Areas of Special Interest
If you identify with any of the below difficulties, or recognize them in a loved one, seeking guidance or treatment from a trained professional is essential. Contact me to make an appointment.
Psychological trauma occurs as a result of exposure to unexpected, overwhelmingly stressful events that lead to a complex variety of cognitive, emotional and physiological symptoms, often including depression, anxiety, a sense of helplessness and vulnerability, and beliefs that one is no longer safe.
In the months following a single traumatic incident, such as a car accident or physical assault, one may experience symptoms, collectively known as post-traumatic stress disorder (PTSD), that include emotional numbing, flashbacks, physical tension, grief, intrusive memories, nightmares, self-medicating with drugs or alcohol, and increased fear and anxiety when exposed to reminders of what happened. Furthermore, traumatic experiences in childhood, such as sexual abuse or traumatic losses, can have profoundly detrimental effects into adulthood that lead to an increased chance of developing PTSD following later exposure to trauma; or prove disabling in and of themselves.
If you, your child, or your family, have been exposed to trauma and are struggling to live as productively as in the past, or if you recognize a desire to deal with painful traumas you experienced in childhood, seeking help from a trained psychologist is essential.
In mental health circles the concept of addiction is surprisingly contentious. I think about addiction in terms of the disease model which at the core describes it as powerlessness to resist using any mood-altering drug (chemical addiction) or engaging in some behaviour (behavioural addiction).
Mood-altering chemicals that can become addictive include alcohol, nicotine, illicit drugs, such as cocaine or cannabis (dagga), and over the counter or prescription medications.
Mood-altering behaviours include sexual addiction, compulsive gambling, compulsive viewing of pornography on the internet, workaholism, compulsive hoarding, shopping, exercising, or even cutting.
Addiction is a chronic, incurable, progressive and often terminal illness. Dependence upon mood-altering drugs or alcohol implies that periods of abstinence do not mean you are ‘cured’. Rather, addicts who have received treatment see themselves as being ‘in recovery’ and continue to build skills throughout their lives to avoid relapse.
Although as serious, abuse of mood-altering substances or engagement in harmful mood-altering behaviours is often connected to underlying difficulties and tends to decrease when the core problems have been faced. However, once an individual has become dependent upon a substance, because of the complex dynamics involved and changes to brain functioning, this needs to be addressed as the primary problem – no matter the difficulties that initially drove the behaviour.
Substance abuse and addiction often leads to an increasing array of devastating consequences for the individual, such as health complications, job loss, feelings of guilt, shame, low self-esteem, feeling ‘out of control’; and always hurts those one may love most.
In spite of the obvious negative implications of continued abuse of substances, many addicts find ways to deny that they cannot stop using or engaging in a particular behaviour – that their lives are out of control – or engage in intricate rationalisations or blaming strategies in order to justify continued use.
Although research suggests that certain individual’s are at greater risk than others to develop addictions, it’s important to recognise that anyone has the propensity to become an addict – it does not mean you are weak, unintelligent or a bad person. Often the circumstances leading to addiction are complicated and painful; but the course of addiction will only lead to further devastation. You have a responsibility to yourself and those around you to seek help.
Finally, loved one’s dealing with a person they care for, such as a spouse or child who is suffering from an addiction may also need psychological support and help to understand how best to assist the addicted individual.
Depression is a mood disorder that primarily causes a persistent feeling of sadness and loss of interest. Also called major depression, major depressive disorder or clinical depression, it affects how you feel, think and behave and can lead to a variety of emotional and physical problems. You may have trouble doing normal day-to-day activities, and depression may make you feel as if life isn’t worth living.
For some people, depression symptoms are so severe that it’s obvious something isn’t right. Other people feel generally miserable or unhappy without really knowing why.
More than just a bout of the blues, depression isn’t a weakness, nor is it something that you can simply “snap out” of. Depression may require long-term treatment. In the face of such a complex illness it is easy to become discouraged, however, most people with depression feel better with a combination of medication and psychological counselling.
