcome intruder

If you would like to speak to a trained psychotherapist about any of these issues, please do get in touch.  And if you would like further support concerning hepatitis or diabetes, I have included below two support groups.

Chris Warren-Dickins LPC is a Licensed Professional Counselor in Ridgewood New Jersey NJ 07450. 
To book an appointment, please telephone +1 (201) 862-7776 or email chris@exploretransform.com
http://www.diabetes.org/
http://www.hepatitiscentral.com/

A few years ago I was interviewed by Wandsworth Radio to discuss Men's Health Week (here is a link to the interview:  http://www.wandsworthradio.com/show/wandsworth-tonight/ ).  During this discussion I mentioned this: “Women seek help — men die” (Jules Angst and Celile Ernst).  This is a blunt way of summarising the statistic that suicide is the single biggest cause of death in men aged 20 to 45 (in the US there are 3.53x more male suicides than female suicides).  To seek help, to share the burden, implies that we are admitting defeat, and that we do not have the strength.  “We are less of a man.”
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Instead of seeking help, the statistics suggest that men deal with distress in other ways -

1. Men are nearly three times more likely than women to become alcohol dependent
2. Men are three times as likely to report frequent drug use than women
3. 73% of adults who ‘go missing’ are men
4. 87% of rough sleepers are men
5. Men make up 95% of the prison population
6. Men commit 86% of violent crime
7. Boys are around three times more likely to receive a permanent or fixed period exclusion than girls

We need to challenge our perception of men seeking help.  Strength has many facets, and it includes emotional awareness, intellectual savvy and tactical planning.  It is a sign of strength to learn what our vulnerabilities are, and to work out what our most constructive coping mechanisms are.  When we are in distress, this can be difficult to do alone, and so it makes sense, it is a sign of strength, to seek help.
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In an article in the Guardian Matt Haig quoted from the book ‘White Noise’ (Don DeLillo):  ‘What could be more useless than a man who couldn’t fix a dripping faucet - fundamentally useless… to the messages in his genes?”  And Haig added:  “What if, instead of a broken faucet it is a broken mind?”

We need to normalise the concept of a man seeking help.  To seek help for emotional distress is just about as normal as a man fixing a tap!

Chris Warren-Dickins LPC is a Licensed Professional Counselor in Ridgewood New Jersey NJ 07450. 
To book an appointment, please telephone +1 (201) 862-7776 or email chris@exploretransform.com

