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Mental Health Blog of Dr Finian Fallon, Practice Manager of ABC Counselling and Psychotherapy. All views expressed here are that of Dr Fallon alone.

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Reflections on the Changing Direction TeleHealth Conference

Posted on 19 September, 2018 at 9:35 Comments comments (0)

I attended the Changing Direction conference on September 17 2018. The conference was initiated with efficiency by Minister Jim Daly and it was subtitled "Augmenting Mental Health Solutions through Digital Technology". I live-tweeted (@finianfallon) my attendance and posted highlights on my LinkedIn account . Here are a few brief reflections, very definitely written from my talk therapy lens, on the conference:

1. Minister Daly seemed certain that there would not be significant additional spending in the area of mental health in the near future. He expressed an opinion that existing resources need to be optimised. This is despite the continued fall of spend in  mental health services in Ireland over many years and the lack of psychiatric support in hospitals and excessive waiting lists for children and adolescent services around the country. I am not sure that many in the coal face of the mental health field would agree with his view. There appeared to be a consensus around the pressing need for administrive support among many psychiatrists at the conference.

2. I was disappointed that the focus of the conference was so much on psychiatry. The Minister acknowledged this, but it seems to me that there was an assumption by many of the attendees that psychiatry should and will always lead the way in mental health services. My question from the floor about the challenges to psychiatry and diagnosis and increasing awareness around issues with medication did not appear to land and the question was not substantially addressed, I felt.

3. Related to this issue, towards the end of his speech Dr John Hillery, President of the College of Psychiatrists of Ireland made a jocular reference to what seemed to me the possibly unecessary medical training that psychiarists receive. Though his comments were in jest, I have long wondered why psychiatry has such a prominent place in our mental health services when most psychiatrists do not deliver psychotherapy and most clients/patients have a preference for talk therapies. If psychiatrists do not complete medical training, they are no better placed to provide services than highly trained psychologists. Remember, there are nurse specialists (including in Ireland) and psychologists around the world who have prescribing rights. Someone attending the conference asked me why there were such problems recruiting psychiatrists: he suggested that aside from issues with salaries in Ireland, less and less medical students were choosing psychiatry as it is increasingly seen as a problematic, unscientific branch of medicine.

4. While the American psychiatrists and telepsychiatry experts present obviously had the same good intentions as any practitioner, the US approach seems more volume and process than outcome oriented. It has to be said that the enhanced access and equity benefits that arise from telehealth are unquestionable, but to my mind psychiatrically led mental-telehealth will only serve to embed a diagnostic and medication form of mental health treatment. Both of these approaches are increasingly being critiqued. Indeed the 2006 Vision for Change policy document recommended a move towards a case formulation approach.

5. I also asked a question about including an explicit reference in our telehealth policy to independent and private sector practitioners who provide significant supports to many thousands of Irish citizens each year. Again, this seemed to go over the heads of the psychiatrically dominated panel who replied by saying that GPs are in the private sector. It seems clear that the very existence of psychologists, psychologists and counsellors is secondary, if it is very much recognised at all, to the importance and dominance that psychiatry maintains for itself in Irish mental health services.

6. I wrote in my doctoral thesis a few years ago that technological impacts on talk therapy and psychotherapists are imminent. These solutions are literally knocking on our door now. Therapists, practitioners and accrediting bodies need to get on this train very quickly and get up to speed with marketing and providing online services. Someone spoke to me during my thesis work about how quickly the ship building industry in Scotland pracitcally disappeared: this could happen to the talk therapies, or at least there could be a drastic shift in the structure of the market in favour of online, cheap services. Minister Daly was adamant that the comparison between online and face to face therapies is moot, based on the available research. One of the conference speakers said that practitioners had greater resistence to online technology / telehealth than patients: pracitioners need to get on board with this reality.

6. Minister Jim Daly and his team (he also thanked Tom O'Brien) are to be congratulated on arranging such a conference at short notice.


Finian Fallon 19/09/2018

The GRA Wellbeing Survey 2018

Posted on 29 August, 2018 at 6:55

I have recently completed a survey on behalf of the Garda Representative Association in Ireland which represents rank and file members of the Irish Police Force (An Garda Síochána). The survey received over two thousand responses and included the first large-scale assessment of trauma and PTSD prevalence among Irish police.

My findings suggest that one in six GRA members may have Post-Traumatic Stress Disorder and that more than one in four members have significant symptoms of trauma.

If you have problems with trauma, burnout or work stress we may be able to assist you.

The full survey is available here:

http://www.citycolleges.ie/wp/wp-content/uploads/GRA-Wellbeing-Survey-2018-Final.pdf

The Challenge of Being Loved

Posted on 17 April, 2018 at 11:15

I sometimes hear people say that “you can’t be loved unless you love yourself”. I don’t agree. I have come across many examples in my work and in life where people with little, or not a lot of, love for themselves are able to find partners who love them more than they are able to love themselves. In these experiences, the continual drip, drip of being loved can have a cumulative and transformative effect. Relationships can be great places of healing for us all.

