Monday 3 December 2018

The importance of slowing down

I've been struggling so much with this particular aspect in my life - slowing down... In the therapy room I often encourage my clients to take on some kind of meditative practise as a way of slowing down both the mind and body in a far too fast-paced world. Things become blurry when we move with speed and we do need to let the dust settle in order to see the world clearer.

And it might come as a surprise that I've struggled with this since I speak so fondly about it. Slowing down is not something that comes naturally to me (or to most people) and I have used speed as a measure to avoid difficult emotions. Eventhough I have learned how to deal with difficult emotions the impulse to speed up still comes up even for me and slowing down is rarely my first impulse.

When I started training in Compassion focused therapy slowing down was one of the first things we were taught. Things happen when we start pacing ourselves also in the therapy room. It allows for that outside perspective we often need. It allows us to see the world from above in a way we just can't while we're constantly running around or feeding our mind.

Nowadays I've built pacing down into my daily routine. If I'm lucky I get to start the day with a short yoga session. Throughout the day, I take little micro meditations either with the help of the app called Pause or Calm. The Pause app is brilliant because it helps you to center and focus, literally, since it asks you to focus on a dot on the screen. I use that when I am very wound up and really need help to calm down. The Calm app has a number of different programmes and you can choose a particular meditation or can choose a programme. I've made my way through the self-to-self series which is about how we relate to ourselves and how we can meet ourselves with more Compassion and understanding. I've just started the programme meditating on emotions hoping it can give me some inspiration I can use with my clients.

The most common experience amongst the people I meet is the idea that meditation needs to be perfect. No,  in fact there are two ideas. One is that it needs to be perfect and that our mind should never wander. Yet, this is the default set up of our brain. It is constantly on, even when we sleep. The other idea I meet is the idea that meditation is about emptying the mind from thoughts and not think at all. Now, for me that sounds really scary! Imagine the emptiness and loneliness connected to an empty mind. I have at brief moments experienced something that could be labelled as emptiness - a moment of deep reflection where time passes without me noticing it. The difference though is that my mind was active even then. When I first started trying to meditate I struggled in particular with this idea of emptying your mind and I never found striving for that helpful. A third idea I meet is the idea that meditation should be pleasant. It can be pleasant at times and the brain normally enjoys a moment of slowing yet it is not the purpose. The way meditative practises are used in Compassion focused therapy is to help us work through difficult issues. Yet, sometimes I've met very experienced yogis who have used it as a way of getting away from difficult emotions and thought. In my opinion this is not what it should be used for but rather to improve our innate psychological functioning.

So even if you feel a bit of resistance towards slowing down, because it is not what our brain wants when we are wounded up, stick to it. Explore your resistance. There might be a new aspect of yourself to discover!

Friday 9 November 2018

Navigating Swedish health care system as an expat

This week I've for different reasons realised how incredible challenging it can be to navigate the Swedish health care system as an expat. Having said that it is a challenge even if you are a Swede. Even for me who has a good idea of how it works I find it daunting to say the least.

So how to go about it if you need help with mental health issues?
Health care is divided into primary care and specialist care. The primary care is suppose to function as the portal into the specialist care (in reality it more often become the bottle neck). So if you have mental health issues you should first enlist with a 'vårdcentral' and get an appointment with a GP. The GP can then refer you onto a specialist unit if that is what you need. The GP can also write you a referral for therapy if that is what you need. There are two types of referrals, one for short-term therapy (6-10 sessions) and one for long-term therapy (15-20 sessions). You need to choose who to see from a list of accredited therapists and inform your GP. They will then send the referral to that therapist. The therapy sessions are funded by the healthcare system and will cost you 160 SEK/ session.

Can I see you based on a referral from my GP?
No, I do not take referrals out of principle. I am all for therapy being widely available but the system has been shaped so that the system determines how many sessions you should have and what kind of treatment you should have. I do not find that ethical. Also, once you've used you number of sessions then you cannot get a new referral for another year. On a positive note you don't have to get a referral to see me and I normally can see you within a couple of weeks time. Check my website for available appointments.

I have medication that needs to be monitored by a psychiatrist
There are two ways to go about that. One is to go the route through the healthcare system and start with your GP and get referred into the specialist care/psychiatric care. There are benefits and downsides with this depending on your mental health status. You can also choose to go privately to a psychiatrist that is affiliated with the healthcare system. I used to have a psychiatrist I cooperated with and am currently trying to set up a cooperation with someone new.

I urgently need help
For urgent mental health issues you need to contact the psychiatric emergency. Psychiatric emergency Malmö. Psychiatric emergency in Lund. 

I am looking for a private alternative
Most private health care providers are still affiliated with the public system and so the difference between private and public health care providers is quite limited. There is no big difference between going to a private vårdcentral and a public one.

