Exam Results

I have a bone to pick with exams.
Perhaps ( or probably!) it’s because of personal experience but I can’t say I’m happy with the leaving cert in particular. It’s gotten far to much credit for my liking.
Your whole life, apparently, depends on this one exam. This will dictate who you become in life. The money you make, the house you live in, all of this is dependant on this one set of results.

Well, frankly, that’s not true. Anyone who says it is, is wrong.

Added unnecessary stress, pressure and competition is the very last thing anyone needs while they are trying to make important decisions. Even those who should know better can be guilty of heaping on the stress at the worst time possible.

These are just exam results. Good or bad they are no reflection of who you are as a person, of your intellectual capability, or what you’re going to accomplish in life.

If you want to talk about exams or plans or college or just what’s on your mind, call me on 087 7097477 for an appointment.

Robin Williams

If the tragic loss of Robin Williams shows us anything, it shows us just how pervasive depression is. His apparent suicide is testimony to the fact that depression honours no boundaries, and holds no lines. Any and everyone of us can experience depression at any time. 


Ask for help. Listen to those who are asking for help.  

Every day People can and do survive the blackest and most hopeless of depressions and come out the far side. It does get better. 


Call on 087 7097477 for an appointment or if you think you may be in danger of harming yourself call the Samaritans on116 123

Working with Sufferers of Bulimia, part II

As mentioned in Working with Sufferers of Bulimia, part I the need for counsellors who work with sufferers of Anorexia, Bulimia, to enhance their understanding of these disorders in order to improve the quality of the therapy they provide is becoming more and more apparent as each new piece of research emerges. Furthermore, “Delineated treatment specifically tailored to the needs of each disorder” (Quinlan, 2013) as required for the treatment of eating disorders may be best accomplished by a full understanding of the differences in characteristics of these disorders.

Though there is no such thing as a typical patient or client, commonalities do emerge between sufferers of bulimia. It is often found that women who are engaged with the binge purge cycle, have been engaged with weight loss or have concerned with their weight and or a fear of being fat since their early teens (Beaumont, George and Smart, 1976). Additionally, further commonalities in personality traits have emerged among bulimic sufferers. Research into the personality traits of bulimic sufferers has show that they will often display more impulsive behaviours than those with Anorexia, (Garfinkel, Moldofsky and Gerner, 1980). These findings are confirmed by research carried out that showed a higher that average impulsivity often expressed by substance abuse (Pyle, Mitchell and Eckert 1981). In marked contrast to this, those sufferers of Anorexia are often “markedly obsessional, socially withdrawn” ( Bruch 1973). The rigid control of the anorexia patient is at variance with the more outgoing and extroverted style of behaviour of the bulimic patients. Bulimic patients however may alter their naturally outgoing social style as the binge purge cycle takes over their time and efforts, and they may become withdrawn and isolated. Add to this the on-going shame associated with bulimia and the sheer volume of time many bulimics give to their binge purge cycles and even though they may actually crave interaction, friendships and social encounters, they may find they withdraw and retreat into the comfort and familiarity of their food obsession rather than actively seek out and engage with others.

Once again given the propensity for sufferers of bulimia to maintain a fairly even weight, then identifying their eating disorder can be very difficult among their friends and family and so this eventual withdrawal can seem all the more difficult to explain and leave residual feelings of hurt or anger by those who cannot understand her behaviour.

Working with Sufferers of Bulimia; Part I

Counsellors who work with sufferers of Anorexia, Bulimia, and other eating disturbances (Norma Leclair and Belinda Berkowitz, 1983) are acutely aware of the rise in prevalence of sever eating disorders among young women. Of this trifecta, bulimia is silently increasing year on year and is one of the most under reported and un-explored. One of the major concerns with Bulimia is the frequency with which is goes undiagnosed. Given the fact that the sufferers body weight typically will not fluctuate in the same way as other eating disorders, and the shame and secrecy that surrounds the binge purge cycle,( Pyle, Mitchell and Eckert, 1981) as well as the substantial physical and psychiatric illness that goes with repeated binge purge cycles (Mitchell, Hatsukami, Eckert, & Pyle, 1985) up to as many as one third of Bulimia sufferers do not seek treatment, (Fairburn & Cooper, 1982; Yager, Landsverk, & Edelstein, 1987). Add to this a conservative estimated increase in the mortality ratio of up to 30% (Patton, 1988), and we have what makes for very grim reading.

Dietary awareness and Nutritional Counselling (L. K. George Hsu, Barbara Holben, Shirley West, 1990) in conjunction with cognitive behavioural modification has been found to greatly assist in the treatment of Bulimia, however what this article is concerned with are some of the common characteristics among those being treated in private practice for bulimia.