The problem for some, is that they can feel overwhelmed when they get an inkling that they may be loved, or that there is this possibility in their relationship. Sometimes, people experience a terror of being loved. This can push some into a repetitious, defensive mode where they behave apparently irrationally and eventually push the other person away.

On exploring these reactions, we can sometimes see that for some, their reactions are old and familiar, while at the same time being too alive and so damaging in the present. These seemingly irrational reactions are often based on early life experiences with carers, family or influential friends.When those who are supposed to love us are not capable of doing so, we can adopt defensive ways of protecting ourselves.

These defenses may include refusing to allow ourselves to be loved, or choosing not to believe in love. This defensive reaction can become a habit and unconscious with practise. In effect, our unconscious dynamics from earlier experiences can leak later on in life into our daily adult lives.

Talking through these issues and understanding our repetitive patterns can bring us into understanding and choice. Working through our old defenses from our childhood can bring us into our adulthood, and into to the big task of being loved and being in love.

Sometimes we need to try new ways of reacting to love repeatedly, before we work out how to be loved.

The task of being loved is a difficult one for some. Being open to the slightest possibility, and not writing yourself off as someone who cannot be loved or who doesn't believe in love, is enough to begin the journey. Maybe, just maybe, you can love and be loved.

Prosody - the Rhythm and Cadence of the Therapist's Voice

Posted on 20 March, 2018 at 11:20 Comments comments (0)

Prosody can be described as the cadence, rhythm or melody of a voice. Prosody is increasingly considered an important element of any therapist’s skill set, which can be taught or at least thought of in therapist training. Teaching and learning this skill is no different to the skill of summarizing, paraphrasing or asking questions. Authenticity in the use of such skills is at the root of their value.

There was a theory that our speech emerged in from the trilling of birds, our evolutionary ancestors. I recall listening to a radio programme years ago that spoke of the gurgling and cooing sounds shared between a mother/ and child and described as “motherese” or “care taker speech”. It appears that children are born with all the components of speech and that they lose some of these as the particular language of their care givers becomes absorbed (after all, we are occupied by language, as the Lacanians might argue). The recollection of the panel member on the radio show describing speech as the “icing on the cake”, after the prosody skills had been learned or shared via the caregiver, has long remained with me. We know from research how a lack of prosody can indicate problems in other areas of childhood functioning, and the relevance of early intervention where prosody problems emerge.

The work of Stephen Porges and others in the field of trauma demonstrates the essential need for safety in psychotherapy treatment. A comforting, calm therapist voice may be one element of helping the clients' brain to enter into a relational frame of mind and reconnect with their cognitive functions in order to integrate or reprocess trauma.

I would also argue that when my voice is calm, and I am aware of this in my psychotherapy work, that I also present as outwardly calm and safe. Also, it seems that in these circumstances, I am more in contact with my authenticity and a therapeutic frame of mind.

In this informative Finnish study of prosody (2014), Elina Weiste & Anssi Peräkylä explore the concept and demonstrate that prosody can be beneficial in both affirming and challenging a client’s perspective. They conclude:

“We have shown how in formulations of emotion, continuing the intonation contour of the client’s talk, combined with a low and quiet voice, is a way for the therapist to preserve the client ́s perspective, and respond empathically to the client ́s emotional descriptions of their difficult experiences.”

https:\helda.helsinki.fi/bitstream/handle/10138/152613/Weiste_Perakyla_Prosody_of_empathy.pdf?sequence=1

Have you considered the impact of your voice and prosody on your client work?

Controversy about anti-depressant medication

Posted on 14 March, 2018 at 7:05 Comments comments (0)

We at ABC recognise the value of anti-depressants for getting some clients through difficult times. If someone is on medication, it is very important not to come off these suddenly without guidance from a medically trained doctor. However, a recent research study has generated a lot of disagreement about how safe these medications really are. Some researchers believe that they are safe, while others insist that they are much more dangerous than has been acknowledged. Some anti-depressant users report increased suicidality, while others believe these medications have literally saved their lives and prevented suicide. There is also contoversy about the side-effects of such medications, with a significant portion of people reporting these including reduced libido or sex drive. Some of these side-effects are reportedly long lasting while others insist that these do not last long. Another dispute relates to the impact of coming off anti-depressants: again there are often two sides to this argument with one side saying the impact of coming off the medications is minimal while others say that the impact of withdrawal can last months or years. Another concept, the idea of depression being caused by an imbalance in brain chemicals. has been shown to be inaccurate and this has been acknowledged by psychiatrists in the UK.

In truth, no one can predict the impact a particular medication can have on someone. It is best that users of any mental health medication inform themselves as to what might be the side effects and impact of long-term use.

Here is a link to the Council for Evidence-Based Psychiatry in the UK which gives one perspective on the recent controversy: http:cepuk.org/


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