Deadlines, financial commitments, school tasks or important social obligations easily lead many adults and children to feel anxious at times. Mild anxiety can even help one focus, prepare and deal more effectively with daily pressures.
However, if you or your child begin to feel that the frequency or severity of your experience of anxiety is becoming so overwhelming that it is interfering with your ability to function, it may mean that you are suffering from an anxiety disorder.
Common features of anxiety disorders may include a racing heart beat, shortness of breath, extreme fear, tightness in the chest, sleep disturbance, dizziness and trembling. You may experience recurring fear and worry about your health, safety or seemingly inconsequential issues. You may experience intense anxiety when exposed to specific places, objects, or types of social situations. You may have experienced a panic attack and worry that it will recur. Or you may battle with persistent unwanted thoughts and feel compelled to perform particular rituals and routines to get rid of the anxiety this creates.
You may also find that you live with a deep sense of vulnerability, anxiety, insecurity or even pressure to perform that may be linked to the type of environment, relationships to your parents, and experiences you endured while growing up.
Anxiety disorders can be treated and if you find yourself struggling with one or more of the above symptoms seeking help from a trained psychologist is advisable.
Grief / Loss
Grief occurs as a natural response to loss and is most often associated with the loss of a loved one as a result of death. However, grief can be experienced in the face of many other kinds of loss, including the death of a pet, loss of health, financial stability, employment, or following divorce, a miscarriage, or the news of serious illness in a loved one.
Grief is a highly personal experience and the feelings one may experience depend on a combination of factors, including one’s personality, background, spiritual beliefs, and dominant styles of coping.
Healthy responses to loss include feelings of sadness, anger, regret, psychosomatic symptoms, including stomach pains or a tightness in the chest in the face of reminders of the loss, exhaustion, a feeling of fragility and a sense of detachment from daily routines, as well as, in the case of bereavement, frequent memories, dreams, or strong sensations that the loved one may still be there. Over the course of time most individuals come to a place of acceptance or resolution; they may still feel some sadness when reflecting but achieve a sense of peace and feel as though they have worked through the loss.
Grief begins to become unhealthy when individuals find themselves stuck in a state of mourning. Over time there are no shifts in the intensity of the symptoms described above. Feelings of sadness, intrusive thoughts or images, or a deep yearning over the lost loved one may persist and begin to interfere increasingly with work and relationships. One may even have been in a place of denial for many years and suddenly find the grieving triggered by other stressful events.
If you are struggling to manage a loss and are becoming concerned for yourself or a loved one, seeking help from a trained psychologist is essential.
Life presents all of us with challenges, often on a daily basis, with which most of us are adequately able to manage. Indeed, throughout our development, whether as children, adolescents or adults, these challenges generally lead to a greater sense of agency and maturity.
However, even the most resilient of individuals, couples and families may face situations, such as the loss of a job, moving house, divorce, separation, or financial problems, that lead to excessive distress or difficulty functioning. Psychologists refer to these as adjustment difficulties.
Children, in particular, may find dealing with particular stressors or changes difficult and begin to display behavioural or emotional problems for a protracted period (usually > 3 months) as a consequence. This in turn may lead to more significant psychological problems, such as a major depressive episode or an acute anxiety disorder.
If you, your child or your family have recently faced a significant challenge and are finding adjusting to life after difficult then seeking help from a trained psychologist is essential.
Eating disorders are primarily characterised by intense emotions and abnormal behaviours around food, weight and body image. Due to the physical complications that often occur as a result of eating disordered behaviour, eating disorders are considered extremely serious and have been confirmed as the group of psychiatric disorders with the highest mortality rates. The most notable eating disorders at present include Anorexia nervosa, Bulimia nervosa and Binge eating disorder.
