 How are your dreams these days? If they’re unusually vivid and bizarre, you’re not alone. Your housemates might not be interested in the content, but that’s OK, the internet is, with social media and online forums awash with people outlining in detail their “lockdown dreams”. Some of these are clearly symbolic of our current daytime fears – difficulty breathing, trying to scrub bugs off our bodies, being trapped. But the virus and its consequences don’t always take centre stage. Some people’s dreams have entirely different distressing themes; others are finding that they are simply dreaming more, and that the dreams are more fantastical. It’s a strange irony that as our waking hours become more monotonous, our nighttime lives seem more varied. Scientifically, what makes our dreams more or less graphic is essentially mysterious. Research suggests that the more in tune we are with our feelings during our waking hours, the more colourful (literally) and memorable are our dreams. Medications that tinker with adrenaline and noradrenaline – two neurotransmitters that mediate our levels of arousal and our response to stress – can have dramatic effects on dreams. Many patients taking beta blockers, which interfere with these neurotransmitters, notice intense new dreams or nightmares. Other drugs that interfere with noradrenaline are used, along with therapy, to treat severe nightmares. Under lockdown we have fewer opportunities to use our normal coping strategies. Are the anxieties of our collective subconscious creeping out for unfettered play at night? A more prosaic factor may be the disruption of our usual routines. It’s probably not too controversial to say that we might be finding time for a little more morning rumination during the lockdown (before, ahem, leaping out of bed to work a productive eight-hour day from home). Disrupted or altered sleep is commonly reported after any kind of stress, from perceived social sleights to natural disasters. And we don’t have to be directly affected by events for them to start weighing on our subconscious. In 1986, the Nasa Challenger space shuttle exploded in footage that was widely viewed. Interviews several weeks later showed that even among children living on the west coast of the US, in the wrong timezone to have seen the accident live, and without local personal connections, a quarter experienced repeated shuttle-related dreams. Reassuringly, 14 months after the explosion, these dreams, and other anxiety symptoms, had substantially reduced. To be clear, this is a different phenomenon from the chronic nightmares of post-traumatic stress disorder. The puzzle here is why so many of us are having such realistic and memorable dreams as this crisis develops. Scientists have tried to capture how national trauma affects sleep quality. During the first Gulf war, in 1991, nighttime missile attacks on Israel came with little warning. Sleeping was dangerous. Unsurprisingly, telephone surveys found high rates of reported sleep problems. But when researchers followed up by actually recording sleep, they couldn’t find evidence of decreased sleep quality during the conflict. The immediate effects of stress on sleep seem to be subtle, not easily captured by monitoring our brain waves or nighttime movement. What you remember on waking is a faded facsimile of the dreams you had. Dreams, particularly vivid dreams, usually happen during rapid eye movement (REM) sleep. It’s a ghoulish sleep stage we shift in and out of during the night. In terms of the brain’s electrical activity, it has a lot in common with being awake. If you are purposely woken during REM sleep – a favoured trick of sleep science laboratories – you are more likely to recall your dreams. We are still in the early stages of understanding sleep, and we know even less about the science of dreams. They are as slippery to study as they are for us to understand individually, sneaking off as we wake. We think that dreams help us to cope with stress and process emotion, but this is a tricky idea to test scientifically: we don’t have a method to manipulate our dreams without affecting other aspects of sleep. When something is difficult to study in humans, neuroscientists often turn to animals. You can’t ask a rat whether it dreams of electric sheep, but you can record how much REM sleep it’s getting. Rat studies show that the effects of stress on REM sleep depend on the amygdala – a small structure buried deep in the brain that directs the emotional response to our external world. The amygdala is packed with receptors for stress hormones. What really gets our stress system going are situations that feel unpredictable and uncontrollable. And it’s loss of control that might be important for our dreams, too. In mice, short bursts of escapable stress led to increased duration of REM sleep; if the stress was of the same intensity, but inescapable, REM sleep was decreased. Coronavirus is causing financial hardship, social isolation, loss of our normal roles, and, for some, loss of loved ones. These stresses are real and present, others are feared or existential. Uncertainty and unpredictability dominate our experience. So far so normal, in the sweep of human history. What’s different about the current crisis is the additional stress of social distancing. Our bizarre dreams are the tip of the psychological iceberg. We are now, like it or not, taking part in a giant experiment into the effects of increased stress in tandem with dramatically reduced social contact. This is an opportunity to learn about how we respond to this dual assault, what factors affect how this impacts different people, and what helps us through. Stress and social isolation were problems before coronavirus bared its spikes – this crisis could transform our knowledge of how to help those who may still face social isolation when the lockdown lifts. Research efforts are under way. For example, the public can take part in the King’s College Repeated Assessment of Mental Health in Pandemics study. As for these vivid lockdown dreams, for most of us they will pass. In the meantime, normal sleep hygiene rules apply. That also means no refreshing that live coronavirus feed just before bedtime – although I’m still working on that at my end. Dr Mary-Ellen Lynall is a neuroscientist and psychiatrist at the University of Cambridge https://www.theguardian.com/commentisfree/2020/apr/12/coronavirus-stress-lockdown-dreams-vivid-scientists#maincontent
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 Grief is a natural response to losing someone you care about. There's no right or wrong way to grieve. Everyone’s experiences of grief are individual. The important thing is to do what feels right for you.