I have worked as a psychotherapist for the LGBTQ+ community for a number of years, and I am also part of that community, so I wanted to share with you ten top tips for working with us.
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1. Do not assume that homophobia, biphobia and transphobia sit safely in the past.  The LGBTQ+ community experiences power imbalances and discrimination every day, and you may not even see it. High numbers of LGBTQ+ youth experience rejection by their family, and the Ali Forney Center reports that 75% of LGBTQ+ youths that come to them ‘have been assaulted or abused in their homes for being LGBTQ+’.  And this is just in the US.  When I was a therapist at an LGBTQ+ charity in London (England), I sometimes worked with asylum seekers who had been fleeing persecution in Uganda and Pakistan.  Their own family members and friends wanted them dead simply because they identified as gay.  This was hard work, as they struggled to make sense of their identity as a gay man, a Muslim, and a loving son, brother and friend.
2. Do not underestimate the impact of discrimination.  According to the Ali Forney Center, ‘LGBTQ youth comprise 40% of the homeless youth population in New York’, and this is largely due to rejection from their families.  According to the Hetrick-Martin Institute, LGBTQ+ youth who report family rejection are ‘8.4 times more likely to attempt suicide, 5.9 times more likely to have high levels of depression, 3.4 times more likely to use drugs, and 3.4 times more likely to engage in unprotected sexual intercourse’. Discrimination can leave an imprint for years, and it can significantly influence someone’s interpersonal skills.  They may be less inclined to trust or accept things at face value, and they may have had few people to share their feelings about their emerging sexual or gender identity.  Addiction, anxiety and depression may have fuelled this despair, especially if they felt isolated from the rest of society.   
3. Maintain awareness of developments in the political and legislative arenas.  There are too many powerful people who want to strip the LGBTQ+ community of their right to work, right to marry, right to have children, and right to be served by a business.  In the majority of US states someone can lose their job simply by identifying as a member of the LGBTQ+ community.  There is a similar lack of legislative support for members of the LGBTQ+ community who want to adopt or foster children.  Consider the impact this has on the psyche, being treated as second-class citizens
4. Be sensitive to privacy and safety.  Just because you know the person’s sexual or gender identity, does not mean it is safe for anyone else to know.  When I worked at the LGBTQ+ charity in London, I was conscious that the clients might not want to take the paperwork home as it had logos that could be linked to the LGBTQ+ community  
5. Know your local LGBTQ+ organizations.  There are many decent, and local, LGBTQ+ organizations, but each one is not for everybody. I have known of LGBTQ+ walking groups, coffee meetings, an LGBTQ+ creative writing group, a Jewish LGBTQ+ group, a Christian group, and a Muslim LGBTQ+ group
6. Consider your conversations, documentation, policies and procedures.  Whether you are having a conversation, writing an email, creating a document, a policy or procedure, are you assuming that a married couple consist of a man and a woman, and two parents of children are a man and a woman?  Do you make assumptions about sport (football for men and ballet for women), colors (pink for girls, blue for boys), and even the family structure (a female as the caregiver and the male as employed).  Do you have expectations about what a ‘man’ and a ‘woman’ should look and sound like?  Maintain awareness for gender-normative and hetero-normative assumptions in our conversations, documents, policies and procedures  
7. A cultural and historical perspective check – Understand where that LGBTQ+ person is coming from in terms of their culture.  Are they surrounded by family members and/or friends who are homophobic or transphobic?  Some cultures view the LGBTQ+ community as evil, or a sickness to be ‘cured’.  It is a tough decision to make between your sexual or gender identity, and the family and friends you have always known.    In addition, consider the history of that member of the LGBTQ+ community.  Older members have grown up in a time when society was a great deal less accepting, and so they may have a different perspective of their gender or sexuality than someone who grew up more recently
8. Do not confuse gender and sexuality.  For example, if someone is transitioning from male to female, this does not make them gay.  Being transgender is about the gender they identify with, and being gay is about who they are sexually attracted to (their sexuality).  A transgender man transitioning to be a woman will not necessarily be attracted to men
9. If you are unsure, ask.  We all have different perspectives, so a person-centred approach would be to start with the individual and the meaning they attach to terms such as LGBTQ+, trans, etc.  If you are working with someone who identifies as transgender, you may stumble over whether to refer to them as ‘her’ or ‘him’.  A common approach to this is to refer to them as ‘they’, and, the best approach is to ask them how they would like to be addressed  
10. Failing that, here is a quick list of some common terms.  However, each term is the subject of debate, so these should not be viewed as definitive definitions –

• LGBTQ+ = Lesbian, Gay, Bisexual, Transgender, Queer.  I tend to use the + to be all-inclusive, because some say the correct term is LGBTTQQIAAP (lesbian, gay, bisexual, transgender, transsexual, queer, questioning, intersex, asexual, ally, pansexual)
• Transgender = An umbrella term for anyone whose gender identity or expression is not in line with the gender they were assigned at birth
• Transsexual = Some argue there is no real distinction between the term transgender and transsexual, whereas others argue that the term transsexual focuses on those who have the desire to transition to wish to have gender affirmative surgery
• Non-binary = Someone who does not identify solely as a man or woman
• Cis-gender (cis-male or cis-female) = Someone who identifies with their birth gender (so cis-male is someone who identifies as male and who was born male)
• Gay, or homosexual = Someone attracted to someone of the same sex
• Bisexual = Someone attracted to men and women
• Asexual = Not sexually attracted to anyone
• Lesbian = A female homosexual
• Queer = This is an umbrella term for anyone whose sexuality or gender does not identiy as heterosexual and the gender they were born with (cis-male or cis-female)
• Intersex = Someone who cannot be distinctly identified as male or female because of their sex characteristics (genitals, etc)