If you have a private health insurance you might be able to get quicker and easier access through a special CAPIO clinic that only serves patients for insurance companies:

I cannot get an appointment with my vårdcentral
Unfortunately the entire Region is understaffed with GPs and so it can sometimes be a nightmare to get an appointment with GP which is often the way access point to further health care. You can now also get appointments with an online doctor instead for certain conditions. You can get quick and easy access if you have a Mobile bank ID. Here are links to the major ones:

I want to see a doctor in English
While it is impossible to go through medical school in Sweden without knowing English (as much of the literature is in English) not everyone feels confident to speak English. Make sure you inquire about an english-speaking doctor when making the appointment.

Funding therapy
Many home insurances grant their clients 8-10 sessions of psychotherapy and most of the times you only need to provide the receipts. Some international insurances have the same policy but with some you need to get pre-approval. Check what the rules are for you insurance.

Some Swedish employers offer their employees "friskvårdsbidrag" psychotherapy is not covered under those rules but stress treatment is so in certain cases you can get a contribution from your employer to cover your sessions. You will need receipts stating it is stress treatment however.

Thursday 1 November 2018

Compassion in practise

Many clients ask for exercises they can do between sessions. Experiencing and embodying compassion is an importat feature of the therapy and I always encourage my clients to work some form of self-practice between the sessions. It can look very differently but I was myself helped, in my self-practise, by having audio meditations I could follow. My mind tends to wander off very easily and unless I keep it tethered by either a yoga position and someone's voice I find it hard to stay with the practise.

The Compassionate Mind Foundation in the UK has released a number of different meditiative practises tailored towards working with Compassion. I warmly recommend you to try them and just notice what happens. What comes up? Sometimes it is not what we expect, sometimes it can help us get in touch with blocks and fear. So keep an open mind and just allow what comes to come.

Tuesday 23 October 2018

Learning about loneliness

Last week I went for Advanced CFT-training in Stockholm together with prof. Paul Gilbert. He talked a lot of loneliness and its central role in what human suffering.

It is no coincidence that we react strongly to loneliness, after all we are pack animals. Eventhough we live in societies where you can manage pretty much on your own our wiring in the brain is still that of  a tribe member. Without good connections and a tribe in the back we die.

The training days got me thinking about loneliness and the role it has played in my life. I recognise that loneliness is not only at the core of many of my clients struggles but also at the core of my own. It makes me wonder if my choice of occupation also was to address that feeling. Because let's be honest, therapy is one of the most intimate moments with a stranger we can have. Rarely are we so close and so in tuned to each other with someone we don't really know.

Over the weekend I have been reflecting a lot on what this loneliness has made me do, besides chosing my current occuptation or self-revealing in a blog like this. ;) I could see very clearly that loneliness has been like a shadow following me around for most of my life and it has ironically caused me to withdraw.

What Paul Gilbert explained is that emotions sometimes become fused together and in my case my loneliness is fused with shame. Any sign of loneliness is a sign of me being wrong, in essence. We often define shame as "I am wrong" rather than Guilt which would be "I do wrong". Shame is a powerful emotion and it often causes us to withdraw. So during the past couple of days I've been faced with this insight that loneliness and shame walk hand in hand for me. I am completely perplexed by it and yet it makes so much sense when I look back at both my personal and professional life. It is deeply problematic though because loneliness can be cured by connection but I hold myself back out of shame.

I also realised that this governs many other emotions in me but especially anger. As showing anger could lead to a rupture in the relationship and that would ultimately mean I would be alone and in addition be a bad person. This is of course not conscious thinking in me nor in clients. It is rather a description of deep emotional processes within us. Therapy can help us uncover this and reveal underlying motivations that come with these processes.

And as I have now uncovered this loneliness and shame, it has given me new motivation to actually work with that feeling of shame and adress the sense of loneliness.

Wednesday 17 October 2018

Compassion and motherhood

My son recently turned 2 and it made me look back at the last three years and the changes I've gone through. Becoming a mother is a period filled with turmoil and a lot of different emotions. One of the greatest struggles for me was the lack of support system around me. Not because I'm surrounded by unwilling people but because the need of support of new parents is vast.

We often say "it takes a village to raise a child". Yet, our Western society is based on a principle of independent individuals who shouldn't need anyone. In addition we are fed images from social media, regular media and other places of the sucessful mothers (and fathers) who have it all together and on top of that manage to start a company, bake lovely cakes, play with their children and upload all of it to their instagram account. It gives us an ever so eschewed image of what parenthood is like and a sense that we are failing because we cannot live up to that.

When I became a mother I decided I needed some external emotional support to help me better understand the issues I and others go through. I asked one of the supervisors and teachers in Compassion Focused Therapy, Dr. Michelle Cree, to help me out. Michelle has written the very insightful and warm book called the Compassionate Approach to Postnatal depression. In the book she describes not only about the postnatal depression but also gives a very good description of the challenges we as new parents face and how we can approach that with Compassion.

For those of you who are curious you can listen to a podcast with Michelle where she discusses her book and her work with new mothers.