Eating disorders are psychiatric illnesses and not simply lifestyle choices and often involve a great deal of secrecy and shame, as well as negative and distorted thinking about body image. Individuals trapped in destructive cycles may feel torn as the behaviours become their only source of temporary comfort, structure, or control, in the midst of chaotic circumstances, even as the larger tapestry of their lives is slowly destroyed. When individuals or families eventually seek help it is often as a result of co-occurring interpersonal problems, substance abuse, depression or increased social isolation that is seriously impairing functioning, or placing the individual at significant risk for health problems.
Some common signs of disordered eating patterns are:
- Anorexia nervosa is a life-threatening eating disorder characterized by the restriction of food leading to excessive weight (loss relative to age and developmental trajectory), a negative body image, intense fears of gaining weight despite already low weight and persistent behaviours that assist in self-starvation.
- Are you or a loved one intensely preoccupied with your body shape and / or weight?
- Do small changes in your weight or perceived shape influence your mood considerably?
- Are you constantly exploring diets for weight gain, counting calories or fat content in food, or otherwise overly preoccupied with food or its preparation?
- Do you become defensive when confronted about your weight or body shape?
- Are you experiencing physical problems related to weight loss, such as low energy, hair loss, or missed periods?
- Do you find yourself avoiding situations that involve food or do you engage in rigid rituals around food, such as chewing your food a certain number of times before swallowing?
- Do you follow an extremely strict exercise regimen to the point that other’s have described your need to keep in shape obsessive?
- Bulimia nervosa is a serious mental illness characterised by a recurring pattern of binge eating followed by dangerous compensatory behaviours to try to counteract the potential weight gained by the amount of food consumed. Although bulimic behaviours can lead to serious physical consequences, individuals often feel trapped in the cycle of problematic eating, battling constantly with conflicting feelings of guilt and shame. Compensatory behaviours typically include purging behaviours, such as self-induced vomiting, the misuse of laxatives, or other medications, or non-purging behaviours such as compulsive exercising and dieting. People with bulimia are often slightly overweight and purging in particular has been found to be ineffective, over the long term, in managing weight gain.
- Are you extremely preoccupied with your weight and body image?
- Do you notice wide fluctuations in your weight over short periods of time?
- Do changes in your weight dramatically impact your mood?
- Do you engage in compulsive dieting or exercising in an effort to control your weight?
- Are there signs in your home that an individual or loved one is binging, including the disappearance of large amounts of food or multiple food wrappers in the bin?
- Are their signs of purging in your home, including packages / wrappers of laxatives, enemas or diuretics, or the frequent smell of vomit in the bathroom?
- Do you hoard or hide food and / or avoid eating at mealtimes for fear of losing control or to maintain a façade of control?
- Has your lifestyle begun to revolve around food and / or established rituals linked to binging and purging behaviour?
Binge eating disorder
- A ‘binge’ basically constitutes the consumption of a much larger than normal amount of food in a short span of time (usually under 2 hours). The defining characteristic, however, is that the individual feels powerless to stop eating, even when uncomfortably full, and that the behaviour is often driven by unwanted emotions. This behaviour becomes increasingly problematic when it occurs at least once a week for a 3 month period.
- Do you often eat until you feel so full that you feel uncomfortable?
- Do you feel consistently concerned with your body image and weight and have a history of failed diet attempts?
- Do you feel that your eating is out of control?
- Do you eat large amounts of food when you feel frustrated or depressed?
- Do you often eat large amounts of food in secret because you are ashamed of the amount?
- Do you eat more quickly when binging?
- Do you feel disgusted or depressed after eating?
If you answered ‘yes’ to any of the above questions and are concerned that you or a loved one may be suffering from an eating disorder it is highly advisable to seek help by making an appointment for an assessment with a trained professional.
Borderline Personality Disorder
It may be that you or a loved one are suffering from a borderline personality disorder, or traits thereof. In addition to temperamental factors, most individuals suffering from this disorder have grown up in extremely toxic and traumatic family contexts, were often exposed to sexual, physical and verbal abuse, as well as having suffered severe abandonments or losses.