​Chris Warren-Dickins LPC is a Licensed Professional Counselor in Ridgewood New Jersey NJ 07450. 
To book an appointment, please telephone +1 (201) 862-7776 or email chris@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 the analytical 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 LPC is a Licensed Professional Counselor in Ridgewood New Jersey NJ 07450. 
To book an appointment, please telephone +1 (201) 862-7776 or email chris@exploretransform.com

​When I worked in the UK an organization called Samaritans launched a #TalkToUs campaign. They urged people who are struggling to speak out about their problems, claiming that isolation only makes things worse. But if someone is feeling suicidal, how easy is it to speak out? And if someone is brave enough to tell someone about these feelings, how can it help?

Troubled by the suicide of a fourteen year old girl, the vicar Chad Varah set up the Samaritans in 1953, hoping that he could help people who were contemplating suicide. However, 62 years later, the number of suicides in the UK is on the rise, and recent figures put this at 11.9 suicides per 100,000 of the population.

Most studies are in agreement that the reasons for a person’s suicide are often complicated, and it is often not possible to point to a single factor. What we can say from the statistics is that there are certain groups for whom suicide may be more common (for example, there are 3.5 male suicides for every 1 female suicide in the UK). In ‘Preventing suicide in England: Two years on’ (February 2015) the Department of Health identified the highest rates of suicide amongst the population “in the North and South West of England”. They also found that “middle-aged male rates have risen most since 2008, “among younger men…suicide remains a leading cause of death” and “there is also the alarming rise in self-inflicted deaths of prisoners after the previous fall”.

And what would the Samaritans say? When discussing the statistics on suicide, they say that there is a significant amount of under-reporting of suicide because deaths are often misclassified.  For example, the death will be classified as accidental or undetermined intent if a coroner cannot conclusively establish whether there was intent to take their own life.

The Samaritans was established in 1953 when suicide was still a crime. The laws might have changed but suicide is still considered by many to be a taboo subject. We often hear people refer to someone ‘committing suicide’, as if the tragic case of someone dying by suicide (the phrase the Samaritans prefer) is still a criminal act.

A great deal of anxiety surrounds conversations about suicide, as if discussing it might trigger someone to feel suicidal when they would not ordinarily consider this as an option. Some have referred to this anxiety as ‘inner wobbliness’, and when this is reinforced throughout structures such as the workplace and the media, it becomes ‘institutionalised moral judgment’ (Dale: 2005). Too quickly an opinion is formed that certain topics are out of bounds, and that talking about them is considered to be too risky.  And yet it is the silence and isolation that kills.

So if it is the silence that kills, how can talking help? Here are a few thoughts –
• Someone can hear the depth of your anguish. Too often our thoughts and feelings are dismissed or reduced by unhelpful phrases such as: ‘I am sure things will work out somehow’ or ‘Look on the bright side’. If someone truly acknowledges the depth of your pain, allowing it to come into the room, sometimes that can help to lessen its potency.
• It normalises things. It is not shameful, and it is more common than you think, for people to have suicidal thoughts. If you talk to someone who listens to you without judgment, you can see that you are not alone, and that having these thoughts does not make you a failure.
• It allows you to see that these are just thoughts. Thinking about something does not make it happen. And talking about thoughts does not mean that you are acting on them. If you talk about your thoughts, sometimes you can see that these are just thoughts, and sometimes you realise that they are as temporary as many other thoughts.
• It helps you to realise what you really want. A cognitive therapist might question a client’s reasons for dying, listing the reasons for living and identifying alternative views to the problems. Often someone who is suicidal wants a situation to change, wants to feel differently, but they don’t really want death. Talking can help you to work out what you really want, and how you can achieve that.