The prevalence of young white middle class women towards bulimia is borne out by Pyle et al (1981) but it is the psychosocial traits that concern me in my practice at Midwest Counselling the most. The awareness of variances between the different forms or eating disorder has given rise to the need for counsellors to enhance their understanding of these disorders in order to improve the quality of the therapy they provide.

For example, it is only in comparison to Anorexic patients that the traits of Bulimic patients are seen to emerge. Whereas with Anorexia it is a morbid fear of being fat, accompanied with a totally distorted view of the body that drives self-starvation, by contract those sufferers of Bulimia are fully aware of the abnormality of the binge purge cycle in which they are caught; and this, along with the fear of lack of control over the binge purge cycle as well as the inherent shame associated with the binge purge cycle feeds negative thought pattern and a depressive mood.

Delineated treatment specifically tailored to the needs of each disorder are the means by which treatment may be most successfully delivered, and as such further research into each is urgently required

Coping with Child Sexual Abuse in Adult Relationships, Part III

The Role of Sensorimotor Psychotherapy in counselling adult survivors of Child Sexual Abuse (CSA) has been shown to facilitate clients in dealing with elements of Post-Traumatic Stress Disorder (PTSD) that commonly follow the survivors into adult relationships.

The primary function of Sensorimotor Psychotherapy is three fold; firstly to assist with calming and acting as safe guard as the brain responds in a ‘bottom up’ manner to the traumatic event ( Piaget 1952). That is to say the client is at the mercy of their somatic and kinaesthetic responses without cogent control over them and the role of the therapist is to harness and manage the clients experiences until such time as the client has re-established these differentiating lines; Secondly, to equip clients themselves with the necessary tools to deal with these abreactions and upsetting bodily responses and lastly to facilitate the reintegration of a ‘top down’ response, i.e. helping the client to retrain their responses to include a reasoned and logical response. (Pat Ogden and Kekuni Minton, 2000). Clients have also reported that through therapeutic relationship and the couple relationship sensorimotor psychotherapy helped them to limit the information they are processing at any one time;  giving them the opportunity to investigate the cognitive and emotional aspects of the  initial trauma without becoming so physically distressed as to prevent them from adequately doing so. As discussed in Coping with Child Sexual Abuse in Adult Relationships, Parts I and II, the role of the couple relationship is paramount in the rehabilitation of adult survivors of CSA, survivors of sexual abuse require safe and healing relationships from which recovery can most ably begin. (Courtois, Ford & Cloitre, 2009)

Sensorimotor Psychotherapy operates in a holistic way by attending to the physical, cognitive and emotional responses CSA provokes in its adult clients. By refocusing their attention away from the context and details of the original trauma and focusing instead of the bodily sensations in isolation form their context client have found they have been able to disassociate the physical reaction from the emotion and cognitive responses.

This gives rise to a feeling of safety that allows for the safe exploration of the cognitive and emotional impact of the abuse and furthermore may give rise to an increased feeling of safety as they begin to re-experience the trauma in a way that offers them the potential to physically protect themselves.  By adopting a sensorimotor psychotherapeutic approach and concentrating on the physical responses, we are directly dealing with the somatic effects on the body and this in turn helps enable emotional and cognitive assimilation of the traumatic experience

Coping with Child Sexual Abuse in Adult relationships. Part II

In the psychotherapeutic treatment of adult survivors of Child Sexual Abuse (CSA) therapists are often mistaken in treating the survivor in isolation and fail to include in their therapy, the role of the partner in their couple relationship. This is to limit and detract from the therapy on offer as “If, as we can all agree, healing takes place in moments of secure attachment (Solomon, 2003) then the opportunity provided for healing within the current couple relationship is a vital and dynamic opportunity that ought not be overlooked” (Quinlan, 2013).

In my practice at Midwest Counselling I too have found it common that adult survivors of CSA seek out and replicate the trauma of their abuse (Briere & Scott, 2006). Attachment theory, (Bowlby, 1988) may account for why in some cases the “normal” attachment processes formed in early childhood are replaced in adulthood by this re-enactment of disruptive relationships, and may even lead to re-enactment of traumatisation (Allen, 2001). Because of unresolved issues arising as a result of the CSA, such as fractured impressions of how adult sexual relationships are supposed to work, or errant self-images as a result of childhood programming, then often the adult generalised view is fractured and errant. For instance they may view all physical contact as frightening, painful or abusive, or that all men/women are inherently dangerous. It follows then that these views shadow them into their adult couple relationships.