People who have endured long-term exposure to traumatic or abusive circumstances through their childhood years will, as adults, have unique stories in terms of how they coped and the degree to which they may still be affected. However, people who have developed a borderline personality as a response to such a history often report a particularly tortured existence fraught with insecurity, deep-seated vulnerabilities, bouts of rage, uncontrollable urges and addictions, self-destructive behaviours and at times extreme and irrational styles of thinking.
The questions below tap the specific symptoms individuals with borderline traits often report:
- Do you or a loved one frequently make frantic efforts to avoid being abandoned or rejected?
- Do you have particularly intense and unstable interpersonal relationships?
- Do you feel that you have no real sense of identity or self?
- Do you feel chronically empty?
- Do you struggle with intense anger or bouts of rage?
- Do you at times become extremely paranoid or feel as though you are suffering a panic attack when life becomes overwhelming?
- Are you very impulsive? (e.g. spending money, promiscuous sex, substance abuse, reckless driving or binge eating)
- Do you have a history of suicide attempts, or struggle with thoughts of suicide?
- Do you sometimes cut yourself or otherwise engage in forms of self-mutilation?
My approach to working with individuals with borderline personality disorder draws heavily on schema therapy which has an established track record in the treatment of this complex condition. The approach is pragmatic, accessible and is founded upon a caring and authentic client-therapist relationship that prioritizes clients feeling safe and secure.
As a clinical psychologist I am particularly passionate about the personal growth of each individual or couple with whom I work – no matter the extent of the difficulties you may be facing. Indeed, you may feel that, although you are functioning reasonably well in most areas of your life, you have a desire to explore some areas of minor difficulty or focus on self-improvement in a particular area.
Areas that you may to choose to focus on in terms of personal growth include, amongst others:
- Improving your general coping strategies, such as conflict management, assertiveness, stress-reduction and managing anger.
- Overcoming procrastination, indecisiveness, or poor problem-solving strategies.
Entering psychotherapy with the intention of growing in any of the above areas is a wonderful personal investment that may well significantly improve your quality of life in terms of your work and relationships.
Separation Anxiety Disorder (SAD)
The essential feature of SAD is developmentally inappropriate and excessive fear, anxiety or distress related to separation from home or a person to whom the individual is attached; in most cases a parent or caregiver.
When separated from home or major attachment figures, your child may exhibit social withdrawal, apathy, sadness, or difficulty concentrating on tasks or play activities. When alone, especially in the evening before bed, young children may report unusual perceptual experiences (e.g., seeing people peering into their room, scary creatures reaching for them, feeling eyes staring at them) and demand that they not be left alone. Your child or teen may struggle with abnormal fears that something bad will happen to them or a parent when separated, such as death or accidents, and frequently report somatic complaints, such as stomach aches, in anticipation of potential separations. Children or teens struggling with separation anxiety often feel depressed over time and the disorder can become increasingly detrimental if your child begins to refuse to attend school.
Children with this disorder are sometimes experienced as emotionally demanding and in need of constant attention. The child’s excessive demands often become a source of frustration for parents and can lead to resentment and conflict in the family.
If your child or teen displays any of the above features and you are becoming concerned that the symptoms are impacting school, social and family life it is important to gain a clear understanding of the origin of the problem by seeking professional help.
Attention Deficit / Hyperactivity Disorder (ADHD)
Usually diagnosed in early childhood, ADHD is a lifelong disorder that affects both children and adults. It is a syndrome loosely characterised by persistent over-activity, impulsivity and / or difficulties sustaining attention. The symptoms of ADHD must manifest in at least two environments in the child’s life, such as at home and at school. ADHD affects both boys and girls and you should definitely become concerned if secondary behavioural or emotional problems begin to arise, or your child begins to suffer academically or relationally as a result of the symptoms.