Follow the Samaritans’ lead and speak out about your problems. And if you know of someone who is struggling, try to be available to them so that they don’t feel isolated.

Chris Warren-Dickins LPC is a Licensed Professional Counselor in Ridgewood New Jersey NJ 07450. 
To book an appointment, please telephone +1 (201) 862-7776 or email chris@exploretransform.com
​

The bully at work:  He might sit right next to you, breathing down your neck as you read this, or she might be the person who conducts your performance review.  It is easy to spot the snarling, curled lip spite of a bully because we daily dodge them during our commute as they shoulder us out the way. We have been ducking and diving out of their way since the school playground.
​
However, unlike the school playground bully from our past, or the shoulder-shover on the train this morning, there is no escape from the work bully.  We can hold our breath for a train journey, but to face a work bully for the entire day, every working day, can sometimes be more than we can endure. Changing jobs is drastic, and sometimes not even an option, especially in this fragile economy.  We have all heard the statistics about lost work days due to stress, anxiety and depression.  So what can we do to withstand this?  If we cannot change what is happening to us, perhaps we can look at ways to strengthen our resolve.  To befriend the bully from within.

As I am an integrative psychotherapist, I work with clients to find the approach that suits them.  You might find one or more of the following approaches might be useful to befriend the bully from within –

Karpman’s drama triangle (Transactional Analysis)
Bullying can be an act of overt or passive aggression.  In addition, as situations are often fluid, we adopt different roles in response to different circumstances.  As a result, the ‘bully’ label is often not fixed.  Only the honest amongst us can admit that we all have the potential to become a bully at certain points in our lives.  Just as any one of us can adopt the role of ‘victim’ or ‘rescuer’.

A concept from Transactional Analysis is Karpman’s drama triangle:  In social situations we can sometimes adopt one of the following roles:  Persecutor, Victim or Rescuer.  If one person is leaning in one direction (for example, they are becoming a Victim), that can often make others appear as if they are adopting one of the other roles (they are becoming the Persecutor or the Rescuer).  As a result, people perceive each other in terms of these contrasting roles, without recognising that we have elements of each in all of us.

By adopting one of these roles, there is often a payoff.  If we become the Victim, for example, we might be protected by a Rescuer in our life.  We do not have to go to the effort of rescuing ourselves.  If we adopt the role of Persecutor, we do not have to accept the pain of recognising that we all have vulnerabilities.  Our tendency to adopt one of these roles can often be subconscious, so it is hard to challenge this alone, but the more we recognise that these roles exist, the more likely we are to challenge this, and avoid viewing a situation in such a simplistic way as consisting of a Persecutor (or ‘bully’), a Victim and a Rescuer.
To view the ‘bully’ as a whole person, rather than simply the Persecutor – 

• See the workplace bully as someone who is probably acting in fear. Aggression, whether it is overt or passive, is born of fear, so if we just see the aggressive behaviour, we have missed a trick.
• A bully often feels inferior, and so their behaviour is a way of managing that perceived inferiority.
• When you interact with the workplace bully, make eye contact and remain civil, even if the bully has descended into childishness

 
‘Pain’ Management (Mindfulness; Cognitive Behavioural Therapy)
To befriend the bully, we need to learn how to tolerate the discomfort.  I have worked with clients who have been living with a physical condition which causes them chronic pain, and together we have tried out the following suggestions that you might like to try to manage the ‘pain’ this bully causes you –