Subsequently then in treating adult survivors of CSA, the circularity of systemic family therapy may also be helpful. As mentioned in Coping with Child Sexual Abuse in Adult relationships, Part I, in couple relationships, it is commonly found that the partner of the survivor of CSA is bringing with them their own problems of equal measure. Therefore, as the therapy investigates the paradigm that exists between the couple, a pattern of co-dependant coping strategies may emerge. This iterates the importance of treating the client in a holistic way, and of looking at more than just the trauma of the CSA but also at the extended influence this is having on their couple relationships. So too, the benefit to couples counselling is massive, it can help raise a number of questions that could facilitate to a great extent the investigation into the nature of the couple relationship that exists that is been brought to couple therapy for “fixing”.

Given the aforementioned propensity for adult survivors of CSA to seek out and form relationships that emulate patterns and elements of the original abuse, then the benefit of including the partner in therapy is inherent. By engaging with both partners the therapist can work on limiting the re-enactments and re-traumatisation of the client. Furthermore and equally as importantly by soliciting the participation of the clients partner, the therapist can encourage and facilitate the growth of understanding and respect, and the identification of mutually beneficial goals that may ultimately lead to a constructive and nourishing adult relationship.

Coping with Child Sexual Abuse in Adult relationships. Part I

In my practice at Midwest Counselling, of the many long-lasting impacts child sexual abuse (C.S.A.) and one of the most prominent is the difficulty for  adult survivors of C.S.A. to maintain healthy fulfilling couple relationships. The merits of focusing on the role the partner has in this recovery is becoming more and more apparent (The Australian and New Zealand Journal of Family Therapy, 2012) as too is the value of using a multidisciplinary approach (Ibid). For many therapists the focus of the therapy is the healing process for the traumatised individual rather than looking at the potential healing opportunities provided by a safe and trusting couple relationship. Furthermore, in many situations it is a couple who have presented with relationship, intimacy or sexual issues stemming from CSA and are looking for help from within dynamic of the relationship; and so the work of treating CSA needs to take place within a couples counselling  paradigm.

Ignoring the impact of CSA on adult relationship or focusing only on the survivor of CSA or ignoring the role the other partner can play may limit the healing opportunities within the therapeutic relations and can level the client feeling let down or dissatisfied particularly if you are working within the confines of couples counselling. Similarly it is a well-established consensus within the psychotherapeutic and counselling communities that treatment of complex trauma, especially with regard to CSA that survivors of sexual abuse require safe and healing relationships from which recovery can most ably begin. (Courtois, Ford & Cloitre, 2009)

While this notion had generally been accepted to apply to the therapeutic relationship, it is important not to overlook the restorative opportunities and potential offered from with the confines of existing couple relations; especially when the clients have expressed a desire to work on and improve the sexual contact, intimacy or other aspects of their relations. If, as we can all agree, healing takes place in moments of secure attachment (Solomon, 2003) then the opportunity provided for healing within the current couple relationship is a vital and dynamic opportunity that ought not to be overlooked.

As per the attachment theory the security of the existing couple relationship (as well as the security of the therapeutic relationship) can allow the therapist to encourage the client to explore the trauma and its impact from a safe place.

In using this approach is it also important to recognise the frequency with which one finds that if one partner bring to the relationship a history of CSA, then the other partner will bring problems of equal measure, often, though not necessarily always, sexual abuse. Therefore it may very well be the case that as a therapist you may find yourself treating not one, but two separate victims of traumatic childhood or early life experiences.

Eating Disorders

Every day millions of people live with eating disorders. Men and women, young and old, eating disorders are indiscriminate when it comes to ethnicity or economic demographic. However adolescent women are make up the largest portion of suffers of eating disorders. Year on year this is one group where the numbers remain proportionally higher.

The equation that thin is beautiful had typically been the domain of emaciated Hollywood starlets but it is the frightening rise in popularity of reality TV modelling shows that must carry their own portion of responsibility today. The ratings for these shows are worryingly high, especially given how barbaric they are in their treatment of vulnerable young girls.

In one show (Americas Next Top Model, Cycle 12) the appalling line “What have you been eating?” was directed at a contestant (London Levi-Nance, 18 yrs. old) a young woman who had previously openly admitted she had suffered an eating disorder in the past. Obviously it is the height of irresponsibility to posit such a pointed question at a young woman in this position but that it is dangerous, pointedly cruel and unnecessary should also be pointed out. There is no way to misinterpret the derogatory tone of the question and the young lady’s guilt laden defensive response and subsequent tears leave no doubt as to the impact this callous and withering sneer had on her.

Given the proliferation of eating disorders;  up to 2000, 00 people are currently engaged in some form of  recorded eating disorder in Ireland (Source; Independent.ie), it is imperative that we all inform ourselves as to the nature and danger of eating disorders. Our daughters, sisters, friends and neighbours are squarely in the cross hairs and it behooves each one of us to ensure we are equipped with the information to help them manoeuvre this passage of life armed with the support and knowledge that will safely guide them through.