Grieving can be painful, but the grief and pain will lessen over time and there will come a time when you can adjust and cope without the person who has died. It’s impossible to predict how you’ll react to the death of someone you care about, even when you know what’s going to happen. You may go into shock or feel numb. You may feel disbelief and that what’s happened isn’t real. You might carry on – or try to carry on – as though nothing has happened. In the first few minutes and hours, you may go through many different feelings and emotions, and that is normal. There’s no right or wrong way to feel and react. If you’re alone at this time, you may want to ask family and friends, or a spiritual or religious leader, to come and support you. Grief is not just one feeling, but many emotions that follow on from one another. You may find your mood changes quickly, or that you feel very differently in different situations. People who are bereaved sometimes say they feel ‘up and down’.  With all the talk of the coronavirus, it is not surprising that you may start feeling anxious. When you suffer from anxiety already, something like the fear of getting ill can tip you over the edge. This virus can set off a whole range of thoughts, feelings, and reactions from panic, social withdrawal, anger, difficulty concentrating, and hypervigilance for your health. You may start avoiding social settings, suddenly worrying about getting into the lift or taking the bus to travel to work or the shops.
You may know rationally that the chances of getting the virus are negligible if following the guidance, and even then, most people recover quickly, but your mind may still go into overdrive. There are many things that you can do to manage your fears and anxieties: Stay informed We have one of the finest state health organisations in the NHS with very clear instructions on how we can remain healthy as a nation. Keep things in perspective Take a break from watching too much news coverage, it will allow you to start focusing on your life; you then start focusing on the here and now as opposed to the 'what if'. Consciously decide to have a healthy boundary to how much news you watch is an excellent first step in taking back control. Wash hands regularly Stay healthy by following the advice of sneezing into tissues and binning, and washing hands, these are all good practices at the best of times. Little things like using hand sanitiser and frequently washing your hands are all we can realistically do. Maintain Social Networks Maintain social networks and day to day arrangements, it is important in reducing anxiety. Stay active and connected to your social network. Exercise quickly reduces the physical symptoms of anxiety, while having a meaningful conversation with a friend is known to provide for your emotional needs. You need to remind yourself that there are whole teams of highly professional people who are making sure that we all remain healthy Seek Professional Support If you are feeling overwhelmed by the stress, seek support. If this is getting in the way of your everyday life, talking to a counsellor will help you gain perspective and give you ways of managing your anxiety other than just your friends and family saying you are overreacting. 
The NSPCC have flagged up an increasing incidence of reported hate crime directed at children and young people. Police forces across the UK recorded 5,349 hate crimes during the period 2016 to 2018. There has been a significant spike in children reporting hate crimes during counselling sessions following terrorist attacks in the UK, calls rose a third after the attacks in Westminster. The charity has helped to provide 2,700 counselling sessions for race and faith-based bullying in the past three years. Nearly half (48%) of the sessions were with 12 to 15-year olds, 9% were 16 to 18 years old and a staggering quarter were children aged 11 or younger. Callers to the NSPCC reported bullying and cyber-bullying, verbal abuse and racist name calling. Some reported self-harming or no longer wanting to go to school because they were worried about the abuse they face. The NSPCC have launched an ‘Understand Me’ campaign to encourage young people to speak up about and challenge racism and prejudice and to seek help. It wants the government to make it a legal requirement for social media companies to prevent online bullying in order to halt the rising number of children affected.  Therapy offers a person a reflective space away from friends, family and colleagues with a skilled professional within a safe environment. Research has shown that regardless of the therapeutic orientation, it is the relationship with the therapist that offers the potential for transformation:
The value of relating with integrity and the co-constructing of meaning that take place in the context of trust cannot be underestimated. Truth-telling is an essential facet of our humanity. Sharing our experiences in a safe non-judgmental environment where it is held and acknowledged is both cathartic and healing.  Psychosynthesis is an integrative transpersonal psychology that provides a universal framework for incorporating one’s own body, feelings attitudes and behaviour into a harmonious, synthesised whole, that incorporates all human dimensions, physical, emotional, mental and spiritual. Psychosynthesis assumes we all have multiple sub-personalities that help us to function in the world mostly without much reflection of conscious choice. The techniques include guided visualisation, daily self-reflection, role playing, drawing and dream work. Users learn to become the observer and director of their own sub-personalities, so they can function in a harmonious and balanced way.