• Enter into the ‘pain’. Really tune into the thoughts, feelings and bodily sensations this bully evokes in you.  Become aware of, and accept, what is, rather than trying to ignore it, or fear the future uncertain.  Try to be specific when you describe these experiences, but at the same time recognise these thoughts, feelings and bodily sensations as simply thoughts, feelings and bodily sensations.  If you allow yourself to experience a distance from these, you may be able to see that they are often temporary.  They are not the whole of you.
• If entering the ‘pain’ seems overwhelming, anchor yourself in the moment by focusing on your breath. Allow thoughts, feelings and bodily sensations to come and go, but keep returning your attention to each breath.  Ask yourself ‘How uncomfortable is it right now?’ rather than fearing the future uncertain.
• Manage your expectations. It is probably unrealistic to expect to never suffer any ‘pain’ from this bully, and so you will set yourself up for disappointment.
• Caricaturise the bully. In the privacy of your own home, draw him with distorted features and give him a comedic name.  This can offer you distance from his aggression. 
• You can try all sorts of affirming statements including: I am choosing to go to work today.  I have strength to withstand this situation.  There is more to me than my working life. 
• Give yourself space when you need it. This can even be in a toilet cubicle, or a refreshing walk during a lunch break
• Give yourself a few minutes each day to stop and become aware of your breathing, letting thoughts, feelings and bodily sensations come and go without resistance or challenge
• When you leave work, try as much as you can to leave it behind. Change your clothes when you return home, and resist working at home.

 
Assertiveness (Cognitive Behavioural Therapy)
Whether it is the person who is perceived to be the ‘bully’, or the person perceived to be the ‘victim’, either party may feel that the situation has arisen because either party has an issue with assertiveness.  No one is assertive all the time, so to assess how assertive you are in a situation, ask yourself:  ‘How much do I act on other people’s wishes at the cost of my own?’  If you are frequently doing this, and it is causing you difficulties in your life, you may need to consider working on your assertiveness.

Assertiveness includes the ability to ask for something but also the ability to say no.  Consider the following points when you think about times you have asked the work bully for something, or when you have had to say no to him –

• Watch for inappropriate smiles or apologies
• Keep it brief, speak clearly and confidently
• If you are unsure, if you feel unable to answer immediately, ask for more information. If you are still unsure, state clearly that you will need to think about this and you will come back to him with an answer at a later date
• If you have given your view and the work bully keeps asking the same question, trying to force you to change your mind, consider yourself like a strong old tree swaying in the wind: Simply repeat your point without changing it.  You can empathise with the work bully’s position without having to alter your own position in any way:  For example, ‘I understand you are under pressure to have an answer today but, based on the information I have at the moment, I will not be able to offer you an answer today.  I will, however, come back to you first thing tomorrow with an answer’. 
• Don’t use the phrase ‘I cannot’ when you mean ‘I will not’
• Avoid blaming others

Chris Warren-Dickins LPC is a Licensed Professional Counselor in Ridgewood New Jersey NJ 07450. 
To book an appointment, please telephone +1 (201) 862-7776 or email chris@exploretransform.com

​Wedding buzz killed off by living under a tyranny of ‘shoulds’?  Relationships often transform once the initial excitement has subsided.  You can be left with a bitter aftertaste if you expect life, and everyone living in it, to be a certain way.  This is known as the 'tyranny of shoulds':  He should think about my feelings before he stays out late.  She should know that I need time to myself.  
​
We all have needs, and so the 'shoulds' are an attempt to communicate these needs.  But your needs are more likely to be met if you consider these three things -

1.  Communication comes across better in a less mandatory way.  If you replace 'you should' with 'I would like it if you could...' it sounds as if there is more wriggle room for the other person.  As a result, it is less likely that their defences will be up, and they are more likely to listen.
2.  If your partner is listening, rather than defending a perceived attack, they are more likely to hear how important this is to you, and why it is important.
3.  With more wriggle room for the both of you, there is the chance that your partner might also communicate their needs in response.  Once you have heard your partner's perspective, you might end up altering your position.

I hope that you find this helpful.  Do get in touch if you would like to discuss any of this in more detail.
 
Chris Warren-Dickins LPC is a Licensed Professional Counselor in Ridgewood New Jersey NJ 07450. 
To book an appointment, please telephone +1 (201) 862-7776 or email chris@exploretransform.com