To begin here are three main types of eating disorders:

•           Anorexia

•           Bulimia

•           Binge purge Eating cycles

Anorexia or anorexia nervosa is the name given to starving yourself because you believe you are overweight. People who suffer from this disorder are convinced they are overweight and highly restrict their food intake. It does not mean a loss of appetite or interest in food, but it does mean reducing and restricting your food intake to that point of starvation. People who are up to 15% under the medically agreed healthy weight for their height and body type and are dieting by refusing foods may be suffering from this disorder.

Bulimia or bulimia nervosa is characterised by cycles of binging, that is, excessive eating, and then purging yourself of the food by inducing vomiting, taking laxatives or enemas and sometimes by exercising obsessively. The process of ridding your body of the calories eaten is called “purging.”

Those who suffer from Bulimia may repeat the binge purge cycle many times a day. In contradiction to anorexia, sometimes people who have bulimia can go undiagnosed for a much longer period of time. Oftentimes with bulimia, there is no dramatically obvious weight loss and so the condition remains unnoticed by those close to the sufferer. Because the cycle of binge and purge comes with a great deal of shame attached and can take place over such a long period of time, there can often be a compounding of many of the initial psychological issues that contributed to the bulimia in the first place and great deal of work may need to be done to uncover the core issues at heart. Of the two, bulimia is now the most common eating disorder. It is estimated that 2% of Irish adolescent girls may be suffering from bulimia at any given time. (Source, bodywhys.ie)

A point that needs to be made known and that we need to be reminded of is that eating disorders are a potentially life threatening mental illness.  They are not a lifestyle choice, a fad or diet gone wrong.  We can characterise an eating disorder by looking beyond the average diet to the point that unhealthy preoccupation with eating, dieting, exercise and a distorted sense of body image have taken on significant ramification in a person’s life.

Beyond the two outlined here, there are a large variety of eating disorders, with various different characteristics and causes that can affect a person at any given time. A common theme eating disorders however can be low self-esteem and the eating disorder is an attempt by the person to try and deal with deep rooted psychological issues by engaging with an unhealthy relationship with food.

Again it is so very important to debunk the fairly common misconception that eating disorders are a fad, a choice, or an attempt at attention-seeking. These kinds of misconceptions and judgements serve only to detract from their seriousness of the disorder and blame and further criticism on an already suffering individual. Eating disorders are serious, and potentially fatal, mental illnesses which require intensive psychological and physical intervention. It is common for a person to evolve from one eating disorder to another, and somebody with anorexia may progress into bulimia and or a different binge eating disorder, and vice versa.

Without the correct medical diagnosis and care as well the correct counselling and therapeutic support medical complications including life threatening organ failure is possible.

It is important to remember that person with an eating disorder should not be blamed for having it! Eating disorders are usually the result of a long standing series of complex interactions between social, biological and psychological factors which bring about theses harmful behaviours.

In conjunction with medical care, treatment of eating disorders nearly always includes cognitive-behavioural therapy or psychotherapy like what we offer at Midwest Counselling and Psychotherapy. Sometimes medication may also be needed and in severe cases a cross functional team may need to work hand in hand including hospitalisation combined with psychotherapy. There is some comfort to be taken in that knowledge that eating disorders are treatable, so it is important that we continue to watch out for symptoms among our friends and acquaintances and in particular among young women.

For help in tacking an eating disorder or if you are worried someone in your life has an eating disorder, feel free to call me for an appointment on 087 7097477 or (061)639472.

January Blues???

It’s dark, cold and a very long way to pay day.

Is it any wonder that the third Monday in January has been awarded the dubious honour of being called Blue Monday – the most depressing day in the year?

The resolution to begin a lifestyle overhaul got postponed till all the Quality Street were finished, the exercise regime is impossible in the dark and wet… and sure you can’t quit smoking when it’s this gloomy out?? Hardly inspiring stuff, is it?

Putting a little balance back into our lives is really what these resolutions are about and are a big help in finding a bit of peace for 2013.

Take 10 mins and look at your life in terms of 8 different categories and try to (honestly) give each one a rating out of 10 – if you’re falling below 5 in any of the areas it may be time to take a look at it and see what can be done.

  • Health
  • Money
  • Social life
  • Partner/relationship
  • Work/career
  • Friends/family
  • Home
  • Personal growth/spirituality (religion, interests, hobbies,)

Set yourself reasonable and attainable goals and as always feel free to fail and start again.

Best of Luck and Happy New Year!

If you feel you many benefit from talking to someone,

please feel free to call me on 087 709 74 77 or

email me in confidence at midwestcounselling@gmail.com.