Creativity can have positives outcomes for health and well-being. Research has found parallels between creative training processes and counselling methods. Studies has shown that personal growth, confidence and enjoyment are developed through creative training and counselling combined. This leads to improvements in functioning in relationships, communication, problem solving and capacity for divergent thinking and feeling. Divergent thinking is a central feature of creativity. Divergent thinking tends to be tentative, exploratory and orientated to multiple possibilities, including the ability to hold contradictory ideas simultaneously in one’s mind while incorporating and modifying new ones. For many clients, learning and practising divergent thinking and feeling is the beginning of positive growth and change. Rogers argues that “the mainstream of creativity appears to be the same tendency as the creative force in psychotherapy”. As such, the client and counsellor, can be co-producers of ideas along with solutions that are novel and useful by creating a new way of being for the client, which is more fulfilling and empowering and ultimately creative.  Over the years there has been considerable research into why people leave or stay in therapy. A recent study, where clients were interviewed about what influenced their decision to stay or leave therapy showed that they regularly reviewed their decision to stay. The three main influencing factors were the urgency of their need to change, how they felt about their therapist and if the process was moving them towards their goals for therapy. For many clients in the study, they were strongly influenced by the extent to which their therapist had been able to present them with a credible plan to resolve their problems.
When there is an unplanned or premature ending to therapy, it leaves a lot of questions for the therapist. I believe transparency is crucial, as is engaging with the client in where you are in reaching their goals and how they are feeling about the process and their progress. When the core conditions are in place for unconditional regard, empathy and congruence, there is the possibility to explore whether their feelings and needs are being meet or not, while challenging your own work to give each individual client the best of yourself. Children as young as five will be able to get help for mild depression through apps on their smartphones after the NHS’s treatment advisers recommended the use of such devices in their care. See the full story on the Guardian website.... https://www.theguardian.com/society/2019/jan/23/nhs-prescribe-app-therapy-children-depression?CMP=share_btn_tw  When we lose a loved one, the emotions in the aftermath are often so raw they dominate everyday living. Many also fear that sooner or later, others and they themselves, will forget their loved one. For some grief looks like depression, with feelings of anger, bitterness, impatience and are irritated by friends. Others experience friends and community members avoiding them, not knowing what to say, which can lead to social anxiety.
In grief, we can discover that the people we love, and attach to, where there were mutually rewarding relationships, have affected us in ways that were not in our awareness previously. They have a fundamental impact on our sense of self, the loss creates confusion about ourselves, who we are and who have we become., as well as our sense of purpose - how to be without that relationship. Grief is a gradual, long-term process, about mourning a death and working with the rupture towards a sense of accepting a new reality, the finality of their absence, exploring ways of having a meaningful life without them, while loving and caring for them without their presence, through holding on to memories, making them part of the story to your life. Loss is intrinsic to the human experience and at the far end of the spectrum is grief which is one of the greatest manifestations of psychological pain that we can go through. When finding a profound sense of gratitude for having loved the way we did, in honouring the memory of the loved one, their legacy lives on.  Psychotherapy students are often taught theory developed back in the 50s and 60s with no reference to recent findings, and as therapists we can a get stuck in fixed theoretical positions that do not evolve and that are stagnating. Research, both quantitative and qualitative, can be a means of supporting us in getting unstuck, the problem is there is little funding available for mental health research.
Miranda Wolpert, professor of evidence-based practice and research at University College London says ”therapy research is too much focused on competing modalities and what goes on in the counselling room, instead of looking at external factors in clients’ lives and the resources that contribute towards client behaviour change, then therapy can build in the counselling relationship”. We also need to explore clients ability to manage their mental health issues when not in therapy, what works for them in and out of therapy and how to tailor those findings to specific needs of others .In Person-Centered therapy listening to the client tracking what is going on, looking at what is being communicated is research in itself. Counselling is exploring human distress and its meaning while supporting the clients to find their own answers.. With the need to have scientific evidence based evidence, we can lose the art form of therapy and being creative in the process, due to the pressure of winning contracts within the NHS. Evidence from numerous studies shows that across all populations and all types of presenting issues, different therapies achieve roughly the same outcome. Mick Cooper, Professor of Counselling and Psychotherapy at Roehampton University says randomised controlled trials (RCT) give us an indication of the average effect and cost effectiveness of a particular intervention and allow comparison of when you do something and when you don’t and that is what commissioners want to generally know. We need studies showing what we do is effective so we do evolve moving forward. |
AuthorJacinta Bourke is a counsellor and psychotherapist operating in the Ealing W5 and surrounding areas. She is a member of BACP - the British Association for Counselling and Psychotherapy. Archives
April 2020
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