If your child displays one or more of the symptoms below it is advisable that they be professionally assessed:
- Short attention span
- Unable to foresee consequences of behaviour
- Poor time estimation
- Poor planning skills
- Language delay / language impairment / delay internalizing speech
- Comorbid specific learning disorders, generally poor performance
- Low self-esteem
- Lack of conscience
- Poor self-regulation and lack of impulse control
- Low frustration tolerance
- Low mood
- High rate of activity
- Delay in motor development + poor coordination
- Low ‘conditionability’
- High level of risk-taking behaviour
- Underdeveloped adaptive behaviour
- Physical Condition
- Immature physical size and bone growth
- Minor physical abnormalities
- Neurological soft signs
- Increased respiratory infections
- Accident prone and high rate of injury
- Problematic relationships with parents, teachers and peers
- Can ADHD be diagnosed by my child’s educator?
- ADHD is a recognised psychiatric disorder and the first case descriptions in the medical literature, by a professor of child medicine based in England, appeared in 1902. Therefore, children thought to meet the criteria for the diagnosis need to be professionally assessed by a clinical psychologist, in conjunction with input from other professionals, including child psychiatrists, dieticians, and educators before any treatment options are considered.
- Isn’t ADHD just a clever way of justifying bad behaviour?
- The literature is clear that about 1 in every 100 children suffers from the extreme form of the syndrome (i.e. displays multiple symptoms in each cluster) of ADHD. Although these children are often creative, spontaneous and intelligent, they often struggle terribly in the school environment and stand an increased chance of further difficulties as they age because of their symptoms – which are extremely difficult for them to manage without appropriate intervention.
- My GP has decided to place my child on medication but I’m not comfortable.
- It is within general medical practitioner’s scope of practice to prescribe psychostimulant medications, such as methylphenidate (Ritalin). However, general practitioners often lack the time to perform comprehensive assessments to establish the degree of severity and causes of the ADHD related problems. Furthermore, children placed on such medications need careful monitoring and follow-up and it is very important that psychostimulant medications are never prescribed apart from a multi-systemic intervention. Such an intervention may include a behaviour modification programme, individual therapy for your child and / or parent training.
- As a parent I feel ashamed because I find it so difficult to control my child.
- Relational and family problems are not the primary cause of this syndrome – although they act to maintain the symptoms and are often a result of poor management of the symptoms. Rather, ADHD arises from a genetic predisposition to having an over-active temperament that interacts with pre-natal, peri-natal and early life factors, such as anoxia at birth, or smoking / alcohol use during pregnancy. As a parent you may look back over your life and remember being very similar to your child with respect to inattention and hyperactivity. This makes parenting without clear knowledge and support very difficult. Furthermore, psychologists will often interact with a child with ADHD and feel just as exhausted and helpless! The good news is that at least a third of all children learn to cope through multi-systemic support and intervention to control impulses, learn to focus attention and do not develop secondary emotional or behavioural problems.
Oppositional Defiant Disorder (ODD) and Conduct Disorder
Psychologists recognize two disorders that usually appear in childhood or early adolescence whose primary features are behavioural problems that have become so severe as to impact upon academic performance and peer and family relationships. The onset of poor behaviour is usually slow and insidious but can have very detrimental effects into adulthood that include criminal behaviour, drug or alcohol addiction, and non-completion of school.
Oppositional defiance disorder (ODD)
Oppositional defiance disorder is usually diagnosed in younger children and entails a pattern of hostile and defiant behaviour at home and school.
- Does your child often lose his / her temper?
- Is he / she extremely argumentative, deliberately annoying, angry, spiteful or vindictive?
- Does your child often blame others for their mistakes or actively refuse to comply with basic household rules or requests?
Conduct disorder is more commonly noted in early adolescence and entails a broader pattern of rule breaking and misbehaviour. The disorder is associated with serious anti-social tendencies in adults and needs to be treated seriously.
- Does your child have a history of cruelty or aggression toward people or animals?
- Is your child particularly destructive and have they ever stolen another’s property?
- Has your child been bunking school or playing truant?
- Does your child tend to lie without compunction?
If the above descriptions fit your child it is important that you seek help from a trained professional. Interventions range from therapy and behaviour modification education with parents and teachers to admission of the child into youth rehabilitation programmes or in-patient therapeutic programmes.